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Oct. 18 2009 - 3:06 pm | 33 views | 2 recommendations | 4 comments

Steroids for the mind: When treatment becomes simulation

Prozac, a selective serotonin reuptake inhibit...

Prozac, a selective serotonin reuptake inhibitor

“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;

–”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.]


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  1. collapse expand

    Great post…

    As someone who suffered greatly since childhood what they called shyness, extreme shyness and rebellion…something schools quickly couldn’t define…my problem…the angry guy who is also shy and seemed to have too many friends who followed his lead…who while appearing in front of a class would wilt and collapse in a wave of blushing and fear and shaking so bad that someone had hold down the paper I was trying to read to the class because I just shook so badly…I could never finish any report until…to this day I remember a very kind and at the same time mean fellow student, a black girl who used to tease me on the playground incessantly, took my papers from my shaking hands, pushed a another student from the front row and placed my writings down on the desk, so I could at least read it…and still I terrified…I stood like a Don Knotts act trying my best…the fear was incomprehensible to me…to the teachers…but my school yard tormentor smiled and never said another word once I finished.

    Fifty years later I wonder how and whether depression or anxiety crippled my life. In the 1970’s the answer was yes…I had achieved success by proxy…that is I urged people that trusted my judgment to to act in concord…it worked. But it did not bring me to satisfaction.

    Now this was weird…so I sought out some help who was more than happy to offer me SSI’s, there were, if I remember right two to chose from…they both made me crazy, violent…which I already had a tendency…so fuck that.

    Then a tragedy, a moment of personal failure, of the sort that questioned one’s fabled view of one’s self…a friend died in a situation where we both should have died.

    The reevaluation was skewed by my own insanity.

    Drugs were the answer…and still are…they advanced somewhat…laughingly…my Harvard educated Psychiatrist…was insulted at the idea that the meds which took six weeks to work… and then created crazy side effects…insulted that I would think that I was a guinea pig for the pharma industry that only used drugs developed for anything other than depression or anxiety would not be totally effective…never mind that the ones that work for me are destroying my liver.

    So here is the bottom line…the drugs help…lots…the anxiety is in control, the anger is in control…I found a combination of drugs that have something to due with other physical concerns but the side effects help me.

    Now there is talk of designer drugs. Now a good friend of mine who suffered from an extreme bout of cancer is looking to some stimulates, new designer stuff he gets overseas to compensate for the buzz he used to get from smoking…that little edge that aided his thinking…and his thinking is pretty good, actually wins a bit of professional accolades and money and has offered me the chemical help…hey I’m getting old…should I say no thanks…a man who needs drugs that are killing his liver to survive a regular day for everyone else?

    I work in the creative arenas and my question is the same…can taming madness quash creativity? I mean someone who views the world differently than, say, a sane world lose a edge?

    To address, finally the point of your post, when losing some desire, no not desire, more ability, in regards to sex, advise usually says stop taking the drugs for a period, take on some anxiety, have sex, while the rest of the world is told, in commercial after commercial, take drugs and when the mood is right…you have 48 hours.

    It is all very confusing…I may be suffering mental illness, SSI didn’t help but the science made sense to me…now I can’t take the drugs that help with the SSI’s that appeal to my intellect, I am working the side effects but this talk of designer help for college finals or stage craft but it seems wacky yet make me jealous…imagine starting well and just being able to improve without the hurt…damn unfair…how many homers can be hit with drugs…but then how many medical breakthroughs are possible? On drugs?

    Crap…I’m confused.

    • collapse expand

      Sure sounds like yours has been a pretty successful journey down a long, arduous (very arduous) road. And I really appreciate your taking the time, and having the courage, to share this part of your story. It’s the kind of comment that can only help others on similarly difficult roads, even if the individual specifics are always totally individual and highly specific.

      I’d guess you know there’s a huge literature on madness and creativity. But others may not so here’s a link to a NY Times article that cites several good books.

      And finally, well, crap, we’re all confused!

      In response to another comment. See in context »
  2. collapse expand

    Thank you, Todd for this T/S piece. As a practicing psychologist I am concerned by the trend of “disorders” being created based on the availability of drugs that can alter (aka “treat”) behaviors/characteristics. With the newest DSM-V on the horizon and expected to offer ever more diagnoses, as have prior revisions of earlier manuals, the points you raise are very important indeed.

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