Peter Kramer, Listening to Prozac

[eub]

I read Listening to Prozac with the impression that it would be a pill-over-talk counterpolemic to Of Two Minds. It isn't at all; the author comments that "To my mind, psychotherapy remains the single most helpful technology for the treatment of minor depression and anxiety [...] the belief -- espoused not infrequently by health-care cost-cutters in the `managed care' industry -- that medication can obviate psychotherapy conceals, I believe, a cynical willingness to let people suffer." He talks about how drugs interact with therapy. In one patient, experiencing the drug effect, even temporarily, gave a glimpse of a different way of living. In another, the drug-given ability to bear troubling emotions deepened the affective quality of memory, as talk therapy may hope to. The author usually prescribes drugs only after therapy; a suicidal patient who was given an immediate prescription said that his mood improved, but he felt phony and could not accept his medicated personality as himself.

The book is not really about Prozac as a treatment for depression, but Prozac as a modifier of personality (he is talking about a minority of responders to the drug): how this changes the way we think about personality, and about mental health and illness. He suggests, for example, that some people have an unusual sensitivity to negative social cues, to rejection and loss, which may be culturally shaped into a histrionic, emotionally needy personality, or into a closed-off one. An SSRI's effect may be to decrease the sensitivity. Some people experience less pleasure than others, or have a weaker drive to seek pleasure, which could lead to passivity or to a sense of emptiness in life. Some people have a greater avoidance of risk; some have subclinical obsessional tendencies. At least in some people, SSRIs can alter all of these traits, which can alter personality in turn. The author is not much interested in whether any of these traits are inborn or acquired, but he does believe that they can persist through all kinds of circumstances (including psychotherapy). His focus on personality change goes as far as "The evolutionary model [...] holds that in a given society an `antidepressant' is any chemical that leads to a rewarded personality -- different cultures may have different antidepressants," though I don't think he would insist on this point.

As I have been doing in these book writeups because I am lazy, let me drop a few thought-provocative quotes on you:

If someone develops a pill that makes people less gullible, we will see gullibility as a biological predisposition -- shake our heads sadly behind the backs of parents of gullible children, express annoyance at gullible adults who fail to seek treatment, and wonder in a different way about ourselves if now and then in our social dealings we find ourselves taken in.


More recent observations by Suomi suggest that nervous, shy infants foster-reared by unusually nurturant mothers grow up precocious and socially adept. In particular, when subjected to social stress these monkeys tend to recruit others to help -- and this trait enhances their social status in the troop. [...] Perhaps social facilitation is the healthy version of reactivity [...]


It is my observation that patients who say they have not grown since early childhood, and who in fact appear immature or socially stunted, often do quite well when properly medicated -- and without the need for any social-skills training. Having observed people in the school or workplace, and watched television shows and read books that model social behavior, and dreamed of social competency, seems to be enough for them. Once they are less inhibited, they interact with surprising success. The limiting factor in their past failures was social anxiety or a missetting of the sensor for social distance, and not any failure to have matured.

Comments

[shoebox-bird.livejournal.com]

That's a good point. And, I fear the latter is often the case.

On the other hand we have a general conception of how each organ of the human body is "supposed" to function. Perhaps there is one for the brain, and things can go wrong.

[indigodove.livejournal.com]

Good point also -- it's very true that things can go wrong with the brain too. Sometimes more seriously than we can comprehend. I just worry about the folks who aren't ill and made to feel that "something is wrong with me" when, in fact, they just aren't like everyone else. It's very hard to tell the difference between the two. There's just no easy answers to it.

Thanks for giving me more to think about :)