Dr. Neruda's Cure for Evil (51 page)

“Okay, you don’t want to,” I said. “I do.”

“I don’t want you to drop it, Rafe,” Diane said. That was uncharacteristic: she would normally argue her point of view herself. And her tone, even when addressing me, was cool and contemptuous.

“See? You lose,” Joseph said. “We’re not dropping it.”

I looked at Diane. I couldn’t read her. Did she feel it was my job to take him down a peg—or was she testing my willingness to fight? Either way, this was unlike her typically bold and straightforward manner. “All right,” I said and returned my attention to Joseph. “What was—oh yes, how can I argue that depression is caused by anything except a chemical imbalance when you can relieve it with a drug? Am I to understand, Joseph, that since scientists can impregnate a woman with frozen sperm you have concluded that what makes babies is a syringe?”

Harlan laughed. Joseph dismissed me with both hands. He was a small man, no more than five three. Small and unathletic, yet the old man’s clothes he wore as a boy were long gone. He dressed in Armani suits for evening wear, Banana Republic clothes for casual wear, and jogging suits for a night like the one we had just spent. He was in a red and white one now, on his feet, twirling away from me in disgust. “That’s bullshit.” He turned to face me. “That’s beneath you, Rafe. I’m sorry to hear you resort to that bullshit.”

“I’m sorry, too. I don’t want to resort to bullshit. What’s wrong with my point?”

Joseph stared, as if searching for signs of sarcasm. He couldn’t find any, since there were none. He sighed. “Artificial insemination proves that a sperm and an egg make a baby, not love.”

Silence greeted this remark. Not a respectful silence, recognizing logic triumphant. I think we felt dismay at what this implied for humanity’s future.

“So your point,” I said, after the room’s gloom persisted long enough for Joseph to check each of our expressions, settle back in his chair, pick up his espresso cup, note that it was empty and replace it on the coffee table. “So your point is that since Prozac can relieve depression’s symptoms—”

“Not its symptoms!” Joseph’s tone was so sharp that Harlan jerked his head away and pretended to clean out his ear. Diane smiled at him. Joseph ignored his pantomime. “Don’t diminish it by saying symptoms. What is depression if not a collection of symptoms?”

“Exactly,” I said. “What is depression? That’s the question you haven’t answered, any more than artificial insemination answers the question of what is life. A patient goes to a doctor and complains that he can’t sleep, he has no appetite, he has trouble concentrating, he feels his life is joyless, and that there’s no hope for any of these things to change. The doctor says he’s suffering from depression. He prescribes your drug and some of those things are changed. He eats more, sleeps more. His doctor praises him, his family praises him—”

“That’s not all—”

“Let me finish. The patient goes off the drug. And he can’t sleep again, he can’t eat, he has trouble concentrating—”

“So?” Joseph appealed to Diane. Evidently he had given up on me. “You put him back on the drug. How is that different from a recurrence of any illness? A person is infected, you give him an antibiotic. That doesn’t mean he can’t infect again.”

Diane looked to me, mouth set, arms crossed, like a professor waiting for an answer. I could understand why she might, sensitive to my friendship with Joseph, refrain from answering him herself, but why look at me so crossly? I hoped the annoyance was meant for Joseph. Harlan also looked at me expectantly. They appeared to be demanding that I refute my friend. I wasn’t sure that I wanted to refute him: I wanted to know if he was right or wrong and I doubted debate offered certainty.

My tone was an appeal, not argument: “Tell me, Joseph, how is it different from the person who feels awkward at a party, getting drunk every time he goes to one? Or a ghetto kid—who is right to feel his life has few prospects—buying crack to feel a surge of bliss? Have you cured depression, Joseph, or simply created socially acceptable addicts? Maybe you’ve helped the depression. Or maybe you’ve invented your own illness, and used that to overwhelm depression.”

“Oh, come on,” Joseph said. “Are you telling me antidepressants are completely useless in your work? That you would rather have people sink lower and lower—”

“I see you still haven’t read my book, Joseph.” He didn’t respond. Harlan smiled to himself. Getting no admission or denial, I continued, “Yes. At best drugs are useless. At worst they add a new problem. I never use them.”

