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Love and Death and Wisdom and Stuff
July 18, 2005 9:12 AM   Subscribe

Broadly speaking, the brief includes the claims that in prizing persons, we prize a complement of emotion; that in prizing moral perception, we prize the emotional dispositions that make it possible; that in cultivating character, we cultivate virtues but also emotional sensibilities. Wisdom in Love aims to show that passions, love and concern, in particular, ground the substance of a worthy life and, perforce, a life of wisdom. A loving attachment, appropriately fixed and cultivated, underlies felt-significance. This makes the goods that animate a life matter. Conversely, a love that's misaligned or stunted brings on personal deterioration and despair. Right action and reasonable belief presuppose apt emotional attunement to the world and others, as well as appropriately responsive character that is rooted in emotional dispositions and operative in moral perception. This gives a philosophical frame equipped to separate false, sentimental, inept, or frozen emotions from more worthy ones, tied deep into worthy roots.
Wisdom in Love: Kierkegaard and the Ancient Quest for Emotional Integrity reviewed. On a related topic, Peter D. Kramer, author of Against Depression ponders "So, Dr. Kramer, what would have happened if Kierkegaard had taken Prozac?" See also Philosophy And Depression by Tim Ruggiero
Also by Richard Anthony Furtak, a translation of a poem by Rainier Maria Rilke--Sonnets to Orpheus, 1.2  mostly via Online Papers In Philosophy
posted by y2karl (38 comments total) 3 users marked this as a favorite

 
The cold logic of true love?
posted by Thoth at 9:25 AM on July 18, 2005


I read that piece about Kierkegaard needing Prozac, and I was dumbfounded.

The beautiful and introspective mind that produced Fear and Trembling and Sickness Unto Death seems to me to be the antithesis of someone who needs Prozac. Or, perhaps, he could be seen as an example of how one can use the power of thought to reason through depressive thoughts.

Yes, he acknowledges the struggle of being, but he shows in the end how one can be ultimately content.

The idea that we could have medicated that mind and lost the introspection he produced is sad.
posted by dios at 9:45 AM on July 18, 2005


Good point about Kierkegaard, dios.

y2karl, thanks for posting that wonderful translation; here's a Google cache for those who don't like pdf files.

"She slept the world. Singing god, how then
did you fulfill her that she never hoped
to be awake? See, she got up and slept..."
posted by languagehat at 10:11 AM on July 18, 2005


Great post, y2karl. Rilke is always good. I don't know if I can add anything of value that is distinct from those articles, but it is my understanding that psychiatry's goal is to bring people from the edges of the bell curve toward the mean. And the exceptional creative folks are necessarily farther from the norm. Non-medical drug use has long been useful to people exploring past societal inhibitions.

The feelings I was left with after reading Fear and Trembling were not ones of despair or even melancholy. Instead I had the feeling that Kierkegaard was both humble and determined.

Or, what dios said.
posted by sciurus at 10:17 AM on July 18, 2005


The idea that we could have medicated that mind and lost the introspection he produced is sad.

Yes, and without alcoholism, we wouldn't have had Poe. Without opiate addiction, no Xanadu. Without tendencies uncomfortably close to pedophilia, no Alice. Down with happiness and well-adjusted children! Hooray for misery, addiction, disease, deviancy, suicidal tendencies, and general human suffering, as long as it leads to interesting books!
posted by Western Infidels at 10:19 AM on July 18, 2005


Can well adjusted children reasonably exist without some kind of educated insight into those 'interesting books' and perhaps even, the origins of their creation?
posted by Thoth at 10:36 AM on July 18, 2005


Sorry, to clarify... How prescisely 'well adjusted' can somebody ever be if they are insulated from confronting and dealing with the existence of moral ambiguity?
posted by Thoth at 10:45 AM on July 18, 2005


y2k-Great post. I think the Furtak book should be very interesting if the review is anything to go by. The reviewer's point, in a world that at every turn puts the objects of our care at risk, we are made intensely vulnerable. Kierkegaard does not flinch from the fact that suffering is to be expected in any life infused with passionate concerns, is not strongly enough made, for I think that Kierkegaard didn't just accept suffering, and he didn't just use it to fuel his philosphical writing, he used philosophy in order to try and understand his suffering.

