Friday, September 15, 2006

Happy pills and the worship of suffering

I should rename this blog "Let's pick on Fr Neuhaus" for all the material I write at his expense. This post is no different. In today's installment the good father discusses the medicalization of happiness:
What he calls artificial happiness is being promoted by mood-enhancing drugs recklessly prescribed by primary-care physicians, by the obsession with exercise, and by “alternative” medical practices from acupuncture to meditating with crystals. What Dr. Dworkin has to say about mood-enhancing or psychotropic drugs is I think the most persuasive and most important.

The book is also about turf battles within the medical profession, between primary-care physicians, specialists, psychiatrists, and the pharmaceutical companies. Dworkin’s argument is that the champions of “artificial happiness” are winning all the battles and now have recruited religion, as well, to their cause. He is greatly alarmed that religious leaders are not alarmed by the psychotropic revolution. I believe he is on to something to which more attention should be paid.

In our discussion, I suggested that I was not very taken with his extended treatment of the fascinating discussions about the connections between brain, mind, and consciousness—discussions in which I have played a modest part over the years. Against the more vulgar materialists and determinists, the book seems to come out on the side of the proponents of “emergent materialism.” I indicated that I found this position philosophically unpersuasive, positing as it does the grounding of the rational in the irrational. Dworkin indicated that he was not advocating that position, only reporting it. I wish that were more clear in the book.

It should also be underscored that the pharmaceutical remedies for clinical depression—in the tradition usually called melancholy of various gradations, or acedia, or spiritual torpor—can frequently be a great blessing, so long as they help equip people to address other problems rather than escape or evade them.
...
At the core of Dworkin’s enterprise is a sharp critique of the now widespread notion that unhappiness is a disease that is to be medically treated. I spoke of the Christian spiritual tradition in which unhappiness in many forms is an essential part of growth, also in the growth toward holiness. The writings of saints such as Teresa of Avila, John of the Cross, and Mother Teresa of Calcutta are replete with counsel on the uses of unhappiness. Pushing the envelope for the crowd at the Strand, I alluded to the understanding of “redemptive suffering” in the course of attaining happiness, as in wholeness, as in holiness. My impression is that this got into territory where Dr. Dworkin, and some in the audience, were not comfortable, as in happy. But our solid agreement is in contending that it is false and dangerous to go along with the notion that unhappiness is a disease to be medically remedied.

And Dworkin is surely right that we need to contend also against religious leaders who aid and abet the notion that happiness—as in feeling good about oneself—is the goal of life. I believe he exaggerates the dominance of the tradition associated with Norman Vincent Peale, “positive thinking,” and feel-good religion in general. His point is that the psychotropic revolution is putting such religious approaches out of business, and with the unwitting cooperation of the happiness preachers.


As long term readers of this blog know, I take antidepressants and I am very suspicious about arguments to the effect that such medications are a copout, or a way to avoid dealing with the real problem behind the depression, or that they somehow rob the depressed person of some meaningful suffering. I'm glad that Neuhaus didn't go there. I haven't read the book, so I can't say whether Dworkin's alarmism over psychotropic drugs is along these lines or is something to be taken seriously. Besides antidepressants and drugs like Ritalin, I'd be interested to know just what drugs are being prescribed, for what symptoms, and to what effect in the lives of the people taking them. There is certainly a danger in setting expectations for drug therapies too high, but I wouldn't assume that the widespread use of them equates to abuse.

But I think that there are other agendas at play in the debate over these drugs, and Neuhaus has certainly tipped his hand regarding his. Neuhaus comes close to representing in his comments that perverse value that I have labelled the worship of suffering. It is almost as if Neuhaus welcomes suffering as just more raw material for his personal holiness project. Now it is important to learn how to cope with suffering, because I believe that suffering will inevitably affect every person from time to time. But a meaningful life cannot be built upon a welcoming of suffering. I've quoted Victor Frankl many times on this blog, only because his insight into meaning and suffering is so blindingly obvious. Frankl said that one can find meaning in suffering only when the suffering is unavoidable. When suffering is avoidable, one should avoid it. Willingly enduring avoidable suffering is meaningless, it is masochism.

I think that the other bolded quote above exposes the other major agenda behind much of the criticism of antidepressants and other psychotropic drugs, that it is threatening to put the religious priesthoods out of business. Priests are the original grief counsellors. Like personal injury lawyers and modern grief counsellors, they rely on the suffering of others to earn their keep. Now don't think that I'm being overly cynical. Suffering exists, and people have the right to offer their assistance to those who suffer. The main criteria for judging these practicioners of the ameliorative arts is by their effectiveness. If they can help those who suffer, then more power to them.

But when new methods or new tecnologies arise that compete with these practicioners for the service of amelioration, lets not pretend that the protestations of the old guard are always motivated by the welfare of their clientele. One gets a sense that Neuhaus is struggling not just with the prospect that these drugs will eat into his pastoral care practice, but that they support a philosophy that poses a direct threat to the very basis of the religious ideal. That philosophy is materialism. If suffering can be relieved by material means, than the whole theoretical structure upon which suffering has been explained and justified, beginning with Original Sin and winding its convoluted way through the substitution, death, atonement, resurrection and onward, seems to be on a much shakier foundation.

58 Comments:

Blogger Peter Burnet said...

Duck, Duck, Duck...

Never in the field of human blogging has there been such a distance between what someone said and what the blogger fisking him asserts that he meant.

September 16, 2006 5:32 AM  
Blogger Susan's Husband said...

I have to say that I understand Dworkin's concern. Just consider how treating real cases of ADD is leading to the medicalization of "boyness".

September 16, 2006 6:40 AM  
Blogger Duck said...

Peter, you have no sense for subtext, do you?

