Expriemental Reflexive Writing:

This assignment is an attempt to turn your lived experiences with your body, its medical and health conditions into an anthropological inquiry. In other words, you ask yourself how do you know your body and what is your body to you? These questions should be answered by reflecting on how sociocultural conditions shape your answers to the said questions. For instance, if one says, my body is my temple, or I am a black woman* or my body tells me I am straight or homosexual or bisexual or I live with trauma then how such an answer is inspired by sociocultural settings. If body is one’s temple: does this mean one is sanctifying the body or does it mean body is one’s protected ground, or does this mean one assumes complete autonomy to protect and take care of one’s body? How is this taken care is done? By sport or taking medication and vitamin supplements? How medical industry, media, movies and fashion magazines feed the idea of taking care of one’s body? Another example is how bodies become the point of shame for instance, why sanitary/period products are advertised as blue blood? Is period shameful and how one’s body is shamed? You may consider these provocations and write about your body, its medical and health condition and your autonomy over it. Please, note that this is not a purely theoretical practice rather, you need to ground it in anecdotes and stories and literally lived experiences. 

Practising open science is an assignment  that asks students to practice the presentation of their ideas, research, and   academic learning in an accessible language. It is both matter of producing   content  and engaging with posted content. Each student is expected to deliver three sets of   social media activities and they can choose any of three different formats: a)   Vlogs, b) micro-blogs, and c) Instagram posts (including pictures, drawings,   sketching, poetry or infographics) d) blogs. For instance, if a student chooses to   vlog, they provide 5 video clips focusing on living with period pain   during education and each vlog should explain their point or experiences   progressively. In Vlog 1: students produce a vlog that explains the   conceptual underpinning of their reflexive story. However, students can also   use the narratives or cultural histories of the period according to a   particular context. In Vlog 2, their share lived experiences that illustrate   their points in Vlog 1 and similarly, they progress to Vlog 5 which   summarises and make a final point. 

An Instagram post is a set of posts   (5 posts images + 100 words) that introduces their selected topic. Microblogging is a series of 3   microblogs and each not exceeding 500 words. You introduce your content in   the form of a series, each microblog should come with one curated photo. Blogging   means that you will provide a single blog that is a minimum of 1500 words   including pictures that are specially curated and selected for the blog   (please just don't pick up pictures from the internet) 

What does it entail: you choose any topic of mentioned below that   resonates with you and develop new content around it. You may approach them as theoretical concepts or case studies or continue developing your   reflexive story or connect the selected topic to your   disciplinary background. You may go completely “scientific” and   impersonal or personal and scientific. What is the style:  you   may apply any creative measure but you need to provide contents that are   scientifically relevant, they show certain social complexities of body,   health, medicine and bodily experiences. These contents should showcase: (1) topics should be related to the course (2) series (Vlogs   and Microblogs) should be coherent and each video or text should connect   seamlessly to the next (3) the content should be understandable for the   general public. This means a relatively educated person who does not know   medicine, public health or medical anthropology should be able to understand.   (4) keep in mind aesthetics, presentability and sound quality (please don't   send badly taken photographs, selfies and recordings while there is sun or   light behind you).

Topics:  

1. Body and body image (race, gender, sexual orientation,   body size including genitals)

2. Body and desires (I enjoy sex …., sex can be   painful… I (dis)like this kind of pornography… monogamy & polyamory &   open relationship, shamed desires & alternative sexual practices)

3. Body and sexual health (IUD, menstruation, STI &   STDs, myth and pains of virginity, aphrodisiac food and sexual health) 

5% of this assignment is for your engagement with other posts   in the Instagram page that you should follow. Students must engage with the   Instagram page, look at each post and articulate their reactions to the post   conceptually in the comment section.  You   explore the already existing posts and the new ones that I add now and then. Your   comment on the post and reflect on them from an academic and political   perspective. Please see comments by previous students and try to think about   their perspectives while forming an idea. 

Collaborative Pleasure & Solidarity:

Each student finds a peer with whom they   form a group and shall explore a specific form of pleasure. These pleasures   should be related to the context of body, embodiment and medical encounters.  Please, see the following suggestions and choose accordingly. These suggestions are not exhaustive and you may discuss any other ideas with the   teacher.

