Soothing the Sad Savage

In the latest New Yorker, Louis Menand reviews reasons to be skeptical of psychiatric drugs, including this stuff I teach in my health econ class:

Fifteen years ago, [Irving Kirsch] began conducting meta-analyses of antidepressant drug trials. … Kirsch’s conclusion is that antidepressants are just fancy placebos. … Drug trials are double-blind: neither the patients (paid volunteers) nor the doctors (also paid) are told which group is getting the drug and which is getting the placebo. But antidepressants have side effects, and sugar pills don’t. Commonly, side effects of antidepressants are tolerable things like nausea, restlessness, dry mouth, and so on. … This means that a patient who experiences minor side effects can conclude that he is taking the drug, and start to feel better.

But after 6000 words of such skepticism, Menand still concludes: take the meds.  Why?  Because impressive authors have written eloquent testimonials:

The recommendation from people who have written about their own depression is, overwhelmingly, Take the meds! It’s the position of Andrew Solomon, in “The Noonday Demon” (2001), a wise and humane book. It’s the position of many of the contributors to “Unholy Ghost” (2001) and “Poets on Prozac” (2008), anthologies of essays by writers about depression. The ones who took medication say that they write much better than they did when they were depressed. William Styron, in his widely read memoir “Darkness Visible” (1990), says that his experience in talk therapy was a damaging waste of time, and that he wishes he had gone straight to the hospital when his depression became severe.

The only reason Menand can imagine resisting such artists is a perverse religious desire to suffer:

What if there were a pill that relieved you of the physical pain of bereavement—sleeplessness, weeping, loss of appetite—without diluting your love for or memory of the dead? Assuming that bereavement “naturally” remits after six months, would you take a pill today that will allow you to feel the way you will be feeling six months from now anyway? Probably most people would say no. … Gerald Klerman once called “pharmacological Calvinism” … the view, which he thought many Americans hold, that shortcuts to happiness are sinful, that happiness is not worth anything unless you have worked for it.

Numbers schmumbers – only uncivilized animals, or religious nuts, would not let eloquent authors soothe their savage doubts, until they accept being comforted by their culture’s conventional ways to show that folks care.

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