All In Your Head

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New at Reason: Complications—can't you just take a pill for that? Joli Jensen considers how the arguments over anti-depressants are not as simple as either side wants you to believe.

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  1. wow. I needed a pill to get me through that.

  2. My god. I am usually irritated by people who feel the need to slam the latest offering at Reason, as I almost always find something to enjoy in every article, but…

    What an empty pile of bullshit, faux-introspective, patronizing, masturbatory postmodern garbage that was.

    I particularly liked the scare quotes around ‘adult attention deficit disorder’. I live with and am engaged to someone who has ADD, and watch her struggle to be even barely functional when she is not medicated. Thank you for minimizing, belittling and trivializing her illness.

    From all of us who suffer from chronic depression, thank you for poo-poohing our claims to have serious medical issues. And thank you for doing it wrapped up in a poison cocktail of both psychobabble AND postmodernism. There’s nothing I enjoy more than being told my inability to function in my day-to-day life, my social anxiety and my depression, is just a fucking DISCOURSE.

    I suggest that as a professor of ‘communication,’ in the future, you stick with what you know best: turning out reams of patronizing and meaningless verbiage on the topic of ‘communication’. Leave medicine to those who might have some professional qualifications.

  3. popper: Me too. A Xanax will do.

    isildur: “What an empty pile of bullshit, faux-introspective, patronizing, masturbatory postmodern garbage that was.”

    Thank you, very well said.

  4. Hmmm… I found it to be an interesting article filled with thoughtful examination of current trends in psychiatric medication from the perspective of an author who, tho skeptical, sounds as though she’s sincerely trying to keep an open mind.

    Usually brainwashed reveal themselves with their sudden leap to attack other perspectives, even when that perspective includes the entirely “Reason”-able perspective that the author is “happy to let other people take whatever legal or illegal drugs they want as long as they realize what they are doing.”

  5. isildur:
    Wow man, pop a couple more pills or something. I didn’t get the feeling she was trying to belittle anybody or trying to say that nobody can benifit from a pill or five. She was very clearly pointing out that HER choice is to deal with things of her own willpower, without meds. Good for her. Not good for you. Maybe good for others? It wasn’t a blanket assertion.

    Did you even bother to read the whole article? The very last line, the one that should be sticking most freshly in your brain, is: “In today?s mediated and self-interested marketplace of discourses, we each need to sort out our truths with diligence, skepticism, and persistence.”

    Sort out your own damn resolution to your problem, without being so touchy to the fact that some people don’t belive they have an attitude problem, and that in fact it is society that made up the “disorder” to begin with. If this doesn’t jive with your experience, then ignore her and pop another pill.

  6. 2d paragraph should have read “Usually the brainwashed…”

    You know, I honestly never noticed before how using quotation marks can give something a much scarier connotation than it would normally have. Those three words in the above paragraph are certainly much more frightening when I hit the “scare quotes” key.

    Then again, maybe it’s time to switch my meds again!

  7. I suppose your alcoholism experiences have warped your outlook significantly. After all, you deal with alcoholism mostly through personality control. Support, meetings. Willpower. Rules.

    Surely anybody else who has problems being functional are just… weak? Lazy? Not trying hard enough? Not willing to make the big changes?

    I was under the impression that alcoholics quit because being an alcoholic was making them unhappy. Not because there’s some blind virtue to being clean and dry. People who are nonfunctional while NOT taking something can’t quit and get better. They can’t just say, “Today, I’m going to be functional,” and have it work, easy as that.

    The prescription medications handed out today don’t make one ‘happy’. They make getting out of bed less overwhelmingly scary. Like always, getting happy is something you have to find on your own. But it’s easier when you don’t hate yourself for laying in bed for the past 48 hours.

  8. Well, I’m pretty shocked that this article actually made it to the Reason front page. Seeing as how it imbodies just about every easily mocked pet-peeve for self-styled hard-headed libertarian types. I fear vitriol will inhibit an even remotely civil discussion of the ideas and personal experiences in it so I won’t bother for now.

    At the same time I would defend whoever decided to put it up. Obviously, some people can’t take a piece of personal writing for what it is. And for what it is, I think it’s a decent piece. I found it to be the opposite of patronizing, and refreshingly different. Even while taking issue with parts.