1-     Healthy Eating, Exploring Nutritious   Food & Cooking Together: each pair visits a grocery store and explores the spice section (e.g.   Turmeric) or other specialised edible items (e.g. Olive Oil). Please try to visit small-scale stores dedicated to certain types of food practices such as stores that sell items for Southern European cuisines or South East Asia   (India, Pakistan) or various East Asian countries or Middle Eastern cuisine. Choose one item, search for its nutritious qualities plus its cultural signification then cook it together and explain what kind of pleasures were involved in this experience. Your visual essay should pay attention to the dimension of doing   something together, taste and health, the impact of the chosen and cooked item on   each body (was it energizing, was it aphrodisiac, was it sleep-inducing, was   it relaxing or it caused bodily discomfort end etc.) 

2-     The pleasure of solidarity: the paired students share with each other certain medical challenges that have shaped their lives (disability, mental health, body image issues etc.). Each takes turn and share their stories with the other and the listener should take into account setting up an atmosphere of comfort and safety. You may invite your peers to dinner and listen to them, go for a walk and hike, take a window shopping trip or just visit their rooms; basically, you may improvise to find the most comfortable experience for your peer who shares with you. After listening to each other, your visual essay should reflect the impact of sharing and how the (dis)comfort of sharing turned into the pleasure of solidarity and being for each other. Your essay should show the various dimensions and acts of solidarity for instance, did you hold the hand of the one who shared to create bodily comfort, what kind of bodily gesture occurred to produce and perform the pleasure (this could be as little as maintaining eye contact).

3-     Truth or Dare: the paired students will design 10   questions around sexual pleasures and pains. Five questions should address the “truth” in a manner that the addressee will explain how they have discovered pleasure, or encountered pain and how those experiences shaped their ideas of body within sexual experiences. Five questions should address the “dare” in a manner that the addressee will explain how they envision reflecting on the previous pleasure and pain and seeking pleasure or avoiding pain in their future sexual experiences. PLEASE, NOTE THE DARE   QUESTIONS MUST NOT ENTAIL ANY FORM OF IMPOSSITION, AGGRESSIVE ACTS OR ANY FORM   OF BOUNDARY CROSSING. DURE TO THE EMOTIONAL INTENSITY OF THIS PRACTICE, PLEASE, ENSURE THAT YOU   HAVE GAINED RECORDED CONSENT FROM YOUR PAIR BEFORE THIS PRACTICE. 

4-     Visit a drugstore (including “coffee shops” & Kruidvats or Eros: please explore the medicines, vitamins supplements or other medically relevant items (including items relevant to sexual practices and reproductive health). Please, take the inventory of items that each person is familiar with them and each person should select at least one item. You share with each other how you have experienced each of these items and what kind of pleasure or pain it has produced for you and the listener should question further and expand the social cultural and bodily dimensions of the item. 

5-     Felt pleasures: the paired students should visit two or three sex shops together and select one item that they are familiar with and one item that they are not familiar with it. Accordingly, they should discuss how these items bring forth bodily or mental pleasures or cause harm, pain and patriarchal and gender-oppressive pain in sexual practices. 

Example for microblogging:

