Hamm − In the morning they brace you up and in the evening they calm you down. Unless it’s the other way round. That old doctor, he’s dead naturally?
— S. Beckett, Endgame
Since the 1980s, a conviction has been spreading in the West that our spiritual problems could be resolved particularly by the neurosciences. Some books on neurology − for example by Oliver Sacks − have become bestsellers. Psychiatry has taken a decisive turn towards an organicist vision of mental ailments. The vision of the Ancients was likewise organicist − for them it was the black bile, for us it is the cerebral neurotransmitters.
Thus, it’s no longer borage and hellebore that cure those ailments. In 1938, Lucio Bini and Ugo Cerletti − inspired by the way in which pigs were stunned in slaughterhouses − applied the first electroshocks: an electric discharge in the brain provoked an epileptic attack in the patient. The technique proved efficient in treating grave states of melancholia, but on the wave of enthusiasm, the therapy of electro-convulsions was applied in case of most mental ailments. Electroshocks went out of fashion in the 1960s, stigmatized as a cruel method (the critique was launched by the pharmaceutical companies, which were interested in selling expensive medicines instead of the shock therapy, which was rather cheap). Thus we entered the golden age of psychopharmaca.
1. Prozac for Mayakowsky
The most successful among these have been the antidepressants and certain drugs that treat “panic attacks” (known for a while as anxiety attacks: Pan was chased away by the drugs). It was discovered that, when we feel low, our brain produces an insufficient amount of two neurotransmitters, noradrenalin and serotonin; antidepressants stimulate the production of these agents of good mood. Thus, in the 1950s and afterwards, depressive people were prescribed tricyclics and IMAO (inhibitors of mono-amino-oxides). Bipolar persons were treated with “mood stabilizers”: lithium salts and anti-epileptic drugs. The year of 1988 saw the beginning of the triumphant march of serotoninergics: their earliest example is Prozac (fluoxetin). They even dared call it “the happiness pill”. More than 40 million persons are taking it today.
From 1988 to 1998, the consume of antidepressants doubled or tripled in many industrial countries. Three percent of the American and British population take them on a regular basis.
And yet, psychiatry still does not seem satisfied with this triumph. Instead, it thunders against the fact that around one half of the depressed patients, some of them serious cases, just would not be cured. In fact, many depressed persons refuse to recognize that they are sick: they interpret their state as a way of being-in-the-world and reject all treatments. Medicine claims to have an objective criterion for evaluating subjective conditions, insomuch as, if one says “I am unhappy, but I am not sick”, the doctor will consider him doubly sick: because he is depressed and because he refuses to admit it. Not wanting to qualify yourself as sick is considered a symptom of your sickness as such.
In the epoch of Stalinism, there was an epidemic of suicides among Russian poets. Had Mayakovsky been taking Prozac, he may not have killed himself. But to say that the cause of Mayakovsky’s suicide was an untreated depression attack is a way of distorting the reasons at one’s will. And why thinking that “life is still worth living, even though I failed in what was giving sense to my life” should be a sane thing? Mayakovsky belonged to a generation that avowed their very existence to the Revolution, only to find himself in a state of beaurocrats and the GPU. With Prozac he may have continued living in the byt of a USSR that he was appalled with − the man Mayakovsky would have survived, but we would have lost the poet. I am not saying that Mayakovsky did well in killing himself, I am only saying that his suicide was the pinnacle of a life that was given to a Cause. However, many therapies today practice precisely the philosophy of the Last Man, as Nietzsche termed it: the important thing is to live, regardless of why or how. Even if I am a slave, I must live happily.
Questions of this type were raised by the anti-psychiatrists of the 1960s and 1970s (Laing, Esterson, Cooper, Szazs, Guattari, etc.). According to them, depriving the depressed person of all sense of his unhappiness is an act of violence, even if it is a different sort of violence from the strait jacket of the past times.
Many detest technology as such, and psychopharmacology all the more. Even if the psychopharmaca have saved many lives and their use has made it possible since the 1970s to carry out the great de-asylumizing reforms in the West (in Italy, it was Act 180, inspired by Franco Basaglia, that led to the closure of asylums). Community care − treating the mentally ill outside of segregational institutions − managed to affirm itself precisely because the psychopharmaca made it possible to control acute crises. Thus, it is really not the case of denouncing the psychopharmaca. Instead, I would like to draw attention to the way in which the diffusion not only of psychotropes, but also of medical technology in general, reveals some essential things about the contemporary way of life.
