October 06, 2005


In the October issue of Reason, Maia Szalavitz argues that the nationwide urge to medicate our problems away isn't really as bad as it might seem, despite the recent backlash against it. Mostly, I agree. Yes, drug companies often have perverse financial incentives to foist their preferred treatment on patients; but so do psychotherapists or those who advocate 'talk therapy'. And yes, drugs like Paxil and Prozac can have horrifying side-effects, for a small part of the population, but so can many other forms of therapy—only a few years ago did researchers realize the harm done by the popular "debriefing" method used to prevent PTSD. But Szalavitz' main argument takes aim at the view that relying on little pills to cure, say, depression is somehow less 'authentic':
Even if drugs outperformed both placebos and talk and had no side effects, there would still remain the complaint that these medications kill pain rather than address its cause… The notion that emotional pain and difficulties inevitably lead to growth and maturity is a largely unexamined assumption with deeps roots in Western religion… But such critics rarely consider how often pain truly leads to growth—and how often it leads to stagnation, self-destructive escape attempts, and greater emotional damage. ... Since pain is so common, however, we want to think it’s essential to growth. We want it to mean something—and don't like to imagine we could learn to be happier, better people without it....

[But anti-medication advocates also cite the pleasure of learning and working through trauma or depression or whatever.] For the mental health professions… the ability to feel joy—or at minimum, to feel OK—is at least as important to recovery from depression and anxiety as discovering the origin of the pain. In fact, in many cases restoring the ability to feel pleasure may be all that is needed. The source of the trouble could be some misfiring neurons, stuck in the angst of 20 years ago or simply signaling for no emotional reason at all. Regardless of the origin of the problem, if you fix the neurons, the distress is gone. A number of studies indicate that effective depression treatments, whether talk or drugs [emph. added], lead to regrowth of neurons in an area of the hippocampus that is often damaged by emotional trauma.

While this phenomenon might be unsettling if, as in the movie Eternal Sunshine of the Spotless Mind, drugs made these changes by erasing the memories that make us who we are, there’s no evidence that antidepressants do that. And those who argue that we should be able to impulsively act out our prickly, irritable, depressive characteristics to provide human variety are not usually the ones who have to live with those who do so.
This, I think, is exactly right. Depending on the person and the situation, anti-depressants often do nothing more than lower certain inhibitions and allow other impulses to come out and get attention for a change. Nothing insidious there. In an aside, Szalavitz describes heroin as "strengthen[ing] the voice that says it's going to be OK." Yes, just like that. (Don't do heroin, though.) This doesn't strike me as inauthentic or unnatural. Nor is it another way of saying that "Drugs just mask the problem."

Give me a few more years and maybe I'll say something entirely different, but not now. I do think the pharmaceutical industry is woefully under-regulated, that incidents like this are out of control, that too many questionable diseases are being hyped and marketed, that we don't understand drugs nearly as well as we should, and that for many people—again, depending on the context—other forms of therapy really do work better than pill-popping. But the backlash against the very idea of antidepressants, say, worries me as well.
-- Brad Plumer 9:15 PM || ||