Hello friends! Today I wanted to talk to you about a topic that is really close to my heart, as it is something I myself and many of my friends have struggled with: disordered eating. We often hear about eating disorders, especially anorexia and bulimia. We hear stories and see movies about people (usually girls) starving themselves or eating huge meals just to throw them up. We are very familiar with these concepts of eating disorders, but not many people know that these kinds of negative behaviours towards food can take on many other forms. Disordered eating is a catch-all term for any kind of eating behaviour that deviates from the healthy norm. Picture a spectrum that goes from normal eating to an eating disorder–– disordered eating encompasses everything in the middle. It often exhibits similar symptoms and behaviours to eating disorders but with lower severity or frequency. Many close friends of mine and I myself have struggled with disordered eating all our lives. Although the lesser severity of disordered eating can be a positive thing, it can also pose a danger to those suffering from it, as it is harder to detect and is more often brushed off as “just normal teenage insecurities”. However disordered eating can be paralyzing and take over the entire mind and life of someone struggling with it, or it can escalate into a clinical eating disorder if left unaddressed. Therefore it is not something to just brush off or not take seriously and it is important that more awareness is raised on the subject. That’s why today I want to tell you all about some of the most common and recognizable symptoms of disordered eating so you can hopefully better detect it in yourself or anyone in your life. These are just some of the symptoms and behaviours of disordered eating and this is by no means a comprehensive list, so I encourage you to check the links I’ve attached at the bottom of this post if you’d like to learn about other signs. The first symptom I want to talk about, and the one that has been most difficult for me, is an obsessive fixation with body image. From its name, it may seem that disordered eating should only concern eating behaviours, but oftentimes these behaviours are born in reaction to a negative relationship with one’s body and a feeling of lack of control over its appearance. In this way, many people who struggle with disordered eating are also experiencing severe preoccupation with the shape, size, and weight of their bodies. This can manifest through obsessive weighing, measuring, and body-checking or avoidance of public situations or situations that require their bodies to be on display, such as the beach. Often, those suffering from disordered eating also have body dysmorphia, which is a disorder that skews one’s vision of their own body, causing them to hyper-fixate on perceived flaws. This can make people affected by it feel constantly too large and like they take up too much space. This line of thinking often leads to the development of the second symptom I want t talk about, which is the restriction of food consumption. This is the most obvious symptom associated with disordered eating as it’s in the name. People with disordered eating develop obsessive preoccupations with their caloric intake and with the food they consume, how much they consume of it, and when. They may take on carb-free diets, intermittent fasting, or develop their own food rituals that they strictly follow. All of these behaviours––and the ones I haven’t mentioned yet––come down to a fear of not being in control. People with disordered eating may significantly limit the quantity of food they consume, the variety of food they consume, and the frequency with which they consume it in order to feel in control over their consumption. These behaviours lead to the third symptom I’d like to tell you about, one that often goes unnoticed and unacknowledged. This need for control over consumption leads many people with disordered eating to isolate themselves socially, especially in avoidance of social situations that require eating together. Unfortunately, though, most social situations involve some sort of eating, so oftentimes people with disordered eating isolate themselves completely so as to avoid any danger of consuming more than what they allow themselves. This is a really bad aspect of the disorder as it only helps it grow stronger: the more you isolate yourself the easier it is to reinforce your disordered behaviours and the more difficult it becomes to reach out for help and to rebuild a healthy relationship with food. Finally, a common symptom of disordered eating is excessive exercise. Another form of control, exercising constantly and obsessively can make one feel in command of their appearance and body. But this can reach dangerous levels of physical exertion––especially when coupled with a restricted diet––where too many calories are burned while not enough is being consumed. This can be really dangerous and detrimental to one’s health and can cause adverse health effects including malnutrition and dehydration. This is just a brief overview of disordered eating and some of the symptoms which it can manifest, but I hope it was helpful to those of you unfamiliar with the topic to start to get acquainted with it. I hope this post can help you recognize the signs in those around you so you can offer a helping hand. Speaking of… watch out for my next post in which I will explain how to go about helping someone you know who might be suffering from disordered eating. I hope you all have a wonderful rest of your day. Stay healthy, stay happy! 

Orla delivered a final video essay discussing teh eating disorder by engaging her intelocutors through visual methods and illustrations. They imagined anneroxia and body in stress and decribed it. This poetic essay is a critical understanding of body in distress when food becomes one’s poision, to use one of Orla’s phrases.

Part of her Final Essay 

Becoming Sexually Active

By Jessie Shackleton

“I didn’t really know what I was doing. I was exploring, I didn’t realize it was something sexual.”

The M word, ‘masturbation’, or even worse … the F word, ‘fingering’. These are enough to make grown men blush: awkward, shameful, and uncomfortable. A topic to avoid in general conversations. This invisibility of female masturbation affects the way young woman experience their first sexual desires and exploration of body. Many of the interviewees mentioned their lack of knowledge of sexuality and pleasure when exploring their first sexual desires. Most young women I spoke to explained that they discovered bodily pleasures, without knowing what female masturbation was. Some described how they first experienced sexual pleasure by satisfying feelings of the water in the bath or by ‘humping’ their cushions at night. One of the interviewees described to me how she felt a heightened connection to her body and what her body could do and feel. This connection occurred simultaneously with an increasing awareness of her body because of puberty. Social media, peers, and growing general knowledge of sexuality affect these conceptions.

