In the early to mid 1990s something happened. The view that many social commentators and academics offer is that neo-liberalism swept into town, dissolved society and turned us all into individuals. This is a non-explanation in that no-one can spell out what neo-liberalism is – so the explanation boils down to something happened.
The something is caught in a review of Peter Kramer’s Listening to Prozac by Roy Porter. Roy was the one of the leading historians of medicine in the world at the time. He came from a left leaning point of view and was committed to history from the bottom up – or as he put it the Bidet as opposed to the Shower approach to history.
But here in this review of Listening to Prozac, dated March 3 1994, which may have been published somewhere, Roy, like many others, appears to have been somewhat defanged.
See what you think. I find it difficult to understand how a Roy Porter and others didn’t see Listening to Prozac as just plain crass. (It’s worth reading if only for the snippet on line 4).
Prozac, the anti-depressant that has taken America by storm, has become the legal counterpart to cocaine in the ‘greed is good’ Reaganite years. Introduced by Eli Lilly in 1987, this prescription drug has been swallowed by up to eight million Americans, including Donald Trump, Gary Hart and ‘half of Hollywood’; a million prescriptions a month are being filled, and it’s grossing $1.2 billion a year. It’s hard not to write about Prozac in the language traditionally reserved for movies – indeed it gets a plug in the latest Woody Allen film.
A smart pill for the daily ills of modern society was long overdue. The sixties favourite, Valium (‘mother’s little helper’) had proved habit-forming; many of the later innovations Anafranil for obsessive-compulsive disorder, Xanax for panic anxiety – triggered serious side-effects. Prozac, by contrast, has seemed to many just what the doctor ordered. A laboratory drug drawing upon advanced psychopharmacological research, Prozac (fluoxetine hydrochloride) works by boosting the action of serotonin (the so-called mood transmitter) in brain cells. Seemingly non-addictive and unusually benign, it has the power to lift the depressed, to make the shy outgoing, the anxious assertive and perfectionists accepting. Sufferers said it made you ‘better than well’, at long last they ‘felt themselves’.
After the euphoria, a reaction has predictably set in. Tragic cases were reported Del Shannon’s suicide and a Kentucky mass-murderer who was on the drug. Prozac ‘survivor groups’ have been formed. And pundits have conjured up the fearful spectre of the mass prescribing, on demand, of this potent chemical kick: isn’t the Brave New World dystopia finally being realized by the little green and white capsule that has starred on the front page of Newsweek?
Peter Kramer’s book is a provocative contribution to the debate. A professor of psychiatry at Brown University, and an enthusiastic champion of the drug, Kramer supplies extensive case materials suggesting it gives both the clinically depressed and the sub-clinically ‘blue’ the boost they need to thrive at work, at home and in bed, and hence grow in self-esteem and independence. Kramer is confident about Prozac’s safety.
But it’s not so much its clinical discussions that makes Listening to Prozac intriguing reading, but rather the clarity and candour with which Kramer explores the wider issues. Prozac is a striking symbol of the new, seemingly all-conquering, but highly problematic biological materialism. If Freudianism dominated American psychiatry to the 1950s, emphasising inner conflict, and if the ’60s saw the heyday of a liberal egalitarianism stressing nurture not nature, the ’80s brought a reductionist backlash with a vengeance that recast individual differences in biochemical and increasingly genetic terms. The striking efficacy of Prozac reinforces this trend. You’re depressed? It’s not primarily because you’re poor, out of work, oppressed, abused or trapped in the rat-race; it’s because your brain has a chemical imbalance – and one proof of that is that Prozac rectifies it.
Psychiatry itself, Kramer argues, is thus becoming drug- driven – the shift, so to speak, from ‘listening to patients’ to ‘listening to Prozac’. Traditional psychiatry developed a taxonomy of mental illnesses; the new psychiatry, Kramer holds, may recognize disorders in terms of the drugs that treat them: you must have depression because anti-depressants work for you. Many of course deplore these trends as short-cut psychiatry – fixes rather than healing. Medications like Prozac, critics claim, make you high without ever gaining insight into why you were low, unlike psychoanalysis which properly insisted that understanding must precede recovery. But Kramer can plausibly rejoin that psychotherapy has all too often made the depressed dependent and victimized the victims. By contrast, psychopharmaceuticals work fast; by ‘revving people up’, they facilitate escape from the maelstrom of despair. In the end, psychotherapy may be far more addictive than pills.
