The Autonomy Enhancer (in part)--DHS claim #1

Here is what I accomplished today in outline the first point of the Psychopharmacological Hedonist Strategy (this follows my "The Psychopharmacological Hedonist's Orthdoxy: Part 1).

The Autonomy Enhancer

Among bioethicists, the principle of autonomy is one of the most important moral goods. Physicians should not, according to the principle of autonomy, coerce a patient to undergo treatments or therapies; the physician must respect that patient’s innate capacity to make good decisions for him or herself given impartial, comprehensive information. The emphasis on protecting patient autonomy creates the impression that the physician-patient relationship is a free market exchange between equal contractors (see Donchin 2001, 368). Healthcare, on this model, looks dangerously close to a commodity (see Tong 1998, 150). In the case of psychiatry, potential patients are presented with an array of choices: psychotherapy, homeopathy, psychopharmacology, psychoanalysis, or philosophical counseling. Kramer, in part, sees his book as offering good reasons why a consumer of psychiatric care out to consider psychopharmacology over the other options. This is the first sense in which Kramer is appealing to the principle of autonomy in Listening to Prozac. He is presenting a book that offers consumers good information about why Prozac and the pharmaceutical therapy in general is a good practice for dealing with subclinical mental illnesses.

The second, and more important sense, in which Kramer appeals to autonomy, is to argue that Prozac is actually a chemical promoter of it. This might seem like the worst kind of science-fiction nightmare: medical science in the service of making better consumers. Moreover, its not clear that after 15 years of Prozac (and its cousins), we can conclude that it actually does deliver on Kramer’s promise for better living through chemistry. However, let’s put aside, for the moment, the question of whether Prozac actually does make us more autonomous, and consider the abstract moral question: is there anything ethically problematic about a drug that makes humans better able to make choices and thereby fully participate in a liberal, democratic society? Afterall, Kramer disclaims many times in Listening to Prozac that his speculations about the positive impact of Prozac for rewriting our cultural narrative on what makes us who we are—biology or biography?—are simply that, speculations: “[t]he biological study of the self is so primitive as to be laughable” (1993, 283). When we attend to his abstract, speculative, and gender-neutral claims—Prozac is good for autonomy—some very interesting problems emerge.

First, how is it that Prozac is a chemical autonomy enhancer? Remember, Kramer has encouraged his readers to give up old psychiatric paradigms—long, drawn out analytic sessions directed toward spurring anxious analysands to choose their authentic paths—and replace that paradigm with a neuroscientific view of mood, i.e. biography becomes biology and hence responds best to biological interventions. If we accept this paradigm, then what follows is the metaphor of psychopharmacology “mending” or “restoring” us to a better biological state of existence. A psychopharmacological intervention into our badly bruised biology may be a far more effective way of “leveling the playing field,” one could argue, than striving toward building more just and equitable institutions. Consider what ethicist Mike Martin has to say about weighing the choice of treating a subclinical, yet unhappy patient suffering from an unjust world or dedicating energies toward making the world more just:

Depression can be ‘normal,’ in the sense of an understandable and expected response to harmful social structures and yet have pathological aspects that disrupt our ability to carry on with our lives. We cannot wait until the vaster problems of community are resolved before dealing with the suffering generated by those problems (1999, 284, my emphasis).

Unjust social institutions, Martin concedes, do injure people. Sexism, for example, may impact a woman’s sense of self, leading her to mistrust herself and thereby ability to make good decisions. Such women, Kramer’s reasons, might make themselves too dependent on men, and more dangerously abusive men (1993, 68). Ostensibly, though he doesn’t spell this out, women might become dependent on men, precisely because they project a competent, autonomous self. The old-style feminist approach was to challenge—through protest, educational and legal reforms, and “consciousness raising”—cultural cultural assumptions that women are simply incapable of self-determination. Second-wavers—“modern” feminism—want to create a world that taught their daughters to see themselves as powerful and capable as men are, while the new style—“postmodern” feminism—is too impatient for this work, and opts for personal enhancement drugs that more effectively transform the female self into a powerful and autonomous self (see Zita 1998; Metzl 2003).

Kramer helps sell this “postmodern” feminism—this elixir for a “masculine” self-determination in his chapter on “Sensitivity.” I want to point out two moves that Kramer makes in this chapter: (1) he offers up a new mental health diagnosis facilitated by Prozac interactions on “needy” women and then, (2) names this diagnosis “rejection-sensitivity,” which, I will argue, deemphasizes gender. We learn about rejection-sensitivity in connection with “Lucy,” who has low self-esteem and a pronounced need for male attention. Lucy is not clinically depressed, but she does suffer from a perception that her boyfriend does not love her enough, which she builds from the slightest insensitivity on his part. Kramer finds that Lucy responds well to Prozac and then launches into an exploration of a new mental illness category—rejection-sensitivity—that is reified by Prozac. Psychopharmacology, therefore, does more than merely treat patients, but it also acts like a diagnostic tool, enabling the psychiatrist to discover pathology where he didn’t see it before. If you give Prozac to a “normal,” albeit overly sensitive person, and she becomes less sensitive, and therefore efficacious in the world, then what you thought was a normal state may in fact be an abnormal state, or at least potentially abnormal state. Jennifer Radden (2003) refers to this type of diagnostic methodology as “drug cartography,” a practice whose problems which I will outline in the next chapter.

Kramer credits the discovery of rejection-sensitivity to Donald Klein, who was a pioneer in biological psychiatry. However, Klein’s nomenclature for the illness was “hysteroid dysphorics” who he described as:

. . . usually females whose general psychopathological state is an extremely brittle and shallow mood ranging from giddy elation to desperate unhappiness. Their mood level is markedly responsive to external sources of admiration and approval. Such a patient may feel hopelessly bereft when a love affair terminates, then meet a new attentive man and feel perfectly fine and even slightly elated within a few days. Their emotionality markedly affects their judgment. . . .They are fickle, emotionally labile, irresponsible, shallow, love-intoxicated, giddy and short-sighted. They tend to be egocentric, narcissistic, exhibitionistic, vain and clothes-crazy. They are seductive, manipulative, exploitative, sexually provocative, and think emotionally and illogically (cited in Kramer 1993, 74-75).

Kramer acknowledges that this syndromal description reads more like a “misogynist’s picture of womankind,” however he nonetheless champions Klein’s work from moving us away from the even worse misogyny inherent to Freudianism. What Klein discovered the “psychobiological defect” of “hysteroid dysphorics,” who were so traumatized by any perceived or actual rejection, that to compensate maladapted the above personality style (75, 77). When Klein intervened with MAOI inhibitors—an older generation antidepressant—these women no longer degenerated into self-destructive behavior as a result of rejection.

The American Taliban

Thanks to Kriscinda for alerting me to The American Taliban website. Folks, just click and see, this needs no commentary.

Hurray for the Washington Post: The Clash of Culture and Biological Psychiatry

Yes, another post from me tonight. My colleague alerted me to a three part series in the Washington Post on the difficulties of reconciling cultural and race differences with the determination of psychiatrists to pursue genetics and neurochemistry as a means to understanding the basis of mental illness.

First let me give all you loyal readers the links to each article. The author is Shankar Vedantam, who I have been a fan of for a long time because of his pieces on drug companies and mental illnesss. I remember a few years ago that he reported that clinical trials on Prozac (something that is well-documented now) revealed that Prozac was no more effective than a placebo AND that older antidepressants actually did a better job. If you want the whole scholary history on that, you should read David Healy's book Let Them Eat Prozac, which has a companion website. By the way--yes, another digression--I am writing a review of that book right now, which I promise to post for you readers as well.

Now, the links for the articles:
(1) Patient's Diversity is Often Discounted 6/26/05
(2)Social Network's Healing Power Is Borne Out in Poorer Nations 6/27/05
(3)Racial Disparities Found in Pinpointing Mental Illness 6/28/05

I interrupted my careful reading of these pieces to report them to you. But, to give you a preview of some of the important insights in this series, let me mention a few details.

First of all, Vendantam points out how NO Native Americans were involved in clinical trials for drugs, and yet are quite regularly written prescriptions. My guess is that it is far more "cost efficient" to write prescriptions for pills than to treat the myriad mental health problems among Native American populations.

Secondly, I was not at all surprised to discover that American-born Mexican have mental health trends that are more similar to "Americans" than Mexicans. The immigrants begin to repeat typical American patterns of mental dysfunction: depression, alcoholism, etc.

Thirdly, White women are three times more likely to commit suicide than African-American women or Mexican-American women. The reasoning here, which seems sound to me, is that white women simply don't have the same social supports.

Now, for a juicy quotation from the piece that resonates nicely with my own recent writing (perhaps should be incorporated in my book):

Unlike anti-psychiatry groups that wish to do away altogether with drugs and doctors, advocates for cultural competence argue only against one-size-fits-all thinking. Genetic vulnerabilities and brain chemistry are undoubtedly important, said Lewis-Fernandez, but his patient was badly served because doctors assumed all her problems could be reduced to brain chemistry.

