Criminally Ill

Women and The Pathology of Mental Illness

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I feel like a pharmacist—I measure out my Zoloft as precisely as I can. I use my trusty pill cutter that has been with me since I started this medication twenty-three years ago. I have a prescription for 50mg (blue) and 25mg (green). My previous 100mg were yellow. The pastel colors make it feel like a game. Is this the adult version of “Candy Land”? I try to do the math in my head, but my dyscalculia laughs at me. With the help of my psychiatrist, I realize that I should take one of the 50s, one of the 25s, and one half of another 25. I carefully line up the green 25mg pill in the cutter and slice. I throw the two and a half pills in my mouth and guzzle water. I have chosen to taper down on my SSRI during societal collapse.

I notice more than I ever have before. Where do you hide when you’re afraid of your senses? What’s a girl to do when her entire body feels like a bomb that could explode at any second? What happens when that bomb does explode? Will there be people to help with the carnage? Do you know what it’s like to fear moving even the slightest inch, because what if it shakes something loose that you can never get back?

I was put on Zoloft at age sixteen. I say “put on” because I wasn’t necessarily forced, but I didn’t exactly consent either. I had been bullied and ostracized by my three best friends and I wasn’t able to digest the trauma. I started feeling sick every time I ate. I became afraid of food. I had an abdominal ultrasound done which just showed a lot of gas. I was out of school for four months. My pediatrician put me on a liquid diet. I started to reintroduce solids, but was still wary of food causing me pain. My doctor then gave me a prescription for Zoloft. My parents did what they thought was best: had me take the medication and go to cognitive behavioral therapy. I was ready to die, so I acquiesced.

I was never told how difficult it would be to decrease this medication. As someone who had original diagnoses of Generalized Anxiety Disorder, PTSD, and Sensory Processing Disorder at sixteen, I’m realizing that what I really have is Complex Post Traumatic Stress Disorder, and you can’t medicate away C-PTSD (or SPD for that matter). PTSD is a one-time event. C-PTSD is surviving in an ongoing, consistent traumatic environment or having multiple back-to-back traumas. I had compounded and varied trauma from the age of 3 onwards. I learned physical pain early due to recurrent UTIs and ear infections. My parents divorced when I was four, and my mom began a relationship with a butch lesbian cop (ACAB). In third grade, I was diagnosed with two learning disabilities (dyscalculia and language processing disorder). Then, at sixteen, I had the traumatic friend incident which got me put on meds.

As an adult, I have had a multitude of traumatic incidences, primarily sexual assaults, which didn’t help the already existing C-PTSD from my childhood. Everything I do, everything I am is at least partially related to having experienced too much ongoing trauma in my formative years. It’s hard to exist in an already difficult world with a gaping, open wound. It’s hard to exist in a world that sees me and women like me as “crazy” or “mad.” However, I do not apologize for how I show up in this lifetime. Much of it was not really my choice.

At eighteen, my medication care was transferred to a psychiatrist, Dr. Collins. She was nice and mousey. She wore glasses and was probably in her forties when I started seeing her. I wanted to please her. As a child who was diagnosed with two learning disabilities, I learned early that authoritative figures (namely teachers, but also doctors) found me frustrating because I needed more time, different directions, and accommodations. I would contort myself into compliance, but even that wasn’t enough for adults to like me. I wondered what Dr. Collins thought of me. Was I a “good” patient? It didn’t occur to me until my late thirties how much power a psychiatrist actually has.

Historically, women psychiatric patients have been treated poorly (we still are in many ways). Women have been pathologized for any and everything. Initially, there was the diagnosis of “Hysteria.” The word means “uterus” in Greek. The “symptoms” were anything from anxiety to infertility. Later, lobotomies began which were done primarily on women, even though men were institutionalized at higher rates¹. All women who spoke up or stood up against, specifically men, though really anyone, were thought to be mentally ill and their “treatment” was anything that would make them more docile, more malleable, more suitable to a white cishetero patriarchal society.

Nobody wants to be “mad” or “crazy” or any other subversion to what is considered mentally well. I was, and still am, a mostly compliant patient. I’ve never hidden pills or not taken them. I’m prescribed Xanax as well and am careful to only take the correct amount; not because it’s a powerful benzo, but rather I don’t want it taken from me. I don’t want Dr. Collins to think I’m being shifty. I don’t want to be found non-compliant or criminal.

In the spring of 2025, I had a meeting with my psychiatrist. She didn’t affirm what I was saying. I mentioned being on a “fairly high dose” of Zoloft and she stopped to correct me: “Your dose is not high.” Ok, well, 100mg for 23 years feels significant. And what’s worse is, it hasn’t felt like it has been working for at least the last six to ten years.

