Depression is a mental illness that can be difficult, and sometimes nearly impossible, to treat and deal with. According to the CDC, 1 in 10 U.S. Adults have been reported to have depression and are usually these people in the following categories: people between the ages of 45-64, women, Blacks/Hispanics, non-Hispanics other than white, people with less than a high school education, divorced couples, the unemployed, and people without health insurance or coverage. In order to get out of depression, drugs can be used as an escape route of all of the troubles and frustrations. Eventually, they become the friend of the user. While some psychiatrists believe that medical drugs can have positive effects, others believe that it can lead to negative results. American Psychiatrist Peter D. Kramer’s Listening to Prozac discusses how the advance of the anti-depressant drug, Prozac, might change the way we see someone’s personality and the relationship between neurology and that particular personality. By coining the term “Cosmetic pharmacology”, he discusses the philosophical, ethical, and social consequences of using psychopharmacology, which is the study of drug effects, to change one’s personality (Kramer 15). By the end of the book, Kramer suggests that it is neither ethical nor unethical to treat an individual suffering from depression with Prozac to help him or her climb a career or denying him or her that possibility.
Throughout the book, Kramer struggles to put some of his mildly depressed patients into the correct diagnostic category, such as those who experience hypersensitivity, or OCD. However, he seems to be aware of the danger in this. Let’s look at the first two case studies that were introduced in the book. The first story that Kramer introduces is a woman named Tess. Before Kramer prescribed Prozac to Tess, Tess was deeply depressed. She had suffered an abusive childhood and grew up taking care of her family after her alcoholic father passed and her mother was in the mental hospital. She missed out on a lot in life including dating, hanging out with friends, etc. After Kramer prescribed Prozac to her, Tess became a different person, as described by Kramer. He states, “She looked different, at once more relaxed and energetic-more available-than I had seen her, as if the person hinted at in her eyes had taken over. She laughed more frequently, and the quality of her laughter was different, no longer measured but lively, even teasing” (Kramer 7).
The second case involved with another woman named Julia. Julia was a successful, married woman with children but suffered OCD. She was very compulsive and had zero tolerance on failure. When she was prescribed Prozac by Kramer, she became more tolerant of her children’s behavior and easier to deal with, However, when Kramer “lowered the dose”, “two weeks later Julia called to say the bottom had fallen out: ‘I’m a witch.’ She felt lousy-pessimistic, angry, demanding. She was up half the night cleaning. And there was no way she could consider getting a dog. ‘It’s not just my imagination,’ she insisted, and then she used very words Tess had used: ‘I don’t feel myself.’”(Kramer 29). After Kramer stopped giving Tess Prozac for a while, she returned to the same way she was before. Kramer seems concerned that psychiatrists might mask the difficulty posed by the diagnosis of these patients by defining less severe mental states as illness. It almost seems as though the logic Kramer wants to avoid is that if it responds to an antidepressant, then it is depression. He states that we have used medication response to infer the cause of the disease since the last half of the twentieth century.
Prozac’s ability to cause such a drastic change on a biological level causes much concern because the change does not need to be processed cognitively or even consciously through the I-function, which is a psychological technical term that refers to how the brain creates a sense of self. This fact therefore challenges “the model of healing through cognitive powers, due entirely to its biologic effectiveness. Personalities through the use of Prozac can be altered instantly, and do not have to be painfully acquired through insight and hard practice. The power of biology here can is seen to be exerted over a large spectrum of human behavior. Prozac is able to do what only psychotherapy could have done in the past. It has the potential to alter a particular element of personality. For example, it can eliminate the specific trait of rejection sensitivity. It is quite a feat for just a pill to sculpt personality trait by trait.
Although Prozac seems to induce alarming effects, it does not mean that it should not be used. Kramer advocates its use. He notes patients seem to gain the insight and perspective that years of psychotherapy would aspire to achieve, but in a fraction of the time. He also claims that Prozac frequently seems to push patients toward a normal or near-normal condition, sometimes called by psychiatrists’ hyperthermia. He feels that, many patients including some who may never have had a diagnosable mental illness-are better able to explore both their past and their current circumstances while they are taking Prozac. To some medication constitutes help in recovery from childhood trauma or protection from the threat of terrible decompensation. He feels the drug seems to aid rather than inhibit the struggle to locate the self.