When lacking external information, many adolescents turn to peers for conformity. The young women I spoke to, shared how they gradually were able to talk to their friends about female masturbation around the ages of 15-16. The experiences with this differed among the interviews. Some found it comforting and helped them to discover the normality of their desires and pleasures. Others felt it was too embarrassing. I believe that speaking with peers about sexual pleasures can create a social-emotional community that increases trust and understanding, but there should be a larger sex-positive framework to support these conversations. In a familial context, there also seemed to be little to no discourse over self-pleasure. This again causes the invisibility of female masturbation and seems to cause increasing experiences of shame and discomfort: “It would be an absolute nightmare. If my mum talked to me about fingering and self-pleasure, I would retreat into my room to never come out again.” I believe that it would be beneficial for parents to show openness to talking about masturbation and other aspects of sexuality. This can reduce shame and reassure adolescents that pleasure and desire are natural, and not dirty.

 I inquired where they believed this feeling of shame around female masturbation came from. One of my interviewees explained: “When I started going to high school, all a sudden the boys would start talking about porno and jerking off. Masturbation became something of the boys. And it was all quite grotesque.” Another explained how without knowing what female masturbation was or even the vocabulary of ‘fingering’, she knew that it was an embarrassing subject that she shouldn’t ask about:

“I was at the hockey club and these guys were making jokes about jerking off and fingering. The other girls were laughing along with them. I had no idea what fingering was. But I knew that if I asked what it was, it would be embarrassing, I felt so uncomfortable. When I got home, I looked it up on my mum’s laptop.”

 An example for the final assignment 

Rethinking Antidepressants:

The Flaws of Trial and Error and the Side Effects of Antidepressants

By: Franciszek Dziduch

Personal Vignette

Emptiness. Total and utter emptiness, as if I was a vacuum that sucked in all the nothingness residing on the peripheries of presentness. Alienated from what there is, being in what there is not. Emotionless, numbed, fumbling through the road that would lead to the betterment, at least that’s what they told me, it’s just some swamps and bogs on the way. What they would not tell me, is how these swamps will devour me for six months, my eyes blurred with the mud, the gateway to “improvement! well-being! mindfulness!” no longer visible.

I was diagnosed with the spectrum of OCD in late August. I was baffled that it took the psychiatrist around 10 minutes to suggest introducing antidepressants, namely Escilatopram, a variation of SSRI inhibitors. Although sceptical at first, the psychiatrist spent the majority of the first (sic!) session telling me that most of my problems would go away, such as a constant state of mild anxiety, obsessive-compulsive behaviours, intrusive thoughts, or irrational fears. She sold me. Little did I know that my journey with antidepressants would only worsen my state, rather than improve my well-being.

At first, I felt as if they were not working. For the first two months, my mental state did not change, and my mind felt boggled by the number of intrusive thoughts. Triggered by tumultuous personal experiences, I scheduled another meeting with the psychiatrist, this time online. I was surprised by her advice: let’s double the dosage and see how it feels.

I complied with the counselling, and this is when it all started. Yes, I felt less stressed, I had less intrusive thoughts. But at the same time, I stopped feeling anything. Perpetually numbed and drowsy, my days began consisting of attending classes, working, and sleeping in between. I did not care about anything and was extremely unmotivated. I felt nothingness. Haunted by constant boredom, I started engaging in dangerous activities, hoping that it would bring back the adrenaline and stress I had felt before. But I was only met with a sense of indifference.

Only later did I find out that what I experienced was anhedonia: a side effect that is common with SSRIs, which manifests in reduced ability to experience pleasure. For a while, I tried to ignore how I was feeling, afraid that otherwise there is no hope, and I will return to my previous state. Both the psychiatrist and the therapist I started seeing encouraged me to try and wait a little longer. Having both psychiatric care and therapy online, as I lived abroad from my home country, I had no other option, as I could not try other medication, since Dutch pharmacies would not accept Polish prescriptions. I tried to remain hopeful. 

The Industry of Antidepressants: A Scientific Background

To find out more about the issue of trial-and-error methods and the antidepressant industry, I interviewed Natalia Szczepańska, who is a 23-year-old finishing their fifth year at the Warsaw Medical University (WUM). They wish to specialize in children’s psychiatry, as they believe that this is a neglected topic in Poland, especially since mental problems among children and teenagers are constantly on the rise. Based on their knowledge of their experience in the field of Polish psychiatry, Szczepańska believes that, to some degree, antidepressants may be too often prescribed in Poland. The main issue is that it is impossible to gather data regarding the frequency of prescribing antidepressants and no statistical research is currently carried out.

