As a psychiatrist, I treat personalit traits. I help people feel better about themselves. I can help them change their temperament. Medications are one of my tools. Since 1988 when Prozac came out, I have seen medication alter personality and I have taught this notion to primary care doctors for two decades. However, although we know that the SSRIs change temperament, the understanding of personality is controversial. One way of thinking about personality has been proposed by Lewis Goldberg. He suggested a five-dimension personality model, nicknamed the "Big Five":
1. Openness to Experience
2. Conscientiousness
3. Extraversion
4. Agreeableness
5. Neuroticism
The third and fifth trait can be changed with intervention. For example, neuroticism, the tendency to be calm, secure and self-satisfied vs. anxious, insecure and self-pitying is malleable with psychotropic medication. The biological bases of personality has long been debated. Phineas Gage in an 1848 accident where a large iron rod was driven through Gage's head leading to a personality change has been the proof that the brain is responsible for personality.
7% of American adults take antidepressant medication, many of whom experience a profound personality change. Researchers (published in the Archives of General Psychiatry, 2009) saw strong drops in neuroticism and increases in extraversion in patients taking antidepressants. Adults became much less neurotic in a matter of eight weeks.
A few weeks ago I gave a presentation to primary care doctors at a free clinic. I suggested that most of the time, when they prescribe antidepressant medication, they are helping their patients improve the quality of their lives by improving their personalities. I was not popular. The overwhelming response was that this was a free clinic and as such, they did not want to be in the business of cosmetic psychopharmacology. The longstanding debate over chemically altering someone's brain continues.
When it comes to dog personalities, we accept that different dogs have different temperaments. The American Kennel Club Gazette in March of 1979 made a list of six types of dog personalities:
1. aggressive
2. confident
3. outgoing
4. adaptable
5. insecure
6. independent
If dogs come in different personalities, then it stands to reason that personality is at least in part due to chemicals in the brain. As such, an alteration of brain chemistry will alter personality. If we opt to tweak personality traits, and there are medications that can help us with that, is that wrong?
I think it upsets people to think that they are not completely responsible for their own behavior. If a medication can change personality, then that takes away our notion that we are responsible for our positive traits. It is hard for us to imagine that our behavior is a product of our chemical soup and not our cherished family background. We want to believe that we can make good human beings by modeling good behavior. We do not want to think that behavior is some sort of random event of DNA. However, what we want to believe and what science tells us may be two different things.
Doctors are in the business of helping people feel better. Changing personality traits are in line with these goals. I think we should be glad we have the tools to help irritable people be less irritable. Treating temperament is a new frontier and I am excited to be part of it. I hope the doctors at the free clinic will come to the same conclusion.
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