Coming of Age on Antidepressants
April 16, 2008 2:15 PM   Subscribe

Who Are We?

Ask Your Doctor.

The "Antidepressant Prescriptions on the Rise" link is gold what with the "Overcome depression with Amoryn" Google ad.
posted by hal9k at 2:27 PM on April 16, 2008

Hmm… I wonder if I should send these links to my in-laws, who since retiring have pretty much made a hobby out of pathologising normal human behaviors in others, hashing things over with whoever will listen at great length and occasionally pushing some kind of “intervention”, usually in the form of a very awkward conversation or a long letter (never an email) in a somewhat officious tone. Deperesions a bit mundane for them though, they generally prefer whatever Oprah happens to be pushing this week.

(Not that our shared circles don’t include actual genuine crazy people of course, but I really doubt their armchair efforts would be much use there either. )
posted by Artw at 2:43 PM on April 16, 2008

Wasn't this just linked to a couple of days ago? Or am I in the twilight zone?
posted by no_moniker at 2:45 PM on April 16, 2008

Were you thinking of this?
posted by Artw at 2:50 PM on April 16, 2008

Wasn't this just linked to a couple of days ago?

I posted the Medicated Americans link as a comment in that thread.
posted by homunculus at 2:53 PM on April 16, 2008

The NYT article actually seems balanced and interesting.

The other one raises some good points, too. if doctors are prescribing drugs to patients simply because the patient saw it on tv and asked for it, that is a big problem, regardless of what the drug is.

it's just that articles like this, no matter how well-balanced, tend to be skimmed and then used as ammo by the "depression is fake/why dont they just get over it?/OMG meds kill artists!" crowd (see first two comments, as best I can interpret them)
posted by drjimmy11 at 3:20 PM on April 16, 2008 [1 favorite]

A suspicion that low level mental illness is over diagnosed, or that medication might not always be a helpful repsonse to such conditions, is absolutely not the same thing as "depression is fake/why dont they just get over it?"
posted by Artw at 3:30 PM on April 16, 2008 [1 favorite]

The other one raises some good points, too. if doctors are prescribing drugs to patients simply because the patient saw it on tv and asked for it, that is a big problem, regardless of what the drug is.

How is it a problem? A doctor should know if a drug would cause some physical problem, and I say let people take whatever drugs they want. Everyone is going to die in the end anyway, what's the harm in people enjoying life more then they otherwise would?
posted by delmoi at 3:49 PM on April 16, 2008

Well, there are two elephants in the bedroom. Vested interests on one side trying to sell as many drugs as possible, and vested interests on the other side pushing a neo-puritan bootstrap model of mental illness.

In between are people suffering from varying forms of mental illness, who really need a better diagnostic and treatment model. I feel highly uncomfortable caught between a doctor who keeps pushing additional drugs onto my budget, and the anti-drug activists who have no problem calling me a zombie, a killer, numb to the world, and an unfeeling addict.
posted by KirkJobSluder at 3:53 PM on April 16, 2008 [5 favorites]

vested interests on the other side pushing a neo-puritan bootstrap model of mental illness.

Um, is there a big-ass strawman in the room as well, or what?
posted by Artw at 3:56 PM on April 16, 2008

Not anymore, the elephants ate it. Now there's a lot of dung in the room, but at least the elephants look happier.
posted by homunculus at 4:00 PM on April 16, 2008 [5 favorites]

i've had this very experience. after suffering from depression for nearly 15 years before trying antidepressants, i've now been on 2 prescription meds for nearly a decade. i'm sure a lot of it is tied up with the issues that cause the depression (lack of self-worth or self-esteem, virulent self-hatred), but i have a very strong sense that i don't know who i really am.

i've over-compensated for this over the years, saying to myself (and anyone else who might listen) that "i'm _____ kind of person" -- painting with broad strokes about political interests, spiritual beliefs, compassion, and the like. but as even these broad personal identity benchmarks are changing/shifting/being obliterated, i still find myself saying, "well, if i'm NOT a ______, who am i?"

i experimented with trying to "establish a baseline" 2 years ago, when i took myself off all my meds "just to see" what i was like. the lack of major difference, one way or the other, was incredibly disconcerting. i understand now, as is pointed out in the article, that it can be very hard to understand the concept of a "baseline" when you've been altered for so long.

no great insight or understanding with this comment, just wanted to add a voice. mental health threads tend to have a lot of comments here on the blue, and i was concerned (like drjimmy11) that the "depression isn't a real disease, get over yourself!" crowd might get ugly.

thanks, as ever, to homunculus for a thought-provoking read that i wouldn't have otherwise seen.
posted by CitizenD at 4:00 PM on April 16, 2008 [2 favorites]

I think wondering "who I really am" is missing the point. There is no "who I really am" seperate from your brain chemistry. If you are clinically depressed is "who you really are" being masked? Or are you really the depressed person and the anti-depressants are masking the real you? How about anxiety and xanax?

