Friday, 7 March 2008

Prozac in a culture of consumption

by Kim Fabricius

The use of antidepressants needs to be placed in the larger context of postmodern cultural assumptions about what constitutes the human condition. In a society where health and happiness are now taken to be inalienable rights, many experiences previously taken to be normal and inevitable, if painful, parts of life – for example, stress, shame, guilt, grief, let alone melancholy or angst – have been pathologised and medicalised. Treatment becomes de rigueur, and not just through the prescription of pills but also through referrals to therapy and counselling (with their own hidden premises about what the ancients called the good life).

The irony is that in a culture of consumption that values autonomy and choice above all things, these interventions represent profoundly disempowering developments and collude not only in self-alienation but also in social fragmentation. Moreover the privileging of the emotions over the intellect, the displacement of hard thinking by the simplistic soundbite, and our obsession with speed to the occlusion of patience, all conspire to guarantee that no critique will be taken seriously even if it is heard – particularly if it is spoken by a philosopher, let alone (heaven forbid!) by a theologian.

O tempora! O mores! Or, in the vernacular, what goes around comes around.

25 Comments:

kim fabricius said...

This little uncontextualised post is, in fact, an email that I sent to the Letters Editor of British broadsheet the Independent on Februray 28th, a few days after a full front-page headline, with inside stories, about new studies that suggest that antidepressants don't "work". A spate of letters followed, but I searched in vain for any that ventured (albeit briefly) into situating and exploring the issue in its Sitz im Leben.

So, late in the day, I rifled off this email, which was not published. I also sent a copy to Ben for his personal perusal, and he liked it and asked me if he could post it at F&T. Voilà.

Shane said...

Where's Tom Cruise when you need him?

Craig Bennett said...

I must admit I don't know whether you are for or against antidepressants and therapy Kim?

I have found myself recently in the position of having to take antidepressants on a daily basis which has helped greatly in my day to day functioning. Mind you my brain is a bit foggy in some of its workings since I collapsed at work last October and hospitalized for 7 weeks diagnosed with Viral Encephalitis.

I disagree with your assessment of counseling as it is a form of healing which Jesus is all for. In my case I take Lovan and not Prozac; I suffer from depression which comes from a combination of organic causes and the emotional upheaval of having to learn to walk and do things that we take for granted once again.

For me the medication has helped me get to the place where I am able to talk through and about the issues of life that I'm going through at the moment and I have to say have helped me greatly in my prayer and devotional life in understanding Gods purposes in all of this.

Blessings craig b

kim Fabricius said...

Hi Craig,

I am "against" neither antidepressants nor counselling as such, but I think that we are trigger-happy in prescribing both because we live in a "therapy culture". (See Frank Furedi's Therapy Culture: Cultivating Vulnerability in an Uncertain Age [2004], and his earlier Culture of Fear: Risk-taking and the Morality of Low Expectation [1997], as well as his Where Have All the Intellectuals Gone? Confronting 21st Century Philisitnism [2004], for some refreshingly cynical takes on our contemporary obsessions.)

I'll bracket my black suspicions regarding the moral rectitude of multi-national pharmaceutical companies and simply say that some forms of depression - those diagnosed as endogenous or having a genetic or organic aetiology - are no doubt properly treated with prescription drugs. Reactive depression is another matter altogether, and it is there that my concerns lie. And I think that behaviours/conditions other than depression (ADD for example) have been pathologised and medicalised far too quickly.

With respect to counselling, I am specifically concerned about the anthropological presuppositions that are smuggled into its practice, as if there were a "view from nowhere" in understanding the nature and telos of being human. It is not that I would ignore or reject the insights of the social sciences - on the contrary - but it is crucial that they are submitted to theological critique. And of course there are the resources of our own Christian spiritual traditions on which to call in pastoral counselling. (See Deborah van Deusen Hunsinger's Theology and Pastoral Counseling: A New Interdisciplinary Approach [1995] for a superb contribution on the relation of theology to the clinic.)