I acknowledged that he did not condemn the use of antidepressants, and I qualified my statement regarding the worship of suffering by saying that his comments "come close" to it. But what to make of all this generalized hand-wringing over the problem of "medicalizing happiness"? What's the real agenda here? Suspicious minds want to know.

If happiness can be medicalized, then it should. I think the idea that antidepressants are "happy pills" is a misnomer. They are "lessen unhappiness" pills. They don't bring instant happiness, but they do relieve chronic anxiety and depression. They don't relieve all anxiety, and it would be foolish to do so. Anxiety is our early warning system, it has to be in good working order to help us navigate around the perils that life throws at us. But what happens when the warning lights are stuck in the on position? We know that there are medical reasons for this to happen. It is all brain chemistry. If you can improve the functioning of a person's anxiety/early warning system through drugs, then why not do it? Why all the panic about medicalizing happiness?

As for this talk of "redemptive suffering" and holiness, well, I was a Catholic raised on this stuff, so I have standing to say that it is all a bag of hooey. I was told things like "offer up your suffering to God", which just gave me the scary idea that God was this being that fed on people's suffering, like some vampire. It also makes you too accepting of suffering, too tolerant of it and passive in the face of it, when you should be finding its causes and kicking it in the ass. I think that the idea of holiness, at least in the Catholic view, is based on a worship of suffering. What is holiness but an attempt to imitate God? And what do we worship God (in the person of Jesus) for? His suffering. The idea of holiness gives you a psychological motivation to welcome suffering.

September 16, 2006 8:15 AM  
Blogger Peter Burnet said...

It is right it should be so:
Man was made for joy and woe;
And when this we rightly know
Through the world we safely go.
Joy and woe are woven fine,
A clothing for the soul divine.
Under every grief and pine
Runs a joy with silken twine.


You are so mixing up philosophies of the good life with medical treatment of afflictions that it is hard to respond. Medication is medication and dope is dope. He and Dworkin are both worried that, thanks to modern psychology, we are losing the ability to tell the difference. What is so oppressive about that?

If happiness can be medicalized, then it should. I think the idea that antidepressants are "happy pills" is a misnomer. They are "lessen unhappiness" pills.

You seem to be both calling for drug induced happiness and acting insulted when anyone suggests that's what we are doing. Anyway, Neuhaus is clearly not Tom Cruise, so why try so hard to push him into that corner?

September 16, 2006 8:53 AM  
Blogger Duck said...

Yes, that first sentence is contradictory, it should have read "If unhappiness can be ameliorated with medicine, then it should".

The problem with dope is that ultimately it only multiplies unhappiness. So dope is not a true happiness pill, it is an unhappiness pill masquerading as a happiness pill.

September 16, 2006 9:02 AM  
Blogger Duck said...

Why do I pick on Neuhaus so much? Well, if you reread my article you'll note that my main beef with him is philosophical. His biggest objection to the medicalization of happiness is not that it might actually work, but what the idea implies, namely materialism. The church has spent so much time and effort over the ages spiritualizing and moralizing unhappiness that the idea that there could be material, medical explanations and treatments for it shows that the emperoror (or the Pope in this metaphor) has no clothes. He seems to be saying "even if these drugs can relieve your suffering, you should think twice about using them, for fear of what spiritual benefits your suffering could bring you". To which I say "read Frankl".

Also I think that there is a lot of general hysteria over the use of psychotropic drugs, and I chalk it up to the kind of cultural ignorance that often resists new, beneficial technologies. I also think it has to do with this notion that the people who take these drugs are "cheating". We all rank ourselves in the social hierarchy, and people who deal with the problems of life without resorting to medications may feel that they've earned a higher status because of it, which they attribute to their superior moral character. Dealing with these problems with medicine to them is the equivalent of cutting in line, the line of status and social recognition. So for people who don't have to take these medications, it is not a matter of being grateful for not having the kind of medical problems that these people have, but a sense of being cheated, and therefore there is a need to delegitimize the practice.

September 16, 2006 9:20 AM  
Blogger Peter Burnet said...

Dealing with these problems with medicine to them is the equivalent of cutting in line, the line of status and social recognition. So for people who don't have to take these medications, it is not a matter of being grateful for not having the kind of medical problems that these people have, but a sense of being cheated, and therefore there is a need to delegitimize the practice.

Duck, I'm used to hearing that kind of analysis about sex, but about Ritalin and Prozac? Do you actually know people who argue that?

Anyway, I gather your problem with Neuhaus is that he is a Catholic priest.

September 16, 2006 9:42 AM  
Blogger Duck said...

Noone argues like that, just as noone argues that they aren't religous because they hate their father. Gee, for a cantankerous old curmudgeon, you sure do have a lot of faith in people's stated intentions. Did you hear that Brad Pitt wants to save humankind? What a noble chap!

Well, I guess you could say that your problem with Noam Chomsky is that he is a leftist, which is true, but not informative, since leftism is a general philosophy that you don't agree with, but Noam Chomsky is a specific example of leftism with his own arguments and expressions that you take particular issue with. So why you think that saying my problem with Neuhaus is that he is a catholic priest is true in a general sense but misses the point. And why you think that is a reason to be dismissive of my arguments is rather curious.

September 16, 2006 10:14 AM  
Blogger Peter Burnet said...

I can get my head around the idea of someone railing against sexual freedom because he is bitter he missed out on the fun. I can can get my head around Brad not wanting to marry her but hiding it under his publicist's pseudo-altruistic drivel. But I can't get my head around someone who doesn't need Prozac feeling he was cheated by not taking Prozac. Or that he earned a higher status for it.

Duck, being very wary of medication/alcohol/drugs and arguing for avoidance or great care has a long history on both physical and spiritual grounds. I'll bet you there are as many doctors out there counselling against anti-depressants as priests.

