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Messing up your own mind with psychopharmacology
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PROZAC, the American anti-depressant, is often targeted at children now that its coverage of the adult market is complete.

The makers of the hugely popular pill, are seeking permission to market the drug to youngsters in peppermint and orange flavors.

American doctors are increasingly turning to anti-depressants as a solution to the troubles of childhood. Will they come in those adorable bunny shapes, or perhaps as "the little bluebird of happiness? Depression was first diagnosed as a clinical illness by the Diagnostic and Statistics Manual of Mental Disorders in 1952, about the same time research on psychoactive chemicals in the human brain began. A drug called LSD was patented by the pharmaceutical giant, Eli Lilly, in 1956. TIME Magazine declared that this wonder drug "may actually help psychiatrists clear up mental illness."

It was also promoted as a cure for alcoholism and as an "aid in facilitating psychoanalysis." The notorious psychedelic never found its way to market, but provided a clue for researchers on the interaction between the chemicals in our brains and our perception of reality. 

A particular set of amino acids, neurotransmitters (NT), which facilitate the electrical impulses from cell to cell, were isolated; one particular NT, Serotonin, seemed to be particularly important and associated with fluctuations in mood.

Eli Lilly secured patents and marketed its powerful Serotonin inducing drug, Prozac, in 1987, leading the way for related drugs (blanketly named "anti-depressants") to find mainstream acceptance in the psychiatric community. Presently, 40,000,000 U.S. citizens are being prescribed some form of an anti-depressant, for everything from Bulimia to "winter blues." 

This staggering number, amounting to roughly a sixth of the adult population (and increasingly offered to overweight people and 'problem' children) is the apotheosis of an information age rationality, in many cases voluntarily embarking on a "cosmetic psychopharmacological" journey where cure may be a code for brain enhancement and Huxleyesque social control. I hesitate to add that this number is more than the amount of votes President Clinton obtained in 1992.

"The reason that more than half the prescriptions are made in the USA is because we always believe in the technical, scientific approach to solve problems in all realms. Older countries have traditional, foundation philosophies that are more inclusive of a broader moral, spiritual, and emotional world view. This is irrelevant in a nation where technology is king." said Teresa S., Ph.D. 

She continues to say that "this is the truth of medicine that there is not an easy one to one correlation between treatment and cure."

In fact, no one has actually been able explain how the mechanism works, as well as the inordinate amount of 'depression' suffered by Americans.

Inconsistencies and omissions in the testing of drugs, in the procedural O.K.'s, and international commerce, allow these new drugs to pass muster well before anyone can gauge possible long term consequences, and obviously money does a lot of the lobbying. 

Eli Lilly rakes in almost 2 billion dollars alone on Prozac, about half the profits in the industry. Many drugs that come to market are gambles the producers make, expecting lawsuits in their cost-benefit analysis. 

The lurid tales of Prozac driven violence, as well as the documented tendency to facilitate 'suicidal ideation' are not surprising, since the majority of users are bummed out to begin with; however, the privatization of health care (HMO's or managed care by name, cost cutting and cognitively-behavioristic by nature) has all but undercut other methods of treating depression.

The catch-22 the therapists find themselves in is an impressive one. Since both their referrals and payments come from HMO's, therapists are at the mercy of the provider, who increasingly recommend pills over the more expensive, and more involved analysis.

In many cases, the psychologist is directed by someone with less background in the field to recommend anti-depressants, and since each individual session requires justification, they (in a worst case scenario) may be compelled to diagnose patients who may or may not be a potential suicide.

This information, in many cases, will become part of the patient's permanent record, perhaps to be revealed to prospective employers, or who knows… 

The dangers to the patient, in the therapeutic sense, are evident but the companion question of patient privacy, a privilege of free democratic societies, is yet another step on the road to techno-totalitarianism. Indeed the already eroded trust between client and therapist is compromised. To its' credit, many folks have attributed the righting of an otherwise miserable existence to Prozac and related SSRI's (selective serotonin reuptake inhibitors). 

The documentation of these successes and the militant defence of the drugs by users, has overwhelmed most criticism, in short, we are barrelling ahead. The science behind the SSRI's is solid in creating effects, if not on solving causes, in cases such as children of alcoholics who have naturally low serotonin, help provide an excellent therapeutic tool. 

"SSRI's are no threat to therapy (in practice) but they are prescribed in a diagnostic fashion. 'We will see if you have this chemical problem by prescribing the medication.' The problem is the client then does not know if his improvement is due to therapy or medication and is afraid to give up either," explains Teresa S. 

Some proponents contend that taking SSRI's is similar to the function of insulin for a diabetic, in which the patient still needs to learn to control both eating and lifestyle upon treatment. The diabetic takes insulin to live. Are anti-depressants a life long treatment?

Prozac disrupts serotonin and dopamine; two of the most involved NTs in frontal lobe function — that part of the brain which controls empathy. The question begs, will patients be "cured" by Prozac rather than addressing, in psychotherapy, circumstances which may lead to an understanding of their feelings of anxiety, shame, guilt, injustice, remorse, etc? 

A side effect of anti-depressant use is a de-sensitivity to others around you. The standard reasoning for their success is that it helps these patients to focus on their selves instead of on the needs of those around them.

This is a potentially dangerous strategy for Americans, in particular, estranged as they are from the rest of the world; from their own government; from themselves (the chronic identity crisis); as well as from history. Perhaps the information age is simply too tough on the soul. 

An underlying pessimism (from the cynical rich to those meek waiting to inherit the earth; when it's no longer of any value of course) and a fantasy of transcendence (endemic idolatry, aliens saving us, and the biosphere project, for example) dominates the American subconscious. 

