COST OF SOOTHING A TROUBLED MIND
‘Blue Dreams’ arrives in the thick of a debate about pharmaceutical approach to mental health
The world’s first transorbital lobotomy was performed in 1946 by Walter Freeman, in his Washington office. Using an ice pick from his own kitchen, he went through the eye sockets into the brain of his patient, a 29-year-old severely depressed housewife, and cut into her frontal lobes. Then he sent her home in a cab.
The history of mental illness treatments reveals medicine at its most inventive, desperate and disturbing. There have been aweinspiring discoveries — of the healing properties of lithium, for example, a soft, silvery metal produced in the first 20 minutes after the Big Bang. But remedies generally seem to have run a narrow gamut from the unpleasant (Cotton Mather’s prescription for depression: “living swallows, cut in two, and laid hot reeking unto the shaved Head”) to the outright sadistic. Aside from Freeman’s lobotomies, there is a long tradition of poisoning patients or inducing comas to “reset” the brain. In one notorious treatment, turpentine was injected into a patient’s abdominal wall in the hope of encouraging a fever high enough to burn away her hallucinations.
We’re lucky to live in more evidence-based, scientific times. Or do we? In Blue Dreams, a capacious and rigorous history of psychopharmacology, the psychologist and writer Lauren Slater looks at the fact that despite our ravenous appetite for psychotropic medications (about 20% of Americans take some psychotropic drug or other), doctors don’t really understand how they work or how to assess if a patient needs them. In the case of antidepressants, two-thirds of patients taking an SSRI (Prozac, Zoloft, Celexa, etc.) would improve on a placebo alone.
Still the misconception that depression is a matter of “low serotonin” persists. “There is no proof that a depressed person has a chemical imbalance,” Slater writes. “When you choose nevertheless to put that person on a medication that will alter neurotransmitter levels in his or her brain, then in effect you are causing a chemical imbalance rather than curing one.”
None of this is news, or should be. Blue Dreams arrives in the thick of a debate about the pharmaceutical approach to mental health, and synthesises forceful critiques from Gary Greenberg, Irving Kirsch and Robert Whitaker, among others. Slater is pithy, readable and generally fair, although I wish she had engaged more thoroughly with the defence of antidepressants, mounted perhaps most persuasively by Peter Kramer in his recent book Ordinary Well, which explored flaws in the studies that examined the efficacy of antidepressants.
The real strength of this book comes from Slater’s very particular position. She is patient and psychologist, part of the first wave of people who were prescribed Prozac in the 1980s. She describes how, in the years since, her mind has been saved and her body destroyed.
For 35 years, Slater has taken one psychotropic medication or the other. Her 1988 book Prozac Diary documented the relief that medication brought her, at the age of 26. She’d long been suicidal and suffered from eating disorders, obsessive compulsive disorder and a depression so crippling, she was hospitalized five times between the ages of 13 and 24.
Prozac “hurled me to heaven”, she writes in Blue Dreams. “I lived a gilded life, rich and buttery, producing books and babies as fast as I could, because I knew the Prozac would wear off, and eventually it did.”
She found another drug cocktail that eased her symptoms. But at 54, she writes, “my body is in the shape of an octogenarian with issues”. Her memory is shot. The antipsychotic she takes causes insatiable hunger and her weight has ballooned. She has diabetes. Her kidneys are failing. Her feet are covered in weeping sores and her eyesight is in trouble.
The drug Slater relies on is called Zyprexa. Curiously enough it’s the same drug Andrew Solomon described taking almost 20 years ago, in his National Book Award-winning history of depression, The Noonday Demon: An Atlas of Depression. He writes of the relief and anguish the drug brought him with eerie similarity, of having to choose his mind over his body.
What accounts for this sluggish progress, these intolerable bargains? There’s a “dry pipeline of new drugs,” the psychotherapist Gary Greenberg wrote in The New Yorker,“an indication that the drug industry has begun to lose faith in the myth it did so much to create”. Looking to the future, Slater seems to find hope in the “drugs not discovered but rediscovered”: in the encouraging studies of psychedelics and depression.
Blue Dreams, like all good histories of medicine, reveals healing to be art as much as science. Slater doesn’t demonise the imperfect remedies of the past or present — even as she describes their costs with blunt severity. And, improbably perhaps, she ends on a note of hope, calling these early efforts to address mental illness “the first golden era.”
If the story of the magic bullet of psychopharmacology is coming to an end, another story — a potentially better one, Slater believes — is coming to take its place.