I appreciate this new spate of books by philosophers about emotion. I think Therapies of Desire by Nussbaum, an older book at this point, is a great starting place, and the perfect place to refute the idiocy of Kramer's piece about Kierkegaard. Nussbaum makes the argument that philosophy was in fact seen as therapy in the ancient Greek world, that what to us seems of academic (even if absorbing) interest was to the Greeks a way to shape and control desire. I'm not sure I agree with all of her readings, but the direction of the book highlights how limited Kramer's vision of life is.

For Kramer, people and their emotions are divorced from the work they do. It's as if he's taken Cartesian dualism to an absurd level. Not only does he use a reductive biological metaphor to describe depression, something that may be open to debate, but which is unacceptable in someone trying to write about the creative process; but he fails to understand that persuing artistic production or philosophy or any work is often a way that people use to try and understand and control depression. The closest he gets: If both illnesses cause the sort of suffering that can alter worldviews or shape art, why do we react to depression and syphilis differently? reduces depression to something which might shape art or philosophy. The Ruggiero article comes much closer to acknowledging that while neurosis may not be necessary for artistic production, artistic production may be a legitimate response.

I think Adam Phillips does a much better job than Kramer, a much much better job, at trying to understand how emotions play out in our lives, what meanings they have, and how that relates to the kinds of choices we make and where we position ourselves in the world. On Kissing Tickling and Being Bored has been one of my favorite books for many years, not simply because Phillips does a great job of using case examples to explain basic psychoanalytic concepts, but because he's never in a hurry to dismiss problematic feelings as unnecessary and sick. Phillips' more recent books have gone so far as to suggest that engagement with literature, whether reading or writing, can itself be a kind of psychotherapy, something with which I agree.
posted by OmieWise at 10:51 AM on July 18, 2005


here's a Google cache for those who don't like pdf files.

I was trying to do that myself. Thank you, languagehat, that was a neat trick.
posted by y2karl at 10:57 AM on July 18, 2005


For all Rilke fans, or fans of translation ;) , I recommend Reading Rilke by William Gass, in which Gass talks a lot about the problems of translation, and then tries his hand. I think it's worth reading even if you end up hating it. Here's a review at the excellent Complete Review.
posted by OmieWise at 11:08 AM on July 18, 2005


How prescisely 'well adjusted' can somebody ever be if they are insulated from confronting and dealing with the existence of moral ambiguity?

How would the availability of medicine for sick people eliminate moral ambiguity from the world, or insulate anyone from it?
posted by Western Infidels at 11:09 AM on July 18, 2005


"For [serotonin inhibition pharmaceuticals are] nothing but the beginning of terror
which we are barely able to endure and are awed
because [they] serenely disdain to annihilate us.


Seems lacking, somehow.
posted by Haruspex at 11:50 AM on July 18, 2005


Uh, upon review, my grammatical expertise is what's lacking. Apologies for a pointless post.
posted by Haruspex at 12:10 PM on July 18, 2005


How would the availability of medicine for sick people eliminate moral ambiguity from the world, or insulate anyone from it?

Can you so easily reduce the identities of Poe, De Quincey, Carrol and Thompson to that of drunk, addict, paedophile and suicidal depressive? Was their only contribution just 'interesting books?'
posted by Thoth at 12:11 PM on July 18, 2005


Camus has the image of Kierkegaard dancing wonderfully, his mouth contorted into a half-sneer, half-grimace - a dancer in total agony and incredible form. The implication I got was that K's dance was marvelous, perfect on its own terms - and inseparable from K's pain, yes, but ... his genius could not transmute his pain into something it was not, and the pain must inspire pity in the viewer, and we are allowed to wonder what it would have looked like had K suffered less.

As far as the biological basis of depression - we will never be able to draw a bright line. I do believe there are some people whose brains are just broken, period - think of severe schizophrenics - whose suffering can't end on its own, and can't be redeemed by art or love or religion. But how many are like that? Most people fall in the gray area, so the decision to take medication must be a personal one.

Kramer and Furtak both seem like advocates to me - Kramer is focused on alleviating suffering, and he's willing to gloss over the gray areas to do it. Furtak is defending the search for meaning and growth in life, but if some people decide Prozac is one of their tools on that journey, what is the problem? Is alcohol any less distorting to the soul?

