Pharmutopia: Antidepressants and the numbing-down of America.

The Weekly Standard, June 5, 2006

By Sally Satel

Artificial Happiness
The Dark Side of the New Happy Class
by Ronald W. Dworkin
Carroll & Graf, 336 pp., $24.95

PITY JOHN GREEN? His wife makes him miserable, but he wants to stay married for the sake of his young son. When Green’s doctor starts him on the antidepressant Prozac, he finds himself less distraught and able to live “happily inside his loveless marriage.”

As a psychiatrist, I think this might not be so bad: The father gets some peace of mind and the boy grows up in an intact (albeit imperfect) family. But to Dr. Ronald Dworkin, who interviewed John Green for his new book, the man is a “victim” of drug-induced “artificial happiness”–a state of being, the author writes, in which “what [people] get from life doesn’t penetrate them too deeply.”

As a card-carrying member of the new Happy Class, John has seen his powers of introspection blunted by Prozac. And his fate, Dworkin gloomily predicts, is “to stagnate in a pool of sham happiness, and sacrifice any chance for the real thing.” (Of course, if John went for the “real thing” for himself, it might lead to a much more troubled life for his child.)

In Artificial Happiness, Dworkin sounds the alarm about societal damage created by “an entire class of people who stupefy themselves regularly and constantly . . . and live not on society’s fringes but its mainstream.” Unfortunately, his case relies heavily on sweeping generalizations, cherry-picked anecdotes, and heavy doses of judgmentalism about how people should live, and assumptions about what they feel.

A practicing anesthesiologist with a doctorate in political philosophy, Dworkin says there is an excess of hollow happiness in our culture. This abundance, he argues, is the product of three new movements: psychopharmacology, alternative medicine, and obsessive exercising. All of them flourished along with the decline of traditional “doctoring,” an era when family docs took time to talk to patients. Today’s primary care physicians embrace and promote these compensatory movements for the purpose of combating the “disease of unhappiness,” something their medical forebears did by just spending quality time listening and giving advice.

Unfortunately, says Dworkin, these remedies backfired, seducing patients into an “artificial happiness” that prevents them from taking stock of their lives and changing them for the better.

The Big Socratic Questions loom: How to live a good life? What is true happiness? Dworkin’s solution is “to live in accord with the demands of [one’s] conscience.” He may be right that if only some pill takers, acupuncture junkies, and exercise zealots had “sensible people to talk to,” or read about the world’s great philosophies, the unhappiness that is allegedly driving their misguided efforts at relief would melt away. It’s not so hard, he says; people can “change their situation with the slightest effort.”

Neurosis, anyone? What might look to an outsider like problems easily fixed with modest adjustments can seem insurmountable to the sufferer. Making changes often requires painful confrontation of emotional conflicts that many people (perhaps most) want to avoid like the plague. And of course, there are people like John Green, whose despair was a rational response to a difficult situation. Would it be better for Green to leave his wife in pursuit of authentic happiness, whatever that is? Who are we to say?

Dworkin’s analysis of John Green at the beginning of his chapter on antidepressants prefigures the one-sided discussion that follows. Yes, there are some patients who report feeling muted on the drug, but keep taking it because (as in John Green’s case) the benefits outweigh the risks. Others suffer a loss of empathy, competence, or ambition–but these are just more reasons, as Dworkin notes, why primary care doctors should not prescribe psychiatric drugs: They rarely follow up, and so these effects go unmonitored.

In my experience, patients tend not to like that anesthetized sensation and frequently stop taking the drug anyway. More important, though, are the vast numbers of people on antidepressants who choose to stay on them because the drug’s stabilizing effect on mood gives them the sense of control needed to expand their outlook or improve their circumstances. We hear nothing of them from Dworkin. Although data are difficult to come by, it seems implausible that millions of people continue to take a drug that really makes them paralyzed.

Nonetheless, the author frets about the “implications for society when millions of people fight their unhappiness with external cures.” While no responsible person claims that the rapid expansion of psychopharmacology and alternative medicine has been without problems, the book gives us scant evidence that they are further corrupting the nation’s psyche and character.

Dworkin is much stronger when he takes to task primary care doctors for improper medical care, such as prescribing medication without properly diagnosing a psychiatric condition, or prescribing alternative therapies that have not been proven effective. He is right to criticize lax standards and suggests some worthy remedies. Yet blanket speculations pop up as fact: “Primary care doctors stopped being idealists; for them, antidepressants became a source of power,” “Both doctors and patients want the deceit and need the deceit perpetuated by the psychotropic drug ideology,” and “[people] remain at the stage of life where they found Artificial Happiness.”

Questions abound. Are alternative medicine and exercises “prescribed” primarily to treat unhappiness? Are physicians really the major engine behind their popularity? Dworkin’s formulations are too pat to be persuasive. Furthermore, was there so much more genuine happiness before the arrival of these new movements? After all, “artificiality” is as old as humankind–if to be artificial means not wanting to make hard life changes, or engage in probing psychic inventories.

Artificial Happiness: The Dark Side of the New Happy Class is a provocative and well-written book with many edifying excursions into medical history, sociology, and religion. Yet every dark side implies an upside. And that aspect is virtually unacknowledged by Dworkin, leaving this reader to think that she got only half the story. Artificial Happiness starts with a shaky premise and ends with an unsatisfying conclusion.

Sally Satel is the co-author of One Nation Under Therapy: How the Helping Culture Is Eroding Self-Reliance.