Making Peace with Prozac
Mawkishly sentimental TV commercials can wring buckets of tears from some people. But grown-ups — especially educated people who've had Psych 101 — don't necessarily take those tears at face value. We say the sorrow being expressed is not "real" or "genuine," because its apparent object, the TV commercial, is obviously trivial. We might say such crying is a "symptom" — a displaced manifestation of some other, some real sorrow. Or maybe it's chemical, PMS or depression. We might want to tell the tearful person to lighten up or get a grip.
Likewise, some joy seems more genuine. Susan, who takes Prozac, claims to simply feel more joy, but her unmedicated brother smirks that she is "on happy pills."
People do distinguish between "the genuine article" of joy or sorrow, and the sham. And this is no surprise: we often distinguish between the real thing and the sham in other areas of high affect as well. We speak of real love, real beauty, real courage, real fear, etc., implying that less real versions may exist.
I want to look at what should count as real joy and sorrow. And I especially want to think about what we should make of joy apparently enabled by Prozac. Susan has noticed that people seem uncomfortable when they find out she takes Prozac. Her family is especially suspicious. They murmur that she's "not herself" anymore; Susan's depression has been chronic from childhood, so they were used to her mopey and tearful persona. Some are downright disapproving. Susan worries that her Stoically-inclined friends think less of her. She fears they may feel betrayed: they thought Susan's good temper, her even disposition, her sense of humor, were real, and now they discover she's not really like that at all. She worries they might feel she's won their regard under false pretenses.
In the Nicomachean Ethics, Book II, Aristotle says "It is possible ... to feel fear, confidence, desire, anger, pity, and pleasure and pain generally, too much or too little; and both of these are wrong. But to have these feelings at the right times on the right grounds towards the right people for the right motive and in the right way is to feel them to an intermediate, that is to the best, degree; and this is the mark of virtue." In this famous passage, Aristotle reminds us that many things have to come together in order for a feeling or action to be really virtuous. A person can fail to hit the mark in many different ways: right feeling/action but wrong grounds, wrong degree, toward wrong people, with wrong motive, and so on.
In the 20th century, John Austin gives us some practical advice on how to figure out the real thing. Austin said that in discussions of the real vs the unreal, we need first to know what counts as unreal. As he put it, "it is the negative that wears the trousers. .. [A] definite sense attaches to the assertion that something is real, a real such-and-such, only in the light of a specific way in which it might be, or might have been, not real."
I'm going to take for granted, with Aristotle and Austin, that there are multiple ways in which joy and sorrow can fail to be real, and examine some of those ways to fall short. Once we're clear on the negatives, the ones wearing the trousers, we can undo the trousers and peek underneath.
One way in which Prozac joy might fail to be real is by failing to feel like joy. That is, Prozac joy is artificial joy in the same way that Cool Whip is artificial whipped cream.
I've presented this analogy with food metaphors, because the argument relies on the idea of a distinctive quale of whipped-cream-induced pleasure. In philosophy talk, qualia are the phenomenological properties of our sensations and experiences. "Phenomenological" is a fancy philosophical word meaning, roughly meaning "pertaining to how something is or feels for a consciousness, from the inside." Sometimes qualia are called "raw feels" or "raw sensations." How pineapple tastes, how red looks, how brownies smell are all examples of qualia.
The Cool Whip argument says, in effect, that anyone with a semi-educated palate can tell Cool Whip from the real thing, or real cheese from Velveeta, etc.; the qualia are different. In the same way, the argument implies that anyone can tell the quale of real joy or sorrow from sham; just introspect, and, if you're familiar with the real thing, you'll feel the difference.