Ultimately drugs like Prozac aren't going to fundamentally change the human race, or philosophy, or art. They're another tool that some people will choose to use.
posted by lbergstr at 12:13 PM on July 18, 2005


I feel like Matt Lauer confronting Tom Cruise here but Kramer wrote nothing about Kierkegaard needing Prozac. He used the eternal 'what if' question he always received form audiences as a hook on which to hang his concern that we have romanticized depression. This is a thesis not without merit.

There's a health food store here in Seattle with a neon sign in its window that reads Limp In, Leap Out. I have seen friends suffer years of utter sadness and self-torment, go through years of therapy and then go on a course of anti-depressants and then just wake up and live. How something so simple can have an effect so sudden and so profound on a person's life is a marvel to me. I have no easy answers nor a fixed position on the meaning of this--only questions.
posted by y2karl at 12:31 PM on July 18, 2005


y2karl writes "He used the eternal 'what if' question he always received form audiences as a hook on which to hang his concern that we have romanticized depression. This is a thesis not without merit."

Agreed, but Kramer does more than that, he suggests that depression is analgous to syphillis or to TB. There's an ontological problem with the comparison that may be inseparable from an argument about the biological basis of depression, but which exceeds it. The problem is that our experience of self is inseparable from our experience of our emotions. In fact, it's arguable that there is no self without the emotions. This is not true of physical ailments, although certainly in extreme cases people come to identify very strongly with their physical illnesses as well. But where Kramer's piece fails, even, I think, as an expression of caution and concern about how we think about depression, is in the lack of acknowledgement of the constitutive nature of emotions. Instead, Kramer seems to suggest that there is some person separable from the emotions, and that treatment is simply the uncovering of that person. As a description of human life I find that inadequate, as a therapist I find it very problematic. Again, I understand that a discussion of the biological basis of depression is a subtext here, but if we can leave that aside, I still find Kramer's position overly simplistic and unconvincing.

lbergstr writes "I do believe there are some people whose brains are just broken, period - think of severe schizophrenics - whose suffering can't end on its own, and can't be redeemed by art or love or religion."

Unfortunately, pretty much all we have to back up that belief is faith. The evidence is pretty weak, especially in the case of severe schizophrenics, whom I think everyone assumes is the group of people most likely to show evidence of brain malfunction. It is simply not true that people do not get well from schizophrenia. I'm reading Operators and Things right now, written by a woman who was severly schizophrenic for about 6 months, and then got well.

It has long been recognized that schizophrenia follows roughly something called the law of thirds, in which 1/3 have one psychotic break and recover completely, one third have intermittent psychotic breaks with relatively normal functioning in between, and one third are chronically ill. Although I disagree with many of the things in this schizophrenia factsheet, even they admit that "Most individuals experience periods of symptom exacerbation and remission, while others maintain a steady level of symptoms and disability that can range from moderate to severe. Research shows about ten percent of patients remain severely ill over long periods of time, while one half to two thirds significantly improve or recover with treatment, some completely." Since treatment for schizophrenia is typically only symptom ameliortation, I would argue that the line about with treatment has little bearing on the numbers.
posted by OmieWise at 1:08 PM on July 18, 2005


I haven't read K's diaries - only Purity of Heart and Fear and Trembling - but my impression is that his depression is less biological than it is intellectual. The profound importance that K gives to faith and human will constantly puts him in a position of failing to live up to his own standards. Is there a difference between someone whose powerful intellect drives them to depression and someone whose chemical make-up is the cause?
posted by mullacc at 1:33 PM on July 18, 2005


Can you so easily reduce the identities of Poe, De Quincey, Carrol and Thompson to that of drunk, addict, paedophile and suicidal depressive? Was their only contribution just 'interesting books?'

I don't see how it's germane to the question I was asking, frankly. But no, I cannot and would not reduce anyone's identity to their mental ailments, which is exactly the point. Some seem to think that helping someone like Poe would ultimately be tragic, because think of the books we wouldn't have! That attitude - the belief that Poe's art arose from his suffering - is the reductionistic one. It's nonsensical and selfish at the same time.
posted by Western Infidels at 1:42 PM on July 18, 2005


Western Infidels writes "That attitude - the belief that Poe's art arose from his suffering - is the reductionistic one. It's nonsensical and selfish at the same time."