"Sure, after a certain amount of suffering for a certain amount of time, your brain reacts," he said. "The idea of mainstream psychiatry is that the pill will correct the chemical imbalance in the brain. Yes, but the imbalance keeps happening because of the situation she is in, and the pill can't correct the situation."

Sound familiar? What I particularly like about this first article is that Vendantam reports what the "mainstream psychiatrists" think about what Psychiatry should be like, which makes it plain what a bad place we are for addressing mental health issues across racial, religious, sexual, ethnic, and cultural diversity:

Mainstream psychiatrists say such examples are interesting but insist that the field stay focused on biology and brain chemistry. That is the only way to integrate psychiatry with the rest of medicine and to produce objectively verifiable treatments, said Regier, of the American Psychiatric Association.

So, the need to legitimize "Psychiatry" is more pressing than understanding what cultural forces--good or bad--are impacting how those who are "different" experience and understand their mental illnesses. What a loss!


Oh--for "I"--you should check this series out for its discussion of the unscientific nature of the DSM. And, let me close with my favorite quotation from the piece:

"When science becomes a religion, it becomes scientism," he [Renato Alarcon, a Psychiatrist at the Mayo Clinic] said. "There are fundamentalists among the scientists."

The Psychopharmacological Hedonist's Orthodoxy: Part 1

A tiny contribution today, but the indication that I made some good progress and know my direction for the next few days.

How Did the Bioethicists Lose Sight of Gender in the Cosmetic Psychopharmacology Debate?: The Psychpharmacological Hedonists’ Orthodoxy.

The core insight—that both worries and intrigues Kramer—of the cosmetic psychopharmacology question is that Prozac reifies what personality traits are currently socially rewarded in a culture (1993, 270). The dilemma presented by Prozac, then, is if a pill can help a socially unrewarded person achieve the kind of personality likely to bring them recognition and success, should we prescribe it? Kramer’s answer to this question seems to be yes. Above, I demonstrated that Kramer thinks that the conformity that Prozac potentially creates is not a bad conformity, since it strives to make all people more assertive. Since Prozac promotes attributes that Kramer believes are in line with feminist aims, then Prozac is no mother’s little helper, hence, we do not have a misogynist pill on our hands.
While Kramer’s belief that Prozac is not a “mother’s little helper” drug goes a long way to explaining why enhancement debates that specifically concern Prozac become “gender-neutral” debates, I will now lay out, in greater detail, the argumentative strategy that Kramer adopts to defend enhancement (“cosmetic psychopharmacology”). I will refer to this strategy as the “’psychopharmacology Hedonist’ strategy” (PHS), because, as I will show, it becomes the “orthdox” strategy of ethicists supportive of Kramer’s defense of cosmetic psychopharmacology. The psychopharmacology Hedonist strategy consists of three claims:

PHS 1: Prozac gives us a greater range of personality choices from which to choose, therefore it maximizes autonomy for persons formerly crippled by indecisivenesss, shyness or a lack of assertion.

PHS 2: Hedonism pursued by licit pharmaceutical means is not unethical; moreover, hedonism is commensurate with an authentic self-creation project.


PHS 3: The belief that depression offers a “special perspective” encourages moral development is the product of pseudo-scientific thinking.

I will tackle each one of these claims to show not only the flawed reasoning, but also the way each claim diverts from the gender implications of cosmetic psychopharmacology.

No Mother's Little Helper: REWRITE

I worked on rewriting the third installment of the "book" and breaking it--eventually--into two sections. Here is the first installment of the rewrite, subjected for any viewer criticism:

This is No Mother’s Little Helper

“ . . . in the bioscience discourse of depression, the personal is not political, the personal is biological.” --Bradley E. Lewis (56)

The naïve view of the players in this Prozac, bioethics debate is that they are simply white, middle-class men for whom the question of gender never arises. This is simply not true. Back in 1993, when Kramer introduced the question of the ethical permissibility of Prozac, he wasn’t wholly blind to the gender implications of this drug. However, he believed that on balance Prozac was good for women in their quest toward libertaion and equality. Kramer embraced the ways that Prozac helped make women less sensitive to rejection, more assertive, and energetic. Anticipating the feminist criticism that his exhuberance for Prozac—particularly for subclinical obsessive and neurotic women overwhelmed with the competing responsibilties of mothering and work—might recall an earlier exhuberance for “mother’s little helper,” Kramer takes pains to distinguish Prozac from Valium or Miltown. He begins by highlighting at least two important differences between the current era of Prozac and the era of “mother’s little helpers.”

First of all, mainstream, American Psychiatry has traded in psychoanalysis and its particular conceptual language of intrapsychic conflicts for a more biological paradigm (read: objective and observable) (see Metzl 2003; 2003a). The development and success of antidepressants—beginning in the 50’s—spurred psychiatrists to consider the neurochemical basis of mood regulation, rather than exhort patients to explore their early childhood attachments (see Healy 1997). Psychoanalysis gave way to biological Psychiatry and psychopharmacology, which holds out the promise for greater scientific rigor than the pseudo-science of Freudianism.

Secondly, the guiding mission of psychiatrists treating neurotic housewives with Valium or Miltown was “to keep women in their place, to make them comfortable in a setting that should have been uncomfortable in a setting that should have been uncomfortable, to encourage them to focus on tasks that did not matter” (Kramer 1993, 39). Rather than being an “opiate for the masses,” Kramer heralds Prozac as a liberatory drug, which gives more gusto to women’s protests. “The prominently neurotic today are often political liberals,” claims Kramer, so why not give a boost to their cause by handing out Prozac? (Kramer 2000, 15). Women have certainly come a long way, baby, and Prozac is just the drug for the anxious, post-women’s movement, woman.

In discussing the case of Julia—a woman plagued by an obsession with keeping her house ordered—Kramer begins to consider why Prozac is a “feminist” drug. Once Julia is on the drug, she is able to more easily let go of her need to control the household. She can handle messy dogs and a less-than-perfect husband and children. Before Prozac, she was unable to leave the home and enter back into the workplace, stymied by her fear of losing control. After Prozac, she returns to a career in nursing, with a desire to specialize in pediatric nursing—certain she will no longer be irritated by the unruly children. Kramer uses this case study to illustrate why Prozac is no “mother’s little helper”; “it was the opposite of a mother’s little helper: it got Julia out of her house and into the workplace, where she was able to grow in competence and confidence . . . There is a sense in which antidepressants are feminist drugs, liberating and empowering” (Kramer 1993, 40). The measures Kramer uses for the liberatory power of Prozac is: do women become more breezy and fun-loving in their romantic life (rather than needy and draining), are they more assertive and risk-taking at work, and, how resilient are they to criticisms at work or in their private life?

By labelling Prozac a feminist drug, Kramer makes plain to us what he understands feminism is: making woman act and think more like we expect men to act and think. Kramer’s notion of feminism is not informed by the writings and actions of feminists, but rather current market demands for 21st century femininity:

A certain sort of woman, socially favored in other eras, does poorly today. Victorian culture valued women who were emotionally sensitive, socially retiring, loyally devoted to one man, languorous and melancholic, fastidious in dress and sensibility, and historionic in response to perceived neglect. We are less likely to reward such women today . . . We admire a quite different sort of femininity which . . . contains attributes traditionally considered masculine: resilience, energy, assertiveness, and enjoyment of give-and-take . . .(270).

Since temperament, or personality, has a biology, which can be altered by pills, then why not utilize these pills to help women better conform to current societal expectations? Remember, that in the background music of all of Kramer’s musings on the permissibility of cosmetic psychopharmacology is a simple, repeated theme: mood and temperament are ultimately biological. Kramer does not offer up a crass reductionism, he does acknowledge that environment has a significant impact on a person’s life; real traumas—namely, the fact that Tess’ alcoholic father sexually and physically abused her or Lucy’s discovery of the mother’s murder at the hands of their manservant—biologically encode themselves in such a way as to make these women more vulnerable, more sensitive, and perhaps more needy (Kramer 1993, 112). Biography, nonetheless, ultimately becomes biology—some rerouting of neurochemistry in a way that is maladaptive to these women in a society that now expects them to be peppy, energetic, and resilient. Enter Prozac with its powerful, fast, and economically efficient restorative powers for brain chemisty gone awry. Hence, biology might have used to be destiny—even if that biology was a product of a sexist culture—but now we have a pill to undo that damage. Furthermore, this helps women become what Kramer, perhaps understandingly, misinterprets what the second-wave women’s movement for total equality was: help women act and think like men.

