Gottschalk Chemical Self

[pp. 61-84 in Rubin, L. (ed.) Psychotropic Drugs and Popular Culture: Essays on Medicine, Mental Health and the Media McFarland Publishers 2006].

Among contemporary men, will there come to prevail and even flourish, what may be called The Cheerful Robot? (CW Mills, 1959, p. 171).

“Better than well,” “Personality enhancer,” “Euthanasia of the soul,” “Designer drugs,” “Normalizing drug,” “Cosmetic psychopharmacology” – these are some of the terms that have been used to discuss the effects of a new category of drugs (Selective Serotonin Reuptake Inhibitors, henceforth SSRIs) that are increasingly advertised in a variety of media. 1 Chief among those new drugs is probably Prozac, which has been the subject of countless magazines, articles, televised debates, and jokes. In some sense, Prozac does not only denote a particular drug manufactured by the E Lilly corporation, but connotes other SSRIs, a trend in the social construction of the self, a cultural phenomenon, perhaps even a weltanschauung. 2 That a therapeutic technology prescribed to relieve psychiatric disorders gains so much popularity is a bit puzzling and requires reflection.

The purpose of this chapter is neither to reject outright the use of these drugs, nor to resolve the philosophical debates about human nature that they have fueled, nor to deny that biology might very well be among the causes of the disorders which Prozac and other SSRIs promise to alleviate. Rather, I am interested in (1) critically examining the articulations between these drugs and the postmodern condition or “structure of feeling” which, as many theorists suggest, characterize the present moment, 3 and (2) discussing some social implications of the increasing manufacturing, endorsement, and consumption of these drugs. Since every chapter in this book examines the representation of psychotropic drugs in a variety of media, I have chosen to ground my discussion in the major websites which advertise them. 4 After all, few other technologies symbolize the postmodern moment as the computer and the virtual world it enables us to experience.

Before proceeding, I want to emphasize that my reading of these websites is neither the “true” nor the only one possible. Depending on her or his paradigmatic orientations, any reader could easily provide different interpretations of these websites, and suggest different links between them, the drugs they promote, and the postmodern moment. No reading is ever innocent and neither is this one. On the contrary, it is purposefully informed by, and seeks to contribute to, both symbolic interaction and critical-postmodern sociological theories.

I must also ask the reader looking for tight logic, unarguable “facts,” and cold analysis to be patient as this essay is not disciplined in that way. As commentators suggest, the unpredictable social changes introduced by the SSRI “revolution” might be as profound and disturbing as those introduced by the atomic bomb, the computer, and genetic engineering, among others. Accordingly, the changes resulting from this revolution defy quick answers, absolutes, and traditional models. Like the effects of SSRIs themselves, these changes prompt us to think differently. Accordingly, grounded in my (intertextual) analysis of these websites and inspired by the theoretical traditions mentioned above, I can only propose reflections, futuristic projections, and theoretical interrogations. Still, I hope that this essay will be sufficiently interesting and stimulating to keep the reader’s attention, to inspire her or his own interpretations, and to pursue the critical examination of increasingly worrisome trends in contemporary approaches to the self in this most bizarre and (self-)destructive postmodern moment.

The main thrust of my argument is that the chemical asylum is increasingly replacing the concrete physical one. In other words, the growing endorsement and marketing of SSRIs accomplish, at the individual and chemical levels, the same functions as the concrete bricks-and-mortar buildings: the control and “rehabilitation” of people whose behaviors or emotions are considered abnormal. However, this chemical asylum accomplishes more than this. First, in contrast to the physical asylum, commitment to the chemical one is often a voluntary decision –albeit a decision that is encouraged and normalized daily by countless effective commercial ads. Second, whereas the physical asylum was typically restricted by objective material conditions (staff, number of beds, budget, etc), such limitations no longer characterize the chemical one. Virtually anybody can “check in,” for as long as necessary. Third, whereas the physical asylum was typically reserved for particularly troublesome behaviors, the chemical one has significantly extended the list of conditions it proposes to regulate. Fourth, by ingesting SSRIs, the virtual “patient” no longer metaphorically internalizes the ‘medical discourse’ but chemically re-calibrates his and her brain in accordance with this discourse which radically re-defines the meaning of the self, of one’s emotions, and of what is “normal”. Fifth, finally, the physical asylum was itself regulated by public officials and was open to public scrutiny. It still enabled patients to develop micro-communities, to protest unfair treatment, to play a part in their own and others’ progress towards mental “health.” Located in one’s head, the chemical asylum eliminates this potential.