    Thanks you, Reason. And enjoy your hate mail.

  9. You would think anyone who bothers to peruse the offerings of Reason.com would be able to read well enough to, you know, understand what they’re reading. Tell me, guys, do you even bother reading the articles in toto, or do you just skim until you find something objectionable?

  10. Aww, it looks like I jumped to conclusions.

    How could I stay mad at you, thread?

  11. Man, I wish my Prozac made me as high as the barbituates that were handed out like candy in the 1950s…

    I think that the only really damaging part of this article was the implication that feminism is somehow being damaged by the new SSRI trends in the same way that it was in the 1950s. I would reiterate that the function of these newer drugs is not to keep one in a pleasant stupor, but to allow one to escape self-induced stupors like sleeping too much or alcoholism or illegal drug use that impair functionality. Stating that relying on these drugs will lead to an inability to reason properly about the societal sources of anxiety and depression in women is completely illogical. The cause and the cure can be handled and thought about seperately, and even someone who subscribes to the mainstream cure can still agitate and advocate for societal changes. In fact, as someone who is almost certain that her panic disorder stemmed mainly from the societal pressures facing young, successful women today, I would ask that you reject the notion that treating debillitating symptoms is capitulating to some over-arching power structure. Instead, it is with my informed choice that I can have the energy and confidence to challenge these power structures.

    It is continuing prejudice against those who suffer from depression and anxiety disorders (anxiety disorders that afflict mostly females) do not take a reasoned and thoughtful approach to medication. The author points to this general unease herself, saying that many waiver in the decision making process. To say that to make a medication decision is to capitulate to the drug industry’s portrayal of neuroscience or to doctors who mainly want to have a “cure” under their belt is to underestimate the power and reasoning ability of those who choose to medicate. Portraying those who choose to medicate as unable to rally in mental health advocacy is a damaging stereotype that is uninformed and should not be perpetuated.

  12. I think the only damaging part of the article is that there’s nothing there to criticize or defend, except the lack of argument.

    Does Joli even say anything? “I felt better about this. You may too.” That’s the whole article. She kept building up about how she was going to examine decision styles through her own personal discourse (“stories,” in Yet Another Edition Of Grade School Postmodernism), but all she did was say that on balance, she liked A better than B. Because she liked the story. Or something.

    I’m all about questioning the current mode of treatment for depression. Even though I seem to have benefitted from SSRIs I’m willing to believe that it was mainly due to the placebo effect. But apart from saying that some studies exist, Joli just brushes by this issue.

    There’s a great article waiting to be written about the trend toward pill-popping from a libertarian perspective, or even from a perspective that libertarians might find interesting. Something that will challenge my biases and make me think. Instead, Joli wrote this.

    This crap should have come from the midlist writer on Salon. There’s personalized writing, and then there’s meaningless gassing. I got no sense of her other than Joli like-a da booze and Joli like-a da warm fuzzies from support groups and Joli still feel-a da sad. (Since she wrote in a personal style, as noted above, I feel free to use her first name. Except that she didn’t communicate anything about herself and I know her no better now than several months ago.)

    And yes, I read the damn thing from first word to last, because I believed that in Reason, a writer would be eventually expected to come to the point. I was wrong. I read it when it came out in the magazine, with mounting disbelief.

    Nick, bad editor! No biscuit.

    For the personalized issue, can I have mine Joli-free?

  13. Joli refers to clinical depression and anxiety disorder as “normal human experience” (real quotes, not scare quotes), because it normal for healthy people to sometimes feel melancholy or worried. The implication is that the phenomena described as mental illnesses are merely extreme expressions of those normal states. This looks to me like saying that the gushing of blood from a small cut that is experienced by a hemophiliac is merely an extreme version of normal bleeding. Similarly, cancer is merely an extreme expression of the normal human experience of cell growth. What bull.

    Symptoms can look like a severe version of something normal, while still resulting from an underlying cause that is most abnormal. Ms. Joli, please don’t assume that people who can’t get out of bed, who can’t walk out the front door, or who can’t hold a normal conversation are experiencing the same thing as you. It’s presumptuous and demeaning.

