What You Can Change _. And What You Can't - Martin E. Seligman [21]
The antipsychotic drugs produce nasty side effects. The most noticeable are cardiac arrhythmia; low blood pressure; uncontrollable restlessness and fidgeting; immobility of the face, robbing the patient of the ability to smile; tremor; and a shuffling gait. A few patients die. A devastating, and especially hideous, side effect is tardive dyskinesia, when the drugs destroy something (as yet unknown) in the brain’s control of movement. Its victims suck and smack their lips uncontrollably.
Lester’s family pretends not to notice. But Lester often looks like a frog catching flies.
Between one-quarter and one-third of drugged patients develop this deformity. The longer you take the drug, the more likely it is that tardive dyskinesia will develop. And once it starts, it is completely irreversible.11
Depression. Antidepressant drugs work about 65 percent of the time. Like the antipsychotics, they are cosmetic. Once you stop taking them, you are just as likely to relapse or have a fresh attack of depression as you were before. They do not alter the deep pessimism and helplessness characteristic of depressives. When you recover from depression using a drug, you have acquired no new skills and no new insights into how to handle life’s recurrent setbacks. You credit your recovery to a drug or to a benevolent physician, not to yourself.
Antidepressants, like antipsychotics, have nasty side effects. The monoamine-oxidase (MAO) inhibitors, a once commonly used type of antidepressant, can be fatal. The tricyclics are milder, but they can produce cardiac problems, mania, confusion and memory loss, and extreme fatigue; a large minority of patients cannot tolerate them. The newest entry—Prozac—produces less drowsiness, dry mouth, and sweating than the older ones, but it produces more nausea, nervousness, and insomnia. Eli Lilly, its maker, may now be reaping the consequences of premature media hype, for there are case histories suggesting that Prozac causes unprecedented suicidal preoccupation. No controlled study has yet been done.12
Anxiety. Anti-anxiety drugs relieve anxiety. They relax you dramatically and make life seem rosier. But like the antidepression and antipsychotic drugs, they are cosmetic. Once you stop taking them, anxiety returns in full force. Worse, when the anxiety stems from a real problem, you find you have done nothing in the meantime to surmount it. To the extent that anxiety is a message to do something about your life, anti-anxiety drugs prevent your getting the message. In addition, these drugs are overused in anxiety disorders: They are probably useless for panic disorder and for generalized anxiety disorder.13
Anti-anxiety drugs do not have the nasty side effects that the antipsychotics and antidepressants have. They probably won’t kill you, even in megadoses. But unlike the others, the antianxiety drugs become less potent the longer you take them, and they probably are addictive.14
Mania. Lithium works well on mania. The main problem with lithium is that many manics refuse to take it because they like staying manic. In past centuries lithium had been used as a drug, but it was in disrepute (because it produced heart attacks) when John Cade, the Australian researcher, revived it by discovering its anti-manic property. Unlike the rest of the aforementioned drugs, lithium therefore generated few unpleasant surprises.15 The medical field was forewarned, and from the outset, patients who took lithium to relieve manic-depression were carefully monitored by their physicians.
Your Genes and Your Personality
The final principle of biological psychiatry is that personality is genetic. This is so contrary to the political sensibility