The Tyranny ofHappiness: Ethics and Cosmetic Psychopharmacology
"Cosmetic psychopharmacology" is a term of art invented by Peter Kramer in his book Listening to Prozac. Prozac, of course, is an antidepressant, but what is so intriguing about it is not what it does for patients who are clinically depressed but what it does for those who aren't: patients who are shy and withdrawn, or who are rather compulsive, or who have poor self-esteem, or who are just plain chronically sad. What Kramer found was that when he put some of these patients on
Prozac (but not all or even most of them), they underwent a kind of
personality transformation. The controlling, compulsive types became laid-back and easygoing; shy people became more self-confident and assertive. Lonely hearts went on Prozac and pretty soon they had three dates a weekend. It is this kind of effect that Kramer calls cosmetic psychopharmacology, and it worries him. And what worries him is not something as simple as Prozac making sad people happier but less interesting or less creative. What is more deeply worrying is that for at least some of the patients on Prozac, their personality changes really do seem to be for the better. Kramer's patients say things like, "I feel like I've been drugged all my life and now I'm finally clear-headed," or, "I never really felt like myself until now." Some patients seem to
be able to see themselves in a way that they had been incapable of before. They don't just get well; they say, "I'm better than well."
There are lots of questions to be answered here, empirical questions about how often these personality transformations actually happen, and philosophical questions about the difference between curing a mental illness and enhancing your personality. But what interests me is another question, which is rather different. Some of the patients that both Kramer and other psychiatrists describe are a special sort. These are people who are empty and confused, sad or lonely people whose lives don't seem to have any direction, people like Kramer's patients who say things like "I don't know who I am," or "The whole world seems
Carl Elliott to be in on something that I just don't get."1 These people sound strikingly like the alienated Southern heroes in Walker Percy's novels, like Will Barrett in The Last Gentleman, a prosperous young Southerner who looks at all the prosperous Southerners around him and says, "Why do I feel so bad when they all feel so good? Why do I feel better
holding a shotgun than a three-iron?" Percy's most direct statement on
this question comes, of course, in his satire Love in the Ruins, whose psychiatrist-hero Tom More invents what he calls a stethoscope of the human soul, the Ontological Lapsometer, which can diagnose and treat
these existential illnesses. So I want to concentrate on just this one
particular sort of worry about cosmetic Prozac, the worry that Percy had, which comes down to something like this: suppose we could relieve all these patients of their sense of spiritual emptiness or alienation, these people who feel disoriented and lost in the world. Would that be a good thing, or is it sometimes better to feel bad than to feel good?
Now when some people try to articulate why it might sometimes be better to feel bad than to feel good, they often say that anxiety or depression is part of the human condition, or part of what it means to be human. That may be right, but it is not what I want to say. What I want to say is not about human beings in general but about human beings in the West in the twentieth century, and the predicament that many of us find ourselves in.
All human beings, no matter where or when they live, live within certain frameworks of understanding that give sense to their actions and to their lives. As Charles Taylor points out, they include understandings about what sort of lives have dignity, what counts as a good life and what counts a failure, what kind of life is worth living, and most important for us, when a life has meaning, or sense. We could call these frameworks transcendent in that they involve a kind of orientation toward a higher good or goods that are independent of our own will, or preferences, desires. Taylor, for example, develops a concept that he calls "strong evaluation."2 Strong evaluation is not about what we happen to prefer or have an interest in, but about what we think that people would be the worse for not preferring or having an interest in. So I would not think worse of a person if, say, he thought Dickens was a better writer than Tolstoy, even though I might think that he was wrong. But I might well think worse of him if he thinks that novels are a waste of time. I once heard Pauline Kael say on the radio that she couldn't really be friends with anyone who liked the movie "Forrest Gump." That's a strong evaluation, but it is also a kind of trivial aesthetic
The Tyranny €if Happiness
evaluation. What I have in mind are the kind of serious ethical evaluations that we make when we say, for instance, that a person is wasting his life.
How does this notion relate to our predicament as 20th century Westerners? In other times and other cultures a person might worry about his life being a failure within a given framework of understanding about failing to meet the demands of his station in life, or of losing his honor, or of failing to live a life that will get him admitted into heaven,
or displeasing his ancestors, and so on. Very often we feel some of these demands ourselves. But modern, twentieth-century Westerners face another problem: not that of failing to meet the demands of one's framework, like a Southern gentleman who backs down from a duel, but of being unsure of what the framework is. This uncertainty is an altogether new and frightening kind of feeling, a feeling Taylor compares to vertigo: a sense of imbalance, because not only don't you know what kind of life to live; you don't know what, if anything, can tell you.