This essay is divided into three sections. In the first, I ground my arguments by analyzing SSRI websites, explore the main themes they articulate, and draw parallels between them and various aspects of the postmodern condition. In the second section, I use a number of key insights from symbolic interaction theory to discuss, at the micro level, some implications of the effects of SSRIs for our understanding of the self and the social relations that construct it. In the third section, I use critical theory to offer, at a more macro level, some tentative conclusions about the increasing acceptance of SSRIs, the effects they produce, and the problems they raise. It goes without saying that these three sections are interwoven; they have been separated for the purpose of (hopefully better) organization and communication.

Welcome to MyTherapy.com -- Computerized Psychiatric Diagnosis (http://mytherapy.com, Phillip W. Long, M.D, 1995-2005.)

Choosing to examine SSRI websites as strategic cultural texts which articulate the postmodern moment or condition seems obvious. This new technology’s recent and rapid proliferation and its increasing colonization of both public and private spheres are changing every aspect of daily life in ways we cannot fully understand, and will continue to do so in ways we cannot presently imagine. 5 Importantly, it is not solely the growing number of computers per se which is truly baffling, but the exponentially multiplying number of websites, discussion lists, emails, hypertexts, links, and the resulting volume of information which swells faster than we can think. Everywhere we turn, we can both see this increasing colonization, and experience it in the growing number of tasks that we now perform with/on computer screens rather than with a real and physically copresent human being. From web classes to guitar lessons, from the self-check-out lines at the supermarket to buying about everything imaginable online, from sex to romance, from the dentist to the loan officer, from the airport to the versateller, an increasing number of face-to-face interactions are rapidly being replaced by person-to-terminal ones.

A particularly telling example of this replacement of human beings by computer screens is concretized on the Paxil 6, Prozac 7, and Zoloft 8 websites that all feature psychological quizzes that readers concerned about their states of mind are invited to answer. Although the questions which appear on these quizzes are standard and also appear on TV and in printed commercial ads, what is unique about the on-line quiz is the instantaneity of this virtual “consultation” which provides an immediate answer/diagnosis: “Your answers suggest that you may have experienced panic disorders” – the Paxil website responds to my own answers to the electronic McQuiz. 9 Although these websites repeatedly remind us that the electronic quiz cannot replace a consultation with a real doctor, in the solitude of the interface, it is still a first point of contact between the (we hope) anonymous concerned reader and the equally anonymous and abstract psychopharmacological-medical complex. While the faceless terminal should not, we are told, substitute for the real doctor, it might have already displaced a friend’s sympathetic ear or sustained self-reflection.

These websites do not only encourage readers to take these quizzes but also recommend that you “bring your doctor a printout of your responses to the questions in this self-test.” 10This simple suggestion already implies the complicit links between the websites, drug companies, and the medical institution. “Only your doctor can make a diagnosis” and only your doctor can prescribe SSRIs. 11 By recommending that we take their quizzes and bring the printout to our doctor, the SSRIs websites legitimize the information they present, the drug, its manufacturers, the usefulness of the quiz , and a decidedly strange approach to psychological and emotional problems. Through such links, the websites also position the isolated reader as inescapably dependent for her and his emotional well-being on a virtual network of large, faceless pharmaceutical companies and medical organizations.

Neurotransmitters R Us: Medical Absolution , Chemical Self-Esteem, and Therapeutic Narcissism

If knowing yourself is the road map, liking yourself is the vehicle…Try not to overanalyze or be too critical of yourself. Recognize the good things about yourself. You are a worthwhile person (Prozac webpage, p. 2, 2004).