As to Chomsky, I might enjoy attacking him, but I doubt I would spend a lot of time analysing his every word to prove (gotcha!) he has an anti-capitalist bias. That's a given. As is His biggest objection to the medicalization of happiness is not that it might actually work, but what the idea implies, namely materialism. for Neuhaus.

September 16, 2006 10:39 AM  
Blogger Duck said...

I'm not trying to prove he's an antimaterialst, I'm saying that his antimaterialism is one of the motives behind his reluctance to accept the medicinal use of psychotropic drugs.

But I can't get my head around someone who doesn't need Prozac feeling he was cheated by not taking Prozac. Or that he earned a higher status for it.

That's fine, if you don't see it, you don't see it. This is my theory. It is similar to how us brights look down on you weak religionists who need the crutch of faith to deal with your problems. You mean to tell me that there isn't some self-congratulatory, status motivated component to that? Or are we merely stating an objective fact in an impersonal manner?

September 16, 2006 10:54 AM  
Blogger Oroborous said...

I can't get my head around someone who doesn't need Prozac feeling [...] that he earned a higher status...

Perhaps it's a cultural difference.

In America, the land of rugged individualism, except in certain specific local urban areas it's still mildly embarrassing to need to see a psychologist.
Doing so has harmed the political aspirations of national politicians, and some have even suffered from negative associations due to their spouse seeking treatment.

September 16, 2006 10:59 AM  
Blogger Duck said...

This book review at Amazon.com of Dworkin's book has whetted my appetite, I'll be buying the book and giving an in-depth review on the Daily Duck soon.

He belittles the 1980s buzzword "stress" with its accompanying surge of mind-body activities and denigrates the moral deficit he perceives to be underlying a widespread obsession with fitness culture. He also argues that "many Americans are only superficially religious, outwardly professing belief in God while crossing over to medicine for help when life grows really difficult."

I'll be interested to know what he has against fitness and why it shows a moral deficit. But the second sentence just adds to my point that the real beef here is that the new drugs compete with religion. To which I say "let the games begin!"

September 16, 2006 1:13 PM  
Blogger Bret said...

Duck wrote: "But the second sentence just adds to my point that the real beef here is that the new drugs compete with religion."

Sure, of course they do. Besides miserably unhappy people turning to religion for help when drug therapies aren't available, I think there are a couple of other important factors.

The first is an awareness of the role of brain chemistry on our own moods and behaviors. I think we seem much more mysterious to ourselves when we don't have drug experiences. In other words, if I drink caffeine I feel and behave one way, if I have a drink I feel and behave another, if I eat chocolate (thank God for chocolate) I feel really good, etc. It takes the feeling of magic away, I think, and makes it harder to feel and believe in the spiritual realm.

The second area is in the use of strong psychedelics. Many people who use these have experiences of seeing/hearing/feeling/being God. But then the drug wears off and it's pretty obvious that one didn't really experience God, which leads to skepticism of similar non-drug God experiences.

I know that primitive people's have used psychedelics to enhance religious experiences, but I think they did it with a naivete not available to us living in this millennium.

I take an over the counter mood enhancer called SAMe. Works remarkably well. I am, on average, in a much better mood when using it. As such, I may represent the possible danger with mood enhancing drugs. I wasn't depressed before. Indeed, I was reasonably happy. Now, I'm even happier. Seems like a good deal to me.

But what if eventually there's a pill that makes everybody really happy all of the time. Like Soma from Brave New World.

If I wasn't so happy from taking SAMe, I might worry about that.

September 16, 2006 11:33 PM  
Blogger Peter Burnet said...

But what if eventually there's a pill that makes everybody really happy all of the time. Like Soma from Brave New World.

If I wasn't so happy from taking SAMe, I might worry about that.


And Duck thinks it's the people who aren't taking the pills who have status issues.

Tell us, Duck, do you think generally speaking a person who is in a more or less constant state of happiness and satisfaction is as likely to recognize injustice around him and be moved to do something about it as the person who is not? To create a great work of art? To start a charity? Think of all those happy assertive Type "A" guys in human resources that torture you so.

September 17, 2006 5:51 AM  
Blogger Duck said...

Tell us, Duck, do you think generally speaking a person who is in a more or less constant state of happiness and satisfaction is as likely to recognize injustice around him and be moved to do something about it as the person who is not?

This idea of being in a constant state of happiness from antidepressants is totally bogus. It's not like that. Speaking from my own experience, not being depressed in the face of anxiety gives me more confidence to take action in difficult situations where you know you should do the right thing. When you are depressed, you obsess and over every way your actions will backfire on you.

I did buy Dworkin's book yesterday and read the first chapter, and I have to say that my worst suspicions of him have been confirmed. He's painting the same image that you are of the doped up happy person who's lost the ability to tell right from wrong and will just blithely live with whatever mess life throws at him oblivious to any consequences for himself or anyone else. You guys are inventing straw men.

If you haven't experienced depression, you just aren't aware of how debilitating it can be. No course of action looks right, they all lead to disaster. You lose the ability to act. You totally misread the true cost/benefit ratio of ordinary social interactions. You have this idea of anxiety and suffering as the true gauge of right and wrong, that has to be experienced without filters. But the human mind is not a perfect mirror of reality, and suffering can cloud the view as much, or more, than happiness can.

I'll defer to another sage whom I've criticized in the past on other topics but who I agree with on far more things, and that is Dennis Prager. Prager believes that making yourself as happy as you can be is a moral obligation that you owe to everyone you love and care about. Unhappy people can't make others happy. He wrote a book about it, Happiness is a Serious Problem.

So unless you are trying to improve your art or your holiness, I don't see that wallowing in suffering makes any sense at all.

September 17, 2006 6:24 AM  
Blogger Peter Burnet said...

It's hard not to conclude I am arguing with a strict rationalist who has decided that, because there is no objective demarcation line between treating recognized afflictions and altering consciousness to avoid life's tougher side, there is no difference and therefore we should chuck any efforts to distinguish them. Chronic depression is a recognized affliction we treat. Bret's situation is completely different, no matter how much Bret himself can handle it.