Now people experience this feeling in different ways: as vertigo, absurdity, emptiness, the malaise. And when we try to articulate it we ask questions like: Is this all there is? What is the sense of life? How does it all fit together? But Walker Percy puts his finger on the way the question appears to many of us, which is What am I supposed to be doing? This is not idle philosophizing: it is a practical question about action. Who am I supposed to be, and what am I supposed to do next? Percy's characters are more often than not Southerners who don't really fit in the South. Sometimes they get a kind of nostalgia, or false nostalgia, for the old antebellum South, the stoic South where their grandfathers lived, not because they ever knew those times or even think they were especially enlightened but because at least then honor was honor and sin was sin and a person knew where he stood.
Let me try to make an analogy between this deep sense of existential imbalance that Percy writes about and a similar but shallower variant that may be more common. I was born and raised in the South, but over the past nine years I have lived in five different countries. Each time I come back to the South after a period away I feel slightly disoriented. Things are pretty much the same, but they feel different, even slightly foreign. Little things, of course, like having children say "yes sir" when they address me, and being expected to go to church on Sunday, but also the larger patterns in which people live their lives. I feel a little like an anthropologist in my own country. What I once took for granted as the way to live now seems arbitrary, just one form of life among many, and perhaps not even the best one. And this seems
Carl Elliott to cut its legs out from under it. Something like this, I suspect, is going on with this deeper, more radical sense of alienation. It is not just questioning the givenness of one's own form of life; it is questioning whether any form of life can have the kind of justification that you feel you need. It is a sense that all our ethical and epistemological practices are up for grabs.
So my question is this: suppose you are a psychiatrist and you have a patient who has precisely this sense of alienation; say, an accountant living in Downers Grove, Illinois who comes to himself one day and says, Jesus Christ; is this it? A Snapper lawn mower and a house in the suburbs? Should you, his psychiatrist, try to rid him of his alienation
by prescribing Prozac? Or do you secretly think that maybe, as bad off as he is, he is better off than his neighbors? Because, as Percy puts it, even though he's in a predicament, at least he's aware of it, which is a lot better than being in a predicament and thinking you're not.
Now obviously, how you answer this question is going to turn on how you see the culture around him. Some societies seem to call for a response of alienation. I felt a little like this when I lived in South Africa, for example. If you see American society as hopelessly shallow, or materialistic, or unjust, then you are going to say that if a person doesn't feel radically alienated and dissatisfied and out of step, then something really is wrong with him.
Your response about treatment is also going to depend on whether you see this ailment as a medical problem. Some people are tempted to say: if Prozac fixes it, the problem must be biological. In fact, Kramer suggests in the last chapter of his book that Percy would have realized the value of cosmetic Prozac, perhaps even endorsed it, if he had just realized that what he thought were spiritual problems were, in fact, biological problems. I don't think so. What Percy was trying to do was to show that to treat existential problems, like alienation, as scientific
problems is a kind of category mistake. In other words, if a person is depressed by the emptiness of life as an American consumer, you are missing the point completely if you try to see this as a psychiatric issue.
Seeing this as a psychiatric issue is like seeing holy communion as a dietary issue. It is not completely off-base, but at bottom you have misunderstood what is really going on.
But what is going on? What, in fact, does it mean to say this is an existential problem, not a psychiatric problem? The point I am moving toward is that some of these worries that Percy had about the Ontological Lapsometer, and which some of us seem to have about cosmetic Prozac,
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have their roots in our own particular form of life, and in particular, about that framework within which we think of our. lives as having sense or meaning. For lack of a better term, I will follow writers like Taylor and Lionel Trilling and call this framework an ethic of authenticity.3
I want to point out just a few features of this ethic that I think are widely held in our culture. The first is what we might call, following Michael Walzer, the notion of life as a project.4 By the notion of life as a project I mean two related things. First is the idea that whether our lives make sense or have significance is largely up to us; that the sense or significance of our lives depends on how we live them. This idea, that how we live our lives will determine their significance, is in turn tied to a second idea: that our lives are planned undertakings which, to a large extent, we control and for which we are responsible. External factors playa part in our lives, most of us will acknowledge luck, fate, karma, deity-but not so much that we feel ourselves exonerated from overall responsibility for the shape that our lives take.
