For most people, mental healthcare can look a certain way. It starts with getting in with the right provider, getting a diagnosis and figuring out what the best treatment looks like for your specific needs — whether that includes different styles of therapy, medication or other building up an arsenal of coping skills to help you navigate the stressors and anxieties in your life. Your brain, after all, is a part of your body like any organ that needs proper care to continue to work with you rather than against you.
But what happens when one of those potential treatments — medications like Xanax — takes up so much space in the conversations around mental health? And how do we grapple with the ways these treatments are seen and presented as the simplest and least disruptive means of treating mental health conditions amid a growing mental health crisis?
Those are just some of the questions that Maria Shriver and her daughter Christina Schwarzenegger explore in their new Netflix documentary “Take Your Pills: Xanax” — and a huge part of the larger conversation they had with Dr. Julie Holland (author of Moody Bitches, Medicating Women’s Feelings and more) and Oprah Daily’s Pilar Guzman in their panel at SXSW’s SHE Media co-lab event, the Future of Health earlier this month. Building on the work of Schwarzenegger’s previous documentary of the same name that explored the use of Adderall in competitive academic environments and the pervasive cultural idea that medication and pills are a instant one-size-fits-all solution, the follow-up looks closer at yet another worrying part of the puzzle that is U.S. mental healthcare: the increase in prescriptions of Xanax and how it can undercut true mental health solutions.
“So the first [documentary] was, obviously focused on Adderall. And that one sprouted from a personal experience. So this kind of felt like a natural evolution, when we were focusing on stimulants to then also focus on anti anxiety medication,” Schwarzenegger said. “And I think a few of my goals for the film were one, for people not to feel alone — that was a huge thing for me when I was struggling coming off of Adderall — and, really, for people to kind of understand that they’re not the only person experiencing it. And… I really want people to gain more knowledge about this subject to feel like they have some educational tools so that they can understand the short-term and also many of the long-term effects of being on these medications.” She also notes that she really wanted to spread the word on the alternative methods that exist beyond simply throwing a pill at a problem as complex as mental health and anxiety.
All About Benzos
A good place to start here is understanding what these pills are, how they work and how widespread these prescriptions have become: Benzodiazepines — a class of drug that includes Xanax, Valium and Ativan. As the Cleveland Clinic notes, they function by getting your brain to release the neurotransmitters that will “slow down” your nervous system called gamma-aminobutyric acid (GABA).
They are often prescribed for anxiety, insomnia and seizures but there’s also been a more recent uptick in prescriptions for back pain or other kinds of chronic pain, according to a 2019 study published in JAMA Network Open. That study notes in particular that there was a steep increase in prescriptions of this class of medication between 2005 and 2015, with majority of those prescriptions coming from primary doctors and the vast majority of the prescriptions went to women, middle-aged adults and individuals with public insurance like Medicaid or Medicare.
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Another thing to know about these medications is that, as Schwarzenegger says, there are some long- and short-term side effects and quite a few unknowns about what they do to our brains with consistent use. As Dr. Holland said “For short-term use, the downside of things like Xanax or Klonopin or Valium, one downside is it kind of turns your brain into Teflon a little bit: Things don’t stick very well. The more you take, the more this becomes an issue, you get a little disinhibited. The way if you had a couple glasses of wine, you might say something to your friend or boss that you wouldn’t. So the disinhibition, sedation, the Teflon brain? Not great side effects.”
There are also numerous documented symptoms of withdrawal from these medications that can feel as bad, if not worse, than the feelings that got you your prescription in the first place. “I do see issues with withdrawal,” Holland adds. “If you abruptly stop it, you’re going to have a problem. There’s also something unique to Xanax, which is rebounding anxiety. Most of the benzos, they come up, you feel less anxious, they start to taper off, you feel okay, go to sleep, you go about your day. There’s something about Xanax that you feel less anxious… but when you come down, you kind of end up a little lower than where you started.”
When Quick Fixes Become A Vicious Cycle
These are complications that a lot of people might be willing to look past when in search of a solution to something that feels so agonizing and seemingly impossible to sit with, let alone overcome — like living with anxiety, depression or any of the comorbidities that often come with them. While removing stigma from needing mental health help in all its forms (including medication) is an important part of the process, there’s a line between removing stigma and perpetuating the myth that “this one pill will fix you” or that there is a true silver bullet in pill form for the situational stressors, whole-body health issues and generational trauma that often are the real reason for the symptoms of anxiety.
There also needs to be a critical eye toward the pharmaceutical industry that encourages these “silver bullet” solution narratives that allow these relatively inexpensive to produce and acquire medications to take center stage in treatment over the alternatives that are more costly both monetarily and in terms of time and level of commitment required to feel the benefits.
