The first time I did heroin, it was a Listening to Prozac moment. Like the patients that psychiatrist Peter Kramer describes in his 1993 book, I felt the way I wished to be, but better than I'd thought possible.
Moments before, I'd been insanely jealous: I'd found out my boyfriend had been with another woman. I was shouting at him in a grotty New York welfare hotel. I was filled with self-hatred. I'd been suspended from college because of my involvement with cocaine. I thought I had ruined my life. I was about as miserable and low as could be. And then I wasn't.
I was sitting in a dingy room with peeling paint and crooked furniture. My boyfriend and the couple who lived there desperately wanted me to shut up: He had large quantities of cocaine, they had large quantities of heroin, and neither wanted to attract attention. I'd always resisted heroin because from what I'd read, I knew I'd love it. But my anger got the better of me, and I impulsively snorted the huge line they offered in the hope of quieting me.
Suddenly every atom of my being felt nurtured; every ounce of my essence felt well and light. My jealousy no longer bothered me. I also felt very nauseated--but didn't mind. Nothing could touch me. If I'd been able to feel even close to this naturally on even a semi-regular basis, I thought, I'd never have gotten into such trouble. For once, I wasn't a raw nerve, vulnerable to every tiny stimulus. For once, all the voices in my head that said I was worthless, that told me I was irreparably selfish and vile, had shut up. For once, I felt everything would be OK.
Needless to say, I soon added heroin to my cocaine habit. Although most people don't respond to opioids with the kind of rapture I felt, for me it was love at first sensation.
During the next three years, I deteriorated rapidly, to the point where I found myself injecting both cocaine and heroin up to 40 times a day, broke, and begging a man I detested for heroin. I knew then that I had to stop. The impulse I had to try to seduce him to get the drug broke through my rationalizations about "not really" being an addict. But when I quit heroin that day at age 23, having asked my parents to take me to a hospital detox program for help, I thought I was doomed for life to my vicious internal milieu.
Fortunately, through 12-step programs, I was able to dramatically reduce the crime rate in my mental neighborhood. Using techniques they share with cognitive therapy, my groups taught me, for example, that when I thought others didn't want me around, that was my own, possibly flawed perception--not necessarily the truth of the situation. By behaving like someone I would want as a friend and cutting off the internal debate over whether or not this was "authentic," I was able to gradually stop torturing myself. By doing estimable actions, I gained self-esteem. This made escape with drugs much less attractive.
But these cognitive techniques did not eliminate my bouts of depression, during which all that self-hatred would return furious as ever--and during which I was unable to feel any joy or relief. Twelve-steppers insisted that pain, as the founder of Alcoholics Anonymous put it, was "the touchstone of all spiritual progress," that my depression was telling me something I needed to hear.
No Pain, No Gain
Few would dispute the notion that painful experience can build character, just as stressing muscles by lifting weights increases strength. But it's also clear that most people most of the time prefer to avoid pain. The tension between these facts has led to a curious situation in mental health: Unlike in any other area of medicine, treatments that reduce pain and suffering, rather than being welcomed as miraculous breakthroughs, often are denigrated as "quick fixes." They're viewed as band-aids that cover up, but do not solve, the real problem--only marginally more acceptable than illicit drugs. "I oppose the use of heroin for the same reason I oppose the use of Prozac," the psychologist Jeffrey Schaler writes in his 2001 book Addiction Is a Choice. "I think relying on these is an existential cop-out--a way of avoiding coping with life."
Peter Breggin, a longtime critic of psychiatry and author of the 2000 book Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications, expressed a similar sentiment in a 1994 Psychology Today article. "When so many Americans feel depressed and hopeless," he wrote, "we are dealing with a social phenomenon. The very idea that drugs are the answer suggests a moral, psychological, or spiritual vacuum." From this perspective, psychiatric medications treat symptoms, not causes. Unless someone is getting to the root of the problem with talk therapy, according to this view, drugs are anesthetics that kill pain and temporarily improve function but allow patients to avoid necessary emotional struggles.
The influence of this critique was illustrated by the cover story of the November 2004 issue of Forbes magazine. Under the headline "Just Say No: How America Could Kick Its Prescription Drug Habit," the article clucked, "The 1990s made pill-popping for happiness an acceptable therapeutic alternative for millions of even mildly depressed patients." Forbes approvingly quoted a patient who said, "Drugs just mask the problem." A psychologist moaned, "Psychotherapy just can't compete with drug company advertising. We get crushed."
Anxieties about antidepressants, magnified by the ongoing debate over their side effects, extend beyond mental health professionals who face competitors with prescription pads. They also show up in the qualms of psychiatrists who worry that these drugs can be dangerous short cuts and in the public statements of regulators who suggest they're overused. Most important, the backlash against antidepressants may discourage people they would help from trying them by reinforcing the sense that there is something fundamentally suspect about turning to drugs for assistance in coping with life. Although the critics of drug therapy raise some valid points, the premise that pills are bad because they're easy is pernicious and needs to be challenged.
If a drug were discovered that could eliminate the need for arduous physical therapy following stroke or spinal injury, it would be hailed by patients and physicians alike, even though patients would lose the character-building opportunity of agonizing rehabilitation exercises. But when someone suggests giving Prozac without psychotherapy to an adult who suffered severe trauma as a child, many therapists wail that this "easy way out" will merely postpone the necessary painful reckoning with the past. Giving shy people medication to ease socializing is dismissed either as pathologizing normal human variation and creating greater conformity or as helping the socially awkward avoid the hard work needed to overcome their fears.
But why should someone who suffered trauma have to suffer more to overcome it, if there's a less difficult, equally safe, and effective alternative? Why shouldn't the shy be on a level playing field with the naturally outgoing if that is what they want? Why is it easier for us to let go of the idea that physical suffering is a message from God that we should bear in order to temper our souls than it is to shake the idea that emotional pain must be endured for our own good?