Now we tend to take for granted this picture of our lives as our projects, but in fact it is not at all a universal picture. Think, for example, of the idea of life as something that is entrusted to you and determined by God, so that the purpose of your life is to follow God's will. The result is not a picture of life as something that we control and are responsible for, but a picture of life as something that is given to us; not something that we create, but something that is given, whose contours we fill in. Or take, for example, the idea that you inherit your life from your parents, and your purpose is to take over their position and social station and accomplishments. This idea does not fit a picture of your life as essentially your project, as we tend to think here in America, but a life lived in historical time for your parents and for your children; not life as an individual project, but as a collective project taking place over generations. When advertisers use slogans such as, "You only go around once in life," they are playing on this cultural sense we Americans tend to share: first, of our lives as disconnected from a larger historical context, and second, that our lives are essentially what we make of them.
The second feature of this contemporary ethic I want to point out concerns the content of the good life. An ethic of authenticity says that in order to answer the question, "How should I live?" I will have to look inward, because there is no single universal way of living a meaningful life. The answer to this question will differ from one person to the
Carl Elliott next, and each person has to discover the answer for himself. "You have to find yourself," we sometimes hear. "You have to find your own way." "You have to be true to yourself." Each "self" is different and unique; for a life to be a good life, a meaningful life, a life properly oriented toward the good, we have to get in touch with ourselves.
How does this ethic of authenticity relate to Prozac and the worries that we might have about it? First, if the meaningful life is connected to the authentic life, the life that is uniquely yours, then the possibility arises to live an inauthentic life. Many people would think that an inauthentic life is somehow a wasted life, or a life that failed to meet its potential-a Gauguin who didn't go to Tahiti, or perhaps closer to the mark, the life of someone who is play-acting at something he isn't, like a German who idealizes the life of the American Indians and consequently spends his weekends in the Bavarian countryside wearing a loin cloth and living in a teepee. Not that there is anything wrong about this kind of life, of course; the problem comes only if it is not truly your life. An unease with this kind of inauthenticity lies at the root of some of the worries that some people have about Prozac. It would be worrying if Prozac altered my personality, even if it gave me a better personality, simply because it isn't my personality. This kind of personality change seems to defy an ethic of authenticity.
Yet the very idea of an authentic self is slippery. Can we really say that Prozac has moved a person away from her authentic self, or her
true personality, if, like Kramer's patients, she says she feels like herself only when she is on the drug? If a patient says "I don't feel like myself anymore" when she discontinues the drug, it is tempting to argue, as Kramer does, that Prozac doesn't simply change the self so much as restore the true self, the self that has been masked or hidden by pathology. However one chooses to construct these changes, either as a derangement or as a restoration of a true self, the vocabulary with which the changes are discussed (by Kramer as well as by many people
who have taken Prozac) bears testimony to how deeply the notion of a true or authentic self is embedded in our culture.
Second, this ethic of authenticity connects the meaningful life in a crucial way to the individual. What becomes very important is the
uniqueness of a life. Many Americans start to feel a greater sense of meaninglessness as they come to feel their lives are not unique. The natural home for the American novel of alienation is the generic, faceless suburb. I think this, for Walker Percy, was very important, and lay behind some of his own reservations about psychiatry as a whole, and
The Tyranny of Happiness
why he had more confidence, in fact, in the novel as a way of dealing with alienation. Percy's insight was that if you are alienated and empty and lost in the world, then you will very likely find it therapeutic, in a very peculiar and backhanded way, to read a novel about a person who is alienated and empty and lost in the world. As Percy put it in his famous essay, there is a difference between a commuter on a train who feels bad without knowing why and that very same commuter reading a book about a man who feels bad without knowing why. 5 Whereas, as Percy didn't add but might have, there is no difference between the commuter who feels bad without knowing why and the same commuter reading a copy of DSM-IV.
Part of the reason for this difference is simply that a novel validates the reader's predicament. By describing your predicament, the novelist certifies it as something legitimate and real. Now DSM-IV does this, too, of course, by giving your illness a name, but there is a radical difference between the way the novelist looks at the man who feels bad and doesn't know why and the way that medicine ordinarily does. Binx Bolling is going to look very different in the pages of The Moviegoer than he would in the Archives ofGeneral Psychiatry. That difference is this: the medical standpoint looks at the man who feels bad and doesn't know why and says: this fellow is in a fix. He's in bad shape. What he needs is to get in therapy, develop his self-esteem, get a prescription for Prozac. Whereas what the novel says, more often than not, is sure, this guy is in bad shape; but doesn't it look better than the alternative? The novel and the movie celebrate the man's predicament, in a perverse way. Sure, Tom More is a depressed lust-ridden mental patient who drinks vodka with his grits, but who would you rather be: him, or his Presbyterian wife? The novel says, of course you're depressed. Take a look around you; it would take a moron not to be depressed.
