New p14, rabin, med self, (jules.jen).pmd

The Medicated Self: Implications of Prozac on
Selfhood, Embodiment, and Identity
Author: Cara Rabin, University of Pennsylvania
Faculty Sponsor: Dr. Paul R. Wolpe
Abstract
a person’s sense of self and identity is understood to As knowledge about molecular neurobiology and refer to his or her defining elements of personality and genetics has grown and as biotechnology is character. Implicit in this definition is the belief that there increasingly able to modify and moderate what was once considered permanently determined by our is something stable and enduring about the self. In such a biological and genetic fate, selective serotonin view, this “fundamental core of selfhood,” has been reuptake inhibitors, particularly Prozac, have been defined by the personality, thought to be composed of a pushed to the forefront of bioethical debates. The combination of temperament and character. Temperament use of Prozac and other pharmacological interventions was thought to be composed of inborn biological in the brain raises concerns that other aspects of characteristics while character was thought to be the result biotechnology have not. The brain is considered the seat of mind and consciousness: Therefore, of life experiences and acquired social attributes (Kennedy, interventions in the brain have a unique set of ethical implications. Though today we can alter many things Sociological conceptions of the self have generally about ourselves with great ease, the use of Prozac focused on a self that is developed in a continual process has broadened the scope of changes we can make of interactions with others. Sociologist George Herbert to our moods, temperaments and feelings. This Mead conceived the self as an entity that is not fixed in article aims to open an essential dialogue about Prozac’s impact on identity and selfhood.
time but is constantly in flux because its developmentoccurs in interactions, which change throughout the lifecourse (Howson, 2003, p. 18). Sociologist Erving Is it ethical to use a drug intended for therapeutic Goffman also viewed the self as an entity created through purposes to alter the self in ways that transcend the drug’s interactions with other people; the self is defined in a medicinal intention? Fundamentally, then, are drugs able context. He equated the character one performs with the to change the self at all? More specifically, can true self (Goffman, 1959, p. 37). Similarly, Jean Paul antidepressants known as selective serotonin reuptake Sartre viewed the self as an amorphous and malleable inhibitors (SSRIs) fundamentally transform the self ? This entity. He believed that individuals are thrown into the raises perpetually unanswerable questions: What is the self? world without any determinate nature. In Sartre’s view How is selfhood constituted? Can selfhood be dramatically we are entirely self-creating rather than having a self altered? And, ultimately, does the use of Prozac, as an created by genes (DeGrazia, 2000, p. 37).
archetypal SSRI, transform, modify, or otherwise change A biological conception of the self rests on the fact a fundamental self? These questions emerge in the context that genes and biochemistry are large factors in of a society with greater and greater psychopharma- determining our character, personality, and temperament.
The self is essentially programmed from birth. Biologicalselfhood in its most extreme level is expressed by Lauren Conceptions of Selfhood
Slater in Prozac Diary. She states, “Prozac’s view and What is the self ? Since the dawn of time, now mine, that history is meaningless, stories no more philosophers, scientists, religious leaders and writers have than convenient construction. That the person, a mere wrestled with the notion of self and identity. Traditionally, concoction of chemicals, is programmed from birth, purebeast” (Slater, 1998, p. 114). Inherent in a biologicalconception of selfhood is the notion that mood, Cara Rabin is a Junior at the University of Pennsylvania
personality, and character are informed by a biological and is majoring in Health and Societies.
infrastructure. The biological view of the self is ultimately Email: [email protected]
reductionist in that it diminishes selfhood to smaller and Dr. Paul R. Wolpe is the faculty sponsor for this submis-
smaller components: neurons, cells, and now the DNA sion. He is an Associate Professor of Sociology and a
within the cells. American psychiatry adopted this Senior Faculty Fellow of the Center for Bioethics at the
biomedical model in the 1950s, although the model was University of Pennsylvania.
