Cosmetic Psychopharmacology Essay, Research Paper
The Controversies Surrounding “Cosmetic Psychopharmacology”
Throughout one s life generalizations and characterizations are made about one s personality. It starts almost the second one is born, “She has a cranky demeanor, she cries all the time.” During the school years children are characterized as outgoing, energetic, antisocial, shy, aggressive, etc. These characterizations lead to the generalizations of the “loners”, the “overachievers”, etc., all of which continue with the person throughout their life. As a result, many look at certain personality traits as abhorrent and tend to dissociate themselves from such traits which would lead to a bad stigma in society. Shy people strive to attain more self-confidence so they will be perceived as outgoing or fun loving, while passive people look for ways to become more aggressive in business dealings. This ever present need to attain the wanted characteristics of society parallel the need for many to attain the thinness portrayed by society as beautiful. The easiest way to attain the physical characteristics of society s perceived beautiful person is through cosmetic surgery. Likewise, a new and innovative concept has emerged to make changing one s personality characteristics just as easy. This concept is termed “cosmetic psychopharmacology.”
Sam, an architect, was seen as a nonconformist by his friends. His sarcastic yet charming manner attracted many people to associate with him. His unusual views on sexuality sometimes hindered his relationship with his wife, but, for the most part, the marriage was without conflict. Dr. Peter Kramer first saw Sam as a patient in 1988 due to the persistent depressive state from which Sam was suffering. After several sessions of psychotherapy, where Sam began to deal with the issues surrounding his depression, it was clear to Dr. Kramer that psychotherapy alone was not enough for Sam. As Dr. Kramer and Sam resolved the issues in Sam s life the sadness and paralysis of feeling continued. Eventually, Dr. Kramer prescribed a newfound antidepressant drug called Prozac for Sam. Neither was prepared for the advantageous results that appeared. The drug seemed to affect every aspect of his life. He completed projects on the first try and gave presentations without notes. His self-confidence skyrocketed and his memory became more efficient. Sam pronounced himself “better than well” (Kramer, 1993).
In 1994, Trisha sustained multiple injuries from a car accident. Her battle with the insurance company continued for the next four years. As a result of her chronic pain and the difficulties with the insurance company, Trisha began suffering from depression. Two years ago her therapist encouraged her to try a mild dosage of Paxil, an antidepressant. After three weeks of the drug Trisha became a new resident at a local State psychiatric hospital due to the suicidal tendencies that resulted from the ingestion of Paxil. The doctors continued prescribing higher and higher dosages of Paxil until Trisha felt like a “zombie going through the motions of life” (Spinally, 1998). Eight months after finally stopping the medication Trisha s memory and organizational skills remain obstructed. She states, “I feel as if I have had a chemical lobotomy” (Spinalli, 1998, p. 4) .
These two personal accounts represent the wide range of effects antidepressants have on an individual. They also question whether the use of such drugs can be applied to persons not suffering from a disorder who simply want to enhance their personality. Sam s anecdote is one of many described in Dr. Kramer s Listening to Prozac. In almost every account the individual receiving Prozac undergoes remarkable changes not only in their ability to deal with depression but with their personality traits as well. It seems as if a drug mainly used to treat mental illnesses such as depression may also be used to “fix” a person s personality. This potential use of such drugs led Dr. Kramer to coin the term “cosmetic psychopharmacology” (Kramer, 1993).
Yet, Trisha s account expresses the negative aspects an antidepressant can have on one s system. These contrasting accounts force one to question the validity of Dr. Kramer s and others claims on the use of antidepressants in “cosmetic psychopharmacology.” Are these drugs actually effective in changing one s personality? Another important question that arises is whether the prescribing of antidepressants for such a reason is ethical. Due to the subjective nature of psychology in general, is it legitimate for a doctor to prescribe prozac to someone whose personality may not seem up to par?
These questions appeared six years ago when Dr. Kramer s Listening to Prozac hit the bestseller list. The book sparked a magnificent controversy all surrounding the term “cosmetic psychopharmacology.” Ever since the coining of this term researchers have scurried to either support or dispute Dr. Kramer s claim all the while debating the ethical dilemmas of such a concept.
“Cosmetic psychopharmacology” refers to the prescribing of a medication such as Prozac or Paxil to an individual not suffering from any sub-clinical conditions or any form of psychopathology (Sperry, 1998). These individuals seek to transform their personality characteristics. For instance, a person who was once shy may become confident or an introverted person may become more social (Speyrer, 1998; Toufexis, 1993).
