Biology 202
2003 First Web Paper
On Serendip

"If the human brain were simple enough for us to understand, we would be too simple to understand it" (1).

In his book Listening to Prozac, Dr. Peter Kramer thoroughly examines how Prozac has revolutionized the power of psychopharmacological medication and what it teaches us about the human self. Prozac has demonstrated the ability to transform a person's behavior, outlook, and conception of self through a neurological change of biology, thus providing more evidence that brain does indeed equal behavior. Perhaps more fascinating than the answers it provides about human neurobiology are the difficult questions, ironies, and problems its usage raises. The administration of Prozac challenges the model of healing through cognitive powers due to its purely biologic effectiveness. This success has widened the gap between the un-medicated and medicated human self. Which is the "true" reflection of a person? Do Prozac's transformations emulate an unnatural idealized social norm or release a healthy individual trapped in an unnatural state? How does this reflect or change our definitions of "illness" and "wellness"?

Dr. Kramer's discussions hinge upon the idea that the nervous system controls behavior. The case studies he provides show people who, after taking Prozac, have remarkable "transformations" of multiple facets of behavior including perceptions, motivation, emotions, sense of choice, values, and personality (defined by given temperament as well as developed character). Prozac's ability to change a person so drastically on a biological level causes much apprehension because the change does not need to be processed cognitively or even consciously. Dr. Kramer asserts that this change need not coincide with any self-knowledge because it is "evidently not necessary"(32). His comment points to a desire among many that the conscious self (I-function) has a stronger influence on behavior than biology does because we intimately connect behavior with self-identity. Relying on a foreign substance to change biology (and self) without apprising and receiving sanction from the conscious-self first seems unnatural. The utter reliance on biology without utilizing our human gift of cognition seems to be a violation of how humanity has separated itself from our own inner animal. Dr. Kramer dismisses claims that Prozac compromises our vision of humanity through changing behavior in psychobiological terms by saying, "biological models are not reductionistic but humanizing, in the sense that they restore scale and perspective and take into account the vast part of us that is not intellect" (143). Further compromising psychoanalysis in favor of pharmacology, Dr. Kramer writes, "we are symbol-centered creatures, and some of our worst stresses are symbolic. But to my mind these final causes were like the pebbles that finally turn a tenuously balanced collection of rocks into an avalanche" (141). He goes on to write that rearranging the pebbles will not stop the avalanche; only changing the structure of the rocks, our brain's biologic functions, is totally effective. The symbolic pebbles (cognition, the I-function, conscious self, memory etc.) he describes may be visible and therefore more focused upon, but as seen with Prozac patients, they are ultimately forgotten in the bigger picture of biologic determination.

After seeing the dramatic difference Prozac makes, Dr. Kramer poses a critical question: "had medication somehow removed a false self and replaced it with a true one?" (19). His patients praised the effects of the drug saying "I feel like myself", and when they were weaned off of Prozac, they complained "I'm not myself again" (10). For people suffering from acute depression or anxiety, the medicated self ironically becomes the "true" self despite being in an altered state. One of his patients said jokingly that she has changed her name – "I call myself Ms. Prozac" (11). Here, self is not only dependant on biology but on medication. Her cognitive I-function has literally begun referring to itself as "Prozac" rather than her realized or given name. By naming herself Ms. Prozac, the patient demonstrates how this medication has the potential of becoming and defining a new self based entirely on the pill's neural actions while eliminating the old self as false and somehow untrue. Dr. Kramer later comments that Prozac differs from other mood-brightener medications because it has "characteristics" and a "personality" which affects the human brain (257). It is interesting to note that Prozac is given a "personality". It becomes personified because of its own, almost human, ability to create a sense of self in the patient. The irony is that the concept of one's true personality becomes vague because of the medicine's effectiveness in expressing its own "personality". The long-acting nature of Prozac may cause "a very steady cushion against decompensation [that] may translate into a new continuous sense of self" (182). Therefore, the true sense of self that Prozac provides may be an effective physiological personality-high which effectively mimics a continuous and realistic sense of self.

However, Dr. Kramer has reservations that Prozac carries its own set of prescribed alterations. Rather, he says that medication merely clears the way for patients to discover their true selves, which have been masked by traumatic events and psycho-environmental occurrences. He cites that "repeated stress sensitizes rats to produce higher levels of CRF" which "can lead to the changes in the cell's genetic material, the DNA and RNA". Outside environment can change biology, which in turn, changes the behavior and the self. Dr. Kramer parallels physical stress, like electric shock, with psychosocial stress, such as sexual abuse, because they both can "cause cell death in the nerves affected by the cortisol system" (117). He states that "medication is like a revolution overthrowing a totalitarian editor and allowing the news to emerge in perspective" (221). However, this begs the question: whose "news" is emerging after the evil editor of psychosocial stress is overthrown? Is the resulting change in self the result of the medication's design, society's expectations, or is it indeed the "true self"?

Dr. Kramer freely admits that "Prozac supports social stasis by allowing people to move toward a cultural ideal" thereby indicating that Prozac not only hints at future "cosmetic psychopharmacology" but in fact represents its arrival (271). Prozac "induces pleasure in part by freeing people to enjoy activities that are social and productive...enjoyed by other normal people in their ordinary social pursuits" (265). In people with minimal depression, Prozac serves as a social un-inhibitor or the equivalent of having a few drinks and becoming an ideal social mover. Merely because social forwardness is sanctioned by our society as "productive" does not sanction science to change people's biology so they derive pleasure in fulfilling the cultural ideal. We have the potential of creating a homogeneous society with modified and standardized behaviors despite a hereditary and experiential biology of difference. As Michael McGuire defined as a "trait distribution phenomenon," a normal human temperament may be changed medicinally because the culture does not reward it, therefore leading to unhappiness, unfulfillment, and depression. One might argue, however, that if we can biologically cure people's minor depression because of society's narrow-minded ideals and their own personal trauma, what is the harm? By medicating such people with Prozac and then diagnosing their problem, we may create a more and more narrow definition of "normal" and "well" by expanding what we think of as deviant. By over-prescribing Prozac, we are eliminating more types of biologic temperaments by labeling them as "illnesses". Society may not accommodate biology, but should we limit biology to fit society?

Listening to Prozac proves difficult because it tells us so much of what we do not want to hear. It challenges engrained ideas about distinctions between biology, cognition, medications, and our sense of self. What we value – conscious human control - turns out to be secondary to that which supposedly demeans us – our biologic animalistic determination. Yet, Dr. Kramer frames this realization as beneficial; by accepting this, we are accepting our greater innate complexity rather than simplicity. However, it is important to recognize the dangers of falling under Prozac's spell. Happiness void of repercussions is no more contained within a Prozac capsule as it is with any other drug. Society's influence on the brain, behavior, and the medication of "illnesses" should not be ignored. Prozac may call to us as the savior of those with minor depression, but its overuse can drown difference in sea of medicated sameness.

References

1)Kramer, Peter M.D. Listening to Prozac. New York: Viking, 1993.


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