Here's the scene: my doctor's office, packets of trial-size Viagra in ridiculously erect stacks upon his desk; in a bowl, a scramble of candied goods in blister pouches-- the by-now-passe´ Prozac, the mild, middle of the road Zoloft, the newer, niftier stuff like Remeron and Effexor; it's all mixed together in a foiled, tinselly heap. My doctor reaches out--he is a tall, lanky man with black hair that falls like fresh ink before his eyes--and tosses me six free panels of the Prozac. "One hundred twenty milligrams a day," he says. "Let's see if that does it."
By now, at least half of the industrialized world must know that 120 milligrams of this space-age medicine is, well, a lot. It's five times more than the standard dose. But my mood, which for the past 10 years has been more or less buoyed by chemical concoctions, is dangerously down. I am 14 weeks pregnant, and I wake up each morning clutching at the sheets. I am convinced there is a gas leak; the whole city twinkles and smells toxic. The adolescent urges to maim myself come back, and I do it in the bathroom, small slits in my skin, bright red smiles beaming back at me.
Surely I must be having a reaction to the pregnancy. I mean a psychological reaction. After all, I grew up in the heyday of family dysfunction. All the bad things happened to me, which makes me, according to some researchers, a genuinely average girl, dosed on a typical amount of trauma. Of course, I might have some feelings about becoming a mother myself. Of course--isn't it a matter of course?--the phylogenetically correct swelling in my belly might raise a few 50-minute issues for me.
My doctor doesn't think so. "This current episode," he explains, "probably occurred because you went off your Prozac when you first found out you were pregnant." I have a hard time believing his explanation. After all, I went off for only five days, a week at most, not a long-enough time for my bones and tissues to excrete the medicine's metabolites, which over the years have built up in my body like a plaque; like fat thickening an artery. Still, he persists. Still, I insist. I seek out a second opinion, despite the fact that I respect my doctor and his sleek, mechanical mind. I visit a specialist in perinatal psychiatry at Mass. General, who disputes my doctor's explanation but offers up one not entirely dissimilar. "It's the progesterone," she says. "The high levels of progesterone during pregnancy can trigger a depression in 10 percent of the gravid population."
What the two doctors have in common is their reliance on chemicals as an explanatory model for human suffering. The historical aspects of my life mean nothing in these offices, and that, I have to say, is a relief and an irritant, both. I can escape the loftier aspects of the self; I can sink into my skin, become bone, breath, a single sizzling neuron, pinpointed and absolute. In this game, bull's-eyes are possible; go ahead and shoot me; I hope for a hit. The mother melts away. The murkiness of memory just melts away. I am clear and shining.
Physiologically-based explanations for mental suffering are, in fact, nothing new. As far back as the second century, Galen posited a humoral theory of depression that lasted into the Renaissance. According to Galen, human distress occurred when the four principal humors in the body had lost their precarious balance--blood, yellow bile, black bile and phlegm. Depression, he thought, was due to an excess of black bile, which might be corrected through various physical remedies, including rest, warm moist air and, yes, dark leeches sucking at the skin.
Why, then, does the chemical model of mental illness seem so new and discomforting to me? Is it because, when all is said and done, I still long to be a child of Descartes, a child of Christ, a child of Yahweh himself, who holds my invisible, untouchable soul in the massive platter of his palms? …