“Because you’re biased,” Joseph said conclusively, as if making a private judgment, not scolding me.

“Because they’re dangerous.” I insisted. “Are you denying that tricyclics are addictive? Are you denying that neuroleptics cause tardive dyskinesia?”

“In
some
patients!” Joseph complained. “That’s why I didn’t finish reading your book. You throw out everything because some of the drugs aren’t perfect. Is the couch perfect?”

“No. In fact the couch is slow and hard work. Hard for the doctor, hard for the patient, hard for their families, hard for everyone. Not drugs. They’re easy. Drugs make patients easy to deal with. Easier for doctors and hospitals and their families. But what they don’t do is cure depression or schizophrenia. And what’s more, Joseph, and you know this is true, long term those drugs diminish personality—”

Joseph was on his feet. “I knew it. You haven’t read the research on Prozac.” He finally married his actions to his clothes and went jogging, out of the living room and down the hall to his study.

Harlan leaned forward, shook the espresso pot, and asked Diane if she wanted more.

“Not if you have to make it,” she said.

“I don’t mind,” Harlan said. “I’m depressed. I got nothing better to do.” He stood up, carrying the empty pot. “I like the idea of Joey inventing his own disease.”

Joseph appeared with reading material for me. One was a dissertation in manuscript. There were two issues of the
New England Journal of Medicine,
and finally a popular paperback by a psychopharmacologist. “She’s a dope,” Joseph said as he handed over this book, “but read her case histories in the last chapter for the descriptive data on Prozac’s effects. You haven’t read it, right?”

“Right,” I said. “Remember, Joseph, I would never use drugs on children—”

“I know, I know,” he handed me the rest of the pile. “These reports indicate that Prozac is different from any other antidepressant. It’s only been in use a year—”

“I know that, Joseph.”

“—and I want you to look at the rat studies on kindling.”

“Kindling?”

“You don’t know about kindling?”

“No,” I admitted.

“That’s irresponsible,” Joseph squeaked.

Harlan groaned.

Joseph’s voice stayed high. “I’m sorry. But it is. I know you don’t believe in psychopharmacology,” he appealed to me, “but that doesn’t mean you should ignore neurobiology. Freud wouldn’t.” Diane mumbled something. I couldn’t hear what because Joseph continued, “The kindling research has a bearing on your abused kids. They prove that emotional trauma can change brain chemistry.”

“They
prove
it?” I asked.

“In my opinion that’s the only reasonable conclusion you can draw from the kindling studies. Stress and trauma start a vicious cycle in the brain. And I believe the inescapable conclusion is that it means it can only be healed with drugs.”

“Give me a break,” Diane said. Joseph ignored her.

I glanced at the
New England Journal of Medicine
article. “Prozac and the New Self,” it was called. I said, “Point taken. I haven’t done enough reading to debate it with you.” I looked at my old friend and let him win. “Okay, Joseph, I’ll do my homework.”

C
HAPTER
S
EVEN
A Crisis of Faith

I
SHOULDN‘T BELABOR THE OBVIOUS TO PROFESSIONALS.
W
ITHIN A FEW
years, Joseph’s claims for Prozac were widely hailed in the media. Nowadays, it is an almost accepted fact that Prozac produces profound character changes in many patients, particularly mild depressives, people with low self-esteem, or emotional sensitivity, namely the sort of neurotic who had been considered psychoanalysis’s exclusive province. Namely patients like Gene Kenny. Prozac’s supporters claim that their patients aren’t merely relieved of the immediate physical effects of emotional pain; their experience of everyday rejection, loss, conflict, guilt and so on is altered, both in how they feel and react.

So why not prescribe Prozac for Gene? Readers of my book
The Soft-Headed Animal
know there is no proof, as Joseph Stein himself admits, that
any
psychological condition, ranging from schizophrenia to mild mood disorders, is organic. Shocking though it may seem to a lay audience inundated by half-truths and wild claims from psychobiologists, geneticists, and drug companies, there is no scientific proof that what we call mental illness exists. When autopsied, the brains of suicides, schizophrenics, manic-depressives, indeed the whole range of psychiatric disorders, show no measurable difference from the brains of people we label as mentally well. Only if (and this
if is
crucial) the “mentally ill” were subject to shock therapy, neuroleptics or sedatives do their brains show damage. Few things in psychiatry are as clear as this evidence: mental illness—insofar as one can consider it organic—doesn’t exist and the fashionable physical and chemical treatments, if used for long, may cause brain damage, irreversible damage that truly
is
a mental illness.