However, it is important to note that although the case studies described narrate a significant change in the functioning of individuals, transformation is not all that common. Not all patients respond in this manner, others merely recover from depression, as you would expect of an anti-depressant. After all, medication is supposed to heal a patient, not transform personality. Kramer also notes that while certain patients seemed to be handicapped in aspects of their personality most of what we would call their personality persisted in a recognizable manner.
This causes us to raise many questions. Among these questions is whether it is ethical to prescribe a drug that increases things such as a person’s self-confidence, resilience, and energy level without any ill effect, even when there is no underlying manifestation of illness? In this effect, it may be possible for the medication to rob us of human characteristics, such as anxiety, guilt, shame, grief, self-consciousness. This raises the question of whether medication will eventually convince us that these affects are not uniquely human. Are we not losing sight of something about ourselves that should be included in our conception of self, when we see things like guilt as something to be treated, rather than seeing them as part of the human condition? Prozac may eliminate illness, but in so doing it may also be eliminating what is a perfectly sensible response to life’s circumstances. More so, the overuse of Prozac may mean that perhaps a sickness of the culture at large exists.
This not only seems to reveal to patients what they believe to be their true selves, but for psychiatrists, such as Kramer, it seems to alter ideas about the human condition as well. For example, the author changed his ideas about basic personality theory as a result of listening to patient experiences with Prozac. He now accepts that many behaviors, which were believed to be inborn, are actually neurotic. It is fascinating and unnerving to think that a modern medication such as Prozac has the potential to allow a person to experience, on a stable and continuous basis, the feelings of someone with a different temperament and history.
Faiza Mahmood wrote a commentary on Kramer’s Listening to Prozac. According to her analysis, the use of Prozac has shown that medication that induces a neurological change in one has the ability to transform a person’s behavior, and conception of self. This provides evidence that brain does indeed equal behavior. A portion of the brain is inducing individuals to behave in a certain manner, and conceptualize themselves differently. Prozac contradicts the discussion of chemicals influencing the brain but not determining patterns of behavior. In this case, the chemical makeup of Prozac is in fact determining the behavior of patients. There does however, exist, an element of unpredictability in the generation of the patterns even upon taking Prozac. It may not work for one individual as it does for another. This is evident in the fact that not all patients undergo transformation. Prozac also seem to oppose the idea that drugs are not capable of targeting the individual details of particular patterns, as evidenced by examples aforementioned; this is not always the case. It does not always influence patterns at fine scales, but can have the potential to do so.
Overall, Listening to Prozac brings to attention that what we often value: human conscious control. This may be secondary to our biologic determination. We may just be largely a product of genetics. Kramer’s book is a thoughtful, at times fragmented and inconclusive reflection on cosmetic psychopharmacology. Concepts such as mood personality become unstable yet fascinating. While Kramer ultimately defends cosmetic pharmacology, he does not pretend to have answers. Instead he suggests possibilities, and frequently offers opinions, but remains very candid about his own discomfort with the idea of cosmetic pharmacology. It seems as if his aim is more to explore what the effects of Prozac mean for larger philosophical questions about the self and who we are. In addition, Kramer’s book is a good book to look at for our cause in Project Prozac. As a team, we dedicate finding all areas of depression and help bring awareness to the table and dealing with depression. Listening to Prozac is a stepping stone to unlocking the root causes of all depression.
Bibliography
-Kramer, Peter D. Listening to Prozac. New York: Viking. 1993. Print.
-Mahmood, Faiza. “Listening to Prozac: A Review and Commentary”. Serendip. 2006
Link: http://serendip.brynmawr.edu/bb/neuro/neuro06/books/fmahmood.html
-United States. Center for Disease Control and Prevention. CDC Features:Depression. 31. Mar. 2011. Web
Link: http://www.cdc.gov/features/dsdepression/
-RNR
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