Psychopharmacology Nightmares and the Sanctuary Model

In an enticingly titled NY Times op-ed “Diagnosis: Human” this past week, Harvard ethicist Ted […]

David Zahl / 4.3.13

In an enticingly titled NY Times op-ed “Diagnosis: Human” this past week, Harvard ethicist Ted Gup warned of the dangers of approaching our problems in an overly/exclusively pharmaceutical fashion. The temptation with certain types of psychotropic drugs being that they will serve as quick-fix band-aids rather than as part of an actual cure, and in doing so, they may even backfire. Part of his concern has to do with what he sees as the fallout of prescription-happy doctors when it comes to the diagnosing of boys with ADD/ADHD. You’ll have to read the whole article to understand just how deep his conviction runs on the issue, but suffice it to say, he speaks from (painful) experience.

For what it’s worth, I don’t think Gup is ruling out the benefits of medications when it comes to mental illness (Lord only knows where some of us would be without them!). It’s more of a strong caution, especially when it comes to children, which strikes me as wise. Human nature being what it is, when medication becomes just another vehicle of convenience and control (a servant of what we might call self-salvation) rather than one of help and healing, it can be a very slippery slope, even tragically so, and full of hidden costs. Of course, the line isn’t always so clear. His concluding paragraphs are particularly searing:

00106296-058879_catl_6001Ours is an age in which the airwaves and media are one large drug emporium that claims to fix everything from sleep to sex. I fear that being human is itself fast becoming a condition. It’s as if we are trying to contain grief, and the absolute pain of a loss like mine. We have become increasingly disassociated and estranged from the patterns of life and death, uncomfortable with the messiness of our own humanity, aging and, ultimately, mortality.

Challenge and hardship have become pathologized and monetized. Instead of enhancing our coping skills, we undermine them and seek shortcuts where there are none, eroding the resilience upon which each of us, at some point in our lives, must rely. Diagnosing grief as a part of depression runs the very real risk of delegitimizing that which is most human — the bonds of our love and attachment to one another. The new entry in the D.S.M. [the psychiatric bible which has expanded its definition of depression to include some forms of grief] cannot tame grief by giving it a name or a subsection, nor render it less frightening or more manageable.

The D.S.M. would do well to recognize that a broken heart is not a medical condition, and that medication is ill-suited to repair some tears. Time does not heal all wounds, closure is a fiction, and so too is the notion that God never asks of us more than we can bear. Enduring the unbearable is sometimes exactly what life asks of us.


A doozie of an editorial, if also a bit of a downer, eh? Fortunately, Gup’s piece came across my desk the same day as another, considerably more hopeful one on basically the same subject, i.e. how we deal with grief and/or negative emotions. It’s an article that expresses–in delightfully non-religious terms–many of the insights we like to peddle on this site. I’m referring to Tony Schwartz’s post for the Harvard Business Review from this past January which asks the question “What If I Could Be Myself At Work?”. It may sound a little flaky, but a few paragraphs is all you’ll need to figure out what makes it such incredible bait. The post could just as easily be titled “What If My Office Was An Environment of Grace and not Law?” or “What If My Office Was Basically Like A Really, Really Good Church?” Schwartz is the president and CEO of something called The Energy Project, and it will probably come as no surprise that the managerial method he and his colleagues were adopting is something called “The Sanctuary Model”. If this whole Mockingbird thing doesn’t work out, I just might have to apply for a job, ht JD:

For two years now, we have been holding regular “community” meetings at our office to give team members an opportunity to check in about how they’re doing, not just professionally but also personally. Each person answers several questions beginning with a deceptively simple one: “How are you feeling today?”* The rest of us simply listen.

sf-02-09-sanctuary-ad1It was only when we faced a sudden crisis that I finally understood why these meetings had been so important. On a weekend last October, the 23-year-old son of one of our team members died unexpectedly and tragically.

It dawned on me that day how powerful and liberating it is to say exactly what you’re feeling, and to feel truly listened to without judgment.

The everyday experience of corporate life can be overwhelming in and of itself… In addition to whatever stresses we bring from home, including not getting sufficient sleep, we’re deluged with email, running from meeting to meeting, skipping meals, and working longer and more continuous hours than ever. Is it any surprise we’re struggling? Worse yet, in most workplaces the unspoken expectation is that we will check any strong emotions we’re feeling at the door.

“How many of us,” [psychologist Sandra] Bloom writes, “have ever felt truly safe in a social setting … [meaning] cared for, trusted, free to express our deepest thoughts and feelings without censure, unafraid of being abandoned or misjudged, unfettered by the constant pressure of impersonal competition, and yet stimulated to be thoughtful, creative, spontaneous and solve problems?”

To the contrary, as demand grows, we feel more anxious, more isolated, and more vulnerable.