Better Than Prozac is a
short book summarizing the current state of psychopharmacology, combined with a
brief history and speculation about its future. It is admirable in both the clarity of its writing and its
frankness about the limits and potential of psychiatric drugs. Samuel Barondes uses a couple of his
patients as central examples to illustrate his ideas. Clara was a 26-year-old Philosophy Ph.D. student working on the
seventeenth-century British scientist and philosopher Francis Bacon. She was filled with self-doubt about her
studies, and had taken a leave of absence from her studies. She came to Barondes after having tried
psychotherapy, saying she felt hopeless and suffering from severe
insomnia. He prescribed a small bedtime
dose of the sedating antidepressant Elavil which helped her sleep, but did not
remove her moderate depression. She was
interested in trying Prozac, and after some deliberation Barondes agreed to
give her a prescription. It started to
help, and she soon revealed to him that she had other anxieties concerning her
appearance, since she believed that she had a deformed nose. The Prozac seemed to alleviate her
irrational feelings and her mental health improved enough for her to be able to
complete her Ph.D. thesis and get a job teaching at a women's college. Nevertheless, the medication also has some
unwelcome side effects and has not completely removed her depression or her
fears about her face.
In subsequent chapters, Barondes
briefly outlines the discovery of the helpful psychiatric effects of
anti-psychotic drugs, antidepressants, and anti-anxiety drugs. His account takes a positive view of this
history, placing it in a narrative of scientific progress and exciting
research. His account is in stark
contrast with some other recent accounts, such as Robert Whitaker's Mad in
America, who puts the use of psychiatric drugs in the context of the
eugenics programs of the early twentieth century and argues that medications
such as Thorazine are brain-damaging chemical straightjackets with no real
therapeutic effects. While Barondes
acknowledges the severe side effects of some medications, he emphasizes their
great benefits. His account is not a
piece of scholarly research, but he does have a reasonable bibliography for
those who want to pursue his sources.
The second half of the book starts
with the case of Martha, who experienced symptoms of panic, but who was
diagnosed with the rare condition Graves disease. This leads Barondes to discuss the importance of genetics for
psychiatric diseases, and this is the cornerstone for his suggestions about the
future of psychopharmacology. He moves
on to discuss experimental trials with laboratory animals with different
chemical formulations, and the reasons why different people can have very
different reactions to the same medication.
Strikingly, he reports cases in which people have become murderously
violent after taking medications, and he expresses no skepticism about this
Barondes himself has served as a
consultant for pharmaceutical companies, and some may think that he is
insufficiently critical of big pharma.
He does acknowledge that sometimes the policies of these corporations
are driven mostly by the desire to financial profit rather than to provide the
most useful medications, although it's clear that in many cases, providing a
great drug will of course help to create profit. The value of Better Than Prozac is not primarily in its
social commentary but in its ability to explain psychiatric neuroscience in
relatively simple terms. Ultimately,
Barondes does not believe that we will make great advances in new medication
until we make some significant progress in understanding of the biology of
mental illness. So this is a more
cautious book than its title might suggest.
© 2003 Christian Perring. All rights reserved.
Christian Perring, Ph.D., is Academic Chair of the Arts & Humanties Division and Chair of the
Philosophy Department at Dowling College, Long Island. He is also editor of Metapsychology Online Review. His main
research is on philosophical issues in medicine, psychiatry and psychology.
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