In an abrasive review of Listening to Prozac appearing in The New Republic, David Rothman, articulates a very good reason why feminists might not share Kramer’s belief that Prozac is a feminist drug:

A feminist criticism of Kramer would rightly see Prozac as enforcing the values of aggression and self-seeking ambition . . .Indeed, there is no subtly to Kramer’s rebuttal of the indictment that ‘we are suing medication in the service of conformity to social values.’ In his stories, Prozac emerges not only a male-gendered drug, but also as a quintessentially American drug. It does not enhance pleasure or bring happiness, but promotes adroit competitiveness. It is not a street drug that brings a quick high, it is an office drug that enhances the social skills necessary in a postindustrial, service-oriented economy (1994, 36)

While Kramer does respond, in his “Letter to the Editor” to Rothman’s review, and rightfully points out that Rothman has oversimplified both his views and dismissed his qualms about Prozac, he doesn’t address this particular criticism that Rothman makes. However, Kramer has already anticipated Rothman’s criticism in Listening to Prozac. In last chapter, “The Message in the Bottle, which is the meatiest section of the book—at least for bioethicists and feminists—Kramer articulates both criticisms of cosmetic psychopharmacology and counterarguments to those criticisms. Sometimes he lets certain criticisms simply remain unchallenged, offering two ways to look at the same situation, but not necessarily committing himself to one position over the other. A perfect example of such as criticism is to consider that Prozac’s impact on the high stakes workplace of post-industrial capitalism will resemble the impact of steriods on sports. At issue here is the undermining of autonomy—the ability to make uncoerced choices.

If one or two athletes take steroids, and thereby enhance their athletic performance, then they gain a distinct advantage over the others. One could also argue in those cases, that the athletes freely chose to take steroids for enhancement purposes. However, the situation dramatically changes when everyone “freely chooses” to take steroids, and therefore, if you want any hope of competing you will have to take them too. Do steroids in sports constitute coercion? Yes and no. Technically, the athletes can still choose to not take steriods, however, the result of that choice will be that they will most likely be unable to compete. Likewise, one can view taking Prozac as a “free choice” to enhance “masculine traits” that are more competitive in the marketplace, as eventually leading to a similar scenario as steroids in sports: unfortunate men and women with irritating and ineffectual feminine traits lining up to take their Prozac so as to have any hope of competing in the marketplace.

In two places in this chapter, Kramer leaves us with two interpretations of this possible Prozac scenario. First, while addressing directly that Prozac can become like steroids, he forsees the first outcome: “a myriad of private decisions, each appropriate for the individual making them, will result in our becoming a tribe in which each member has a serotonin level consonant with dominance”(274). On the other hand, he reconsiders:

But the pressure to engage in hyperthymic, high-serotonin behavior precedes the availabilty of the relevant drugs. The business world already favors the quick over the fastidious. In the social realm, an excess of timidity can lead to isolation. Those environmental pressures leave certain people difficult options: they can suffer, or they can change. Seen from this perspective, thymoleptics [drugs that can transform personalities] offer people an additional avenue of response to social imperatives whose origins have nothing to do with progress in pharmacology (274-5)

So, either we can surmise that liberal prescribing of Prozac will result in all of us electing to take the drug to model ourselves after the most socially rewarded ideal, or we can simply embrace Prozac as a pharmacological solution to a social dilemma it is not responsible for creating. Neither of these interpretations, however, is very satisfying, particularly for a feminist interested in Rothman’s question.

David DeGrazia attempts to counter the criticism that Prozac will lead to greater social conformity more definitively than Kramer does: “But while there may be some risk of social quietism, the risk attaches to all uses of mood-improving drugs, not just to cases of cosmetic psychopharmacology, as well as to mainstream religions and many other clearly acceptable practices and outlooks that brighten our outlooks” (2000, 39). Moreover, DeGrazia addresses the fear that we might undermine competition, since everyone can get a leg up with Prozac, by claiming “we are still far from such a scenario . . . the mere possibility of such a scenario does not cast significant doubt on Marina’s enhancement project” (39). Both of DeGrazia’s counterarguments are fallacious, they distract from the issue at hand: will liberal prescribing of Prozac as an enhancement drug will lead to greater conformity with social ideals and if so, is this moral?. Rather than answer “yes” or “no” and then evaulate the morality of such an outcome, DeGrazia makes the claim “everyone else is doing it, so don’t just blame Prozac.” Again, not a particularly satisfying response to Rothman’s question.

The second time Kramer leaves us with competing interpretations on how to view the possible consequence of Prozac as social engineering (whether that be the result of private decisions or a totalitarian government), he offers an even sunnier second interpretation. Discussing the advantages to rethinking temperament as biological, and moreover, as technologically malleable, he suggests our first option: “Emphasis on temperament can be divisive or oppressive, if a culture too strongly favors one temperament over another—traditionally masculine over feminine traits, for example” (298). However, he quickly follows with option two: “Or, awareness of temperament can be inspiring, leading perhaps to efforts to minimize psychological harm to children, or to foster a social environment welcoming to constitutionally diverse adults” (298). This second option sounds more promising, however, it strikes the reader as a non-sequitor. How is it that discovering that temperament is pharmaceutically alterable—even if it is the result of horrific traumatic experiences—may lead us to imagine a more just, and safe world?

Let’s backtrack in the text and see if we can follow his reasoning here. A few pages before this suggestion, Kramer proposes that with the updated, biological psychiatric view—that all biography eventually becomes biology—we might see mild depressions as akin to carcinogens. “An unreliable lover enrages us—he is doing not just psychic but physical harm . .” (296). Hence, within the conceptual framework of the post-Prozac era, we can view traumas to the self as causing physical damage (since really there is not difference between the physical and the psychic for Kramer) that not only can be mended with Prozac, but Prozac can also act as a prophylactic protecing us from future damage (perhaps like sunscreen or vitamins?) If we take this statement above (“an unreliable lover”) together with the suggestion that Prozac might be healing (and remember, here is going beyond the more benign statement that Prozac is a least a solution to a problem it didn’t create), then we might conclude that Kramer is proposing that Prozac will make the world safer and more just, because it can “erase” the damage done by trauma. This can play out several ways: we can restore women’s broken self-esteem from abusive relationships, or we can intervene early in the life cycle of a potential abuser.

Now let’s add another level of nuance to our interpretation of Kramer’s option two. Remember that Kramer has assured us that Prozac is no mother’s little helper because it gives women vitality and energy to “leave abusive relationships or stand up to overbearing bosses”(272) rather than deaden them to a bad situation. He also says that they are feminist drugs because “they free women from the inhibiting consequences of trauma” (271). What this means then, is that Prozac treats the symptoms (broken, inhibited women) of culture that violently devalues femininity, by restoring their biological self to a pre-trauma state. Moreover, it gives extra zest and vitality to women, who might have been cursed with a shy and socially retiring inborn temperament. However, if this is true, then what you really have here is damage control for a misogynistic culture. If the culture devalues what is feminine and violently takes it out on women, then one solution is to cure the wounds of misogyny and then repackage the victims as more masculine, so as to make them less vulnerable to that same violence again. Kramer, in a piece he wrote for the Hasting Center Report, gives credence to my interpretation when he writes: “If Prozac induces conformity, it is to an ideal of assertiveness; but assertiveness can be in the service of social reform . . .” (2000, 15). Hence, Prozac is immune from feminist criticisms because—even if it makes women conform to a masculine ideal—women will be more liberated with those masculine traits than without them. At bottom, what Kramer is suggesting—which the sociologist Devereaux Kennedy points out—is “it may be far easier to alter and manipulate [biology] than culture or social institutions” (1998, 385). If a culture does not punish effectively misogynistic behavior, then the answer is to socially engineer women, through medication, that joins them, rather than beats them. Rothman’s concern still lingers, namely, shouldn’t we be bothered by a drug that enforces aggressive and ambitious, self-seeking behavior?

Women and the Front Lines

In a lead article this morning in the NYT --discussing yet another pair of suicide bombers and insurgent violence--the AP reports:

The lethal ambush on a convoy carrying female U.S. troops in Fallujah underscored the difficulties of keeping women away from the front lines in a war where such boundaries are far from clear-cut. At least one woman was killed, and 11 of the 13 wounded troops were female.

Why did this make me pause? Interrupt my casual Sunday paper reading? Because, I find it odd that we have some sort of intent or policy to keep women from the front lines. While the death of several women is horrific, and, while I don't support this war, nor have I ever supported this war, I am bewildered by recent efforts to keep women from the front lines (see this Washington Post article from May 18th).

Many may wonder why I--Ms. Melancholic Feminista--oppose any efforts to restrict where women can fight. You might think that my opposition to the war, of course, leads me to oppose women from fighting in the front lines of the war. But, these are two separate issues (1) Is the War Just? and (2) Should women be fighting on the front lines?

The fact that it is hard to tell, exactly, where the front lines are is irrelevant.

[However, I cannot help but point out how much this report of suicide blasts seems to fly in the face of Rumsfeld's insistence that this is not a guerilla war:

Mr. Rumsfeld said he does not view the ongoing, low-level conflict in Iraq as either a guerrilla war or an endless "quagmire," like Vietnam.
Attacks against U.S. troops in Iraq are more like terrorist attacks being carried out by criminals, foreign terrorists and officials from the ousted government of Saddam Hussein, he said.