In late summer, I saw a post on Threads from someone who said they did a genetic test called GeneSight. The test shows which psychotropic drugs would work best for a person. It’s not a perfect science, but many patients have had good outcomes with this test. The test sorts medications into three columns: green, yellow, and red. “Red” is the column you don’t want to take anything from, “yellow” is okay, with some caveats, and “green” is supposed to be the best. I asked Dr. Collins if I could do this test. It’s not offered everywhere, but I noticed that someone administered it at her clinic. She told me I could do the test and that the only reason she never brought it up to me was due to cost (insurance of course does not cover it).

The test showed Zoloft in the yellow column for me. I found out that I’m not metabolizing the medication as well as I could or should be. The test also showed that I might feel better on a lower dose. I had felt mostly stable, but still with a shit ton of anxiety. It didn’t feel like the 100mgs of Zoloft was doing anything, especially when I compared it to how I felt the first five years I was on it.

Dr. Collins and I finally talked about lowering my Zoloft dose. I was scared she would say no. She had the authority, after all. As psychiatric patients, we are often treated like criminals. Our words never seem good enough. We are deemed untrustworthy. There is a dance one must do during psychiatry sessions. You want to be honest, but you don’t want to be too honest that you get a 5150² placed on you. Suicide is still referred to as “committing” a crime. We are “bad” or “wrong” if we die by our own hands. We are “bad” or “wrong” if we don’t take our meds. We are “bad” or “wrong” if we deign to question the psychiatrist’s judgment of us.

Dr. Collins agreed that I could start to decrease my Zoloft. She wanted me to go down by 25mg, which is the standard tapering that many doctors abide by. The problem with this is that decreasing by 25mg is actually too much. If you’ve been on an SSRI for several years, a much slower decrease is needed. Still, she had the final say. She asked me, “Why don’t you start with 25mg and see how to goes and and if we have to, we can decrease it to 12.5mg?” I didn’t want to “see how it goes.” Everything I read online from other folks doing this (and from my own instincts), I knew a 25mg decrease would be far too much. I pushed back, knowing full well that she could say “no.” Thankfully, she relented. I have to hold down a job and other responsibilities. I can’t be feeling like shit all of the time. There is no rush anyways so what was the point of trying to make me decrease quickly?

Thus, in August of 2025, I started my initial 12.5mg decrease. It was an already stressful time and I had months of back-to-back ocular migraines. I also cried every day–a weeping that just never seemed to end and came on out of nowhere. As a person who is used to crying (I find it regulating and just happens), this was different. I felt like a leaky faucet that was perpetually on. My second decrease happened in mid-December. I had a much easier time with this one. Interestingly, I currently feel similar to how I felt before I started tapering. Was this medication really not doing anything for the last several years? It hurts to think about that. With everything going on in the world, I have been able to handle it all. I am not floundering. I am not afraid to leave my house (most days). I am doing the things I need to in order to take care of myself.

I feel resentful about being placed on this med in the first place. I know I needed it, and it did save my life, but no one explained to me how hard it would be to decrease the dose or attempt to go completely off of it. I’m also resentful that my psychiatrist, who is actually one of the better ones, didn’t check in with me about decreasing after I had been on it for three or five years. Now, here I am, having been on this medication for 23 years. I have never known an adult version of me without it. I feel an unexplainable grief about this. It’s like the person I was growing into at sixteen was a different person than the one I did grow into once I had the traumatic events and medication. I don’t know who I was supposed to be and I desperately want to know her.

It feels incredibly tender knowing that someone else is in charge of my mental health care–someone who may not have their own lived experience with this; someone who doesn’t know what it’s like to be seen as “crazy,” “non-compliant” or “criminal.” I feel terrified knowing that someone could deem me “unfit” and put me somewhere against my will. There is a slight performance I must do in order to appear “healthy” and “functional” in front of my psychiatrist. I am mostly doing ok, good, even, but everyone who knows this dance, knows the delicacy with which we have to move in these spaces. It’s not fair.

I could wax on and on about the systemic issues in mental health care/non-care in this country. I could talk forever about how we desperately need more community structures in place for us “mad” people. I’m exhausted by it all, though, and I’m just trying to survive right now. I wish we could all have what we need. I wish we all could exist without worrying about how we fit into (or don’t fit into) capitalist society. I wish we all had access to genetic testing and communal care. What if we had the autonomy to decide which medications we wanted to be on? What if people on psychotropic drugs wouldn’t get in trouble for not taking their meds? What if we had a society that had social systems in place to care for us all? That is the world I dream of.

I wish there was help without restraints.

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10. this Aldous Harding song:

1. Tone A, Koziol M. (F)ailing women in psychiatry: lessons from a painful past. CMAJ. 2018 May 22;190(20):E624-E625. doi: 10.1503/cmaj.171277. Epub 2018 May 21. PMID: 30991349; PMCID: PMC5962395.

2. An involuntary psychiatric hold for at least 72 hours