Meaning and medication in the care of treatment-resistant patients

When patients fail to respond to psychopharmacologic treatment, one reason is that the meanings that treatment and/or wellness hold for them are psychologically intolerable. The result may be noncompliance with medications or the repeated emergence of intolerable side-effects, or a defensive attachment to the medications that prevents improvement. When treatment resistance emerges from the level of meaning, it may be that it can be resolved only by addressing it at that level. This paper argues for the importance of integrating psychological understanding into the pharmacologic treatment of treatment-resistant patients, and explores some factors that mitigate against integration. Several treatment vignettes are presented, suggesting ways of working with meaning in relation to pharmacology. Finally, the paper explores benefits of integration for treaters, even if integration does not result in the resolution of treatment resistance.