Psychiatrist Peter Kramer, M.D., wrote Listening to Prozac in hopes
ofgetting us to understand the personality types our culture is breeding
in us--and to decide whether we like ourselves. In the process, he has
become something of a celebrity and admits to being changed by the
experience.
PT: There has been a fire storm and you have become the lightning
rod for reactions for and against Prozac. How do you explain people's
reactions?
PK: There are some interesting issues that relate to Prozac. I like
to think that most of them are taken up in the book. I think that much of
the reaction in the press, unfortunately, is standard journalistic story
telling in which heroes are made and unmade, which has actually very
little relationship to the facts.
PT: You said in your book that Prozac is a whole gamut of opinion.
It's become that, hasn't it?
PK: I underestimated the publicity capabilities of the American
media to take something and run with it. I felt Prozac had already
achieved a level of celebrity that was astonishing. To think it could
increase by another order of magnitude was more than I
anticipated.
PT: Were you really surprised?
PK: Yeah. I actually thought the publisher would have trouble
earning back the advance.
PT: How do you explain the enormous commercial success of the book?
Is this American enthusiasm for feeling good--all the things that you
deal with in the book itself?
PK: I have thought about this so long that I have 10 responses to
this. The first is that every summer leading up to this book, there's a
serious book that makes it onto the nonfiction best-seller list that
"oughtn't be there." The David McCollough book about Truman is a terrific
book, but it's thick enough that it's an aberration on the best-seller
list. Or In the Name of the Rose by Umberto Eco, or Steven Hawking's
book, A Brief History of Time.
PT: You would include your book as one of the ones that shouldn't
have been on the list?
PK: It's a difficult book, and a serious book. Best-seller lists
don't have books that try to explain what neurotransmission is and why
we're working with failed theories and try to pull together amine theory,
cellular biology, pharmacology, and medical ethics. Anyone who predicts a
book with that content will be a best-seller is taking a very long
shot.
PT: So your book was a weird event when it became a
best-seller.
PK: I have some ideas about how the weird event happened. I had a
very committed editor who had enough connections to get the book
thoughtful consideration.
And the other thing, which I didn't think of sufficiently, was that
people who were on Prozac and were hungry for some explanation would pick
up a book that had Prozac in the title. The book was a best-seller on
both coasts before the publication date and before any reviews.
PT: It wasn't just that the book was read. People have opinions
about Prozac and the use of Prozac independent of whether they've used it
or are candidates.
PK: The book put the right question on the table, which was not
does this work for depression or does this cause suicide, but what are
these nonstandard uses and what do they tell us about what we demand of
people as a society.
What do they tell us about the types of solutions we look for? How
do they fit in with a whole American tradition of ameliorism or optimism
about man's perfectability? The book gave people the framework to discuss
something that they had wanted to discuss but that had not been
crystallized.
PT: You talk about why we continue to discuss failed theories.
Specifically, which failed theories?
PK: First of all there's the amine hypothesis, the idea that
depression is related to or caused by or equivalent to depletion of
serotonin or norepinephrine. There's lots of evidence that that can't be
the whole answer and even some evidence that contradicts that theory
entirely.
One is that you can deplete people of these chemicals and most
don't get depressed. Another, that there are drugs that don't seem to
have any direct effect on these systems that act as antidepressants. Plus
there are contradictions within the literature as to whether you're
up-regulating or down-regulating pathways that use these
chemicals.
Then there's the whole Cartesian dichotomy between mind and brain.
It's imperfect but convenient to use as a manner of expression or
analysis.
The last thing is not so much something that's wrong as
exaggerated, which is that our evidence regarding biological
underpinnings of personality is very limited. It's weak even in the areas
where it has been best researched. When we talk about the biology of
personality, which is really what the book is all about, we are riding on
the back of three very weakly supported concepts or concepts that have
even been outmoded.
This is a book that underlines the weakness of our understanding of
depression and personality and gives a sense of societal shift in our
beliefs about ourselves that is "in advance of the evidence." Which
really means lacking evidence.
PT: With Prozac, aren't the people who come in asking for it being
whipsawed by the ambient society and its thinking? How realistic or
unrealistic is the expectation of an introvert becoming an extrovert? And
should you reward it?
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