I am clearly not subtle enough in thougt to understand the differences here.]

So, I do think it is a violation of liberty to tell women that they are not allowed to carry out their job, which is to fight this "war." If these women want to be in the military and have willingly accepted the risks and responsibilities, to deny them the front lines is simply wrong. Where does it come from? Well, no doubt some outdated views of womanhood, i.e. that women should not be exposed to danger, harmed, or expected to be able to defend themselves. Yes, the cult of femininity has returned to keep women in their place.

What I also find objectionable to this sort of effort is that it ultimately will work against women gaining further freedoms in this country. History teaches us, over and over again, that when soilders fight bloody wars, governments--at least democratic ones like Ancient Greece or the Civil War--cannot deny these soilders the right to vote, or full participation in the society. Democracy, many argue, resulted from cheaper materials for battle, allowing more men to fight. Once men have fought for their country, it becomes difficult to deny them participation. Likewise, the right to vote was extended to African Americans after the Civil War, in part because they fought for the Union. Lasty, the women's suffrage movement was born from the Civil War, because of their own wartime participation (an nurses, etc.). Granted, women already have the right to vote, but certainly we do not have full equality. In particular, we are less and less certain that women are autonomous agents (as recent legislation restricting women's reproductive rights demonstrates). Yet, if women are fighting this war alongside the men, it becomes much more difficult to characterize them as incapable of autonomy (that is, dependent on men to protect them and to make decisions for them). And, I think, in my cynical way, that this is why the House brought forward a bill to ban women from fighting in the front lines.

What do you all think?

This is No Mother's Little Helper

This is No Mother's Little Helper
Posted by: aspazia.

This is No Mother’s Little Helper: Or, How Did the Bioethicists Lose Sight of Gender in the Cosmetic Psychopharmacology Debate?

The naïve view of the players in this Prozac bioethics debate is that they are simply white, middle-class men for whom the question of gender never arises. This is simply not true. Back in 1993, when Kramer introduced the question of the ethical permissibility of Prozac, he wasn’t wholly blind to the gender implications of this drug. Kramer embraced the ways that Prozac helped make women less sensitive to rejection, more assertive, and energetic. Anticipating the feminist criticism that his exhuberance for Prozac—particularly for subclinical obsessive and neurotic women overwhelmed with the competing responsibilties of mothering and work—might recall an earlier exhuberance for “mother’s little helper,” Kramer takes pains to distinguish Prozac from Valium or Miltown. There are at least two important differences between the current era of Prozac and the era of “mother’s little helpers.”

First of all, mainstream, American Psychiatry has traded in psychoanalysis and its particular conceptual language of intrapsychic conflicts for a more biological paradigm (read: objective and observable). The development and success of antidepressants—beginning in the 50’s—spurred psychiatrists to consider the neurochemical basis of mood regulation, rather than exhort patients to explore their early childhood attachments (see also Healy 1997). Secondly, the guiding mission of psychiatrists treating neurotic housewives with Valium or Miltown was “to keep women in their place, to make them comfortable in a setting that should have been uncomfortable in a setting that should have been uncomfortable, to encourage them to focus on tasks that did not matter” (Kramer 1993, 39). Women have certainly come a long way, baby, and Prozac is just the drug for the anxious, post-women’s movement, woman.

In discussing the case of Julia—a woman plagued by an obsession with keeping her house ordered—Kramer begins to consider why Prozac is a “feminist” drug. Once Julia is on the drug, she is able to more easily let go of her need to control the household. She can handle messy dogs and a less-than-perfect husband and children. Before Prozac, she was unable to leave the home and enter back into the workplace, stymied by her fear of losing control. After Prozac, she returns to a career in nursing, with a desire to specialize in pediatric nursing—certain she will no longer be irritated by the unruly children. Kramer uses this case study to illustrate why Prozac is no “mother’s little helper”; “it was the opposite of a mother’s little helper: it got Julia out of her house and into the workplace, where she was able to grow in competence and confidence . . . There is a sense in which antidepressants are feminist drugs, liberating and empowering” (Kramer 1993, 40). The measures Kramer uses for the liberatory power of Prozac is: do women become more breezy and fun-loving in their romantic life (rather than needy and draining), are they more assertive and risk-taking at work, and, how resilient are they to criticisms at work or in their private life?

By labelling Prozac a feminist drug, Kramer makes plain to us what he understands feminism to be: making woman act and think more like we expect men to act and think. Kramer’s notion of feminism is not informed by the writings and actions of feminists, but rather current market demands for 21st century femininity:

A certain sort of woman, socially favored in other eras, does poorly today. Victorian culture valued women who were emotionally sensitive, socially retiring, loyally devoted to one man, languorous and melancholic, fastidious in dress and sensibility, and historionic in response to perceived neglect. We are less likely to reward such women today . . . We admire a quite different sort of femininity which . . . contains attributes traditionally considered masculine: resilience, energy, assertiveness, and enjoyment of give-and-take . . .(270).

Since temperament, or personality, has a biology, which can be altered by pills, then why not utilize these pills to help women better conform with current societal expectations? Remember, that in the background music of all of Kramer’s musings on the permissibility of cosmetic psychopharmacology is a simple, repeated theme: mood and temperament are ultimately biological. Kramer does not offer up a crass reductionism, he does acknowledge that environment has a significant impact on a person’s life; real traumas—namely, the fact that Tess’ alcoholic father sexually and physically abused her or Lucy’s discovery of the mother’s murder at the hands of their manservant—biologically encode themselves in such a way as to make these women more vulnerable, more sensitive, and perhaps more needy (Kramer 1993, 112). Biography, nonetheless, ultimately becomes biology—some rerouting of neurochemistry in a way that is maladaptive to these women in a society that now expects them to be peppy, energetic, and resilient. Enter Prozac with its powerful, fast, and economically efficient restorative powers for brain chemisty gone awry. Hence, biology might have used to be destiny—even if that biology was a product of a sexist culture—but now we have a pill to undo that damage. Furthermore, this helps women become what Kramer, perhaps understandingly, misinterprets the second-wave women’s movement for total equality wish to be: help women act and think like men.

In an abrasive review of Listening to Prozac appearing in The New Republic, David Rothman, articulates a very good reason why feminists might not share Kramer’s belief that Prozac is a feminist drug:

A feminist criticism of Kramer would rightly see Prozac as enforcing the values of aggression and self-seeking ambition . . .Indeed, there is no subtly to Kramer’s rebuttal of the indictment that ‘we are suing medication in the service of conformity to social values.’ In his stories, Prozac emerges not only a male-gendered drug, but also as a quintessentially American drug. It does not enhance pleasure or bring happiness, but promotes adroit competitiveness. It is not a street drug that brings a quick high, it is an office drug that enhances the social skills necessary in a postindustrial, service-oriented economy (1994, 36)

While Kramer does respond, in his “Letter to the Editor” to Rothman’s review, and rightfully points out that Rothman has oversimplified both his views and dismissed his qualms about Prozac, he doesn’t address this particular criticism that Rothman makes. However, Kramer has already anticipated Rothman’s criticism in Listening to Prozac. In last chapter, “The Message in the Bottle, which is the meatiest section of the book—at least for bioethicists and feminists—Kramer articulates both criticisms of cosmetic psychopharmacology and counterarguments to those criticisms. Sometimes he lets certain criticisms simply remain unchallenged, offering two ways to look at the same situation, but not necessarily committing himself to one position over the other. A perfect example of such as criticism is to consider that Prozac’s impact on the high stakes workplace of post-industrial capitalism will resemble the impact of steriods on sports. At issue here is the undermining of autonomy—the ability to make uncoerced choices.

If one or two athletes take steroids, and thereby enhance their athletic performance, then they gain a distinct advantage over the others. One could also argue in those cases, that the athletes freely chose to take steroids for enhancement purposes. However, the situation dramatically changes when everyone “freely chooses” to take steroids, and therefore, if you want any hope of competing you will have to take them too. Do steroids in sports constitute coercion? Yes and no. Technically, the athletes can still choose to not take steriods, however, the result of that choice will be that they will most likely be unable to compete. Likewise, one can view the taking Prozac as a "free choice" to enhance “masculine traits” that are more competitive in the marketplace as eventually leading to a similar scenario as steroids in sports: unfortunate women and men with irritating and ineffectual feminine traits lining up to take their Prozac so as to have any hope of competing in the market place.