Once again you call for the medicalization of happiness and then get very indignant that anyone would even suggest we are medicating ourselves to be happier. I don't have a problem with anti-depressants and can easily imagine myself taking them. But you know a lot of people are taking them without needing them, or are taking them for too long in some cases, and that they can make a mess for some people. Some people do get dopey and isolated with them. Long-term effects are still largely unknown. People are demanding them of doctors for themselves and their kids rather than awaiting a diagnosis.

You seem to be defining happiness as the absence of debilitating pain. I'm ok with that, but as a good stoic you should know that's not how far too many modern folks are defining it. And they are getting a lot pushier about it all.

You don't have to celebrate cancer in order to argue that trying to eradicate all disease may not be such a good idea. Nor are you anti-medicine or lost in a spiritual miasma just because you think there may be better ways for some people to confront some kinds of unhappiness than pharmaceuticals.

September 17, 2006 9:03 AM  
Blogger Bret said...

Duck,

I don't think anybody - not Neuhaus, not Dworkin, not me, not even Peter - thinks that withholding medical help from the significantly depressed is a good idea.

The question is more when does the distinction between significantly depressed and not ecstatically happy become hopelessly blurred, and does it matter anyway. Prager might be right that we should all do everything we can to make ourselves as happy as possible. What if we added Prozac to the water supply in Tehran? Maybe the mad mullahs wouldn't be so mad. What if we spiked the Dems' drinks with happy potions? Maybe Bush Derangement Syndrome would melt away and we could have some sane debates. Maybe what the world needs is not less CO2, but more monoamine oxidase inhibitors to escape from Crighton's State of Fear.

But what if Prager is wrong? Though I wouldn't want you to worry about that possibility.

September 17, 2006 9:19 AM  
Blogger Duck said...

But you know a lot of people are taking them without needing them, or are taking them for too long in some cases, and that they can make a mess for some people. Some people do get dopey and isolated with them.

How do we know this? Have you done a study of these people, or are you just using your gut instincts? Dworkin thinks he knows who needs them. He discusses three cases in his first chapter, though how he knows about them is unclear. Two of the people are unhappy in their relationships, then take antidepressants and are happier, but his criticism is that they are avoiding dealing with their bad relationships and therefore denying themselves a chance to experience "real" happiness in the future. In the third case a woman lives in an unhappy marriage, but when she gets on antidepressants she gains the confidence to get a divorce, but in this case he says the drug is "making the decision" for her. Somehow he knows the right decision for each of these people to make, and he knows that the antidepressants are interfering with their ability to make them. Its pure arrogant nonsense. The guy is a nanny who wants to run people's lives for them.

because there is no objective demarcation line between treating recognized afflictions and altering consciousness to avoid life's tougher side, there is no difference and therefore we should chuck any efforts to distinguish them.

No, I think that it is up to individuals to distinguish this on their own. For ages we've had no problem moralizing happiness and have attributed depression to bad character and poor morals, when in fact it was often, if not mainly, a medical condition. My point is how will you know the right approach to take unless you've tried them both? Why this reluctance to let people try medications to help them deal with anxiety and stress? You're right, there is no objective way to draw the line, but the question I have is why is there such an urgent need to find this line? What is the real danger of taking medications where a person may not be clinically depressed?

I also take issue with this notion that people are taking drugs to avoid problems. The drugs don't make problems go away, they still have to be dealt with. Antidepressants don't make your relationship problems or job stresses go away. It's not an either-or situation. For a person prone to depression or anxiety, I think that the drugs actually help them deal with their problems. Happy people are better problem solvers than depressed people are.

And there isn't always a problem to be "solved" that is underlying unhappiness. Much of life's problems are just unavoidable and need to be dealt with. How many men and women put up with jobs that they are miserable in to support their families? You can't just chuck your job when you have responsibilities. So if antidepressants will help someone endure these unavoidable stresses and be able to come home in a good mood to spend time with his family, rather than coming home burned out and sullen, then why does it make sense to tell him that he has no right to "medicalize" his problems, that he has to "deal" with them? Stoicism is one thing, masochism a totally different thing.

September 17, 2006 11:41 AM  
Blogger David said...

FRED: Maybe you can clarify something for me. Since I've been, you know, waiting for the fleet to show up, I've read a lot, and--

TED: Really?

FRED: And one of the things that keeps popping up is this about "subtext." Plays, novels, songs--they all have a "subtext," which I take to mean a hidden message or import of some kind. So subtext we know. But what do you call the message or meaning that's right there on the surface, completely open and obvious? They never talk about that. What do you call what's above the subtext?

TED: The text.

FRED: OK, that's right, but they never talk about that.

September 17, 2006 4:06 PM  
Blogger Duck said...

Here's the text:

"Happiness breaks out. Religious leaders predict disaster."

September 17, 2006 5:07 PM  
Blogger Duck said...

I posted my review of Dworkin's book on Amazon. I'm still planning on a more in-depth review on the Daily Duck in the coming week.

September 17, 2006 10:40 PM  
Blogger Peter Burnet said...

Duck:

What is your opinion on performance enhancers in sport. Everybody decides for himself?

September 18, 2006 3:10 AM  
Blogger Duck said...

Interesting that you would bring up the comparison to sports. Sports are structured competitive activities for which we apply a rulebook so that we an be assured that the winners "earn" their status. It is a status-driven endeavor. Which tends to confirm my suspicion that the opposition to mood-enhancing drugs is status driven. Are you worried that people who take antidepressants are "cheating"? Should they be forced to earn their happiness with the body that Nature gave them?

Life isn't (or shouldn't be) a competitive activity, we're not competing for some prize based on who acheives the most happiness. My drug-assisted happiness doesn't tarnish your drug-free happiness. It's not a zero-sum game.

