Well, actually, that’s pretty much the only place you can adopt a kid. But if you’re thinking about adopting, or if you’re just curious about it, or if you want to read a story about, among other things, greasy spoons, social workers, my choices in automobiles, my testicles, my wife’s fallopian tubes, our sex life, hospitals, and my sartorial tastes, then this is the one for you. I wrote it a while back and it ran in Tin House and was anthologized in their Cooking and Stealing anthology, which featured much good writing and thus worth the three bucks amazon is now charging for it. But my contribution is here for your downloading pleasure.

http://www.garygreenbergonline.com/media/littlebrownshack.pdf

A review I wrote for the Nation of some books about how the Internet is ruining us.

http://www.thenation.com/article/159279/my-monster-my-self-nicholas-carr-and-william-powers

And coming up, also in the proletariatti’s house organ, a review of David Brooks’s latest. You can read it here second.

My blog friend Frank in Florida writes

No doubt you’ve seen the latest humoral news in the New York _Times_, where we’re advised that “it’s worth listening to serotonin no matter what it has to say.”  Would love to see you weigh in on your blog.  Here’s the link:

http://www.nytimes.com/2011/05/03/science/03angier.html

Actually, I hadn’t seen it. But now I have. And someone has made the mistake of encouraging me. So.

First, let me say that Natalie Angier is one of my favorite science writers. And that’s not only because she selected one of my articles for inclusion in one of those Best American anthologies. It’s also because she writes sentences like this:

Other researchers have determined that serotonin in the gut helps orchestrate the remodeling of bone, the lifelong buildup and breakdown of osteoclasts and osteoblasts that make the human skeleton such an exciting organ system to own.

I mean, talk about making a silk purse out of a sow’s ear, or, in this case iambic pentameter out of clangy biojargon. Which is nothing compared to what she has done for the vagina (not that the vagina isn’t already a silk purse or anything). And it (the passage, not the vagina) is funny too.

But I see Frank’s point. It’s not that the article is inaccurate, although this also nicely wrought sentence

Five years later, scientists found serotonin in brain extracts as well, and they soon learned that the recently invented hallucinogenic drug lysergic acid diethylamide worked by tapping into the brain’s serotonin system and that if you took too much LSD you might end up wearing hair garlands and overusing the word “wow.”

as everyone who’s memorized my book knows, is not quite accurate. LSD was discovered pretty much when serotonin was (late 40s, although serotonin had actually been identified in the 30s), and the connection was made not by figuring out that LSD “tapped into the serotonin system” but by recognizing that LSD had a molecular structure related to serotonin (both are tryptamines; LSD contains within it the serotonin molecule) and deducing that its consciousness-altering effects must be somehow related to the fact that there is serotonin in the brain. But whatever. It’s a nice, cracky sentence, and it manages to convey a little Angier bio (as she does later when she talks about her psychiatrist) even as it gets across the rudiments.

So the article didn’t quite get under my skin like it evidently did Frank’s. Maybe that’s because my underskin is already full up with all the breathless neurotalk out there, the latest fMRI finding that proves that our mental life isn’t just a figment of our imaginations. But I see his point. Like here

For all the intricacy, serotonin in the brain has a basic personality. “It’s a molecule involved in helping people cope with adversity, to not lose it, to keep going and try to sort everything out,” said Philip J. Cowen, a serotonin expert at Oxford University and the Medical Research Council. In the fine phrase of his Manchester University colleague Bill Deakin, “it’s the ‘Don’t panic yet’ neurotransmitter,” said Dr. Cowen. Given serotonin’s job description, disturbances in the system can contribute to depression, anxiety, panic attacksand mental calcification, an inability to see the world anew — at least in otherwise vulnerable people.

A basic personality? A job description? A fine phrase? It’s one thing to be breezy and entertaining when dealing with eyeglazing content, and in the process informing people of something interesting and maybe even important about themselves and their world. It’s another entirely to deepen misunderstanding by, to borrow from Dr. Hyman, committing the error of reification. It’s a molecule, Natalie. Not a personal assistant. Its “involvement” (and someday I’ll get to the evasions neuroscientists commit in their language, the way they cover up their lack of understanding of just exactly how all those molecular events give us conscious experience by using imprecise verbs that still somehow manage to convey a linear causality) in our conscious lives is no smarter or more personal than, say, bacteria’s “involvement” in digesting our food.

One could as easily say, “We use serotonin to keep ourselves calm.” Of course, there would be a metaphysics involved, as blog friend Matthew recently reminded me. And indeed there is some kind of dualism lurking in that statement. But, and this is my point, there is metaphysics at work in the scientists’ formulation as well, one that I find more distasteful than my own, as it cancels out human agency and replaces it with neuromyth. And Angier makes like the question of which myth to believe doesn’t even exist.

Actually, this reverence for serotonin reminds me of somethign Homer Simpson once said. It’s in the monorail episode, just after he saves Springfield by lassoing the runaway train to a huge donut sign. “Is there anything a donut can’t do?” he asks.

One of the things that seems to really get psychiatrists’ dander up about my book is my contention that the invention of antidepressants leads to the invention of depression. They argue back, sometimes impolitely, that antidepressants were invented by doctors seeking to treat a common and under-recognized scourge that has afflicted people in all times and places. But in a recent study, researchers inadvertently support my hypothesis by proposing precisely what I suggest: that psychiatric diagnosis be changed to reflect what drugs are doing.

