Peter Kramer wrote the manual to Prozac; now he's trying his hand
at fiction.
PERHAPS AMERICA'S BEST-KNOWN PSYCHIATRIST, PETER KRAMER, M.D.,
WROTE ONE OF THE LAST DECADE'S HOTTEST SELLERS, LISTENING TO PROZAC. THE
BOOK GAVE A BALANCED VIEW OF ANTIDEPRESSANTS AND HELPED PUT PROZAC IN
HOUSEHOLDS ACROSS THE NATION. WITH HIS FIRST NOVEL, SPECTACULAR
HAPPINESS, THE PSYCHIATRIST AND RESEARCHER AIMS TO JOIN THE RANKS OF
PHYSICIAN/WRITERS LIKE ANTON CHEKHOV AND WALKER PERCY.
Robert Epstein: Tell us about your novel.
Peter Kramer: It's a peculiar book. It has a hero who is very
thoughtful and sensitive, a very good husband and father who, for various
reasons, has decided to blow up beachfront homes on Cape Cod. It starts
the moment he sees his estranged son's picture on television with a
subtitle reading "son of accused bomber." The title is somewhat ironic.
There's a theory of anarchism that was popular in France in the 1960s.
One use of the phrase "spectacular happiness" in the book has to do with
what level of happiness is possible in that sort of society.
RE: Have you tried fiction before?
PK: I took a half step into fiction with my last book, Should You
Leave? The book was about the ways people thought about relationships
over the last half-century. Most of the vignettes were fictional and in
second person.
RE: Tell us a bit about Listening to Prozac, the best-seller you
wrote 10 years ago.
PK: Prozac had been on the cover of Newsweek and New York magazine.
It already had some celebrity and then it started developing notoriety.
Some claimed it caused suicide or violence. So I wrote a book about what
the public thought and what it was like to live in a culture where it
looked as if aspects of personality that had previously been subject to
psychotherapy were now occasionally responding to medication.
RE: Many misinterpreted your book. They came away thinking that
Prozac was a panacea. But don't you also believe in the importance of
psychotherapy?
PK: In Listening to Prozac I explicitly wrote that psychotherapy
remains the most important treatment for minor mental disorders.
Psychotherapy can settle down anxiety disorders and give people tools for
avoiding or living with depression. We are very psychological creatures.
Part of our environment, part of our stress, part of our sense of
security, is based on interpersonal relations, learning and all the
things that psychotherapy influences.
RE: Recently a jury in Wyoming awarded millions of dollars to the
family of a man who took an antidepressant. They believed it caused him
to shoot his wife, daughter, granddaughter and himself. Following that, a
researcher in the United Kingdom cited studies that show as many as a
quarter of the people who are not depressed, but who take SSRI drugs,
become agitated and that some may become suicidal. What is your
perspective?
PK: I don't think the answer is clear. When I wrote Listening to
Prozac, the cases that had come to trial tended to be those in which
people had been violent before. They had an illness, usually manic
depression, which is known to get worse when people are given
antidepressants. Often they hadn't received good follow-up from their
physicians. With good medical supervision, [these drugs] tend to be safe.
The problem, of course, is that doctors tend not to do the kind of
vigorous follow-up they should do with mentally ill patients. Very few
studies give these medicines to people [without depression].
One, at UCLA, checked how people who had no history of depression
responded to these medicines. They gave them Paxil and saw how they did
in interpersonal interactions. They tended to have more leadership
qualities, be more conciliatory and be leaders in solving problems. As I
remember, there were no severe untoward effects. Occasionally, I've had a
patient call saying, "I'm agitated." Either we lower the dose, take him
or her off the medication or try other treatments. I haven't seen cases
where things spiral out of control instantaneously. My worry is the lack
of testing of long-term usage. For example, if Prozac decreases the
length of time to the next depressive episode, this can only be known by
having large-scale studies. When a medicine goes from being used by a few
people to being used by hundreds of millions of people, and for long
periods of time, there have to be studies that look at the public health
implications and the effects of long-term use.
RE: When you wrote Listening to Prozac, children were not being
given Prozac or other antidepressants. Now there are millions on these
drugs. But studies looking at the effects on children have not been
done.
PK: The truth is that [older] antidepressants don't work well in
children or in adolescents. Medicines like Prozac really are the first
ones to have shown some effect--and often not very dramatic effects--in
children and adolescents. The older antidepressants don't seem to work,
and there are some unusual side effects in children. With good reason,
both doctors and parents are very eager to see an episode of depression
terminate quickly, so they turn to medicine. It's true that we don't
really know the long-term effects on the brain.
RE: There have been various books and commentaries written in
reaction to Listening to Prozac. For example, Dr. Peter Breggin, author
of Talking Back to Prozac, has been very critical.
Tags:
anarchism,
anton chekhov,
aspects of personality,
best seller,
half step,
last decade,
listening to prozac,
notoriety,
novel peter,
peculiar book,
robert epstein,
second person,
vignettes,
walker percy
