Diets, Drugs, and Values

Earlier this month, popular diet drugs aimed at the brain were pulled off the market because of dangerous side effects. Meanwhile millions of people are treating depression through "mood" pills - even though researchers know little about how they work or what the long-term effects might be.

These are headline events. But even as researchers and talk-show hosts raise issues of drug testing, safety, and dependability, other experts are posing larger questions about cultural values and how Americans deal with problems of personal happiness?

At the crux of the debate: Is satisfaction a matter of body chemistry that can be adjusted with a dose of drugs? Or is the recent trend toward mood-altering pills another symptom of a quick-fix society that has lost its moorings?

"We're a consumer-oriented society, so the idea of using drugs to solve problems is completely consistent with the way that we approach much of life," says Allen Kanner, a psychologist in Berkeley, Calif. He argues mood drugs don't address the kind of life problems that are often involved with depression and which require individual work and rethinking to change.

"Drugs are a material solution," Dr. Kanner says. "That's why they fit so well into the consumer mode."

The drugs at the heart of the current debate all target a brain chemical called serotonin - which some researchers have linked to a variety of disorders, from depression and appetite to social phobias and rage.

These drugs include Prozac, and other relatively new antidepressants such as Zoloft, as well as the appetite-suppressant pills known as "fen-phen." The latter is a combination of diet drugs pulled off the market by manufacturers after the US Food and Drug Administration warned two weeks ago that users should immediately stop taking the pills or risk serious health problems.

The drugs have been actively promoted by pharmaceutical companies as revolutionary. And while many people have claimed that drugs like Prozac have allowed them to lead happier lives, several studies have shown no significant difference between the way patients respond to an antidepressant or to a placebo.

EVEN some psychiatrists who defend drugs like Prozac as an emotional painkiller that can aid severely depressed people are critical of attempts to cast brain chemical research as definitive knowledge.

"The brain is like the universe; it's enormously complicated," says William Appleton, a psychiatrist who teaches at the Harvard Medical School and is the author of "Prozac and the New Anti-Depressants." "We can't really explain anything on the basis of serotonin. In a way, it's a scientific hoax to say it explains something. The idea that this is a science is a fake."

Others question the cultural forces that have contributed to the current drug phenomenon, which has led an estimated 28 million people world-wide to try Prozac since it was introduced in 1987.

Part of the growth in mood drugs, they say, is due to pressure from health-insurance companies, which would rather pay for the relatively cheap, quantifiable method of treating depression through pills instead of through psychotherapy. Others have been drawn by testimonies of dramatic results.

But psychiatrists ike Peter Kramer, author of "Listening to Prozac," also worry that society has become intolerant of certain personality traits. Although Dr. Kramer says he admires the kind of loyalty and long-term commitment he finds in patients who may spend time mourning the end of a relationship, he questions whether such qualities are valued by a culture that demands assertiveness and an ability to cope with rapid transitions of all kinds - at work and in relationships.

"I think we're living in a time where certain temperaments are less well-rewarded," says Kramer, whose book explores personality changes experienced by patients on Prozac. "We're less tolerant of certain sadnesses. If there's an easy means of altering something, we'll try it. What we're treating now is what in other generations would have been called normal, or a normal variant."

"I think we're a culture that just values getting on with it," he adds, "and with going after the next best chance."

Many mental health professionals, however, are challenging that cultural assumption. They insist that lasting change can't be found in a pill. And they argue that simply medicating, or dulling, emotional distress circumvents the kind of wrestling that can lead to profound individual growth and insight.

"Depression says, 'I'm paralyzed about a moment of choice,' " Peter Breggin, a psychiatrist and author of "Talking Back to Prozac," said on a recent edition of the Boston-based public-radio talk show, "The Connection." Depressed patients, he said, are invariably on the verge of great, positive change in their lives. "The self-hate of depression can be turned to a powerful energy ... I'm excited when somebody comes to me who is depressed, because it tells me they're full of life."

There is also an emerging trend in the field of psychology - called "ecopsychology" - which heralds a change in perspective among a growing number of professionals. Ecopsychology moves away from the Freudian point of view, which emphasizes the role of the individual psyche as all-important, to a broader view that considers the individual and his mental health in relationship to the world around him.

Emphasis is placed on developing better relationships with people and the environment, and a deepening sense of spirituality. "Those are the kinds of things we really need to work on," argues Kanner, who is an ecopsychologist. "If we're going to make it through the various crises we face, this is the way we have to go. I think this is very cutting edge."