First, a little recap. While it appears to be true that some portion of the population (I would say a much smaller portion than falls under the diagnostic criteria for major depression, dysthymia, adjustment disorder, etc.) suffer from the “inexplicable unhappiness” that Hippocrates observed, it is also true that antidepressants weren’t created to treat those people. Rather, as my book recites in painful detail, they were discovered when people took new drugs and unexpectedly felt better than well. The allure of such drugs is obvious. What is less obvious is how to market them in a society reluctant to let people simply take drugs to feel better—a problem exacerbated by the Marsilid scandal of the 1950s (an early “antidepressant” that killed a few people and came to be denounced as a “pep pill”) and by the Valium/Xanax scandals of the late 1960s and early 1970s, in which public scolds, some of them Congressmen, railed against the widespread use of minor tranquilizers and denounced users as little better than potsmokers (and their doctors as drug pushers). As a result, for many years, antidepressants wandered around in the pharmaceutical wilderness, a treatment in search of a disease.

When various historical forces—the FDA’s insistence that drugs be specified for particular diseases, the American Psychiatric Association’s turn to a descriptive psychiatry, Nixon’s War on Drugs, the invention of SSRIs—converged to anoint depression as that disease, antidepressants, as we all know, hit it huge, and suddenly there was an epidemic of depression. But there remained a  problem for the drug companies: as I’ve described here, the connection between the drug and the disease has always been tentative and contingent. The poor performance of antidepressants in clinical trials is probably in part the result of trying measure them with a test (the Hamilton Depression Rating Scale) that is poorly matched to the actual effects of the drug. Sticking with the Hamilton bolsters the case that these drugs are antidepressant medication, but at the high cost of amassing data indicating that the drugs are not effective—data once suppressed but now embarrassingly public.

The predictable backlash—claims that antidepressants are simply tricked out placebos—misses the real point, which is that researchers have been so intent on insisting that the drugs cure depression, and cooking the books accordingly, that we don’t have any systematic understanding of what antidepressants actually do. But that doesn’t mean there isn’t an emerging consensus. Consider the data recently mined by a group of Canadian scientists. They looked at an epidemiological study of over 20 thousand people, of whom 1441 had been prescribed antidepressants in the past year. Only 718 of them, fewer than half, met the criteria for a psychiatric diagnosis within a year of their prescription. And one quarter of them didn’t qualify for a diagnosis at any point in their lives. These results correspond nicely with those of a group of French data miners. They looked at insurance company records and determined that 53 percent of patients who received antidepressant prescriptions had not been diagnosed with any of a long list of disorders for which antidepressants are indicated or used off-label. So it may not matter as much as you think that antidepressants don’t work for depression or their other official or unofficial indications, because most of the time, that’s not what they are being used for.

 So what are the actual uses of antidepressants? Why are people getting the prescriptions and taking the drugs? While they don’t meet diagnostic criteria, still, according to the Canadian researchers, “results suggest that these individuals …have other forms of mental health difficulties and needs for mental health treatment that may not be recognized in the DSM-IV.” In other words, people aren’t just randomly showing up at doctors’ offices and emerging with prescriptions for Prozac; they are “experiencing difficulties” with which they and/or their doctors think the drugs will help.

But what kind of difficulties? Another group of researchers suggests an answer. They gave Paxil to 120 depressed people, placebos to sixty, and cognitive-behavioral therapy to another 60. Then, instead of just comparing their Hamilton scores, they also measured changes in the subjects’ personalities. As expected, there wasn’t much difference in the effects of the various treatments on depression. But Paxil changed people’s personalities much more than the therapy or the placebo. Paxil takers scored lower on something called Neuroticism and higher on something called Extraversion than they had at the beginning of the trial, while the other groups’ personalities remained stable. The strongest effect of antidepressants, in other words, is on your personality. The antidepressant effect, the researchers suggest, is secondary, a side effect due to the drug making you happier with who you are. 

Of course, that’s the last thing the drug companies want you to think. They’ve spent an awful lot of money reassuring the public that their drugs don’t change our personalities. If that’s the main effect of the drugs, then they’ve got some explaining to do. Or at the very least, they’d better get busy inventing a new disease for their drugs to cure—and it better be a better disease than Prozac-deficit disorder. And here, to get back to the point I started with, is where the Canadian researchers are offering some help. Lest their their study lead to a dangerous conclusion—that “the prescribing of antidepressants is appropriate among individuals lacking psychiatric diagnoses”—they suggest that “the nosological approach should take lower level psychiatric symptoms into consideration so that treatment options can be studied and administered.” In other words, psychiatrists should do exactly what they claim they never do: rejigger their diagnoses to accommodate the drugs they prescribe. Better they should lower the bar to entry than admit what is really going on. Better they should pathologize more of us than to relinquish some of their hard-earned (if ill-deserved) power.

Gary Greenberg, PhD is a psychotherapist, author, teacher, and historian of psychiatric diagnosis. His writings are characterized by penetrating insight, elegant wordsmithing, entertaining story telling, and a dig-deep, no-holds-barred search for underlying meaning. I rate his recently published “Manufacturing Depression” as one of the best books ever written on any psychiatric diagnosis.

more (as if that’s not enough)