Thursday, April 17, 2008
Comfortably Numb: How Psychiatry Is Medicating a Nation
By Onnesha Roychoudhuri, AlterNet. Posted April 17, 2008.
OR: You say that the drugs came along at a culturally ripe moment, at a time when we had socially and politically moved away from collectively approaching problems.
CB: The arrival of Prozac in 1988 was a perfect storm, culturally and just in terms of the drug itself. In the '70s Valium paved the way for Prozac. It was the first psychiatric drug for anxiety that became mainstream. The earlier generation of antidepressants had a lot of side effects and could be fatal in overdose, and Prozac seemed very clean by contrast. It was the first drug that you didn't have to be crazy to take. You could be a judge or a journalist and take Valium and obviously millions of people did. It entered the culture, from the Rolling Stones' "Mother's Little Helper," Valley of the Dolls to celebrities talking about their Valium use.
Culturally, the '80s were the time when we gave up on collective enterprises of doing things. The country had experienced multiple recessions, and there was a sense that a college education really didn't get you a good job anymore. With the Reagan revolution, it was time to straighten up and "pull up your bootstraps" and do things as individuals. I think that transferred into how we took our drugs. There's not such a huge difference between illicit and licit drugs. In the early part of the '60s, when there was a spiritual aspect to the drug taking, people took drugs together. One of the hallmarks of the Prozac revolution is that people take them individually, and even the treatment is individualized. It used to be that if you were taking a psychiatric drug, you were probably working with a therapist, and now the large majority of people taking psychiatric drugs are in no ongoing dialogue with a caregiver.
OR: As a contrast to the American cultural relationship to antidepressants, you talk about the sale of SSRIs in Japan.
CB: There wasn't really a term for depression in Japan. The drug companies invented one [kokoro no kaze, or "one's soul catching cold"]. There weren't any sales of antidepressants in Japan until the late 1990s, because they didn't really think that depression was that much of a problem. I'm sure people were depressed in Japan, and part of it was probably underreported, but in any case, there was a different attitude. A cultural minister in Japan said they didn't really think of depression, in its milder forms, as anything bad. Rather, they saw it as a sign of awareness and artistic sensitivity.
The drug companies put on a brilliant advertising campaign and, sure enough, the sales of antidepressants went up five-fold in a very short time. But our American sensibility is to be uncomfortable with unhappy feelings and root them out as quickly as possible. I want to be very clear not to romanticize suffering, but there can be a utility to some difficult emotions.
The American notion of happiness is a very recent phenomenon in human history. You could argue that only since WWII and really since the '60s and '70s has happiness been the goal. Ironically, I think if you set happiness to be your primary goal, it tends not to work out very well. The late Canadian novelist Robertson Davies said that happiness is a byproduct, and that you become happy when you're engaged in productive activity or when you're in a relationship with someone you love. So this idea that we have to be happy is a highly American thing and highly problematic concept.
OR: The British health [service] recommendations reveal a pretty different relationship to depression.
CB: The clinical guidelines to the National Health Service for mild depression recommend watchful waiting, diet and exercise, self-help and counseling, cognitive behavioral therapy, and then if all those things don't work, to try antidepressants. Our de facto practice in the United States is pretty much the opposite. I think a critical development that coincides with the Prozac entry into the culture is that family doctors now prescribe most antidepressants. It used to be that psychiatric drugs were primarily prescribed by psychiatrists. Family doctors just realistically aren't going to know cognitive behavioral therapists to refer people to. Or they don't know the research on diet and exercise on even severe depression. So, managed care is yet another factor in the move towards the quick and expedient approach, which is hastily writing antidepressant prescriptions rather than plumbing the larger issues.
The burgeoning industry generating the pills that make us feel like we are OK has addled our society to the point of total indifference to daily strife, 4000 dead troops? Oh well. Shooting and killings in schools? Oh well.
In addition to 'dumbing down' America BIG PHARMA has been 'numbing down' the dumbed down and created what we have today, a society focused on American Idol instead of their future. While they are asleep at the switch, the rest of us un-addled watch in horror the current events removing our rights and liberties.
There is no way to awaken the Prozac addled in America so here we sit arranging deck chairs on the Titanic while the band plays on, helpless to stop the inevitable.
Sad state of a once mighty country.