Listening to Prozac

2006 Book Commentaries [5]
On Serendip [3]

Listening to Prozac

Bethany Canver

The question as to whether nature has a more significant role in shaping personality and behavior than environmental nurturance or visa versa has long been debated. In his book Listening to Prozac, Peter D. Kramer begins by exploring how biological determinism, or those genetic components which are thought to be immutable, are not only mediated by the experiential but may also not be as static as is widely thought. He asserts that there may actually be a surprising degree of flexibility with regard to concepts that are generally thought of as inborn like personality, temperament, and self. This raises the question as to what is it that makes someone who they are and how altering that which makes someone who they are also alters one's sense of identity?

Though Prozac has been used to treat depression, OCD, panic anxiety, premenstrual syndrome, substance abuse, and eating disorders (1) [6]). Though it is counterintuitive to make a diagnosis based on a patient's response to drugs, Kramer reminds us, from the point of view of a physician, that it is difficult to "extrapolate back from symptom and behavior to chemistry".

Transformation accurately describes the changes that Prozac facilitates because it is as if the "old" or premedicated self has been replaced by the "new", medicated self.

If a trait or behavior can be changed "in response to a biological treatment, [it] must have been biologically encoded".

A drug like Prozac which effects rapid and transformative changes in a patient does so in the absence of psychological insight on the part of the patient which leads us to question how psychology and psychiatry will be affected. Prozac demonstrates that "improvement" or "wellness" can occur without a deeper self-understanding. In a capitalist society like ours which is constantly striving for cost efficiency it is conceivable that traditional therapy and psychoanalysis will become obsolete with the rise of fast acting pills. Pharmacology treats that which is physiological and therefore is not taking into account the emotional, cultural, or psychological. If Prozac which responds only to the physiological is helpful, then the importance of emotions, culture's impact, and psychology becomes inferior to the physiological neural systems.

To illustrate how the availability of a drug will influence the diagnosis that is applied to a particular behavior, Kramer uses the example of panic anxiety which became a widely used diagnosis once an effective drug became available.

Kramer suggests that the expansion of what we understand to be mental illness would mean adopting the notion of illness along a continuum opposed to illness as a dichotomy. Patients would no longer be either ill or well but would fall somewhere along a behavioral spectrum where the line between "normal" and "pathological" would become significantly blurred. Alternatively, I can imagine an attempt at moving people away from the ends of the spectrum in order to achieve a greater degree of uniformity. By expanding the definition of that which is pathological, much of the heterogeneity of society will be diminished in an effort to reach "normality".

Not only might behavior be presented along a wellness-illness continuum, but it might also be viewed, as Kramer postulates, as a product of evolution. Those behaviors that are perceived as pathological may confer evolutionary advantage or perhaps they do not serve any contemporary evolutionary advantage. It is not difficult to see that what once might have been "a successful reproductive 'strategy' is now the variant human trait underlying chronic and recurrent depression" (1) [7]) and the effectiveness of traditional psychotherapy in this instance is thrown into question. Yet if an environmental influence caused the problematic neurochemical alteration, why would we not expect environmental influences to be able to reverse or at least continue to alter neurochemistry? I believe that the only factor that differentiates treating pathological behaviors using drugs or using psychotherapy is the time that elapses before change takes place. The quickness with which drugs illicit responses makes pharmacology an attractive alternative to traditional psychotherapy.

It is not a novel that treatments arise which result in the "enhancement of normal functioning, opposed to treatment of illness".