Um, who made this argument? No one in this thread. No one in any of the linked pieces.
posted by OmieWise at 1:50 PM on July 18, 2005


OmieWise: Um, who made this argument? No one in this thread. No one in any of the linked pieces.

dios: The idea that we could have medicated that mind and lost the introspection he produced is sad.

dios was talking about Kierkegaard, not Poe, but it reads like the same argument to me. I don't think it would be sad to alleviate the depression of millions of people who suffer in obscurity, even if it did mean losing the occasional Kierkegaard or Poe.
posted by Western Infidels at 2:02 PM on July 18, 2005


I cannot and would not reduce anyone's identity to their mental ailments, which is exactly the point.

While it's much clearer now your comment was likely tounge in cheek, it seemed initially that your point was completely opposite to this... Poe's art was tied to his alchoholism, the fruits of which are trivial when compaired to their cost.

Being reductionistic is pointlessly speculative, sure. However, I think it is not suffering, illness or flaws which create art... It's the artist, obviously. However, some great art completed in the context of suffering and perhaps 'sickness' has great value.

If we could sponge the pain and despair from art by travelling back in time to medicate those responsible for their 'sicknesses' before it manifested in their work, would we be a more 'well adjusted' society as a result? Or would we in fact simply lack a more complete understanding of ourselves, and those around us? Would we be as capable at experiencing empathy, compassion and understanding? Would we just perhaps be getting half the picture? Would we even have culture that understood the existence of suffering?
posted by Thoth at 2:59 PM on July 18, 2005


Would we even have culture that understood the existence of suffering?

The most well adjusted person I have ever known was a very kind and generous person, and, among my friends, was the happiest to be alive. He was like a tonic. You wanted him to come to your party. But, incredibly likeable and charismatic as he was, he was not the most sympathetic person I had ever known, not someone to whom you would necessarily want to pour your aching heart when you broke up with your girlfriend. There he was a few cans short of a six pack. So, maybe, you have a point.

As for the most well adjusted person I have ever known, he led a charmed life, had a beautiful wife and beautiful children and a dream job that that grew like an oak from an acorn out his hobby: home brewing. One sunny summer day in the town where he lived, a 22 year old divorced father from the wrong side of the tracks had a blow out with his wife when he came to pick up the kids. They had a fight and his ex-wife called the police on him. When the police came, he had crawled under the house with his kid and a 22 rifle. The police cordoned off the area. They eventually talked him out from the under house but not before he took a couple of warning shots over their head. At the same time, the most well adjusted person I have ever known was driving home from the golf course in his pick up, on a road a half mile from the golf course, the one road the police forgot to block. He had the radio on and his elbow hanging out the window, and one of those 22 bullets flew right into his ear canal and killed him dead. Had the window been up, had he arrived a fraction of a fraction of a second later, he might have missed the bullet or been hit in the head or missed entirely, and wounded or not, he quite possibly could still be alive, in pain or bliss. Bob Dylan once said Any day above ground is a good day. Life is danger and suffering is universal. We will always understand it or we will never understand it, as the case may be.
posted by y2karl at 4:01 PM on July 18, 2005


Quite frankly, we are better off that Kierkegaard did not live in an age of medication.

He understood and, in beautiful rhetoric, offered a way through pain and anguish. The self is a relation which relates itself to itself. Without an introspection as to what constitutes our self, we fall into a despair... it is our sickness unto death. But it is in the depth of despair where we face the ultimate question of who we are, and it is only in answering that question do we find contentment. The individual is therefore subjected to an enormous responsibility: at some point one must make the existential choice, and the presentiment to that choice is itself fear and anxiety. But until we make that choice, we live with fear and anxiety. Or, as we do now, inoculate ourself from the question with drugs.

One can see a very definite thread in the works of S.K. that can be seen in the writings of the brilliant Paul Tillich, who pointed out that it is in the self-realization of our fear and anxiety of our own smallness, nothingness and inconsequential-ness, we see the way through. The courage of being in the face of non-being. One can see this thread, too, in Freud's work. And one wonders how Freud would fit in the world of psychology today, where the cure is through avoiding the introspection, anguish and doubt.

There is a reason that addicts often have to hit "rock bottom." We all have to, at some point. It is only there that we know ourself and face our real choice... the one that we avoid as long as we can. It is when we face who we are and what we are to be. It is the essence of existentialism. And while Hegel and medicine and science seek to try to move to some perfection of man through synthesis and subtraction, they never get away from the basic question that is irreducible beyond each person's individual choice.

