Prozac Generation

Back in the old days psychiatrists thought that it was all in the mind. Now that they have overcome that bias they have gotten trapped in the idea that it’s all in the brain.

Admittedly, not all psychiatrists and psychologists bow down to the gods of psychopharmacology, but more and more young people today are taking psychotropic medications on a regular basis, from an early age.

Casey Schwartz reports on this phenomenon on The Daily Beast site this week. She begins anecdotally by explaining how she started taking psychotropic medications and how they came to feel like a normal part of life. She adds that all of her friends have followed the same culturally-prescribed course.

Eighteen years ago Elizabeth Wurzel predicted the trend. She saw us becoming a Prozac Nation. To honor her prescience I think it fair to call the cohort that Schwartz describes a Prozac Generation.

Reviewing a new book by Kaitlin Bell Barnett, Schwartz writes:

But it turns out I was far from alone—if anything, my story was increasingly common. By 2009, 25 percent of American college kids would be prescribed some kind of psychotropic medication, according to a new book called Dosed: The Medication Generation Grows Up.

The author, Kaitlin Bell Barnett, is squarely a member of this medication generation. Now 30, she went on Prozac when she was still in high school to treat her clinical depression. In her debut book, she has put together a serious-minded assemblage of research and anecdotes that addresses the question of what it means to grow up in a generation that’s been infiltrated by pharmacology like no other generation has before.

Clearly, taking psychotropic medication for all manner of emotional distress has physiological implications. I am not competent to discuss them, so I will not.

But it also has important moral implications. I have occasionally written about those, so I am happy to see that Barnett has raised the same issues.

Schwartz summarizes:

The implications of Barnett’s book are important and unnerving.
If a child is dosed with psychotropic drugs throughout the process of growing up, what does that mean for their sense of agency? For their ability to achieve mastery over their emotions and behavior? Who would they be if not for their pill?

As the psychiatrist David Mintz observes, kids who’ve taken meds throughout their formative years, can often “end up thinking of their feelings not as guides but simply as symptoms.”

Emotions have a crucial role in human existence. Some of them, especially the negative ones, are early-warning signals that alert you to danger, whether it is physical or psychological. They also tell you when your dignity and self-respect have been damaged or threatened. Positive emotions like pride reward your successes. They encourage you and motivate you toward greater successes.

Emotions should be taken as “guides.” Growing up involves learning to read emotions and to act accordingly. 

If psychiatry treats emotions merely as symptoms it is systematically alienating people, not just from their emotions but from the reality they reflect.

Of course, traditional psychoanalysis did not teach people to use their emotions to guide them through reality. It saw emotions as relics of a lost past and taught people to treat their emotions as the residue of unprocessed past traumas.

Pills, Schwartz writes, also exempt people from moral responsibility:

Undeniably, another factor in the rise of the pill is the appeal of blaming biology. Of her own experience with Prozac, Barnett writes, “It also seemed to absolve me of fault: just as the ads on TV said, I had a chemical imbalance that needed medication to be righted.”

While we are on the topic of moral responsibility we should ask how we have gotten to this point. Who bears the responsibility for the Prozac Generation?

When Prozac debuted everyone knew that it was far more effective than traditional psychoanalysis and psychoanalytically-oriented therapies.

Psychiatrists who did not know how to cure with words found that they could achieve better therapeutic results by writing prescriptions. It was easier than relearning talk therapy.

Insurance companies colluded with the practice by paying more to prescription writers than to talk therapists.

Roughly, psychiatrists are paid $250 for a twenty minute consultation the ends with a prescription. They pay about half as much for one hour of talk therapy.

A psychiatrist can bill $750 for an hour’s worth of medication consultations and around $125 for one hour of talk.

If you want to know why Americans have become drugged out, look to the insurance industry.

The solution: if insurance companies decrease their payment rates for prescription writing to, say, $50 for twenty minutes, I suspect that far fewer Americans will be taking psychotropic medication.