Saturday, July 19, 2008

CCEF Paper #2: Counseling & Physiology

Response to Listening to Prozac

“To Prescribe or Not to Prescribe?”

Reading Listening to Prozac is a fascinating experience. Peter Kramer’s book is something like “Darwin meets Freud meets Huxley,” and it raises a panoply of questions while giving few solid answers. At bottom, it’s a book on ethics. Should we prescribe Prozac-like drugs to people, especially people who were previously considered “normal?” Should we pharmacologically tinker with mood, temperament, personality, self? If so, when and why? What would be “doctorly,” and what would be right?

Kramer seems both ambivalent about Prozac and excited about it, too. He is breathless in his descriptions of the surprising ways Prozac and its pharmacological kin produce remarkable changes in patients with few side effects. And yet, he is the one who is raising the ethical questions that Prozac has created by changing the way we understand personality (for example: “cosmetic pharmacology”). Of course, I don’t see how Kramer could come to a firm conclusion on his questions with no transcendent standard of right and wrong.


For Kramer, “listening to Prozac,” means changing the way that we (including researchers, practicing doctors, and patients) perceive the “self” and its problems. There is a shift from a mainly Freudian psychodynamic theory of personality (from which Kramer comes and is still most comfortable) to a biologically based “spectrum theory” of personality that comes from “listening” to the results of both pharmacological dissection and the surprising experiences of those who have been taking Prozac. It’s both (1) what does Prozac change in the brain, therefore telling us about what the brain is, as well as, (2) what does Prozac change in my sense of myself, therefore telling me more about who I am? And from there, Kramer insists that it is changing our entire culture’s sense of the self, for good or ill.

I wonder about a third kind of “listening”–the so-called “placebo effect.” How much of these remarkable changes in people’s experience can be chalked up to expectations from the medication–what they thought they would hear when they listened to Prozac? Would this, perhaps, explain some of why it seem efficacious for so many different kinds of problems?

“What is Depression, Really?”

I was amazed by the amount of speculation upon which the book was built. Kramer admitted that scientists don’t know really know what depression is–not just what causes depression, but physically speaking, what depression actually is. And they don’t know exactly what serotonin does, either. Perhaps it functions as the brain’s “police.” Perhaps it helps people experience pleasure. The book was theory built on theory. Yet for all of that speculation as to what’s actually going on in our craniums, here we are prescribing away! And Kramer, for all of his sophistication, doesn’t seem to see the irony of that. Instead, he believes that American doctors under-prescribe! I’m all for the alleviating of suffering, but this book didn’t build confidence that my psychiatrist actually knows what it is he’s doing.

“What Is Temperament, Personality, Character?”

In this book, the quest to figure out what exactly is temperament, personality, and character is what intrigued me the most (and Kramer, too, I think). What part of who I am is determined by biology (and therefore very malleable with a very small pill), what part is shaped by nurture, and what is part is created by my choices? Is there any part of “me” that is unchanging and eternal–a soul?

Kramer seems to posit a soft-determinism where we are biologically handed a temperament at birth, but our life’s experiences can help or hinder that temperament along (ex. a catastrophe, physical or mental, could damage or ruin the biology). Therefore, the solution to our problems is, first, medicine to repair the biology, and then, psychotherapy to understand the dynamics that led to the brokenness in the first place and cope in the future. Nothing is said about a soul, and yet, perhaps Kramer slips it in the last few words of the acknowledgments to his loved ones, “The drug will never be invented that sustains the spirit the way a family can” (pg. 405). Curious.

It seems that Prozac is shifting the boundaries of what we consider to be temperament, personality, and character–and even “self.” We are back to bodily humors, what Kramer whimsically calls “neurohumors,” as a way of talking about what makes us do what we do. I’m sure there is something to it, but I also know that we can’t abandon the eternal soul and the worship dynamics of the human heart.

“Prozac as Savior”

I found it fascinating that, in the last and summary chapter, Kramer’s main interlocutor is novelist Walker Percy, representing something of a Christian world-view. Kramer takes him seriously, but eventually dismisses Percy’s insistence on the reality of sin and the potential goodness of suffering. For as much as he deals with ethical choices, sin does not seem to be a living category for Kramer. He says that one (side?) effect of Prozac is the numbing of moral sensitivity, and that this may be a good thing!

With his stories of lives changed by a little pill, Kramer almost presents Prozac as Savior, or at least, as Prozac as Prophet (revealer of the secrets within). Of course, any alternative Savior to our Lord Jesus Christ will never truly save nor satisfy.