And what about drugs like caffeine and nicotine? Stimulants change your brain chemistry. Are you unsure of who you really are after you drink your coffee? Or is that who you really are and the groggy, grumpy you from before you get your caffeine bump is the mask? Falling in love causes massive changes in brain chemistry. Are you only the real you when not falling in love? Or only when falling in love? Or what?

There is no "real you", or "real me", or whatever. We feel like there must be because it's scary to think otherwise, but I don't see any rational way of defining a default state of brain chemistry absent outside influences; those influences are always present in one form or another.

One of my favorite short stories deals with exactly this issue and gets right to the heart of it:

Greg Egan, Reasons To Be Cheerful.

I recommend it to anyone.
posted by Justinian at 4:29 PM on April 16, 2008 [13 favorites]

I forgot the important corollary: In the absence of any rational basis for defining a "real you", just find the thing that makes you happiest and go with that, whether it be stoicism and abstinence from drugs, meditation, SSRIs, drugs, love, whatever. If you're happy, who cares.
posted by Justinian at 4:31 PM on April 16, 2008

justinian, your point is well taken. my use of the phrase "who i really am" was a lazy short-cut. i do understand that identity is shaped by all the things you mention, and more. after decades of depression-fuelled "identity crises," and given that my interpretation is that no single other factor in my life has been as impactful to my lived experience as my depression/bipolar/borderline (i've had all these diagnoses, ugh), i (probably ill-advisedly) seem to allow myself to persevorate on my perceived lack-of-strong-identity.

so, i don't know how to communicate about this very well. what i *do* know, or at least feel (anecdotally), is that most other people i encounter have a much more stable sense of their identity than i seem to. that's probably just perception error on my part, as well. i don't know. i do know that the linked story resonated with me. probably because there's a psychological addiction to these antidepressants, despite the fact that i'm sometimes unconvinced of their efficacy and often ponderous about their long-term affects.

of course, when one is suicidal a lot of the time, one doesn't tend to worry about long-term affects of anything.

i look forward to checking out that egan story you referenced.

i don't mean to sound defensive here, not sure if your comment was specifically pointed at my previous comment.
posted by CitizenD at 4:42 PM on April 16, 2008

[and in response to your corollary: that's the problem...nothing seems to make me happy anymore. and that only feeds the cycle: am i incapable of feeling happy *because* of the antidepressants? are the medications "truncating" my happy emotions as well as the bad ones? is it existential despair? would things be different if i was on different prescriptions, or none at all, or different dosages, or...? i've lost the sense of what *could* make me happy (or help me to be happy, rather), so all of these other issues then get wrapped up in the reflection/analysis. and i have to tell least in my experience, losing sight of what *could* make you happy is an identity-shattering thing...]
posted by CitizenD at 4:48 PM on April 16, 2008

Artw: It's not a straw man if people really do argue that position. The reason why this is such a touchy issue is because the "by the bootstraps" folks who say that mood disorders are just a moral failing best solved by a kick to the rear are neither rare, nor soft-spoken.

CitizenD: The last time I tried to see what a drug-free baseline was like, I got about two months into it and 2/3rds of the way down when all of the really nasty symptoms came charging back. Big phone bill? Only way out is to kill myself. And no matter how hard I tried, my monkey brain wouldn't let go of it. Unable to get to sleep until 4 am because I would write, and rewrite, and revise, and rewrite a single sentence in an email sent 8 hours ago. Then sleep for 14 hours to compensate. The nervous tick came back, this time between the shoulder blades rather than the right eye. And tension headache after tension headache after tension headache, projectile vomiting headaches that didn't respond to ibuprofin (which is robbing peter to pay paul because NSAIDs feel like I downed a bottle of draino) or toxic-over-the-long-term levels of Tylenol. A conversation with someone not my partner that went over 5 minutes made my skin crawl.

