One thing I don't think I made clear enough yesterday is that I'm not arguing that people shouldn't take drugs if they're depressed or ADD or OCD or what have you, because that is their "true" self. I am all in favor of better living through chemistry, and a quick glance through accounts of early twentieth century mental institutions should be enough to convince anyone who thinks that the mentally ill should just tough it out and learn to look on the bright side of life.
Rather, I am disputing the notion that there is a true self, either au natural or chemically enhanced. Both the pre- and post-medication selves regard themselves as the "true" self, with, I think, roughly equally valid claims. For that matter, both Megan McArdle two hours ago and Megan McArdle now regard(ed) themselves as my "true" self, even though they are slightly different. People don't need to justify their decision to feel better by saying that the self that feels better is closer to some sort of platonic ideal of me-ness. It's enough simply to want to feel better. The best justification for medication is that the medicated self wants to keep being that way, while the unmedicated self wishes it were fundamentally otherwise.
Megan, I think you're ignoring the reason many people feel that anti-depressants, while valuable in dealing with depression, do their job at a real cost to our sense of self. Their problem is that they inhibit feeling. Quite often people on anti-depressants notice that they simply can't feel genuine emotions anymore. This is good to the degree that it eliminates highly destructive negative emotions, but it is bad in that it removes the very feeling sense of "self" that makes us feel alive and unique as individuals. Many people quite taking anti-depressants for exactly this reason. They appreciate the alleviation of severe suffering, but they simply can't abide the loss of the emotional capacity to feel and relate from a core of emotional feeling that often accompanies their use. There's no question that this feeling core of "self" changes from day to day, even moment to moment, but it's still there. A drug that makes us incapable of feeling whatever it is that we are in the moment, replacing such feelings with a vague, placid, "happiness", does indeed have a destructive affect on our ability to be an authentic self.
Conradg,
I think you make a good counterpoint, but (and this can be a sensitive topic because we may or may not have personal experiences of these medications) your description seems more appropriate to older anti-depressants like lithium or anti-psychotics rather than what, I think, Megan is focusing on, drugs like Prozac et al. Although I'm no expert on the subjective feeling of taking a "new line" antidepressant, I think for most people it is quite a bit less dramatic than "...removes the very feeling sense of 'self' that makes us feel alive and unique as individuals."
sefrankel - actually the newer SSRI's have even more people reporting the secondary effect of inhibited general emotion. This is of course where the difficult philosophical issues come into play. If you reduce your suicidality by also cutting yourself off from rapturous feeling, have you indeed done something "unnatural" to your personality?
It's an excellent reason to give people information, then let them decide what trade-offs they want to make.
Thank you for the clarification, Megan. I agree with your points as stated above.
The best justification for medication is that the medicated self wants to keep being that way, while the unmedicated self wishes it were fundamentally otherwise.
That's my justification for drinking too much.
Obviously the unmedicated self is the "true" self.
Contrary to what the marketers would have you believe, though, your true self is not necessarily superior to any medicated version thereof. My "true" self is quite nearsighted, but in my corrected state I can read and drive a car. I'll take the corrected version, thank you very much.
sorry for the double -- edited because in my corrected state, I cannot type.
Conradg: Gotta tell you, for me it was just the opposite. About a month after I started taking anti-depressants was the first time in months I actually felt strong emotions (other than varients of sadness and malaise). And I don't think my experience is uncommon. I'm with Megan: The "authentic" self is overrated.
The only thing an honest assessment will reveal is that the "true self" has inherent flaws when judged against an ideal baseline -- some of which are present from birth, some of which are accumulated during a normal lifespan. Unbalanced chemistry is simply one of the many possibilities for having a composition of self that deviates from normal.
A very few people take the extremist position that the self is untouchable and therefore the true self is whatever it happens to be naturally, but most people live somewhere in the ongoing bioethics debate between correction versus ehancement.
I'll add that on occasion people who want to kill themselves are too depressed to plan & carry out their deaths until the anti-depressants have given them the energy to do so. That is, there may be a gap between medications providing enough drive to kill yourself & the meds completely curing the depression.
In these cases the anti-depressants can be, if not blamed, at least considered part of the problem.
Yes, that is a problem, but as I understand it, it's a problem with nearly any form of treatment for depression. I remember my high school English teacher, who in a previous life had been a therapist, describing this as a problem with treating depressives several years before Prozac hit the market.
I tend to think there is a true self or at least a kind of "core-self." I'm basically a happy and financially generous person who also tends to be too blunt and self-involved. I don't handle other people's personal problems at all well, they either bore me or emotionally exhaust me. I like Chinese things, science fiction, jazz, and have an interest in religions. I think almost all those things consistently remained regardless of whether I was anxious or high or whatever.
I get the "can't step in the same stream twice" and "we're always changing" thing, but to conflate neurochemistry with time is something that requires a little bit of argumentation that wasn’t present here.
Except when they’re trying to make a specific point or pass a freshman level phil class, I don’t think that anyone claims with conviction that they have “changed”, at the level of who they are, in the course of two hours. This was a throw-away line.
Chemicals swing both ways, just like Mickey Mantle (more home runs swinging lefty than righty) or George Michael (more home runs swinging..okay, bad joke – and my own throw-away line). The point is - McArdle is in favor of better living through chemistry. So am I. There is, however, a LOT of poorer living through chemistry, too. Pounding 12 beers every morning = bad chemistry; meth at any point = bad chemistry; etc.
Depending on your view of it (i.e., susceptibility to psychoactive drugs is due to personality or genetics), McArdle is either virtuous enough or lucky enough to see herself, in the altered state, no less authentic as when unaltered. There are a lot of folks in a different boat, however, for whom psychoactive drugs (legal or illegal) don't work out so well. I think these folks are probably more themselves when they sober up. I think the premise of their hope, for those trying to recover, is that they are more authentic sober than drunk.
Talking about true self, etc., is missing the point. What we consider to be our ‘self” is a mixture of our familial/societal conditioning and our genetics. The bottom line is that if you really look at what’s going on in the world, what we consider normal is insane…a species in the grip of mind and emotions, with each individual mistaking their personal experience as having some kind of independent reality. I don’t deny that medications can help, but like so much of our medical system it’s a Band-Aid that does nothing to address the root cause of our suffering.
Those emotions, intuitions, and interpretations of experiences have evolved over time and probably work pretty well to help man survive in more primitive conditions. The problem is that our world has changed so fast that our instincts and emotions aren't able to keep up.
A lot of the heuristics we use to make guesses fail spectacularly under some circumstances, but probably worked pretty well when used by a hunter gatherer just trying to survive.
I suspect that a lot of our mental problems are from stress due to this environment/adaptation disconnect and due to successful adaptations in a hunter/gatherer tribe not be successful adaptations in an urban technological environment.
The effects of anti-depressants vary tremendously from individual to individual. Some work on some people, others have bizarre effects. I have one friend who went through 26 different medications over 5 years before giving up. This suggests that our "individual selves" are very, very different, and that our brain chemistry is far more complex than we can, at this stage of the game, rationally quantify. I'm all for better living through chemistry, but SSRIs are incredibly unreliable, and even those that do seem to work for a time often change in their effects over time. Finding out who we really are is a spiritual matter, not a chemical equation.