On the SSRIs websites, the different sections, which explain the various disorders the drugs can alleviate, repeat the statement that “some people find comfort just by learning that depression (or social anxiety disorder or panic attacks, or post-traumatic stress disorder) is a medical condition.” 12. Repeated like a mantra, the websites reconstruct a wide variety of emotional pains which have probably always characterized the human condition as “a medically recognized psychological condition with a suspected biological component,” 13 “a common medical illness,” 14 “a real medical condition,” “a serious illness”, 15 a medical illness “as real as diabetes or arthritis,” 16 “heart disease,” 17or "high blood pressure.” 18

This medical reconfiguration of unruly emotions both reassures and absolves the reader for experiencing the “wrong” feelings. Depression is “An Illness, Not a Weakness,” it is “not something you’ve brought on yourself, and it doesn’t reveal a personal weakness or an inability to cope,” “it’s not a character flaw,” “it’s neither a ‘mood’ nor a personal weakness that you can change at will or by ‘pulling yourself together’” claims the Prozac website. 19 The Zoloft website offers similar reassurances and suggests that “depression doesn’t mean you have a flawed character or aren’t strong enough emotionally. It is actually a medical condition like diabetes and arthritis.” 20 Like many other physiological dysfunctions, the websites tell us, those seemingly emotional problems can also be chemically altered and recalibrated for better functioning.

Challenging our everyday logic and dismissing centuries of theorizing and philosophical reflection on the symbiotic/symbolic relationship between self and others, the websites reconstruct the self through stories of cells, serotonin, and synapses. 21 As Crossley puts it,

We are increasingly attuned to hear references to ‘brains’, ‘neurotransmitters’, etc. as more real, truer and deeper accounts of what and who we are. We are less trustful of our own everyday language of self-hood and personal life, more enamoured by the ‘facts of the ‘hard sciences’ of the brain. ‘Misery’ is not enough, we believe only in ‘low serotonin’. 22

The swallowing of this rather bizarre approach to such a complex issue as the emotional self is facilitated by an equally strange but tasty two-layered coating. The first promises that this chemical re-calibration will enable the emergence of an enhanced self. As SSRIs proponents tell us, the self that the drug liberates will be more uninhibited, smiling, charming, anxiety-free, extroverted, outgoing, confident, flexible, and accepting than the self sans SSRI. We will be better than well, claims Kramer, the author of Listening to Prozac. 23

The second layer suggests that this enhanced self is really our true self. The Prozac website, for example, promises that “With treatment, you can feel like yourself again.” 24 Following the same logic, the Paxil website’s main page shows the picture of a young healthy and attractive white woman, who looks straight at the reader, smiling with self-confidence. She is wearing on her sports jacket a sticker with a bold “Hello” print and, underneath (in supposedly her own handwriting), the word “Me.” 25 Paxil is thus presented as having rescued the young woman’s real, peppy, relaxed and self-confident self from the throes of social anxiety disorder, panic disorder and/or depression. As the website implies, those emotional experiences did not express her “real” self but resulted fromserotonin deficiency or other neurochemical dysfunctions for which neither she nor anybody else can reasonably be held responsible.

Equating the “enhanced” self with the “true” self provides both a medical promise and an endorsement of our cultural obsession with narcissism 26that is repeated dailyby countless commercialads hailing us in a variety of mass media. “Feel good about yourself,” “be kind to yourself,” “enjoy yourself,” “treating yourself like the wonderful person you are is a good way to affirm your self-worth,” and “write down everything you like about yourself,” the virtual therapist recommends on the Prozac website. 27

From a postmodern perspective, there is an interesting parallel between Baudrillard’s characterization of the contemporary moment as “hyper-real” 28 and SSRIs proponents who declare that the drug will enable us to become “better than well.” 29 Gone are those emotional limitations we all suffer from and which, if successfully confronted through long and hard work, might make us “just” well. More is promised. With very little effort, we can become better than well, better than we have ever been, and better than we ever hoped to be. Flattered by such promises and understandings, we might be increasingly encouraged to completely re-think the self we have always experienced as limited and limiting, as painful and burdensome, as “false”, and as easily replaceable by its chemically enhanced, ideal, yet curiously “true”, version. However, this approach is hardly surprising and is perfectly attuned to the logic of our “throwaway” society. Constantly encouraged to replace defective appliances by sexier, sturdier, and “lower-maintenance” models, and reminded daily that we too can surgically alter our less-than-perfect body parts, the frequent --and medically approved-- suggestion that we chemically alter our very sense of self starts to sound increasingly reasonable.