It took about a month to get back to where I was feeling relatively "normal." By "normal" I mean able to function on 45mg of an SSRI a day rather than pretending to live well on > 3grams of Tylenol, a dozen antacids, and an iron will not to slit my own throat or scratch at those occasional episodes of formication. Fuck, I'll be glad if I never experience that sensory quirk again.
posted by KirkJobSluder at 4:58 PM on April 16, 2008 [1 favorite]

I was diagnosed with MDD when I was ten (although they called it Monopolar Depression then), and for the next ten years I hopscotched from one antidepressant to the next.

Prozac, Elavil, Elavil Plus: They must work for some people, but they did absolutely nothing for me. Manerix gave me wild mood swings. One doctor put me on Paxil when I was twelve or thirteen; it was new and still in trials. I became more outwardly social, but inwardly, well, it's the only time I've ever been suicidal. They don't give Paxil to kids anymore.

Talk therapy was useless for that whole period. The setup was always like this: The doctor would talk to me for a while, and then he'd send me out and call in my mother. It's funny that it never occurred to anyone how that scenario isn't at all conducive to trust, which is kind of crucial to the whole exercise; I never told any of my psychiatrists anything. They chalked up my monosyllabic responses to social anxiety or paranoia, both of which, as luck would have it, were pretty accurate diagnoses, but I'm sure there are a TON of kids who get the same treatment when there's nothing remotely wrong with them.

When I was nineteen and frustrated with the ineffectiveness of the meds, I had the doctor wean me off of them. I'd always had a lingering suspicion that the pills were doing me more harm than good. Now, in my seventh year without medication, I still don't know. When you think about it, there's really no way for anyone to know if long-term antidepressants do anything for teenagers, since they're pretty much guaranteed to come out the other end a changed person, medicated or not.

I know there are plenty of kids who absolutely, positively need medication. But I think those cases are pretty clear-cut and obvious. The common practice of doctors prescribing pills that do who-knows-what, for children with so-called "diagnoses" that are really only nebulous guesstimations, seems extremely unethical and irresponsible.
posted by Sys Rq at 4:59 PM on April 16, 2008 [1 favorite]

It's not a straw man if people really do argue that position.

It absolutly is a strawman if you paint that position onto anyone whos views you disgaree with (or think you might disagree with) and then use it to beat the shit out of them.
posted by Artw at 5:04 PM on April 16, 2008

delmoi writes "what's the harm in people enjoying life more then they otherwise would?"

I don't think there is anything wrong in being helped enjoying life or being given instruments to do that. Yet as an elder client of mine said , there are things that are just another dependecy, disguised as a bunch of "better".

She was referring to computers : while she appreciated all the opportunities and enhancements a PC can give almost anybody, she dreaded the idea of having to learn how to use effectively the PC to live well. As a frequent flier, she found herself being almost forced to use a PC to book her flights, unless she agreed with putting up with increasingly unqualified, rude and uninformative operators. She appreciated the fact that booking by PC was fast, efficient and unexpensive and definitely the way to go in the future, she definitely wasn't a luddite both in theory and in everyday practice. Yet she felt she was being pushed behind, a sort of Eco's digital divide , if you will.

She pointed me out that once, to make her "happy", all that was needed was an human being an a telephone line helping her book the flights. Now she needed to learn how to make herself happy by learning to use a computer, as the low-cost budget airlines she enjoyed traveling with offered reliable service only by WEB. She didn't complain about having to learn, as she was a perennial student, but she primarily saw layers of complication, rather then a quick "phone and ask".

All things considered, she said, what I needed was a phone number, a phone, and a competent operator on the other side, who was also likey to be a "specialized person" trained to do that well and fast. Now she needed to have a basic understanding of how computer operates, some experience, a personal computer and, more importantly, an operating computer system at the company side. She saw the phone system as incredibly more easy to operate..."just talk" she said.

Similarly, let' suppose that on kind of Prozac that is utterly harmless is discovered, with side effects so neglegibile and with a cost so low that it can be safely added to to tap water, like chlorine is today, with the effect of reducing cases of severe depression to zero and generally improving the mood of all the users. Wouldn't that rock? Few would ever argue against it, and few would ever phantom how was it possible to be "really" happy without it!