Address: 3401 Market St, Suite 320, Philadelphia, Penn-
not embraced by broader culture at the time. The biological sylvania 19104
conception of the self was controversial precisely because Email: [email protected]
it sug gests that psychiatric symptoms can be decontextualized as primarily biological or genetic (5HT) by blocking the channels that suck away too much serotonin, making it available at the presynaptic neuronal According to Carl Degler, a Stanford sociologist, membrane for longer periods of communication cultural needs influence what science discovers and then markets as scientific truth. Thus, conceptions of self are Understanding the biochemical workings of Prozac intimately tied to the society in which they arise. During credits a disclaimer. Though scientists have a general idea the 1950s and 1960s, biological conceptions of personality about how Prozac binds with receptors at the cellular were viewed with suspicion and hostility. Forty years later, level, its precise mechanism of action is still unknown. In in a society such as ours filled with the material fruits of fact, mechanisms of action are unknown and hotly debated a new biology—CAT scans, MRIs, prosthetics, for all chemical types of antidepressants. Depression itself recombinant DNA, genetically engineered plants, and of is not fully understood by biologists. The reigning biogenic- course, psycho-pharmaceuticals—a view that favors amine hypothesis is just that—a hypothesis. In fact, Kramer biological understandings of the self is consistent with argues that it is “demonstrably false or incomplete” the scientific zeitgeist. In the 21st century, therefore, it is (Kramer, 1993, 283). Psychiatrist Peter Breggin similarly necessary to understand the self through two lenses: one critiques the biopsychiatric framing of depression open to biology and the other to culture. We now know expressed in the biogenic-amine hypothesis. He defines that genes and environment interact at every level— depression as an emotional state of despair, desperation behavior, feeling, chemistry, and anatomy. Genetic material or other responses that do not necessarily have a biological can be modulated by external circumstances. Neurons or genetic cause (Gardner, 2003, p.120). Despite both and synapses are plastic. In his bestselling book, Listening physicians’ understandable suspicion of the unproven to Prozac, psychiatrist Peter Kramer claims that experiences biogenic-amine hypothesis of depression, Prozac’s leave a biochemical and anatomical mark or scar on the seductive popularity arises within a technological advanced brain (Kramer, 1993, p. 122). Therefore, the conception society in which the mass media and the scientific of biological selfhood must now be modified to include community favor a fundamentally biological hypothesis the notion that genes are in fact impacted by our social of depression and a corresponding biological treatment.
experiences. Neither the social nor the biologicalconceptions of self and identity are sufficient to The Lovechild of Medicine and Technoscience
understand how the self is constituted today.
According to Chris H. Gray in Cyborg Citizen, one great creation of the modern era is “technoscience.” The The Magic of Medication: How Prozac Works
marriage of technology and science in modern society is Once scientists established that biological profoundly changing human culture and medicine in infrastructures contribute to some of the components unprecedented ways (Gray, 2001, p. 13). With the that comprise the conceptions of the self, such as developments of the biotech millennium, human lifespan, temperament, cognition and mood, they set out to create mental and physical abilities and even personality are being drugs that could modify malfunctions in mood and molded in ways which were previously unimaginable disposition (Barondes, 2003, p. 19). However, all (Lewis, 2003, p. 52). Prozac must be understood in our, hypotheses must be viewed within a socio-cultural context.
as Donna Haraway states, “cyborgian world.” To Haraway, Likewise, antidepressants work within the dominant we are all theorized and fabricated hybrids of machine sociocultural hypothesis that brain chemicals, specifically and organism—cyborgs (Lewis, 2003, p. 54). In this neurotransmitters, contribute to depression. Within the modern world of hybrids, we can readily alter our biology framework of a biological contribution to depression, the like never before. The expressions of an individual’s transformative capabilities of Prozac can only be neuronal architecture are no longer understood to be appreciated through an understanding of the changes it inevitable or irreversible. Within our technoscience culture, affects on characteristics fundamental to conceptions of which challenges our traditional western dualisms, it no the self and identity. Neurotransmitters are chemicals that longer makes sense to consider biology or environment, nerve cells use to communicate with one another.
nature or nurture, alone. We must consider their synthesis (Barondes, 2003, p. 22). The communication between the and how that contributes to a sense of self in the neurotransmitters occurs at points of contact between nerve cells called synapses. Antidepressants are thought Despite our increasingly mutable biology, we cannot to work by increasing the influence of these ignore the fact that the use of Prozac and other neurotransmitters in the spaces between synapses, thereby pharmacological interventions in the brain raise concerns ensuring that they are available for interaction and that other aspects of technoscience have not. The brain communication for longer periods of time. Prozac is considered the seat of mind and consciousness; it is specifically inhibits the neuronal uptake of serotonin considered the locus of selfhood in Western society and The Medicated Self
therefore interventions in the brain have a unique set of of the self in the modern world. Understanding the impact ethical implications (Farah and Wolpe, 2004, p. 36). The of Prozac on the modern sense of self is an absorbing drug’s global affect—its ability to extend social popularity, and daunting task. Kramer believes that Prozac business acumen, self-image, energy, flexibility, mood and fundamentally alters the self. He suggests that Prozac flirtatiousness—touches too closely for many on fantasies should be understood as a drug not that acts on a particular about medication for the mind. (Lewis, 2003, p. 50).