September 18, 2006 5:43 AM  
Blogger Peter Burnet said...

Boy, you really are into sub-texts. Yeah, Duck, you got me. I'm jealous of all those country club invitations and hot babes those pills get you.

But what really gets me going are those people who take Tylenol 3 for their so-called migraines. Ha! I know low moral fibre when I see it.

September 18, 2006 6:04 AM  
Blogger Duck said...

Well then, what is the point of your question? We don't let anyone decide, we let doctors and patients decide. These aren't over the counter medications. I don't see the problem.

September 18, 2006 7:25 AM  
Blogger Hey Skipper said...

It should also be underscored that the pharmaceutical remedies for clinical depression—in the tradition usually called melancholy of various gradations, or acedia, or spiritual torpor—can frequently be a great blessing, so long as they help equip people to address other problems rather than escape or evade them.

Nowhere did Fr. Neuhuas, or anything I read about Dworkin's book, suggest the cause-effect relationship might be precisely the inverse of that explicitly stated above.

Clearly, and constructively, unhappiness can be the consequence of extant problems. Equally clearly, but unacknowledged by the good Fr., unhappiness can be the cause of subsequent problems, which in turn reinforces the pre-existing unhappiness.

Where profound unhappiness has no rational connection with circumstances -- the problem facing Duck and millions of others -- then why not look for a medical solution?

I have a friend who came home from an overnight business trip and found his wife had shot both their children and herself. I doubt anyone would care to argue she shouldn't have been on antidepressants; unfortunately, in the early 90's, there were few, if any, to be had.

What would Dworkin say about her?

What if we added Prozac to the water supply in Tehran? Maybe the mad mullahs wouldn't be so mad.

I have long advocated loading all our C-5s to the ceiling with Valium, then fly them in a raster scan across the Middle East, carpet bombing the place until the residents can no longer tell the difference between a Kalishnakov and a cat.

September 18, 2006 8:03 AM  
Blogger Peter Burnet said...

Believe it or not, I was just trying to explore the boundaries between what we see as natural and what we see as artifical intervention. I actually don't think the case against performance enhancers in sport is all that strong.

Did you ever stop to think that, if your objective is to get people to see chronic and situational depressions as medical afflictions that should be treated medically, there are better and more promising ways than to chracterize everyone who questions whether chemical mood-enhancement is a good general response to life's more unpleasant side as cold and jealous status seekers?

Skipper:

until the residents can no longer tell the difference between a Kalishnakov and a cat.

I know some pretty excitable Darwinist materialists who seem to have the same problem. Do you think its their medication?

September 18, 2006 9:28 AM  
Blogger Bret said...

duck wrote: "My drug-assisted happiness doesn't tarnish your drug-free happiness."

That's not so clear. Let's take an example. Many high-school students are prescribed Ritalin. Without it, they tend to do poorly in school. With it, they do substantially better and therefore have a better shot at winning an admission to a desirable university. That university spot is then potentially no longer available to someone else who isn't thought to need Ritalin. Yet, that someone else might also perform better if they had access to Ritalin.

With the aid of your anti-depressants, you probably perform better at work. You probably have more opportunity for promotions. Therefore, your other colleagues have less opportunity for promotions.

In this localized sense, it is a zero-sum game, and the person who gets the performance enhancing drugs, whether for sports, schools, careers, etc., has an advantage relative to those who don't have access to the same drugs.

I realize that this is mitigated by a number of factors. For example, because you're performing better, society as a whole is probably better off economically. So globally we're likely all better off, but locally there are still losers because of your better situation.

Also, I realize that anti-depressants have (far) less positive effect on those who aren't depressed. Yet I know from my SAMe experiences, they might well still have some positive effect.

So why do some people get performance enhancing drugs, but not others? You talk about Dworkin wanting to be a nanny, but really, that is the exact situation now. The medical profession is my nanny and tells me I can't have performance enhancing drugs because I'm deemed not to deserve them, while others do.

It seems rather arbitrary to me, and I usually find arbitrary schemes that give some people advantages relative to others unfair (rule by fiat, where the rulers in this case are the doctors). It seems to me to make it fair, anyone who would like to try anti-depressants and other performance enhancing drugs should be able to.

Or nobody should.

September 18, 2006 11:20 AM  
Blogger Duck said...

Bret - sssshhhh! Don't tell Peter.

September 18, 2006 11:43 AM  
Blogger Bret said...

Which part?

September 18, 2006 11:55 AM  
Blogger Duck said...

The part about promotions and stuff. Right now he's not concerned about the impact to his status, but you might just scare him into a visit to his doctor to regain the edge, and then it will just be one bigh happiness arms race. And then who will write the poems?

September 18, 2006 1:24 PM  
Blogger Peter Burnet said...

BTW, Duck, a propos the point I made in the Hitchens thread above about everybody trying to position themselves in an oppressed minority position, it occurs to me that the proverbial man from Mars who read this post and the comments from Skipper, Bret and you would conclude we treat anti-depressants like medicinal heroin--tighly guarded and only available to a very few under highly controversial circumstamces. He would never guess tens of millions of North Americans take them regularly and they are a whopping profit-maker for the drug companies.

September 19, 2006 10:13 AM  
Blogger Peter Burnet said...

BTW, Duck, a propos the point I made in the Hitchens thread above about everybody trying to position themselves in an oppressed minority position, it occurs to me that the proverbial man from Mars who read this post and the comments from Skipper, Bret and you would conclude we treat anti-depressants like medicinal heroin--tighly guarded and only available to a very few under highly controversial circumstamces. He would never guess tens of millions of North Americans take them regularly and they are a whopping profit-maker for the drug companies.

September 19, 2006 10:26 AM  
Blogger Hey Skipper said...

