Case 3, Episode 4: Medication and Consent – When the Answer Isn’t “Take This”

“Every time I took their pills, I lost pieces of myself.” — Cynthia, 62

You’ve met with Cynthia several times now. She shows up. She’s quiet. She listens. She watches. She’s begun asking small questions: “Are you here every day?” “Do you like this place?” But when the topic of medication comes up, her body changes. Shoulders tense. Eyes narrow. Voice sharpens.

“I don’t do meds anymore. That’s how they controlled us in there.”

This is not noncompliance. This is informed fear—from decades of involuntary treatment, overmedication, and medical betrayal. So how do you treat someone who may benefit from medication…but who refuses it—for very good reasons?

Step One: Reframe the Goal

The goal is not to “get her on meds.”

The goal is to:

• Restore agency

• Rebuild safety

• Reopen the door to possibility

 Medication is a tool. But in Cynthia’s case, the relationship is the treatment.

What Medication Meant in Prison

 For Cynthia, pills were not about healing.

They were about:

• Control – silencing her fear, flattening her voice

• Punishment – “Take this or go to solitary”

• Confusion – never told what she was taking, or why

• Loss – of memory, energy, will

This isn’t psychopharmacology. This is trauma. If we ignore that, we risk repeating the harm.

How to Prescribe Without Coercion

 Lead with Consent, Not Assumption

“I want to learn more about your experiences with meds. Tell me if it would  be okay if we talked about what worked and what didn’t?”

 Normalize discussion without pressure.

Use Transparency as Therapy

“If we ever explore meds again, you’ll know exactly what they are, what they do, and you’ll have the final say—always.”

Information becomes empowerment.

Invite Collaboration Through Curiosity

“If you ever felt like things got too overwhelming—tell me what would help you feel more steady”

Sometimes the best entry point is how they want to feel, not what we want them to take.

Explore Alternatives First

• Grounding strategies

• Somatic therapies

• Nutrition and sleep support

• Peer-led groups

If we rush to medicate, we miss the moment to show: “You matter, even without a prescription.”

When Medication Is Indicated

 Yes, Cynthia may benefit from a low-dose antipsychotic or mood stabilizer.

But only if:

• She agrees

• She understands why

• She sees it as support, not sedation

 Consider:

• Low-dose risperidone or aripiprazole for paranoia or distressing voices

• Prazosin if trauma-based nightmares arise

• Gabapentin or clonidine for anxiety or autonomic arousal (if tolerated)

Start low and slow. Track side effects together. Let her decide the pace. Even a “maybe” is progress.

When the Best Intervention is No Med at All

Sometimes, the most radical act of care is to say:

“I’m here, even if you never take anything.”

That level of unconditional presence is often what makes medication possible later. Not because we pushed. But because we waited—and listened.

Coming Up Next: Episode 5 – Designing a Healing Environment 

In the next episode, we’ll explore how Cynthia’s surroundings either reinforce her trauma…or become part of her recovery.

We’ll ask:

• How do we shift care from surveillance to sanctuary?

• What routines, rituals, and relationships help restore trust?

• And how do we design environments that say, “You’re safe to be yourself here”?

 Because before a person can heal, they must feel safe enough to try.

Reflective Prompt for You

• Have you ever had to let go of your treatment agenda to meet someone where they were?

• What changed when you did?

Sometimes, healing begins the moment we stop needing to fix—and start offering to stay.