After all, the promise that we can effortlessly and chemically achieve a “better” self is not that different from the truly hallucinatory assault by countless other ads which repeat ad nauseam and 24/7 the delusional guarantee that the frenetic consumption of disposable objects and services will also help us attain instant sensuality, popularity, respect, approval, love, tenderness, self-esteem, a sense of security, control, competence, wisdom and a sexier self. In a hyper-consumerist society which promises virtually everybody instant “pre-approval” and “immediate delivery” with “0 dollars down” or “no credit’, it is hard not see the relationship between the peddling of SSRIs on the net and the promotion of a multitude of other objects which all serve to gratify narcissistic needs, keep depressive tendencies at bay, and calm existential anxieties. In fact, the Prozac website explicitly endorses this link between “feeling good about yourself” and consumption by suggesting that the therapeutic project of self discovery cum self-esteem should include “buying something,” or “watching a funny movie or TV show.” Echoing most other commercials, the website thus also proclaims that, in addition to SSRIs, self-esteem requires a trip to the mall and/or passive entertainment by asinine spectacles. 29

Resonating with our postmodern fixation on the private lives of stars and celebrities, the Prozac website also encourages self-esteem by reminding us that a great variety of famous political figures (Lincoln, Roosevelt, Churchill, Princess Diana, Calvin Coolidge, Richard Nixon, Menachem Begin, General Patton) and artists (Van Gogh, Hemingway, Mark Twain, Marilyn Monroe, Nijinsky) have all suffered from depression . 30 Interestingly, this website conveniently omits the simple fact that most of those illustrious people managed to accomplish great political feats or works of art without the benefit of SSRIs. The Zoloft website develops this idea and tells the abridged story of country singer Naomi Judd’s “triumphal” victory against panic disorder, thanks to a combination of Zoloft and cognitive-behavioral therapy. 31 Juxtaposed to other stories of everyday unknown people who also successfully struggled against different disorders (“Alan Chambers,” the CEO who defeated depression, and “Drusilla” who overcame panic disorder), the Zoloft website gently invites the reader to feel similarity between themselves, political leaders and stars, or at least, the reasonably successful.

The reduction of emotional, cognitive, or interactional problems that have troubled individuals living in vastly different societies and historical periods to simple deficiencies in neurotransmitters legitimizes the medical discourse by stimulating narcissistic needs, absolving the troubled individual of all responsibility, and promoting a facile sense of self-esteem in the reader by suggesting that “enhanced self” equals “true self”. Whereas the attainment of genuine and enduring self-esteem typically requires sustained personal investment, some worthy accomplishment, the realization of one’s goals, or, at the very least, the repeated experience of positive interactions with people who matter to us, the friendly virtual therapist insists that none of these inconvenient efforts are necessary in the mellow and cheerful Land of Prozac.

In tandem with self-esteem and narcissism, these websites also promote a particularly strange approach to self-other relationships. Asides from the commonsensical observation that web-surfing is typically a solitary activity, these sites also promote a sense of social and psychological isolation in the reader by suggesting that –except for the drugs-prescribing doctor--the therapeutic endeavor is essentially a solitary one. In fact, while almost every “disorder” section on these websites repeats that we must talk to our doctor, the multitude of other people who fill our lives and guide our sense of self, those others who are always and complexly implicated in our emotional conditions are completely absent. None of the very scientific explanations or quiz questions ever mentions these others’ possible influence, importance, and inevitable presence in the very fibers of our being. We are never encouraged to ask these others how they see and “feel” us, to discuss the quiz questions with them, or to engage them in a heart-to-heart conversation. Establishing an authoritative conversation with the reader, the terminal virtually eliminates all these others from consciousness or, at best, relegates them to the status of residual and negligible variables in the neurochemical equation.

Two exceptions deserve attention. The first is the Zoloft website, which, in the various “disorders” sections, mentions that friends and relatives can help. Interestingly, however, the role of these significant others is often reduced to their ensuring that the disturbed family member or friend seek medical assistance and continue to take her or his medication:

One important thing family members and friends can do for those who are depressed is to help them get appropriate diagnosis and treatment. This may mean getting them to see a doctor in the first place, or encouraging them to stay with treatment until they feel better. 32

While the other two sections which discuss panic and obsessive-compulsive disorders also provide advices to relatives and friends, these advices are always the same, regardless of the disorder:

        Learning as much as possible about the…disorder
        Adapting to changes that take place during treatment
        Understanding that stressful periods may be difficult for everyone
        Encouraging the patient to stay on his or her prescribed medication and/or therapy. 33

The providing of exactly the same advices to those “caring others” helping a friend or relative who is suffering from different disorders implicitly suggests that, except for these four rather commonsensical injunctions, their contribution to the therapeutic enterprise is limited and perfunctory at best.