Kierkegaard would have been lost to us if he was on Prozac. We would all be at a loss. Human suffering is not a good, in and of itself, but it is not a bad, either. Instead of hiding, masking, and deadening the anguish and fear, we might consider trying to face it. That is what Kierkegaard did for himself and for us.
posted by dios at 4:12 PM on July 18, 2005


dios-Well said. Thanks for your contributions to this thread.

Western Infidels writes "I don't think it would be sad to alleviate the depression of millions of people who suffer in obscurity, even if it did mean losing the occasional Kierkegaard or Poe."

I'm not sure why you think this is an Either/Or proposition. It sounds as if you're advocating forced medications. Otherwise, you may misunderstand my position, which is that K. produced his philosophy as a way through depression. Sure, if Peter Kramer got his hands on him he might suggest medication, but that is, after all, what psychiatrists do. Anymore. Kramer's essay was stupid not because he wants to alleviate suffering, but because he is too blinded by biological psychiatry to understand that K. was embarked on the cure already. My job is pretty much alleviating the suffering of depressed people, which doesn't make me an expert, but which does suggest (at least to me) that my motives are not in question here.
posted by OmieWise at 5:00 PM on July 18, 2005


Instead of hiding, masking, and deadening the anguish and fear, we might consider trying to face it.

I totally reject the idea that taking Prozac means you are not facing your anguish or fear. The symptoms are not the disease, as OmieWise pointed out in a different context.
posted by lbergstr at 5:16 PM on July 18, 2005


the cure is through avoiding the introspection, anguish and doubt...

hiding, masking, and deadening the anguish and fear...


If you think anti-depressants hide, deaden or mask the anguish and fear, brother, you've got another think coming. Your's is not the voice of experience. Antidepressants don't make your problems go away, they don't change who you are as a person. They are not a high, there is no euphoria. Lost souls do not themselves find. They merely, when they work, provide a floor beneath your feet. Some people find themselves struggling where before they were paralyzed, find a little light where there was darkness. They get up, they fall, but not as far down. They wake up and live.

Kierkegaard would have been lost to us if he was on Prozac.

We simply do not know this. We don't know what Kierkegaard could have given us, had he such a floor beneath his feet. And would he wish his suffering upon himself ? and if his contributions were such a gift, should we celebrate his pain ? Gee, I sure am glad that man was so miserable--it sure added a lot to my life! Thank you for being in such pain, Soren--you sure made some great art! Being in hell is not necessarily good for the soul. Pain does not automatically bring out the best in us.

Anti-depressants do not make a person whole nor do they diminish the desire to become so. They don't end anguish or self-doubt. I have seen people who have spent years in therapy go on anti-depressants. They didn't stop struggling, they didn't start giggling. They woke up and they started to live. For the lucky, for whom they work, there can be quite a profound change, and having experienced it, few ever wish to return to paralysis and feeling dead while alive. The change for some people can be quite profound. I personally wouldn't deny Kierkegaard the choice, were I able to give it to him.



And PS, this addicts have to reach rock bottom to quit taking drugs stuff is bullshit and myth. Plenty of people quit using drugs without hitting rock bottom. You don't need to go through hell to quit drugs. That's not only romanticizing pain, that's romanticizing inflicting pain, a piece with wishing pain on bad people who serve to suffer--the same mentality that thinks boot camp prisons really work, that you really have to stick it to people in prison because they deserve it. They get to watch color TV all day! That's not right--they deserve to suffer! Let's make it hard for them! Let's humiliate them!

I don't think pain makes anyone noble or deeper and I don't wish it on anyone for any reason. And I know god damn good and well that wishing pain on other people does not make you a nobler and deeper person. No sir. Far from it. There's a name for that: cruelty. The first rule is do no harm. For good reason.
posted by y2karl at 6:14 PM on July 18, 2005


Very well said, Dios and Y2Karl.

I would like ro re-point to Philosophy And Depression by Tim Ruggiero. Truly an inspired piece that I need to forward to my parental units. (they are usually pro-medication. I was on Ritalin, my wife on Prozac.)

