Notes on a scandal

In 1996 Zoe Heller, the author of Notes on a Scandal, took part in a widely reported debate with Roy Porter about Prozac. She defended the drug. It had restored her to life. He said today’s miracle invariably ended up in tomorrow’s tragedy and asked, Why is it that we never learn?

The story of a schoolteacher who seduced one of her male pupils.

In 2003, Notes on a Scandal came out. It was made into a stunning movie in 2006 starring Cate Blanchett. This was the story of a schoolteacher who had seduced and was having continuing sexual relations with one of her male pupils.

In 2006, Rosie Meysenburg started up SSRI Stories, a website for cases of violence triggered by SSRI drugs (see The story of SSRI Stories). To collect the material she posted, Rosie had to review reports of criminal and other legal cases in which media reports mentioned SSRIs. To her astonishment, she began to notice that she had a series of cases involving women teachers convicted for inappropriate sexual behavior toward male pupils — with the women typically taking an SSRI. For one woman, the Courts decided her drug had caused the problem. This was the plot of Notes on a Scandal.

The most obvious thing SSRIs do is change sexual functioning — almost all people on an SSRI will notice some change within hours of having had it. Ian Hindmarch’s women volunteers in Leeds in 1983 almost certainly all had changes in their sexuality or sexual behavior. Delayed orgasm is extraordinarily common to begin with; reduced libido comes later. In many cases, things return to normal when the drug is stopped. In a not inconsiderable number of cases the changes are permanent — we don’t know how often this happens.

Curing homosexuals?

At the start of the antidepressant story, Roland Kuhn celebrated the fact that imipramine, an SSRI, had cured some homosexuals he had seen (discussed in greater length in The Antidepressant Era). Thirty years later Peter Kramer celebrated in the same way for Prozac. No one argued this was impossible. There are good grounds to accept that SSRIs can shift some of us along the axis of our sexual orientation.

But it’s not reasonable to think the shifts are likely to be only one way — in the direction some would view as normalizing. For every one whose change in orientation the Catholic Church might celebrate, there is likely to be another whose change would pose problems for the bastions of morality. There won’t be one without the other.

In 1999, 13-year-old Matt Miller was taken by his parents to see a doctor, as he was unsettled in a new school. The doctor, who was on Pfizer’s speakers’ bureau, put him on Zoloft. Matt became restless on Zoloft. A week later he hung himself in the bathroom between his and his parents’ bedroom.

Auto-erotic asphyxiation gone wrong.

Pfizer argued Matt’s death wasn’t caused by Zoloft; it was a case of auto-erotic asphyxiation gone wrong. To argue their case, they wheeled in Parke Dietz, an expert who had offered the view that Anita Hill’s claims that she had been harassed by Supreme Court Judge Clarence Thomas were just fantasy. But Dietz didn’t come up with this idea of auto-erotic aphyxiation first — Pfizer did. Where did they get it from?

The idea almost certainly came from their studies, whether healthy volunteer trials like the Leeds study (see Mystery in Leeds), or in one of their trials for other purposes or in convincing reports to the company. This idea didn’t come from anyone’s understanding of what 13-year-old boys normally do.

Would Zoloft-induced impulses to auto-erotic asphyxiation be more or less plausible than a 13 year old spontaneously turning to this sexual expression? If it seems more plausible that Zoloft had induced auto-erotic asphyxiation, then whose fault would this death have been given the volume of data on Zoloft and sex that Pfizer had?

If Matt had practiced auto-erotic asphyxiation regularly (before starting Zoloft), another set of complications opens up. Zoloft inhibits orgasm. Could Zoloft have changed things, leading him to go too far? If so, whose fault would his death have been then, given that Pfizer had not warned about this? Knowing what they knew, Pfizer should have been honor-bound to warn anyone else who engages in auto-erotic sexual play or any form of sexual play, about this possibility.

Pfizer really should have told us what they knew about sex.

It was one thing for Pfizer to argue for auto-erotic asphyxiation gone wrong, but they really should have told the court of the range of sexual changes they knew about.

In the Miller case, Pfizer flew Ian Hindmarch over to a pre-trial hearing. At this he claimed that the volunteers in his Zoloft study in Leeds (see Mystery in Leeds) were just suggestible. Nothing much had happened to any of these women. But the study remained unpublished, and its full details have probably never been seen by any regulator.

Four years later, the FDA put a Black Box warning of the risk of suicide in children taking Zoloft and other SSRIs. It’s difficult to believe that many people will have ever thought that Matt Miller died because of auto-erotic asphyxiation rather than a straightforward Zoloft-induced suicide. This warning should drive a stake through the heart of Pfizer’s argument.

Professional auto-erotic asphyxiation?

For most people, the only remaining unanswered question of interest is likely to be where Pfizer got the auto-erotic asphyxiation idea from in the first place. The only remaining question for most people, that is, except the American Psychiatric Association, who after the Black Box warning rushed out a statement that the APA believes Antidepressants save lives. As outlined in Professional Suicide, this is an extraordinary example of a professional suicide note.

But perhaps what the APA, and more recently the Irish College of Psychiatrists, has been doing is not suicide after all — perhaps it is auto-erotic asphyxiation?  Let’s hope it doesn’t go wrong.

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  1. William Styron, in his vivid description of his own fight with depression and suicidality, wrote that, in the 1980s he was prescribed Halcion, valium and Ativan. He wrote:
    “For some time now, experts in psychopharmacology have warned that the benzodiazepine family of tranquilisers … capable of depressing mood and even precipitating a major depression. Over two years before my siege, an insouciant doctor had prescribed Ativan as a bedtime aid, telling me that I could take it as casually as aspirin. The PDR…..reveals that the medicine I had been ingesting was a) three times the normal strength, b) not advisable as a medication for more than a month or so and c) to be used with special caution by people of my age.” (He was mid-sixties.) “It seems reasonable to think that this was still another contributory factor to the trouble that had come upon me. Certainly, it should be a caution to others…..Many psychiatrists, who simply do not seem to comprehend the anguish their patients are undergoing, stubbornly maintain their allegiance to pharmaceuticals in the belief that eventually the pills will kick in, the patient will respond and the somber surroundings of the hospital will be avoided. I’m convinced that Halcion (triazolam) is responsible for exaggerating to an intolerable point the suicidal ideas that had possessed me…. One cringes when thinking about the damage such promiscuous prescribing of these potentially dangerous tranquillizers may be creating in patients everywhere.”
    With respect to the infamous sexual function impairment warned of, he wrote:
    “Dr …… with a straight face, said that the pill at maximum dosage could have the side effect of impotence. Until that moment, although I’d had some trouble with his personality, I had not thought him totally lacking in perspicacity, now I was not at all sure. Putting myself into Dr ….’s shoes, I wondered if he seriously thought that this juiceless and ravaged semi-invalid with the shuffle and the ancient wheeze woke up each morning from his Halcion sleep eager for carnal fun.”
    And this was written over 25 years ago, before the SSRIs took over.

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