Dejection − for centuries an exquisite topic of melancholy humanists − has increasingly become the object of investigation that is carried out by scientific methods: demographic research, epidemiological tables, statistical correlations, etc.
The scientific approach produces lots of numbers. As for depression, it has supplied us, among other things, with the following figures:
— In today’s world, about one person in 20 suffers from depression in some moment of his or her life.
— 2-4% of the population has suffered or will suffer from bipolar disturbances.
— The occurrence of depression, in Western countries, is permanently on the increase. According to the WHO, in 2010 depression will be the most severe health problem in the world after cardio-vascular diseases. It will affect between 25 and 45% of adult population, with an increase primarily between children and adolescents.
— 85% of single episodes of depression last less than two years, 73% less than a year, and around 60% less than six months.
— Even if women are more prone to suicide than men, successful suicides are primarily masculine. The urge to commit suicide is especially high among young people between 16-24 years of age, singles, widowers, and unemployed persons.
— One mostly becomes depressed in spring. Another, minor peak can be observed in autumn. The in-between seasons make us more unhappy.
— Globally speaking, on every depressed man there are two depressed women. Women seem more prone to panic attacks and alimentary disturbances (anorexia, bulimia) than men, whereas men are more prone to autism, conditions of hyperactivity, alcoholism, and drug addiction, as well as to criminal activities and risky forms of behaviour.
— In Italy, there are 15 million depressed persons, of which 9 million have been diagnosed as such. In seven years the number of depressed persons has risen from 10 to 15 million and it will have doubled by 2020 − one half of all Italians will be affected by melancholy.
But is it true that in our times we witness such a vertiginous rise of depression? Or is it the psychiatry of today that diagnoses as depression what would have been diagnosed differently in the past? Until some decades ago, being depressed was only a symptom, which could signal entirely different syndromes; just as fever, for example, can be a symptom of very different diseases, from malaria to influenza. Why is it that at first it was considered a symptom and then it was transformed into a fundamental pathological category? Probably it was precisely owing to psycho-pharmacology; it has reaped its most notable successes exactly by producing drugs that change people’s mood. It does not matter why you are sad: antidepressants will reduce the burden of sadness. And it was only a step away from isolating depression as an ailment in itself. In short, it was the antidepressants that brought about the triumph of the diagnosis of depression, not vice versa.
The dominant strand of psychiatry is convinced that depressions − just like most mental ailments − are largely genetically determined. (Even Hildegard of Bingen, in the 11th century, claimed that melancholy was passed on to children.) Canonical studies make difference between monozygotic twins (that is, twins that are genetically identical) and dizygotic twins (simply siblings that were born at the same time). If a genuine twin suffers from major (very grave) depression, in 65-75% the other twin will be depressed in the same way; and that will happen even if the two twins live completely separated, meaning that they cannot influence each other. On the other hand, if a false twin becomes depressed, the risk of the other twin becoming depressed as well is only 20-25%. These data are considered as an ultimate proof of genetic causality. Besides them, the media have endorsed for years the theory of genetic origin of almost all forms of human behaviour − including homosexuality, goodness, working creativity, conjugal infidelity...
But things are a bit more complex. In fact, if depression were determined solely by specific genes, the correlation of depression between genuine twins should amount to 100% (given the fact that their genomes are identical), but that is not the case. The genes alone cannot explain the growth of depression in the Western world in such a short period of time. Paradoxically, genetic theories of depression prevail at the same time as it has been established that mal de vivre cannot have solely endogenous (solely organic) sources.
However, many find it depressing to read these data and theories on depression, wagering on the fact that depression should have a sense: that, moreover, beside the possible causes of depressions, there should also be reasons for it, often even good reasons for being unhappy. In fact, there is a clash between two ways of thinking about human existence: the scientific one, which prefers causes to reasons or meaning; and another, derived from the humanist and historicist vision, which prefers reasons or meanings. Currently our culture, which has already become secularized, is in the process of “causalization”: the primacy of causality undermines the research on reasons or meanings.
