I have a particular, peculiar obsession with pills. Tiny, circular, mostly white, seemingly innocuous. This obsession dates back to the 1980’s, to the infamous (and as yet unsolved) Tylenol murders in Chicago. I was thirteen years old when I first read about the Tylenol murders, and I’ve been hooked on pills ever since.
Well, not literally. I do have a history of popping orange-flavored baby aspirin, and I once took “The Pill” when I was nineteen. I’m familiar with pill lines and tonguing (a la Silver Linings Playbook, or Girl, Interrupted). I’ve had bad reactions to tricyclic drugs and I’ve never been able to decide whether I’d like the blue or the red pill from The Matrix.
I own giant, pill-shaped ice cube trays. It is hard to split giant pill-shaped ice cubes.
Pills weren’t always in the form we see them now; the first compressed pill wasn’t invented until 1843, by a Mr. William Brockedon. This invention led to the mass production of pills as we know it today (THANKS BILL). Big Pharma is called Big for a reason: the market for pharmaceuticals is huge, bringing in globally nearly one trillion in revenues. The US market accounts for a third of the global market. (There is a joke on The Big Bang Theory in which Bernadette, who works for Big Pharma, laughs at her company both creating and curing a disease in one month. It’s funny because it’s true.)
Imagine my delight in reading Don DeLillo’s novel White Noise, in which the fictional drug Dylar is introduced. Dylar pills are UFO-shaped, with a tiny hole drilled into each one. Dylar is a black-market drug, with horrible side effects (think of any drug ad you see on television every single day) and supposedly will cure the terror of death. White Noise was published in 1985, just two years before Prozac hit the market in 1987.
Dylar is my latest obsession. How prescient, Don DeLillo.
Modern psychiatry (by modern I really mean the last fifty years or so) is fixated completely on chemical cures. When Prozac came on the market, it was the first of the ‘new’ antidepressants, a class of drugs called Selective Serotonin Reuptake Inhibitors, or SSRI’s. These new drugs were touted to work better than their predecessors (tricyclic antidepressants, monoamine oxidase inhibitors, etc.), with less severe side effects and better efficacy. Books have been written about Prozac: it’s one of the most prescribed medicines in the world. And yet, if you bother to research Prozac or even read the entry of fluoxetine in Wikipedia, you’ll find something very interesting: it’s been proven that it doesn’t actually work.
Pills from Medieval times up through the 19th century were gilded, coated with gold and silver; oddly enough, the silver coating prevented any medicine from actually being released into the body. The 18th century saw the first sugar-coated pills, because of course a little sweetness makes any pill easier to swallow. You are going to need a lot of fucking sugar to swallow the truth about Prozac. Just giving you fair warning.
The list of side effects for any of the SSRI drugs reads like a horror story, everything ranging from sexual dysfunction to suicide. Suicide is a side effect of an anti-depressant? This is on top of the gastro-intestinal concerns, nightmares, anxiety, and sleep disturbances. You may also experience a rash, or a severe tremor. You may also experience withdrawals from Prozac, or what is termed Discontinuation Syndrome. A syndrome in addition to your original disorder.
Around 2003 or 2004, I was working as a triage counselor at a crisis center. We assessed adults (over eighteen) who were in crisis. We did not see children under eighteen. We started getting calls from younger adults who were having suicidal thoughts and had just started on SSRI drugs. Of course no one believed them—how ludicrous! An antidepressant drug can’t cause suicidal thoughts! Following this, of course, came reports that the new SSRI drugs could cause suicidal ideation in children; following that, adults up to the age of 25.
The New Yorker published an article in September 2013 that claimed that SSRI’s, which are meant to alleviate depression by building up the amount of serotonin in the synapses of the brain, are actually no more effective than placebo. No more effective than placebo. The article, entitled “The Psychiatric Drug Crisis,” authored by Gary Greenberg, is focused on the pharmaceutical companies, who, though they have profited well (and continue to profit) from the new modern antidepressants, are in a crisis. They are dropping all research on antidepressants; they are not creating new or improved SSRI’s.
