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Wednesday, October 4, 2006

Reading List: Artificial Happiness

Dworkin, Ronald W. Artificial Happiness. New York: Carroll & Graf, 2006. ISBN 0-7867-1714-9.
Western societies, with the United States in the lead, appear to be embarked on a grand scale social engineering experiment with little consideration of the potentially disastrous consequences both for individuals and the society at large. Over the last two decades “minor depression”, often no more than what, in less clinical nomenclature one would term unhappiness, has become seen as a medical condition treatable with pharmaceuticals, and prescription of these medications, mostly by general practitioners, not psychiatrists or psychologists, has skyrocketed, with drugs such as Prozac, Paxil, and Zoloft regularly appearing on lists of the most frequently prescribed. Tens of million of people in the United States take these pills, which are being prescribed to children and adolescents as well as adults.

Now, there's no question that these medications have been a Godsend for individuals suffering from severe clinical depression, which is now understood in many cases to be an organic disease caused by imbalances in the metabolism of neurotransmitters in the brain. But this vast public health experiment in medicating unhappiness is another thing altogether. Unhappiness, like pain, is a signal that something's wrong, and a motivator to change things for the better. But if unhappiness is seen as a disease which is treated by swallowing pills, this signal is removed, and people are numbed or stupefied out of taking action to eliminate the cause of their unhappiness: changing jobs or careers, reducing stress, escaping from abusive personal relationships, or embarking on some activity which they find personally rewarding. Self esteem used to be thought of as something you earned from accomplishing difficult things; once it becomes a state of mind you get from a bottle of pills, then what will become of all the accomplishments the happily medicated no longer feel motivated to achieve?

These are serious questions, and deserve serious investigation and a book-length treatment of the contemporary scene and trends. This is not, however, that book. The author is an M.D. anæsthesiologist with a Ph.D. in political philosophy from Johns Hopkins University, and a senior fellow at the Hudson Institute—impressive credentials. Notwithstanding them, the present work reads like something written by somebody who learned Marxism from a comic book. Individuals, entire professions, and groups as heterogeneous as clergy of organised religions are portrayed like cardboard cutouts—with stick figures drawn on them—in crayon. Each group the author identifies is seen as acting monolithically toward a specific goal, which is always nefarious in some way, advancing an agenda based solely on its own interest. The possibility that a family doctor might prescribe antidepressants for an unhappy patient in the belief that he or she is solving a problem for the patient is scarcely considered. No, the doctor is part of a grand conspiracy of “primary care physicians” advancing an agenda to usurp the “turf” (a term he uses incessantly) of first psychiatrists, and finally organised religion.

After reading this entire book, I still can't decide whether the author is really as stupid as he seems, or simply writes so poorly that he comes across that way. Each chapter starts out lurching toward a goal, loses its way and rambles off in various directions until the requisite number of pages have been filled, and then states a conclusion which is not justified by the content of the chapter. There are few cliches in the English language which are not used here—again and again. Here is an example of one of hundreds of paragraphs to which the only rational reaction is “Huh?”.

So long as spirituality was an idea, such as believing in God, it fell under religious control. However, if doctors redefined spirituality to mean a sensual phenomenon—a feeling—then doctors would control it, since feelings had long since passed into the medical profession's hands, the best example being unhappiness. Turning spirituality into a feeling would also help doctors square the phenomenon with their own ideology. If spirituality were redefined to mean a feeling rather than an idea, then doctors could group spirituality with all the other feelings, including unhappiness, thereby preserving their ideology's integrity. Spirituality, like unhappiness, would become a problem of neurotransmitters and a subclause of their ideology. (Page 226.)
A reader opening this book is confronted with 293 pages of this. This paragraph appears in chapter nine, “The Last Battle”, which describes the Manichean struggle between doctors and organised religion in the 1990s for the custody of the souls of Americans, ending in a total rout of religion. Oh, you missed that? Me too.

Mass medication with psychotropic drugs is a topic which cries out for a statistical examination of its public health dimensions, but Dworkin relates only anecdotes of individuals he has known personally, all of whose minds he seems to be able to read, diagnosing their true motivations which even they don't perceive, and discerning their true destiny in life, which he believes they are failing to follow due to medication for unhappiness.

And if things weren't muddled enough, he drags in “alternative medicine” (the modern, polite term for what used to be called “quackery”) and ”obsessive exercise” as other sources of Artificial Happiness (which he capitalises everywhere), which is rather odd since he doesn't believe either works except through the placebo effect. Isn't it just a little bit possible that some of those people working out at the gym are doing so because it makes them feel better and likely to live longer? Dworkin tries to envision the future for the Happy American, decoupled from the traditional trajectory through life by the ability to experience chemically induced happiness at any stage. Here, he seems to simultaneously admire and ridicule the culture of the 1950s, of which his knowledge seems to be drawn from re-runs of Leave it to Beaver. In the conclusion, he modestly proposes a solution to the problem which requires completely restructuring medical education for general practitioners and redefining the mission of all organised religions. At least he doesn't seem to have a problem with self-esteem!

Posted at October 4, 2006 21:49