In two places in this chapter, Kramer leave us with two interpretations of this possible Prozac scenario. First, while addressing directly that Prozac can become like steroids, he forsees the first outcome: “a myriad of private decisions, each appropriate for the individual making them, will result in our becoming a tribe in which each member has a serotonin level consonant with dominance”(274). On the other hand, he reconsiders:

But the pressure to engage in hyperthymic, high-serotonin behavior precedes the availabilty of the relevant drugs. The business world already favors the quick over the fastidious. In the social realm, an excess of timidity can lead to isolation. Those environmental pressures leave certain people difficult options: they can suffer, or they can change. Seen from this perspective, thymoleptics [drugs that can transform personalities] offer people an additional avenue of response to social imperatives whose origins have nothing to do with progress in pharmacology (274-5)

So, either we can surmise that liberal prescribing of Prozac will result in all of us electing to take the drug to model ourselves after the most socially rewarded ideal, or we can simply embrace Prozac as a pharmacological solution to a social dilemma it is not responsible for creating. Neither of these interpretations, however, is very satisfying, particularly for a feminist interested in Rothman’s question.

The second time Kramer leaves us with competing interpretations on how to view the possibility that Prozac will result in social engineering (whether that be the result of private decisions or a totalitarian government), he offers an even sunnier second interpretation. Discussing the advantages of rethinking temperament as biological, and moreover, as technologically malleable, he suggests our first option: “Emphasis on temperament can be divisive or oppressive, if a culture too strongly favors one temperament over another—traditionally masculine over feminine traits, for example” (298). However, he quickly follows with option two: “Or, awareness of temperament can be inspiring, leading perhaps to efforts to minimize psychological harm to children, or to foster a social environment welcoming to constitutionally diverse adults” (298). This second option sounds more promising, however, it strikes the reader as a non-sequitor. How is it that discovering that temperament is pharmaceutically alterable—even if it is the result of horrific traumatic experiences—may lead us to a more just, and safe world? Let’s backtrack in the text and see if we can follow his reasoning here. A few pages before this suggestion, Kramer proposes that with the updated, biological psychiatric view all biography eventually becomes biology—we might see mild depressions as akin to carcinogens. “An unreliable lover enrages us—he is doing not just psychic but physical harm . .” (296). Hence, within the conceptual framework of the post-Prozac era, we can view traumas to the self as causing physical damage (since really there is not difference between physical and psychic for Kramer) tha not only can be mended with Prozac, but Prozac can also act as a prophylactic protecing us from future damage (perhaps like sunscreen or vitamins?) If we take this statement above (“an unreliable lover”) together with the suggestion that Prozac might be healing (and remember, here is going beyond the more benign statement that Prozac is a least a solution to a problem it didn’t create), then we might conclude that Kramer is proposing that Prozac will make the world safer and more just, because it can “erase” the damage done by trauma. This can play out several ways: we can restore women’s broken self-esteem from abusive relationships, or we can intervene early in the life cycle of a potential abuser.

Now let’s add another level of nuance to our interpretation of Kramer’s option two. Remember that Kramer has assured us that Prozac is no mother’s little helper because it gives women vitality and energy to “leave abusive relationships or stand up to overbearing bosses”(272) rather than deaden them to a bad situation. He also says that they are feminist drugs because “they free women from the inhibiting consequences of trauma” (271). What this means then, is that Prozac treats the symptoms (broken, inhibited women) of culture that violently devalues women, by restoring their biological self to a pre-trauma state. Moreover, it gives extra zest and vitality to women, who might have been cursed with an shy and socially retiring inborn temperament. However, if this is true, then what you really have here is damage control for a misogynistic culture. If the culture devalues what is feminine and violently takes it out on women, then one solution is to cure the wounds of misogyny and then repackage the victims as more masculine, so as to make them less vulnerable to that same violence again.

While Kramer is always dancing around the question of whether or not Prozac puts more pressure on women to conform or not, what emerges in his argumentative strategy is a classical libertarian line of argument. This, I wager, is the reason why the gender implications of Prozac drops out, for the most part, from the bioethics debates over cosmetic psychopharmacology that follows the publication of Listening to Prozac. Libertarianism, as a political and philosophical theory, focuses on maximizing personal freedom to make decisions, and minimizing any state or communal regulation over that freedom. Moreover, libertarianism is a metaphysical theory of the self (something that Kramer’s writings suggest is outdated), because it asserts, rather than proves through evidence, that individuals are the best agents to make good decisions for themselves and that any state interference in peoples’ ability to make their own choices is a violation of liberty. Hence, what becomes the focus of moral debates that are issued forward in the language of libertarianism—free choice, autonomy, preferences—is a shift away from the concrete reality of the impact of Prozac, specifically Prozac's impact on women in a misogynistic culture. What follows instead, are debates about the compatibilty of cosmetic psychopharmacology with the exercise of personal freedom, if one must rely on a prescription from an expert. Or, the debate shifts to considerations of equitable distribution of enhancement technologies. Thirdly, a lively debate over how to properly diagnose mental illness emerges—should listening to drugs be the method for mapping mental illness? And, lastly, you see those arguing for the importance of conserving some our communal ties to each other, which are, perhaps, strenghtened in times of personal crisis. So, old debates between radical individualism and community become a primary lens through which bioethicists consider whether or not cosmetic psychopharmacology—or any enhancement biotechnology for that matter—is ethically permissible in a liberal society. And, old debates over the rigor of psychiatry as a medicine discipline draw a great deal of attention. What doesn’t emerge is a sustained engagement with the impact of cosmetic psychopharmacology on how our culture values traits and behavior that is different from idealized masculinity.

Moreover, it appears that while Kramer is well aware that cosmetic psychopharmacology can disproportionately affect women, he or his supporters can always dismiss this worry by stressing that Prozac gives a sufferer more, rather than less, autonomy. Since autonomy is so crucial to traditional bioethics debates, then giving women more autonomy should ward off suggestions that it is socially engineering women to become like men. After all, by taking Prozac, women are giving themselves more of a choice in what sort of person they want to become, and what preferences they hold. So, once given Prozac, women can choose between their earlier, socially irritating self, or their socially rewarded Prozac self. The choice is ultimately theirs to make, so it would seem odd—to anyone subscribing to this reasoning—that Prozac disproportionately harms women.

The final reason why the bioethics debates on Prozac do not put gender at the center, is because of a very successful and powerful red herring that Kramer puts forward again and again in his writings: that our distaste for Prozac and its capacity to wipe out melancholic traits comes from a deeply rooted psychopharmacological Calvinism that sees values in those traits. Psychiatry--as it strives toward a biological and scientific approach—should take any opportunity to disabuse people of the pseudo-scientific thinking that melancholic traits are what makes its sufferers deep, artistic, or likely to go on a self-discovery search for authenticity. Melancholy is simply passé. We created a cult of melancholy—praising the usefulness of depressed or anxious moods in the quest for authentic existence—in an era of bad science. Modern science has opened our eyes to how debilitating these ailments (even personality traits) are, and to how depression is, in fact, a disease treatable like diabetes. Hence, we have to let go of this 19th century romanticization. While Kramer is making a rather reasonable and compelling point, it certainly does not address Rothman’s concern that Prozac is remaking women into men—that Prozac is a powerful new tool for making women fit into institutions built around concerning masculine values and ideals. But it is a successful red herring because it preoccupies many of the ethicists that take up his invitation to debate cosmetic psychopharmacolgy.

Why the Citizenry of the Prozac Nation are Women

The reason why bioethicists do not consistently confront the serious gender matters tied up with the debates over “cosmetic psychopharmacology”—namely, prescribing pills for a personality makeovers—is because they often separate moral questions from political questions. However, the reality of our current Prozac Nation is that women by far comprise its citizenry. Women make SSRI visits to their physicians at 2.4 times the rate that men do, a disparity that Center for Disease Control (CDC) researchers point out is far greater than the disparity in the rates of overall health visits between men and women (NCHS 2004, 60-61).


When the psychopharmacological Calvinists and Hedonists discuss the permissibility of “cosmetic psychopharmacology,” they tend to create thought experiments in different worlds, which admittedly can clarify the core ethical concepts, but then miss that those who are asking their physicians if Prozac is right for them are women living in a misogynistic culture.

At the end of Listening to Prozac, for example, Kramer tweaks a thought experiment entitled
“The Message in the Bottle” first presented by the Christian existentialist novelist, Walker Percy. In Percy’s version, you have an island castaway who discovers in his beach strolls at least 22 messages stuffed in bottles, which have drifted from far away shores. What the messages say, argues Percy, matters less than that they signify “transcendence,” the human quest to travel away from our safe well-trodden islands to distant, and uncertain shores. Now, consider Kramer’s version:

. . . imagine a woman—one who finds herself a castaway, always feeling like an outsider, somewhat sad, compulsive in her ways that seem alien to her, quirky in ways that are only partly comfortable, oversensitive to slights, limited in her capacity to enjoy the fruits of the island, a bit vague in her thought, listless, doubtful of her worth. She has struggled to ascertain the roots of her unease and perhaps has come a certain distance toward that goal, having made herself aware of the difficult experiences of her childhood. But her mood and social circumstances remain unchanged, and so her search continues. Now let us imagine that as she walks along the beach she finds a bottle containing not a slip of paper but a number of green-and-off-white capsules filled with a white powder. Questioning and desperate, she decides to take the capsules, one each day, and in time she feels bolder and less troubled, more at ease with herself, keener of thought, energized, more open to ordinary pleasure. Is there a message after all, a message in the capsule? (1993, 281).