Fact is , happines is also relative to our own perception of how happy we feel we are and how much we think we should be. If being prozac-style-happy becomes the popular , both commonly and easily achievable "happines level", then some people would seek this level of happines also because everybody else seems to be doing so and enjoying it, so why shouldn't everybody else?

Yet, that happines level would depend on a pill that you just don't know how to manufacture by yourself (yet), creating a dependecy.

I'd rather have a Dabbawala system of happines, something that doesn't depend on advance chemistry and kissing Lilly ass.
posted by elpapacito at 5:12 PM on April 16, 2008

I suppose should point out (lest I be lumped in with the bootstrapping New Agers) that I do very much believe Depression is real, as I'm still dealing with it on a day-to-day basis.
posted by Sys Rq at 5:18 PM on April 16, 2008


Cool, it has a name.
posted by synaesthetichaze at 5:50 PM on April 16, 2008

Artw: It absolutly is a strawman if you paint that position onto anyone whos views you disgaree with (or think you might disagree with) and then use it to beat the shit out of them.

And um, where did I do this? I've not painted that position onto anyone participating in this thread. Nor did I paint that position onto anyone who has not communicated that position to me. I'm a bit baffled as to why you are taking offense over a post that has apparently nothing to do with you at all.

elpapacito: Yet, that happines level would depend on a pill that you just don't know how to manufacture by yourself (yet), creating a dependecy.

But it's not about happiness. I'm not happy now that Artw decides to take offense over words that have nothing to do with him. And I'm not happy that you are buying into the rhetoric that this is about happiness.

It's about finding a treatment to relieve physical and cognitive symptoms that are very real, very debilitating, and over long periods of time, potentially fatal. Those symptoms were not responding to the multiple non-drug treatments I was engaged in at the time. So I made the decision that the risks and side effects of drug dependency were much less than the long-term risks associated with the disorder.

And I was self-medicating before with even worse over the counter drugs that had pretty much stopped working at safe levels. The cognitive effects of prescription opiates (those rare times I could get them) were even harsher.

I'd sell my soul (metaphorically speaking) for relief from perpetual headaches and acid reflux, compulsive behavior, panic attacks, paranoia, sleep disorder, suicidal obsession, annoying muscle tics and the rare but disturbing ants under the skin. $70 a month and some edge off my libido? Chump change in my opinion.
posted by KirkJobSluder at 6:24 PM on April 16, 2008 [1 favorite]

KirkJobSluder-- good point: that the issue here is not "happiness" (at least, not for people suffering from serious mood disorders). . . I often compare chronic depression to chronic pain. I have never heard arguments against pain meds for chronic pain sufferers. I think this is due to pervasive cultural misunderstanding about depression, which includes the tendency to lump together a whole spectrum of experiences. We're not talking about "the blues" here. And we're not talking about personal "baggage". Rather, the type of long-term, serious depressive disorder that merits psychiatric treatment, in my opinion, has a marked physiological aspect and can profoundly interfere with an individual's capacity to work and to maintain relationships--and can be fatal. It's a disease. On the other hand, I think it's obvious that big pharma is happy to sell pills to anyone who'll buy 'em--so I'm sympathetic to suspicions that these sort of meds are overprescribed. . .

Summing up, I think step one in moving towards a meaningful public discourse on the topic lies in unpacking an oversimplified, singular meaning of "depression". When we can see the broader spectrum of these experiences more clearly, we can better discern the appropriate use of psychiatric treatments.

PS--the key message of the article--lest this be overlooked in the current discussion--is a call for better and more long-term clinical study of these meds; I couldn't agree more (but long-term studies are irrelevant to big pharma marketers, so don't hold your breath).
posted by flotson at 9:09 PM on April 16, 2008

I have never heard arguments against pain meds for chronic pain sufferers.

Believe me, I agree with your main point. But if you haven't seen the insane hoops that chronic pain sufferers and doctors who treat them have to jump through and the stigma they face, you haven't really been paying attention.

At least nobody gets sent to jail for treating depression. Not so for treating chronic pain.
posted by Justinian at 9:23 PM on April 16, 2008 [1 favorite]


I was unaware of the issues surrounding chronic pain and opioid therapy, but it didn't take me long to find, for example, this. Thanks for bringing this to my attention.
posted by flotson at 10:01 PM on April 16, 2008


I hate for this to be my second post here ever, but I feel it needs to be said because I see this kind of attitude a lot:

Antidepressants are not magical fucking happy pills.