malfunction, which is at the root of an illness, but rather However, the notion of feeling liberated through as one that contributes to a general reshaping of substances is certainly not new. Has man not been using personality. He believes that Prozac has transformative substances to alter brain functioning since the dawn of powers; it can instill self-confidence, lend the introvert time? What makes the SSRIs different from alcohol, the social skills of a salesman and enhance a person’s cannabis and other naturally occurring compounds that performance at work and play. Kramer’s central concern go back to our earliest history? As I write this paper, I am with Prozac involves its ability to alter these aspects of drinking coffee; its active ingredient, caffeine, enhances personhood, as he illustrates with a study of his first patient both arousal and attention. Caffeinated beverages, drugs on Prozac, Tess. After “listening” to Tess on Prozac and and alcohol all induce changes in the brain which can to other patients treated with the drug, Kramer concludes affect mood, temperament and disposition. LSD, alcohol that Prozac’s action often goes far beyond a single intended and amphetamines all have wide reaching effects on brain effect; to him, “you take it to treat a symptom, and it chemistry; the line between their use and the widespread transforms your sense of self ” (Kramer, 1993, p. 267).
However, not everyone believes that a drug alone The high level of existential questioning that can alter the self. Ronald Dworkin points out that after encompasses the use of Prozac arises because of its awe- an individual starts taking medication, life continues by inspiring ability to alter the brain with a chemical and virtue of its own momentum. He elaborates, “if before anatomical selectivity that was never before possible. This taking the drug, people hiked for recreation or shopped is where medicine and technoscience meet. Prozac is because it was their favorite pastime, they generally do so special in its selectivity within the brain and how that afterward” (Dworkin, 2001, p. 97). The tastes and interests specificity enables its action. Alcohol and caffeine, among of an individual do not change. External circumstances other drugs, have widespread affects on brain chemicals; cannot be altered with Prozac. An individual on psychotropic they do not specifically seek out and bind to a particular drugs still generally reacts to specific environmental events neurotransmitter in the way that Prozac can. Furthermore, in an appropriate manner; his or her mood will go up and as Harvard Psychiatrist Robert Aranow explains, Prozac down according to environmental stimuli. Prozac’s enables a “conservation of mood” that other drugs don’t.
mechanism is decidedly specific to a biochemical process.
Amphetamine, alcohol and other street drugs used to The world outside the individual’s neurons inevitably elevate mood all ultimately result in a crash. Prozac breaks the rule of “what goes up must come down” (Kramer, David DeGrazia comes to the same conclusion as Dworkin—that Prozac doesn’t change the fundamental Prozac not only differs from illicit drugs like cannabis self—through a different lens. He believes that “a person and LSD, but also differs from the psychopharmaceuticals can be true to oneself even while transforming and even that came before it. Until SSRIs were discovered, most creating the person one is. One’s self is not merely waiting psychotropic medications had significant risks and side to be discovered after all… Part of the human endeavor effects that severely limited their attractiveness. Many is deciding and trying to become who we want to be” people were unable to withstand the side effects of tricyclic (DeGrazia, 2000, p. 34). He proposes that we consider antidepressants and MAO inhibitors (Barondes, 2003, p.
the image of the self not as something given, but as 39). As Kramer describes, Prozac’s ability for something that is dynamic and mutable (Brown and neurochemical modification with few downsides Toufexis, 1993, p. 62). He situates Prozac as one method encourages many people who would never have taken an that an individual can use to affect his or her selfhood, earlier antidepressant to be open to taking such an SSRI.
which will inevitably change over time through non- SSRIs, with a better balance of properties than earlier antidepressants, have transformed the practice of Other psychiatrists focus on Prozac’s pharmacological psychiatry. In fact, they have transformed the nation into “magic,” yet contend that the chemical changes it produces do not alter the self. As quoted in Time, Dr. DanielAuerbach argues that Prozac cannot change personality, Does Prozac Change the Self ?