“What is important to notice is that we still have no idea what depression is,” they remark. There is one main theory: that some people have a deficiency of monoamines, namely serotonin, dopamine and noradrenaline. But at the same time, everyone knows that this theory is not true, as studies have shown that restricting generating monoamines in participants does not lead to depression, so there is no correlation. Furthermore, antidepressants bring back the levels of serotonin in a depressed person to the same ones as in a healthy person in only a couple of hours — and everyone knows that depression can’t be cured in such a short span of time. Thus, deficiency of aminoamines is one of the many factors of depression, but not its source. Szczepańska concludes that the possibilities of curing depression are limited; “We have drugs, they are good, and the effectiveness is confirmed, although not among everyone — but it still is the best that we have right now.”

 I am at the movies. Everyone around me is sobbing and aching for the character. I can also feel my body tightening up, my throat narrowing clustered in an invisible clasp, I am rising up to finally express something… Maybe the moment came now? But no. That’s that. Not a tear shed from my eye. There is a barrier I cannot escape, a bridge on which I can only gape, immobilized. And suddenly the words explode in my mind, of the soft voice from the psychiatrist’s ward: “Part of their job is to block any tears”. Well, fuck that.

What Szczepańska seems to refer to is the groundbreaking study published in 2022, called “The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence”. Undertaking a thorough review of the research on serotonin proved that “there is no convincing evidence that depression is associated with, or caused by lower serotonin concentrations or activity” (Moncrieff et al., 2022). The scholars also warn that the understanding of depression as a serotonin deficiency may lead to the decision to take or continue taking antidepressant medication, “potentially leading to lifelong dependence on these drugs” (Moncrieff et al., 2022). The study created a widespread belief that antidepressants are useless and are just fake advertisements from industries that want to sell their products. Nevertheless, this is not the case: as argued by Bogusz, such voices show only a deep misunderstanding of the subject. The study did not review if the antidepressants work but rather focused on the comprehensive understanding of depression (Bogusz, 2022). A 2018 study, which reviewed studies encompassing 116 477 participants taking 21 different kinds of antidepressants, proved that antidepressants “were more efficacious than placebo in adults with major depressive disorder” (Cipriani, et al., 2018).

 Nevertheless, there seems to be another problem. Des Spence, a British GP, who wrote for the British Medical Journal, believes that the definition of depression is too vague, which links it too close to medicalization (2013). They further pose a bold statement that mental illness is the pharmacological industry's “golden goose”, which they support by demonstrating that around 75% of those who write definitions of depression are linked to the industry (Spence, 2013). Moreover, the guidelines of the National Institute for Health and Clinical Excellence are against prescribing antidepressants for those with mild depression and argue to privilege psychotherapeutic interventions, which is followed by studies suggesting that only one in seven people benefit from pharmacological treatment (Spence, 2013).

This is also attributed to the trial-and-error method, widely used to assign correct medicine to people diagnosed with mental issues. A 2016 study estimates that 50% of patients with depression respond inappropriately to antidepressant treatment (Cacabelos, 2016). Another study surveyed 700 patients who were treated with SSRIs: the results showed that 38% experienced side effects, notably weight gain, decrease in libido, or sleepiness (Cascade et al., 2009). This phenomenon is often attributed to the questioned method of trial and error, where psychiatrists try out on patients different forms of antidepressants until they find the right one that actually improves their well-being (Gaffey, 2023; Cacabelos, 2016).

Pills, pills, pills. You first take a quarter for a couple of days, then half, then three-third, then one per day. It’s not working? Take two a day! Pills, pills, pills. Bittersweet taste that makes you nauseous, the parasite that kills motivation from the inside. That takes away “my” from “myself”. The self becomes them, leaving out of the equation everything else.