Peter:

the proverbial man from Mars who read this post and the comments from Skipper, Bret and you would conclude we treat anti-depressants like medicinal heroin--tighly guarded and only available to a very few under highly controversial circumstamces.

Those circumstances are the real crux of the issue. Many, including Dworkin and Neuhaus seem to find some redemptive value in suffering, and are singularly disinclined to countenance the chemical treatment of unhappiness/depression.

My inclination is that individual sufferers should make that decision for themselves, which will no doubt lead to some over medication. However, the alternative is to put others, who aren't paying the personal cost, in the position of deciding just how much that cost is worth.

My friends wife would -- I know I am hypothesizing here -- likely have availed herself of modern anti-depressants. But she wasn't visibly depressed enough to get through some approval gauntlet.

That, apparently, Dworkin completely failed to address.

September 19, 2006 11:13 AM  
Blogger Peter Burnet said...

...disinclined to countenance the chemical treatment of unhappiness/depression.

Your conflating of the two is making it very difficult to get a grip on this issue.

So, do you think the use of ultra-powerful codeine painkillers should be entirely up to the individual?

September 19, 2006 12:28 PM  
Blogger Bret said...

peter burnet asks: "So, do you think the use of ultra-powerful codeine painkillers should be entirely up to the individual?"

I'm not sure who you're asking. But my answer is yes.

September 19, 2006 5:37 PM  
Blogger Peter Burnet said...

For children too? All up to parents?

September 20, 2006 4:57 AM  
Blogger Duck said...

Peter, you're trying to put all drugs in one basket. Psychotropoics are different from narcotic painkillers which are different from anabolic steroids. Each set of drugs has its own purposes and its own set of dangers when they are abused. The societal permissiveness for each set of drugs should be based according to those dangers and those benefits.

Nowhere in my complaints of Dworkin's book do I suggest that pschotropic drugs be made freely available over the counter. You keep going back to this question, but I don't know why. Are you buying into Dworkin's theory that doctors are being reckless in their habits? Are you suggesting that further oversight of doctors is warranted? Should we be rationing happiness?

September 20, 2006 5:49 AM  
Blogger Peter Burnet said...

Duck:

you're trying to put all drugs in one basket.

I don't think so, but you are trying to put all unhappiness in one basket.

I am trying to relate all this to the concerns of the Dworkins of the world, what I've read in the press, what I've observed in my practice and what my wife observes in her school. You are clearly terribly concerned about people who need this stuff not getting it or being talked out of it by the "life's tough" brigade. That's fine, I can go with you further than you probably think, but what I don't get is why you scoff at those who claim they are over-prescribed, especially for children, and who worry about unknown side effects and a general reliance on drugs to avoid something as wispy as "unhappiness". You don't seem to want to admit that there is a qualitative difference between treating the afflicted and coddling the unhappy (Paul Johnson), even if we can't be sure exactly where the boundary is, and that people worry about that for many good psychological, spiritual and physical reasons.

A big concern is Ritalin for young boys. It is very common and I hate to say so, Duck, but I'm pretty sure in many cases the pressure to prescribe it comes from parents with issues of their own who are themselves often under this kind of medication and whose reactions to their kids' problems is to school/doctor/expert shop until they get a diagnosis that absolves them and a treatment to go with it.

Now, we all may look back on our youth with rose-tinted glasses, but I've thought very hard over the past few days about my school years and, try as I might, I do not recall anybody from either elementary or high school unable to keep himself from disturbing the class or sit quietly. Bad students, sure. JDs, you bet? But no one who couldn't sit still and focus if he tried (or was threatened). So what the hell is going on and why are you unconcerned?

And BTW, as a practical matter, these things are subject to fads. It's like wife abuse. If you don't do the hard work of distinguishing the truly needy from the ideological fellow travellers, reactions will inevitable set in and those suffering serious depression in the future may meet up with doctors like the new-age trendy I met a couple of years ago who resisted very hard prescribing me antibiotics for a bad double ear infection on the eve of a trial. (She wanted to teach me all about aural hygiene instead). And if Bret gets his way and we all have the right to self-prescribe drugs, then that will simply result in a lot more drugs being made illegal as a result of the inevitable horror stories. Be careful what you wish for.

September 20, 2006 6:20 AM  
Blogger Harry Eagar said...

Fr. Neuhaus (and Pope Benedict) seem more worried about vulgar materialists than anything else. Cannot imagine why, unless they view it us unfair competition.

Be that as it may, there is no materialist more vulgar than me, and when I look at the actual performance of the Catholics and suffering, I am not impressed.

Even before drugs, when the flock suffered and could have ameliorated its suffering by, eg, eliminating the infamous thing, the infamous thing notoriously set itself up to offer a spiritual ukase that suffering is good for you, you should thank god for it and leave the priests to their benefices.

It is not obvious to me that even Catholics are (materially) worse off for the suppression of the monasteries, though obviously priests are.

September 20, 2006 2:22 PM  
Blogger Peter Burnet said...

Harry:

Now that's what I call a sub-text.

September 20, 2006 6:05 PM  
Blogger Harry Eagar said...

Well, I am a very vulgar materialist. I don't know how to evaluate how much psychic suffering Duck is suffering, let alone whether it is sufficient.

But I can understand the suffering of going to bed hungry, or, worse, being unable to prevent your children from going to bed hungry.

The church is inconsistent about suffering. Much earlier, Mother Theresa was called into the debate on the side of suffering, to my surprise.

September 20, 2006 6:46 PM  
Blogger Duck said...

With children it is a much more difficult decision, but I still think it is up to parents and their doctors to decide. To hear from some of the criticism of Ritalin you would think that there are no children who benefit from it. I disagree, I know of several children who have. I don't know what the "horror" stories are, if they exist. As you say, popular reactions to such things are faddish. I think there are a lot of people with no direct contact with people on the drug who are wringing their hands based on what they hear in the media.