Prozac’s power to modify personality bolsters the belief that biochemistry underpins not just mental illness but temperament in general. If this ‘neurohumoralism’ be true, then, Kramer submits, why should physicians restrict themselves to treating the sick? Why shouldn’t neuropharmacology routinely and openly be in the business of prescribing pills to make people feel the way they want?
It’s this suggestion of course that meets indignant resistance. To some it seems to threaten the Hippocratic dignity of the medical profession, reducing the physician to a pusher. To others it unleashes terrifying prospects of the mind and mood control envisaged in Anthony Burgess’s Clockwork Orange or Walker Percy’s Thanatos Syndrome. Suffering (not only puritans will argue) has positive functions and should not be short-circuited. Stiff upper lip Englishmen may note that Prozac is a characteristically American product, tailor-made to adjust people to crazily competitive capitalism – as evidence of one of his Prozac successes, Kramer boasts that a formerly depressed patient is now dating three men a weekend!
The issues Prozac raises are serious, and it is to Kramer’s credit that he airs them freely and frankly. He is right to detect hypocrisy in expressions of pious horror at the idea of psychiatrists dispensing feel-good pills, when all sorts of other fixes are readily available in bars, over the counter and on street corners, and millions are daily body-building with steroids or having face-lifts and breast-implants. We have permitted medicine to branch into cosmetic surgery: can it then be honest to berate ‘cosmetic psychopharmacology’ and the personality-sculpting it offers? Isn’t the critics’ predilection for psychotherapy over psychopharmacology simply ‘no pain, no gain’ snobbery? If happiness on demand is going to be the West’s expectation, we need to decide whether our dream peddlers are going to be pharmaceutical corporations, Bolivian drug barons – or who?
Kramer forecasts the medicalization of everyday life and feels quite comfortable with it (he would, wouldn’t he?, critics will claim). We may be less sanguine, but it’s a prospect we’d better face. Neuropharmacological advances, breakthroughs in diagnostic technology, the economics of medibusiness, the new consumerism and capitalism’s instant hedonism all these pressures are bound to make the next century the age of the drug.
The issue is not whether we like it but how we will live with it. Kramer’s optimism may not appeal to all, but his forthrightness in facing medicine’s changing agenda is undeniably refreshing.
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Copyright © Data Based Medicine Americas Ltd.
He got one thing right ‘the age of the drug’
It’s all very well postumising Prozac in such flowery language, but, unfortunately, it led to companies like GlaxoSmithKline producing Paroxetine
Unfortunately, for GlaxoSmithKline, Paroxetine, was developed and promoted as the ‘wonder drug’ to beat all others
It did beat all others –
In revenue, in publicity, in world ranking – once unleashed in the 90s, it wasn’t long before Paroxetine started to crumble
The press took hold, Paxil cases abounded, a grandfather shot dead almost his entire family – the case won and Then – What Happened ..
Children hanging themselves from Prozac, the only antidepressant licensed for children – although GlaxoSmithKline tried to get a share of this market
GlaxoSmithKline refusing to tell adults that they run the same risks as children
Kramer is a faculty member of Brown Medical School, where he specializes in clinical depression. He is also the author of several books. In his 2005 book Against Depression, he argues that the socio-economic costs of depression are so large and the effects so pervasive that modern societies should aim to eradicate the disease in the same fashion as it did with smallpox.
Kramer’s most notable book is Listening to Prozac (1993). This work was grounded in the observation that, treated with antidepressants, some patients reported feeling “better than well.” This result led Kramer to consider the feasibility of “cosmetic psychopharmacology,” the use of medication in healthy people to induce personality traits that are desired or socially rewarded. In the book, Kramer considers the consequences for medical ethics and critiques the tendency of the culture to reward particular personality styles, namely those characterized by energy and assertiveness.
The ego has landed for a state visit – is Trump still taking the pills? It might explain a lot.
I should probably start reading books, but the one i won’t read is the the one above. How hard can it be to write a book about something that everyone prices and celebrates? Yes I know the book got alot of attention, and also that it spurred a “talking back at- book”. Some people saw the dangers, some people celebrated the success. Sounds like we are still there, the critical side is critical, while the celebrating side still celebrates, but with revised adjectives.
