Coming of Age on Zoloft (35 page)

Yet the stigma question isn’t as simple as it’s often made out to be. What’s been happening over the last few decades is more than just a removal of stigma from cases of mental illness that were once stigmatized, an unshaming of the previously shamed. By now, a troop of social scientists, journalists, and other observers have documented the ways that pharmaceutical companies actively “market” diseases, to doctors and the public alike (a feat they achieve by such means as funding public awareness campaigns and screening days, bankrolling patient-advocacy groups, and running educational retreats for doctors), and then tout their products as the means to treat these newly publicized ailments.
19
Drug companies that encourage us to perceive ever wider swaths of experience as mental illnesses aren’t white knights waging a noble war to remove stigma from horribly stigmatized diseases. Instead these companies are creating stigma
‡
with one hand before they profitably remove it with the other. In carving out new territory for illness, they are stigmatizing what hadn’t been before, and then—voilà!—declaring that the illnesses they’ve defined are real and, therefore, should not be stigmatized. With one gesture, they sicken us; with another, they turn around and remind us magnanimously that it isn’t our fault that we are all so mentally ill—and ask us, by the way, whether we’d like to buy some medicine.

IN MY INTRODUCTION
I wrote that one of the stranger things about growing up is attaining an age where you can look back and actually perceive historical change as having happened during your lifetime. When I read, when I talk to my parents about their experiences and reflect on my peers’ and mine, when I try to think about what’s been different for us, I start to see my generation as one that is defined by mobility and choice. We were raised in an era of unprecedented consumer abundance: brought up to count on disposability, endless customization, and a hundred varieties of any item we might desire. We have also lived through a marked breakdown of social expectations, particularly the expectation of continuity. The patterns that structure behavior and define our life plans are fading, the benchmarks that once defined success becoming less relevant and less dependable. Consider these oft-repeated facts: thirty years ago, a man might expect to work for the same company for all his life, but many young millennials expect to change jobs, and even fields, every year or two. The average age of marriage is rising. The women of my generation were raised by their second-wave feminist mothers to believe that we can (and should) do it all—pursue careers, have families, take time for ourselves—but with little hard guidance about how it’s supposed to be possible to fit it all in. Relationships come with fewer expectations: that they’ll last, or of what is meant by “relationship” at all, and sex more often takes place outside of them. Our lives feel unscripted; we are re-writing the roles from scratch. The erosion of expectations is freeing, but it can also generate a kind of panic, as it does for the high-achieving students Joseph Davis described, whose inability to conceive of definite goals for their ambition leads to a dizzying and constant feeling that they haven’t achieved
enough
. We are moving and experimenting more, accumulating less. There’s nothing holding us down.

There’s nothing holding us down.

I remember reading, when I was thirteen or so, a lifestyle article in the newspaper about how people in their twenties were living together in shared rental houses. The article described this phenomenon as if it were new and fascinating, which is funny to me now, but what made it memorable then were the descriptions of the house and the lives of the people inside it. Rambling hallways, communal meals, good music on the stereo, funky jobs, interesting conversation late into the night—the piece painted a vivid picture of young adulthood as a promised land of easy community and bohemian good times, and I read it with a mounting sense of impatience for the day I’d be old enough to join the fun.

Do I need to tell you that it wasn’t always like that? The period after college, in particular, was a hard time for me, as it is for many. Aware of our advantages, my friends and I were surprised to find ourselves feeling so lost. The world seemed sharp-elbowed and mysterious, and real community was hard to locate. Sometimes I wonder whether one thing antidepressants have done in my time is to help underwrite this unprecedented historical invention,
one’s twenties
, a long period of time in which we’re permitted to explore, to not be settled down, to wander among the social and economic and physical landscapes of our country, trying to find a place for ourselves. This wandering is a privilege and often fun, but it is also difficult. Maybe it would not be so psychologically taxing if it were better defined, if its meaning were somewhere, in some way, clearly laid out for us. But it is not. We must each decide or work out what it means for ourselves; we must draw our own maps. It’s hard to travel without a map, to wander. My sense is that some of us are better equipped, by constitution, for this wandering than others. Perhaps antidepressants are in part a technology that helps to make it supportable for the rest. Maybe they are capitalism’s answer for some of the things that capitalism doesn’t supply well: warmth, connection, and a diffuse sense—in a world of limitless possibility and little in the way of tradition—of rightness.

There’s at least some evidence that I’m not inventing this sense that life has grown more unstable in recent years. Not long ago I was arrested by an American Psychological Association press release headline that screamed, “Average Child Today Is as Anxious as Average Child Mental Patient in the 1950s.” The studies it referenced found that American children and college students alike display significantly more trait anxiety today than they did sixty years ago. The change correlates highly with a significant nationwide dip in the level of social embedded-ness (as measured by factors like the prevalence of divorce, the percentage of people living alone, and how much individuals report trusting others), and a rise in the level of perceived overall threat (including factors like crime, and the fears of environmental degradation and nuclear war) over the last sixty years. “Societies with low levels of social integration produce adults prone to anxiety,” the researcher wrote in her conclusion, noting that anxiety is a factor that predisposes people to depression. “Until people feel both safe and connected to others,” she observed, “anxiety is likely to remain high.”
20

If our aggregate bad feelings really are in part the product of social disconnection, it is ironic that the remedy we’ve embraced is itself a disconnected one. Depression can be thought of as a crisis in one’s ability to feel close and connected to others. But as medication becomes the standard of treatment for emotional disorders, human contact becomes less and less a part of the cure. As society grows less embedded, mental health care becomes less embedded too; in this generation, for the first time, the professionals in our society who are assigned to handle human emotional pain are often assigned to handle the emotional pain of 1,400 humans at once. And it’s not just doctors that patients are disconnected from. As a cure, there’s something a little pyrrhic about antidepressants; in order to obtain the relief that they offer, you have to consent to the premise that your pain is irrational. In both senses, antidepressants underscore the feeling of aloneness that they are supposed to mitigate.

