Books: Peace in a pill

My wife is prone to occasional panic attacks. In crowded movie theaters or driving on busy freeways, Jennifer may be nearly overwhelmed with an urge to escape. Her heart races, her vision blurs, and she fears she will faint. Some months ago her doctor offered to prescribe something to help her manage the problem. It reflects how radically society has changed that neither Jennifer nor I blinked at the notion that fear could be categorized as a disease and treated with a pill. In The Antidepressant Erapsychiatrist David Healy (University of Wales College of Medicine) traces this shift in Western medicine in a detailed examination of the history of "psychopharmacology" and antidepressants in particular. The book's excruciating clinical detail and dense prose makes it a tedious haul for the lay reader. But the book's wary observations should be heard above the hoopla over Prozac and the other "magic bullets." For example, pharmaceutical companies help create markets for their products by fostering the idea that mental illness is everywhere. At the turn of the century, depression was not considered an illness, and even in 1960 drug company executives were unsure there was a market for antidepressants. Then in 1961 Merck distributed to therapists worldwide 50,000 copies of a book called Recognizing the Depressed Patient, helping turn its newly released amitriptyline into the first big-selling antidepressant. "Merck not only sold amitriptyline, it sold an idea," writes Dr. Healy. Dr. Healy also debunks the public perception that for every mental illness there is or soon will be a designer drug to cure it. Today's drugs neither work for just one disease (they have a range of effects) nor are they effective regardless of other factors in the patient's life. In fact, nobody knows for sure exactly how or why antidepressants work. Meanwhile, evidence that argues against the theory and practice of the day tends to be ignored. "There has been astonishing progress in the neurosciences but little or no progress in understanding depression," he writes. Most of Dr. Healy's warnings seem neatly illustrated, at first, by Lauren Slater's bestselling Prozac Diary. The short, evocative memoir describes her decade on Prozac, when she was transformed from a 26-year-old, unemployed, neurotic patient afraid to leave her house into a therapist with a Ph.D. in psychology. Ms. Slater relates the strange and frightening clarity of being normal-living without voices in her head or a compulsion to count-as well as the downsides of long-term Prozac use: dependency, sexual dysfunction, and "Prozac poop-out." "Behind every crooked thought lies a crooked molecule," promised the Prozac promotional pamphlets, and initially the drug worked so well that she believed them. But eventually she concluded, "So long as I could choose anything at all, I was more than my chemicals, more than my cure." Christians wholeheartedly agree. A science that rejects or ignores the soul (Dr. Healy prefers the latter option) cannot explain why chemical processes in our brains affect mood nor define how physiology relates to personality, circumstances, and the knowledge of our Creator. This is largely why Jennifer decided not to have her prescription filled. Then again, my wife also knows that we live in a fallen world and sometimes medical science can help when our bodies malfunction. For now, the prescription still waits in a side pocket of her purse.