Monday, June 27, 2005

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 na├»ve 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?