Prescriptions for Happiness?

Actually, the power of the placebo complicates all efforts to test the therapeutic efficacy of psychotropic drugs. When placebos alone can produce positive curative effects in the 40 to 50 percent range (occasionally even up to 70-80 percent), the active drug being tested is hard-pressed to demonstrate its superiority. Even if the active drug exceeds the placebo in potency, the question remains whether the advantage is at least partially due to the superior potential of the active drug itself to mobilize placebo effects because it is an active substance that stirs vivid body sensations. Because it is almost always an inactive substance (sugar pill) that arouses fewer genuine body sensations, the placebo is less convincingly perceived as having therapeutic prowess.

Drug researchers have tried, in vain, to rid themselves of placebo effects, but these effects are forever present and frustrate efforts to demonstrate that psychoactive drugs have an independent "pure" biological impact. This state of affairs dramatically testifies that the labels "psychological" and "biological" refer largely to different perspectives on events that all occur in tissue. At present, it is somewhat illusory to separate the so-called biological and psychological effects of drugs used to treat emotional distress.

The literature is surprisingly full of instances of how social and attitudinal factors modify the effects of active drugs. Anti-psychotic medications are more effective if the patient likes rather than dislikes the physician administering them. An antipsychotic drug is less effective if patients are led to believe they are only taking an inactive placebo. Perhaps even more impressive, if a stimulant drug is administered with the deceptive instruction that it is a sedative, it can initiate a pattern of physiological response, such as decreased heart rate, that is sedative rather than arousing in nature. Such findings reaffirm how fine the line is between social and somatic domains.

What are the practical implications for distressed individuals and their physicians? Administering a drug is not simply a medical (biological) act. It is, in addition, a complex social act whose effectiveness will be mediated by such factors as the patient's expectations of the drug and reactions to the body sensations created by that drug, and the physician's friendliness and degree of personal confidence in the drug's power. Practitioners who dispense psychotropic medications should become thoroughly acquainted with the psychological variables modifying the therapeutic impact of such drugs and tailor their own behavior accordingly. By the same token, distressed people seeking drug treatment should keep in mind that their probability of benefiting may depend in part on whether they choose a practitioner they truly like and respect. And remember this: You are the ultimate arbiter of a drug's efficacy.

How to go about mastering unhappiness, which ranges from "feeling blue" to despairing depression, puzzles everyone. Such popular quick fixes as alcohol, conversion to a new faith, and other splendid distractions have proven only partially helpful. When antidepressant drugs hit the shelves with their seeming scientific aura, they were easily seized upon. Apparently serious unhappiness (depression) could now be chemically neutralized in the way one banishes a toothache.

But the more we learn about the various states of unhappiness, the more we recognize that they are not simply "symptoms" awaiting removal. Depressed feelings have complex origins and functions. In numerous contexts—for example, chronic conflict with a spouse—depression may indicate a realistic appraisal of a troubling problem and motivate a serious effort to devise a solution.

While it is true that deep despair may interfere with sensible problem-solving, the fact is that, more and more, individuals are being instructed to take anti-depressants at the earliest signs of depressive distress and this could interfere with the potentially constructive signaling value of such distress. Emotions are feelings full of information. Unhappiness is an emotion, and despite its negativity, should not be classified single-mindedly as a thing to tune out. This in no way implies that one should submit passively to the discomfort of feeling unhappy. Actually, we all learn to experiment with a variety of strategies for making ourselves feel better, but the ultimate aim is long-term effective action rather than a depersonalized "I feel fine."