Every blessing, Craig, in your own struggles. Whatever you are taking and doing, I pray that it "works".

Shalom,
Kim

tortoise said...

Where's Tom Cruise when you need him?

Strange how we never see Tom Cruise and Kim Fabricius together in the same place at the same time. Hmmm...

Shane said...

I keep waiting for Ben Myers to leap to an impassioned defense of Lacanian psychoanalysis (suitably interpreted through Zizek) in response to Kim's worry about anthropological presuppositions. (Of course, these days even the psychoanalysts doubt psychoanlysis works.)

At any rate, I think Kim's right that our culture does sometimes 'over-pathologize' negative emotions and that--at least in America (can't speak to medical practice elsewhere)--doctors do seem pretty apt to push the pills.

Anony-mouse said...

Forget prozac. A jockey full of bourbon and a good dose of Barth's CD does the trick for me. Takes the edge off and curbs my desire to correlate (take that, Tillich!). So depressing when non-theologians try to tell us we're wrong about something.

Shane said...

>>So depressing when non-theologians try to tell us we're wrong about something.

You have no idea how depressing the other side of this relation feels too.

Craig Bennett said...

G'day Kim.

Sorry if I came across a bit strong. Sometimes within Christian circles a lack of faith is blamed for a persons illness.

I do agree with you that there is a trend to quickly and over medicate and often people would rather pop a pill then to deal with the issues of life.

The Bible says much about counseling others and therefore it is a good thing if Biblical wisdom is used.

Anonymous said...

I would suggest that most if not all dis-eases have an emotional content, even an emotionally causative element. And that, that emotional element needs to be addressed if any kind of true healing is to occur.

Plus what is needed is not hard thinking, but wholistic or soft thinking along the lines when you go to a Homeopathic practitioner, who takes the necessary time to ask you all sorts of questions about yourself and your temperament altogether, and thereby gets a comprehensive and portrait of your unique pyscho-physical makeup.

And therefore "treats" you as a living being in process, rather than someone with a reductionist catch-all dis-ease name such as flu, or migraine headache, and yes, even depression.

Ben said...

[Sorry, not the Ben you all know and love]

I had to write this last night off-line since I don’t have on-line access at home. Having read some of your comments this morning, some of what I said has been overcome by events. I’ll post them anyway in solidarity with Craig and the many others like him. I haven’t personally taken any anti-depressants, but they have saved the lives of a couple of people I love deeply.

Bottom line: I know you are going after a broader cultural phenomenon that tries to medicate everything every unpleasantness, but I found the tone of your original post in need of some nuance (some of which you addressed in your later comments.)
----
Original post
I know it’s hip to bust on antidepressants these days, but frankly there are a some people for whom these drugs are a life saver.

I agree that our society medicalizes too quickly. (Personally, I don’t even take aspirin.) Anti-depressants are over-prescribed and many people do take them in order to blunt the realities of life. Still, some people are suffering from things that go beyond normal stress or grief. Some people need them because of genetic disposition or hormonal imbalances [as you have now stated in the above comment]. Others admittedly have problems because their thought patterns or behaviors have kept them from dealing with life and have put them in a deep hole. Even these might need medicine to give them a fighting chance of face up to themselves and putting their lives straight. (Keeping in mind that problems will always find their way around medicine if you don’t get to the root of the problem.)

To follow your line of argument, however, a number of physical sicknesses and diseases used to be a “normal” part of “the human condition,” yet we don’t have a moment’s hesitation about treating these kinds of illnesses with the medical solutions we have now discovered.

Many, if not most, therapies are indeed a load of crock, but good therapies (in line with how God intended society) help people get to the bottom of issues and teach them how to accept and deal with stress and grief. Rather than “disempowering development” in “self-alienation” and “social fragmentation,” good therapies empower people to assess themselves realistically and to participate in society in more healthy ways. [I’m glad you clarified this nuance in your comment.]