The second exception is the Prozac website that also indicates that relatives and friends can help. However, the extent of this help is limited to “accepting that depression is a real illness – not a weakness or a character defect,” and that loved one “can’t ‘snap out of it’ and it won’t go away with time.” Implicitly recruited as agents of the medical discourse, friends and relatives are told to:

This implicit assumption of social and psychological isolation is even reproduced in the pictures of “successful patients.” Interestingly, and with one exception on the Paxil and Zoloft websites, these people are always displayed alone. Although seemingly benign, these depictions of single individuals reinforce the individualistic assumption guiding our approach to psychological and emotional problems –an assumption which remains essentially ideological. Here again, the pictures represent “enhanced” individuals as people who have suffered from, confronted, and overcome their various emotional problems alone, under the intermittent professional guidance of an invisible but benevolent physician.

The websites’ curious ontological assumption of socially and psychologically isolated individuals which organizes the quizzes, the explanations of the disorders, and the therapeutic options is also reproduced in its implied prognostic promises. More specifically, the websites’ complete lack of attention to the social dimensions of the self is reproduced in their complete lack of attention to the social consequences of the chemically regulated self. Whereas I have discussed above the rather limited role significant others are called upon to play in the therapeutic enterprise, their absence in the “post” illness phase is a bit puzzling and betrays the same reductionistic understanding of the importance of social relations in individuals’ lives. There is, for example, no discussion of the simple fact that those significant others will have to somehow re-adjust their ways of interacting with this new enhanced self, that they may question its authenticity, or simply feel “weird” around it.

On the contrary, evoking an optimistic and self-sufficient mindset reminiscent of the effects of SSRIs themselves (and the logic of most commercials), these invisible significant others will, it is implied, naturally and joyfully greet the Prozac-regulated family member, colleague or friend, embrace without questioning the new qualities which she now displays, and show her the same approval they would express upon seeing her new car, plasma TV, designer clothes, furniture, nose job, stomach tuck, or breast implants. In other words, the websites offer neither information nor advise on how significant others will react to her (“true”) new and improved self. And whereas the websites provide cautionary statements that different people react differently to SSRIs, they never discuss the rather commonsensical fact that different people may react very differently not to SSRIs but to their colleague, relative or friend who has been chemically altered. For all intents and purposes, those others who are –for good and ill-- so implicated in our emotional life have completely disappeared from the (electronic and emotional) picture. As we will see in the conclusion, this tacit and rather a-social elimination of significant others from the pre- and post-“illness” phases resonates quite well with the effects of SSRIs on social relations.

Interestingly, the websites’ sections that discuss different disorders remind the reader that the therapeutic interventions for most of those disorders may also entail talk therapy, group therapy,cognitive-behavioral therapy, or a combination of those with SSRIs. But since, as we are repeatedly told, these disorders are medical illnesses which, like high blood pressure, arthritis, or diabetes, are caused by biological dysfunctions, it is difficult to precisely understand how talking could be beneficial to the restoring of a healthy neurotransmitter traffic between cells. Further, since, as we will see below, SSRIs reduce emotional reactivity to both oneself and others, it is not clear whether the purpose of such talk is to assess how a patient really feels or how SSRIswork. Accordingly, the title Listening to Prozac (rather than to the patient) must be read literally.

Overall, the websites represent us as quite isolated individuals who can only have meaningful conversations about our inner souls with doctors and psychotherapists. Web surfing, taking the quiz, the informal and personal mode of address on those websites, and the very explanations they provide about what ails us effectively repeat the same message: Mental disorders are purely private (and biochemical) troubles. Talk to your doctor because s/he is the only one who can understand you, properly diagnose you, and, in the absence of any compelling alternative, heal you through drugs which alter the circulation of those unruly neurotransmitters. Your significant others are relatively irrelevant to what you are experiencing and, in any case, cannot really help you overcome your condition, except by showing encouragement and optimism, listening to you, refraining from judging you, and ensuring that you see a doctor and take your medication.