3. Placebo Antidepressants
Since times immemorial humans have been dissatisfied with certain mental states, and they have always tried to change the tone of their own mood by using substances − alcohol, caffeine, tobacco, camomile, cocaine leaves, peyote, etc. Considering this ancient tendency of homo sapiens to be dissatisfied both with his body and with his soul, many cultures of the past devoted themselves to permanently deforming the body or the soul. Modern humans, with their tattoos, pharmaca, and surgeries do nothing else than perpetuate this passion for self-correction. Nevertheless, our age has seen a turning point in that.
To be sure, psychiatric biotechnology disposes so far only with some dozen varieties of drugs: a somewhat skimpy assortment, if we think of the kaleidoscopic diversity and subtlety of our spiritual torments. It is a bit like wanting to perform Gershwin’s Rhapsody in Blue and having only a tambourine and a fife at hand.
But are these antidepressants really effective? Facts, evidence…
It is said that around 80% of the depressed persons react well to antidepressants. Even if it is often difficult to establish why. Actually, some researchers have acted as killjoys, asserting that the efficacy of antidepressants has been much overrated. In today’s medicine, the placebo effect (Latin for “I will please”) is taken to be an irrefutable fact: it has been established that, when a would-be doctor gives a concoction without active substances to his patients as a medicine, a certain percentage of sick persons will get better or recover. Placebo means that a part of medicine − from the shamans to the present-day biotechnologists − is magic. Today, a drug gets officially accepted if it produces more clinical improvements than those that are magically produced by the placebo: if a false drug, for example, cures 35% of cases and the tested drug cures 45%, the American Food and Drug Administration proclaims it efficient. Now, it has been calculated that the “happiness pills” produce effects that are statistically barely superior to those of the placebo. Irving Kirsch and his collaborators have found out that the improvement owed to the placebo has a value of 82%, which means that only 18% of the positive reaction is due to the active substance. Briefly, when a depressed person takes a drug and feels better, we can never know whether that improvement was due to the active substance or to suggestion.
Other studies, however, show great efficiency of the psychopharmaca. But the point is that today medical research is becoming increasingly dependent on pharmaceutical companies − thus, the researchers and the sponsor tend not to publish results that are unfavourable for the industry. It is not by chance that, when the patent of a drug runs out, researches that reconsider the efficacy of that drug sprout like mushrooms…
There are others who deny straight away that antidepressants can effect cure, if one understands cure as eliminating the first cause of an ailment. In fact, as long as the subject takes them, he or she will feel better, but once they are off the drug, they will become depressed again. Thus, the pill, taken until the end of one’s natural life, will function as a permanent mental prosthesis.
Others again object to the necessity of eliminating depression, at least if it is not devastating. Depression, like any other ailment − they say − also performs a useful function. Just like the toothache signals to the subject that something is wrong with his or her molar, the depressive feeling signals to the subject that something is wrong with his or her existence. But alas, finding the rotten spot in the existence of a melancholy person is usually far more difficult than finding a caries. Therefore, there is a great temptation in psychiatry to reduce the cure to administering an anaesthetic: what is important is that the client should no longer feel the fatigue of life and that he should sing praises to his psychiatrist.
Critical voices follow up closely: is it desirable to have a humanity that is incapable of suffering mental pain − since it has been systematically cancelled by some chemical contraption − and thus incapable of realizing what is going wrong? Our mood is also a judgment that we pass on the world, even if the growing psychologization of our hardships leads us to perceive all our “non-adaptive” reactions as pathological. For example, a patient visits a psychoanalyst and complains that he no longer manages to feel well with his habitual friends: “What has gotten into me?” At a certain point, the analyst asks him: “But do you really like those friends?” As if stricken by a lightning, the patient changes the tone: “Well, no! Deep within, I find them all dull and narrow-minded! I should actually change friends.”
Between satisfaction that is due to success and love and one due to a psychopharmacon, the difference is that, in the first case, other people have mattered. Is it an irrelevant difference?
