“Right,” I said. “Remember, Joseph, I would never use drugs on children—”
“I know, I know,” he handed me the rest of the pile. “These reports indicate that Prozac is different from any other antidepressant. It’s only been in use a year—”
“I know that, Joseph.”
“—and I want you to look at the rat studies on kindling.”
“Kindling?”
“You don’t know about kindling?”
“No,” I admitted.
“That’s irresponsible,” Joseph squeaked.
Harlan groaned.
Joseph’s voice stayed high. “I’m sorry. But it is. I know you don’t believe in psychopharmacology,” he appealed to me, “but that doesn’t mean you should ignore neurobiology. Freud wouldn’t.” Diane mumbled something. I couldn’t hear what because Joseph continued, “The kindling research has a bearing on your abused kids. They prove that emotional trauma can change brain chemistry.”
“They prove it?” I asked.
“In my opinion that’s the only reasonable conclusion you can draw from the kindling studies. Stress and trauma start a vicious cycle in the brain. And I believe the inescapable conclusion is that it means it can only be healed with drugs.”
“Give me a break,” Diane said. Joseph ignored her.
I glanced at the New England Journal of Medicine article. “Prozac and the New Self,” it was called. I said, “Point taken. I haven’t done enough reading to debate it with you.” I looked at my old friend and let him win. “Okay, Joseph, I’ll do my homework.”
CHAPTER SEVEN
A Crisis of Faith
I SHOULDN‘T BELABOR THE OBVIOUS TO PROFESSIONALS. WITHIN A FEW years, Joseph’s claims for Prozac were widely hailed in the media. Nowadays, it is an almost accepted fact that Prozac produces profound character changes in many patients, particularly mild depressives, people with low self-esteem, or emotional sensitivity, namely the sort of neurotic who had been considered psychoanalysis’s exclusive province. Namely patients like Gene Kenny. Prozac’s supporters claim that their patients aren’t merely relieved of the immediate physical effects of emotional pain; their experience of everyday rejection, loss, conflict, guilt and so on is altered, both in how they feel and react.
So why not prescribe Prozac for Gene? Readers of my book The Soft-Headed Animal know there is no proof, as Joseph Stein himself admits, that any psychological condition, ranging from schizophrenia to mild mood disorders, is organic. Shocking though it may seem to a lay audience inundated by half-truths and wild claims from psychobiologists, geneticists, and drug companies, there is no scientific proof that what we call mental illness exists. When autopsied, the brains of suicides, schizophrenics, manic-depressives, indeed the whole range of psychiatric disorders, show no measurable difference from the brains of people we label as mentally well. Only if (and this if is crucial) the “mentally ill” were subject to shock therapy, neuroleptics or sedatives do their brains show damage. Few things in psychiatry are as clear as this evidence: mental illness — insofar as one can consider it organic — doesn’t exist and the fashionable physical and chemical treatments, if used for long, may cause brain damage, irreversible damage that truly is a mental illness.
This confusion between the fact that drugs can change how people act and feel, and whether this constitutes a cure of their psychological crises, runs through every level of our society. Prozac, as an example, is supposed to “treat” depression by raising the amount of serotonin in the brain. And yet no scientist can show that depressed patients have lower levels of serotonin than people who are considered normal. (Some psy-chobiologists, to make their flawed logic consistent, respond to this fact by suggesting the entire population take Prozac.) When Prozac artificially raises serotonin, a minority of patients report they have more energy and accept defeat and frustration with less sadness. What its advocates leave out is that snorting cocaine can be shown to have the same effect, just as smoking cigarettes can be shown to improve concentration, and that alcohol can relieve anxiety. The difference — and it has a profound effect on the results of clinical trials of psychiatric drugs — is that when people medicate themselves with illegal narcotics, cigarettes, or alcohol, they don’t have a psychiatrist telling them they are ill when sober and cured when drugged. None of the material Joseph gave me clarified the murky logic of psychopharmacology. Insight alone doesn’t always cure. Drugs don’t cure. Not if the goal is an independent being, a person who is free from both a therapist and a pill. We like to call our profession a science, our patients sick, and our treatments medicine, but the psychiatrist, whether armed with a drug or a couch, is treating a perception of illness with only the prejudiced testimonies of its victim and an intolerant society to confirm his success. In that context, broad claims of success must always be regarded skeptically. Then and today, I could find no proof that medicating Gene Kenny would have been anything more than surrender to the modern culture of instant gratification.
Nevertheless, our New York coffee table scientific argument had several important consequences for me. What I did not, and could not have realized at the time, was the consequence it would have for Gene Kenny. That night his case seemed to be the least likely to be affected by the question Joseph and I debated. What was significant appeared to be entirely personal. Diane maintained an angry silence during the cab ride to her apartment. I had Joseph’s recommended reading in my lap. I tried to begin a few conversations. She answered in monosyllables, including when I apologized on Joseph’s behalf for treating her as if she weren’t a psychiatrist. “I’m just a stupid cunt to him,” she insisted. When we arrived at her door, she said, “Maybe you should go to your place tonight.”
“Okay,” I said, fighting the shrink’s impulse to talk this out immediately. She believed in that principle as fervently as I and must have had a good reason to delay.
Her tension at rejecting me relaxed. She kissed me affectionately and whispered, “I’m sorry. I’m just very tired.”
Not much of an excuse for a trained analyst. I played along. “Sure. Call you tomorrow.”
I wanted to study the articles anyway. I had an intuitive feeling that there was something valuable in Joseph’s dogma. And there was. I stayed up late reading, especially fascinated by the kindling studies on rats that suggest stress and rejection create biochemical changes which may then go on to have a life of their own. Of course they don’t really answer the age-old cause-and-effect argument, but they do call into question whether talking therapies alone can succeed in undoing the damage. They also, by the way, imply that early treatment is vital, very encouraging for someone who, like me, treats abused children and sometimes despairs of preventing long-term difficulties. I had lured “Timmy” out of his multiple personality defense against his abusers, but how could I feel secure that he wouldn’t suffer again later, in much the same way that Gene had reappeared with his old problems in a new guise?
By morning, I knew I had to investigate the kindling research. I called Joseph at eight o’clock. He promised to send unpublished material on a variety of neurological studies. Joseph was gracious and not smug about my apparent surrender to his point of view. (I didn’t tell him that I was unimpressed by the Prozac data.) Diane phoned soon after I hung up.
“I’m sorry,” she said in a sleepy voice. Her register is naturally low and husky. The morning gave her an even lower octave. It was sexy.
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