For full article, go to:
http://www.nytimes.com/2005/04/17/magazine/17DEPRESSION.html?

There's Nothing Deep About Depression

By PETER D. KRAMER

Published: April 17, 2005

Shortly after the publication of my book ''Listening to Prozac,'' 12 years ago, I became immersed in depression. Not my own. I was contented enough in the slog through midlife. But mood disorder surrounded me, in my contacts with patients and readers. To my mind, my book was never really about depression. Taking the new antidepressants, some of my patients said they found themselves more confident and decisive. I used these claims as a jumping-off point for speculation: what if future medications had the potential to modify personality traits in people who had never experienced mood disorder? If doctors were given access to such drugs, how should they prescribe them? The inquiry moved from medical ethics to social criticism: what does our culture demand of us, in the way of assertiveness?

It was the medications' extra effects -- on personality, not on the symptoms of depression -- that provoked this line of thought. For centuries, doctors have treated depressed patients, using medication and psychological strategies. Those efforts seemed uncontroversial. But authors do not determine the fate of their work. ''Listening to Prozac'' became a ''best-selling book about depression.'' I found myself speaking -- sometimes about ethics, more often about mood disorders -- with many audiences, in bookstores, at gatherings of the mentally ill and their families and at professional meetings. Invariably, as soon as I had finished my remarks, a hand would shoot up. A hearty, jovial man would rise and ask -- always the same question -- ''What if Prozac had been available in van Gogh's time?''

I understood what was intended, a joke about a pill that makes people blandly chipper. The New Yorker had run cartoons along these lines -- Edgar Allan Poe, on Prozac, making nice to a raven. Below the surface humor were issues I had raised in my own writing. Might a widened use of medication deprive us of insight about our condition? But with repetition, the van Gogh question came to sound strange. Facing a man in great pain, headed for self-mutilation and death, who would withhold a potentially helpful treatment?


Copyright 2005 The New York Times Company

But I still think the best medicine is laughter and good people around us, whether they're supportive cyber friends or close by And another mind stress depression relaxer are pets. Kidlet wasn't home today so Ken & I were left with baby sitting her zoo. It was all good, baby ferret ruled the house most of the day, she's such a cutie, pottie training is going well. Who needs prozak when you can watch Mischief and Twitch wrestling. Well maybe there were a few stressfull momements of us worrying about the cat being too rough, killing the ferret and thinking of how to explain to our dd what happened, but all~in~all, we didn't need prozak. YET

Bobby aka Oma in Alberta

http://www.villagevoice.com/news/0304,baard,41331,1.html
The Guilt-Free Soldier
New Science Raises the Specter of a World Without Regret

by Erik Baard
January 22 - 28, 2003 alert me by e-mail
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illustration: Richard Borge
A soldier faces a drab cluster of buildings off a broken highway, where the enemy is encamped among civilians. Local farmers and their families are routinely forced to fill the basements and shacks, acting as human shields for weapons that threaten the lives of other civilians, the soldier's comrades, and his cause in this messy 21st-century war.
There will be no surgical strikes tonight. The artillery this soldier can unleash with a single command to his mobile computer will bring flames and screaming, deafening blasts and unforgettably acrid air. The ground around him will be littered with the broken bodies of women and children, and he'll have to walk right through. Every value he learned as a boy tells him to back down, to return to base and find another way of routing the enemy. Or, he reasons, he could complete the task and rush back to start popping pills that can, over the course of two weeks, immunize him against a lifetime of crushing remorse. He draws one last clean breath and fires.

Pills like those won't be available to the troops heading off for possible war with Iraq, but the prospect of a soul absolved by meds remains very real. Feelings of guilt and regret travel neural pathways in a manner that mimics the tracings of ingrained fear, so a prophylactic against one could guard against the other. Several current lines of research, some federally funded, show strong promise for this.

At the University of California at Irvine, experiments in rats indicate that the brain's hormonal reactions to fear can be inhibited, softening the formation of memories and the emotions they evoke. At New York University, researchers are mastering the means of short-circuiting the very wiring of primal fear. At Columbia University one Nobel laureate's lab has discovered the gene behind a fear-inhibiting protein, uncovering a vision of "fight or flight" at the molecular level. In Puerto Rico, at the Ponce School of Medicine, scientists are discovering ways to help the brain unlearn fear and inhibitions by stimulating it with magnets. And at Harvard University, survivors of car accidents are already swallowing propranolol pills, in the first human trials of that common cardiac drug as a means to nip the effects of trauma in the bud.

The web of your worst nightmares, your hauntings and panics and shame, radiates from a dense knot of neurons called the amygdala. With each new frightening or humiliating experience, or even the reliving of an old one, this fear center triggers a release of hormones that sear horrifying impressions into your brain. That which is unbearable becomes unforgettable too. Unless, it seems, you act quickly enough to block traumatic memories from taking a stranglehold.