Those drugs, and the abused ones like meth and cocaine, don't add to life, they keep it from you.
I spent 8 months on meth. (it seems like 22 of the longest days of my life) I also spent 9 years on ritalin. They both have the same effect of narrowing your focus to just the subject at hand. Anything else, be it emotions, loves, desires, really anything of passion, gets a back seat. I believe that every person is capable of living through the screwballs life throws at you. The medication just dulls yous sences a bit, for a while. They rob you of some of your personality. They make you less real. I prefer reality.
posted by Balisong at 9:03 PM on July 18, 2005


From the Ruggiero essay: A man of 35 years wakes up one day acutely aware of a vague anxiety, a feeling of uneasiness, perhaps melancholy.

He lost me in the opening. People that suffer from clinical depression usually experience their first onset long, long before age 35 - it's a lifelong thing. What he's describing is grief.
posted by lbergstr at 10:37 PM on July 18, 2005


Yes, and without alcoholism, we wouldn't have had Poe. Without opiate addiction, no Xanadu. Without tendencies uncomfortably close to pedophilia, no Alice. Down with happiness and well-adjusted children! Hooray for misery, addiction, disease, deviancy, suicidal tendencies, and general human suffering, as long as it leads to interesting books!

Western Infidels, I think you miss the point and/or the boat. The problem with the prozac nazis is their view of life that any emotion that deviates from the sterile glee of suburban formica is a sign of mental illness. The point is that some negative emotions and perspectives are authentic, and should not be devalued via pyschiatric diagnosis. I don't see an attempt to vindicate alcoholism, etc., but rather an attempt to continue seeing the bulk of our human experience as something authentic (as opposed to malady inspired illusion). I think this is very healthy.

The danger of psychology and psychiatry is not the generally bad science that underwrites it, but the fact that it's a form of bad science that society absorbs swifty, making people "neurotic" (cf. Woody Allen).

The challenge for psychology and psychiatry is to strive to be something better than an ideology that wins in virtue of labeling all that its provincial practitioners disapprove of as disease.

The word 'science' should mean something.
posted by Como Gomez at 11:09 PM on July 18, 2005


When I was 19, I went through a very heavy depression for about 14 months. I became lost in the feeling of the world's utter meaninglessness. Looking back, it was a lot like when I discovered that there wasn't a Santa Claus, only much more complete. There didn't seem to be an escape from it, so I exploited it to the best of my ability, wringing out some of the most creative moments of my writing career--if not the most mature. Getting on with my life was a matter of accepting that maybe the world truly has no meaning, but that perhaps it did. If it did, and even if it didn't have meaning, I was going to make a meaning for it, and call it that, just to keep things stationary. I no longer preoccupy myself with the ONLY meanings of things, but I still regard depression as a potent, if limited, creativity-enhancing substance.
posted by squirrel at 3:00 AM on July 19, 2005


I loved the piece about Philosophy and depression, it reminded me of this (now dead) post about Samvega.

I think that when depression becomes debilitating, then drugs are a very good thing personally, but I do think there needs be a middle way here.
posted by fadeout at 3:30 AM on July 19, 2005


I'm not sure why you think this is an Either/Or proposition.

I don't think that. But I do think that even if it was an either-or proposition, the anti-drug attitude that arises from this romanticization of depression is indefensible.

It sounds as if you're advocating forced medications.

Certainly not. Where did I even hint at such a thing?

Kramer's essay was stupid not because he wants to alleviate suffering, but because he is too blinded by biological psychiatry to understand that K. was embarked on the cure already.

Belief that Man is more than the sum of his biology is essentially to believe in the supernatural. That's fine, but it's not science or medicine, either.

I don't think that drugs are the only way to deal with emotional problems of one sort or another, but there's no reason one could not be "blinded by" therapeutic psychiatry, in precisely the same way that some pill-pushing doctors are "blinded by" biological psychiatry. The importance of biology really can't be overstated. Both therapy and medication are surely useful, but only because they both effect brain chemistry - i.e., because they're both ultimately biological.

There has been a trendy backlash against these extremely useful new drugs, an unfocused hand-wringing "What if we're destroying the artistic minds of our generation?" attitude. That's a bunch of selfish, ignorant crap, and I suspect only those who have no personal experience with depression would dare to spout such rubbish. Would these people advocate a revival of slavery, because they liked the music the slaves made?
posted by Western Infidels at 6:36 AM on July 19, 2005


Western Infidels writes "There has been a trendy backlash against these extremely useful new drugs, an unfocused hand-wringing 'What if we're destroying the artistic minds of our generation?' attitude."