but that “what gets changed is symptoms of a disease” There is no easy answer to the question of whether (Brown and Toufexis, 1993, p. 62). Prozac enables a Prozac changes the self, just as there is no singular concept person’s true personality, imprisoned by an illness like major depression or minor dysthymia, to emerge. It cannot questions about the biological foundations of who we are manipulate people. It can, however, contends psychiatrist and how the self is constituted. Prozac forces us to Hyla Cass, correct an imbalance and allow people “to be reexamine what is constant in the self and what is mutable, who they can be.” It can free an individual from a what can be modified and what should be altered. At the depressed state that inhibits his or her ability to feel and very least, by activating a dialogue of what it means to be show love and it might be able to liberate an individual’s human in a postmodern world, Prozac privileges a discourse creativity. But a new selfhood can’t be purchased in a pill.
If Prozac isn’t a new self packaged in pill form, what isit? Prozac’s effect on the self may be considered analogous References
to a catalyst’s affect on a chemical reaction. A chemical 1. Barondes, Samuel H. Better than Prozac. Oxford: Oxford catalyst is a substance that increases the rate of a reaction 2. Brown, Deborah Edler and Anastasia Toufexis. “The Personality that would already occur by providing a new pathway for the Pill,” in Time Vol. 142, (October 11, 1993): 61-63.
3. Degrazia, David. “Prozac, Enhancement and Self-Creation,” reaction to occur with a lower energy of activation The Hastings Center Report 30, no. 2 (2000): 34-40.
(Zumdahl, 2005, p. 741). Like a catalyst, Prozac enables 4. Dworkin, Ronald W. “The Medicalization of Unhappiness.” The an individual to more fully actuate his underlying desires Public Interest. (Summer 2001): 85-99.
5. Farah, Martha and Paul Root Wolpe. “Monitoring the and potential; it allows more readily for an expression of Manipulating Brain Function.” The Hastings Center Report 34, a self that is already there. Prozac increases the “surface no. 3 (May-June 2004): 35-45.
6. Fraser, Miriam. “The Nature of Prozac,” History of the Human area” people have available to experience life in both Sciences. London: SAGE Publications, (2001): 56-84.
positive and negative ways. Thus, Prozac may be seen asa catalyst that allows the individual the chance to exploit 7. Gardner, Paula. “Distorted Packaging: Marketing Depression as Illness, Drugs as Cure” in Journal of Medical Humanities Vol. the productive optimization of biological capital (Fraser, 24, Nos.1/2 (Summer 2003): 105-130.
2001, p. 68). It provides a path for the self to be actualized.
8. Goffman, Erving. The Presentation of Self in Everyday Life.
It also, to quote from Kramer, “catalyzes the precondition 9. Gray, Chris Hables. Cyborg Citizen. New York: Routledge, 2001.
for tragedy—participation” (Kramer, 1993, p. 258). In 10. Howson, Alexandra. The Body in Society: An Introduction.
this way, Prozac’s action is strictly biochemical—it acts on 11. Kennedy, Deveareux. “Biological Psychiatry and the the serotonin (5T) receptor. By doing this, Prozac cannot Postmodern Self,” Sociological Forum, Vol. 13, No. 2. New alter the entirety of an individual’s self-conception. If we York: Springer (June 1998): 377-386.
12. Kramer, Peter. Against Depression. New York: Viking, 2005.
are, after all, more than just an information superhighway 13. Kramer, Peter. Listening to Prozac. New York: Viking, 1993.
of neurons separated completely from the world outside 14. Kramer, Peter. “The Transformation of Personality,” Psychology the brain, then Prozac can only potentiate change.
Today Vol. 26, (July/August 1993): 42-53 15. Lewis, Bradley E. “Prozac and the Post-human Politics of Ultimately, it must be the person who does the changing.
Cyborgs.” Journal of Medical Humanities Vol. 24 (Summer 2003): The ethical issues raised by Prozac’s use in the postmodern 16. Slater, Lauren. Prozac Diary. New York: Random House, 1998.
world are as complex as the drug’s biochemical 17. Zumdahl, Steven S. Chemical Principles, Fifth Edition. New mechanisms. The use and usefulness of Prozac raises York: Houghton Mifflin Company, 2005.

Source: http://www.bioethicsjournal.com/pdf/pbj2.1_rabin.pdf