To understand the Polish case of the trial-and-error method and its possibility of failure, Szczepańska begins by asserting that there is a myriad of psychiatric drugs, mostly for depression, divided into an enormous number of groups, each different significantly. “It is hard to find out which antidepressant will be the right one for the patients — after all, every time it is an individual problem,” they say. Often one antidepressant can work great for one person, while another will only experience the side effects. They reiterate that often side effects are unavoidable, as antidepressants have a powerful impact, but “this is the best that we have right now”. Moreover, it is impossible to constantly supervise a patient and sometimes they will not share everything with their GDP, such as having an addictive personality. However, Szczepańska believes that GPs must keep in mind that “we are trying to cure a person and not a walking disease”.

 Falling asleep everywhere all the time. During class. Between classes and work. Unable to move. Your brain says yes, your body screams don’t. Or the other way around. At this point you don’t know what is what.

Szczepańska describes the usual commencement of pharmacological treatment: it is important to notice that general practitioners (GPs) can prescribe antidepressants. The typical consultation takes 15 minutes. “This is just too little to diagnose mental problems and what they are,” Szczepańska asserts. They asked me to imagine a representative example of how such a consultation looks. “A patient comes to the GP, and the GP will say, okay, you’re sad, I will give you a drug that will make you feel better”. Szczepańska demonstrates two reasons for such quickness to prescribe an antidepressant: the GP wants to have a feeling of agency, while the patients are often frustrated if they do not get a prescription, feeling that they were mistreated. “That’s why in Poland you have so many prescriptions. We don’t have time to run MRI tests to diagnose depression, we know about it too little, and often, antidepressants end up being wrongly prescribed.” Szczepańska reiterates that in their opinion, therapy cannot be forgotten and should be privileged over pharmacological treatment. Nevertheless, in Polish reality, therapy may often be unaffordable, and antidepressants are the cheaper option. If the patient cannot undertake therapy, the GP cannot leave them with nothing: “Patients should not be disregarded for economic reasons”.

Everything bottled up. Threads of fear woven into a belt of indifference, hanging by the feeble button in the shape of a pill. For now, it tightens around my waist, making it hard to breathe, containing what I try to ignore. But it can break anytime — the button just needs to snap.

The Side Effects of Antidepressants: Embodied Experiences

To research the issue more, I carried out anthropological fieldwork. I focused on Polish people from my age group, as their experiences could inform mine, as well as uncover that there is a bigger problem that remains unaddressed. It is important to remember that there are always two sides to one narrative. While I do not disregard the importance of antidepressant treatment, as it does save lives, the plurality of experiences must be acknowledged, and the pharmacological treatment should not have a top-down approach, but a bottom-up focus on the patient, rather than attempting to label their mental problems into fixed categories. The interviews consisted of six participants, whose names were changed to protect their identity. All participants were prescribed antidepressants due to depression and/or extreme anxiety. The prescribed antidepressants are predominantly selective serotonin reuptake inhibitors (SSRIs), with exceptions such as add-on medication prescribed in cases of incomplete response to an SSRI or anxiolytics that mitigate anxiety. It is important to notice that all of the participants relate to their past: while most of them eventually were prescribed antidepressants that actually helped them significantly, some stopped taking antidepressants altogether following their unpleasant experiences.

Almost all participants account for experiencing numbness, dissociation from the environment and extreme drowsiness. For Jola, the first antidepressant she took was Miravil. “Together with this one, I just plummeted, and my mental health collapsed,” she says. She felt as if she was taken out of her life, she wouldn’t leave her room and almost did not eat. “Once, I ordered bubble tea, I spilt it on the way home, and I just couldn’t stop crying. The smallest things were the most tragic”. The second antidepressant she was prescribed, Mirzaten, made her feel better, but she gained over 10 kilograms, which she couldn’t handle. Next came Venlaflaxine — this one, did not change her mental state at all. She remembers to have been taking Brinletix, too, but this one also made her feel only worse. She can’t place which drug caused what, but what she remembers is headaches, sleeping too much and too little, eating a lot, and then nothing. “I went through most of the side effects that are listed on the drugs’ leaflets”. She notes that some of the side effects were just “unbearable”.  Emilia began with Fluoxetine at the age of thirteen. At first, the smaller doses were enough, and she felt as if the drug fulfilled her expectations. But, over time, the small doses became too little, so she started taking higher doses, which resulted in insomnia. To battle the symptoms, she was prescribed Hydroxyzine. The drug made Emilia feel absent and drowsy, and she had trouble focusing. She remembers finally being able to go to sleep, but then she wouldn’t be able to get up. Daily things like moving or going to school seemed impossible. She continued taking the combination of Fluoxetine and Hydroxyzine until the age of sixteen. She reminisces that overall, Fluoxetine did not do “what it was supposed to”. There were times when she tried other drugs, like Wellbutrin or Asentra, but those were short episodes that caused deep depressive episodes to resurface, along with suicidal thoughts of heightened frequency. Maja has been taking Zoloft for three and a half years now. She notices two side effects that significantly affect her life: dreams and lack of libido. Maja is often tired by the vividity of her dreams — if a dream is unpleasant, its realism can make her “fucked up” for the rest of the day. She notices that each person she knows and that has a history with Zoloft experienced a similar side effect, but no one is ever notified about it before beginning the treatment. She believes that the lack of libido, a common side effect when taking antidepressants, can lead to conflicts or even ruin relationships. “It’s a tough issue because it really depends on the partner’s consideration and patience, and it makes you feel bad”.