You are Just Like Us: The SSRIs State of Mind and/on the SSRIs Website

Considering the psychochemical effects of SSRIs, it is difficult to resist exploring the various ways these websites evoke –in both content and form-- the effects of the very drugs they promote. The websites are obviously pitched to a troubled yet rational, intelligent and educated reader who seeks a quick solution to emotional and social problems that reduce happiness, focusing, self-control, productivity, and a general joie de vivre. The tone of the “voice” speaking to us in those websites is relatively unemotional, relaxed, even, and friendly. It uses a no-nonsensical, informal language to explain a variety of disorders to “you” the reader. Depression is “not something you’ve brought on yourself,” “with treatment, you can feel like yourself again,” 35 claims the Prozac website. Reassuring the reader on every page that depression or other disorders are probably caused by neurotransmitter malfunctions, the voice sounds indeed like that of a friendly virtual doctor who does not judge, condemn or insist on difficult self-reflection, conversation, or soul-searching. It gently produces textually what the drug induces chemically. It soothes, calms, removes responsibility, and encourages us not to feel the guilt or shame that we might normally experience upon realizing that we cannot control our emotions. But in so doing, it invites a kind of alienation between one’s self and the emotions one experiences, and hence within the self. 36

The websites also communicate this SSRI “state of mind” through pictures of (typically solitary) individuals whose general characteristics and clothing style typify members of the ethnically-diverse, economically comfortable, conforming, but guilt-prone and threatened middle-class. Neither too fat nor too thin, neither too young nor too old (although the few older faces look amazingly healthy and wrinkle-free), neither poor nor outrageously wealthy, they look like our friends, acquaintances and relatives who belong to the same rough social class we identify with or aspire to. They are the executives, administrators, high-ranking bureaucrats, and other professionals with whom we are likely to interact and collaborate in our everyday lives. Their facial characteristics are also revealing. They are convulsed by neither ecstatic laughter nor painful tears. They neither show sign of surprise nor fear, neither anger nor disgust, neither anxiety nor conflict. They are smiling and relaxed, reasonably cheerful and satisfied, pleasant and accepting. In effect, they graphically project the kinds of disposition people experience once they have been properly regulated by Prozac or other SSRIs. 37 By themselves, therefore, these pictures not only already evoke how the chemically enhanced self feels and looks, but also invite identification by the middle class reader, who is implicitly reminded that those “medical” conditions once associated with weakness of character are indeed not unusual in people “just like us” --or, considering the bleak alternatives in contemporary society, like we would like to be.

Importantly also, these people seem professionally successful. As the occupations which characterize the comfortable middle class often entail emotional skills, an outgoing nature, ability to work in small and large groups, adaptability, a conciliatory disposition, a general smoothness of character, but also extensive and often difficult “emotion work”, 38 one cannot help but wonder whether we should not also chemically regulate our own emotions in order to remain competitive. Together, these successful faces and stories, paired with the numerous promises that SSRIs will re-enable our “productivity”, implicitly communicate the professional and economic advantages these “personality enhancing” drugs obviously bestow. As Zita remarks,

Prozac is more than a medical remedy for a mental dysfunction. It appears on the contemporary scene with a promise to reconstitute out of the chaos of unlimited postmodern disintegration the individual-based, white middle-class norms for gender, sex, and work. 39

Having medicalized emotions, insisted on our social isolation, and encouraged --through pictures, content, and tone, -- alienation from the self and others, the websites evoke the seductive mindset one can enjoy on SSRIs, provide visual “proof” that success, peace of mind, attractiveness, and productivity will increase among those whose emotions have been properly re-calibrated, and promote a fake sense of identification with a virtual community of people who seem very similar to us. They are just more mellow and successful.

SYMBOLIC INTERACTION THEORYON PROZAC

Prozac disrupts two of the neurotransmitters most involved in frontal-lobe function –serotonin and dopamine—and in that process can rob us of our sensitivity, self-awareness, and capacity to care or to love. Put simply, the SSRIs are anti-empathic agents. That means they are anti-life –anti human life in the fullest sense (Breggin and Breggin, 1994, p. 210).