    But, be that as it may, dragging schizophrenia into the discussion is totally inappropriate. My cousin carries a little extra weight, sleeps a lot, and can’t get it up because of his medication. On the other hand, he no longer cuts himself, or thinks the dog is talking to him through psychic powers. He is NOT just customizing his mood to enjoy life, and is underlying condition would be agonizing, dangerous, and debillitating in any culture at any time.

  14. joe: good comment.

    I have a relative who is also schizophrenic. His meds allow him to carry on a pseudo-normal life, but he is not dangerous to himself as he could be when not on his meds.

    I never understood the posters in the clinic I worked in that stated that Lincoln, Churchill, and a whole bunch of other famous people in history had bipolar disorder or schizophrenia.
    How could that have been politicians (or writers, philosophers, scientists, etc.) with such a debilitating disease?

  15. I did, in fact, read the whole article. Desperately hoping that, amidst all the empty postmodernism, there was something of substance — some recommendation, or analysis, or conclusion.

    Instead, at the end, all I saw was: “I believe your illness isn’t an illness” and “I’ve been thinking about these things a lot, see.”

    I can forgive an article failing on any of: Is there a point? Is it well-argued? Is it well-supported by reference to facts or a process of rational analysis deriving from facts?

    But this failed all three. It had no point, just pointless personal rumination.

    It was not well-argued, but rather was the kind of third-rate postmodernist tripe about ‘discourses’ that serves only to obscure, not clarify.

    It was not well-supported by, well, anything — just occasional anectdotal references to ‘many reputable neuroscientists’ (reputable according to whom? Only one such scientist is actually named), and authors I’ve never heard of (but whose word is, apparently, gold) whose works are described in adverbial splendor: ‘compellingly’ is a particular favorite. It’s clear Jensen is ‘compelled’ but gives no reason, aside from the names of the authors and titles of the books, that *I* should be. Is this an article or a bibliography?

    Failing on all three counts, Jensen concludes with a kind of Romper Room platitude: ‘We all have to put on our thinking caps.’

    I can get this level of meaningless butchery of the English language from self-appointed victims with cautionary tales to tell at any progressive bookstore, in the ‘self-help’ section. I choose instead to read Reason because it’s been, up till now, free of this kind of garbled whining.

  16. Interesting how this article brought responses from a whole bunch of names you don’t see too often at this site. No joe-bart-jen-etc. I wonder what it means.

  17. Why did you have to go and quote from Michael “Certainty is a mental disease : A fact I’m 100% certain of.” Shermer ?

  18. ADD, adult ADD, ADHD, SSRI’s. FUCK THAT!!! Real men deal with their problems the same way real men always deal with a problem. Kill it or buy it a drink. That way your problems are either gone, or they become your friends. Sheesh.

  19. There’s obviously a colossal difference between medication being used to control dangerous psychiatric disorders and what the medications described in the article are most often prescribed for. There is no way that everyone prescribed Zoloft or Prozac is using it to control dangerous conditions. The web-sites for Z & P clearly state that they are for the treatment of milder conditions.

    (Prozac: depression, obsessive compulsive disorder, bulimia nervosa, panic disorder. Zoloft: depression, social anxiety disorder, postraumatic stress disorder, panic disorder, obsessive-compulsive disorder.)

    I’m in no way downplaying these conditions, but comparing them to schizophrenia is like comparing bullets to atom bombs. You don’t want to be on the receiving end of either, but there is a big difference.

    The question here is – with the widespread prescription of these drugs – what are people really taking them for. Mood modification is a tricky bit of business with serious and profound implications.

  20. I’m with Isuldur on the “scare quotes” around “Adult Attention Deficit Disorder.” Hey, I don’t consider it a disorder, merely a different way of thinking, but thanks to “better living through chemistry” (the 15 mg. of Ritalin I just took), I have a pretty good chance of making my deadline instead of running around the house looking up fascinating facts that have nothing to do it with it.

    So, it’s 2004, and I can take a pill, with few side effects (for me) that makes me work better? Cool! Luckily, all the attempts to stigmatize people for taking head-meds haven’t gotten to me — then again, that might be because I couldn’t concentrate well enough to pay attention to them, pre-pill. If only I’d had Ritalin in college, I might have taken courses where I had to pay attention to get a grade instead of courses where I merely had to write your way to one…one hard-scrabble attempt to focus at a time.