This confusion between the fact that drugs can change how people act and feel, and whether this constitutes a cure of their psychological crises, runs through every level of our society. Prozac, as an example, is supposed to “treat” depression by raising the amount of serotonin in the brain. And yet no scientist can show that depressed patients have lower levels of serotonin than people who are considered normal. (Some psy-chobiologists, to make their flawed logic consistent, respond to this fact by suggesting the entire population take Prozac.) When Prozac
artificially
raises serotonin, a minority of patients report they have more energy and accept defeat and frustration with less sadness. What its advocates leave out is that snorting cocaine can be shown to have the same effect, just as smoking cigarettes can be shown to improve concentration, and that alcohol can relieve anxiety. The difference—and it has a profound effect on the results of clinical trials of psychiatric drugs—is that when people medicate themselves with illegal narcotics, cigarettes, or alcohol, they don’t have a psychiatrist telling them they are ill when sober and cured when drugged. None of the material Joseph gave me clarified the murky logic of psychopharmacology. Insight alone doesn’t always cure. Drugs don’t cure. Not if the goal is an independent being, a person who is free from both a therapist and a pill. We like to call our profession a science, our patients sick, and our treatments medicine, but the psychiatrist, whether armed with a drug or a couch, is treating a perception of illness with only the prejudiced testimonies of its victim and an intolerant society to confirm his success. In that context, broad claims of success must always be regarded skeptically. Then and today, I could find no proof that medicating Gene Kenny would have been anything more than surrender to the modern culture of instant gratification.

Nevertheless, our New York coffee table scientific argument had several important consequences for me. What I did not, and could not have realized at the time, was the consequence it would have for Gene Kenny. That night his case seemed to be the least likely to be affected by the question Joseph and I debated. What was significant appeared to be entirely personal. Diane maintained an angry silence during the cab ride to her apartment. I had Joseph’s recommended reading in my lap. I tried to begin a few conversations. She answered in monosyllables, including when I apologized on Joseph’s behalf for treating her as if she weren’t a psychiatrist. “I’m just a stupid cunt to him,” she insisted. When we arrived at her door, she said, “Maybe you should go to your place tonight.”

“Okay,” I said, fighting the shrink’s impulse to talk this out immediately. She believed in that principle as fervently as I and must have had a good reason to delay.

Her tension at rejecting me relaxed. She kissed me affectionately and whispered, “I’m sorry. I’m just very tired.”

Not much of an excuse for a trained analyst. I played along. “Sure. Call you tomorrow.”

I wanted to study the articles anyway. I had an intuitive feeling that there was something valuable in Joseph’s dogma. And there was. I stayed up late reading, especially fascinated by the kindling studies on rats that suggest stress and rejection create biochemical changes which may then go on to have a life of their own. Of course they don’t really answer the age-old cause-and-effect argument, but they do call into question whether talking therapies alone can succeed in undoing the damage. They also, by the way, imply that early treatment is vital, very encouraging for someone who, like me, treats abused children and sometimes despairs of preventing long-term difficulties. I had lured “Timmy” out of his multiple personality defense against his abusers, but how could I feel secure that he wouldn’t suffer again later, in much the same way that Gene had reappeared with his old problems in a new guise?

By morning, I knew I had to investigate the kindling research. I called Joseph at eight o’clock. He promised to send unpublished material on a variety of neurological studies. Joseph was gracious and not smug about my apparent surrender to his point of view. (I didn’t tell him that I was unimpressed by the Prozac data.) Diane phoned soon after I hung up.

“I’m sorry,” she said in a sleepy voice. Her register is naturally low and husky. The morning gave her an even lower octave. It was sexy.

“Nothing to be sorry for,” I said.