Some observers say that in the name of human decency there are some things people should have to live with. They object to the idea of medicating away one's conscience.

"It's the morning-after pill for just about anything that produces regret, remorse, pain, or guilt," says Dr. Leon Kass, chairman of the President's Council on Bioethics, who emphasizes that he's speaking as an individual and not on behalf of the council. Barry Romo, a national coordinator for Vietnam Veterans Against the War, is even more blunt. "That's the devil pill," he says. "That's the monster pill, the anti-morality pill. That's the pill that can make men and women do anything and think they can get away with it. Even if it doesn't work, what's scary is that a young soldier could believe it will."

Are we ready for the infamous Nuremberg plea?"I was just following orders"?to be made easier with pharmaceuticals? Though the research so far has been limited to animals and the most preliminary of human trials, the question is worth debating now.

"If you have the pill, it certainly increases the temptation for the soldier to lower the standard for taking lethal action, if he thinks he'll be numbed to the personal risk of consequences. We don't want soldiers saying willy-nilly, 'Screw it. I can take my pill and even if doing this is not really warranted, I'll be OK,' " says psychiatrist Edmund G. Howe, director of the Program on Medical Ethics at the Uniformed Services University of the Health Sciences. "If soldiers are going to have that lower threshold, we might have to build in even stronger safeguards than we have right now against, say, blowing away human shields. We'll need a higher standard of proof [that an action is justified]."

The scientists behind this advance into the shadows of memory and fear don't dream of creating morally anesthetized grunts. They're trying to fend off post-traumatic stress disorder, or PTSD, so that women who've been raped can leave their houses without feeling like targets. So that survivors of terrorist attacks can function, raise families, and move forward. And yes, so that those young soldiers aren't left shattered for decades by what they've seen and done in service.



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Combat and psychoactive chemicals have always been inseparable, whether the agent was alcohol or a space-age pill. A half-century after Japan hopped its soldiers up on methylamphetamines during World War II, the U.S. has pilots currently in the dock for mistakenly bombing Canadian troops while using speed to stay awake. When Eric Kandel, the Nobel laureate in medicine who works out of Columbia, was asked if his genetic exploration of fear was funded by the Pentagon's Defense Advanced Research Projects Agency, he quipped, "No, but you're welcome to call them and tell them about me."

Imagine a world where the same pill soothed victims and perpetrators alike. Henry David Thoreau advised, "Make the most of your regrets; never smother your sorrow. . . . To regret deeply is to live afresh." Without remorse, there would have been no John Newton, a slave trader who found religion during a harrowing storm at sea and later became an abolitionist; he's best known for penning "Amazing Grace."

For doctors, the drugs would present a tricky dilemma. Most people exposed to traumatic situations don't end up with PTSD, but there are few means of knowing on the spot who might need treatment much further down the line. Researchers say that for the medicines to be effective, patients would need to take them soon after the upsetting event. The temptation for physicians might be to err on the side of caution, at the cost of curbing normal emotional responses. Victims might be eager to avoid lasting pain, wrongdoers the full sting of self-examination.

"The impulse is to help people to not fall apart. You don't want to condemn that," says Kass. "But that you would treat these things with equanimity, the horrible things of the world, so that they don't disturb you . . . you'd cease to be a human being."

The very idea of PTSD has been attacked as a social construction, a vague catchall that provides exculpation for the misdeeds of war. But researchers are trying to prevent the onset of a disease, not change the social circumstances that bring it about. James L. McGaugh, a neurobiologist at U.C. Irvine whose study of stress hormones and memory consolidation in rats is one of the cornerstones of the effort, acknowledges the ambiguities but comes out swinging in defense of his work. "Is it immoral to weaken the memory of horrendous acts a person has committed? Well, I suppose one might make that case. Some of your strongest memories are of embarrassments and of the guilty things you did. It doesn't surprise me at all that people would wake up screaming, thinking of the young children they killed in Vietnam," McGaugh says. "But is treating that worse than saying, 'Don't worry if your leg is shot off, we've got penicillin and surgery to prevent you from dying of infection'? Why is it any worse to give them a drug that prevents them from having PSTD for the rest of their lives? The moral dilemma is sending people to war in the first place."

Nevertheless, fellow fear researcher Dr. Gregory Quirk of the Ponce School of Medicine, in Puerto Rico, is troubled by how his work might be used if it progressed from studies of rats to therapies for humans. He argues that fear isn't created and degraded in the amygdala alone, but is also unlearned in the prefrontal cortex, which in PTSD patients is only weakly active. Quirk thinks a physician could stimulate those areas with magnets while patients view the images they fear, and could thus restore balance to the mind. With that same method, he says, firemen could stave off episodes of life-threatening panic. "Certainly the military might be interested in something like that," he says. "If this would be used to go against fear that's important for survival or morality, I would have a problem with that."

