And what constitutes addiction? Most of us are dependent on something, and in the last few decades people have learned to define themselves as gambling addicts, sex addicts, food addicts, exercise addicts, television addicts, and so on. For all the claims about how "nonaddictive" current mood medications are, the mounting evidence suggests otherwise, since most long-term users feel dependent on them and cannot easily stop using them. And although the American Psychiatric Association says withdrawal effects like those experienced by people who abruptly stop using SSRIs are neither necessary nor sufficient for a diagnosis of "substance dependence," such symptoms traditionally were seen as the hallmarks of addiction.
Furthermore, for all my commitment to continued sobriety, I'm far from "drug free" today if you count caffeine, as we should, as a mood-altering substance. I carry a Thermos of strong tea with me every day, carefully doling out my cups to avoid getting a pounding headache. How is this different from carrying a small flask of medicinal whiskey? Aren't caffeine and nicotine as addictive (if addiction exists) as alcohol and heroin, if not more so?
So are popular products like Prozac, Paxil, Zoloft, Xanax, and Celexa best understood as drugs that change us or as medicines that cure us? What makes them one or the other, beyond social convention and a doctor's prescription?
There's another twist. I have spent most of my life learning how to cope with my moods. I'm deeply invested in figuring out how to glean something useful from my depressions as well as learning how to manage and make the most of my periods of elation. I have found ways to minimize the damage and disruption that my periods of gloom and nameless grief can cause. My moodiness is -- and has always been -- my "self." Perhaps there's some benefit to living with, rather than medicating, my temperament. I've certainly learned a lot about the range of ways reality can feel. What does it mean for me to start defining myself as "mood-disordered" or "chemically imbalanced" or "borderline personality disordered" or "ADHD"?
By whose story should I live? Am I simply an especially emotionally responsive person, or have I squandered most of my life trying to compensate for biological dysfunctions that modern medicine now allows me to correct?
When it comes to deciding if I should medicate my moods, I am, as we say in my academic field, situated at the intersection of conflicting discourses. But this is true for all of us, with or without mood swings, possible addictions, or persuasive physicians. The invention and marketing of medications that seem to alleviate symptoms of depression and anxiety make it possible for every one of us to choose to take what some would call drugs and others would call medicine, to become (depending on your point of view) an addict, or your old self, or even a preferable self. We are all faced with this choice, as well as many others. How do we choose well?
Three overlapping but conflicting discourses operate whenever we think about taking pills to influence our emotions -- discourses of addiction, of neuroscience, and of mental health. Each of these has its own opposition, a discourse that challenges all its premises. If I want to choose wisely about taking or not taking antidepressants, I have to find my way not only through each of these three discourses, each with different evidence and assumptions, but through three additional discourses -- the ones that challenge that evidence and those assumptions.
This is a daunting project, but I think it is fairly typical of what modern life asks of each of us. We are always being asked to choose among conflicting stories. The dominant challenge of the modern age is figuring out how to make wise choices.
Might as Well Get Juiced
Most of the stories we are told serve some purpose: to sell a product, support a belief, sustain a social position. The first thing to ask of any contemporary story is the obvious one: Who benefits? In a mass-mediated world, many dif-ferent self-interested groups are offering us stories we seem to want to hear. In the case of mood medication, the pharmaceutical industry is spending and making stunning amounts of money selling us a story of "chemical imbalances" that their product can safely correct. The recovery community and the mental health industry are both telling us a story of epidemic levels of disorders that require their particular kinds of treatment. And the medical establishment believes it is now better able to "do something" for the many patients who are stressed, anxious, and unhappy.
Those who take mood medication often report that they are now much better able to cope with their stress, anxiety, and unhappiness. They are grateful, even if they are simultaneously uneasy about relying on pills or about various side effects. As Peter Kramer's 1993 bestseller Listening to Prozac describes so compellingly, many even celebrate the "new self" that cosmetic psychopharmacology seems to make possible. But even the most fervent celebrators of the possibilities of self-enhancement through medication express ambivalence about going too far with self-transformation. We may have the chemical ability to create and sustain ever more resilient and productive and desirable selves. Should we take that option?
If we are surrounded by contradictory stories, whose stories count? Clearly, we have every reason to be skeptical of the stories told to us through advertising. Is this also true of the stories told to us by politicians and journalists? What about the stories told to us by the medical community, grassroots organizations, teachers, religious leaders, scientists, family members, or even those that emerge from our own gut? People with good intentions and no desire to make money from us can still have a vested interest in persuading us to their way of thinking. But how can we know if it is also in our interest?
It's Not Easy
Because it is all too easy to fall for plausible but damaging stories, we need to find ways to figure out which stories to believe. We aren't as good as we think we are at using evidence to make wise decisions. As Michael Shermer points out in Why People Believe Weird Things (1997), we fall into logical fallacies and superstitious beliefs with amazing ease. In his analysis of pseudoscientific thinking, Shermer identifies a number of characteristics that bolster faith in our current practices of medicating depression and anxiety.
For example, we are too easily persuaded by anecdotal evidence, by scientific language, and by bold statements, all of which have abounded in media coverage of mood medication. I've reviewed news coverage of mood medication since the early 1990s, and Shermer's caveats describe perfectly their heady mix of personal success stories, accounts of scientific breakthroughs, and hyperbolic language of personal, social, and cultural transformation.
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