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The Drug That Runs This Country

Personal Perspective: Pill shamers might think twice about their own behavior.

Key points

  • A psychoactive drug is a substance that affects one’s mental processes.
  • Non-prescribed and over-the-counter substances can also be psychoactive drugs.

It’s transacted at truck stops. Law firm conference rooms. Mom-and-pop donut shops in the presence of complicit police officers. Over ninety percent of American adults score some every day. It’s become so commonplace, people rarely speak about it. They don’t consider it shameful at all. And yet, it’s a psychoactive drug that stimulates the same part of the central nervous system that cocaine and methamphetamine do.

Gotcha, caffeine.

Don’t get me wrong—I love my morning coffee. It enhances my focus and boosts my mood. If it came down to choosing between my cell phone and my morning joe, I’d have a hard time deciding. So I have nothing against America’s favorite drug. But a drug it is. According to the World Health Organization, a psychoactive drug is a substance that, “when taken in or administered into one’s system, affects mental processes, e.g., perception, consciousness, cognition or mood, and emotions.” Can anyone truly deny that this is coffee’s nature—and that we drink it to get exactly this effect?

I make this point because yesterday, it happened yet again—that painful moment I’ve come to expect and dread when dealing with the medical community. I was at my first appointment with a new doctor, whom I’ll call Dr. Z. Before my appointment, Dr. Z’s office had sent me a 17-page new patient intake form. I dutifully answered every question, sighing as I always do when I got to the part that asked what medications I was taking. The form provided two lines; I need at least three-quarters of a page to do the subject justice.

So I wrote my usual, “See accompanying list.” And when I met Dr. Z, I handed her my carefully typed, up-to-the-moment compendium of all the drugs I’m on, the daily dosages, and who the prescribing doctor is. Dr. Z took one look at the list, looked back at me, and put her Starbucks cup down on the counter. “What in God’s name are you on all these drugs for?” she said. Internally, I armed for combat. Pill-shamed, once again.

We went down the list, one by one. When she asked why I was on stimulants, I explained that I use them to ameliorate the sedative effect of the antipsychotics I have to take for my bipolar disorder. She shook her head and took another sip from her Starbucks cup. “You’re taking drugs to counteract other drugs,” she said. “Look at you. You weigh, what, maybe 110 pounds? And you look and sound perfectly sane to me. I think this is clearly excessive.”

I tried to explain how well I was doing, that I hadn’t made a suicide attempt in 20 years, that my mood, for the most part, was under terrific control—and all because of “these drugs.” But I could tell I wasn’t making a dent in her preconception. Once again, I left her office feeling ashamed that I was dependent on substances to control my mood. And angry that Dr. Z could so easily dismiss the hard work and patience that had gone into arriving at this particular medication regime. And deeply worried, as a mental health advocate, about the chilling effect such pill shaming has on other patients who just want to be honest about their medical situations.

I knew I had to do something, quick, to distract myself from the dark cloud that was threatening to overtake me. So on my way home, I stopped at my favorite café. I had a cup of coffee. I felt instantly better.