Saturday, January 21, 2006

Psychopharmacological Gender Engineering

I did a bit of writing the last few days before coming down with death cold. Now, I am quite comfortably sitting in a Panera, listening to good Jazz, and hence feeling perky enough to actually share with my readers bits of what I am working on. I am not sure if this will be the beginning of the book, but it was helpful to juxtapose my mother's experience with my own.

“Imagine that we have 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, “The Valorization of Sadness: Alienation and the Melancholic Temperament,” The Hastings Center Report.

“ . . .in the bioscience discourse of depression, the personal is not political, the personal is biological.”—Bradley E. Lewis, “Prozac and the Post-human Politics of Cyborgs,” Journal of Medical Humanities. (56)

In 1973 my parents moved with two small children from Germany, where the Army stationed my father, to Sacramento, so that my father could set up his medical practice. My mom was a nurse, but chose to stay home and raise my brother and I, while my father put his energy into building a new medical practice. Not long after we had settled in my mother made a visit to her gynecologist, which, she often tells me, was her primary physician in those days. Upon completing her examination, he turned toward my mother, who seemed a bit tense and anxious, and asked her how she was doing. “How do you think I’m doing with two small children under three and a husband trying to start up a medical practice?,” she snapped back. To which her gynecologist responded: “Why don’t I write you a prescription for Valium to help ease your anxiety.”

Almost twenty years later, I found myself facing a nurse practitioner at a gynecology clinic at the university where I was pursuing my Ph.D. Before starting the examination, she was taking my history and noticed that I seemed rather agitated. At the time I was incredibly overwhelmed with my coursework and a bit raw from the ruthless environment of my graduate program. When she asked me how I was doing, I began to talk a little about my worries over upcoming papers when tears began flowing. She immediately wrote me out a prescription for Zoloft and told me that I would feel much better in two weeks.

The differences in my situation from my mothers’, at the time we both found ourselves full of anxiety and confiding in our OBGYN doctors, reflect, to some degree, the feminist gains that women made over the twenty years before I embarked on a Ph.D. in Philosophy. I did not grow up with the expectation that I would seek out a well-situated husband and raise children in the suburbs, but rather that I would take my place alongside men in the professions. My mother re-entered the workforce as soon as I started kindergarten and began to embrace the feminist ideals of egalitarian families and an identity outside of self-sacrificing motherhood. Both she and my father encouraged me to stay single and unencumbered as long as possible while pursuing my professional goals. Like the dutiful daughter that I was, I heeded their advice and singularly molded myself after my favorite female intellectual, Simone de Beauvoir.

Yet, despite following a wholly different life path than my mother did, I found myself face to face with a similar socializing force: the physician armed with the latest psychotropic medication designed for treating female distress. The women of my mother’s generation were the primary consumers of sedatives like Valium or Miltown to ease their anxiety, while the women of my generation are written prescriptions for Selective Serotonin Re-Uptake Inhibitors (SSRIs) like Prozac, Zoloft, or Paxil. The cultural narrative on these medications differs in what they promised my mother’s generation as compared to my own. Valium promised relief for women overwhelmed with childcare duties and tedious domestic routines. It was a pacifying drug that enabled women to cope better with their prescribed roles as domestic goddesses. Prozac, on the other hand, was a liberating drug. It promised energy, assertiveness and vivaciousness. The drugs for female distress had changed with the times.

While enthusiasts of Prozac, such as Peter Kramer (1993) and David DeGrazia (2000), laud Prozac as a feminist drug, other cultural critics, such as Jonathan Metzl (2003) and Bradley E. Lewis (2003) warn of the conservative forces buried within the pharmaceutical advertisements promising that Prozac makes women more attractive spouses, better humored mothers, and more assertive and efficient workers. Is Prozac a boost to the feminist cause, or another, albeit clever, instrument of patriarchy? To what extent was my encounter with psychopharmacology different from my mother’s?

At the heart of this question is a more profound philosophical question about the relationship between technology and human goals. How should human beings meaningfully use technology to improve their lot? When should we restrict biotechnologies that promise to make us better than well? And, how do we reconcile our long held views of what human beings are like and what new technologies reveal about the nature of the self?

We live in the Prozac Age, a time when pharmaceutical innovations promise to cure us from a variety of unattractive and embarrassing personality tics. We are barraged daily by major media sources—television, the internet, radio and news sources—that teach us to see our personalities as far more malleable than previously believed. We are taught to see our unease in social situations, our profound stress with balancing work and parenting, or our alienation with modern society as “chemical imbalances” unjustly conspiring against the desire to reach our fullest potential. The Prozac Age presents to us a simple solution to what seems like intractable and complex social problems. Why worry about our dwindling time with family, our long commutes, or insane work schedules when there are pills that can help us better cope with these greater demands? Why devote seemingly wasted hours to community activism, when an anti-anxiety medication might do the trick?

Quite a bit of ink has been spilled in debating the ethical permissibility of using antidepressants, and other biotechnologies, as enhancement drugs. With hindsight, both my mother and I see the interaction with our physicians as instances of peddling enhancements, rather than treating illnesses. Neither the hectic demands of parenting, nor the intense pressure and stress of graduate school really constitute sickness. Yet, our physicians translated our appropriate responses to difficult social environments into treatable medical phenomena. Both the Valium and the Zoloft were intended to help us better achieve a prescribed social norm. What was normal for women raising young children in the early 70’s certainly is not the same normal for a young, single, aspiring professional living at the beginning of the 21st Century. The pervasive cultural message my mom received was that irritability and agitation in mothers is a mental illness; the post-women’s movement message waiting for me was that an emotional reaction to stressful, competitive work environments is a mental illness.

While the notion of what “normal” adult women should be like had adjusted to reflect the expectations of the sphere where white, middle-class women were more likely find themselves, a common, deeply entrenched attitude about women and femininity persisted. Stressed out, overwhelmed, and complaining women are irritating. My mother’s generation were encouraged to be less willful and more pleasant, while my generation, which had succeeded in breaking into the male dominated professions, better start acting a lot more like men if they were going to make it. Psychotropic medications, whether sedatives or SSRIs, are inextricably intertwined with cultural notions of norms, particularly gender norms.