The point of a thought experiments is to strip away all the contingent and therefore non-essential factors from a particular ethical dilemma in order to discover the essential problem. Many philosophers, to that end, model their thought experiments on science fiction to prevent the reader from getting too mired in details that might muddy their view of the situation, e.g. the particular people involved or places involved. Kramer aiming for the “universal” problem in his thought experiment—contrary to Percy’s contention that we quest after “transcendence” that humans are questing after—our questing is a in fact a symptom of a malfunctioning mind, which is easily corrected by the technological solution of tiny green-and-off-white capsules. However, the his choice of a female, with classic and predictable details of her self-effacing, anxious feminine nature is curious, especially since it is clearly modeled on the women patients that make up the heart of his book on the significance of Prozac to our conceptions of self and identity.

The impact of feminism on philosophy is to challenge the “neutral” or “universal” examples that philosophers tend to use and expose them as more often that not to be representing idealizations of masculinity. Rather than ecompass the breadth of human experience, the assumptions that philosophers make only reflect what men have traditionally valued. Moreover, men have the social and economic power to pursue those ideals aand fashion our social institutions by them. Hence, feminists ask questions about the historical and cultural context in which certain concepts as well as moral values come into existence. In case of Prozac and the cosmetic psychopharmacology debate, my job is to point out to the ethicists some important facts about who is both asking and receiving Prozac from their doctors. The fact that Kramer’s “message in a capsule” thought experiment features a distraught woman seeking to transform herself from a brooder to a pleasure seeker is no coincidence.

Consider a proponent of Kramer’s, the ethicist David DeGrazia, who writes an article defending patients’ rights to demand and physicians’ rights to prescribe Prozac as an enhancement drug. DeGrazia’s abstract summarizes his ethical judgement in universal, gender-neutral language: “A person can be true to oneself even while transforming and even creating the person one is. One’s self is not something merely waiting to be discovered, after all. To some extent, part of the human endeavor is deciding and trying to become who we want to be” (2000, 34). From this statement, we would all surmise that De Grazia advocates the use of Prozac for anyone who wishes to have a more powerful tool to aid in the lifelong process of self-creation. This suggests that the ethical question over the permissibility of cosmetic psychopharmacology transcends gender; it isn’t framed as an ethical question confronting women, akin to the permissibility of breast implants or silicone injections.

Yet, when DeGrazia presents us with his first case study it is Marina, a patient who resembles in many ways the most famous patient in Kramer’s book, Tess. Both Marina and Tess grew up in alcoholic homes with distant or abusive fathers and depressed and inefficacious mothers. Both women assume the parent role and take care of their sibilings. Lastly, Tess and Marina succeed in their careers, while failing socially and romantically. With Tess, Kramer first discovers how effective Prozac can be. What is most remarkable about Tess’s turnaround to Kramer, is her romantic successes: “She became socially capable, no longer a wallflower but a social butterfly. Where she once focused on obligations to others, now she was vivacious and fun-loving. Before, she had pined after men; now she dated them, enjoyed them . . .”(Kramer 1993, 11). Now, through DeGrazia, we meet Marina who resolves on her 30th birthday that she no longer wants to be pensive, self-loathing and socially awkward. She approaches a psychiatrist, who after 4 sessions decides she has no diagnosable disorder. He recommends therapy, but her HMO won’t cover it and so the prohibitive cost leads her to reject that suggestion.

Still, she wants changes. At work, she feels overly tentative, unsure, too prone to worry about possible errors. In her social life, she hates how she endlessly interprets the latest transactions with friends and the way she is attracted to men who are bad for her. She feels alienated by her obsessional thoughts, considering them ridiculous and bothersome even if not very harmful. After extended periods of introspection . . . Marina decides that she wants to become more outgoing, confident, and decisive professionally; less prone to feelings of being socially excluded, slighted, or unworthy if a good partner . . .She calls the psychiatrist who provided the consultation, whom she likes, and explains that she has heard that Prozac sometimes produces transformations like the ones she seeks—and more quickly and less expensive than could be expected from therapy. Marina requests a prescription for Prozac (DeGrazia 2000, 35).

It is Marina’s request for Prozac that forms the basis of DeGrazia’s entire argument that self-creation projects through biotechnologies like Prozac, are not only ethically permissible, but authentic means to becoming what we desire to become. And yet, not once does he highlight that women are more likely to ask for Prozac than men are. The fact that women ask for Prozac more simply does not figure into the Prozac enhancement debate.

Listening to Prozac? How about Listening to Women?

Listening to Prozac? How about Listening to Women?
Posted by: aspazia.

I started this blog to work on my book and today, by gum, I am going to write a post that is dedicated to this end. So, here it is:

"Imagine that we have to hand a medication that can move a person from a normal
psychological state to another normal psychological state that is more desired
or better socially rewarded." --Peter Kramer

In 1993, Peter Kramer published Listening to Prozac, a book intended to draw ethicists into debating the ethical implications of Selective Serotonin Re-Uptake Inhibitors (SSRIs), which were the new generation of antidepressants gaining recognition among psychopharmacologists. Kramer's most provocative thesis is to defend "cosmetic psychopharmacology" as an ethically permissible psychiatric practice. Prozac, according to Kramer, is no mere antidepressant; rather, what we have here is a powerful drug that patients who are not afflicted with depression can use to make themselves "better than well." Prozac promises to transform brooding, socially awkward persons into peppy and popular ones. More importantly, prescribing this drug to the non-afflicted does not transgress the proper boundaries of psychiatric practice.

As Kramer hoped, ethicists and psychiatrists responded to his challenge with both applause and horror. In bioethics circles, which is the arena I am mostly concerned with, the Prozac debate has evolved into a debate over the line between "treatment" and "enhancement," and how new technologies radically rewrite the cultural narrative on depression. While a fringe of anti-psychiatrists will always linger who will question the very legitimacy of the profession in general and specifically any therapeutic intervention, for the most part no one involved in this debate has any serious qualms about the emergence of drug therapy for treating mental illness. Instead, the debate centers on what constitutes clinical depression, that is drawing the line between the kind of "depression" that warrants medical treatment and the kind that is a by-product of our all-too-human nature.

Arguing against Kramer's defense of cosmetic psychopharmacology are the "psychopharmacological Calvinists," who generally find some cultural and personal value in experiences of depression. Prozac, they argue, robs depression sufferers of important insights. Or, it interrupts processes crucial to our moral development--an experience which the first-rate thinker John Stuart Mill credited as transforming his ideas about pleasure, which benefitted all humankind.

On the other hand, the "psychopharmacological Hedoninsts,"--Kramer prominent among them--consistently point out the old-fashioned and romantic ideas to which these Calvinists cling. To still believe that bouts of depression offer us a "special perspective" belies another uncritical belief: that moods are more than neurochemical patterns that color our perceptions of the world. We are each born with a given temperament, a neurochemical profile, that may or may not be valued by the larger culture. Kramer writes

"certain dispositions now considered awkward or endearing, depending on taste,
might be seen as ailments to be pitied and, where possible, corrected. Tastes
and judgments regarding personality styles do change. The romantic, decadent
stance of Goethe's young Werther or Chateaubriand's Rene we now see as merely
immature, overly depressive, perhaps in need of treatment. Might we not, in a
culture where overseriousness is a medically correctable flaw, lose our taste
for the melancholic or brooding artists--Schubert, or even Mozart in many of his
moods?" (Kramer 1993, 20).

Hence the Prozac debate pits the rather romantic ethicists and psychiatrists, who want to preserve a long standing view that depression can be culturally valuable, against the rather unromantic ethicists and psychiatrists, who decode the mysteries of mood into neurochemistry.

And, I think these ethicists have the debate all wrong. The Prozac debate is primarily a debate over which gender traits our culture prefers: competitive, productive, and energetic "masculinity" over self-effacing, unassuming, and irritating "femininity." Both of these camps of the Prozac debate fail to take seriously how cultural preferences for idealized masculinity play out in both the diagnosis and treatment of depression. While the calvinists and hedonists debate the importance of depressive temperaments to art and philosophy, the majority of Prozac prescriptions are written to anxious and overwhelmed women, who have been bombarded by a marketing campaign that trains women to see themselves as ill. Our cultural burden of worshiping wise melancholic men is once again directing our cultural energies toward eradicating the problem of mad depressed women.

The District

I spent the entire day in D.C. with the director of Public Service and a former student today. I have agreed to lead a Service-Learning trip during the winter break in D.C., focusing on poverty issues. So, we headed into DC so I could see the various sites students could volunteer at and get ideas of places and people they can speak to about policy/advocacy.

