I'm so glad I ignored the negative reviews and bought a copy. The book isn't just about Prozac, it's a well-written and insightful analysis of the human condition.
My thoughts on Prozac:
For centuries the only thing human beings had to make them feel better was alcohol. It's expensive, potentially addictive, not very effective, has serious health risks, and is the cause of many accidental deaths and homicides.
Nowadays of course, there are other (illegal) substances available for those who want to self-medicate, usually of dubious quality and with serious risks to mind and body.
Thankfully I'm not currently in need of chemical support, but if I was, my money would be on Prozac; a well researched, professionally produced drug. No drug is without side effects, but what's the alternative? Stay depressed? End up sleeping rough on a park bench? Come to think of it, how many people now sleeping rough might not have ended up there if they'd had access to Prozac?
As someone who's been on Paxil for over a year, I've had many a conversation (with friends and with my therapist) about what it is, precisely, that Paxil (and it's buddies in the Prozac family) does. And should it be doing it? At what point is depression an "illness" that warrants medicated treatment and when is it simply a "normal" amount of bad feelings? Is Paxil a crutch? And if it is, does that mean that it shouldn't be used? This book addresses these questions intelligently and honestly. One of the things I admire about the book is that it doesn't pretend to have answers. It suggests possibilities, yes, and the author will frequently offer his own opinions, but he's very upfront about his own discomfort with the "Miracle Cures" that Prozac, Paxil, etc. have brought about, and the questions these cures raise for the usefulness of therapy. If you know anyone who's on any of these drugs or if you yourself are on them, I cannot recommend this book highly enough. Whatever your own opinion may be, I think you'll find this book offers a lot to think about.
In exploring the role of experience on mood, in chapter five Kramer turns to various observations on "rapid-cycling." Certain people have been observed to swing back and forth between dark depression and wild euphoria in a matter of hours, seemingly with very small (or no) external provocations (pp.108-109).
Kramer applies three models, which he sees are interconnecting, to this issue. First, Kramer summarizes the finding of Robert Post and his "kindling model." Post's work concluded that rapid-cycling was often the end stage of a long-term recurring problem. "The general pattern was a decrease in the interval between episodes and an increase in the severity and complexity of the episodes, until finally rapid cycling set in" (p.109). As time passes, Post's studies seem to indicate, ever smaller stimuli are needed to provoke ever severe episodes. While many biological processes operate in the opposite way, requiring ever greater amounts of stimulus (street drugs, etc.), others (epilepsy; bipolar conditions, etc.) are "kindled." Interestingly, two seemingly unrelated conditions that are "kindled" seemed to respond positively to the same medications (pp. 112f.).
The second model Kramer discusses here is that suggested by stress research in rats (pp.116-118). The rat studies "impl(y) that a variety of psychosocial stressors can serve as triggers" for the biologically encoded factors "kindled" in depression (p. 122).
The third model examined in chapter five is the monkey-separation studies (pp.118-122). Rhesus monkeys seem especially helpful in reflecting on human problems due to similarities between the species (p.118). Kramer concludes from these studies that in the early stages of stress-induced kindling subjects will appear very normal, except that they will have a somewhat heightened sensitivity to loss (p. 122).
Kramer concludes that pain brings scars, even when it does not seem to immediately result in depression (p. 123). He explains, "What distinguishes this view of depression from, say, traditional psychoanalytic models is the recognition that the scars are not, or not only, in cognitive memory. It is not merely a question of inner conflict or of `growing up': `Stop fussing over what your parents did to you!' as skeptics command patients in therapy. The scar consists of changed anatomy and chemistry within the brain (emphasis added)" (p. 123). Kramer notes the implications of his neurobiological conclusions: "It seems that the neural pathways are like the joints in the musculoskeletal system. They are worn down over the years by inevitable trauma... Age alone seems a trauma... if we live long enough we will all become depressed" (p. 135).
The point of this is that Kramer believes that Prozac can have a key role in the treatment of relatively `minor depressive illness' (p. 126). If diagnosed early enough, Prozac and SSRIs "can help prevent the progression of early mood disorder into florid illness" (p. 127).
I found the thoughtful commentary of this chapter five fascinating and not a little alarming. Could Kramer be correct that neural pathways significantly impact mood and that they may have been irreversibly worn down through stress, leaving one more susceptible to depression now?
I do not know what to conclude about this. There are many who dispute this view of neurobiology. But even if Kramer is partly correct in these conclusions, the Bible offers a far richer potential interpretation of this information than Kramer's naturalistic worldview. As Ed Welch points out in Blame it on the Brain (1998), the the body is the mediator of moral action, not the initiator. It is the `equipment of the heart' (p. 40). Bad thoughts and actions, in response to the temptations presented by stressful circumstances, can impact the body. Perhaps my failures to deal with trauma help cause the depression I suffer, and this depression may have permanent physiological effects. The returning feelings of depression that I now wrestle with may be, as Welch contends, `body' rather than `heart' problems (Welch, p. 45), but my response to those feelings is still a spiritual issue not a brain issue. Prozac, or any other treatment that seeks to address the brain alone, can not hope to get at the critical heart issues involved in depression.