I do agree that something in today’s society seems to push people towards depression, but “post-modernism” may be too facile a target. I could counter that it has more to do with the individualism that arose out of some forms of modernism than post-modernism per se – however you want to define Western culture. I’m guessing the people in “pre-post-modern” societies (e.g. modern and pre-modern societies) struggled with depression and suicide, etc. In the past, many were simply institutionalized. (The problem with any historical analogy obviously is lack of comparative data to make any kind of useful comparisons.) My own experience on three different continents leads me to believe that cultures with a saner pace of life and a more relational orientation – e.g. African traditional cultures - aren’t as prone to depression. (But maybe that has more to do with having sunshine year round.)

While I see where you are coming from, the rhetoric of this post sounds more like high-minded axe-grinding than reflections arising out of real suffering. I couldn’t help thinking that sometimes our own sitz-im-leben is too restricted. Maybe all the people we know shouldn’t be taking the drugs, but I find it hard to believe that anyone who has walked hand-in-hand with a loved one suffering from long-term clinical depression would publish this kind of post. I couldn’t help feeling like I was reading “a simplistic soundbite” that only presents one side of the issue. [Okay, I’m cringing a little at the tone of this sentence, but I felt like it needed to be said in light of the posts rhetorical tone.]

I guess my bottom line is that as much as we should go after postmodern excesses and pharmaceutical conglomerates, we could learn a little more about how real depression works so that we can give more thoughtful and nuanced answers rather than soundbites. While anti-depressants are abused by many, some people actually need them, and it’s hard to get them to take them when so many great people are happily bustin on those who do.

Ben said...

PS – Sorry, previous post was rather long-winded.

re: “not working.” The actual data presented in the The PLOS Medicine article which sparked this rash of popular articles needs to be examined carefully. (Some of the data doesn’t seems to make quite the case Kirsch wants to from it). Two quick comments. 1. The actual figures show a) differences between placebo and drug, small as they may be, b.) with increasing effectiveness depending on severity. 2.) Good practitioners will tell you that most SSRI’s don’t even kick in until after a few weeks. As far as I can gather, the studies ended just as the drugs were actually gaining effectiveness (trials ended at 6 weeks). At this point, the charts in the PLOS actually show the drugs gaining more effective and the placebo effects dropping off.

I could rewrite Kirsh’s conclusion like this: “Whereas drugs are effective with severely depressed people, placebos are totally useless.”

But what do I know? I’m just a biblical studies student. At least we are trained to go to the source and examine the original data, not just someone else’s theologizing about them from further downstream. (Father forgive me, I just couldn’t resist. ;-). [All in good fun. Now I’m really going to be hated here.]

kim fabricius said...

Hi Craig,

Jeez, lack of faith blamed for illness! You don't find too much of that kind of irresponsible and pernicious idiocy in the UK.

Hi Ben,

As a matter of fact, I have just come from emailing a dear young friend who has been receiving prescription treatment for ME for years, only now to discover that it looks to have been a misdiagnosis. With re-diagnosis she will be beginning a new course of treatment. We obviously trust that the MDs will get it right this time, because surely her condition does require the administration of drugs.

On the other hand, as a working minister, I come across people all the time who are on medication for no other reason than haste in the surgery (sorry, that's UK-speak - the "doctor's office") and the panacea of the quick fix. The grieving are the most obvious example, but you find it with people who are experiencing other froms of loss or stress too.

In short, I take your and Craig's point. And I hope you can see mine.

You take care.
Kim

Shane said...

I would suggest that most if not all dis-eases have an emotional content, even an emotionally causative element. And that, that emotional element needs to be addressed if any kind of true healing is to occur.

You could suggest homeopathy was therapeutically beneficial, but it isn't . Whether a diluted substance (or 'positive vibes') can really heal a disease is a matter that should be susceptible to empirical proof and nobody should believe those claims in absence of that proof because I take this to be a very important matter.