The primary drug believed to work in enhancing one s personality is fluoxetine, trade name Prozac, which has been used by over 17 million people in the past decade. Eli Lilly introduced Prozac to the world of pharmaceuticals in 1988. It was the first of a new series of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). SSRIs replaced earlier antidepressants such as tricyclics and MAOIs whose multiple side effects were severe and debilitating. Prozac received significant attention and praise for its lack of such severe side effects and its quick results (Prozac: General Information on Prozac, 1999; Brash, 1998).
The class of antidepressants known as SSRIs prevent the resorption of serotonin, a neurotransmitter, back into a neuron, thus increasing the amount of serotonin in the synapse between brain cells. Researchers theorize that one cause of depression is a low level of serotonin in the synapse, thus brain cells do not receive the amount of serotonin they need to provide energy and feelings of happiness to an individual. SSRIs work to restore a normal level of serotonin to the synapse between brain cells in the limbic area of the brain, which regulates mood. This results in a restoration of energy and happiness to the individual (Brash, 1998; Romano, 1999).
Gelfin, Gorfine, and Leer (1998) conducted a study on the effects of prozac on healthy, “normal” people. They took 15 volunteers (nine men and six women) who did not meet any of the criteria for a mental disorder as provided by the fourth version of the Diagnostic and Statistic Manual (DSM-IV). During the first two weeks of the study the volunteers were given one placebo capsule a day. The next week consisted of a 10 mg dosage of prozac a day. For the following 5 weeks the dosage per day was upped to 20 mg. The participants then took a placebo once a day for the last 2 weeks. During these ten weeks the participants remained in ignorance of the type of pill they took.
The researchers administered a variety of different mood and personality tests designed to evaluate different psychological variables. Researchers also inquired about any side effects which occurred at any time during the study. They conducted these tests and inquiries at four different points in time during the study. Once after two weeks, five weeks, eight weeks, and ten weeks of participation. After they gathered all the data the appropriate statistical test (Friedman s non-parametric analysis of variance with repeated measures) was performed to analyze the data and conclude their findings (Gelfin, et al, 1998).
Gelfin, et al. s (1998) results showed that prozac had “no significant effect on mood, general well-being, or quality of life in normal volunteers” (Gelfin, et al., 1998, p. 291) . Their results refute Kramer s claims that prozac may have mood-enhancing effects on normal people. Instead, these mood-enhancing effects exist only when the drug interacts with “target symptoms” (1998, p. 291) such as low levels of serotonin.
Paroxetine, trade name paxil, represents another SSRI. Although not as popular as prozac, paxil works the same way and presents most of the same side effects. It is unclear whether Trisha s account of the negative effects of paxil is extreme or if she may be more sensitive to decreases in specific mental abilities. Nevertheless, paxil remains a prominent drug in the field of treating depression and many are also considering its use for “cosmetic psychopharmacology.”
As a result of Gelfin et al. s conclusions, Knutson, et al. (1998) published their findings from a double-blind study similar to Gelfin, et al. s a month later in the American Journal of Psychiatry. Knutson, et al. chose paxil as their SSRI and evaluated its effects on healthy individuals. Their sample consisted of a total of 48 (20 women and 28 men) individuals who, again, did not meet any of the criteria for a mental disorder as provided by the DSM-III-R. The presence of first-degree relatives suffering from a mental disorder also excluded individuals from the study. The researchers divided the participants into two separate groups. One group, consisting of 23 individuals, received paxil while the other group, consisting of 25 individuals, received a placebo for the four weeks of treatment.
Knutson, et al. (1998) used psychometric measures to distinguish the effects of paxil on the participant s positive and negative affects. A positive affect consists of emotions such as happiness and love while a negative affect includes feelings such as sadness and hatred. The psychometric measures also interpreted the effect of paxil on one s level of hostility. Behavioral measures were employed to see the effect paxil had on a person s “affiliative behavior” (1998, p.374) or cooperation with others. Individuals underwent plasma tests to determine whether differences in an individual s SSRI metabolic rates affected the results. Finally, individuals rated the severity of their physical side effects.
After conducting a repeated measures analysis of variance to examine the significance of the results, Knutson et al. (1998) then interpreted the results. Their data led to a series of conclusions: 1) Paxil significantly decreased a person s level of hostility compared to those receiving a placebo, 2) Paxil significantly decreased a person s negative affect while maintaining his/her positive affect, and 3) Participants using paxil offered more suggestions, less commands, and used combined ideas to reach solutions. Furthermore, these effects were distinctly correlated with the plasma levels of the individual. Thus, in short, Knutson et al. s findings support Kramer s claim that certain antidepressants have significant mood-enhancing effects on healthy individuals.
Is the difference between prozac and paxil so great that it would account for the contrasting results of the two studies? It shouldn t be. Therefore, one must examine the other differing aspects of the studies. The size of Gelfin et al. s study was considerably smaller (15 participants) than Knutson et al. s (48 participants). The smallness of Gelfin et al. s study suggests that the sample may not be representative of the population of healthy individuals. In short, the individual differences of the participants may not have been evenly distributed as those of a population would. With a larger sample the chances of obtaining a non-representative sample decrease. If a sample does not represent the population then the results obtained cannot be generalized to that population.