You really have to read Dworkin's book to understand why I am so exercised. He makes totally baseless and reckless statements about people who take antidepressants. Antother statement he made, in addition to saying that people on the drug are "stupefied", is that their conscience has been turned off. This is totally baseless. Where are the studies that show this? They don't exist, he is making this stuff up.

The problem with putting unhappiness into categories is that you really can't. One of the features of depression is that people become profoundly unhappy over everyday situations. It is easy for Dworkin or anyone else to say that so and so's unhappiness isn't severe enough because the reasons seem so trivial. That assumes everyone's mind is on an equal footing. But people commit suicide over "everyday" unhappiness. In my neighborhood I know of two families that were impacted by a suicide. A 17 year old boy commited suicide over his stresses at school plus over the divorce of his parents. A 38 year old woman commited suicide when her boyfriend dumped her. You really can't gauge other people's unhappiness from the outside.

September 20, 2006 10:55 PM  
Blogger Peter Burnet said...

The problem with putting unhappiness into categories is that you really can't.

Yes you can, however imperfectly. Hey, you are the one who argues depression is a medical affliction and I agree. It can be diagnosed with reference to symptoms like uneven appetite, significant weight gain or loss, sleeplessness (especially early awakening), low sex drive, inability to focus, fear of human contact, inability to take pleasure in the pleasurable etc. It can be recognized as chronic, situational or manic. Just putting it somewhere on an incredibly long continuum of unhappiness undercuts your own case.

ADHD is quite different. Ritalin most certainly does work and that is the dilemma, because "work" means improved behaviour, not happiness. It improves the parents' happiness, not the kid's.

Finally, these dramatic stories about suicides, etc. don't overly influence me. I've never liked it when people take incidents like Columbine and try to use them to catalyze public policy debates and call for this or that reform, even when they call for things I support. I don't mind if you hedonists regale us with all those stories about poor, sexually-frustrated old Aunt Bertha to support your libertine philosophies, but please don't throw up Jack the Ripper. Puts us off our biscuits, it does.

BTW, you are aware, I assume, that the standard diagnostic manual for psychological disorders (DSM) is now in its fourth edition and is at least four times as thick as the first edition. I don't think Gray's Anatomy was ever so expansive. Do you see this as progress and the triumph of rational science? Anything to worry about?

September 21, 2006 2:50 AM  
Blogger Hey Skipper said...

Peter:

A big concern is Ritalin for young boys.

Yes, it is, for very good reasons. If you have a son, and have no particular concern about spiking your blood pressure, read "The War on Boys" by Erica Hoff Summers.

What I have read about Ritalin rates is anecdotally backed up by my kids retelling of the number of classmates going to the nurse to get their daily meds. However, I have no idea whether the rates reflect an objective problem. To make matters more difficult, schools are far different, much more (for lack of a better word) feminized now then when we were kids. So the Ritalin rates may reflect a real problem with boys' classroom behavior that is a consequence of the current inability to be boys out on the playground.

The problem with putting unhappiness into categories is that you really can't.

Yes you can, however imperfectly.


I agree, you can, albeit imperfectly. But I would take a different approach. (NB -- I have absolutely no personal experience with depression, so take this as pure hypothesizing.) Where unhappiness is the reasonable consequence of life circumstances, whether it be due to bad decisions or unfortunate turns of events, it is not a candidate for medication.

On the other hand, where unhappiness is not a reasonable consequence of circumstances -- say, post partum depression despite a healthy child, loving/supportive husband and no financial worries -- and said unhappiness being the cause of subsequent problems, then medication seems the obvious answer, the withholding of which would amount to conscious cruelty.

You are right, stories of suicides can have a Sheehan effect, no matter how carefully used. However, while all I know of Dworkin's book is through Fr. Neuhaus's article, both he and Dworkin appear to completely neglect the possibility that inappropriate unhappiness can turn into a self reinforcing cycle making a mockery out of some nobility of suffering.

BTW, you are aware, I assume, that the standard diagnostic manual for psychological disorders (DSM) is now in its fourth edition and is at least four times as thick as the first edition. I don't think Gray's Anatomy was ever so expansive. Do you see this as progress and the triumph of rational science? Anything to worry about?

That the DSM could expand so while Gray's Anatomy would remain static is not surprising to me. Our knowledge of anatomy was practically complete by Gray's time (IIRC, only one bone, a tiny one near the ear, is the only discovery since).

Our knowledge of the brain is, charitably, in its infancy.

As an imperfect analogy, the plane I flew previously, the DC-9, was a nearly perfectly stupid machine, capable only of maintaining altitude and heading. My current airplane, the MD-11, is aware of its position in space, phase of flight, destination, etc. The gross anatomy of both machines is essentially identical. But the flight manual of the latter is roughly three times the size of the former, and all of the growth is on the "DSM" side.

So to the extent the DSM reflects increased knowledge in both depth and breadth, then it is progress.

I have nowhere near enough knowledge, however, to judge that extent.

September 21, 2006 4:51 AM  
Blogger Peter Burnet said...

Skipper:

Where unhappiness is the reasonable consequence of life circumstances, whether it be due to bad decisions or unfortunate turns of events, it is not a candidate for medication.

Aren't you the guy who threw in the story of the man whose wife killed himself and the kids? I would give him whatever he wanted without hesitation, including heroin.

You are talking about situational depression. Believe me, family law lawyers know all about it. There is no hint of permamnently altered moods or a general philosophical approach to life's harder side there---it's pretty much pure pain and anxiety relief (although taking something to ensure good, non-dopey sleep can often do the trick) and most people recover within a fairly predictable time. Isn't what you are saying like saying we can give morphine for chronic or congenital pain, but not for flesh wounds in battle?

Spend an evening flipping through DSM-IV and then come back and tell me it is all about discovery.