It is easy to take a pill. It’s forbiddingly difficult to remake society in a healthier image. It is also easy to take the flashy argument that mental illness consists of nothing more than being “sane in an insane world” too far. Mental illness is real, and medication benefits millions of people. If one thing emerged from the conversations I had for this book, it’s a conviction that people who are treating an emotional problem do best when the treatment they use is the one they desire and believe will work. It is a powerful thing to talk to someone who uses a medication that they know helps them. If antidepressants impacted my generation by teaching us that we have some recourse to feeling fruitless misery, then they have done us a real and lasting benefit. But it is important for us to hold onto an awareness that there’s more that goes into how we feel than the configuration of chemicals in our own brains. There is value in pushing back against the message—because it’s so well-capitalized and comes out so loud—that suffering and sadness are always signs of disorder, or that there is nothing to be said for understanding them in any other way.

In themselves, antidepressants are a neutral technology. But as products that are sold to us, they arrive along with stories about how we ought to feel, and why we feel the way we do. It is in pharmaceutical companies’ best interest that we feel confused about what is normal, and that we err on the side of assuming that any given problem could be a sign of a mental disorder. We need to remain aware of what these stories are, and continue to ask whether they are true and whether they serve our own best interests too. A simplified version of the biomedical model of mental illness can hurt us when it is carried too far into the way we think about life. The messages that come with medication become damaging when they begin to collapse the distinction between living free of mental illness, and living meaningfully or well—replacing a bigger conversation about our goals and values as individuals and as a society with a circumscribed one that revolves around illness and its saleable treatments, rather than the conditions for health. When the choice of whether or not to medicate fills parents with guilt no matter what they select; when our preoccupation with psychopathology makes negative emotional states more distressing because we fear excessively that they may be signs of a serious problem; when we accept the chemical-imbalance story as an invitation not to think critically about how the environments we live in and the choices we make also contribute to how we feel, the prevalence of medication has begun to create background noise, a cacophony of worry and mystified expectations that distracts us from the real tasks of living, and actually makes it harder to grow up.

While some of us will need medication, or want it, we all need things that medication can’t provide—things we shouldn’t overlook in our enthusiasm for easily classified problems and quick, high-tech solutions. We need things that can’t be commodified or manufactured, that can’t be rendered more efficient, and that will never make any company rich. In our society, with its glistening surfaces, we all need reality checks. We need to talk to each other, as honestly as we can. We need help sorting out what’s worthwhile from what isn’t, what makes us feel good from what makes us feel bad. We need the comfort of feeling like we’re not alone. We need meaningful work and real rest, or at least the hope of these. We need connection and love. And we need to learn, by trial and error, how to take care of ourselves.

Adults need to remember how much they can help, how much young people still need them. Once in a while, young people need an adult to notice when something is really wrong, to intervene and give a medical problem the dignity of a medical name. Without exception, they need grown-ups to pay attention, to listen and hear, and to set examples, not of TV-personality perfection, but of actual, struggling adulthood. They need someone who can walk the fine line between looking out for real trouble and speaking the age old, unmarketable words for which there is no substitute:
I know it hurts
and
Trust me, it’s going to get better in time.

NOW AND THEN,
somebody asks me if I think I was
really depressed
, back in college. Of course I’ve asked myself the same thing. It is hard to know how to answer the question. It happened a long time ago now, and it’s not easy to piece together the memory of an emotion after the fact. I think the only fair answer, though, is “yes.” I was upset, to a degree so pronounced and different that it seemed to demand its own name. I don’t know whether my upset was caused by biological factors or external ones, but the only plausible answer would seem to be a combined one: I was depressed because of a mysterious totality of forces, the contribution of my genes and neurons joining together with my life history, catalyzed by the things I was going through at the time.

Implicit in this question, “Were you really depressed?” is the question, “So, are you glad you took antidepressants?” That one is tougher to answer. Sometimes I catch myself wishing it had never happened. It’s easy to fantasize about the ways my life could have been better without them: maybe I’d have stayed as serious about writing as I was in high school. Maybe if Zoloft hadn’t killed my sex drive, things would have worked out differently with my college boyfriend, Jeff. Maybe, with all the time and energy I spent fretting about whether or not I was really myself on antidepressants, I’d have done something else, developed an interest that was more wholesome or outward-looking. On the other hand, I can’t know whether things would have been worse. Maybe I’d have dropped out of school. Maybe I would have muddled through but had less fun, achieved less, not distinguished myself as much. Maybe I would have taken fewer risks in my life after graduation; maybe I’d have clung more, and maybe that would have been bad for me.

“What if” is an impossible game to win. I can’t change the past, and I am happy with where I’ve ended up. So I say that no, I’m not sorry I used antidepressants. I am sorry, though, about how patchily I was supervised, especially at the beginning. I am sorry that I received medication first and psychotherapy only a long time after. Most of all, I’m sorry for how thoroughly I absorbed the message that came along with antidepressants, the one about having a sick brain. Anti-depressants had been prescribed to me, as I took it, because I was crazy, because I felt things that didn’t make any sense. That suggestion sank in deeply and lasted a long time, hollowing me out underneath the layer of brightness and confidence that the medication imparted. It made me think less of myself, kept me from noticing all the sense I did make, and enforced a tendency to underestimate my own strengths and overestimate the strengths of others that had been part of the problem from the very beginning.