Imagine an old woman with cancer who is convinced that science is bunk and goes to a homeopath instead. She could survive on real medicine, instead she ingests a vial of water that the homeopath says has curative properties and thinks happy thoughts all the way to her early grave.

Anonymous said...

"...nobody should believe those claims in absence of that proof because I take this to be a very important matter."

Should we assume this is a slip in the precision of your argumentation? It's hard to believe you would argue that people should be medical evidentialists *because* you take this to be a very important matter.

In any case, while there is certainly a lot of flaky holistic medicine out there, I have also seen the effectiveness of many aspects of alternative medicine in friends and family. I think the point the first "anonymous" is trying to make is that healing needs to attend to the whole person, rather than treating the objectified body-machine that is the target consumer in so much modern science and medicine.

P.S. Gadamer's "The Enigma of Health" is worth looking at for a comparison between ancient and modern conceptions of health.

EJ said...

Kim, I'm going to correct you, just slightly :) The point about ME is that there is no treatment for it. So, for the past 13 years or so, I've been suffering (without prescription treatment) from pretty life-stopping symptoms that are now almost miraculously under control with new medication (it's called modafinil, if anyone's interested).

[N.B. to everyone else, I'm the friend Kim refers to in his previous post...]

General thoughts:

One of the unsurprisingly common symptoms of chronic fatigue / chronic sleep disorders is depression, and anti-depressants have really helped me to deal with that. Ironically, I'm also prescribed sleeping pills for those nights where the sleep disorder decides to stop happening just when I need a good night's sleep! I also take beta-blockers daily to help with migraines, as well as triptans for when the migraines happen regardless of the beta-blockers.

If you saw my pharmacopeia and didn't know me, you'd conclude that I'm a badly-functioning basket case. In fact, being relatively migraine-free, able to cope with the depression surrounding my condition, able to stay awake for a full day's work... It's without the pills that I'm a basket case.

I agree entirely with Kim's points about our prescription culture. I've had doctors try to force pills on me that I didn't want or need, including one who tried to give me anti-depressants when I was already taking them! Nonetheless, we do risk stigmatising people who actually need drug treatment for depression or other emotional/mental ailments. Throwing the baby out with the bathwater is never a good idea, and we need (as I think Kim has done in his clarifying comments) to resist the urge to classify drugs as bad just because they are often badly prescribed or misused.

As a Christian, I believe that God cares for me, however it might seem sometimes. I believe that friends and counsellors have a crucial place in my life. I also believe that drug therapies are perfectly consonant with a Christian worldview, as long as they are used to secure re-entry into a full life rather than an escape from it.

Wow, this was a long comment! If you got through it all, reward yourself with chocolate or something :)

Shane said...

@ anon,

sorry about that.

nobody should take homeopathy to be effective without evidence because it *is* an important matter about which empirical evidence is easily forthcoming.

the 'i take it' is philosophical jargon-filler. 'i take it that . . .' is the pretentious philosopher way of saying 'um . . .' I try to avoid saying things like this--thanks for catching my mistake.

That you have personal anecdotal evidence fails to establish anything. If you want to prove that a medicine is effective you need a control group and double-blind experiment to prove that it's actually the medicine that brings the healing and not a placebo effect or just an instance of confirmation bias or something like that.

Gadamer's views on health don't really interest me. A phenomenologist, who was referring to Gadamer, incidentally, once told me that nobody is really sick until the doctor tells them they're sick. If taken literally, this is a gross example of what Searle calls "the phenomenological illusion". That I interpret my cough, fever, etc. as a sign of having an illness of a certain sort might be dependent upon the doctor telling me that I have that illness. However, there is an objective fact of the matter as to what I'm suffering that is quite unconnected to my interpretations. If the cells in my body are dividing uncontrollably, then I have cancer--regardless of how I interpret my symptoms or my emotional disposition.

avowofconversation said...