They won't do a damned thing to make you happy. What they will do (used properly) is, for instance, keep you from feeling like sticking a gun in your mouth and pulling the trigger is a pretty dandy idea on a regular basis. They'll let you get up off the couch to do such monumentally difficult things as a single load of laundry because the overwhelming feeling of despair will be held at bay. As my wife puts it, "They turn 'Why bother?' into 'Might as well'."
posted by Mr. Bad Example at 3:03 AM on April 17, 2008 [10 favorites]

I don't want to be lumped into the "neo-puritan" camp, but one thing that bugs me about this is that antidepressants are frequently justified because they reduce the risk of suicide. I'm willing to accept, at least for the purposes of argument, that this is true. But there are millions upon millions of people on these mood-altering drugs (11% of women and 5% of men, so like 20 million or so). Which suggests that suicide prevention isn't really what's going on, because suicide is incredibly rare, as in a rate of 11 per 100,000, orders of magnitude smaller than the number of people on the drugs. So while it's true that suicide is the 3d most-likely cause of death in people ages 15-24, that isn't because suicide is common in that age group (people under 24 are the single least likely group to commit suicide), it's because the three leading causes of death--heart attack, cancer, and stroke--are almost never found in young people, magnifying the effect of suicide in the stats.

Read the first link, above. It's instructive. Some stats:
- 43% of prescriptions are for people with no diagnosed condition
- Though about 10% of the country is on anti-depressants, only 3% receives some form of therapy.
- Odds are favorable that any given person on antidepressants asked their doctor for the drug, rather than having their doctor suggest it.
- Odds are also favorable that it was a family doctor, rather than a mental health specialist, that prescribed the drug.

None of those things cut towards the idea that these drugs are actually being used to combat real mental health problems, real as those may be.

Because there seems to be a problem with the traditional justification for these things, I think it's likely that there's a suppressed motivation going on here somewhere. Maybe it's just greed on the part of Big Pharma. That's certainly plausible. But I tend to suspect that there's something deeper there. Major Depression is a real problem, I'm willing to grant that. But the vast majority of people, even depressed people, do not commit suicide. If every single person who committed suicide was on medication, we'd still be looking at about 0.175% incidence rates. But because the risk of suicide is so vanishingly small, it seems to me that people aren't really taking it for that reason, but because they want a happy pill. I know perfectly well that the drugs don't work that way, but a basic lack of understanding about how drugs operate never stopped the American public from wanting to take them. Might the vast upswing we see in the consumption of these drugs be attributable to the fact that taking a pill that "makes you happy" is a lot easier than realizing that you actually have non-mental-health problems?
posted by valkyryn at 5:30 AM on April 17, 2008 [1 favorite]

valkyryn: No, it's not just about suicide. In fact I will go out on a limb and say that it is not at all about suicide.

Suicides are much more often committed by Manic Depressives (aka Bipolar), who are usually prescribed stronger things than SSRIs.

Sufferers of Major Depressive Disorder rarely commit suicide, but that's not necessarily because of a lack of desire. They (we) might seriously contemplate it, but usually there are enormous motivational roadblocks. "Why bother" is a two-way street in that regard. You say, "the vast majority of people, even depressed people, do not commit suicide," as if to suggest it's not a problem if they're not in mortal danger. To that, I say this: It's awfully hard to kill yourself if you can't even bother to get out of bed. MDD may only rarely be life-ending, but it is certainly life-crippling and potentially life-ruining.

Your main point though -- that people are going and asking their doctors to prescribe, as Mr. Bad Example put it ever-so-elegantly, "magical fucking happy pills" -- is entirely valid. But that's more of a symptom of advertising doing its job. ("Ask your doctor about...") Curious patients, ignorant doctors, and of course the greedy pharmaceuticals industry are to blame for that, but I think most of all it's the government regulators who allow such advertising in the first place.
posted by Sys Rq at 6:13 AM on April 17, 2008

I'm not diagnosed with anything and I'm not taking any meds for anything, but I do sometimes get kind of glum and hopeless. Maybe it's an artist thing. At those times, if there was an inhaler I could snort, pill I could pop or a beverage I could drink that would perk my ass up, I'd take it. When it gets too dark in the house to read, I turn on a light. I wouldn't mind the chance to turn up my mood similarly -- in a legal, inexpensive and long-term harmless way.

