Which brings me to today's topic of discussion: Mental Illness - Is it real or is it all in your head?
"Temperament" usually refers to an inborn, genetically determined and chemically mediated, predisposition to a cluster of responses and behaviors....contrasted to "character," which refers to stable, repeated behavior patterns arising from life experience. "Character" is also used to refer to a person's idiosyncratic traits or...acquired traits; it is environmental where temperament is inborn, psychological where temperament is biological." (Kramer, Listening to Prozac, pp. 148-149)
Dr. Carlos doesn't know me. She has data in her records based on a few minutes of observation, conversation, measurement, and a couple of lab tests: aging white male in reasonably good health, no known life crises, questionable sense of humor. I wasn't asking for her help with my serotonin level, and she wasn't offering. Don't ask, don't tell. Contrary to my entire belief system, it was a physical, as distinct from a mental, exam. As if the two could be separate.
I don't remember where I saw the quote that drew me to this book, but Listening to Prozac turned out to be interesting reading for a while. It came out back in 1993 when the subject was fresher in this culture, but for some of us it takes a while to catch up. It was worthwhile food for thought that will probably not greatly alter my practice, which luckily consists more of doing stuff than taking stuff. This is my reflection - not a review and not a paper - on the points that hit me as most relevant to everyday body-mind functioning. Pardon the ponderous tone.
...what was once a successful reproductive "strategy" is now the variant human trait underlying chronic and recurrent depression....More broadly, we can see how the survival of the tribe, or gene pool, might be enhanced by the presence of some dogged, methodical members....The problem is that our modern technological society demands the ability to face outward, expend high degrees of energy, take risks, and respond repidly to multiple competing stimuli...The environment no longer rewards the full range of temperaments that were necessary for human survival in prior settings. (Kramer, pp. 171-172)
So a certain segment of the population (I'm guessing the INTJs of Myers' and Briggs' typology) just don't fit the dominant paradigm. So they adapt in order to get along in an ESFP world. They don't go out much, turn inward, and develop a shadowy internal world they can maintain according to their hunter-gatherer standards of survival. Or they become so dysfunctional that they take drugs - either medically prescribed, or self-administered - and cope the best way they can. One flew east, one flew west, and one flew over the cuckoo's nest. Some flocked to Prozac, Zoloft, and other popular antidepressants; some found solace in vodka, marijuana, cocaine, speed, psychadelics, coffee, dark chocolate, you name it. I'm purposely lumping disparate mind-altering agents together to make a point which I will disclose as soon as I discover what it is.
The vast majority of these people, including those who are outright inhibited socially, will be "normal" in psychological terms. Most of them will be highly functional in their careers and private lives. No one has ever called people with inhibited personalities mentally ill....(They) have achieved chemically the interior milieau of someone born with a different genome and exposed to a more benign world in childhood. (Kramer, p. 177)
Better living through chemistry, in the words of the old DuPont (or was it Dow?) ads, or "Brave Neuro World," in the words of the recent article in The Nation. If I'm not exactly normal, as in close to the genetic mean, why shouldn't I medicate myself into the mainstream in order to function more easily alongside all those characters whose temperaments are closer to the middle of the bell-shaped curve? It's not like I'm popping black beauties in the john at work to get me through the afternoon or, worse yet, for fun on the weekend, which would be evil because it's "recreational." If I didn't have a benign childhood, maybe I should be able to chemically induce a benign adulthood with an appropriate substance.
As I was typing that sentence, an e-mail appeared in my inbox with the subject-line "Friday Happy Hour." You just can't plan these things. This line of reasoning suggests that every personality type, including every diagnostic pathology, lies somewhere on a continuum. They call it spectrum theory. It resembles Labanalysis of movement in the individual combinations of factors in three dimensions or planes, and it puts in perspective some of the labels that we attach to regular people doing what they have to do.
Cloninger believes there are three biologically determined axes of temperament, corresponding to the three neurohumors: norepinephrine, serotonin, and dopamine....These three axes - reward dependence, harm avoidance, and novelty seeking - ...cover a vast territory....Extremes on three dimensions correspond to personality structures that begin to look like psychiatric deviance....Cloninger's is a true spectrum theory of personality. We are all brothers under the skin, the sociopath, the hero, and the working drone. What distinguishes us is the state of our neurohumors. Where normal personality ends and personality disorder begins is only a matter of convention - of how far along each axis we set the cutoff points. (Kramer, pp. 185-188)
I like this kind of theory, not so much for its cause-and-effect linking of a substance with a pattern of behavior, which seems a little mechanistic, but for the gradations along three different scales. It isn't one-dimensional in explaining differences. Think of reward dependence as the vertical plane, where up is high-maintenance and down is low-maintenance. If harm avoidance is the sagittal plane, then forward is risk-taking and backward is risk-averse. If novelty is the horizontal plane, then left craves variety and right craves consistency.
If you're still reading this, you might be high-maintenance, risk-averse, and craving consistency. Join the club! This doesn't necessarily mean you and I are depressed, even though our moods, behavior, and reactivity to life's travails might mimic the symptoms that fall into the giant catch-all receptacle. Unless you want it to.
Prozac does not provide pleasure; it restores the capacity for pleasure. It is neither excitatory like cocaine nor satiating like heroin....If we accept the proposition that hedonic capacity exists along a continuum, then in treating hypohedonia we are shifting a normal person from one part of that continuum to another. As long as we move from the extreme toward the middle - from atypical depression toward appetitive wellness - that exercise is unexceptionable....Where does treatment and and - to use the word - hedonism begin? (Kramer, pp. 233-234)
Okay, so it's off the mark to compare antidepressants to a cup of coffee in the morning, a beer after work, or snorting lines between meetings. It's more complicated than that. Maybe it's a matter of deferred gratification with a note from the doctor, which is okay, rather than immediate gratification, available on the corner, to which we should just say no. And who am I to say, having neither medical training nor first-hand experience in the pharmaceutical maze.
Clearly I was comparing apples and oranges when I told a friend, who is reliant upon his antidepressants, that my drug of choice was tequila; this was last spring, I know because that's tequila season where I live. And I reassure myself with the knowledge that writing holds off the demons. They say Kafka was alienated, but if he'd been all that alienated he wouldn't have been able to sit down and write brilliantly, compellingly, and convincingly about the experience of alienation.
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