  21. I viewed the article in terms of starting a discussion of issues that no one – even those with a string of neuro-science and Buddhist navel-gazing credentials – really knows the answer to: “what is the self?”

    These are questions worth considering in light of the somewhat modern (as opposed to “post-modern”) ability to chemically alter mood.

    The main thrust of the article “Are you still really ‘you’ when taking medication that alters your mood” seems like a good question that intelligent “Reason”-ing people should consider.

    I’ll hedge my bets by saying this: maybe it IS “postmodern tripe.” (I’m usually extremely wary of people who use phrases like “open a discourse.”) But I think the vitriol levels here are needlessly high – really off the chart. That level of angry response also tends to make me wary.

    Then again, I’m fortunately unaffected by depression or other psychiatric disorder, so this is much more an intellectual and philosophical exercise than a life or death issue of functionality, happiness or sanity for me.

    The 3 rules for good opinion articles work for me: “Is there a point? Is it well-argued? Is it well-supported by reference to facts or a process of rational analysis deriving from facts?”

    But sometimes a good article is only capable of raising thought-provoking questions. I can understand how people can be put off by a change in format, tho, since Reason usually tends toward opinion pieces that fit the 3 Rules.

    I like the fact that the author asks whether people are medicating themselves out of their natural personalities in favor of a personality that better fits the restrictive power structures that make our modern culture function.

    But she still has the ability to matter-of-factly consider the possibility that her personal commitment to 12-Stepping might be brainwashed goose-stepping – and therefore influencing how she views the role of psychiatric medication.

  22. I used to work in an anxiety clinic that did testing on human volunteers with targeted diagnoses of SSRIs during the late 80s/early 90s. Fluoxetine, Fluvoxamine, Sertraline, Clomipramine, I saw them all in testing. My conclusions after interacting and screening 100s of anxiety patients are that:

    1)There are more women than men, but not a lot more, probably a 60/40 ratio.

    2)Some anxiety disorders seem to occur more frequently in some ethnic cultures, which made me wonder if there was not just a chemical imbalance but also a ?learned? facet of the way people deal with their anxiety. In general, Irish folks have more social phobia; Jewish folks more OCD; Italian folks more panic disorder; Spanish folks ?ataque de nervios?; Black folks generalized anxiety disorder.

    3)There is definitely something useful about SSRIs. When you see a line of OCD patients for whom nothing up to then worked (some of whom were considering electroshock/chemo shock therapy) who all begin to report less checking/ruminating behaviors, you know there?s something useful about a medication.

    4)Quite a few of the people who were treated for anxiety did not have to work to get by. They either had someone who would support them, or else they were living off fixed incomes or inheritances. A few of these people had remarkable recoveries when their support system broke down. It really seemed that not having things in life to distract them allowed them to indulge their fears, almost like a hobby, but when they had to get a job to pay the rent they got their lived together enough to start working.

    5)The thinking among the doctors when I left the clinic was that depression and anxiety are regulated by the same neurochemicals, similar to being the two tails of a distribution bell curve. The folks at the extreme tails of the distribution have real problems, folks not so far out can have urges which they indulge or not depending on their circumstances, ad the majority of people do not have clinical level problems.

    6)I don?t remember any patients who complained about tapering off SSRIs, but I also don?t remember anyone who had success with such treatment ever wanting to stop taking them. I did work on a study of Alprazolam (Xanax) tapering. It was really hard for people to get that monkey off their back. Of course, Xanax is in the same family of medications as valium, not an SSRI.

  23. People in chronic pain chronically take drugs for that pain.

    The whole idea that drugs are the cause of addiction is pure voodoo.

    We have a huge PTSD problem in America. (Read Dr. Lonnie Shavelson). People self medicate for this problem with alcohol, pot, heroin, cocaine etc.

    Medicine does not recognise this situation although the Army’s new study into post combat PTSD may change this. The Army is specifically trying to reduce the problem of post combat drug and alcohol problems.

    I must admit that the heavy writing style of the Jensen article put me off from other than skimming it. She appears to be a decent writer lost in Discourse. Another potentially entertaining writer destroyed by POMO.

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