Actually, the backlash has been about the fact that these drugs are not all that much more useful than placebo, they come with serious side effects that make them unpalatable to many of the people they are supposed to be helping, and they increase the risk of suicidality in patients. The FDA has recently put black-box warnings on SSRIs for use in adolescents and children(not a good thing for any drug), and has expanded their warnings to suggest that doctors monitor even adult patients for suicidality. In addition, more and more research is showing that psychotherapy treats almost all mental illness (and especially depression) as well as or better than drugs. This is not therapy with drugs, just therapy. And this without the concommitant side effects that come with meds. And we continue to wait for decent evidence that mental illnesses are biologically based. The importance of biology certainly can and has been overstated, and there is a clear profit motive for doing so. Thinking that mental illnesses ought to be biological does not make it so, and the evidence is quite scant. The efficacy of medications (now in doubt) does not indicate that the problems are biologically based, and it certainly does not say anything about etiology. A tension headache may be relieved by Advil, but that isn't because the brain was lacking ibuprofen in the first place.

I honestly haven't seen anyone (aside from perhaps dios in this thread) making the kind of argument that you're upset about. I'm certainly not making it. I have no interest in anyone remaining depressed. I take issue with Kramer not because he wants to help people, but because I think his approach is so narrow that he is unlikely to help a lot of people who need it. I do agree that there has been some real concern about the effects of psychotropic medications on children, and I think that that's been completely warranted. These drugs are poorly tested on children, they are very strong, and kids really may not need them. In that sense there is a concern about "destroying" young minds, but I just haven't seen that concern turned into a romaticization of mental illness.

One further caveat to my position: I believe that the patient's theory of change is the most important part of helping them to get better. This means that I will always support people in distress taking medications if that's what they feel will help them the most. But that support on my part is for the patients, not for the medications. I know the research and I know that there are many ways to recover from mental illness. My concern with the heavily funded marketing of medications is that patients who don't want to take meds, who do not think that they will be of help, are told that they must largely based on marketing imperatives. I see this all the time. Those patients usually don't do well on meds (because they didn't want them in the first place) and are then switched to other meds, in a cycle that can go on for quite some time. Time during which they may not be getting the help they do want and need. That does, indeed, piss me off, but it's the meds that are being romanticized, not the mental illness.
posted by OmieWise at 7:35 AM on July 19, 2005


Nobody romanticizes them here. A prescription for Wellbutrin, say, costs less than therapy by an order of magnitude, though, and, for those it helps, the difference is profound and sudden. I have friends who have spent thousands of dollars over the years for therapy, really worked in therapy, really got places in yet, and yet, after going on a course of Wellbutrin or Xoloft, find they would rather spend less time in therapy and more time in getting on with their lives. So, there is that, as well. Life is short and therapy very expensive.
posted by y2karl at 8:01 AM on July 19, 2005


y2k-Newer research is saying that this is untrue. I agree that therapy can take a long time, but it does not have to. I think it really depends on what the goal is, how it's articulated, and how the therapist works. Good therapy can work in as little as 6 sessions, and is actually much cheaper than meds. As you can imagine, this is of interest to both insurance companies and therapists, so is the focus of much study.
posted by OmieWise at 9:22 AM on July 19, 2005


y2k-Here is an article at the BMJ suggesting that the costs for therapy are comparable to the costs for meds.
posted by OmieWise at 9:59 AM on July 19, 2005


The importance of biology certainly can and has been overstated, and there is a clear profit motive for doing so. Thinking that mental illnesses ought to be biological does not make it so, and the evidence is quite scant.

I really don't understand. Is the brain the seat of intellect? Is the brain biological? Do you believe that therapy is changing the way a patient's brain works, or do you imagine that it's straightening out the patient's immortal soul? What is there about the functioning of the brain that doesn't fit under the umbrella of biology? What evidence is there that mental illness isn't biological in nature?

I honestly haven't seen anyone (aside from perhaps dios in this thread) making the kind of argument that you're upset about.

I believe it was dios' post I was initially responding to.

I'm sorry if I've ticked you off. I don't disagree that modern anti-depressants are over-used, or that the profit motive behind them is disturbing. However, I've also seen them effect positive, and sometimes dramatic changes in people's lives, firsthand. In light of my experience with these things, I find dios' attitude downright offensive, and it may be that I haven't been as clear as I'd like to think I usually am.
posted by Western Infidels at 11:30 AM on July 20, 2005


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