Love can also be seen merely as an internal state. When we fall in love, serotonin, oxytocin, and pheromones act upon our brain. The day is not far when, if I fall in love with someone who is inconvenient, for example a pauper, I will be able to stop loving that person by way of chemistry. But would that be the right way of not loving the person anymore? Behind the debate on the causes and cures of unhappiness, therefore, a fundamental ethical debate begins to take shape.
In any case, all these scruples will not halt the galloping advance of the psychopharmaca. And it is not only because, be it for chemical or placebic reasons, they prove efficient. Our desire to feel good at once is too strong and it does not matter how we achieve that − we want to consider ourselves happy now, not in a next life or when our grandchildren will live in a Perfect Society.
4. Beauty Treatment for the Soul
Anyhow, medical theories and techniques today tend to remove the realist tropism of the human being, to isolate the patient from his or her being-in-the-world.
We are approached by a subject with a whole complex of symptoms: tachycardia, perspiration, palpitation, incontinence, paleness, adrenergic and noradrenergic discharge... Do we treat these symptoms as organic disturbances? And yet, all these are the physical side of what we normally call fear. Because the subject in question, for example, was almost hit on the road by a gigantic TIR. What is the cause of this state, the adrenergic discharge or the truck? For the psychiatry that dominates today, the true cause is the adrenergic discharge. The origin of our problems is entirely within our brain, not in our relation to the world in which our brain is embedded. It is true that the sense of danger is always based on images − I think that the TIR is going to smash me − but these images refer to something that is outside of me. However, for today’s psychiatry, our mental torments only seem to have a significance, whereas in reality it is only some internal chemical misbalance.
The success of psychopharmaca thus illustrates the spirit of the times. Medicine today − not only the psychiatric one − not only has an ever growing tendency of curing recognized pathological states, but also aspires − on the basis of the laissefair maxim that “the customer is always right” − at modifying anything that bothers us. From the shape of our nose to our incapacity of enjoying classical music, or the absence of desire for our partner (“I am sick. I’ve been married for twenty years, my wife has become old, she is full of cellulite, and I no longer feel any desire to make love to her. Cure me, doctor!”). That is why more and more people resort to aesthetic surgery and bio-technological interventions that optimize our mood, our sexual or professional achievements, our fertility, or our desire. Psycho-pharmacology tends to become a lifting for the moods, a iatrogenic beauty treatment for the soul.
But the growing impact that these iatrogenic beauty treatments have on our lives is only one aspect of the growing domination of techno-sciences in our existence. In the 1970s, Michel Foucault observed this role of biotechnologies also in our political and social life: he used the term biopolitics. A concept that is becoming ever more central in today’s political philosophy.
5. The Empire of Happiness
If on the one side the prevalent need of “Happiness for me, now!” is expanding, on the other side, as if by counterattack, there is an emerging horror of life engineering that would assure the happiness of all people.
This horror emerged in the twentieth century. We have seen how in the sixteenth and seventeenth century Utopias were literary fictions about perfect and happy societies; in the twentieth century, however, Utopias became almost regularly negative, predicting terrifying social arrangements. In 1932, Aldous Huxley published his Brave New World, a futuristic romance that − like Orwell’s 1984 and Bradbury’s Fahrenheit 451 − still enjoys great popularity. In the year of 2579, humanity would be unified into a single World State, governed by wise technocrats (as if anticipating the Empire that Toni Negri and Michael Hardt have made famous with their book of the same name). Poverty and wars have been eliminated and all people are happy thanks to the appropriate governing measures. In this hedonistic Eden, everyone engages freely in promiscuous sex and uses a hallucinogenic drug called soma, which eliminates all suffering and unpleasant memories, making everyone dispassionate and vigorous (a world that would please orgonomist Wilhelm Reich). This system had to dispose of all perturbing forms of life: family, culture, arts, literature, admiration for nature, grief, science, religion, philosophy, history. In that vigilant Empire, one lives in an eternal present, without nostalgias or expectations, merry in the immediacy of pleasures. And at the Empire’s margins, dissidents have survived that refuse to adapt to this imposed happiness − languishing there a bit like today’s American Indians.