 Other participants judged that they did not receive proper support from the psychiatrists. Klara first went to a psychiatrist right before turning 18. Being a minor, she had to be accompanied by her father. She recalls the whole experience as distressing, spending the entire fifty minutes sobbing, feeling extremely self-conscious, because of her father’s presence. “I didn’t feel safe,” she remembers. The psychiatrist prescribed her something, but Klara disregarded the prescription as she did not feel comfortable with the diagnosis. After becoming an adult, she went to another psychiatrist, this time alone, knowing how to prepare. “I felt more like going to a doctor than a therapist. It all seemed very shady,” she says. She thought that what troubled her was very complicated and complex, but at the same time, she knew that she was expected to come, talk about her symptoms, and leave with a prescription. Klara was prescribed Soronil, but due to the COVID-19 lockdown, she was under no supervision. Developing a severe eating disorder, she began self-medicating, for months taking antidepressants on and off, which deregulated her mental state even more, suffering from extreme panic attacks. At last, upon arriving in Amsterdam to study, Klara was lying to everyone that she was still taking them, but she decided to stop on her own. “Each stage of my pharmacological treatment was fucked up, and it’s hard to say what went wrong”. She wonders if the antidepressants were just poorly chosen if she needed more support from professionals, which she did not receive, or if it was mainly the fact of not telling anyone that she stopped taking them.

Karolina, in turn, attributes her poor experience to being prescribed Xanax while being underage, to mitigate the side effects of Sertaline. Normally it is a short-term solution, but she felt as if it was the only thing that was helping her. So, to take it for as long as possible, Karolina started lying to her psychiatrist that she would lose packages or not take them. This would go on for four months. “I was taking it every day or waited for a couple of days and then took a shit ton of them all at once,” she admits. She doesn’t remember anything from the last months of high school; her friends would later tell her that she would respond to them, but there was nothing behind her eyes. This addiction triggered her to spiral further, into alcohol and drug abuse. Her therapist and psychiatrist did not know about anything, as they were in contact with Karolina’s parents, so she hid it from everyone.

Another participant voices her struggle with how dependent she is on Venlafaxine. Living in London, Beata was receiving the medicine through mail delivery, but the mail was overloaded before Christmas, so this time it did not come, and she had to return to Warsaw without the supply. She was overwhelmed by the withdrawal syndromes. She describes it as “clicks in the brain”, as if she experienced an electrical shock with each activity. Even raising her hand would result in “click, click, click!”. This translated to heightened irritation and extreme problems with sleeping. She remembers experiencing severe sleep paralysis, dreaming that someone or something is in her wardrobe and will kill her. Other symptoms of withdrawal were extreme vulnerability and drowsiness: once, she fell asleep on her parents’ couch, and she could not get up for six hours. A little thing like checking out for a flight back to London was too much for her. “I wish someone had told me how serious withdrawal could be, especially if the mail delivery can be so unstable.” Eventually, she judges that there’s nothing she can do about it. What worries her more is the perspective of being dependent on Venlafaxine for the rest of her life. Having been taking it for five years now, she feels how addicted she is to the drug, something that no one warned her about.

Departure Points: Where to Go Next?