Exploring all the ramifications of the increasingly socially acceptable neurochemical construction and recalibration of the self for sociologists working within the Symbolic Interactionist tradition is well beyond the scope of this paper. 40 Still, as a modest step in that direction, I want to reflect here on several question these trends raise with regard to two insights this tradition suggests: Cooley’s metaphor of the “looking-glass” self, and the increasing understanding of the self as “narratively constructed.”

In Cooley’s metaphor of the “looking-glass self”, we derive a sense of self by interpreting how those we interact with react to us. 41 Depending on the “reflections” these human mirrors send back to us, we derive positive feelings such as pride or negative ones such as shame. According to this assumption and the theories derived from it, the sense of self thus necessitates the ability to correctly self-reflect from another’s point of view. Following this line of thought, it seems that the increasing consumption of SSRIs should prompt us to re-think the emphasis we place on this “reflected self”. Following Breggin and Breggin’s 42 suggestion that SSRIs produce a disassociation and diminished emotionalsensitivity to both self and others, it seems reasonable to suggest that those who consume SSRIs will suffer from a weakened ability to “read” others and hence, logically, to correctly self-reflect from their points of view. More importantly, people chemically altered by SSRIs will also be less concerned about this weakened ability, the misreadings such a weakened ability unavoidably engenders, the emotional reactions such misreadings frequently trigger, and the rituals of readjustment they typically require among “normal” people. In other words, the SSRI-regulated individual will not only likely be lessable to “read” others’ reflections but will also care less about these reflections in terms of his emotional well-being, self-esteem, and self-satisfaction. Accordingly, as others are less immediately relevant for his positive feelings, and as SSRIs chemically reduce his experiencing of negative ones, he will quite naturally be inclined to radically re-configure the very essence of such interactions and relationships that used to be primordial for his sense of self.

The Looking-Glass self and Prozac:Fuzzy Reflections and Distortions

Symbolic interaction theorists have typically assumed that self-reflection was a rather rational process and that a correspondence existed between how others reflect us and how we interpret these reflections. In contrast, Freudian theory suggested that our readings of other people’s responses to us are most often distorted by unconscious ego-defense mechanisms which protect the fragile ego and its narcissistic needs. Still, the Freudian discourse claimed that such distortions could be brought out of the unconscious into conscious awareness, analyzed and corrected. With SSRIs, the systematic distortion of others’ reflections is chemically engineered, sustained, and medically defined as “normal”. Regulated by SSRIs, we are less able to correctly self-reflect with others, but it no longer matters since a positive sense of self can be achieved through the consumption of chemicals which make us feel good, regardless of what other people think. In any case, the reduction of emotional reactions to serotonin imbalances so frequently repeated on the websites not only encourages a new approach to the self but also, logically, to others. Since –contrary to what I always believed—I am not my emotions, and since my mind functions in ways which I cannot control, predict, or regulate, it is only a short distance to seeing other people in the same light. Since we are little more than the effects of neurochemical processes, emotional alienation from self naturally leads to emotional alienation from others. Their emotional needs become similarly re-framed and re-constructed as simple chemical imbalances which can rapidly be calibrated to better “fit” the requirements of their social and psychological environments. Will such a reframing radically change the amount of emotion workwe are willing to invest in order to heal the emotional pains and needs of those who matter to us? Since it is chemical anyway, will we echo the old doctor’s suggestion to “take an aspirin and call me in the morning” by telling our emotionally upset loved ones to “take some Prozac and stop bothering us with unreasonable emotional needs?”

The flip side of the story is that when emotional detachment and reduced sensitivity to others and self are increasingly normalized, individuals not regulated by SSRIs will, with increasing frequency, encounter everyday situations and interactions where they will logically self-reflect with individuals very emotionally different from themselves. In such a situation, it is not too far-fetched to suggest that these “normal” individuals will increasingly question their own (now) unreasonable emotional reactions, and will be more likely to re-define them as exaggerated, or as signs of childish “over-sensitivity”. 43 They will increasingly feel the growing social pressure to get “in synch” with the new and improved emotional “program”.

