What You Can Change _. And What You Can't - Martin E. Seligman [20]
Predictably, Miltown was used promiscuously. The industry race was on. Librium (chlordiazepoxide) replaced Miltown and became the world’s number one prescription drug. Valium (diazepam), five times stronger, soon displaced Librium. These drugs presently rival alcohol in their everyday use by Americans. If your troubles make you anxious and you can find a cooperative physician, taking Valium four times a day is quite acceptable.8 Ours is no longer the Age of Anxiety. It is the Age of Tranquilizers.
The second principle of biological psychiatry seems firmly in place. Drugs, claim their advocates, have conquered psychosis and mania and eliminated the more commonplace moods of depression and anxiety. Emotion and mood are nothing but brain chemistry. If you don’t like yours, you can change them with the right drug.
The Seamy Side of Drugs
I have tried to make as sympathetic a case as I can for drugs. I had to restrain myself. Drugs do work on emotion. Mania can be greatly dampened. Depression can be moderately relieved. Anxiety can be almost instantly dispelled. Psychotic delusions can be chemically dissolved.
But there is another side to the story. Why in general do drugs work? You might entertain the naïve image that the drug swoops down on the invading foreign disease and kills it, like a falcon attacking a rabbit. I have a different image of how a lot of drugs work, and while controversial, it may help you understand the seamy side. In my image, drugs are themselves foreign invaders, just like diseases. Your body regards the drug as a toxin, and your natural defenses are mobilized to fight it off. A side effect is that these mobilized defenses happen to kill off the disease. The true side effect of a drug is to arrest the disease. The main effect of the drug is to produce the unwanted lesser illnesses, euphemistically dubbed side effects.
General paresis itself was first arrested by just such a tactic. In 1917, Julius Wagner von Jauregg, an Austrian psychiatrist, intentionally gave paretics malaria. He reasoned that the “minor” disease of malaria, producing high fever and marshaling other defenses, might kill the major disease of paresis. So it did, and Wagner von Jauregg was awarded the Nobel Prize in 1927, becoming the only psychiatrist ever so honored. In my view, Wagner von Jauregg’s tactic was not a peculiar medical tactic. Drugs usually work the same way: by inducing a lesser malady to cure a greater malady.
Psychosis. Antipsychotic drugs seem to “work” about 60 percent of the time, although, surprisingly, well-done outcome studies are scarce. A large minority of patients do not benefit9 (though “benefit” is not exactly a straightforward term, even when the drugs do work—the drugs relieve the symptoms, but the patients do not recover completely). Schizophrenics become more manageable—quieter, less bizarre, more docile—but they are still schizophrenics. This is convenient for hospital staff and can easily be mistaken for a cure.
Lester still finds himself with strange thoughts, but they are not as compelling as they once were. He has also learned not to talk about being a worm, though he often still thinks he really is one.
Sadly, Lester, plagued once again by delusions, has returned to the hospital for monthlong bouts of delusions six times since 1952.
Back-ward overcrowding was ended by the drugs, but it was replaced with a “revolving door.” Many of the people we see lying on grates in large American cities got there by being released, again and again, from mental hospitals by virtue of the antipsychotic drugs. Out on the street, they deteriorate once more—either because they stop taking their drugs or because their drugs lose effect—and the police soon bring them back to the hospital.
Psychotics do not stop taking their medication only because of confusion