Rafael Yglesias - Dr. Neruda's Cure for Evil

Diane crossed her legs, adopting an atypical supercilious attitude that, frankly, she couldn’t quite pull off. “What can’t you believe? Please tell us. I’m dying to know,” she said and smirked at him.

Joseph ignored her sarcasm. He stood up. “Let’s drop it,” he said and then immediately continued, “You won’t admit that we’ve done it. We’ve cured depression, we’ve cured anxiety, fuck — we’ve cured neurosis! We’ve proven that it has nothing to do with whether Mama wiped your ass for you or made you do it yourself. It’s just a goddamn chemical imbalance. How can you, a trained scientist, argue that depression is caused by anything but a bad brain recipe if we can wipe it out with a pill?”

“I can argue it very easily,” I said calmly. My momentary anger had passed.

“How!” Joseph shrieked at me, not very differently from when we were ten years old.

“Let’s drop it, Joseph.”

“Oh, you want to drop it. Because you’re losing.”

“Cool it,” Harlan said and lit a cigarette.

“Stop smoking,” Joseph snapped.

“You wanted to drop it a moment ago,” I said.

“I don’t want to drop it.” Joseph pleaded to the others. “Everybody take note. I don’t want to drop it.”

“Okay, you don’t want to,” I said. “I do.”

“I don’t want you to drop it, Rafe,” Diane said. That was uncharacteristic: she would normally argue her point of view herself. And her tone, even when addressing me, was cool and contemptuous.

“See? You lose,” Joseph said. “We’re not dropping it.”

I looked at Diane. I couldn’t read her. Did she feel it was my job to take him down a peg — or was she testing my willingness to fight? Either way, this was unlike her typically bold and straightforward manner. “All right,” I said and returned my attention to Joseph. “What was — oh yes, how can I argue that depression is caused by anything except a chemical imbalance when you can relieve it with a drug? Am I to understand, Joseph, that since scientists can impregnate a woman with frozen sperm you have concluded that what makes babies is a syringe?”

Harlan laughed. Joseph dismissed me with both hands. He was a small man, no more than five three. Small and unathletic, yet the old man’s clothes he wore as a boy were long gone. He dressed in Armani suits for evening wear, Banana Republic clothes for casual wear, and jogging suits for a night like the one we had just spent. He was in a red and white one now, on his feet, twirling away from me in disgust. “That’s bullshit.” He turned to face me. “That’s beneath you, Rafe. I’m sorry to hear you resort to that bullshit.”

“I’m sorry, too. I don’t want to resort to bullshit. What’s wrong with my point?”

Joseph stared, as if searching for signs of sarcasm. He couldn’t find any, since there were none. He sighed. “Artificial insemination proves that a sperm and an egg make a baby, not love.”

Silence greeted this remark. Not a respectful silence, recognizing logic triumphant. I think we felt dismay at what this implied for humanity’s future.

“So your point,” I said, after the room’s gloom persisted long enough for Joseph to check each of our expressions, settle back in his chair, pick up his espresso cup, note that it was empty and replace it on the coffee table. “So your point is that since Prozac can relieve depression’s symptoms—”

“Not its symptoms!” Joseph’s tone was so sharp that Harlan jerked his head away and pretended to clean out his ear. Diane smiled at him. Joseph ignored his pantomime. “Don’t diminish it by saying symptoms. What is depression if not a collection of symptoms?”

“Exactly,” I said. “What is depression? That’s the question you haven’t answered, any more than artificial insemination answers the question of what is life. A patient goes to a doctor and complains that he can’t sleep, he has no appetite, he has trouble concentrating, he feels his life is joyless, and that there’s no hope for any of these things to change. The doctor says he’s suffering from depression. He prescribes your drug and some of those things are changed. He eats more, sleeps more. His doctor praises him, his family praises him—”

“That’s not all—”

“Let me finish. The patient goes off the drug. And he can’t sleep again, he can’t eat, he has trouble concentrating—”

“So?” Joseph appealed to Diane. Evidently he had given up on me. “You put him back on the drug. How is that different from a recurrence of any illness? A person is infected, you give him an antibiotic. That doesn’t mean he can’t infect again.”

Diane looked to me, mouth set, arms crossed, like a professor waiting for an answer. I could understand why she might, sensitive to my friendship with Joseph, refrain from answering him herself, but why look at me so crossly? I hoped the annoyance was meant for Joseph. Harlan also looked at me expectantly. They appeared to be demanding that I refute my friend. I wasn’t sure that I wanted to refute him: I wanted to know if he was right or wrong and I doubted debate offered certainty.

My tone was an appeal, not argument: “Tell me, Joseph, how is it different from the person who feels awkward at a party, getting drunk every time he goes to one? Or a ghetto kid — who is right to feel his life has few prospects — buying crack to feel a surge of bliss? Have you cured depression, Joseph, or simply created socially acceptable addicts? Maybe you’ve helped the depression. Or maybe you’ve invented your own illness, and used that to overwhelm depression.”

“Oh, come on,” Joseph said. “Are you telling me antidepressants are completely useless in your work? That you would rather have people sink lower and lower—”

“I see you still haven’t read my book, Joseph.” He didn’t respond. Harlan smiled to himself. Getting no admission or denial, I continued, “Yes. At best drugs are useless. At worst they add a new problem. I never use them.”

“Because you’re biased,” Joseph said conclusively, as if making a private judgment, not scolding me.

“Because they’re dangerous.” I insisted. “Are you denying that tricyclics are addictive? Are you denying that neuroleptics cause tardive dyskinesia?”

“In some patients!” Joseph complained. “That’s why I didn’t finish reading your book. You throw out everything because some of the drugs aren’t perfect. Is the couch perfect?”

“No. In fact the couch is slow and hard work. Hard for the doctor, hard for the patient, hard for their families, hard for everyone. Not drugs. They’re easy. Drugs make patients easy to deal with. Easier for doctors and hospitals and their families. But what they don’t do is cure depression or schizophrenia. And what’s more, Joseph, and you know this is true, long term those drugs diminish personality—”

Joseph was on his feet. “I knew it. You haven’t read the research on Prozac.” He finally married his actions to his clothes and went jogging, out of the living room and down the hall to his study.

Harlan leaned forward, shook the espresso pot, and asked Diane if she wanted more.

“Not if you have to make it,” she said.

“I don’t mind,” Harlan said. “I’m depressed. I got nothing better to do.” He stood up, carrying the empty pot. “I like the idea of Joey inventing his own disease.”

Joseph appeared with reading material for me. One was a dissertation in manuscript. There were two issues of the New England Journal of Medicine, and finally a popular paperback by a psychopharmacologist. “She’s a dope,” Joseph said as he handed over this book, “but read her case histories in the last chapter for the descriptive data on Prozac’s effects. You haven’t read it, right?”