Another difference appears in the lack of plasma testing for individual differences in SSRI metabolism in Gelfin, et al. s study. These differences could affect the participant s scores on the tests and, thus, if not accounted for, could misconstrue the results to appear to be non-significant. In fact, the lack of any signs of effectiveness could be due to a slow metabolic rate of the SSRI which simply means an individual would need to stay on the drug for a longer period of time before the demonstration of any effects appears. In people suffering from depression, the amount of time one needs to stay on the antidepressant before seeing significant results ranges from two weeks to four or more weeks (Romano, 1999). Therefore, it is plausible to suggest that some people in Gelfin et al. s study simply needed to remain on the drug for a longer period of time.
Whatever the differences the fact remains that these two studies represent the extent of scientific research done specifically on the effects of an antidepressant on personality in humans. The research in non-human subjects with regards to this concept is limited as well. However, these studies, which involved rhesus monkeys, have found that when an SSRI is used to block the reuptake of serotonin there is less hostility and aggression in the monkeys. The studies also showed that social affiliation was stronger among those monkeys receiving an SSRI.
Although future research is inevitable, the majority of support for this claim currently comes from anecdotal accounts such as those found in Kramer s Listening to Prozac (1993). Such accounts rely on the patient s examination of his/her well-being which is subject to extreme bias. This, in turn, questions the reliability and validity of their accounts as exemplified by Sam and Trisha s different accounts of essentially the same drug. Could it be that Sam s depression simply distorted his view on how he acted before prozac? If this is true then prozac merely restored Sam s personality to its previous capabilities. Or could it be that anything seemed “better than well” after suffering from depressive bouts for so long? If this is true then antidepressants may help one feel better but will never return that person to the self he/she once knew, as demonstrated through Trisha s account. Whichever is true the fact remains that “cosmetic psychopharmacology” will most likely be around for at least awhile. Therefore, the ethical dilemmas of such a concept must be examined.
Should a psychotherapist prescribe an SSRI to a person who shows no signs of suffering from any mental disorder, but simply wants it to make him a better salesperson? Should a person who is considered shy begin taking prozac to instill self-confidence and, thus, become more brash? “Welcome to the New World Order,” states Trisha (Spinelli, 1998, p. 5) . The elimination of personality traits the majority of people find unappealing and perceive as the base for a “bad person” could be compared to the acts of genocide performed by Hitler. On the other hand, Dr. Hyla Cass, a psychiatrist in Santa Monica, California, argues that prozac simply “. . . correct[s] an imbalance, allowing people to be who they can be” (qtd. in Toufexis, 1993, p. 2) .
Sperry (1998) speculates that these differing opinions are the result of two differing perspectives on human nature. One view advocates that life involves a rollercoaster of ups and downs. In order to feel the fullest extent of happiness one must suffer as well – it “is the experience of being human” (1998, p. 56) . If this suffering or sadness suddenly disappears, one s morals and development will be significantly affected. Furthermore, the act of changing one s personality by use of a pill would be an “act of self-betrayal resulting in a seemingly happy, yet phony and pointless life” (Gems, 1999, 222) . Thus, one will essentially become dehumanized.
The other view Sperry (1998) alludes to is the belief that human growth is not hindered by the lack of sadness or suffering. Instead, the main goal of human life is to “be creative and alive” (1998, p. 57) which may occur more easily when suffering is not present. Therefore to encourage suffering would be sadistic.
The second view is supported by statements such as “Nothing changes personality. What gets changed is symptoms of a disease” (qtd. in Toufexis, 1993, 62) . Recent neuroscience research suggesting that personality traits are simply symptoms of biochemical deficiencies also supports this view (Sperry, 1998). However, such research does not come without some criticisms.
Most critiques involve the mention of researchers use of “circular reasoning” (Rotham, 1997). “Once upon a time doctors diagnosed the disease and then discovered a cure. Now doctors have interventions that inspire them to create new diseases” (Rotham, 1997, p. 3) . Rotham s criticism refers to the fact that the discovery of many treatments of mental disorders are empirically driven. That is, the cause of many disorders are sought by a trial and error of pharmacological treatments. If one treatment works then researchers can hypothesize the cause of the disorder because they know how the drug works. This is exemplified in the recent research on biochemical deficiencies resulting in personality traits. A drug such as an SSRI may produce significant effects on a person s personality and presto, the person s traits are the result of an imbalance in serotonin levels.