You could fail to attain the real whipped-cream pleasure in a number of ways: you might fail to feel anything at all (your taste buds aren't working quite right because you have a pizza burn or a cold); you might fail to feel the quale but pretend that you do; you might feel the Cool Whip quale and mistake it for real whipped cream because you simply aren't familiar with the real whipped cream quale; you might even prefer Cool Whip if you've had a certain kind of aesthetically deprived or Puritan or impoverished childhood. So if "not felt" is one sense of the negative, the affirmative must be "felt" or "not feigned." If "misidentified" is another sense of the negative, then the affirmative is "correctly identified." If the problem is a naive or sentimental palate, the real thing is "educated" or "trained"; you feel the feeling at the right times, for the right objects (the really pleasurable ones).
Let's try these senses of "real" on joy and sorrow. "Real sorrow" would require the sorrow quale, not feigned, correctly identified, produced on the right occasions (by really sorrowful objects); real joy is the joy quale felt and correctly identified and produced on the right occasions (by really joyful objects).
When we're talking whipped cream, one opposite of "real" is "artificial" or "unnatural;" another opposite is "misidentified." But these two opposites don't help in explaining people's ambivalence about Prozac joy. The sense that helps is the third, namely, "warranted," or "produced in the right circumstances." When people are disturbed at Susan's joy on Prozac, I don't think they're necessarily worrying about whether or not Susan is feeling the genuine joy quale, or faking it, or misidentifying it; in fact, I don't think they really care at all what quale, subjectively, Susan is feeling. So quale is a red herring here. The point is not what Susan feels, or what she calls her feeling, but whether Susan should feel that way in these circumstances. The central matter is justification or warrant — whether or not Susan's joy is appropriate, or produced by the right things in the right way. I'll be returning to this.
Meanwhile, let's agree that the Cool Whip analogy works only very indirectly against Prozac joy. Let's turn now to a sanctimonious Drug Rhetoric analogy: Prozac joy is unnatural like any artificial drug high. The real thing is unassisted. You don't need the crutch of drugs to get high on life.
The objection that Prozac joy is not real because it's not natural can work only if we know what to call "natural" — and we don't. There's no clear and useful sense of "natural." With remarkable consensus, secular philosophers (i.e., most) have agreed that "natural" is even more vague than "real." At least with "real," we can determine what counts as unreal for various contexts. We can't do even that with "natural". We don't know what ought to count as unnatural in the first place in any context (homosexuality? polygamy? farming? clothing?); and, worse, we don't even know how to find out. Philosophers often think of "natural" as opposed to "supernatural". In that sense, of course, everything that is, is natural.
People sometimes try to pin down the "natural" to "having a normal etiology." According to this restricted view, the natural thing — the real thing — comes about in accordance with the right, or normal natural history, i.e., no exogenous chemicals. No drugs. Real joy is made from the right, i.e., endogenous chemical ingredients as part of normal development. Prozac joy would thus be unnatural in that it has an abnormal etiology. It requires an external agent, the fluoxetine compound, which is not produced naturally by the body.
Now, at least this analysis does attempt to clarify what is meant by "natural." We can almost understand the ideas of natural etiology, endogenous and exogenous chemicals. (Let's leave aside for the moment the difficulty that everything endogenous was once exogenous, and not that long ago. For example, practically everything we eat was recently alive and external to our bodies.) This notion of "real" as "natural" as "produced by endogenous chemicals" is what we hear in contexts of drug abuse and addiction. Teens tempted by drugs are urged to "get high on life" instead. In this drug-prevention context, the appropriate opposite of "real" qua "natural" is indeed "produced by exogenous chemicals." But Prozac is hardly comparable to heroin or crack! For one thing, it's legal, and for another, people on Prozac tend to be productive in socially-approved ways.
Besides, if "real" means "natural" means "endogenously caused", we must now admit that the pre-Prozac Susan, with her chronically low serotonin re-uptake levels, felt real sorrow at mawkishly sentimental TV commercials, and the 15-year-old with a crush on Leonardo DiCaprio feels real love. In both cases, the feeling aroused is endogenously caused and thus real, on this definition of "real." And that seems odd to me. I'd say neither is "real," in another sense, since the apparent object -- the TV commercial, Leonardo Di Caprio -- is, from a larger perspective, arguably unworthy of the intensity of feeling generated. The apparent objects of sorrow and love in these cases are not appropriately sorrow-producing or love-producing, i.e., not warranted.
