Brain Pickings

How Antidepressants Affect Selfhood, Teenage Sexuality, and Our Quest for Personal Identity

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“Though antidepressants are effective at managing negative emotions, they don’t in themselves provide the sense of meaning and direction that a person equally needs in order to find her way in life.”

“Great art was born of great terrors, great loneliness, great inhibitions, instabilities, and it always balances them,” Anaïs Nin famously wrote. But what if it doesn’t balance out? What if the emotional excess, believed to be essential to creativity, was of the negative and crippling kind? One need only look at such tragic heroes as Sylvia Plath, David Foster Wallace, Marilyn Monroe, and Kurt Cobain to grasp the gravity of the proposition. And yet we remain ever so culturally ambivalent about alleviating the anguish of mental illness with the same arsenal we use against physical pain: drugs.

In Coming of Age on Zoloft: How Antidepressants Cheered Us Up, Let Us Down, and Changed Who We Are (public library), Katherine Sharpe explores the heart of this ambivalence through an intersection of her own experience, conversation with medical and psychiatric experts, and in-depth interviews with forty young adults who grew up on psychopharmaceuticals. Having spent a fair portion of my own life on antidepressants, and having recently resumed treatment, I was instantly fascinated, both as an observer of culture and a living sample size of one.

Sharpe begins with an anecdote from her college days, in which she and her six roommates arrived at the accidental and highly self-conscious realization that each one of them was, or had been, on one form of psychoactive drug or another — an incident emblematic of the pervasive and profound cultural pattern at the heart of Sharpe’s book. She writes:

It is strange, as a young person, to realize that you have lived through something that can be considered a real historical change, but that’s exactly what we had done. When I was a child, in the early 1980s, taking psychiatric medication was decidedly a fringe phenomenon. Prozac came onto the market in 1987, the year I was eight. The first member of a family of drugs called SSRIs (for “selective serotonin reuptake inhibitors”), it quickly became the leading edge of a psychopharmaceutical revolution. Throughout the 1990s and 2000s, Americans grew ever more likely to reach for a pill to address a wide variety of mental and emotional problems. We also became more likely to think of those problems as a kind of disease, manifestations of an innate biochemical imbalance. Depression, social anxiety, obsessive-compulsive disorder, and the like went from being strange clinical terms or scrupulously hidden secrets to constituting acceptable topics of cocktail party conversation — talk that was often followed up by chatter about the new miracle drugs for despair.

Artwork by Bobby Baker from 'Drawing Mental Illness.' Click image for more.

But more than a mere statistically swelling phenomenon — less than two decades after the introduction of Prozac, SSRIs had outpaced blood pressure medication to become America’s favorite class of drugs, popped by about 10% of the nation — Sharpe points out a troubling corollary: In permeating everyday life so profoundly, antidepressants also embedded themselves in youth, with an ever-growing number of teenagers taking psychopharmaceuticals to abate depression, ADHD, and other mental health issues. And while relief from the debilitating and often deadly effects of adolescent depression is undoubtedly preferable over the alternative, it comes with a dark side: Antidepressants confuse our ability to tell our “true self” from the symptoms of the disease, and from the effects of the medication, at a time when the search for selfhood and the construction of personal identity are at their most critical and formative stages. And given the teenage brain responds so differently to life than the adult’s, the implications are even more uneasy:

Rightly or wrongly, antidepressants command powerful emotions; they can lead people to examine their deepest assumptions about themselves and the world.

[…]

The notion that depression distorts the true self and that antidepressants merely restore what was there all along has often been invoked against the fear that by taking antidepressants, we might somehow be betraying our true natures. But that belief in particular is one that people who start medication young cannot fall back on. Worries about how antidepressants might affect the self are greatly magnified for people who begin using them in adolescence, before they’ve developed a stable, adult sense of self. Lacking a reliable conception of what it is to feel “like themselves,” young people have no way to gauge the effects of the drugs on their developing personalities. Searching for identity — asking “Who am I?” and combing the inner and outer worlds for an answer that seems to fit — is the main developmental task of the teenage years. And for some young adults, the idea of taking a medication that could frustrate that search can become a discouraging, painful preoccupation.