Dr. Simon Sobo also criticizes this “circular reasoning”. He states that “increasing serotonin has a psychological impact that is nonspecific to the disorders in question” (Sobo, 1999, p. 23) . This simply refers to the fact that although the drug may impact one s personality that does not necessarily mean he/she deserves a diagnosis of a psychological disorder.
Sobo also points out that the effects of a drug may seem to alleviate problems and make things “better than well” at first, but in the long run these effects may be detrimental to a person s survival. Sobo brings up a study done by Dr. Oliver, et al. on the effects of SSRIs in rat pups. These rat pups elicit ultrasonic sounds when isolated from their mother which represent their distress. However, there was a reduction in these sounds when the researchers administered an SSRI. What does this mean? Simply put, the rat pups adopted an attitude of “whatever”, “what s the big deal?”. Thus, the distress of the pups was alleviated. Yet, is this good? Maybe at first, but those ultrasonic sounds communicated to the mother that the pups were scared or that they were hungry. When these sounds were diminished so was the communication, thus placing the pups long term welfare in jeopardy (Sobo, 1999).
Sobo reports that his patients have adopted the same attitude as a result of taking an SSRI and although this alleviates the daily stresses it may cause long term damage. Events that should elicit feelings of anxiety eventually will not and this may cause a person to overlook such events that may ultimately affect their lives. An example given by Sobo is of a woman using paxil who, upon picking her child up from the day care center, witnessed one of the employees screaming at an infant to shut up. The woman continued on her way, not thinking anything of the incident. It wasn t until the next day that the woman questioned her lack of reaction to the occurrence. “Why had she not reacted,” she wondered. She would normally have confronted the employee and brought it to the attention of her supervisor for fear that her child may be treated the same way. Yet, she had been indifferent (Sobo, 1999).
These findings and criticisms are only the beginning of the evaluation of the ethical consequences of “cosmetic psychopharmacology” which will consume the world of psychology. Currently, there is not sufficient research on whether “cosmetic psychopharmacology” could even work. Hopefully, new findings may ease the ethical concerns weighing this concept down. If findings support solely one view then the decision of whether “cosmetic psychopharmacology” should be practiced will most likely be clear cut. Yet, we live in a realistic world where findings very rarely appease everyone. No matter what, the ethical concerns of this concept will remain with us for quite a while just as ethical concerns such as animal rights have. In the end “cosmetic psychopharmacology”, as well as the controversies surrounding it, is here to stay for at least a while. Only time will tell if it is legitimate or not.
Brash, L. (1998, September). Prozac FAQ Page [On-line]. Available Internet: www.ozemail.com.au/ drbrash/prozac2.html
Di Mascio, A., Heninger, G., & Klerman, G.L. (1964). Psychopharmacology of imipramine and desipramine: A comparative study of their effects in normal males. Psychopharmacologia, 5, 361-371.
Gelfin, Y., Gorfine, M., & Lerer, B. (1998). Effect of clinical doses of fluoxetine on psychological variables in healthy volunteers. American Journal of Psychiatry, 155, 290-292.
Gems, D. (1999). [Review of the book Enhancing human traits: Ethical and social implications]. Nature, 396, 222-223.
Knutson, B., Wolkowitz, O.M., Cole, S.W., Chan, T., Moore, E.A., Johnson, R.C., Terpstra, J., Turner, R.A., & Reus, V.I. (1998). Selective alteration of personality and social behavior by serotonergic intervention. American Journal of Psychiatry, 155, 373-379.
Kramer. P.D. (1993). Listening to prozac. New York: Penguin Group.
Paxil (paroxetine HCl) for the treatment of depression [On-line]. (1999, April). Available Internet: www.sbhealthcast.com/static/health_news/paxil/part2.htm
Romano, S.J. (1999, April). Prozac frequently asked questions [On-line]. Available Internet: www.prozac.com/faq.htm
Rotham, S.M. (1997, April 13). The Boom in Psychiatric Syndromes. The Washington Post [On-line]. Available Internet: home.i1.net/ juli/mental/news76.html
Sobo, S. (1999, April). Psychotherapy perspectives in medication management, the inadequacy of 15-minute med checks as standard psychiatric practice. Psychiatric Times, 23-25.
Sperry, L., Prosen, H. (1998). Contemporary ethical dilemmas in psychotherapy: Cosmetic psychopharmacology and managed care. American Journal of Psychotherapy, 52, 54-63.
Speyrer, J.A. (1998, December). [Review of the book Listening to Prozac ]. [On-line]. Available Internet: www.net-connect.net/ jspeyrer/listen.htm
Spinelli, T. (1998, November). Paxil nightmare [On-line]. Available Internet: www.drugawareness.org/trisha.html
Toufexis, A. (1993, October 11). The personality pill. Time, 142, 61-63.