The novel can also do things that a scientific approach to alienation can't do. This relates to the reason why Percy would say that this is an existential problem rather than a psychiatric problem. Any scientific approach to alienation is going to say something about alienation in general-about the characteristics that most alienated people share. The aim of the novelist, however, unless he is a very bad novelist, is to say something not about alienation in general but about a particular person in a particular circumstance. Not Anyone Anywhere, but Binx Bolling, a moviegoer living in Gentilly-whose subjective experience we have access to through the novel. This is a very neat trick. Percy realizes that if you're alienated, it is often precisely because you feel
Carl Elliott as if you are Anyone Anywhere, an exemplar of the type: Alienated American. And if you are Anyone Anywhere, it is not going to help your condition a bit to hear yourself described as a specimen of a type that lacks inclusivity and meaningful relationships and has not actualized his creative potential. Whereas if a novelist tells you not about the Alienated American type but about Binx Bolling, a stockbroker living in Gentilly, who, now that you mention it, seems to be in very much the same predicament as you, well, then you may start to feel a little less bad.
Which brings me to my last point, and that is the connection between an ethic of authenticity and the idea of self-fulfillment. Self fulfillment is an essential constituent of a meaningful life. To many Americans that might sound like a commonplace, but in fact it is very different from an ethic that says your life is meaningful if you have done your duty, or pleased God, or met the demands of honor. And of course, nowadays we think that self-fulfillment involves discovering and pursuing your own values and your own particular talents-for example, though a career. I should point out that in this sense a career isn't simply a matter of selfishness, or narcissism, or even of being free to do your own thing; it's a kind of moral ideal. And what makes it a moral ideal, as Taylor points out, is not just that many people sacrifice their relationships or the care of their children or other important things for the sake of their careers. People have always done that. What is different is that now they feel called to do this. They feel as if they would be wasting their lives if they didn't. They feel that this kind of life is a higher life.
This notion is related, of course, to the idea that interests Max Weber so much in The Protestant Ethic and the Spirit if Capitalism. What interests Weber is not just that people will work harder to get more money, but that work takes on this moral character. Weber traced this idea to Luther's conception of a calling, where the way to please God was not to renounce the world for the monastery, but to immerse yourself in worldly affairs and fulfill the duties that the world imposes on you. This immersion was your calling. The exemplar of this attitude toward work as a moral ideal was, for Weber, the United States, with Benjamin Franklin as a kind of patron saint. What Weber saw in Franklin's writings was that wasting time or losing money was not treated as simply foolishness, or bad business, but as an ethical lapse, as a kind of moral failing. Even now I think that this idea is something that particularly strikes a lot of Europeans who visit the States; it is
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not that Americans necessarily work harder (Germans work hard, too), but that Americans seem to feel guilty or ashamed if they are not working. So much so, in fact, that they feel driven to pretend that they are extremely busy even if they are not.
Now I think this work ethic has played itself out in America in interesting ways. We Americans still place a high value on work in,
for example, Taylor's "strongly evaluative" sense, and see the life of
work as a duty, but not as duty to God; rather, as a duty to ourselves. What Luther referred to as a calling survives nowadays not so much as a calling by God, but as a calling from withtn: the idea of discovering yourself, of finding your own particular place in the world. A meaningful life is a personally fulfilling life, and fulfillment is something that you discover and create on your own, especially through the life of work, and the life of family and household.
Many contemporary Americans find the ties between work, self fulfillment, and the meaningful life self-evident. As T.J. Jackson Lears has pointed out in his dazzling study of American antimodernism, these ties have deep roots in American culture.6 Lears sees the ties between work and the meaningful life not merely in such familiar American images as the industrious, disciplined, "self-made man" of nineteenth century success mythology-a man motivated as much by ethics and ideology as by material reward-but also in less obvious intellectual currents, such as the Arts and Crafts movement that flourished around the turn of the century. Recoiling from the factories and bureaucracies of organized capitalism, craft idealogues extolled the nobility, even the holiness, of honest, creative work. That work had a deeply spiritual character was obvious to craft revivalists such as Horace Traubel, cofounder of the Pennsylvania agrarian community Rose Valley, which offered a return to a simpler, more "authentic" way of life. At Rose Valley, as Traubel tellingly put it, "work was worship, the workbench an altar, and bad work blasphemy."7
We can see something of these ideas in the conflicted attitudes that many Americans have toward Prozac. On the one hand, if the way to lead a meaningful life is to search for self-fulfillment, and self-fulfillment is achieved through a life of honest work and householding, then it makes sense to embrace a drug like Prozac, which offers the promise of doing better, more meaningful work in a happier, more enthusiastic way. Yet if living a meaningful life is also tied to living an authentic life-the life that is uniquely yours, which you discover and develop by looking inward-then a drug like Prozac can seem deeply
Carl Elliott problematic. What could seem less authentic, at least on the surface, than changing your personality with an antidepressant? What could be further from the "simple life" than a life dependent on cosmetic psychopharmacology?