We've now returned to the promising sense of real joy and sorrow that does account for our intuition that sorrow induced by a TV commercial isn't real sorrow, or that puppy love isn't real love, or that fear of Mr. Rogers isn't real fear, etc. If "unreal" means "inappropriate," then the sort of real joy (or sorrow or love or fear) I'm interested in is appropriate joy, warranted joy, justifiable joy: the joy we can give good reasons for. If "unreal joy" is unwarranted joy, how, then, is Prozac-enabled joy unwarranted? ("What's she so happy about?") Let's think about this.
It seems to me there are two main senses in which Prozac joy might be unreal qua unwarranted:
Let's consider these one at a time.
(1) Prozac-enabled joy is too indiscriminate; it's induced by inappropriate stimuli. People who take Prozac are too happy; they are like Pollyanna or Dr. Pangloss, happy even when happiness is unreasonable.
My answer here has two parts: one philosophical, one empirical.
Philosophy first: If you say Prozac joy is induced by inappropriate stimuli, just what do you think are appropriate stimuli for joy? Why should anyone be joyful about anything? Philosophy is remarkably silent about this. You've all heard the arguments that there's ultimately nothing to be joyful about, even in the most pleasant life, because after all, God is dead, nothing makes love and altruism better than hate and selfishness, everything just is (deal with it), life has no objective meaning, and besides, we're all going to die. We're like Sisyphus in Camus, pushing that rock endlessly while the vulture eats our entrails, and the only really important philosophical question is whether to kill ourselves.
Well, sure. We're going to die in the end, so maybe joy is a crock. But if we're going to die in the end, maybe sorrow is a crock too. Sure, if you take the really long view, life is probably pointless. But suppose it is pointless: then both joy and sorrow are a waste of time. Reason is silent here. Reason doesn't dictate whether to be joyful or sorrowful; there's no good reason either way, and yet we must choose, and the choice makes a huge difference to how we live. Those of you who know the philosopher William James can see where I'm going with this. You have no reason to choose one option or the other; since reason doesn't apply, be a pragmatist and choose the one that helps you get into satisfactory relations with your world. For most people, this means choosing joy. Joy, more than sorrow, helps you to get on with things.
Is Prozac joy too indiscriminate? My empirical reply brings us back to Susan. Before Prozac, Susan cried every day. She'd hide the tears, like a bulimic hides vomiting. Like a bulimic, she felt dismayed and ashamed about the tears also. Attempting to keep the crying under control, she had limited her life activities — wouldn't see certain films, or listen to certain songs, or go to certain malls or parks or restaurants with sad memories, etc.
Now her emotional world has been transformed; but so has her cognitive world. Changing her emotional tuning has opened up her awareness of the world in general. Now Susan understands why other people don't cry all the time. She doesn't think her newfound joy is indiscriminate; she thinks it was her sadness before Prozac that was indiscriminate. Now she can discriminate: she has recovered her ability to feel rationally about objects of joy and sorrow. Philosophers love to focus on reason, and hardly ever acknowledge a connection between reason and emotion. But clearly, one's cognitive world can be transformed by feeling, and vice-versa. We can't think straight when we're overcome with emotion (feeling affects thinking); we study art and music appreciation to learn new ways to feel (thinking affects feeling). Prozac changes feeling and thereby changes thought.
Susan is not deliriously and indiscriminately happy. In fact, Prozac seems to filter out extremes of feeling at both the high and the low ends, leaving Susan less capable of wild fluctuations of feeling, and more dependent on reason. She approves of this change. She has traded mindless lethargic sadness occasionally punctuated by mindless ecstasy for fairly consistent awareness of and openness to occasions of moderate to deep joy. Before Prozac, Susan felt stranded on the feeling side of the river, with no bridge to the thinking side. She could see that she'd be happier if she could get there, but she couldn't get there. Prozac gave Susan a bridge, and now she can chose to cross over much more often.