September 21, 2006 6:09 AM  
Blogger Harry Eagar said...

DSM-4 does not recognize homosexuality as a disease, which puts it ahead of your manual.

++++

I do not recall a single ADD kid among the hundreds I went to school with or that my mother taught.

However, I do not deny that it exists. Just about any imaginable -- and some to me unimaginable -- gradations exist in our almost infinitely labile brains.

But I don't believe it exists at a rate of 5%, which reputedly is an not unusual rate of Ritalin administration in some schools.

Since it is a barbiturate, I'd hesitate to give it even to adults unless there were a compelling symptom.

September 21, 2006 8:55 AM  
Blogger Duck said...

You're trying to disassociate depression from life events and treat it like a totally independent factor, as if it were only the result of a virus or congenital defect. But you can't. Repeated, prolonged mental stress can bring about chemical imbalances in the brain, just as Skipper described it.

Like a good Platonist you want to divide people into the mentally healthy, for whom all life events are only capable of inflicting "everyday unhappiness", and mentally ill depressives, for whom we will allow medications. You totally discount the idea that someone who has had good mental health throughout his life can be put into a state of depression through his experiences. You Platonists like things tidy and neat, and abhor the messiness of real life, so you'll just pretend that it doesn't exist.

By the time you're to the point of losing weight and curtailing all your normal activities, you are close to suicide. Can you assure us that the good health brigade will always arrive in time with an accurate diagnosis and aid?

I don't mind if you hedonists regale us with all those stories about poor, sexually-frustrated old Aunt Bertha to support your libertine philosophies, but please don't throw up Jack the Ripper. Puts us off our biscuits, it does.

I have no idea what you are getting at here. Do you not think that suicide is a serious problem? Noone is asking you for support for changes in public policy. Dworkin is the one haranguing for change, he wants people and their doctors disempowered from the ability to manage their own health. I suppose he would want a panel of priests and theologians, or just busybodies like himself, to review each request and determine whether the patients unhappiness is extreme enough to satisfy them.

Exactly how thick should the DSM be? How thick was it in 1600? That's right, they didn't have one then. They had plenty of manuals on how to diagnose and treat witchcraft, though.

You are trying to sow panic about the abuse of antidepressants, but what is the real horror here? Where is the downside to happier people? Do you think that these drugs disable the conscience? Are you afraid of happy people run amok? I don't get where this is all coming from. Unless, as I said earlier, it is the implications to your anti-materialist worldview that bother you.

September 21, 2006 10:20 AM  
Blogger Duck said...

ADD isn't just about children who can't sit still. The opponents of
Ritalin have painted a picture that we are trying to medicate "maleness", which is highly misleading. There are many children with ADD who don't show visible signs of it, but who can't concentrate on tasks. It isn't the happiness of the parents that is driving all this, it is children who have very real problems keeping up with schoolwork. Back in Harry's day, they were just considered "slow", or dumb.

So if children can improve their school performance through Ritalin, is this another case of "cheating the system"? Or are they condemned to live the only life that their natural biology will allow. We can't have them competing on an equal level with naturally well-adjusted people now, can we?

September 21, 2006 10:32 AM  
Blogger Peter Burnet said...

OK Duck, you win. No more artifical distinguishing between the mentally unhealthy and healthy, no more futile and oppressive attempts to make critical qualitative judgments about health (for that would be platonist), no more experts deciding for people, no more stigmatizing the unhappy as either afflicted or not. After all, who can say what is healthy or not?

September 21, 2006 3:57 PM  
Blogger Duck said...

I don't see the connection between the linked article and the point you are trying to make. Heck, I don't even understand your point. Who are the experts that you would have make these decisions, and why are they better situated to make a decision than my doctor? Are you saying that prescribing antidepressants too liberally (by some people's views) will lead to assisted suicide? Now that's a connection that will require some diagramming.

September 21, 2006 4:51 PM  
Blogger Harry Eagar said...

'Where is the downside to happier people?'

It lightens the collection plate.

September 21, 2006 6:19 PM  
Blogger Peter Burnet said...

why are they better situated to make a decision than my doctor?

I wasn't aware we are arguing that anyone other than doctors should be making the call. I thought we were arguing what principles should be informing the doctors.

September 22, 2006 1:51 AM  
Blogger Peter Burnet said...

Hey Duck, while I have your attention, why is trying to draw a distinction between health and illness a platonist notion while drawing a distinction between happiness and unhappiness not?

September 22, 2006 3:15 AM  
Blogger Duck said...

The Platonist notion is that there is a hard distinction between illness and unhappiness that can never be crossed. It is this notion that health/illness is a function of the body and happiness/unhappiness is a function of the mind/soul, which is totally separate from the body. It is the notion that unhappiness can never become an illness of the body.

I posted my thoughts on the Ashbrook Center blog and managed to attract the attention of Dworkin himself. Here is the link http://noleftturns.ashbrook.org/comment.asp?blogID=9003.

September 23, 2006 8:36 AM  
Blogger Brit said...

Nice one Duck. Good to see the Duckians going direct to the source.

The fact that the ignoramus insisted on calling you "Mr Arquette" not once but twice doesn't speak well for the powers of observation on which his book purports to rest.

September 23, 2006 12:43 PM  
Blogger Duck said...

I do not have any relation... to that woman... Ms. Arquette...

(though I wouldn't mind a try, if you know what I mean. Hubba Hubba!)

Thanks Brit. It continues to amaze me how much trouble I can stir up in the larger info-sphere. Isn't the Internet wonderful? We should have a day to celebrate it.

September 23, 2006 1:15 PM  
Blogger Harry Eagar said...

Simple soul that I am, I cannot quite understand what the problem is with people who only think they're happy.

Is it possible to be unhappy and not know it?

September 24, 2006 1:23 AM  

Post a Comment

Links to this post:

Create a Link

<< Home