And sometimes, just like when the room gets dark and I leave the light off so I can appreciate the approach of dusk, I wouldn't take the drug and would explore the little pool of gloom.

The difference is one of control.... darkness isn't so bad if you know where the light switch is.
posted by seanmpuckett at 6:27 AM on April 17, 2008 [1 favorite]

Seanmpuckett, I would too, and I happen to be clinically depressed. You are talking about a totally separate thing, but frankly, I am so sick of despair that I would gladly vivisect it from my life.

On another topic, I seriously doubt people would stop making art if we were all happy. It would just be happy art. After being in treatment for a decade, I've been recently shocked to discover that there is happy music out there that is good. My college radio station plays a lot of happy hipster stuff, and it's fun to listen to. I'm not about to retire my copy of Converge's Jane Doe just yet, but there is good art out there that didn't come from despair.
posted by wires at 7:15 AM on April 17, 2008

Sys Rq, I'm ambivalent on many mental-health diagnoses in general, but I've no problem recognizing that there are in fact people who suffer from symptoms which are categorized as MDD.

But I just don't believe that there are 20 million Americans that suffer this way. Unless one subscribes to the philosophy that it's perfectly fine to use chemicals to modify one's mood at will--a philosophy I reject--there's a problem with the idea of drugs designed for a set of dire psychological symptoms being prescribed at the drop of a hat when, say, you break up with your boyfriend.

This would be a launching point into the kind of moral and philosophical questions posed by the article in the main post: exactly what effect, if any, does the consumption of mood-altering chemicals have on one's identity? I tend to believe that though emotions are completely unreliable in revealing truth, they generally do mean something, even if that something isn't particularly profound. As such, I believe that choosing to ignore those things is, most of the time anyway, a problem, particularly if it's something you do on a regular basis.

I'm not saying that there's no place for psychoactive drugs. If I have a particularly bad day at work, a shot or two of bourbon is good to take the edge off. But doing that all the time is called "alcoholism." There's a difference between saying "I know what's bothering me, I'm dealing with it, my emotions are going nuts tonight, they'll be better in the morning, so I'm gonna have a drink while that sorts itself out." But it's another to say "I don't want to deal with this, I'm gonna drink." Though antidepressants don't produce inebriation, I'm not sure there's a moral difference in terms of chemical dependence. "That's the whisky talking" is a short-hand of saying, "He's taken a psychoactive substance and isn't himself." Why isn't "That's the Zoloft talking" essentially equivalent?

That's not a rhetorical question. I'm actually interested in hearing someone explain the difference to me.
posted by valkyryn at 7:17 AM on April 17, 2008

The difference is that "I've had a bad day at work" isn't even in the same ballpark as the kind of depression antidepressants are designed to treat. It's barely even the same sport. Real honest-to-god depression is a feeling that can be rendered into words briefly as--regardless of external stimuli or circumstances--"Nothing is ever going to be okay again, and there's not a damned thing I can do about it". You don't know you'll be better in the morning, and as far as you can tell, it's not going to sort itself out at all. Ever.

For those who need them (and I can't emphasize that enough; I agree they're overprescribed), they don't fundamentally alter identity--they allow people to have an identity beyond "inert mass". Administered properly, they enable depression sufferers to get up and begin dealing with their problems.

As for the "moral difference", as far as I'm concerned (again, assuming proper diagnosis and treatment), it's about as morally equivalent to alcoholism as insulin therapy is for diabetes.
posted by Mr. Bad Example at 8:29 AM on April 17, 2008

You're suggesting a difference in kind, not degree, between "true" depression and what I describe above. That's contestable, but I'm willing to accept it for the purposes of argument. My question is this: what about people who don't suffer from "the kind of depression that antidepressants are designed to treat"? As I said, I don't believe that anywhere near the 20 million people currently on antidepressants experience those symptoms. Is there a difference between that category of people taking Zoloft and taking Jack Daniels? If so, what is that difference?