As the fieldwork shows, there seems to be a problem with the culture of prescribing antidepressants and the trial-and-error method that accompanies it. There needs to be a fundamental change in the structure of mental healthcare and how it operates, to prevent the cases of enduring the possible side effects or the patient’s noncompliance with prescribed medication. As for now, the mental health care system seems to be working alongside the politics of late capitalism and neoliberal values. As argued by Moncrieff, “public mental health system evolved alongside capitalism in order to manage the problems posed by people whose behaviour was too chaotic, disruptive or inefficient to participate in a labour market based on exploitation” (2022:1); rather than treating a person with mental problems as an individual who needs help, they are being considered the outliers who do not fit in the system and therefore the goal is to make them become a productive labour force again.

Nevertheless, there are alternatives being sought to move from the trial-and-error method when assigning the right antidepressants. One of them is the concept of medical genomics and pharmacogenomics. In this scenario, there would be a clinical routine examining the genes of an individual and how they relate to the respective medication. Cacabelos imagines that in such a case, each patient would carry a pharmacogenetic card, with which doctors could become familiar and, based on the information, assign correct antidepressants, making “drug prescription a genuinely personalized procedure” (Cacabelos, 2016). Another idea is the development of biomarkers in the brain’s reward system, facilitated by MRI scans. With this technology, scientists would be able to examine which antidepressant would correspond best to the patient’s individual brain, and therefore make the choice of the right antidepressant a much more informed decision (Gaffney, 2023). Such new approaches have already reached Poland, too: recently, one of the participants messaged me that they were asked by the psychiatrist to run a blood test, to choose the right antidepressants.

 It’s been a month since I stopped taking the pills. It’s a quiet night and I’m watching videos on YouTube. I remember my last talk with the psychiatrist, her words that growl in my mind like a stomach that rebels against digesting awful food: “Some patients prefer to live on an autopilot, hovering above, but I guess you don’t want that.” Suddenly, I notice that a tear runs down my eye. The first one in 7 months. Listen to this feeling. How it weeps and flutters its wings. Let it fly and rise. Allow yourself to cry. I sob for the next hour, unable to breathe, moans piercing my ears that seem to come from the center of my body and like a radius climb into my throat. The belt brakes and I’m free. I feel.

References

Bogusz, K. (2022, August 6). Antydepresanty nie działają? Bzdura, działają – nawet jeśli nie zawsze wiemy jak. Oko.press. https://oko.press/antydepresanty-nie-dzialaja-bzdura-dzialaja-nawet-jesli-nie-zawsze-wiemy-jak

Cacabelos, R. (2016). Trial-and-Error Versus Personalized Treatment in Depression: The Power of Pharmacogenomics. Psychiatry, Depression & Anxiety, 2(1), 1–2. https://doi.org/10.24966/pda-0150/100004

Cascade, E., Kalali, A. H., & Kennedy, S. H. (2009). Real-World Data on SSRI Antidepressant Side Effects. Psychiatry (Edgmont), 6(2), 16–18.

Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P. A., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet, 391(10128), 1357–1366. https://doi.org/10.1016/s0140-6736(17)32802-7

Gaffney, T. (2023, January 24). Predictive biomarkers could ease the exhaustive trial-and-error of antidepressants. STAT. https://www.statnews.com/2023/01/24/predictive-biomarkers-antidepressants-depression-ssri/

Moncrieff, J. (2018). Against the stream: Antidepressants are not antidepressants – an alternative approach to drug action and implications for the use of antidepressants. BJPsych Bulletin, 42(1), 42–44. https://doi.org/10.1192/bjb.2017.11

Moncrieff, J. (2022). The Political Economy of the Mental Health System: A Marxist Analysis. Frontiers in Sociology, 6. https://doi.org/10.3389/fsoc.2021.771875

Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2022). The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry, 1–14. https://doi.org/10.1038/s41380-022-01661-0

Santen, G., van Zwet, E., Danhof, M., & Della Pasqua, O. (2009). From Trial and Error to Trial Simulation. Part 1: The Importance of Model-Based Drug Development for Antidepressant Drugs. Clinical Pharmacology & Therapeutics, 86(3). https://doi.org/10.1038/clpt.2009.105

Spence, D. (2013). Are antidepressants overprescribed? Yes. BMJ, 346(jan22 3), f191–f191. https://doi.org/10.1136/bmj.f191

‌