If you change the descriptive text in order to be able to continue your ‘celebration’, perhaps you should take a hard look at why the critics don’t have to change theirs….
Long gone are your ‘chemical imbalance’, and serotonin isn’t at all solely responsible for you well being.
And Brown University has produced more ‘celebratory professors’ since, we would probably recognize what large companies have ‘sponsored’ the library and what not at Brown University.
And yes, the medical profession should question itself, anyone knows that end of life treatment with heroine probably would cause states that can be explained as ‘beneficiary’ for the patient. But that is not how we should decide who and who not to medicate.
Roy Porter wrote the History of Madness and many other books relating to ‘historical’ medicine and it was sad to die at just 55, when he was so profligate and noted as such a famous medical historian.
‘Georgian asylum admissions lend no support to the view that male chauvinist values were disproportionately penalizing women with mental disorders’.
There might be something demonstrably apt, in this short sentence …
No disrespect at all to the author of the article, and always good to hear that some do well, but for how long, I wonder, has Kramer himself been listening to Prozac?
For some, it’s usually hard to hear over a previously generally ‘happy’ and healthy person’s post SSRI 20 plus years flashbacks, the permanent alternative state ‘anxiety’, the screeching of the remaining transmitters starting up before quickly screeching to a halt; over the teeth grinding, the chemical ‘Devil with Tourettes’, the gastro trumpeting and the occasional bout of tinnitus. But you can, (especially, if you ended up with no choice) really hear Prozac.
More and more, if you listen to some people who know her personally and for more than a short time, the pale faced middle aged apparent one time siren sounds like a badly aging rock star now obviously suffering from Imposter Syndrome, DID, interpersonal intimacy issues. Determined do whatever is necessary to prevent people from seeing her teetering on the edge of a full Narcissistic breakdown.
Sometimes she must remember (if she can and between yawns) the mass mania and hysteria of her neon yellow heydays. The good old days when she belted out ‘Shiny Happy People Having Fun’ (‘Smack my Bitch Up’ much more than an occasional hidden B Side) at 100,000 decibels. When all who suffered from the big D word – which spread like wildfire or faster than a factory slave from an improbable terrorist overnight – were relieved to know that grief, moving school, falling in love, one two many bad Mondays or redundancy, could suddenly render the brain chemically lob-sided.
Some nights little Princess Prozac must still tuck herself safely back under a little plastic duvet and try to avoid the fading breath impression of an ‘Oh’ gape not quite wiped clean from a child’s bedroom window.
Every eerily haunted child’s bedroom now rows and rows and rows of small wooden new homes beyond it. Not too far (but far too close for some) to a very small window where they say you could see a classroom full of distressed and agitated children; which underground legend has it someone with the key to the door of many schools was forced to look into once. Then looked away.
Hard to read this when another victim of akathisia died as related on Twitter yesterday. Another in a Facebook group.
However, with all the Listening to Prozac and her rivals these were the only two deaths caused by once hidden dangerous neuropsychiatric events ever heard of and at remarkable direct odds with the actual data and open medical knowledge.
It was then unnecessary to argue that doctors should have considered insisting upon the credibility and authenticity of her papers at any time in the last 20 years. Much less to argue basic common sense with professionals that more attention, along with MISSD 101 education in akathisia for all doctors and not just the Head Psyche, should be paid to listening, and consistent listening, as the most basic competency.
As they have been listening to Prozac etc. of course.
Not quite the billion dollar money spinner but perfect, as was already known, and if a proper and full ‘U-Turn’ may later be needed, for present patients who simply don’t appear to be able to get enough of a good thing – or off the last good thing. The niche markets: perfect for the Paul Bloom Anti-Empathy crowd, the erotophobics, the benign masochists, the emerging market of young men who always wanted to be mermen, the very high risk nymphomaniacs (never before compassionately listened to and believed…).
Patrick D Hahn says:
January 30, 2017 at 10:00 am
Dr. Kramer argues like a defense lawyer, as if Prozac were a person whose civil rights we are bound to respect. And he does a very good job indeed of kicking up reasonable doubt, going on for chapter after chapter identifying potential confounding effects in clinical trials. Funny how all the potential confounders he can think of seem to work against the drug and in favor of placebo. Are there any that work the other way around?
