Passing on Prozac
Some responses catch you by surprise. At a friend's Passover seder I mentioned, in passing, that Prozac was suspected of being a carcinogen. The announcement set off a seismic chain reaction. Faces blanched down the length of the table, two people took big swigs of their Mogen David, and someone gagged on a piece of gefilte fish (though that could have just been the body's reasonable response to a foodstuff that defies every natural law.)When I thought about it later, the reaction seemed wholly predictable. As it turned out, of course, half the table was on Prozac, and I shouldn't have been surprised. Many people I know are taking some form of antidepressant, as are statistically hefty chunks of the American population and a sizable cross section of the developed world. To be an adult in the last decade of the 20th century means you can boast some impressive credit debt, a long-forgotten gym membership and an intimate relationship with a Prozac derivative.My problem with this mass addiction has nothing to do with the usual quibbles. I'm no emotional puritan who believes you need to sweat your way to psychic health or that pain is good for you. People have a perfect right to be happy all the time, and if a drug can help them attain unqualified, unapologetic tranquillity, well, why not?The problem, of course, is that nothing proves that simple. For the clinically depressed, Prozac may be a literal lifesaver. Do the rest of us, though, really need it? Too many dedicated pill-poppers are only suffering malaise or boredom or garden-variety neuroses. Why are they filling prescriptions?They're filling them for one compelling reason: Prozac has become the mundane answer to any psychic discomfort and every emotional burp. I know this because I've turned down more prescriptions than the just-say-no poster child. The odyssey began several years ago, when I was experiencing some vague physical symptoms. "It might be psychosomatic," my doctor suggested, passing me off to a conga line of psychiatric interns who all came up with the same answer. "Have you thought of Prozac?" the first intern asked. "Prozac might work," the second one argued. "Why don't you just try the Prozac?" the third one cajoled, getting a bit testy over my reluctance and hauling a big box of samples out from under his plush psychiatric couch--the original emblem of talk therapy, now reduced to a cunning pill dispenser. When I relented and then came back a week later, complaining of several side effects I knew were Prozac-related, the intern wasn't about to be deterred. "That isn't the Prozac," he assured me, fiddling with the pencil sharpener attractively emblazoned with the Zoloft logo and shaking his head until he browsed through his pharmaceutical dictionary (the same one I'd studied at Walgreen's), as a polite afterthought. "Well," he gave in. "Maybe that is the Prozac."There is, of course, nothing exceptional about my experience. What is exceptional--and frankly surreal--is the fact that so many psychiatrists are so ready to almost reflexively prescribe a drug they know so little about. This almost slaphappy impulse, and the consequent nationwide binge, results from a confluence of factors. HMOS have to pass people through quickly (talk equals time equals money), and patients are just as hungry for a quick fix. This is ripe turf for the pharmaceutical conglomerates, who need to turn a really fat profit. If they haven't had time to do any actual long-term studies of Prozac--if, in fact, we are all effectively part of that long-term study--that's the kind of calculated risk our health-care system lovingly nurtures.Risk, though, isn't my real problem with Prozac. Everyone, after all, is hatching some kind of tumor. The reason I really resent the drug, and its pharmaceutical kissing cousins, is that it has effectively displaced a whole art. Freud's form of psychotherapy--the arcane branch that actually had time for talk--believed that people had mysteries to plumb and secrets to tell. His dense cosmology of symbols--whether clinically valid or just a rich artistic constellation--was a tribute to the complexity of our brains, and it revealed a certain faith. Worth more than a 5-milligram capsule at Kmart, our consciousness was something to be tended and honored, something that deserved years and years of relentless analysis. Now that our talking heads have been silenced and our sumptuous neuroses reduced to a mass of misfired neurons, we've given up on all those dreamy layers of meaning. For some, the truly incapacitated, this diminishment may offer revolutionary therapies. For the rest of us, though, it could be the root of our vague, unreachable malaise.