A common dilemma for many seeking counseling: should I take medication? Tim is a client in psychotherapy. He sought help because, “I don’t have the feelings like most people. Nice things don’t make me feel happy. If my kids do good, that’s nice but…[and he shrugs his shoulders]. My wife and I might out, and later she says, ‘That was fun.’ Me? Nothing. I have a great wife, healthy kids, and a good home and family life. But nothing seems to make me happy like other people. I’m just blah, all flat.”
Tim had already seen a number of doctors over an extended period to time, but he never received a full psychological assessment. Not surprisingly, he received many different medications on a trial-and-error, “Let’s see if this helps,” basis. The list of medications is familiar: Effexor, Zoloft, Prozac, Lamictal, Cymbalta, Lexapro, Strattera, Risperdal, Xanax, and Wellbutrin. When Tim came to his current therapy with a psychologist, he was frustrated that the cocktail of prescription drugs was not working. The psychologist gave him a full range of psychological testing to get an objective sense of his psychological functioning. The test data indicated a schizoid personality disorder.
Schizoids are introverts who do not receive much positive emotion in their social interactions. They like and love other people more intellectually than emotionally. They are emotionally flat and “colorless.” They show a narrow range of emotions, but seldom express them in any animated or spontaneous way. They show a definite preference for solitary activities. In a sense, schizoids are like unfeeling robots who go through life efficiently, but emotionless.
Tim’s diagnosis explained why his previous treatment regimens were so unsuccessful: personality disorders do not respond to anti-depressant, anti-anxiety, and anti-psychotic medications. Tim’s problem was that he viewed himself as flawed and frustrated with his emotionless reactions to life; he had difficulty accepting himself. His problem was with his thinking and his behavior, problems that needed to be changed and controlled by Tim, not by medication. Cognitive psychotherapy with Tim targeted his biased views of himself to get him to face his difficulties from a different perspective. He had always put himself down as being weird and inferior. He needed to consider the fact, however, that being different from others does not equal being weird and inferior. Also, he needed to consider some advantages that resulted from his emotionless tendencies. Many people are overwhelmed by emotionally-driven stressors and problems; Tim’s relative lack of emotion, on the other hand, protected him from such difficulties. His presumed “problem” could be recast in his mind from a glass-half-full perspective rather than a glass-half-empty one. Tim slowly began to accept himself more and improve his self-concept. Most importantly, he realized it was futile and self-defeating to reject his personality style. He began to understand that schizoid personality characteristics are relatively stable ones during adulthood; it was unrealistic for him to think these characteristics would change substantially, even with long-term (and expensive) therapy. It was better, therefore, to be more accepting of his schizoid characteristics, and to put those characteristics to work for him in more positive ways. As Tim came to accept his schizoid characteristics more, his confidence and assertiveness grew, and he evaluated himself in more realistic fashion. He stopped fighting and rejecting himself like he had for so many years. He moved forward, facing himself and making what he had thought was a weakness work for him, not against him.
We describe Tim’s case to argue for the importance of diagnostic psychological assessment before designing a treatment plan; we do not describe his case to argue against the use of psychiatric medication in treating psychological issues. In fact, it is important to remember that both medication and psychotherapy play appropriate roles in treating many problems, and many studies find that a combination of drugs and therapy works better than either one alone. It is also safe to say that each approach can be appropriate at different points in the treatment regimen. That is, medications can provide quick early relief from intense suffering, while psychotherapy can give wider and more lasting relief.
Psychology and Stress 