A literary fantasy? But the lithium that persons with bipolar disorders are compelled to take all their lives, isn’t it similar to Huxley’s soma? Recently it has been discovered that the hippocampus and the amygdale in our prefrontal cortex serve to cancel unpleasant memories (Science, 12 July 2007): some have already come to the idea that by reinforcing these two regions we might be able to forget all our negative experiences. We would all have a radiant past preceding a present that is implacably joyous.
In the past decades, research on happiness has gained momentum. Studies on happiness have practically acquired the status of an autonomous scientific discipline. Eudaimonologists are mostly economists (which tells a lot about our priorities: happiness is being assimilated to economic utility, we can accumulate happiness in the same way as capital or immovable properties are accumulated). The popularity of such research is a sign of the substantial nihilism pervading our culture.
In fact, in a nihilist society it is no longer important what reasons one may have to feel happy: everyone, like in a well equipped supermarket, can choose for themselves the values and ultimate goals that they prefer to pursue in order to be happy. What is important is that everyone should feel happy, not the reasons why he or she feels so. But that point of view is repugnant to all those − antiquated humanists − who reject the idea that one should be happy at any price. To live in ignorance and mere illusion of being happy? If it turned out that the more ignorant, stupid, and careless one is, the more happy one becomes, would it be right (?) to prefer happiness? How worth is it to have happiness at any cost? Is happiness without truth really happy? In Huxley’s Empire one must renounce things like art, science, and philosophy, since in order to be happy one must forget the Real. The Technology, that insurrection against nature, takes the place of the Real.
After 1945, the First World (Western Europe, North America, Japan) entered a long period of prosperity, and for many countries it was peace as well. In the course of several decades, life expectancy, average height, and the IQ increased in our populations. And yet, the eudaimonologists show that it has caused a profound and widespread problem: an increase in depression (Ehrenberg), alcoholism, use of drugs and crime (even if the latter has been diminishing in some societies since 1980).
In the most industrialized countries, the welfare state, democracy, civic rights, and free market do not rise the average level of expected happiness. This stagnation of satisfaction affects almost all social levels. Economic, social, and cultural growth is accompanied by the deepening of − new or old − indispositions. Thus, depression would be only one way of manifestation of a pluriform and magmatic Dejection, which occasionally expresses itself in violent behaviour, psychotic delirium, eating and sleeping disorders, use of narcotics or psychopharmaca. This expansion of Dejection has resulted from a cultural change that is still difficult to evaluate.
Probably, indispositions are spreading because we all demand more and more from ourselves and the standards of our ambition seem to have grown drastically. Thus, failure and inability to enjoy oneself are less and less tolerated. Our culture is only apparently more permissive and mild with respect to the patriarchal, forbidding and accusational one of the past. In fact, the modern civilization − as Freud would say − reinforces our Super-Ego. And that, as Lacan has observed, increasingly imposes an inflexible obligation upon us: “Enjoy!” The judging part of us is becoming ever more demanding: we all must be and stay beautiful, young, rich, seductive, famous, envied, happy. We suffer more and more because we do not manage to enjoy things as much as we should.
6. Return to the Desert
“Man”, as Hegel claimed, will be truly free “only when he has surrounded himself with a world that he has created in its entirety” − and it is precisely what we see coming into reality today. But it is precisely because the Hegelian project of unchecked humanization is becoming reality that many consider the present world an impossible place to live. They protest against the normativization of the world by means of techno-sciences, the reduction of thought to calculation, the levelling of political action in administrative choices, the aesthetical uniformization of the planet according to Anglo-American models, etc. In a universe that is becoming more and more anthropomorphized and technologicized, there is less and less place for human transcendence of the Real − by anything that surprises us, leads us into a crisis, or changes us. The Real is what the ancient Greeks called ousia, “the patrimony”, the substance of things, the reality beyond our very human interpretations. Hence a paradoxical, polemical need of emptiness. Like in the first Christian centuries: the temptation of the desert.
Now, the need of psychopharmaca reflects the most crucial specificity of our times: the loss of the Real. Our gaze is increasingly turned towards the psycho-physical organism, abandoning that which captures and transcends it. Let us consider the way in which certain antidepressants were tested. The researchers separated a number of apes from their mothers during the first year of their lives, thus achieving a state of mind similar to human depression; then they gave them antidepressants and they were “cured”. Mamma Prozac was invented. The real loss could now be compensated by a subjective vision through a chemical substance. Human beings deprived of freedom or love would be able to live happily all the same, with the help of fluoxetin.
