So: My own sense of the neurochemical evidence is that the medications so many are taking are far riskier and offer far less benefit that we now realize. So I believe in the "counter-discourse" of neuroscience -- that the dominant serotonin story is misleading and potentially dangerous, and that the critique of the dominant story has it mostly right. The model of chemical imbalance sells drugs but doesn't have much to do with how brain chemistry actually functions in mental states. We still know very little about how (or even if) particular brain chemicals connect with particular moods, feelings, or perceptions, and neuroscientists are constantly revising their always-contingent models.
Evidence is accumulating that suggests much of the anecdotal evidence of successful mood alteration may be due to a placebo effect. Some recent controlled studies do not consistently show positive effects from these medications, and other studies suggest that side effects, including suicidal thoughts and actions, are more prevalent than previously publicized. The effects of the medicine on the brain may be structural, long-term, and not very beneficial. To me, that sounds like an unacceptable level of risk.
But maybe I really do have something wrong with my brain, and my heavy drinking in adolescence and early adulthood was my feeble attempt to deal with a condition these new medications could finally treat. Maybe my belief that I'm selling out my sobriety by taking legal drugs is ludicrous. There are certainly compelling critiques of the recovery industry and 12-step programs (by, among others, reason contributors Thomas Szasz and Stanton Peele) that would suggest I have been propagandized and brainwashed. Critics of A.A. and related programs rightly note the ideological rigidity, lack of empirical evidence, cult-like qualities, hypocrisy, illogic, and cliché-ridden aspects of what has been called "the recovery movement." Have I fallen for an ideology that means I "keep coming back" for lies?
I am also plenty skeptical of the late-20th-century boom in insurance-funded rehabilitation institutions, and I am very much opposed to requiring those arrested for drunk driving to attend A.A. meetings or go into treatment if they want to avoid jail. I get uneasy around the clichés and psychobabble that flourish in some recovery settings. But I am also impressed by the democratic, self-supporting nature of A.A. and inspired by the sanity and wisdom of the people who sustain it. So in relation to this discourse, I (in the language of recovery) take what I need and leave the rest, and I am grateful to be able to hang around with people committed to recovery discourse. Nonetheless, I don't really believe alcoholism is a disease. Taking one drink or pill might not lead me back into active alcoholism, but it's just not worth the risk to me. So I'm choosing to live by the alcoholism discourse, even as I doubt many elements in it and agree with many elements of the critique of it.
You Can't Always Get What You Want
One of the reasons I can do this is that I find much of the dominant mental health discourse so unconvincing. I used to think that we'd made great strides in treating serious mental illnesses such as schizophrenia, and that we are now making progress with anxiety and depression. Not any more; the history of the treatment of mental illness is an appalling one, up to and including the present day. If you doubt this, read Robert Whitaker's 2002 book Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, and learn how the mentally ill have suffered horrible indignities and permanent brain damage thanks to mainstream mental health practices. He points out, for example, that the shuffling gait, jerking arm movements, and vacant facial expression we now think of as symptoms of schizophrenia are due, in large part, to dopamine deficiencies caused by current medication, not the condition itself.
I've also read the academic literature on how the treatment of mental illness is actually a form of social control for deviant or disruptive behavior. I find these accounts convincing, especially in relation to women. The history of the treatment of women's depression shows how historically familiar the current reliance on medication is. Women have long been silenced and dismissed through labeling. When people seek to explain the alleged "epidemic" of depression, they don't look to the possibility of social causes and therefore the need for social changes, but instead focus on controlling and medicating the people who display disruptive symptoms.
Critics of modernity, from the Frankfurt School to the post-structuralists, point out that we can be convinced to become willing participants in our own oppression. They argue that capitalism, patriarchy, and modernity convince us to become what these systems need us to be. Even though I'm less worried about these systems than they are, I think there is at least some value in constant skepticism about the importance of being "normal" if "normal" means being docile and tractable.
In fact, I've long been drawn to the grouchy and the eccentric. There is something enlivening about being a crank, and something scary about how easily difference is labeled pathology these days. The relentless emphasis on "adjustment" that sociologists criticized in the 1950s is now so commonplace as to be almost invisible. But what's so great about being adjusted to systems I don't always believe in or support?
So here's where I end up: Mood medication is too risky for me to take or want to give to my kids, although I'm happy to let other people take whatever legal or illegal drugs they want as long as they realize what they are doing. I don't want my friends, family, or fellow citizens to get sucked into believing they are treating a chemical imbalance with medicine when what they are actually doing is taking drugs to feel better.
I think we make too much of being "normal." Variety and difference are good things. I want people to stop falling for stories about diseases and imbalances that make them eager consumers of expensive, possibly dangerous, and possibly ineffective drugs. Taking drugs to feel better may be just fine for you, but I am betting that the option is particularly dangerous for me. So far, living without most drugs (I'm keeping the caffeine) has worked out pretty well.
You Can Make It If You Try
If Shermer is right, I am most vulnerable to being duped when I believe that I've got it all figured out. The ideologically rigid are the easiest to fool. So in order to make wise decisions, I must do my best to stay open to alternative discourses, to what in scientific inquiry is called disconfirmation, while recognizing that my best bet is to put all easy answers to the test.
Because, at least for me, the easiest answers are the riskiest ones. For now I'll stick with my challenging but familiar anxiety, buoyed by knowing that in previous times and other cultures, worry and melancholy were valued differently. I'll accept that my perspective is not currently the dominant one, and that I may have to turn to historical or marginal or even discredited discourses for support. I'll ally myself with the difficult and eccentric over the easy and productive. I'll remain wary of the long-term effects of drugs that are invented and marketed to treat conditions that I think are just convenient and self-interested renamings of the human condition.
I'll also keep using some of the language of addiction, even though I don't believe alcoholism is really a disease. I'll use it because I gain direct benefit from following the metaphor, and because it gives me a way to make sense of how much different and better my life is now that I neither drink nor use drugs. I also choose to continue with the discourse of addiction, in spite of the compelling arguments about its limits and fallibility, because it allies me with people who are living in ways I value.
In this way, then, I am making the most of what modern life does so well: democratizing knowledge. More and more of us have access to multiple, contradictory ways of defining the world. We have more freedom to choose our beliefs than anyone has ever had before, but this increasing freedom comes without guarantees. We must realize that truth does not automatically emerge in a free marketplace of ideas. In today's mediated and self-interested marketplace of discourses, we each need to sort out our truths with diligence, skepticism, and persistence.
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