-Caveat Lector- From http://www.philosophynews.com/whip/psychiatry/ARCHIVED/psychiatry200008.htm }}>Begin Philosophy of Psychiatry August 14, 2000 Prozac, alienation, and the self by CHRISTIAN PERRING RELATED LINKS * The Hastings Center Report, March-April 2000 http://www.thehastingscenter.org/hcrmarapr_00.html * Enhancement Technologies Group http://www.gene.ucl.ac.uk/bioethics/index.html * WHiP Archive: Philosophy of Psychiatry http://www.philosophynews.com/whip/index.htm#psychiatry A recent issue of The Hastings Center Report has a number of short articles on "Prozac, Alienation, and the Self." The authors are Carl Elliott, James C. Edwards, David DeGrazia, Peter D. Kramer, and David Healy. Elliott, Edwards, and DeGrazia are professional philosophers, and psychiatrist Kramer's book Listening to Prozac is surprisingly sensitive to philosophical issues. Healy, another psychiatrist, has written social-historical books on psychopharmacology, including The Antidepressant Era, which was published by Harvard University Press and has gained the most attention. There is widespread concern that Prozac is used too often and for the wrong reasons. Specifically, some worry that it is used by people who are not seriously depressed but merely want a crutch to help them deal with life. Such a life is considered inauthentic; the happiness of such a life would be a result not of flourishing, but chemical manipulation. Furthermore, there may be some circumstances where happiness is inappropriate, and a sense of alienation is a better reaction. Elliott embraces this sort of worry about Prozac, and more generally about the individualistic approach of psychiatry: If modern culture is alienating, he suggests, it would be better to examine our values and change the way we live rather than take Prozac to feel better. Kramer expresses doubt, in response to Elliott, that modern alienation is a reaction to social conditions. He also suggests that we have a cultural preference for the melancholic over the sanguine, identifying the perfectionism, pessimism and sensitivity of melancholy with intellectual traits. He does not necessarily endorse this preference, and he does not think it provides a strong reason to be suspicious of Prozac. Prozac could help as much as hinder social change: "If Prozac induces conformity, it is to an ideal of assertiveness." Kramer wants us to be at least open to the possibility that melancholy is not necessary for a critical stance towards our surroundings, and that we should indeed question our attachment to melancholy -- that is, he thinks a person can engage in a profound philosophical questioning and still be happy. With deliberate provocation, he questions what he sees as a philosopher's prejudice, the idea that "melancholy is appropriate to modernity." The most straightforward critique of psychopharmacology comes from Healy, who emphasizes the power of the pharmaceutical corporations. He casts doubt on the empirical data supporting the effectiveness of Prozac in treating depression. He states flatly that Prozac does not work for severe depression, calls into question the "pseudoscientific" mystique that has grown up around Prozac, and suggests that the abstract philosophical debate about Prozac and alienation is missing the most important questions. Edwards gives the mildest suggestion. Using the framework of Foucault and Heidegger, he considers the source of our worries concerning the use of Prozac as a mood enhancer. He suspects that we are suspicious of happiness that is not earned through suffering -- there is a virtue in bearing pain. He tries to separate out two attitudes towards technology, one that embraces it and another that eschews it. He suggests both are worth thinking about, we need to understand what assumptions are built into each, and most importantly, we should realize that we don't have to be swept up in the frenzy for technological progress. DeGrazia, in the last article of the collection, emphasizes that one's self is partly created rather than merely discovered by oneself. He argues that Elliott does not sufficiently appreciate this point, and that Elliott's criticism of an enhanced life on Prozac as inauthentic assumes that the self is static and given. Instead of Prozac creating a false self, mismatched with one's real self, it might be possible to identify with one's new self. A central question for DeGrazia is just how malleable the self is. He quickly distances himself from the extreme view of Sartre that we are entirely self- creating and utterly malleable. It takes only a little reflection to see that people have limits and that they cannot always become whatever they want. DeGrazia points out that one long-standing form of self-creation is psychotherapy, and this mode of self-change hasn't been accused of creating inauthentic selves. Given that, why should the use of drugs like Prozac be any more troublesome than psychotherapy? He can see no legitimate difference between these modes of self-change vis-à-vis authenticity. He ends by acknowledging that there may be reasons for qualms about the prospect of a society in which most people use self-enhancing drugs. Nevertheless, he argues, it should not be up to individual psychiatrists to refuse medication to their patients if their reason is such use of medication is not good for society as a whole. It is not for the psychiatric profession to impose its grand vision of the good life on society: Patients themselves should make such decisions. I'm hopeful that the debate about performance-enhancing and mood-enhancing drugs will gather momentum, especially as it becomes clearer how much it overlaps with debates about genetic technology and the increasing use of computers in the body, sometimes known as "cyborg technology." Kudos to the editor of The Hastings Center Report for taking one of the early steps to advance this debate in medical ethics and the rest of philosophy. ________________ Christian Perring, Ph.D., is the editor of Metapsychology, Mental Health Net's Book Review site, and writes a regular column about philosophy and psychiatry in the media for the newsletter of the Association for the Advancement of Philosophy and Psychiatry. He teaches philosophy at Dowling College in Long Island, New York. Copyright (c) 2000 by the Philosophy News Service. All rights reserved. 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