Prozac as a Way of Life
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《新英格兰医药杂志》
In the first flush of its successful seduction of American psychiatry, Prozac engendered a compelling myth. Spurred by Peter Kramer's lucid recounting of his clinical experiences in Listening to Prozac (New York: Penguin Books, 1997), the idea arose that Prozac could make well people feel "better than well." Freud used to say that the best psychoanalysis could do was to turn neurotic suffering into common unhappiness, but Prozac seemed to promise something more. "Better than well" was a concept that not many people could resist.
As a psychiatrist, I was drawn to the promise of the drug. One evening, I decided to try a little myself. I was well, but if I could be better, I wanted to be. I soon noticed my stomach becoming queasy and a quickening of my pulse. Maybe this was the price I would have to pay, I thought. But that night, I did not sleep. I struggled through the next day feeling worse than ever and resolved to put the Prozac away. Better to leave well enough alone.
Some of my patients, however, especially those plagued with anxious preoccupations, have responded very nicely to Prozac. They have felt "back to themselves," freer, and able to expand their range of thinking beyond obsessive rumination. Yet many others have found that although the drug has made them agitated, given them headaches, or made it more difficult to have an orgasm, it has done nothing to transform their personalities. Prozac, it turns out, is not a panacea and not a way of life. It is just another drug, one that helps a certain number of people but does nothing beneficial for the rest.
Despite recent advances in psychopharmacology, we still do not know much about how Prozac's chemical modification yields cognitive and behavioral change. How does the prolongation of the life span of serotonin in the synaptic cleft enable someone to stop obsessing about his upstairs neighbor's heavy footsteps? What does it suggest about our notions of temperament or character that certain aspects, like anxious preoccupation, can be modified by a pharmaceutical agent?
Prozac as a Way of Life steers clear of the biologic issues but takes on the philosophical ones. Most of its essays take the "better than well" myth as a reality and dwell on the ethical implications of cosmetic psychopharmacology, treating the drug as a threat to creative introspection. Only a few address the question of how our culture's spiritual yearnings have attached themselves to a drug. Although the concerns of these medical ethicists may prove to be prescient, there is nothing to suggest that Prozac actually has the power to medicate away alienation in the manner suggested by Aldous Huxley in Brave New World. The selective serotonin-reuptake inhibitors are interesting drugs, but their muting of sexuality, their tendency to produce agitation, and their occasional association with suicidal thoughts and behavior will forever limit their appeal. Although there is much to chew on in this provocative collection, its central premise is flawed. The vast number of people who take Prozac for common unhappiness will notice nothing but side effects.
Mark Epstein, M.D.
New York University
New York, NY 10003((Studies in Social Medici)
As a psychiatrist, I was drawn to the promise of the drug. One evening, I decided to try a little myself. I was well, but if I could be better, I wanted to be. I soon noticed my stomach becoming queasy and a quickening of my pulse. Maybe this was the price I would have to pay, I thought. But that night, I did not sleep. I struggled through the next day feeling worse than ever and resolved to put the Prozac away. Better to leave well enough alone.
Some of my patients, however, especially those plagued with anxious preoccupations, have responded very nicely to Prozac. They have felt "back to themselves," freer, and able to expand their range of thinking beyond obsessive rumination. Yet many others have found that although the drug has made them agitated, given them headaches, or made it more difficult to have an orgasm, it has done nothing to transform their personalities. Prozac, it turns out, is not a panacea and not a way of life. It is just another drug, one that helps a certain number of people but does nothing beneficial for the rest.
Despite recent advances in psychopharmacology, we still do not know much about how Prozac's chemical modification yields cognitive and behavioral change. How does the prolongation of the life span of serotonin in the synaptic cleft enable someone to stop obsessing about his upstairs neighbor's heavy footsteps? What does it suggest about our notions of temperament or character that certain aspects, like anxious preoccupation, can be modified by a pharmaceutical agent?
Prozac as a Way of Life steers clear of the biologic issues but takes on the philosophical ones. Most of its essays take the "better than well" myth as a reality and dwell on the ethical implications of cosmetic psychopharmacology, treating the drug as a threat to creative introspection. Only a few address the question of how our culture's spiritual yearnings have attached themselves to a drug. Although the concerns of these medical ethicists may prove to be prescient, there is nothing to suggest that Prozac actually has the power to medicate away alienation in the manner suggested by Aldous Huxley in Brave New World. The selective serotonin-reuptake inhibitors are interesting drugs, but their muting of sexuality, their tendency to produce agitation, and their occasional association with suicidal thoughts and behavior will forever limit their appeal. Although there is much to chew on in this provocative collection, its central premise is flawed. The vast number of people who take Prozac for common unhappiness will notice nothing but side effects.
Mark Epstein, M.D.
New York University
New York, NY 10003((Studies in Social Medici)