THE PILLBOX – Karla Smith Behavioral Health
January 20, 2020
February 17, 2020



I am of a certain age when I and most of my contemporaries have a pillbox.  It seems like we all take some meds for something or other.  My pillbox is soothing blue and is a duplex in that it holds two weeks of daily meds.  I take five pills daily, all in the morning, as my doctor suggested.  One of those pills regulates my cholesterol while three of them help keep my blood sugar in an acceptable range.  The fifth one is a baby aspirin that I hope prevents blood clots.  Many of my friends have bigger pillboxes for bigger and more meds. 

I sometimes forget to take my pills, usually when I am out of my morning routine.  If I sleep later, or on vacation, or visiting out of town, I will occasionally miss taking some of my meds.  No big deal, right?  I don’t deliberately skip my pills because I don’t like the side-effects, figure I don’t need them, or want to feel differently without them.  It seems natural to take them because my body is aging and I am not surprised that some of my bodily functions don’t work quite right any more and need a medicinal boost.

But I don’t have a brain disorder.  Just like my pancreas and liver doesn’t process sugar, starches and carbohydrates well enough on their own, so too some peoples’ brains do not process thoughts and feelings properly.  I need three pills a day to regulate my liver and pancreas to avoid diabetes.  People with a mental illness need meds to regulate the chemicals in their brain to help stabilize their behavior, moods and feelings.  It’s no surprise that the brain, the most complex organ in our bodies, sometimes needs some chemical assistance.

But people with mental health issues have more complicated issues than I do with my Type 2 diabetes.  First of all, it’s difficult to diagnose a mental illness accurately and cleanly.  Therefore, it is often hard to find the right med for an individual.  Trial and error is a regular pattern.  Secondly, one med for a lifetime will likely not work since body chemistry can change and interaction with other meds may interfere with effectiveness.  Then again, there are varying degrees of mental illness, some forms are more intense and extensive while other forms of the same illness may be milder or more concentrated.  And there are meds, and combination of meds, that can be tried to match the multiple forms of the same generic brain disorder. 

Besides, for some kinds of mental illness – borderline personality disorder, narcissism, multiple personality, to mention a few – there are no meds that counteract the illness itself.

On top of all that, there are negative side effects for most of these meds that range from annoying to dangerous.  It is no wonder that people with a brain disorder have a more difficult time taking their meds than I do taking my five pills each morning.

Despite these hurdles, it is better to take the meds than to ignore them.  Many of them take some time before they are fully effective but they are a crucial piece of any treatment program.  I remember when our daughter, Karla, was in a manic phase of her bipolar disorder, my wife, Fran, called her out-ot-town brother who is a counselor and asked him about Karla’s condition.  He advised that Karla first needed some medication to regulate her mania before we could do anything else with her.  That was sound advice and it fits many situations.

But, of course, the person must be willing to take the meds to begin with and that willingness implies that they accept that they have a mental health problem.  That’s a tough admission for many people. But if they don’t take and comply with the meds, most likely the negative effects of the illness will continue or come back: erratic behavior, losing relationships and jobs, depression, loss of motivation, dangerous actions, etc.  When that happens, I suggest using some form of the question Dr. Phil made famous: “How’s that working out for you?”

Once they are on meds, it is equally crucial that they stay on their meds, even if the dosage or kind of pill they take changes.  Sometimes people feel better and think more clearly and rationally but still don’t like some of the side effects (droopiness, dry mouth, weight gain, rash, tremors, etc.) so they stop taking the meds in order to avoid the side effects.  Most likely, the symptoms of the disorder will reappear, and it’s then time to start over again. 

The wisest and most promising approach is to take and stay on the meds, and talk to the psychiatrist about any problems a person is having.  Once the commitment to maintaining the meds is achieved, other steps can be taken to improve the life situation.  But the meds must always come first.

The pillbox for a person with a mental illness may be bigger than mine and there may be one for the morning, another for noon and still another one for night.  But whatever the regimen is, the mantra remains the same for all of us: take your meds!

If you have comments or questions about these columns, please email Tom Smith at

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