Kim, to add to some of the ambivalent comments and the desire for more nuancing: I also agree with what you say about cultural trends and appreciate your analysis of these. But, having had fairly strong views against medication, I have also had to modify these in the last few years since my father developed rather severe clinical depression. But what concerns me is the effect of the stigma around depression. He should have been receiving treatment - at least therapy if not medication - decades earlier but did not do, largely I think because of the stigma associated with it in his evangelical Christian sub-culture. Now some of that may have changed, but it is still a concern and I think that we need to move beyond the false alternative of the therapist as taboo and the therapist as a fashion accessory, which he or she does unfortunately seem to have become in some contexts!

Anonymous said...

Shane,

Thanks for the clarification!

I agree that anecdotal evidence does not establish proof that holistic medicine works, and I was not offering it as proof, but instead as the reason I am not ready to dismiss it out of hand. In that regard I was addressing a broader phenomenon than homeopathy. It would be a mistake to lump all forms of alternative medicine together and dismiss it as a whole, thereby losing the good along with the bad. One such good is the approach to health as a whole-person phenomenon rather than a disorder of the body, mechanistically conceived.

On that note, I suggested the Gadamer book simply because of its account of the concept of health and the art of healing in the ancient world, which had a fuller appreciation of health as the equilibrium of the whole person.

Your interlocutor does not sound like a very good representative of phenomenology. For a phenomenological account of the body, illness, medicine, etc. that does not take this problematic idealist route, Drew Leder's "The Absent Body" is a good antidote. (If you aren't interested in Gadamer, perhaps I can tempt you with this one!). Leder is both an MD and a PhD in philosophy, and brings the two angles together nicely.

paul maurice martin said...

Not to mention side effects - you might have posted something on "Prozac in a culture of constipation..."

But seriously, I do think there's a cultural tendency to see unhappy emotions as things to be rid of as quickly as possible instead of looking at them closely for their meaning. The profit motive of health insurance companies to get rid of any expenses they can is another significant societal factor in this.

Anonymous said...

Anyone who claims that so called alternative methods of healing (AH)dont work just hasnt done their homework, and are just confessing their own ideological bias.

There are literally thousands of books on the market re AH available out there, and countless millions of people use these methods. Why? Because they work.

One of by favourite books is Radical Healing by Rudolph Ballentine MD. Click on to his biographical statement as to his reasons why he became dis-illusioned with allopathic medicine. He noticed that it does not effectively heal anyone.

www.radicalhealing.com

What is "conventional" (who's convention?)allopathic medicine anyway.

It is medicine based on the ruling paradigm of reductionist essentially anti-religious and anti Spiritual scientism, and as such it is part and parcel of the reductionist secular mind-set that now dominates the Western world.

The same secular paradigm that the bloggers that link into this site criticise.

It effectively reduces our bodies to a slab of meat or a stack of molecules. Altogether it denies the role/function of consciousness, mind, and emotion or feeling.

And guess what! THE MOST STRIDENT critics of alternative healing methods is/are Richard Dawkins and his fellow reductionist true believers---all the benighted "quack" busters, and the critics of "pseudo"-science. The web-sight Butterflies and Wheels (BW)specialises in this attitude. They

By contrast science as a method of free enquiry freely investigates ALL propositions about manifest existence, without any pre-conceived presumptions about what is real and possible.

Isnt it strange that religionists who rail against secular reductionism SHARE the same reductionist blinkers as Dawkins & Co in relation to medicine and healing.

Some Christian doctors dismiss AH methods because these methods are either not mentioned in the Bible or do not square with their nieve and essentially reductionist interpretation(s) of the BIBLE.
As such they too are fellow travellers with Dawkins & Co in this VERY important topic.

Matt said...

There is no doubt that overmedication is a huge problem. That is seen in the recent study that showed prescription meds are showing up in the drinking water. It is possible to dull creativity and medicate away what is a real part of the human existence. I don't know your story but I have a feeling if you suffered from intense mental illness you would probably feel like the pills gave you autonomy rather than took it away as they often help people to maintain a healthy level of functioning.

beth said...