And why do we recognize that someone who is drunk is not really themselves but don't seem to be willing to recognize the same thing for someone on prescribed psychoactive meds? Both are instances where, motivated by the ingestion of chemicals, people do things they wouldn't usually do. The fact that the former creates an arguably "negative" change and the other an arguably "positive" one doesn't strike me as being a particularly compelling reason. Shouldn't it cut both ways?
posted by valkyryn at 8:41 AM on April 17, 2008

As an addendum, I'm not interested in the distinction between "You aren't yourself, and that's a bad thing," and "You aren't yourself, and that's a good thing." Though alcohol is frequently associated with the former kind of change, I know plenty of people who are significantly more pleasant individuals with a few drinks in them. The kind of change isn't as interesting to me as the fact that everyone recognizes that there is, in fact, a change. We say that they're acting "out of character," implying that there is an underlying, default state for that person which is suppressed/altered by the booze and which will reassert itself when they sober up.

Why don't we seem to think the same thing about Prozac?
posted by valkyryn at 8:46 AM on April 17, 2008

valkyryn: Who says they are "out of character"? If drunks become someone else when they have a few drinks, perhaps I should drink more often in the hope that I'll become someone with a little bit less debt. Perhaps I'm skeptical on this because I've never met a person who became a radically different person while drunk.

And do you make the same argument about about things like lunch and tylenol? Because I know nothing gets me cranky quite like missing lunch, or having a headache.
posted by KirkJobSluder at 9:05 AM on April 17, 2008

Which, to explain my bias here. The whole notion of a "true self" that can be rendered inauthentic by whatever gestalt of chemicals that happen to be flowing through our bloodstream from glucose to oxytocin, to alcohol, to Prozac strikes me as a bunch of voodoo ghost-in-the-shell mythmaking.
posted by KirkJobSluder at 9:12 AM on April 17, 2008

Valkyryn: I'm not sure there's a moral difference in terms of chemical dependence.

Well, there you go. What do morals have to do with chemical dependence? There is no moral component to taking a pill that improves your life whether it improves your life by lowering your blood pressure, make your shitty insulin work better, fights your HIV, selectively inhibits your serotonin reuptake, or stimulates your central nervous system like caffeine. If you like the way you feel after you take a pill better than the way you feel before you take the pill, why the heck do morals enter into the equation?

"That's the whisky talking" is a short-hand of saying, "He's taken a psychoactive substance and isn't himself." Why isn't "That's the Zoloft talking" essentially equivalent?

I thought this question was the whole point of my post earlier in the thread. There is no such thing as "that's not him talking". We're always modifying our brain chemistry in one way or another; there is no vanilla unmodified "us", as scary as that may be to think about. You are making a choice about your brain chemistry whenever you decide to take an SSRI or not. You are making a choice about your brain chemistry whenever you decide to drink that coffee or not. You are making a choice about your brain chemistry whenever you decide to exercise or not or go outside in the sunlight or not.

It's all the same as far.
posted by Justinian at 9:26 AM on April 17, 2008

The whole notion of a "true self" that can be rendered inauthentic by whatever gestalt of chemicals that happen to be flowing through our bloodstream from glucose to oxytocin, to alcohol, to Prozac strikes me as a bunch of voodoo ghost-in-the-shell mythmaking.

Next time I'll just let KirkJobSluder talk and I'll shut up, because this was what I said only better.
posted by Justinian at 9:27 AM on April 17, 2008

It's all the same as far.

I'd clame English is a second language except

A) It isn't.

B) People for whom English is a second language write better than that.

I meant "It's all the same."
posted by Justinian at 9:28 AM on April 17, 2008

I want to add that the whole notion of which conditions result in "authentic" demonstrations of personality seems to be decided by culture. "That demon whiskey," as an example, is very much an American protestant thing. (And I've heard at least one very good argument that American prohibition was driven by a fear of immigrant socialism and Catholicism.) If you read Lukyanenko's outstanding Night Watch urban fantasy series, almost all of the important episodes of male emotional bonding and intimacy involve copious volumes of alcohol, and light wizard Semyon is given multiple opportunities to praise vodka binges as an essentially Russian bonding ritual.

In "dry" American contexts, the mood-altering drugs of choice is caffeine and sugar (and as a transplanted Hoosier now in the deep south, the combination of the two is hard to appreciate).
posted by KirkJobSluder at 9:52 AM on April 17, 2008

So essentially, you're all saying that there really isn't a difference, but that this isn't a problem because neither is a problem, because there isn't a "true self" to suppress to being with. That's certainly one way of resolving it. I just don't think it's a very interesting one.

