According to a recent survey, approximately 48 percent of
Americans--almost half the population--has experienced some form of
dysthymic disorder. And all of them may qualify for Prozac. Robert
Millman, M.D., professor of psychiatry and public health at Cornell, sees
the irony of it: "There's nobody nonsyndromal. You can give Prozac to
anyone you want."
Which is anathema to what medical science is supposed to be about.
"We try to convince people there's some specificity to what we do," says
Millman. "But this is embarrassing."
And the list doesn't stop there. Simon Sobo, M.D., director of
psychiatry at New Milford Hospital, reports that "Prozac has been
successfully used for obsessive hair-pulling, panic disorder, eating
disorders, and social and other phobias. It has proven useful to people
to free themselves from addictive relationships; to dispel doubts about
performance; to overcome obstacles that once seemed impossible. I have
even added it to my watering can and found geraniums grow better on
it."
He's joking, of course, but only about the geraniums. Add obesity,
gambling addiction, and PMS to the spectrum of complaints now being
helped by Prozac.
BETTER RECEPTION?
If little is known yet of just how effective these drugs are for
psychological distress, even less clear is the actual impact they have on
those who benefit from them. Are they simply mood brighteners or are they
re-regulating systems that are out of balance? Do they actually change
personality, making you feel better than normal, or merely fine-tune it?
Do people say, "Gee, I feel more myself on this drug" or "Gee, I'm a
different person now"?
Some clinicians, such as Larry Siever, M.D., director of the
Outpatient Psychiatry Division at Mt. Sinai School of Medicine in New
York, offer an opinion between the two: "If you have a staticky, bland
picture on your TV set, you can fix the reception by adjusting the tuning
and contrast. Or simply change the channel. My understanding of the
medications personally is more the former than the latter."
Of course the big fear surrounding the "channel-changing" aspect of
the drugs is that society will evolve into a battalion of "happy
soldiers." Exhumed by Kramer himself, the specter of Aldous Huxley's
soma--Brave New World's fictional drug that anesthetized citizens into a
content unawareness--continues to haunt us and cloud the argument
surrounding Prozac. Yet to many, the analogy seems false.
"The drugs, if properly used," says Siever, "shouldn't dampen
normal signals of anxiety, not even normal depression. It should not snow
under in the way that a hypnotic does a person's normal level of arousal
or awareness, but should allow all of these signals to emerge more
clearly."
And, he continues, extending the argument, "If depression or other
symptoms emerge, whether from psychological or social stresses, aren't
people entitled to treatment for these conditions, just as they would get
if they had an ulcer in relation to the stresses in their lives?"
Siever's example inadvertently reveals yet another controversy
surrounding the use of drugs--any drugs--in fighting these disorders: the
contention that pharmacology focuses on the individual rather than
examining the larger societal problems that lie behind depression and
other ills. Epidemiological studies have shown that more people are
suffering from major depression than ever before--at ever-younger ages.
Prozac, some argue, puts a Band-Aid on individual symptoms rather than
addressing why people are seeking help in ever-increasing numbers.
The response of clinicians is to answer the question with a
question: Why must one solution preclude any other?
The fundamental error, they argue, is to assume that the use of
Prozac as a therapeutic tool equals an interest only in the biological
causes of depression (or sub-depression, or just plain old feeling
lousy). Those who can prescribe medication are, by profession, at least
partly invested in biological solutions. And since Prozac is usually
recommended along with some form of psychotherapy, the conclusion that
interpersonal relationships are somehow ignored--or that individual brain
chemistry is the one and only root being ad-dressed--seems
erroneous.
"We're not saying this is the only way to help," insists Trestman.
"We're saying, 'This is one way, but of course there are others.' Many
more people can be helped by changing the structure of society than
through medicine. But we also have the ability apparently to help many
more people with medication than before. Now we have to figure out should
we? And for whom? And where does it stop?"
OUT OF THE WOODWORK
Other concerns stem from the staggering numbers of people for whom
Prozac would prove beneficial. In 1991, this advertisement appeared in
New York's Times and Village Voice:
"ARE YOU DEPRESSED? DO YOU SUFFER FROM FATIGUE? INABILITY TO
CONCENTRATE? HAVE TROUBLE SLEEPING OR EATING? IF SO, CONTACT..."
The ad was placed to gather subjects for a study of the
effectiveness of Prozac in treating dysthymia. The response, ac-cording
to researcher Jesse Rosenthal, M.D., director of psychopharmacology at
Beth Israel Medical Center in New York, was "literally thousands of phone
calls. It was amazing--all these bright, educated, hardworking people
just came out of the woodwork. We found a mother lode of nice people who
were able to function, but who were quite literally the walking wounded
of New York."
Tags:
benefactor,
best seller list,
cartoons computer,
computer network,
depression,
dysthymia,
edged sword,
gift horse,
healing powers,
listening to prozac,
medication,
molars,
network discussions,
new yorker cartoons,
personality change,
prozac,
psychological complaints,
therapy
