"The notion that suffering is good is paternalistic and, at worst,
sadistic," says Roose. But even if we take that moralistic, almost
religious view, why point our swords only at the dragons marked "take as
directed"? Why not apply the same questions and concerns to
psychotherapy? "The use of psychotherapy in this country has been
grandfathered in," points out Bob Trestman. "It's been accepted already
for many years, first in terms of counseling from religious leaders, and
more recently in the practice of formal therapy. So that we no longer
question either its intrusiveness on who we are or its relative
safety."
Does psychotherapy have side effects? Is it intrusive? Does it
change the essence of who we are? The answer is yes to all. "If
psychotherapy couldn't manipulate or effect change, then it wouldn't
work," states Roose. "The idea that therapy isn't intrusive, that we
don't alter behavior or control people's thoughts is fundamentally
untrue."
What about side effects? "By definition, if a treatment is powerful
enough to work, it's powerful enough to have adverse effects. Every
journal on psychotherapy will talk about people who regress in treatment,
people who have psychotic reactions, people for whom therapy has caused
deterioration rather than progress.
"Still," Roose continues, "because these so-called nonsyndromal
disorders are considered to be in the realm of psychology, we don't think
there's anything wrong in treating them with psychotherapy. We believe
that isn't manipulation while medication is--regardless of
outcome."
MANIPULATION VS. CHANGE
Yet what if the brain reacted, readjusted itself in the same way,
whether in response to a pill or a therapeutic directive?
Last year, in the Archives of General Psychiatry, a research team
headed by UCLA's Lewis Baxter, M.D., reported a study of two groups
suffering from obsessive-compulsive disorder (recurrent, un-thoughts
accompanied by ritualized acts, such as excessive hand-washing). In
treatment, one group was given Prozac with no formal therapy, the other
behavior therapy, in the form of exercises designed to prevent their
compulsiveness, with no drugs. After 10 weeks, scans of their brains were
compared with those taken at the beginning of treatment.
Approximately two-thirds of each group improved. More important,
for those who did improve, rates of glucose metabolism (an indicator of
brain activity) decreased in exactly the same areas of the brain, in
statistically similar amounts, regardless of treatment. The behavioral
techniques actually altered brain function-and did so no differently, no
less intrusively, than Prozac.
"Some may wonder," writes Baxter et al, "how behavior therapy could
produce brain-function changes similar to drugs. [But] the possibility of
both having the same neural effects is not as farfetched as it might
seem."
The brain is the organ of the mind, and its function affects
personality. So how far do we go in treating its disorders and
distresses, its syndromes and its character flaws? By all accounts, the
resounding answer seems to be: as far as it is safe to go. The unanimous
opinion among professionals is that more information is needed.
Yet what about the concern that we are entering an age when even
the slightest wrinkle in character can be defined as a "disorder." Will
we become a Prozac nation? Hardly, thinks Robert Millman, who does not
believe the whole of society is going to become dependent upon these
drugs. The reason? Evolution, which, over the course of time, has created
in us the brain functions that dictate the way we deal with thoughts and
emotions. That intricate interplay, he offers, is way beyond the
primitive effects of any of these drugs.
"The system is so refined," believes Millman, "and drugs are so
primitive, that one can never really replace the other. With drugs,
you're always giving away more than you're getting--if you're not really
debilitated. You're giving away sensitivity, receptivity, some capacity
for pleasure. But it's a reasonable trade-off if you're in pain."
The only question, then, is for what degree of pain do we seek
medical treatment. And, as Bob Trestman puts it, where will it
end?
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