You may have heard the expression: "Life is a comedy to those who think, a tragedy to those who feel." Susan's voted for rationality and comedy. Before Prozac, she couldn't vote at all. Now she mostly lives on the lighter side, in the light of reason.
Prozac joy is neither irrational nor indiscriminate, then. But is it fair?
Consider a sports analogy: If an athlete uses performance-enhancing drugs and sets a record, the officials don't allow the record to count. In the same way, if a person feels joy on Prozac, it shouldn't count because it's cheating. It's not fair to the other players. Or consider a commercial analogy: Prozac joy comes for free (except for the financial expense, which is considerable), but joy should be earned.
The objection that Prozac is unfair, or that joy should be earned, seems to me basically Puritan: if we give Prozac our wholehearted blessing, why, that would be the first step down a slippery slope that would endorse feeling good for its own sake. We'd in effect be approving a kind of ease with the world — the feeling of being at home in the universe which in all cultures is a hallmark of joy. To me, that wouldn't be a bad thing.
Maybe because feeling good wouldn't be natural? See the discussion of "natural" above.
Is Prozac unfair because other people suffer? Is it unfair that some people can be joyful because they take a pill? Other innocent people have to suffer from disease and misfortune and heartbreak, so maybe depressed people should suffer too?
There are a couple of answers to this, aside from "Life is unfair," which also applies. The analogy here is the athletic competition. But I don't see the comparison with Prozac. What's the competition in which rationally joyful people, appropriately joyful people have an advantage and receive unearned prizes? What's the prize? Prozac joy is above all reasonable joy. Maybe people resent Susan's joy out of envy, a grievous and underestimated vice. But my moral intuition says it's prima facie wrong to begrudge reasonable joy. Furthermore, my moral framework, which is basically Aristotelian, tells me that good temper is a virtue, something to aim at.
Finally, what about the moral worry that bad people might be undeservedly happy on Prozac?
I don't agree. Most philosophers think that people who can be rational, who can align warrant and feelings, and keep their passions and appetites under the control of reason, have the best chance at personal integrity and happiness. If Prozac makes you more rational, it restores reason to its proper role in psychic organization, the role Plato gave it, as charioteer. We're talking morally better living through chemistry! Depression makes people irrational, because it disables reason, so people can't feel in accordance with warrant, and so get incredibly sad (and deliriously happy) at really dumb stuff. I'd say, then, that if Prozac enables rationality, it also enables morality. Could a bad person be happy on Prozac? I don't know. But it seems to me that if a bad person became more rational on Prozac, and rationality enables morality, then the bad person on Prozac would tend to become more moral, i.e., not so bad. This is not to say that Prozac can turn people into saints; but that Prozac can help people point themselves toward the light side. It helps you lighten up, when lightening up is warranted. No one says you should be joyful if your life really sucks. But if your life does suck, and you take Prozac, you might well find it easier to be rational and admit that life is unfair; i.e., you can minimize irrational sadness and rage.
Speaking of morality, utilitarianism might even require some people to take Prozac. Here's why. Both joy and sorrow are contagious. People who are sad for no good reason are no fun. By contrast, the joy of reasonably joyful people is fecund; it propagates. This an important difference. More joy is good. More sorrow is bad. Too much sorrow is a bad thing whereas, as Spinoza says, there can't be too much joy. No one takes expensive medication in order to feel more sorrow. People don't commit suicide because they're too happy. People don't worry about how they're going to bear up under the weight of great joy. If, as utilitarianism says, we are morally obligated to behave so as to produce the greatest happiness of the greatest number, we ought, then, to be joyful. We are morally obligated to be joyful. To me this means some of us might be morally obligated to take Prozac.
