Tags: health | pharma | prozac

Mind not the burgeoning sales of Prozac, Paxil, Effexor and Zoloft, the 1990s were Freud's decade.

As the health care debate rages, we are watching a battle the doctor would have relished - between one vision of man as a machine, a set of neurons plugged into the World Wide Web and powered by Prozac, and another of man as a soulful being with burgeoning passions that will not be denied.

It is the decade of human drives versus disk drives, and the id is casting a long shadow, especially over the Internet. The id turns out to be a little like a water balloon, just the way Freud described it.

Squeeze the balloon tight at one point, it swells at another. So as technocrats offer up voice mail with endless digital options but no real voices, mice that point instead of squeak, and the option of going to work or going food shopping without really going anywhere, the id's stock is rising like Coca-Cola. It's the real thing.

Cigars are back. Big, thick ones that are routinely finding their way into women's mouths as well as men's. Strip clubs are sprouting up everywhere and business is booming.

Cosmopolitan magazine has rededicated itself to exploring the female orgasm. Drugs, an unfortunate, artificial and cowardly flirtation with one's mind, are the rage.

I'm told a decent bag of heroin can be had for four bucks (down from twenty) in some towns. Larry Flynt, publisher of Hustler, the first large-circulation man's magazine to photograph women's genitals without any fuzzy lenses, is being depicted as a hero in a major motion picture. Sports Illustrated has gone with an all-bikini swimsuit issue.

Fashion includes piercing body parts-noses, tongues, lips, even parts of the vagina and penis-as if to confirm the existence of the corporeal, to anchor our flesh in moments of pain and loops of stainless steel. Extreme fighting, in which bare knuckles replace padded gloves, is cutting into boxing's popularity.

Movies about disasters are the only ones Hollywood will really gamble big on. People want to see a tornado or volcano or asteroid bust everything up. They want to see how much more powerful Nature is than the stuff we build on it.

Sex is one of the biggest Internet products, with groups on sadism and masochism generating interest no psychopharmacology chat room ever will. The id is snaking through the Web.

Watch for other predictable triumphs of id: Prostitution will skyrocket, violence in movies and television and print will reach a fever pitch. The death penalty and abortion and euthanasia-gripping dramas rooted in organic viability-will be even more vigorously debated. We may even conspire to make war, to kill together, in order to know we are alive together. Strangely, this is all good news for psychiatry, at least the human version of it that seems now to be at death's door, the version in which people's emotions have meaning beyond the synapse.

"Because I predict more and more people will be fed up with simplistic explanations of their life experiences that reduce their psychological worlds to serotonin and norepinephrine and dopamine. Those of us interested in the truth and helping people find it will see our stock start to rise with the id's. I can't wait to watch managed care try to manage what's brewing just under the surface, in that place my patients keep telling me their Prozac doesn't seem to reach." -Keith A., M.D.

This buckshot prescription routine with minimal follow-up by the ship-docs who think life is a cruise so get over your pain is called treatment by effect. If the effect is good, the treatment worked; if it didn't, well, try this. If that doesn't work, get over it, and no, you can't see one of those talking psychologists unless you use this drug. But the real creepiness of all this is guess who are now being given these neurochemical regulators?

Guess which population is now being exposed to these "no big deal" drugs.

Well listen to the hue and cry going on about the 3,000 kids a day who are getting hooked on cigarettes by the tobacco companies. And listen to the whispering nothing about all the children being given the SSRIs.

I see it all the time. If Ritalin doesn't work, guess what we are starting to use? "It's safer than Ritalin." You'll see in the next several years that Ritalin will recede and SSRIs will fly through the roof. I can live with an adult population that can be "smoothed out" by Prozac et al.

But the notion of smoothing out Tommy who hasn't and won't find himself for a whole lot of years yet roasts me big time. Cause little Tommy's brain is still growing and patterning, and producing its own chemical reactions in its own natural fashion. Yes, he will be able to understand and care about a poem in a few years, if not now. That's all right. We do not have the right to smooth him out so much that he never experiences the angst that will make that poem have some meaning.

But, hey, it's America, we dig transience; the hell with tradition, place, and cultural meanings that are longer than the last dress cycle. We need our kids to adjust, man. If Prozac helps, do it, ya know. Works for me, man...