Steroids for the mind: When treatment becomes simulation
“One pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don’t do anything at all”
“Remember what the dormouse said;
“Feed YOUR HEAD”
–”White Rabbit” by Grace Slick
We now have access to pills unimagined when Grace Slick’s incendiary vocals first burned those lyrics into the heads we were trying to feed. Today, the very same medications used to treat mental illness can also be used to design experience and simulate an entirely new psychological reality.
These thoughts came to mind yesterday at an inopportune moment. The panel I was on had just finished our presentations to an academic audience. I was supposed to be thinking about the questions raised about my paper about cybersex and online porn. But instead, I was thinking about a presentation that had been made right after mine by Gurmeet Kanwal, a NYC psychiatrist and psychoanalyst who writes and teaches about medication and psychotherapy. I kept thinking about his provocative talk.
He described a consultation with a couple where the wife had lost interest in sex as a side-effect of the SSRI she was taking for depression and anxiety, a not uncommon side-effect (an SSRI is a selective sertonin re-uptake inhibitor, the class of drugs marketed as anti-depressants starting with Prozac). The husband wanted, really wanted, his sex life back. He was not a mean-spirited man, nor did he lack for love of his wife. But he wanted her to stop the meds even though when she tried cutting back her dose she became anxious and felt unable to handle routine frustrations, like taking care of their kids.
Sounds like a traditional marital power struggle. The meat-and-potatoes of couples counseling. But it got weird, and fascinating. While they had no sex, the meds were letting them be emotionally closer in other ways. So, in response to being annoyed that his sexual urges pushed him into a place where he was asking her to suffer just so he could get what he wanted, she suggested he should take the same sexuality-killing anti-depressant so they could be happily asexual together. She wasn’t kidding. She wanted meds prescribed not to treat an illness but to re-design the sexual struggle in their marriage.
While the audience giggled uncomfortably at the logic of her solution, Dr. Kanwal went on to relate how several religious men have come to him asking specifically for SSRIs just so they could experience a diminished sex drive making religious obligations easier to meet.
Not only is treatment becoming design, normal life and disease are getting harder to separate. In a phone call this afternoon, Gurmeet told me as an example “the line is harder and harder to define … normal shyness is becoming Social Anxiety Disorder.”
In the paper he presented on Saturday he talked about the book, The Loss of Sadness by Allan V. Horwitz and Jerome C. Wakefield. He spoke about how,
because of the turning of the tide against the anti-anxiety tranquilizers in the 70’s, the pharmaceutical companies chose to introduce the SSRI’s as antidepressants rather than anti-anxiety drugs. The authors trace the history of the diagnosis of depression back to the time of Hippocrates and demonstrate quite convincingly that over a period of 2000 years, Depression was labeled as an illness only when a person experienced depressive symptoms either in the absence of any external stimulus, or with an intensity and duration that was grossly out of proportion to the external event. The authors state that once we let go of that defining characteristic, we end up with statistics of the prevalence of depression that make it look like we are living in an age of Depression, by losing the separation between normal sadness and depression, and the treatment of depression increasing 300% between 1987 and 1997.
While too much depression still goes untreated–that is a fact that should not be ignored–we are also using those medications to design and not just to treat. It is comforting to know that the professionals our society have entrusted with controlling access to these life-saving, but also optionally life-altering, medications are struggling with what and how to think about the power medical science is putting in their hands. But it is uncomfortable to realize they have no answers.
Instead, we are in it together. Collectively we need to think through what kind of people we want to be now that medical science is making it possible for us to have significant choice in the matter of who we want to be.
While I don’t know how to think about all this, nor what I would do if (when?) given the option of a life-enhancing designer drug that would make me smarter, more reflective and creative, and a better skier, I do know we need to think now about what to do when that day comes.
[CORRECTION 10/20/09: I've changed the White Rabbit lyrics to reflect memory, mine and several others who wrote to me, that our heads were being fed not kept! I originally relied on an Internet lyrics database rather than memory. While I'm shocked (shocked!) something posted on the Internet was not accurate, but that it indeed seems to be the case and I offer my apologies and my corrections.]