A final common objection to Prozac joy remains: a warning that, whether or not Prozac joy ends up being "real," we should worry that Prozac and other feel-good drugs might help create a society in which people are all pretty much the same, temperamentally — what I call the "monoculture of temperament" worry. As an art professor colleague of mine said: "People need to be depressed and crazy to produce great works of art." I call this the Van Gogh objection. My art colleague's remark is exactly the opposite of what seems true to me: of course, I agree depressed people can create great works of art, but it seems to me they might create even better stuff, more universal, more inclusive of the whole of human experience, if they weren't depressed. The artists I like most — Shakespeare, Bach, Mozart, Matisse, etc. — can be light as well as dark. It's no accident that nobody thinks Schopenhauer is a great philosopher.
Another version of this final objection alludes to Brave New World and other science fiction depictions of societies in which people use mood-altering drugs such as the euphoria-inducing soma. The episode "The Game" of Star Trek TNG depicted a similar scenario. The argument that Prozac makes people less human is analogous. When we play the game or take Prozac, we lose the special thing that is supposed to make humans humans and not robots.
I think this objection is very confused. It's steeped in bad philosophy — the Cartesian dualist picture of what it means to be human. What I'm about to say is old hat in the philosophy world, but I'm not sure the news has reached you all in the rest of the humanities. Cartesian dualism says that there are two and only two mutually exclusive ways to be real: a thing can be mental (which implies that it is like a thought or a soul, or an angel: non-physical, free, active, invisible but manly); or a thing can be physical (which implies that it is like a rock: non-mental, public, observable, and bound by physical laws, hence unfree). We're talking an exclusive "or" here: one or the other but not both.
Descartes was a Christian, and traditional Christianity uses dualist categories to explain what it means to be a person: a person is a soul and not a body. Dualism provides the explanatory framework for personal immortality: our immaterial souls survive death while our bodies die. (How we individually continue to think and feel and know and remember, etc. after we are dead, even though we don't have brains anymore, is a mystery. The brains of the outfit are, of course, just like the intestines and the toes, physical and rotting and rapidly being consumed by vermin.) What does it mean to be a person, then, according to Christianity and according to Descartes? It's a no-brainer (pun intended); we can't be our bodies (or our brains) at all.
Most contemporary philosophers -- and a surprising number of theologians, especially "process" theologians -- reject Cartesian dualism because both tines of the dualist fork collapse under analysis. Thinking of ourselves as simply material bodies bound by physical laws is absurd. It flies in the face of our everyday experience of ourselves as having consciousness and some control over our feelings. It leads to really dumb views like behaviorism. But thinking of ourselves as perfectly free immaterial souls flies in the face of ordinary experience of the body as bound by physical laws, as a chemistry set in which altering the chemicals can alter consciousness. As long as we think within the Cartesian immaterial mind/material body framework, we simply can't explain mind-body interaction. Contemporary philosophers are pretty unanimous in rejecting Cartesian dualism. Although they haven't reached the same unanimity about a new paradigm of explanation for consciousness, I think it's safe to say that they wouldn't worry about Prozac making us less human simply because it works on the body.
So I don't think we need to be disturbed about Prozac joy. Prozac in fact enables people to feel appropriate joy — joy at appropriate objects. Prozac enables integrity. Prozac enables you to get on with things. The analogy that works for me compares Prozac to eyeglasses. Nobody worries that the near-sighted person who wears the glasses has artificial help; the important thing is to be able to see. Naturally it would be better if nobody had to wear glasses at all, just as it would be better if everybody had appropriate joy without chemical assistance. But that's not an argument against glasses or against Prozac.