There are reasons to believe our military would covet mastery of Quirk's technique in humans. People at war dehumanize their enemies to make killing more palatable. Now, in the war on terror, our modern cultural taboos against torture are fraying. Put yourself in the room then. The commission of heinous acts, even deliberate torture, can also visit lifelong torment on perpetrators who aren't hardwired very well to be sadistic. The sounds of screaming?a primordial alert that mortal danger is near?trigger those ****ing hormones even in the torturer.

And couple Quirk's magnetic manipulation of the brain with this: "One of the horrible things I discovered after the Gulf War was that, because of the coeducation of wars, as it were, male soldiers were given extensive desensitization training to make them able to hear women being raped and tortured in the next room without breaking," Kass says. "It's a deformation of the soul of the first order. I cannot speak about it without outrage."

But a trauma-born irrational aversion to necessary war?pacifism in the face of an expanding evil?isn't healthy either. "Such emotions can blind us as well as make us wiser," says Howe. "It's possible that these kinds of drugs would help patients see in a clearer way." On the flip side, could anyone possibly maintain that Ahab was a better captain for not having been chemically mollified after the white whale bit off his leg?



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An uncomfortable reality is that war isn't an aberration; it has a very codified place in our culture. We agree through treaties to normalize it. We demand punishment for soldiers who violate those treaties, though more often those from the losing side. But we don't deny them medical treatment. And one needn't have committed a war crime to feel wracked by sorrow. "In my dreams I meet six Vietnamese people I murdered. Whether they had a gun on them is irrelevant," says Romo, who, as a 19-year-old lieutenant, served as a platoon leader in the 196th Light Infantry Brigade in 1967 and 1968. His ticket home was as a body escort for his similarly aged nephew, who served in the same unit. "I returned to the United States on my nephew's dead body," he says.

Romo and veterans like him have taken it upon themselves to use their experiences to teach peace. But veterans torn apart by PTSD don't have a choice about being Exhibit A in the case against war. "When you see what can happen to a young person, it passes on in a very real way, not in a history-class sense, that reality of what war and blood really is," he says. Who are we to impose this emotionalalbatross on soldiers? As a nation, we elect our leaders. It seems unjust to make veterans a special class to suffer for our sins in wrongheaded wars, or pay a continuing price for victory in the "good" ones.

"That's a heavy burden to put on people to preserve the morality you're talking about," says Dr. Roger K. Pitman of Harvard University, who's leading the propranolol study in people fresh from car accidents. "By that same logic, if you could make a lightweight bulletproof garment for soldiers we still shouldn't do it. For moral reasons we ought to make them able to be shot, to preserve the cost of war, the deterrent to war. But we work to prevent our soldiers from being shot, and I say there are mental bullets flying around there, too."

There's another context to be considered as well, McGaugh notes, one that was made clear by the recent demand from representatives Charles B. Rangel of New York and John Conyers Jr. of Michigan that we reinstate the draft to address racial and economic inequities. "Who are our soldiers?" McGaugh asks. "They are in the wrong place at the wrong time. Very few of their daddies go to Harvard, Yale, or Princeton."

But PTSD doesn't result solely from war. When Kass first heard of McGaugh's research, at a presentation in October, he had a far more intimate horror in mind: rape. "At fraternity parties they'll be popping Ecstasy at night and forgetfulness in the morning," he growls.

The victim would be an obvious candidate for an anti-trauma drug. Would dulling her emotional memories of the event help her to endure the lengthy, perhaps humiliating, pursuit of justice through the courts, or would it rob her of the righteous anger she'll need to persevere and perhaps the empathy to later help other victims? The rapist is part of the equation too. If his victim stabbed him in her own defense, no doubt he would be bodily healed. No physician could refuse to treat him. "If such a person had PTSD stemming from the circumstances of the act, he could be a candidate [for therapy]," Pitman says.

How much of our remorse do we have a right to dispense with, and how much exists in service to others, a check on our worst impulses? "Each experience we have changes our brain and in some sense alters who we are," says Dr. Joseph E. LeDoux of NYU, who studies emotional memory. "The more significant the experience, the more the alteration. We have to decide as a society how far we want to go in changing the self. Science will surely give us new and powerful ways of doing this. Individuals may want more change than society wants to permit."