SSRIs are a perfect fit when no one really wants to reflect on why they can be called "Prozac Nation." Elizabeth Wurtzel, author of the book so entitled. "The trouble is the big-picture problems that have got so many people down are more or less insoluble… So it seems fairly reasonable to anesthetize ourselves in the best possible way. Just as our parents quieted us when we were noisy by putting ourselves in front of the television set, maybe we're now learning to quiet our adult noise with Prozac." 

Three years from the date we've set to lower global atmospheric pollution (and no where near the target), Americans have just begun to admit, freely, that global warming exists. 

A reality check, or a will to bear their share of responsibility does not appear forthcoming. The war against 'depression' is in many respects a war against who we are. The work of pain-driven artists like Van Gogh, Sylvia Plath, Bob Dylan, Leonard Cohen and countless others, serves as a reflection on our selves and as signposts in our subconscious about the world we've created. (Call it 'low' serotonin art.) 

Until we look into the root and cause of contemporary anxiety and fear, depression will remain a mystery; a problem to be solved like diabetes (which makes about as much sense as equating the meaning of this article with electrical impulses in my laptop).

Just as it is not understood why blocking the re-uptake of the NT serotonin ameliorates depression, over-sensitivity to rejection, anxiety, and a host of other conditions. 

Ecstasy anyone?


Help Yourself

Text: Robert S., PhD

Mind not the burgeoning sales of Prozac, Paxil, Effexor and Zoloft, this is the age of Freud.

We are watching a battle the doctor would have relished-between one vision of man as a machine, a set of neurons plugged into the World Wide Web and powered by Prozac, and another of man as a soulful being with burgeoning passions that will not be denied. It is the decade of human drives versus disk drives, and the id is casting a long shadow, especially over the Internet. The id turns out to be a little like a water balloon, just the way Freud described it.

Squeeze the balloon tight at one point, it swells at another. So as technocrats offer up voice mail with endless digital options but no real voices, mice that point instead of squeak, and the option of going to work or going food shopping without really going anywhere, the id's stock is rising like Coca-Cola. It's the real thing. 

Cigars are back. Big, thick ones that are routinely finding their way into women's mouths as well as men's. Strip clubs are sprouting up everywhere and business is booming.

Cosmopolitan magazine has rededicated itself to exploring the female orgasm. Drugs, an unfortunate, artificial and cowardly flirtation with one's mind, are the rage. 

I'm told a decent bag of heroin can be had for four bucks (down from twenty) in some towns. Larry Flynt, publisher of Hustler, the first large-circulation man's magazine to photograph women's genitals without any fuzzy lenses, is being depicted as a hero in a major motion picture. Sports Illustrated has gone with an all-bikini swimsuit issue. 

Fashion includes piercing body parts-noses, tongues, lips, even parts of the vagina and penis-as if to confirm the existence of the corporeal, to anchor our flesh in moments of pain and loops of stainless steel. Extreme fighting, in which bare knuckles replace padded gloves, is cutting into boxing's popularity. 

Movies about disasters are the only ones Hollywood will really gamble big on. People want to see a tornado or volcano or asteroid bust everything up. They want to see how much more powerful Nature is than the stuff we build on it. 

Sex is one of the biggest Internet products, with groups on sadism and masochism generating interest no psychopharmacology chat room ever will. The id is snaking through the Web. 

Watch for other predictable triumphs of id: Prostitution will skyrocket, violence in movies and television and print will reach a fever pitch. The death penalty and abortion and euthanasia-gripping dramas rooted in organic viability-will be even more vigorously debated.

We may even conspire to make war, to kill together, in order to know we are alive together. Strangely, this is all good news for psychiatry, at least the human version of it that seems now to be at death's door, the version in which people's emotions have meaning beyond the synapse. 

"Because I predict more and more people will be fed up with simplistic explanations of their life experiences that reduce their psychological worlds to serotonin and norepinephrine and dopamine. 

Those of us interested in the truth and helping people find it will see our stock start to rise with the id's. I can't wait to watch managed care try to manage what's brewing just under the surface, in that place my patients keep telling me their Prozac doesn't seem to reach." -Keith A., M.D.

This buckshot prescription routine with minimal follow-up by the ship-docs who think life is a cruise so get over your pain is called treatment by effect. If the effect is good, the treatment worked; if it didn't, well, try this. If that doesn't work, get over it, and no, you can't see one of those talking psychologists unless you use this drug. But the real creepiness of all this is guess who are now being given these neurochemical regulators? 

Guess which population is now being exposed to these "no big deal" drugs. 

Well listen to the hue and cry going on about the 3,000 kids a day who are getting hooked on cigarettes by the tobacco companies. And listen to the whispering nothing about all the children being given the SSRIs. 

I see it all the time. If Ritalin doesn't work, guess what we are starting to use? "It's safer than Ritalin." You'll see in the next several years that Ritalin will recede and SSRIs will fly through the roof. I can live with an adult population that can be "smoothed out" by Prozac et al. 

But the notion of smoothing out Tommy who hasn't and won't find himself for a whole lot of years yet roasts me big time. Cause little Tommy's brain is still growing and patterning, and producing its own chemical reactions in its own natural fashion. 

Yes, he will be able to understand and care about a poem in a few years, if not now. That's all right. We do not have the right to smooth him out so much that he never experiences the angst that will make that poem have some meaning. 

But, hey, it's America, we dig transience; the hell with tradition, place, and cultural meanings that are longer than the last dress cycle. We need our kids to adjust, man. If Prozac helps, do it, ya know. 

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