Or do the Ordinarily; well, dream, on …
On Wikipedia – P Kramer suggests that ‘depression should be eliminated -just like any other disease’….and he has the key to the drug cupboard ….
A song – dedicated to Peter the Wolf who wants to make people better or is it better people…
If you’re happy and you know it clap your hands
if you’re happy and you know it
and you really want to show it
clap your hands
if your happy and you know it
and your face will surely show it (fixed drug induced grin)
clap your hands
I have described the dirty tricks and scientific dishonesty involved when drug companies and leading psychiatrists try convincing us that these drugs protect against suicide and other forms of violence (1). Even the FDA was forced to give in when it admitted in 2007, at least indirectly, that depression pills can cause suicide and madness at any age (1, 9).
Prof. Peter Gøtzsche @PGtzsche1 2h
The depression pill epidemic. A two-page summary of the most important issues by me. The pills do not cure, lead to much harm, and should be avoided.
The Depression Pill Epidemic
By Professor Peter C. Gøtzsche
June 4, 2019
In some countries, including the United States, about 10% of the entire population is in treatment with depression pills. This is a tragedy. These drugs do not have relevant effects on depression; they increase the risk of suicide and violence; and they make it more difficult for patients to live normal lives (1). They should therefore be avoided. We have been fooled by the drug industry, corrupt doctors on industry payroll, and by our drug regulators (1).
AntiDepAware @AntiDepAware 1h
Many thanks to @DrDavidHealy, @shanecooke and others present at Prestatyn yesterday for an interesting and informative evening.
Michael P. Hengartner, PhD @HengartnerMP 2h
Research topic on pediatric antidepressant use in Frontiers in Psychiatry edited by Irving Kirsch, David Healy and myself. We welcome all kind of papers, e.g. commentaries, reviews, original papers, etc. Share with your colleagues and submit now: https://www.frontiersin.org/research-topics/10101/antidepressant-prescriptions-in-children-and-adolescents …
The prescription of antidepressants to children and adolescents is a controversial topic.
With respect to depressive disorders, to date no single pediatric antidepressant trial found efficacy on the pre-specified primary outcome (Healy et al., 2019). However, when meta-analytically pooled across all trials, antidepressants appear to have a statistically significant albeit marginally small benefit over placebo (Locher et al., 2017). It also appears that antidepressants are more effective for anxiety disorders than for depressive disorders (Locher et al., 2017).
On the other hand, the risk of suicidal events in antidepressant recipients is about twice that seen in placebo recipients, indicating that antidepressants increase the suicide risk in children and adolescents (Sharma et al., 2016).
Another issue related to the risk-benefit conundrum is the influence of the pharmaceutical industry on the design, conduct and publication of pediatric antidepressant trials (Leo, 2006). Systematic biases and even research misconduct have been documented in several industry-sponsored trials, and these flaws further complicate the interpretation of published findings on the usefulness of antidepressants in children and adolescents (Jureidini et al., 2004).
More than likely what I say here won’t make a difference, many herein will discount it. A few will understand..
After a long history of work in this field, and having done, approximately 60,000 reviews, I have developed grave concerns about what is given out to people in the name of medicine.
My question at this point is. Is it better to have an entire nation in a manic episode, or a few hundred thousand? Because certainly here in the USA, that is where we are heading.
We here consume more drugs than all the rest of the world combined, and that includes street drugs, as well as psychiatric medications. One would think they are different, psychiatric meds, different than street drugs, and would work at cross purposes, however that is not the case. Few drug users, inform their prescribers, they are on street drugs, and many of those psychiatric medications are used, to potentiate the high that comes from street drugs.
Many institutions, in this country have been courted to encourage psychiatric drug prescriptions like the grades schools prescribe ADHD medications, unaware of exactly what those drugs do or don’t do. Yet seem unconcerned of exactly what happens, to those prescribed once they are intoxicated on them.
Its very easy to credit symptoms to a disease, than to credit it to a medication. Which often results an an entire cocktail of many multiple drugs, when symptoms aren’t obligingly controlled, that turn the brain into a chemical stew pre disposed to mania.
Which brings me back to my point. All psychoactive drugs, do similar things, they disconnect feelings from consciousness. They make connections of feelings and behaviors difficult for those who are prescribed them. In some sense they all disassociate.
Much the same as street drugs.
This may be why so many of us do not have a firm grip on reality.