When, instead of a psychologist, you get a prescription

Forty seconds, and the subject is closed

A prescription. Written kindly, by somebody who means well and has eleven minutes. And then the subject is closed, because once something has been prescribed for the fear, the fear has been dealt with. Administratively. Nobody comes back to it.

So you leave with a small box, and the thing you actually needed, which was one hour with somebody trained to listen, was never on the table and was never mentioned.

If you recognise that room, this is for you. It does not matter whether what you have is cancer. Long illness of any kind produces the same forty seconds, and so does caring for somebody who has one.

The first time, it is a gap in the system

I want to be fair about the first prescription, because the easy version of this story is wrong and the easy version helps nobody.

The person writing it is not dismissing you. They are reaching for the only tool they have been given. A prescription is what that room is equipped to hand you. An hour with a psychologist is not in the drawer.

That is a gap in how an appointment is built, and it is why this keeps happening in different countries to people with nothing else in common.

The first time. What this post is about is what happens over the next seven years, and whether that is still a gap. I am going to leave the word for that to you, at the end.

Two to four weeks

Here is the part most people are never told, and it has been on the public record for a very long time.

The medicines most often handed out for exactly this, benzodiazepines, are meant to be short term. Not try to be careful short term. The UK medicines regulator wrote it down in January 1988: they are indicated for “the short-term relief (two to four weeks only) of anxiety.”

Tolerance, which means the same dose stops doing the same thing, can develop after about three to four weeks. So the limit, and the moment the drug starts needing to be increased, are more or less the same moment. That is not a coincidence in the wording. That is why the limit exists.

I have been taking them for seven years. I am still taking them as I write this.

Not because I want to be. Because somebody built the dependency, told me it was my first line of treatment, and never once mentioned that there was a limit, or what the limit was, or what happens when you pass it.

What is actually happening in there

This part explains everything else in this post, so it is worth two minutes.

Your brain has a braking system. The chemical messenger is called GABA, and its job is to quieten things down. A benzodiazepine does not add anything new. It makes your own brakes work harder, which is why the relief is so immediate and so convincing.

Used for a few days, nothing is lost. Used for months, the brain does what any sensible system does when an outside force keeps pressing its brakes. It compensates. The receptors become less responsive. Your own braking system is quietly turned down, because something else is doing the braking.

One. The same dose stops working. Not because you are weak and not because your illness got worse, but because the system it acts on has adapted around it. That is tolerance, and it is physiology, not character.

Two. When the dose wears off, there are no brakes. Your own were turned down and the borrowed ones have gone. What arrives in that gap is anxiety, and the regulator's own guidance notes that withdrawal anxiety can mimic the very symptoms the drug was first taken for.

Dependence of this kind can develop at ordinary prescribed doses, within weeks. It is not a story about misuse. It is what the medicine does when it is taken exactly as instructed for longer than it was meant to be.

The part that took me seven years to understand

All through those years I kept reporting the same thing. Anxiety. It was getting worse, not better. I said so, over and over, to the person I trusted most in that system.

And every time, the answer was more.

“I kept telling them I was anxious. The anxiety was the medicine.”

I was reporting a symptom that was being produced by the treatment for the symptom. And every report produced more of the cause.

I am not saying that everybody's anxiety is their medication. I am saying that nobody ever put it on the list of possible explanations, in seven years, and that it turned out to be the explanation.

What happened when I said it was getting worse

I told my doctor that I had started drinking too much. Not hinted. Told him, in words, as a patient telling the person responsible for her care. Benzodiazepines and alcohol together can kill you. That is not a controversial statement, it is on the label.

What I received, from a man who now knew both, was a stronger dose.

And when it had climbed high enough that even I could see the shape of it, I was not offered a plan to come down. I was offered morphine. Twice a week, as an in-office treatment.

Read that last one again, because it is the argument in one line. At the moment the obvious medical answer was reduce this, slowly, with help, what was on the table was a second and stronger dependency.

The rule nobody writes down

I have spent the past seven months reading my own medical records, every page of sixteen years, and I now think a rule was operating that nobody ever said out loud.

“She already has cancer. It does not matter if we poison her more.”

I am not claiming anybody typed that sentence. I am saying that if you assume it, everything that happened to me makes sense, and if you do not assume it, very little of it does.

Somebody writing that many boxes a month for a person in long-term pain knows what it does. That is not hidden knowledge. But if the person in front of you has already been written down as somebody who will not recover, the damage to the rest of her body stops being a consideration. There is no rest of her life to protect.

In the first post on this blog I wrote about finding four words in my own file, written before any treatment began. This is what those four words buy you, in practice, every day, for years.

Then you are the one who gets called the addict

This is the part that took me longest to say out loud, and it is the reason I am writing today rather than when it is over.

You come out of the bubble. You find out that what you were given for seven years was never meant to be given for seven years. And at exactly that moment, the way you are treated changes.

You stop being a patient who was harmed by her treatment. You become an addict.

As though you had gone to the supermarket and chosen it. As though it were wine, or cigarettes, or sweets. As though the seven years had been your idea.

And the most frightening part is this: I believed it about myself. For a long time. I carried the shame of a thing that was prescribed to me, by name, on paper, by somebody I trusted, who never once told me there was a limit.

In the last five months I have been to five different general practitioners before I found one who understood what had been done to me. One who treated me as somebody damaged by her treatment rather than somebody who went looking for it. He is the first, and he is giving me the chance to start fresh.

Four doctors before him, and the file in front of all of them was the same.

It is not willpower, and I can prove it

I have tried to stop on my own two or three times. Each time the same shape. By the third day, a panic attack strong enough that I went and filled the prescription I was holding and trying not to use.

