After selecting a core group who met the criteria for dysthymia,
Rosenthal and his team divided them up and gave one-half Prozac, the
other half a placebo. Results? An astonishing 62 percent of the Prozac
group showed significant improvement after only eight weeks (as opposed
to 18 percent given placebos). Other studies conducted by Rosenthal have
shown a more than 70 percent success rate.
The number of people who responded to the advertisement is evidence
of widespread, if low-level, depression--and in greater numbers than were
previously imagined. But what struck Rosenthal was that, while their
average age was 36, almost 80 percent of them were single, and another 9
percent were divorced. Nearly 90 percent of them had been in therapy on
and off over the years.
"They had a lot of insight," reports Rosenthal. "But they still had
symptoms."
Which begs the question: Were these people dysthymic (read
"unhappy") because they couldn't get themselves involved romantically, or
were their persistent blues preventing them from successfully interacting
with others?
The distinction is an important one, and crucial in the argument of
a "drugs vs. societal change" approach to combating low-level depression.
Romantic-courtship may be more difficult now than ever before--which may
lead many to remain single and unhappy. If so, working toward easier
social interaction would benefit. If, however, the reverse were true, and
the subjects' dysthymia was what prevented them from dating, then
focusing on the individual--in order to correct the social--seems
justified. "And that focus is not to be dismissed," stresses
Trestman.
DOES PROZAC = LEARNING?
Whatever the root, one can see them, sipping Cranzac (Prozac and
cranberry juice--a popular cocktail for those unable to tolerate full
doses of the drug), nuzzling up to potential mates at the local singles'
bar, smiling, their psychological wounds successfully sutured. Given
time, wouldn't a more positive outlook lead to better interactions, and
the potential relationships that developed continue to promote good cheer
once Prozac is tapered off?.
"Of course," agrees Trestman. "If people start responding
differently to you, and you start feeling different about yourself, you
set up new habit patterns that reinforce your changed state of affairs.
It may be that Prozac resets the adjustment in the brain after a number
of months, and that afterward people would be at this new point and could
taper off without relapse."
In other words, first the drugs make you better, happier, more in
control--then you do the rest of the work on your own. Cornell's Robert
Millman concurs: "The drugs change a person's emotional reward system.
Your sense of acceptance increases. Your feeling state is changed. Then
hopefully you take this new ammunition and go out and use it on your
own."
Wait a minute. What are we saying here? That "real learning" occurs
on Prozac? That the drug does not simply solve your problems medically,
but requires you to do half the legwork yourself? Yes, believes Millman,
"So that even when you take away the medication, the same situation in
life may create different responses in an individual. Where once the
thought of initiating romance seemed too stressful, it now seems
possible. Where once life seemed sad, lonely, and defeating, it now
appears worthwhile and conquerable."
SYNDROME VS. CHARACTER
Still, there are fears. Is Prozac bringing to light the frightening
number of people who suffer from some sort of distress? Or is it that
what were once called "character traits" are now being reclassified as
"syndromes"--because they can be smoothed out by medication? And, if such
a trend continues, will there be anyone left who isn't "disordered"? Who
doesn't need drugs?
Some doctors bristle at the distinction between syndrome and
character. "It's a false and meaningless boundary:' insists Steven Roose,
M.D., of Columbia University. "People implicitly cross the border from,
well, it's a syndrome, that means there's something wrong with the brain,
to, well, that's just their character, their personality, so that's
psychology."
Such dualism is destructive, believes Roose: "If somebody has a bad
temper and works to control it, we don't say they're altering who they
are. But there's a paranoia that somehow with medication, we're trying to
control the essence of individuality, that we're manipulating
someone."
No doubt the moral arguments about character altering are being
applied more severely when treatment involves medication as opposed to
psychotherapy. Consider one recent New Yorker cartoon: "If they had
Prozac in the 19th century." One panel features Karl Marx saying, "Sure,
capitalism could work out its kinks!" In another, Edgar Allen Poe is on
friendly terms with the raven. A third shows Nietzsche outside a church
with his mother, saying, "Gee, More, I like what the priest said about
the little people."
The implicit message is that, without suffering, without the
character quirks that made Poe poetic, for example, we would be deprived
of his brooding masterworks. True, perhaps, but if suffering is so
enlightening, if it is part of what makes us "us" and we should try our
best to preserve it rather than medicate it away--isn't that also an
argument against any kind of treatment? Shouldn't we then avoid seeking
any kind of relief, for fear that we may be damaging, even destroying,
the human spirit, the creative urge, that which defines all of us, the
brilliant and the dullard?
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