Our first stop was the DC Central Kitchen, which is one of many "providers" housed in the largest shelter in the world. My students will work at the DCCK for two weeks in the mornings. We next spoke to a director of the shelter, which was very inspiring to me. The shelter has become "private" so that it can take in people that shelters who get government money cannot take in. I wondered what this meant? Did it mean that a "private" model was better at addressing the homeless population than government solutions? No. What it meant for this shelter is that they were running on a budget of $182, ooo.00 a year when they really needed something like $69 million to cover the expenses of all their services. To make this work, then, they depend a great deal on volunteers.

I was hopeful about the world that there are people in the world committed and compassionate enough to dedicate themselves to restoring the lives of the most battered and broken human beings on the planet. The men, women and children who become the "homeless" in our country have often seen the absolute worst in their lives: abuse, violence, poverty, mental illness, addiction, etc.

In order to rebuild their lives, the basic requirement is some stable foundation, some place they can rely on to be their home. Without a home, people spend the whole day in survival mode: walking quite a distance for meals, trying to protect their only belongings from being stolen, or braving the indifference of the people that pass them by on the street.

So many people think, write about, and act to eradicate homelessness. And, boy, do we need them during this administration. But, I started thinking about how radically things would have to change to begin to make affordable housing available to this growing population of homeless people.

In the "district," the neighborhoods where a majority of the poor have lived for at least a couple of generations are being gentrified. We spent a great deal of time around the Dupont circle/Adams Morgan area today, which is turning into a sleek, hip "urban" neighborhood. I was completely blown away when we walked by a "new restaurant" in the area: Hamburger Mary's (which is a longtime favorite restaurant transplanted from San Francisco). We walked by a huge Whole Foods, across from two cafes, a jazz club and newly built "condos." If you walk one block away, you will see what this neighborhood looked like before: convenience stores, greasy spoons, hair salons, and dive bars.

The contrast is something. The real estate in this neighborhood, because of all the gentrification has skyrocketed. Rent for a one-bedroom is probably $15oo.oo. There are outdoor cafes, yummy ethnic restaurants, fancy "garden supply" stores and pet daycare facilities. Why am I mentioning all of this?

Well, what is the cost of this gentrification process? A great deal more homeless people, displaced from their neighborhoods with less opportunities for livable wages. And, yet, can you imagine what it would take to reverse this? Why on earth would landlords, making a windfall on high real estate market value, agree to lower rents for low income folks? All of the young, yuppies don't want to live around these folks anyway.

I asked one of the men I met today (who works for the National Low Income Housing Coalition) what the current administration's solution is to making affordable housing available. He reminded me that what the President is always touting: "creating an ownership society." I passed by a huge Countrywide office (a mortage lender for "high risk" clients).

But, I don't get it. How can you buy a house if you don't make enough money to pay rent in the district? Where would you buy the house? What happens if you need to fix the roof in a year?

The other casualty of this strategy is "community." Yes, there it is again, that damn theme popping up in my ramblings. Gentrification destroys neighborhoods and their informal support networks--sharing in watching kids, building up local schools, knowing when a neighbor is in need. You replace neighborhoods with glossy and gleaming buildings occupied by workaholics who wouldn't put their kids in DC schools anyway. They shove the low income folks into smaller corners of their former neighborhoods and try to avoid eye contact with them as they swiftly walk by them toward the Starbucks.

And yet, let's be honest, I love this part of D.C. I love the restaurants, I love Whole Foods, and I love the lovely landscaping. I am part of the problem. I am the one of the people that needs to weigh how important that funky neighborhood is to the lives of the people it displaces. The transformation required in my own bleeding-heart-self is dramatic.

I know there must be creative ideas out there about how to save neighborhoods without sacrificing Whole Foods. Or, am I deluding myself?

On Being a Fan

Za finally wore me down and got me to see Episode 3 of Star Wars at the Senator Theater. A unique feature of viewing Star Wars at the Senator was a 6 minute documentary showing before the main feature. A young lad from Baltimore filmed the Star Wars fans waiting to buy tickets for episode 1 back in 1999, and then the fans who lined up this year. It is a real treat to see some of these same guys, older, fatter and yet still Star Wars committed. You see them fighting each other with plastic light sabers, playing bongo drums, and of course the fans in full costume (either a storm trooper or Darth Vader). The documentary also is full of hilarious dialogue, e.g. some young men are laying down in sleeping bags and report that people keep driving by and throwing things at 'em.

But, being that melancholic thinker sort, I couldn't help but realize how little I resemble these Star War fans. Afterall, Za finally got me to go (after 2 margaritas). Well, he also said: "Star Wars is very important to me." Ok, so I went. But, I felt really alien if not a bit lonely. These odd Star War enthusiasts have a complete community, and it seems a rather accepting community organized around a long-lived passion for Star Wars.

When we entered the theater and I looked around at all of the young kids, I reflected back on the very first time I saw Star Wars (episode 4). This was when I was 7 years old in a movie theater that probably doesn't exist anymore. My parents took me and my brother and we were mesmerized. I still have not forgotten the famous "bar scene" in that episode, or Chewbacca (who my brother can still imitate). I remember forcing my parents to line up for the Empire Strikes Back a few years later ("Luke, I am your father."). So, I had something like a fan nature when I was little. Does being a fan of something require a child-like disposition?

When the film started, I was giggling the same way the 7 year old did when R2D2 made his silly squealing noises. I loved R2 when I was a kid. I still love him. And, then the film progressed and I realized that to really get into this episode, to love it like those fans, I had to remember my 7 year old self. I had to suspend my years of "critical" training (especially, the critic I am of film) and be mesmerized by the story that started when I was a kid.

I felt sort of sad that I didn't have kids of my own to watch this with; many of the folks in the audience who were my age brought their children.

I am still a bit disconnected from Za's passion for Star Wars. I tried to conjure some of it up Saturday. But, he is a fan and I am not. Being a fan requires, it seems, for you to protect part of your childhood from your adulthood. I have gotten too old. I find it either a waste of time, childish, or a bit looney for people to line up the night before to get movie tickets or concert tickets. I don't have posters of my favorite bands up anywhere. Damn! I am sort of tarnished. Because I think that fans have a joy for life that I want desperately to reclaim and to share!

I'm all for the Community, as long as its the right sort . . .

For the first time since beginning this blog, I haven't been able to post for 4 days. I took a road trip to Wausakee, WI with two of my friends. It was surreal to be in the car for that long, and we hauled a trailer full of furniture on the way back. We had two days between the long trek, which we spent at a charming "club" in northern WI. The Wausakee Club was incorporated in 1890, by some Chicagoans (men) who wanted a place to hunt and fish. Soon after, according to my friend (let's call her Emma), the wives wanted to come along. So, the men built huge cabins surrounding three lakes. They put in the tennis courts and a golf course (I played twice, once barefoot!). What is really interesting about this club is that it is a "commons." Families have bought memberships and they hold all the property in common. They pool their resources to maintain the property, roads, and common buildings.

One of the features that I really loved about this club was the common dining space. Three times a day, a bell rings to alert the members that breakfast or dinner is served. Everyone eats from the same menu, and families can interact with each other and discuss how fishing went or what they are reading. The families, who are members, are descendants from the orginal 1890 families. So generations of these families have grown up intertwined. They have a newsletter and listserv. If you show up with your brood of kids, you can be certain that other children will be there to run around the property with--to go fishing, invent games, learn how to canoe, swim, etc. It's an idyllic place.

These families have set up a commune; a place where they can blend their families, appreciate unspoiled nature, support each other in crises, and share in caring for their patch of the earth. They have chosen to make decisions together and choose what is in the best interest for all the members. They have created a small version of Rousseau's ideal--hell even Marx's fantasy of pure communism. But, of course, these families are extraordinarily wealthy and probably very few of them advocate the politics of community. Perhaps they are more likely to be environmentalists, and even to see the benefit of social insurance programs. But, certainly, they have amassed their wealth through the unfettered free market, so that they can retreat to this idyllic community in a remote place in WI.

I couldn't help thinking about how ironic this all is. And, I am certainly making bold and unfair judgments about the members of this club. For all I know, they could all be voting for labor. But, my suspicion is that a good many of them are committed capitalists. Why is it that when you earn more money than any member of your family could likely spend, you would choose to create this kind of haven? A communal dining hall, acres of pristine and well cared for forest, unpaved roads. This retreat is unpretentious, rustic and disconnected (hence, I had no access to either the internet or my cell phone).

Can we count on the Wausakee folks to support legislation and policies that would give these same sorts of retreats to common folks? I honestly don't know the answer to the question. I suspect some would, but others are too insulated from knowing that this sort of life (a Walden retreat) is now a luxury.

But, it seems, that wealth allows you to embrace the very best of community, without having to share it with, well, the common folk.

Stories We Tell Ourselves

I've been thinking alot about the challenges I face when I try to get students to think more critically and compassionately about other people. What we are often combatting are deeply entrenched cultural interpretations of others' behavior or circumstances that must be broken down to get students to actually care, relate or empathize with the so-called pariahs, broken down, or miscreants of our society. I am not trying to get them to have more sympathy for--say mass murderers, rapists, or even violent bullies. I am trying to get them to be less judgmental of pregnant teenagers, the homeless, single parents (most often mothers) drawing from TANF.