(Why is it that the pharmaceutical companies are in crisis, and not the actual individuals who are depressed? Why the focus on the ‘cure’ and not the patient? These are questions I’d like to see someone answer. Someone who doesn’t work for Big Pharma, ideally.)
The Big Pharma companies are making billions on these drugs, so why the sudden halt to research in this area? Good question. Greenberg, in his essay, traces the history of the treatment of mental illnesses, and discovers that the treatment of mental illness with drugs lies in the scientific theory that all mental illness is rooted in biology, basically, and therefore can be treated as any physical disease.
Mental illness is just a chemical imbalance, and it can be cured with chemicals! Interestingly, Greenberg points out that the explanation for how antidepressants worked came many years after they were invented. The first antidepressants were thought to affect the neurotransmitters dopamine and norepinephrine; it wasn’t until later that it was discovered that the drugs seemed to affect the amount of serotonin available in the brain.
It’s science! It’s a chemical imbalance! (How often have you heard this phrase in the last twenty years? It’s like an excuse, one that makes everything better: he’s got a chemical imbalance, that’s why he acts this way. Just like low blood sugar. It’s a disease, just like diabetes.)
Greenberg goes on to write that “Within a decade of Prozac’s approval by the F.D.A. in 1987, scientists had concluded that serotonin was only a finger pointing at one’s mood—that the causes of depression and the effects of the drugs were far more complex than the chemical-imbalance theory implied.” This information, of course, was not widespread and continues to be overlooked.
But this had been the story for decades: it’s a chemical imbalance, it can be corrected with chemicals. Except that no one really knows how the chemicals work, and why the drugs do work for some, but not for many. The science behind SSRI’s turns out to be no more than a clever marketing scheme, one that is ingrained into our culture so much so that ‘chemical imbalance’ is a common phrase, along with ‘take a chill pill.’
I think the next question is this: if serotonin doesn’t cure or fix depression, then what will? There are millions of depressed folks, hanging on, waiting for the next solution to all of their problems. If depression does not have a biological base, after all, then where does the problem lie? I think the answer will be a more nuanced, complicated one.
Winnie, a colleague of Jack, the main character in White Noise, studies a Dylar pill that Jack gives her. Jack wants to know the contents of the UFO-shaped pill, and what it does, how it works. Jack has learned of Dylar through his wife, Babette, who has been taking it. It has not worked for her, it has not cured her terror of death. And yet, Jack is sure that it will work for him.
Jack and Babette are obsessed with death and are searching for a cure, one that is manufactured. Nearly thirty years later, and society is still struggling with the same demons. Pharmaceutical companies have a large hand in this, as they spend enormous amounts of money advertising directly to the consumer (this is banned in most countries, and an argument could be made that it should be banned in the US as well). The idea that you can pop a pill for any ill is pervasive in our culture, and possibly manufactured. The belief that something is wrong with you, but that there is a cure for it, is an attractive trap. Who isn’t afraid of death? Who wouldn’t want to vanquish that fear?
Winnie eventually tells Jack that “There is no medicine, obviously.”
This was true in 1985, and it’s still true now. I know there are medicines that do work, that do improve and lengthen our lives. But I find myself leaning more towards natural remedies, and not manufactured ones. I find myself wondering what humans did to alleviate depression a hundred years ago, or a thousand. I find myself wondering where research will go next; will serotonin be a factor in future research on depression, or will it be a thing of the past, like blood-letting? I wonder.
Every generation has its panacea; for my generation, it was Prozac. What will the next panacea be? What medicine will be in the next saucer-shaped pill?
Jennifer Hensley is a writer of mostly non-fiction, currently ghostwriting for a local start-up. Obsessed with pills, modern psychiatry and post-modern fiction. She is a native of Nashville and rescues cats.