The 'guinea-pigging' of vast swathes of the population has, up till now, solved two problems: the 'time' problem (namely, how to avoid addressing the underlying reasons for mental health problems), and how to create new markets amidst the flourishing of generic drug production, particularly outside of the US and Europe. Clearly the interiorisation of unhappiness is far more profitable than the outward realisation that perhaps misery has nothing to do with you personally and everything to do with the world in which you live.
- infinite thØught

(via wood s lot)

This seems appropriate to the discussion at hand. Yes, we all know examples of the need of therapies, remedies, pills, meds, yes, we may need them too. However, part of society's 'illness' is for all illness to be your personal problem. Why are prosperous western democracies so rife with clinical depression, schizophrenia, etc. etc. ? My country (USA) is the biggest exporter of arms in the world. Calls itself a Christian nation. There is a lot of cognitive dissonance here, a lot of lack of inspection. If Jesus tells us to wake up and to see, he doesn't assure us that we'll like what we see,or that we'll be all safe and comfey. As a matter of fact, perfect love is like asking to be killed. Scary religion, Christianity. Pass the meds, please.

EJ said...

Kim, I'm going to correct you, just slightly :) The point about ME is that there is no treatment for it. So, for the past 13 years or so, I've been suffering (without prescription treatment) from pretty life-stopping symptoms that are now almost miraculously under control with new medication (it's called modafinil, if anyone's interested).

[N.B. to everyone else, I'm the friend Kim refers to in his previous post...]

General thoughts:

One of the unsurprisingly common symptoms of chronic fatigue / chronic sleep disorders is depression, and anti-depressants have really helped me to deal with that. Ironically, I'm also prescribed sleeping pills for those nights where the sleep disorder decides to stop happening just when I need a good night's sleep! I also take beta-blockers daily to help with migraines, as well as triptans for when the migraines happen regardless of the beta-blockers.

If you saw my pharmacopeia and didn't know me, you'd conclude that I'm a badly-functioning basket case. In fact, being relatively migraine-free, able to cope with the depression surrounding my condition, able to stay awake for a full day's work... It's without the pills that I'm a basket case.

I agree entirely with Kim's points about our prescription culture. I've had doctors try to force pills on me that I didn't want or need, including one who tried to give me anti-depressants when I was already taking them! Nonetheless, we do risk stigmatising people who actually need drug treatment for depression or other emotional/mental ailments. Throwing the baby out with the bathwater is never a good idea, and we need (as I think Kim has done in his clarifying comments) to resist the urge to classify drugs as bad just because they are often badly prescribed or misused.

As a Christian, I believe that God cares for me, however it might seem sometimes. I believe that friends and counsellors have a crucial place in my life. I also believe that drug therapies are perfectly consonant with a Christian worldview, as long as they are used to secure re-entry into a full life rather than an escape from it.

Wow, this was a long comment! If you got through it all, reward yourself with chocolate or something :)

Ben said...

PS – Sorry, previous post was rather long-winded.

re: “not working.” The actual data presented in the The PLOS Medicine article which sparked this rash of popular articles needs to be examined carefully. (Some of the data doesn’t seems to make quite the case Kirsch wants to from it). Two quick comments. 1. The actual figures show a) differences between placebo and drug, small as they may be, b.) with increasing effectiveness depending on severity. 2.) Good practitioners will tell you that most SSRI’s don’t even kick in until after a few weeks. As far as I can gather, the studies ended just as the drugs were actually gaining effectiveness (trials ended at 6 weeks). At this point, the charts in the PLOS actually show the drugs gaining more effective and the placebo effects dropping off.

I could rewrite Kirsh’s conclusion like this: “Whereas drugs are effective with severely depressed people, placebos are totally useless.”

But what do I know? I’m just a biblical studies student. At least we are trained to go to the source and examine the original data, not just someone else’s theologizing about them from further downstream. (Father forgive me, I just couldn’t resist. ;-). [All in good fun. Now I’m really going to be hated here.]

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