She relays her own experience:

When I first began to use Zoloft, my inability to pick apart my “real” thoughts and emotions from those imparted by the drug made me feel bereft. The trouble seemed to have everything to do with being young. I was conscious of needing to figure out my own interests and point myself in a direction in the world, and the fact of being on medication seemed frighteningly to compound the possibilities for error. How could I ever find my way in life if I didn’t even know which feelings were mine?

This inner torment makes perfect, if tragic, sense in the context of developmental psychology, the commonly accepted credo of which is that establishing an identity is adolescents’ primary developmental task. When that process is disrupted by folding in the effects of medication, or the adopted inner storytelling that mental illness renders one somehow handicapped or fundamentally flawed, the consequences can be serious and far-reaching:

Though antidepressants are effective at managing negative emotions, they don’t in themselves provide the sense of meaning and direction that a person equally needs in order to find her way in life.

And even though modern psychology does away with the notion of the immutable self — something Nin herself so eloquently articulated more than half a century ago — Sharpe reminds us that despite what we may rationally believe about our scientific selves, we hang on to the romantic ideal of their metaphysical manifestation with emotional fervor:

For the last twenty years, the dominant academic theories of personhood have focused not on the idea of essence but on performance and changefulness, the sense that we don and doff identities at will as we move through our lives. Intellectually, we all know that the true self is more of a metaphor than a literal reality — we don’t really believe that there is some perfectly realized version of each of us hovering out there, just waiting to be discovered like a vein of gold.

But no matter how well we understand the academic critique of the essential self, or how much we feel disposed to dismiss “Who am I?” … most of us still want to feel, in some way, like ourselves. We may never achieve the highly concrete answer to the question of who we are that we first imagine possible as a young teenager — but a notional sense of self is something that we rely on from day to day. … A feeling of authenticity is, admittedly, an intangible thing to lose — but in a society that still prizes a notion of authentic selfhood, however problematic, it can be a significant one.

Artwork by James Thurber from 'Is Sex Necessary?' Click image for more.

Among the facets of selfhood most deeply affected by adolescents’ and young adults’ use of antidepressants, Sharpe notes, is that of sexuality. Every SSRI warning label cautions that the drug might — meaning, to decode the big-pharma-euphemism here, most likely will — produce “sexual side effects” ranging from loss of interest in sex to performance difficulty to inability to reach orgasm. For teenagers, most of whom are only just beginning to experiment with and understand their sexuality — whether parents approve or not — the repercussions can have an additional layer of gravity over the frustration these “sexual side effects” present for adults:

Just as teens don’t have a sense of their baseline adult personality with which to judge whether and how antidepressants may be affecting them, teens also lack a baseline impression of their own sexuality. Adults who are familiar with their own sexual norms will have an easy time knowing when those norms have been upset. But for adolescents who are just growing into their sexuality, the picture can be more mysterious. … Because SSRIs influence not just performance but also a person’s thoughts and desires, these side effects are relevant for teens who aren’t having sex as well as for those who are.

Artwork from 'An ABZ of Love.' Click image for more.

Coming of Age on Zoloft is fantastic and pause-giving in its entirety, embodying the rare bravery of asking important, complex questions in a society that fetishizes simplistic, sensationalistic answers. In a culture where just about the most embarrassing thing is not to have an opinion, Sharpe invites us to form one that is truly our own, however inconclusive and full of what Keats called “negative capability,” rather than a borrowed one that is easier to don but devoid of true understanding. Sharpe herself puts it beautifully:

This book won’t settle those debates, but it does speak to them. Twenty-five years after the introduction of Prozac, we are still collectively attempting to figure out what an appropriate use of medication would look like, in our culture and in our individual lives. We are trying to figure out what our sadness and pain mean — if they mean anything at all — and when they attain the status of illness. We’re trying to figure out when to turn to pills, when to go another route, and how we might be able to tell. … Good answers to the big questions about medication are likely to proceed from careful attention to the actual experiences of the people who have faced them.

For more on how psychoactive drugs affect the romantic and sexual lives of adults, see biological anthropologist Helen Fisher’s excellent analysis of the neurochemistry of desire and SSRIs.

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