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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