The real work here is breaking down, piercing through the powerful ready-made cultural interpretations of these folks: sexually promiscuous, slutty girls; irresponsible, lazy freeloaders, or foolish women who mated and/or married a "dog." Even I fall victim, to these schematas.

But, then, I try to think hard about a problem like teenage pregnancy. It helps to study it in a far away context for the moment, to try and unsettle those pesky cultural interpretations at work. Yesterday, Sharon LaFraniere in "AIDS, Pregnancy and Poverty Trap Ever More African Girls," reported on plight of young girls in Mozambique due to the AIDS epidemic and consequent high rates of orphans and poverty. The story leads with a recounting of how Flora Muchave, 14, was hoodwinked into sleeping with an older man who promised to "take care of her." Her father already died of AIDS, her mother would soon follow, and the family was unable to sustain themselves. She believed this older man, and that left her pregnant with 4 bucks.

As I read this story, I wondered if my students would blame Flora for getting pregnant. Would they impose their middle/upper-class (and often puritanical) values on this young woman? Would they consider her just a "fool" for believing the older man? Would they scold her for not using contraception? Or, would they be disgusted with him? I hoped the latter. But, I never know what will happen when I present these sorts of cases to them. Can they actually understand how desperate Flora's situation is? She is 14, an orphan from Mozambique (not the U.S.), where the AIDS virus is killing off her family, her village. She has not been able to sustain an education, she has no access to birth control (much of this can be blamed on the Bush "global gag rule"), and she has no family security or stability.

Now, add on top of this already desperate situation that she is female. She is young, and female and soon learns, like many other young women in this situation that she can make money to support her family by selling her body. When I reflect on this fact, I get depressed. What sort of culture gets off on 14 year old, poor, and desperate girls? What value, if any, do these men place on a young girls' life? Where is her right to grow up without hating herself? Without degrading herself? And, the bonus prize for this incredibly low self-esteem is pregnancy.

Now, back to the U.S.: what are the important differences between young, poor, U.S. women who get pregnant and this woman from Mozambique. (Obviously, there are differences). But, we have a lot of similarites: lack of education, economic insecurity, unstable homes, little if any access to contraception--but more importantly comprehensive seuxal education. Our U.S. girl grows up learning that her body has cash-value, while simultaneoulsy learning to hate herself.

The other day in a car ride back with three of my friends (all women with Ph.D.s) I asked: how many of you grew up in this culture without hating some part of your body, or being ashamed of your sexual behavior (whether you bought into puritanical notions or not)? Of course, we all learn this.

Now, back to these powerful cultural interpretations I have to pierce through to get my students not to judge Flora (except, the U.S. version of Flora). I have to force them to see these girls on their own terms, to suspend that powerful cultural script that tells them to see her behavior as a "bad choice" or "foolish choice." Anyone who teaches, and teaches students to think critically and compassionately, can attest, I am sure of how exhausting this process is, how draining. And, when we are really honest with ourselves, we have to remember that we have to keep expending that effort on our own selves over a lifetime. It is simply a lot easier to let the stories we tell ourselves, the ones we inherint from a deep seated disgust with human fraility, to do the work for us.

Those Damn Parents

Reading through the Times this morning--an article about parents opposing military recruiters in high schools--I came across this line:

"The Pentagon - faced with using only volunteers during a sustained conflict, an effort rarely tried in American history - is especially vexed by a generation of more activist parents who have no qualms about projecting their own views onto their children."

Can you BELIEVE parents these days? Projecting their own views onto their children? Good lord?! Enough of this "Family Value" stuff (thinks the Pentagon)! Teachers, parents, leave those kids alone!

Do Not Belittle Philosophy

Azar Nafisi begins her memoir, Reading Lolita in Tehran, by relating one of her oft repeated lines to her students: "do not, under any circumstances, belittle a work of fiction by trying to turn it into a carbon copy of real life." This early indication of her position on literature drew me deep into this book. Her central thesis is that literature cultivates our imagination and nutures our capacity for empathy. When we enter into a piece of fiction, we learn how to allow people to be complex and multi-dimensional. What I love best about this memoir is how Nafisi uses fiction, especially books such as Nabokov's Lolita, to reach her students while they are being bombarded with propaganda and rhetoric that bends them toward dismissing anything or anyone that doesn't live up the narrow ideals of fundamentalism.

Later in the book, she tells her class--which is composed of the generation after the revolution in Iran, and therefore swept up with a very black and white view of moral and immoral existence--how to read literature. She writes: "A novel is not an allegory . . . It is a sensual experience of another world. If you don't enter that world, hold your breath with the characters and become involved in their destiny, you won't be able to empathize, and empathy is at the heart of the novel." I was struck by some of the parallels to my own experience of teaching Philosophy 101 this semester. While I wasn't asking the students to enter into the lives of fictional characters, I was asking students to entertain philosophical arguments that challenged their most deeply held beliefs: is there a God?, am I the same person over time?, does truth exist?

Nafisi describes how the politicization of every detail of life: clothing, novels, food, etc. has stunted many of her students ability to appreciate a novel such as The Great Gatsby. They denounce Gatsby's character as embodying everything that is wrong with the West: shallowness, greed, and immorality. This past semester, on more than one occasion, I was met with similar hostility by my students when I presented them with arguments that complicated the concept of "free will" or that God was trully omnipotent, omniscient or trully good.

One day when we were discussing ethics--in particular the difference between Kantian ethics or Utlitarian ethics--I asked my students to reflect on a newstory that had broken that day on the front page of the New York Times. The piece reported that potentially 26 homicides (I forget the exact number) were committed by our own troops on prisoners of war in both Iraq and Afghanistan. I asked my students how a Kantian would approach this. Immediately I was met with outrage. One student shouted out: "those bastards deserved to die! They bombed the Twin Towers." I tried to maintain my composure. Then, another student said: "Isn't it the case that most professors are liberal and want to make us sympathetic to the terrorists?" I was shocked; I could not entice these students to evaluate the question: is it moral to kill prisoners of war? without them diverting to the political rhetoric oozing out of this administration.

Nafisi's book helps me to both understand why this happens, but also emboldens me to continue to force students--even in the midst of this highly politicized era--to challenge what they accept as true, moral, or American, for that matter. It is no fun. And, let me say that I get worried more and more these days that I have right-wing students sending moles into my class to report what I say to David Horowitz's website. But, it is imperative that we do not allow the political rhetoric of this administration to prevent students from learning how to think critically and how to empathize with the unknown other.

While Nafisi admonishes students not to belittle fiction, I will continue to steer students toward the sometimes maddingly convoluted or skeptical arguments of philosophers, just to keep alive that critical mind that does not eat up whatever political rhetoric gets shoved down our throats.

The Pro-Soulers

As an overdue recognition of my guest "catzona" (aka Yehudster) I want to rant today about what he calls the "Pro-soulers." What does that mean you ask? Well, this should be the proper label for the "pro-lifers." I have to say, once I realized that what the "pro-lifers" are really protecting is the "soul," rather than the all-too-mortal life of the mother or child, I finally understood the other positions these politicians take. Silly me, I thought that the issue was reducing the number of abortions.

I was reading an article in Wired magazine about William Hurlburt, who has found, perhaps, an alternative stem cell approach. It is too bizarre to believe, until, again, you realize that the issue is preserving a soul. As Clive Thompson reports:

"Christian critics [of stem-cell research] have a more clear cut view [of when human life begins]. God endows every embryo with a soul at conception. So intentionally destroying an embryo is murder--even if it's only one-cell big."

Hurlburt proposes that we grow pseudo-embryos, e.g. tumors grown from an egg or sperm cell that don't have "the right balance of gene expression to create a fully integrated organism." So, to get around the soul issue, we grow tumors that we can harvest stem-cells from. These tumors grow into "a dense ball of teeth, hair, and skin, a ghastly grab bag of organs like some randomnly constructed Frankenstein." Well, ok fine.

What really fascinates me about this pro-soul approach is how they combine the doctrine of radical free will with the idea of God endowing embryos with souls. So, you see, God lets the soul come into existence after conception--poof. Then, you have to baptize the soul. But, once that process is over, sorry soul, you're on your own. No federal tax dollars (or state) should be allocated to ensure that you have enough to eat, or that you have healthcare. In fact, the quality of your education is really up to your own gumption. Fascinating, eh?

But, here is an issue that I would like to see a pro-souler Christian respond to: when a woman is raped or molested--and a embryo/soul emerges--then, how exactly was God involved there? You see, its the whole problem of evil. If God is wholly good, omniscient, and omnipotent, why does he allow such a horrendous act happen to a woman--that he could prevent--in order to bring another Christian soul into the world. I mean, afterall, it sounds a lot like when the Serbs raped Bosnian women to bring in more of their people. I would expect more from a God.