Particularly if you look at the populations most likely to be given these prescriptions, like middle-aged women and working class or low-income individuals, they are also less likely to have the resources (and most importantly among those resources: the time!) to dig into the consuming work of really healing your nervous system. And if you look very closely at this demographic of women (particularly middle-aged women) that are so frequently under-studied and misunderstood in the medical community, throwing a sedative at problems that are often ones associated with living in a patriarchal, misogynistic, hyper-individualist and capitalist society, it can feel a little bit like we’re circling the drain on the hysteria claims of the not-so-distant medical past rather than really treating the problem.
“What’s also super interesting that these films talk about is so many of [these medications] are marketed and geared to women. When you look at Xanax, it’s really important to look at how these pharmaceutical companies zeroed in on women,” Shriver says. “…Women are raising kids, they’re working. They’re taking care of aging parents, and they have a perfect storm a lot of the time. But as Christina just said, most doctors just say, ‘take it again.’”
And it can’t be understated that the “take it again” energy is sort of part of the business model of the companies behind these medications, as Dr. Holland notes: “Keep in mind we live in a capitalist society. Medicine is a for-profit industry. And for people who are trying to get them in and get them out, the same way that a restaurant is trying to get you in, get you out and up-sell you…If they give you something that you’re going to like and come back in a month and ask for more then you’re a regular customer. Sorry, but that is the sad truth…Not saying all doctors, but there is that element that is transactional.”
Are There Other Options?
So if we throw out the idea that a pill alone is the answer to addressing anxiety, what exactly can be done? It starts with needing to reevaluate the system that got us here and really naming the problems that cause widespread mental health struggles and distress and looking at meaningful ways to address them: We’re talking the patterns of self-abandonment, over-working (by necessity for a large amount of Americans who live paycheck-to-paycheck), non-existent boundaries and a constantly logged-on and tuned-in culture demanding your attention that keep your nervous system in a perpetual state of fight-or-flight.
There’s also an urgent need to address the inaccessible mental health resources in a for-profit healthcare system that leave many uninsured and underinsured Americans out in the cold and desperate for any kind of solutions beyond the “silver bullet pill” they might be able to get from their primary care physician or via telemedicine. And there’s still work to be done in making space in our society for talking about these issues, so there’s less of a culture of silence and shame around taking the time needed to heal and more of a culture of celebration and support.
“My generation was ‘Don’t talk about anything. Pull yourself up by your bootstraps. Therapy is only for people who are suicidal.’ And that’s it,” Shriver said. “I think that this is a conversation that should be happening in every home, every business. It should be a political issue as well… I think all of these are in one big mixing bowl and that’s what this film tried to talk about: What happens when you take Xanax? What happens when you’re working 24/7 — how do you have boundaries? And what else is out there that you yourself can employ for your own mental health, your own emotional, spiritual, and physical well-being? Which is something I think is the responsibility of each and every one of us — but it’s also kind of our collective society’s responsibility to make it okay to talk about.”
And from there, Shriver, Holland and Schwarzenegger all cite numerous alternative methods and coping skills that could be better normalized and utilized by our healthcare system and our education system to give people access to the tools they need to truly learn emotional regulation and heal. There’s exciting work with cannabinoids (think CBD, CBG and THC), psychedelics (micro-dosing), nutrition and hormonal health that also open doors to the larger ways we can help balance our minds and bodies, things that could certainly benefit from getting more attention from the general public who are more likely to be prescribed benzos.
Citing polyvagal theory, which is a working theory that combines neuroscience and psychology to try and understand how humans (as mammals) react to stressors — e.g. how we get out of that fight, flight or fawn response (sympathetic) and into ventral vagal (parasympathetic) mode, which is where we’re most likely to be able to connect to our most social self, feeling safe and secure — Dr. Holland mentions a lot of the non-medication coping skills, the kinds you might learn from a therapist in a talk therapy session, that can also help you re-examine how your mind and body metabolizes stress and learn to sit with it, feel it and survive it on your own terms.
These anti-inflammatory states aren’t so complicated to access — though, the time and ability to prioritize them is often a privilege living in a capitalist nation with extreme wealth disparity — they are things you (believe it or not) probably want to do desperately like yoga, mediation, being in nature, having orgasms, cuddling with a loved one or a furry friend. They’re just the things that will help your brain get that sweet, sweet Oxytocin that helps calm you and get you into that open, safe and trusting place of ventral vagal rather than the intense and stressful “go, go, go” energy we get when our bodies are flooded with cortisol and adrenaline.
And, sometimes, taking the first steps of getting into that mode can be as simple as breathing.
“So just breathing in and out through your nose helps calm you. If you’re really panicking, if you block your right nostril and breathe in and out through your left nostril? That will calm you,” Dr. Holland explains. “It really comes down to this issue of the sympathetic and the parasympathetic. When you’re panting and you’re breathing in and out through your mouth, your body thinks that there is danger. And when you’re breathing in and out through your nose, it basically tells your body that you are not in fight or flight and that you’re in parasympathetic…This is an anti inflammatory state, which we all want.”
Before you go, check out the mental health apps we recommend for giving our brains a little more love:
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