Listening to Prozac: The Landmark Book About Antidepressants and the Remaking of the Self, Revised Edition
a book by Peter D. Kramer
(our site's book review)
Kramer has written an unusual book. It examines the use of Prozac, the antidepressant drug, to treat depression, hypersensitivity, stress, introversion, low self-esteem, sluggish thought, inhibition of pleasure and other disorders. (Prozac was first introduced to the US market in January 1988.) He downplays the side effects, noting that enough people keep taking it to demonstrate the drug obviously gives more to people than it takes away or they’d quit. The common Prozac side effect involving difficulty in achieving orgasm is made more mysterious in his book rather than clarified: why did this side effect get glossed over by Kramer even though it happened often, and why did both he and his patients not find this a serious matter? (They did, actually.) This doesn’t harmonize well with what is known about the body’s and psyche’s important needs in the sexuality area. The need to increase dosages dramatically is another glossed over problem.
Major depressive episodes by adults in 2011
In reference to the charge that it causes suicide and violence in patients, Kramer dismisses this as a propaganda campaign by the Church of Scientology, who loathe psychiatry and their drugs in general. Since it continues to be prescribed by reputable doctors, we can assume that the statistics on these matters, when scientifically analyzed, do not bear out Scientology’s accusations.
As a behaviorist, Kramer kept leaning towards biological and genetic explanations throughout his book and steering clear of environmental ones. But he didn’t exactly end up in the nature camp after engaging in these nature-nurture arguments. As you can see, he started in the nature camp but seemed to end up close to the center by the time he got to the end:
The bad news? Big Pharma is pushing shrinks to be drug pushers who define psychological issues as brain defects needing drugs. The worse news? Many are buying into that nonsense!
Kramer says: “Character [in general psychology] describes acquired traits; it is environmental where temperament is inborn, psychological where temperament is biological. Personality [is] an amalgam of temperament and character. . . . [But] what we now know about the interaction of biology and experience tells us that the distinction between temperament and character will always be arbitrary and artificial. . . . what we are changing with medication is the infrastructure of personality. That is, Sally is able to marry on Prozac because she has achieved chemically the interior milieu of someone born with a different genome and exposed to a more benign world in childhood.” And we say: if something sounds too good to be true . . . .
Kramer says Sally is able to marry on Prozac because she has achieved chemically the interior milieu of someone born with a different genome and exposed to a more benign world in childhood. And we say: if something sounds too good to be true . . . .
He celebrates modern medication allowing a person to experience the feelings of someone with a different temperament. This ignores the increasing dosages and the nasty side effects—such as the sexual ones. He waxes poetic about Prozac—as if it were magic. But like they keep saying in the TV series Once Upon a Time, magic comes with a price!
Kramer says: “. . . [Prozac] allows formerly inhibited people to exercise power in social or political arenas that previously made them uncomfortable, where they may be disruptive of the status quo.” Kramer sees the drug as the opposite of the tranquilizers (mostly Valium) women took—mostly at the advice of male doctors—in the 50s and 60s when they experienced anxiety and depression when they tried to cope with being nothing but housewives, squelching many of their potentials and abilities. Prozac frees, according to Kramer, while those drugs were used in a sexist and political way to imprison. Kramer is right—they were. Jourard, Laing, Putney and Putney and Maslow all questioned these oppressive uses of psychology/psychiatry earlier in the 20th century. Kramer implies that these thinkers would appreciate his reversal of this trend, wherein he uses medication to free and embolden.
The issue of discomfort and its uses is discussed. When people experience anxiety and heightened self-consciousness, these signs ought not be altered except by journeys of self-discovery. Does the artist lose his art when he takes the pill? Abraham Maslow, Erich Fromm, Rollo May and others saw anxiety as a failure of being—as a symptom of alienation from the self. It’s a summons to authentic existence. It shouldn’t be drugged away. Kramer agrees, but makes it clear that he considers Prozac an adjunct to this quest. It empowers this existential search, in his opinion. This is a huge claim for a drug advocate to make—and frankly, it seems like Kramer is reaching.
He says: “. . . noting a certain mismatch between her propensities and the demands of . . . culture, she may strive to create a culture that values her temperament.” Or Kramer might have used the Larry Niven (the sci-fi author) phrase: “Think of it as evolution in action.” So is Prozac giving us spiritual energy and/or the yen for constructive revolution? Does it help find the self and even remake the self? That’s quite a plug for a drug (he claims to have no financial stake in the company that’s selling the stuff). And the array of problems it mitigates or seems to cure is certainly remarkable. But he dismissed the side effects rather cavalierly. There would appear to be more to learn about long-term effects on health, both physical and mental. There is a fine line between brain tweaking and brain damage. Are there some permanent negative effects? Who knows?
There is a fine line between brain tweaking and brain damage—which side of the line is Prozac on?
However, if the stuff can do what Kramer says, it may be a good way for certain types of dysfunctional people to regain functionality, for certain types of depressed people to get optimistic, and for certain types of introverts to get out there and live a little. But unless someone’s mind chemistry is way off, it may not be needed if we can get our lifestyle and parenting and childcare acts together. Because even an inborn negative mood tendency or antisocial tendency often simply won’t actualize as long as a person lives in a good, supportive environment. So one could look at it like this: His implication that society can get its act together reactively after symptom detection points to an approach that is better than nothing, but nowhere near as desirable as getting it together proactively before symptom detection.
