Listening to Prozac: Chapter 1 - First experience with Prozac was with Tess o Accomplished remarkable things in adult life

despite an especially grim childhood, now is clinically depressed o Eldest child of ten born to passive mother and alcoholic father living in poorest public-housing project in the city o Failed marriage: once Tess siblings grown, one of the central purposes of the marriage was lost o Had prolonged affairs with abusive married men degrading relationships that were demoralizing o Tess has a gracious mix of expectation of care and concern for the comfort of her listener o It is said that depressed mothers children, since they have to spend their formative years gauging mood states, develop a special sensitivity to small cues for emotion. In adult life, some maintain a compulsive need to please and are thought to have a knack for behaving just as friends prefer, at whatever cost to themselves. o Source of social failure: masochism grounded in low self-worth o Started Tess on imipramine she started feeling better; better not well wasnt good enough for the author, however o She started to experience trouble at work But what level of stress was it appropriate for Tess to experience? To be rattled even by tough negotiations was unlike her; she was also sobbing in her meetings with the author regarding Jim, which was unlike her o She went on Prozac and it made her feel more energetic than ever, three dates a weekend! o Psychiatrist had never seen a patients social life reshaped so rapidly o Low self-worth, competitiveness, jealousy, poor interpersonal skills, shyness, fear of intimacythe usual causes of social awkwardnessare so deeply ingrained and so difficult to influence that ordinarily change comes gradually if at all. But Tess blossomed all at once. o Tesss management style changed. She was less conciliatory, firmer, unafraid of confrontation. o Tesss relations to those she watched over also changed. She was no longer drawn to tragedy, nor did she feel heightened responsibility for the injured. o Tess goes off the medications and after a while she says, Im not myself; Tesss chronic condition: heightened awareness of the needs of others, sensitivity to conflict, residual damage to self-esteem Psychiatrist wrote her the prescription: Who was I to withhold from her the bounties of science? Then Tess had her renewed confidence, self-assurance, and social comfort back o Prozacs popularity: its ability to alter personality o Loyalty and enthusiasm from patients on Prozac o Is the melancholy or saturnine humor morally superior to sanguine?

o Discomfort with Tesss makeover: It is all very well for drugs to do small things: to induce sleep, to allay anxiety, to ameliorate a well-recognized syndrome. But for a drugs effect to be so globalto extend to social popularity, business acumen, self-image, energy, flexibility, sexual appeal touches too closely on fantasies about medication for the mind. Medication does not transform, it heals When faced with a medication that does transform, even in this friendly way, I became aware of my own irrational discomfort o Cosmetic Psychopharmacology o Chemicals to modify personality in useful, attractive way? Making your personality attractive o Moral indistinguishability between street drugs and these more specific sanctioned drugs o Street-drug abusers vs. prescribed-drug users o How might a substance like Prozac enter into the competitive world of American business? How might a drug that alters personality be used in competitive society? hyperthymia-> optimistic, decisive, quick of thought, charismatic, energetic, and confident individuals; this is considered a mental condition o The issue of personhood o Important paragraph: on imipramine, no longer depressed but still inhibited and subdues, Tess felt myself again. But while on Prozac, she underwent a redefinition of self. Off Prozac, when she again became inhibited and subduedperhaps the identical sensations she had experienced while on imipramineshe now felt not myself. Prozac redefined Tesss understanding of what was essential to her and what was intrusive and pathological. o How far we are likely to go in the direction of permitting drug responses to shape our understanding of the authentic self. Chapter 9: The Message in the Capsule - By reducing human self-consciousness, the drug robs individuals of their souls. What links men and women to God is precisely their guilt, anxiety, and loneliness. - Ethical dilemma: Is Prozac a good thing? o Robert Aranow, Harvard psychiatrist: challenged colleagues to think about the implications of a harmless drug o Schwartz: when normal people experience pain, they are merely in touch with reality and their own human vulnerability. The use of the pill to improve their mood is an act of disconnection, you bring a break between the individual and his humanity But no one faults that interventionso to use medicine to make a person more optimistic than strict realism allows must not be inherently unethical Schwartz main takeaway: mood brighteners disconnect people from reality

Another idea: Affect tolerance = stand to feel what you feel; this is the theory adopted from Zetzel that the capacity for emotion growth to be grounded in the capacity to bear anxiety and depression Schwartz worry: mood brighteners have the capacity to reinforce oppressive cultural expectations Issue of bereavement: medication seems to justify the standard that is in place by labeling those who deviate from a cultural norm as ill and then curing them Randolph Nesse: criticized mood brighteners from the viewpont of evolutionary biology o Bad feelings are useful o These bad feelings carry information vital to the survival of the individual and the species; unpleasant mood states are similarly adaptive o Anxiety reminds animals of circumstances in which they have encountered danger o Based on this logic, shouldnt psychotherapyallowing people to be more assertive in the face of authoritybe as suspect as mood brighteners? According to Nesse and Schwartz, you are preventing people from struggling with reality and thus achieving affect tolerance Reinforce dehumanizing social expectations