Economist Amarthya Sen provokingly invoked the “happy slave” proposed by Tocqueville. Owing to techno-medicine, we could be satisfied even in a Nazi camp − what matters is our mood. At the end of Monty Python’s Life of Brian (1979), a number of unfortunate men are crucified: on the cross, they console themselves by singing “Always Look on the Bright Side of Life!”. What does it matter if they are tormented − if a drug will make them sing all the same?
American philosopher Hilary Putnam has proposed the image of brains in a vat. Cartesius was already practicing “methodological doubt”: if we can be sure of nothing, it may be that an evil demon is always deluding us and, moreover, that all which I perceive, as well as my most logical reasoning, are a result of metaphysical delusion. A hyperbolic doubt, a complete cognitive madness. Putnam’s image modernizes the Cartesian doubt: it might be that, in fact, we have no body, that we are merely brains immersed in organic bath, and that these brains are stimulated electrically, through electric wires, by a mad scientist. These stimulants would then give us all the sensations, objective and subjective, that we call “the world”, including the sensation of having a body and moving around. We believe that we are being-in-the-world, but in fact we are-in-the-vat. I would like to emphasize that Putnam’s image is intended as a bio-technological − and bio-political − contraption.
This metaphysical metaphor has become the theme of various works of science fiction. Especially the legendary Matrix trilogy by the Wachowski brothers (the first ∫lm is from 1999) has impressed many philosophers. In these films, the relationship of domination between humans and machines is presented as inverted: man has fallen into complete − and unconscious − servitude to a sole universal machine, the Matrix. This machine uses human life for self-sustenance and makes humans live in an illusory world − which is a mirror image of today’s America − like brains in a vat. That fictitious universe is not even that bad − after all, in the prosperous America of today life is not too bad either − but the point is that they are nothing but images. Only a small group of dissidents has understood what moves this theatre of illusions. These “illuminated” know what the Earth has been reduced to, having been devastated by the machines: to a pitch-black desert, arid and void of life. In the bowels of this wasteland, the “realists” are fighting against the Imaginary. It is a modern version of Plato’s ancient allegory from The Republic: only the few elected understand that their fellow men believe the shadows on the cavern’s bottom to be the reality, and they are searching for the true light.
Cypher, a character from the film, visits the imaginary world of Matrix and, eating with gusto, pronounces the following words: “I know that this steak doesn’t exist. I know that when I put it in my mouth, the Matrix is telling my brain that it is juicy and delicious. After nine years, you know what I realize? − Ignorance is bliss”. In fact, Cypher talks like the philosophers (Hume, Berkeley, Nietzsche, etc.) who have for more than two centuries ex-alted the sensual appearance against the thing-in-itself, not believing in a reality beyond the perceptible. For modern subjectivism, we can peacefully take the phantasms induced by the Matrix to be the reality. As Nietzsche said in Twilight of the Idols, “the real world has finally become a fable”. Perhaps the success of a film like Matrix signals the resurrection of a metaphysical preoccupation that seemed completely cancelled in the nihilist and pragmatist exaltation of subjective appearances as the only ones that count for us. Today we witness the emergence − in a world that is increasingly virtualized by the technologies − of a fierce demand of the Real.
But this Real in the name of which the “realists” are fighting against the illusion is eventually a desert. Philosopher Slavoj Žižek was inspired by Matrix for the title of one of his books: Welcome to the Desert of the Real. Regarding all the dazzling, glistening, and amusing things that the technologies have to offer, this call to the Real sounds like a mistuned ascetic exhortation; it is no different from the project of the ancient monks as they were offering themselves as prey to acedia. Like the few contesters of Matrix, those monks were also going to live in the desert, they were also searching for the Real − for them it was the Being, God.
After so many centuries, the snake seems to be biting its tail: a cold and dry desert is invoked as the proper place for the Real. As our true, renegade homeland. But so difficult to endure.
— Translated from Italian by Marina Miladinov