This he doesn’t even consider. He's a fixer, not a preventer. We on this website much prefer the latter.
Kramer acknowledges cognitive therapy (see Feeling Good), which has been in vogue for several decades, and helps people get their erroneous thinking replaced by reality-based, constructive thoughts and works well to treat depression. Self-talk is about transforming negative self-talk into positive self-talk, and also has a great record in treating depression, which he doesn’t mention, because he’s promoting Prozac as the best depression cure—which many therapists would disagree with. Since when is drug therapy with serious side effects nearly as good as good cognitive therapy with no side effects?
He also acknowledges that Prozac needs to be used with psychotherapy for maximum effectiveness (and yet most people don't do this). He isn’t pushing drugs as a replacement for psychotherapy—although most doctors seem to be using them that way. TV specials about drugs vs. therapy show that Big Pharma is pushing these Selective serotonin re-uptake inhibitors and ADHD drugs as if they were the fix for messed up brain chemistry. Yet there are plenty of people claiming that drugs like Prozac, antipsychotics, and Ritalin are themselves messing up brain chemistry.
Plenty of people claim that drugs like Prozac, antipsychotics, and Ritalin are messing up our brain chemistry
Is the jury is still out? Not so much. A study in the Journal of the American Medical Association says that SSRI's like Paxil and Prozac are no more effective in treating depression than a placebo pill. A Columbia University and Johns Hopkins study says that doctors routinely prescribe not one but two or three SSRI's and other psychopharmological drugs in combination even though there are few if any studies to back up the multiple usage, and yet some of these combinations can be quite dangerous due to drug interactions.
Our government watches your every move
Once they create the technology, can the thought police be far behind NSA's outrage of spying on us decent citizens?
We must strenuously avoid creating a (Nineteen Eighty-Four or Brave New World) future world with drugs used to control minds. Well, that future is here right now and the social control we all dreaded is now accepted in the form of pills (plus a bit of help from NSA fears due to the FACT that big brother IS watching you!). But don't let someone say they have a chemical imbalance without you asking them what they actually mean by that and where is the science to prove it. Our SSRI- and antidepressant-pushing doctors are pushing drugs and we don't know how they work or how much long-term harm they do. "Drugs may not be the answer for you, and now it turns out that some drugs may not be the answer for almost anyone." (Source: Five Reasons not to take SSRIs; Now that SSRIs don't work for depression, don't take them!)
More pills for kids and adults means more cash for Big Pharma
Breggin clearly demonstrates in Reclaiming Our Children that we aren’t actually a nation of crazies and defectives needing to be saturated in psychiatric pharmaceuticals to fix our broken brains
In Reclaiming Our Children, a book by Peter R. Breggin, a very convincing case is made for more use of therapy and less use of drugs, especially on kids. We concur and consider Breggin a hero for standing up to Big Pharma's chemical assault on kids.
Big Pharma spreading "good health via medicine" across the land
Kramer is looking at the complex systems relationships that pertain to mind chemistry. You’re born with genetic predispositions that make you vulnerable to hypersensitivity, stress, depression, etc. Then you experience various childhood events that either precipitate symptoms in your vulnerable areas or they don’t, depending on how much love, understanding, encouragement, good parenting, and security you encounter, and how many traumas and disappointments come your way. These aren’t just memories. They mute or amplify your inherited proclivities, and change your brain chemistry as they do so. And this is why Kramer is so sure he’s on the right track: If a certain chemical change came from genes or trauma and now makes life miserable, why not chemically reverse the change or at least the effects of this chemical change which is now at the roots of your unhappiness?
From a systems point of view, there’s obviously a lot more to it than that, but from a psychiatric medicine point of view, it may just be the best thing many of these doctors have to offer in their bags of tricks. But, systems being what they are, let’s just hope that the patients’ systems don’t find a nasty way to eventually retaliate for the interference that we call Prozac. Time will tell. It’s scary to have someone tinkering with you at such a basic and intimate level. Perhaps we should be scared. Or perhaps we need Prozac to "get over" our fear! (Fat chance!) M.D.s don't get cognitive therapy training, but plenty of pill-pushing training. Perhaps if they weren't afraid of Big Pharma's awesome power, they'd stop being drug pushers and send patients to cognitive therapists so the patients could avoid having their brains blindly tinkered with. There is a fine line between brain tweaking and brain damage—which side of the line is Prozac on?
Patients’ brains may find a nasty way to eventually retaliate for the interference that we call Prozac
Antidepressants: Do They "Work" or Don't They? showed that although the superiority of antidepressants like Prozac over placebos has been shown to be statistically significant, the observed differences are not clinically significant. In fact, the average difference between drug and placebo is approximately two points on a depression scale that ranges from 0 to 52. In other words, don't waste your money—they're of very little use, except to line the bulging pockets of Big Pharma. A much better idea with proven effectiveness: cognitive therapy—Feeling Good: The New Mood Therapy