Peter Kramer offers an interesting, but unconvincing, analysis of the disease model for depression. There's little science, but much speculation, surrounding the so called biochemical genesis of the depressed mind. It could-should-be just as easily argued that optimistic people are mentally ill relative to their degrees of optimism, and should then be medicated accordingly. Be that as it may, introducing brain disabling medications to mute the cognitive process of "depressed" people seems to me quite insane in and of itself. If a person is melancholy because of, let's say, an endrocine imbalance then it makes perfect sense to treat the endocrine imbalance directly, but I don't think that's where Kramer is leading us, however.

At any rate the depression Kramer speaks of (the disease model) is relatively rare, and no objective test short of empirical subjectivity exists to apprehend the elusive culprit behind this "mood disorder" as of yet. Introducing brain disabling drugs only compounds the problem. If adults choose to be influenced by pseudo science, then fine. State sponsered drug interventions with our children is an entirely different matter. Right?

Interesting article, but disappointing since I didn't learn anything I didn't already know (depression is real, ppl. who don't experience it think it's a "mood" that can be fixed with cheerful music, etc.). I do wish I could find an article I saw long ago about a university study that suggested that ones percieved social standing caused depression (and anxiety). This is seen in animals - I remember a video on pbs of some Baboons and one of them got rejected from the group. Soon after he started developing nervous tic like pulling his fur out and getting sick. And we've all heard about how when a gorilla becomes the alpha male that his serotonin levels shoot up.

Personally I think the whole issue revolves around the tendency for ppl. to take things personally. You should never take anything personally, insults or compliments. It just isn't logical. But habits die hard...

Great to see someone promoting Szasz's ideas!

The only thing I wanted to add which Szasz doesn't take on adequately in my view is that of adults who accept psychiatry. Szasz doesn't question the way that the business of psychiatry, like any business, works to make sure that there are no alternatives known to the one being promoted.

So, people come to a psychiatrist because they have no real alternative. They simply do not know of any other ways of seeking help, so inundated they've been with professionals telling them that "expert" assistance is all that is possible.

Now I know Szasz cannot do everything, but I think it's an important point that he's not taking by the horns, and I don't know why. Any thoughts on this are appreciated.

Vosh, I've been depressed, many times over. Sometimes I've been so depressed that I've virtually become paralyzed. I've even considered, on numerous ocassions, the ultimate personal solution to this mind situation, but happily abstained from carrying it out on myself. Over time I came to realize that virtually all of my depression was environmental (broken family, school hell, unsatisfactory employment-- especially being a high school teacher) and through much soul searching along with the birth of my children, and a brilliant, caring friend at the Naropa Institute in Boulder I finally broke loose from this horrible state of mind. I, with the help of a loving family and friends, no longer labor under the clutches of this frame of mind, but more importantly did it without further scrambling my brain with psychotropic, big pharmaceutical company, mind destroying dope. Depression was and is VERY real, the only question being is it a mental illness? From where I stand I'd say 99% of the time "NO"!

I can see that... I was thinking that if that Baboon I mentioned had "mastered solitude", as Gatto says it, then being kicked out of the monkey group (are they monkeys? I dunno) wouldn't have effected the thing in such a way. As an act of imagination I can simulate what that means and when I do I find my sense of being defeated, being surrounded on all sides, being depressed and anxious - I find that it lifts.

I'm also convinced that a lot more ppl. suffer from this than is generally counted -- how many ppl. could not go to work, much less get through the day, without coffee!? I once worked at a place that was straight out of a Dilbert cartoon called Associates Bancorp. (you may have heard of them; I had not known they were this big famous company). Everyone was really perky and I felt like killing myself. One day it hit me, these ppl. inhale coffee like there's no tomorrow! One guy practically performed a blood transfusion with the stuff and was just brimming over with personality. I wonder what sunny conformists they could be without their coffee drug? Lately I've found I can get out of bed if I have my own good reasons and I'm very glad to have discovered this because I'd hate to live my whole life having only ever been able to get up in the morning and face the day thanks to a chemical stimulant (and I've never been able to tell that weird lie to myself that coffee tastes good - it tastes like sh*t - we really underestimate peoples ability to talk themselves into thinking and believing things).

I don't know that I want to define "illness" as that which you treat with a pharmaceutical...

Illness can't be defined as something treated with a pharmaceutical, but how do you define it? And if "mental illness" isn't illness, are all other illnesses illness if their psychosomatic components are taken into account? Aren't many physical illnesses bodily ailments that may have an origin in mental distress? How is the immune system affected by mind and the brain?


"The intensest light of reason and revelation combined can not shed such blazonings upon the deeper truths in man, as will sometimes proceed from his own profoundest gloom. Utter darkness is then the light, and cat-like he distinctly sees all objects through a medium which is mere blindness to common vision. Wherefore have Gloom and Grief been celebrated of old as the selectest chamberlains to knowledge? Wherefore it is, that not to know Gloom and Grief is not to know aught than an heroic man should learn?"

nt

just testing