Let me re-ask the question this way: If individuals do have some kind of fundamental character, if human nature does, in fact, go beyond chemistry--just assume for the purpose of argument, if you would, I'm not arguing one way or the other--is there a way of describing a difference between alcohol dependency and Paxil dependency in people who do not have diagnosable MDD?

I recognize this may stretch the boundaries of MeFi's entrenched empiricist materialism, but I still think it's an interesting question.
posted by valkyryn at 10:00 AM on April 17, 2008

KirkJobSluder, I'm with you on the distinctly American origins of teetotalism and Prohibition. But the idea that alcohol can be a problem goes back way farther than that. Islam has an almost categorical prohibition against consumption of alcohol, and references to the problems associated with drunkenness show up in the Old Testament. Note that both of these traditions maintain that human nature is more than chemistry. If you believe that human character is merely a function of body chemistry, I really can't see much significance in deciding what chemicals are in play either.

I definitely have met people who experience pronounced personality changes when they drink. I'm not talking about multiple-personality disorder or anything like that. But I know one person who is usually about the friendliest guy you're likely to meet who becomes incredibly belligerent after about three beers. Someone else who is wound up so tight they don't like moving their hands more than eighteen inches from their torso absolutely loves dancing, but only after a few martinis. One can certainly argue that this is merely allowing different aspects of personality to come to the fore--I think that's probably what's happening--but the change is pretty dramatic either way.
posted by valkyryn at 10:14 AM on April 17, 2008

valkyryn: I think that the mood-altering effects of Paxil when prescribed indiscriminately are not very consistent or robust compared to the mood-altering effects of alcohol. And I think with any chemical dependency you need to weigh the risks and benefits. I don't drink alcohol very often because I have multiple factors that put me at a higher risk of serious complications. I take an SSRI because the risks and side effects are mild in contrast to the symptoms I was experiencing when I started.
posted by KirkJobSluder at 10:16 AM on April 17, 2008

KirkJobSluder, so if I understand you correctly, the only difference between booze and prescribed SSRIs is that the latter are more subtle?
posted by valkyryn at 12:45 PM on April 17, 2008

Yes, and the only difference between booze and coffee is that the later is more subtle. (Oh, and the fact that one is a depressant and one is a stimulant, and they have negative effects on different organ systems, and...) *snerk*

You seem so eager to try to shoehorn both into the same kind of moral category and corner me into a blanket statement. And I'll agree with you that they do both fall into the same moral category of substances that should be considered carefully on a case by case basis, considering the risks, benefits, and side effects in relationship to individual medical history and needs.

If in fact there was such a condition as knurdness in which the benefits of alcohol consumption outweighed the risks of chronic alcohol use, then by all means I don't think there is a moral fault for such an individual to drink. And I think that responsible people for whom alcohol is a low-risk drug should make the choice to drink what they want.

And in fact, there is also some fairly strong (but much disliked in the U.S.) research which says that the safest treatment for opiate addiction may be long-term supervised medical use of IV heroin or morphine. Both of these drugs are relatively safe and dirt cheap to produce at licensed and inspected facilities, and have lower long-term risks than either methadone or street drugs. I wouldn't consider it a moral failing for people to receive such supervised treatment.
posted by KirkJobSluder at 2:51 PM on April 17, 2008

In fact, IMO the choice to attach a moral dimension onto chemical dependency is one of those almost-trivial banal everyday evils that add up to a whopping load of preventable human suffering due to bad drug laws, and a host of problems within medical systems resulting in people not getting the care they deserve.
posted by KirkJobSluder at 3:51 PM on April 17, 2008

Someone who insists that you go off antidepressants in order to conform to his doctrine of existential purity is a torturer, period.

It isn't hacking your way through Jean-Paul Sartre's philosophical writings so you can feel smug about enduring life's bleakness.

It's raw, dead, meaningless emotion that expands to fill all available space and blocks any other emotions or information from reaching you.

It's not situational; it's not "my job / marriage sucks and I'm lonely." You could have all possible advantages, and the emotion would still crush you with the weight of an elephant.
posted by bad grammar at 4:16 PM on April 17, 2008

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