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Thursday, Jul 9, 2009
Awash in antidepressants, America is manipulated by Big Pharma and numbed out to basic, and inevitable, human pain -- or so argue critics of our serotonin nation.
By Jerome Weeks
Read more: Drugs, Books, Therapy, Psychology, Doctors, Antidepressants, Depression, Prozac, Psychiatry, Reviews, Book reviews
Jan. 29, 2008 | We are witnessing the rise of the anti-antidepressants.
The '90s, of course, were the age of Prozac, a decade when a class of antidepressants called SSRIs (selective serotonin reuptake inhibitors) came to dominate psychological treatment and public discusssion about why life in America had become such a downer -- even before 9/11. After Prozac's FDA approval in 1987, some 80 million new prescriptions for antidepressants were written in the next 10 years. It was as if America had suddenly caught a bad case of the Superpower Blues: Office visits to doctors for treatment of depression tripled.
With the pills came books. Along with volumes about the new psychopharmacology like Peter Kramer's bestseller, "Listening to Prozac" (1993), there were Martin Seligman's "Learned Optimism" (1992) and "Authentic Happiness" (2002), which helped launch "positive psychology," a broader attempt to understand not illness but happiness.
But soon enough the good feelings gave way to a backlash: Where there was once "Listening to Prozac," now there is David Healy's "Let Them Eat Prozac." "Authentic Happiness" has been countered by the newly published "Artificial Happiness: The Dark Side of the New Happy Class" by Ronald W. Dworkin. In 2005, it was Kramer's "Against Depression"; now it's Eric G. Wilson's "Against Happiness."
Yet the recent volley of books represents more than an attack on our current overreliance on drug therapy to treat depression. They rip into the massive sales of the drug companies, dispute the medical thinking behind doping the populace and question whether the antidepressant advocates understand depression, happiness or the human mind.
What happened in the '90s wasn't an epidemic of the blues or just a new biomedical discovery taking hold. In Charles Barber's compelling new book, "Comfortably Numb: How Psychiatry Is Medicating a Nation," the author contends that we underwent a major shift in attitudes toward mental illness and medications. Depression was redefined and popularized; the use of psychotropic drugs was greatly expanded to include what might be termed "personality repair."
And psychiatry became Big Science. Because of the speed and effectiveness of the new drugs in treating conditions that traditional therapies struggled with for years, psychotherapists lost their leadership in mental healthcare. Amazing advances in brain imagery and neurosurgery only heightened therapists' poky obsolescence. The bioengineers took over.
They weren't the only ones. The advent of managed care gave primary caregivers the power to greenlight treatments. This means that therapists are often dependent on the family doctor for patient referrals -- at least when the family doc isn't the one dispensing the pills. Of those 80 million new antidepressant prescriptions in the '90s, non-psychiatrists wrote 60 million. And if studies of primary caregivers are any indication, most of those diagnoses of depression were made in less than three minutes.
Once we add the multibillion-dollar weight of the pharmaceutical corporations behind some of these changes, we have what Barber calls "the Serotonin Empire": "a formidable testament to the ease and rapidity with which massive sociological change can occasionally be realized."
A counterrevolution by therapists, sociologists and humanists was probably inevitable. This was so not just because of their losses in prestige, income or turf. The mechanistic model of the brain that biological psychiatry is founded on -- block a neurotransmitter here, snip a tumor there -- is seductive but reductive. Almost by definition, it is mindless; it bypasses human consciousness entirely. It offers the illusion of mastery over thought.
Yet no direct link between serotonin and depression has been established. As "Comfortably Numb" notes, all of the new brain pills affect only four neurotransmitters. We're not sure how even those work, and there are more than a hundred others we haven't a clue about. We might as well be trying to map out a chess match when we're not clear how even the pawns move.
Accordingly, many current therapy books -- including "Comfortably Numb" and Dworkin's "Artificial Happiness" -- preach a degree of humility before the resistant complexity of the human mind (and of depression itself). Among other suggestions, they call for a greater acceptance of ordinary unhappiness as a temporary but unavoidable fact of life.
To that end, Eric Wilson's "Against Happiness: In Praise of Melancholy" is a loopy, feeble blow against the empire. The new book is a heartfelt defense of being bummed out. The chairman of the Wake Forest University English department, Wilson is Hamlet-mad for sadness. He extols depression the way 19th century aesthetes swooned over tuberculosis because it made them fashionably pale and broody.
Life means pain and death, Wilson repeatedly reminds us, and we must embrace these to find our "sorrowful joy." But most people are too harried and hollow to grasp this, too distracted by happy pills and shopping malls. We've probably never taken the time to walk through "autumn's multihued lustrousness ... with hearts irreparably ripped." Nor have we "stared for an hour at the sparrow lying stiff on the soiled snow."
No, never have. But they're at the top of my to-do list: ripped heart, dead sparrow.
In attacking our American way of happiness, Wilson is not suggesting we wallow in misery. There are severely depressed people out there; they need medical help. It is the enforced cheerfulness of contemporary consumerism that bugs Wilson, the great mass of "paper-thin minds" that can't appreciate the "luminous gloom."
Wilson actually makes sense on the irritations of our jollied-up culture or the need for normal grief. Lesley Hazleton made the same arguments, pre-Prozac, in 1984's "The Right to Feel Bad." Barber and Dworkin, among others, also cite our self-absorption, isolation and materialism as contributing factors. Americans gulp down chemical boosters whenever things aren't perfect. If that sounds harsh, consider that we report suffering from mental disorders at three times the rate of other developed countries.
Next page: Are you depressed, or just bummed?
Van Gogh on Prozac
Is therapy dead?