 I'm thinking especially of those that feature those intense compressed parables of human suffering and relief. A young woman is miles away (geographically or emotionally) from loved ones and then becomes warmly reunited because she uses a certain airline or long distance service. Or Dad has died, we all miss him terribly, but thanks to his wise investing, the children's college education money is secure. Or it's the first day of school, the five-year-old child stands alone in the playground, looks longingly toward Mommy's car as she drives off, and then a kindly teacher offers the child an M&M and a special hug, and we all feel so much better. Some of us cry at this stuff.
 My four-year-old friend Megan is playing she's Cinderella. She loves this game. I am her wicked stepmother. I cackle and tell her "Scrub the floors, my pretty! You're not going to the ball!" Megan makes a sad face, sighs deeply (she is quite an actress), and stares at the floor. Her dad happens to walk by and asks her why she's sad. She rolls her eyes and tells him, "I'm not really sad." Her sorrow is not real, meaning, in this case, "not felt" or "feigned".
 Jack and Jill have just finished making love. It's the first time for both of them. Jack asks Jill if the earth moved for her. She says, "Yes, it was wonderful," but she's wondering if she really felt what he's asking her she felt, or if what she felt was actually something else, which in her ignorance she's mistaking for "it," since she doesn't really know what "it" is supposed to feel like. Jill is like a color-blind person who experiences a color-quale but isn't sure whether the color-quale he experiences is the "real color." Or like many neurotic people, who find it hard to identify what they are feeling: they don't distinguish anger from sadness, for example. So the therapist might tell the neurotic person, "You're not really sad; I think you're really angry."
 The same analysis goes for fear and love, mutatis mutandis. Consider the claim "You're not really afraid." This could mean "You're pretending you're afraid, but you're really not." That's a claim about a factual matter: one either is or is not pretending, and once we decide which, we know whether the claim is true. But in other contexts "You're not really afraid" is a claim about warrant -- not a claim about what is so, but a claim about what ought to be so. "You're not really afraid" can mean "If you think this through, you'll find you have no good reason to be afraid; your real self, your better self, your perfectly rational self isn't afraid." Or, "you know better than to be afraid of this." We could give similar readings of "You don't really love him." ("You're only pretending to love him " versus "You shouldn't love him, and if you'll just get connected to your real self, you'll find you don't.")
 There's actually a very interesting and much-overlooked issue here. William James is the only philosopher I know of who talked about it. It's the effect of a philosopher's general temperament on his philosophy. I don't like to engage in ad hominems, but really, how can anyone doubt that Schopenhauer and Kierkegaard were depressed? How can anyone not like David Hume?
 John Searle diagnoses dualism's mistake succinctly: dualism wrongly holds
that "if something is mental, it can't be physical; and if something is physical it can't
be mental." The mental and the physical simply aren't two different and incompatible ways of being.
They're completely compatible and as far as we know, the mental always requires the physical,
while the physical sometimes requires the mental. Some physical events and configurations (e.g.
brains) are necessary conditions for mental events (e.g., consciousness); some mental events
(e.g., intentions) are necessary conditions for physical events (e.g., raising my arm voluntarily).
So we can have physical explanations and explanations in terms of mind (intentionality), because
explanations in terms of mind (intentionality) depend on the existence of certain physical
organizations, like brains. Truths and explanations apply at various levels of physical organization.
What's true and explanatory at one level of organization of the physical isn't necessarily true
e.g. wetness. Wetness is real once you have water; but the water molecules aren't wet, even though
or explanatory at another. Some realities depend on specific levels of organization of matter,
they also are real. Consciousness is real once you have brains of a certain complexity, though the
individual neurons aren't conscious. Marriage is real once you have societies of persons; even
though you don't change much, physically or mentally, during the marriage ceremony, you are
nevertheless much changed, socially, once it's over. I.e., being married is a real way to be,
but its being isn't primarily mental or physical; it's something else. Dualism says there are
only two possible and contradictory ways to be real; the truth is that there are many ways to be
real. "Real" doesn't mean just one or two things, and there's no contradiction between the mental
and the physical.
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