Personality Enhancers: Prozac and the Controversial Future of Psychopharmacology

By Michelle M. Neitzel

Terri is 38 years old. She is an attractive woman, trim and well-dressed, with blonde hair and brown eyes. She is slightly reserved, perhaps, but friendly and likable all the same. Five years ago she went through a bi tter divorce. There were no children involved. Even today Terri has trouble talking about her failed marriage and she hasn't dated since then, although she admits that she is frightened of spending her life alone. Six months ago she was passed over at wor k for a promotion that she knows should have been hers. The experience brought to the surface feelings of inadequacy that she realizes have been inhibiting her for as long as she can remember, keeping her from putting herself forward in both social and no nsocial situations. Her friends describe her as a warm and caring person but admit that she does not try to explore her full potential. Terri is prone to occasional bouts of depression and is considering going to a therapist. She hopes her doctor will pre scribe the antidepressant Fluoxetine for her - better known by its brand name Prozac - because from what she's heard it could be just what she needs to get her life "back on track."

Can an antidepressant like Prozac really help someone like Terri, who is not ill but whose feelings of inadequacy and periodic depressions keep her from healthy relationships and a successful career? Yes, very likely. Prozac is effective in treating a wide range of diagnoses - depression, anxiety, obsessive-compulsive disorder, low self-esteem, etc. Furthermore, the side effects are minor compared to those caused by other antidepressants. For example, some patients become excitable or anxious on Prozac , others suffer from a loss of concentration or a lessening of sexual drive. However, these side-effects are more tolerable than the rapid heartbeat, constipation, sluggishness, or lethal food interactions which accompany other medications for depression. As with most drugs, Prozac does not work for everyone and when it does work there can be a wide difference in its range of effects, depending on the person taking the medication. In some patients it will treat only a single symptom, like depression, in o thers it brings about a virtual reshaping of the personality. For these extremely responsive patients Prozac can change inhibition to confidence, anxiety into security, and depression into energetic optimism. This is the response Terri has heard about and would like to see in herself. But does Terri really need this sort of help? Who among us is not afraid of rejection, anxious in new situations, occasionally "down-in-the-dumps?" If Terri's condition responds to Prozac does this mean she was ill or is thi s merely a cosmetic change - the equivalent of a facelift for the personality?

Prozac is classified as an antidepressant but it acts on a wide variety of symptoms. It is actually an SSRI - Selective Serotonin Reuptake Inhibitor. It works by maintaining effective levels of the neurotransmitter serotonin, one of the substances whic h nerve cells use to communicate with each other. Since it's introduction in the late 1980ís Prozac has enjoyed a popularity and notoriety unusual for a medication. There have been front-page stories, prime-time reports, and entire books on the drug. The name has become a household word. But why has it been the center of so much attention? Perhaps the answer lies in the sheer size of the group Prozac is able to treat - those who are troubled but not mentally ill.

It is this ability to help the comparatively "normal" that raises so many questions about Prozac and other drugs like it. Most people suffer in one way or another from minor anxieties, depressions and obsessions. Should we all be on medication? And if we have the ability to improve the quality of our live through medication - even if we consider ourselves "healthy" individuals - should we not do so? Prozac may not be the drug to bring these ethical issues to the forefront, but as we learn how to biochemically fine-tune our moods, temperaments and even characters, the implications of our new-found abilities will continue to creep up on us until they finally land full-blown in our laps.

Prozac, with its minor side effects and multiple applications, may well be the precursor of a whole new generation of psychopharmacological drugs. These drugs will enable us to tinker with the psyche with greater and greater specificity, targeting indi vidual moods, traits, attitudes and emotions. For example, say that a person suffers from a fear of public speaking. A small pill in the morning before work might alleviate that problem - turning the nervous introvert into a vivacious extrovert in time fo r the big board meeting that afternoon.

There is an entire host of such alterations that would enable individuals to function better within this society, achieving greater success in both personal and nonpersonal areas. Imagine if you could change laziness into motivation, disorganization in to efficiency, irascibility into patience. Enough of this tinkering and you can create the perfect overachiever; the person who "has it all" by today's standards. Never before have qualities such as being introverted been classified as illnesses, but if w e are able to modify personality with such precision will such behaviors still be considered normal and acceptable?

On the one hand, individuals would have at their disposal ways of improving the quality of their lives in a manner their ancestors could not have imagined. Depression, anxiety and fear would all be minor obstacles and inconveniences. Instead of being c ontrolled by your negative emotions, you would control them. Only a masochist could ignore the benefits of such an ability. On the other hand, there would be increasing pressure to adhere to cultural standards of desirable behavior. Society today favors a personality in hyperdrive - the confident, energetic, extroverted overachiever. Those not naturally of this temperament would be under pressure to conform to this ideal or else be left behind.

Currently American culture discourages the use of medication to avoid pain. Recent studies show that cancer patients are typically undermedicated for pain, often due to their own feeling that there is something inherently wrong with taking medication. There is a prevailing idea that a person is better for suffering, that pain is an essential component of being human. Is this true? Or in a more psychological sense, are painful feelings and experiences necessary for our growth and development as human be ings?

Perhaps to some extent they are. A person who has never experienced fear might not understand that it's unwise to walk alone down a deserted alley at night. But is the person who lost a beloved parent during childhood more emotionally developed that on e who did not? Not necessarily. Through our own experience of pain we develop empathy for others, as when an embarrassing incident in our past reminds us to use tact. Through pain we become motivated to change, as when the frustration of a dead-end job le ads us to find another. Through pain we broaden our depth of understanding, as when a failed relationship teaches us not to make the same mistakes again. Does it follow that without any pain at all we would become placid, stagnant and self-centered? And i f so, how much pain is enough?

It would be a hellish vision to believe that pain is at the core of our human experience. There are clearly routes other than discomfort or suffering to achieve greater awareness. Reward can be an effective motivator, as well as punishment. We are gene tically hardwired to avoid pain. If the means were at our disposal to avoid pain, I doubt that most people would willingly experience it, even for the sake of their personal growth.

However, the personality-enhancers we are discussing would not necessarily alleviate all forms of pain and discomfort. Like Prozac at its most widely-acting they would shift aspects of personality towards the cultural ideal and would merely shield from oversensitivity to pain. The idea of personality-enhancers makes most people uncomfortable, including myself. There is a feeling of falseness - that effecting such changes biochemically is less valid that through self-examination. But then again, I drink two to four cups of coffee every day without guilt to enhance my mood and abilities. It is all very easy to debate the issue in a general philosophical sense but an entirely different matter when individual cases are considered. Take Terri, for example. Say that on Prozac her depression is lifted, her fear of relationships is overcome and her self-confidence is boosted. She takes more initiative at work and receives the promotion she desired. She begins dating again and meets a man whom she later marries . Her friends say that she is happier than they have ever seen her. Terri considers her life drastically improved and says she owes it all to Prozac. Could we have denied her this happiness simply because she was never seriously "ill" to begin with?

Would I deny myself a cup of coffee?