For years I read that as proof that something was wrong with me. Here is why it is not.

I stopped smoking and drinking on the same day. It will be four years on the sixteenth of October. No clinic, no programme, nobody helping. I decided, and that was that, and I have not gone back. That is its own post and I will write it.

So whatever you want to call what I have, it is not a shortage of will. I spent mine on two things at once and they stayed spent.

“I could get out of this if I wanted to. I do want to. I have tried. The problem is that my body does not want to.”

That sentence is the difference between a habit and a dependency, and almost nobody outside it understands the difference.

The thing I was owed, which has a name

What exists, and what I was never offered in seven years, is a taper. A slow, structured, supervised reduction.

It is ordinary medicine with a joint clinical practice guideline behind it, published in March 2025. The usual shape is a reduction of around a quarter every two to four weeks, slower when the person needs slower, and the guideline warns doctors specifically against leaving a patient alone in the middle of one.

It has a name. You can ask for it by its name. I want a taper plan. And a doctor who will not write one should be told that you know it exists.

And please read this part even if you skim the rest. If you are taking something like this, do not stop suddenly, and do not stop because of anything on this page. Stopping abruptly after long use can cause serious withdrawal, and that can include seizures. This is the one place where the dangerous thing is stopping, not continuing.

Nobody here is telling you to come off anything. The point is narrower: there is a limit, there is a method, you were probably never told about either, and knowing they exist changes the conversation you are allowed to have.

And the hour I never got was also a standard

For years I assumed nobody offered me psychological support because it was not a thing. That cancer care is the tumour and the rest is your own business.

That is wrong. Distress has its own guideline. The NCCN, used internationally, writes plainly that “everyone with cancer has some distress at some point in time. Distress is normal”, and that “ideally, you would be screened for distress at every health care visit.” Since 2015 it has been part of the standards accredited cancer centres are measured against.

The same guideline says out loud why it does not happen: “often, doctors don't ask, and patients don't tell their doctors about their distress.”

Both halves are true of me. Nobody asked. And I did not say, because I had understood, without anybody having to tell me, that this was not what the appointment was for.

One honest limit. The guidance I have linked is British and American, because that is what is published openly and can be checked by anybody reading this. I am in Vienna and my own care was here. I am not claiming these exact documents governed my treatment. The principle is not obscure, not new, and not controversial anywhere.

The women I see online

I see them every day. Women posting that they are in treatment, that they are frightened, that they are fighting. And in the same feed, the acrylic nails, the dinner with friends, the glass of wine. Living, which is exactly what they should be doing.

I look at them and I see myself five years ago. And I want to ask the question nobody asked me.

Who is actually looking after you?

Not who is treating your tumour. Who is looking at the whole of you: what you are drinking, what you are taking, what those two are doing to each other, and whether anybody has ever said the word taper or the word psychologist in your hearing.

In my experience nobody holds that view of you. Each part is somebody else's department, and the person standing in the middle of all of it is you, sedated, exhausted and frightened, which is the worst possible condition in which to be the only one paying attention.

Healing starts from the inside out

There was a moment this year when I thought none of this made sense any more. That writing it down, telling strangers, building something out of it with the only skills I have, was pointless.

What changed my mind was realising what had actually been done. Not treated. Managed. Managed as a person who had been read as dying, while the scans said remission.

That is what has me sitting at this computer with more strength than I have had in years.

And this is the part I would say to anybody at the start of it, or in the middle, or at the moment they are told there is nothing to be done. There is always something to do. You need to be in the right place with the right people. And if you do not have the right place and the right people yet, you need something to hold while you look. I had God and I had my dog.

Healing starts from the inside out. That is not a slogan, it is what I experienced. It did not matter how much I went to the gym or how many supplements I took, nothing moved until I let go of the things that were making me sick from the inside.

And the hardest thing I have had to accept is that one of those things was sitting beside me in a consulting room, writing a prescription, with no questions asked and no thought given to what it was doing to me.

Whether that is cruelty or not, I will leave to you.

“I think it is still terrifying.”

If you are in the middle of it right now

You are not weak and you are not dramatic. Distress is written into the guideline as a normal part of being ill, by the people who write the guidelines, and the fact that nobody in your room has mentioned it does not mean it is not there.

It is allowed to be the reason for an appointment. It is allowed to be the first thing you say instead of the last.

And if nobody has asked you how you are, you are still allowed to answer.

Sources

Committee on Safety of Medicines guidance, Current Problems number 21, January 1988. The original wording: short-term relief, two to four weeks only.

Prescribing benzodiazepines in general practice, Kennedy and O'Riordan, British Journal of General Practice, March 2019. Tolerance after three to four weeks, and the withdrawal risks including seizures.

Benzodiazepines learning module, Medicines and Healthcare products Regulatory Agency. The long-term adaptive changes at the receptors, that dependence can occur at therapeutic doses within weeks, and the withdrawal symptoms including rebound anxiety.

Guidance for the use and reduction of misuse of benzodiazepines, Ford and Law, NHS. How they act on GABA, the compensatory changes that make the receptors less responsive, and that withdrawal anxiety can mimic the symptoms the drug was first taken for.

Joint Clinical Practice Guideline on Benzodiazepine Tapering, American Society of Addiction Medicine, March 2025. That tapering is slow and individual, and that patients must not be abandoned partway through.

Withdrawal effects of benzodiazepines, Mind. Why stopping suddenly is the dangerous part.

NCCN Guidelines for Patients, Distress During Cancer Care. Distress is normal, screening at every visit, and the 2015 standards.