In some ways, the relationship of cosmetic Prozac to an ethic of authenticity is similar to that of psychedelic drugs like mescaline and LSD in the 1950s and 1960s.8 For intellectuals like Aldous Huxley, psychedelic drugs were a powerful tool in the search for meaning in life, a mystical window onto the unconscious through which one could see the "raw materials of human mythology."9 Certainly the experiences that the psychedelic drugs often produced-cosmic consciousness, heightened perception, universal fellow-feeling-seemed to many artists and intellectuals to connect naturally to Eastern religions, not unlike the way the effects of cosmetic Prozac tie into a Protestant ethic. But in at least one important way the attitudes toward the psychedelics current in the countercultural movements of the 1950s and 1960s differed from contemporary attitudes toward Prozac. Intellectuals and artists may well have seen psychedelics as a path to a more authentic life, but they also saw them as a means of revolt-as a way of transcending conventional ways of living. Perhaps Prozac can also be a tool of revolt (as Kramer says, by giving a person the energy to get up and do what needs to be done) but at least as often it seems to be a way of accommodating to conventional ways of life and making the best of them.
Lears sees a pattern in the American search for authenticity, especially in the calls from each generation, from the pre-World War I Greenwich Village intellectuals to the Beats, to throw off the repressive values of the generation preceding it. What has doomed this search to circularity in American life, argues Lears, is its lack of commitment to any wider values outside the self.10 Whereas the search for a more authentic way of living was once fueled by religious or political concerns, it has gradually come to be motivated by purely internal goals, such as
personal growth and psychic harmony. Without a wider framework of meaning, the search for authenticity eventually accommodates itself to the broader culture of consumer capitalism, and what begins as a generation's call for alternative values becomes a mere choice between "alternative lifestyles." For Lears, "What begins as discontent with a vapid modern culture ends as another quest for self-fulfillment-the dominant ideal of our sleeker, therapeutic culture." In a culture of consumer capitalism, this turn inward toward the self ultimately leads to barren territory. "As self-fulfillment and immediate gratification have
The Tyranny of Happiness become commodities on the mass market, calls for personal liberation have begun to ring hollow."11
Lears's diagnosis may be too harsh. Self-fulfillment as an ideal may seem excessively self-centered, but it can also be truly liberating-for example, in the case of women who previously had little opportunity for a career. Remember also that self-fulfillment is a moral ideal. That is, Americans generally do not see self-fulfillment as mere narcissism; they see a fulfilled life as a higher life, a better way to live out one's days. An unfulfilling life, a life that is not authentically yours, is not just an unhappy life, or a boring life, or even just a life of quiet desperation. It is a failure.
For the same reason, this ethic can also be oppressive. It is oppressive in that if you are unhappy or find life unfulfilling, there is something wrong with you, and not only should you pursue happiness, as our founding fathers have instructed us, you should pursue it aggressively. Why? Because if you don't you will be letting yourself down. You will be wasting the time you have on this earth. And if that means taking Prozac, so be it. In this way happiness is not just your right; it's your duty. This kind of thinking amounts to a kind of tyranny of happiness, which I think is especially pronounced in American life (I don't think a Scot, for example, would feel it nearly as strongly). It also gives cosmetic Prozac a kind of status here that it doesn't have elsewhere, and that we need to think more carefully about. If Prozac is seen as a kind of ticket to self-fulfillment, and self-fulfillment is your duty, then maybe we can begin to understand why Prozac has become so wildly popular among Americans.
NOTES 1. Peter D. Kramer, Listening to Prozac (London: Fourth Estate Limited,
1994), p. 224.
2. Charles Taylor, "A Most Peculiar Institution," in World, Mind and Ethics: Essays on the Ethical Philosophy if Bernard Williams, ed. J.E.J. Altham and Ross Harrison (Cambridge: Cambridge University Press, 1995), p. 134.
3. See Charles Taylor's Sources if the Self (Cambridge, Massachusetts: Harvard University Press, 1989) and The Malaise if Modernity (Concord, Ontario: House of Anansi Press, 1991); and Lionel Trilling, Sincerity and Authenticity (Cambridge, Massachusetts: Harvard University Press, 1971).
4. Michael Walzer, Thick and Thin: Moral Argument at Home and Abroad (Notre Dame, Indiana: Notre Dame University Press, 1994).