The Narrated Self: (Prozac) Web Site Stories

Many contemporary symbolic interactionists and others have increasingly developed the idea that the self is “narratively constructed”, that the self can be understood as stories we tell different audiences in different situations. 44 As such, and still following Breggin and Breggin’s discussion of the SSRIS’ blunting of empathy, “sensitivity, self awareness, and capacity to care or to love,” the effects of these drugs on the stories we tell about ourselves and others will also change in worrisome directions, since such stories will inevitably reproduce –both in tone and content- this chemically enhanced but emotionally blunted self. 45 What happens when such stories are increasingly circulated, validated as “normal”, and reciprocated? Will we increasingly trace our own and others’ biographies in neurochemical terms? The websites’ constant reminders to “caring others” that “depression is a medical illness” whose causes are essentially neurochemical certainly seem to encourage such an approach. While these repeated messages absolve us of all responsibility, they also encourage us to tell very strange stories about ourselves –to others and ourselves. By reducing the most complex concept of selfhood to neurochemical deficiencies, accidents, or fitness, these stories necessarily reconstruct humanness in a terribly heartless and soulless prose. In such stories, ethical dilemma, moral responsibility, love, empathy, compassion, patience, modesty, passion, and all these experiences which make us uniquely human are relegated to the margins. More worrisome yet, the “genetic” dimension frequently appearing in these SSRIs website stories also suggests that the transition (or return) to a new genetic discourse about personality, temperament, emotional dispositions, and fitness is not far away. 46 In light of the disastrous consequences such a discourse has typically brought about in recent history, we should pay a great deal of attention to these new stories which hail us on our TV screens, computer terminals, magazines, other media, and the people we will increasingly interact with.

FROM THE ASYLUMS TO THE CHEMICAL GATED COMMUNITIES

Swallowing, half an hour before closing time, that second dose of soma had raised a quite impenetrable wall between the actual universe and theirminds (Huxley, 1969, p. 52).

As Breggin and Breggin suggest, Prozac and other SSRIs alleviate painful emotional experiences and conditions by weakening our emotional responsiveness to self and others, by chemically producing a disconnection from self and between self and others, their needs, problems, etc. 47 Whereas the medical success of these drugs is typically explained by their ability to selectively act on certain neurotransmitters rather than many (thereby reducing unpleasant side-effects), at a social emotional level, their advantage is that they alleviate our symptoms by blunting our affect. Yet, this blunting also seems to increase happiness, a relaxed attitude, outgoingness, sociability, approachability, acceptance of both others and self, and --in the worst cases--desensitized violence. 48 Metaphorically, SSRIs thus seem to enable the feelings of well-being and self-confidence by chemically erecting mental-emotional “comfort zones” which effectively screen out whatever might cause too much emotional upset, anxiety, or justifiable depressive bouts.

In social psychological –and even political--terms, what these drugs offer is the ability not to pay too much attention to the self’s and others’ emotional expressions, or to pay a different kind of attention—a more detached one. If frequent watching of TV violence has been shown to cause a certain desensitization to real life violence, then perhaps SSRIs accomplish very rapidly and chemically the same result. The claim that such a chemically-engineered self is “better than well” is, to say the least, rather worrisome as it both implicitly and explicitly repositions “normal” (or “just well”) emotions as inferior and lacking. In other words, by suggesting that reduced emotional reactivity and empathy are signs of an enhanced self or express one’s “true” self, these websites implicitly promote a particularly troubling vision of what the healthy self should be and feel like. And behind the young, cool, “chilled”, hip, accepting and attractive faces smiling at us on the website screen, there is something quite chilling about these drugs which produce people whose shyness, insecurities, anxieties, and depressive tendencies have been effectively dulled; people who are basically well-disposed, cheerful and accepting because they might have simply ceased to care enough to react with appropriate emotional vigor.

The replacement of the self one experiences as painful but real by its chemically enhanced version which seems much less vulnerable to emotional interference reproduces, at the neurochemical level, the same kind of distortion Baudrillard and other postmodern theorists detected in the mass media and postmodern culture generally. 49 As they saw it, television not only mediated our perceptions of real social conditions but also re-constructed and disabled our very ability to understand and confront these conditions for what they really are. Prozac functions in a similar fashion. It not only mediates our perceptions of our own and others’ emotional conditions, but it also re-constructs and disables our very ability to understand and confront those conditions for what they really are. Both, in effect, facilitate our acceptance or tolerance of conditions (macro and micro) which used to trigger pain, outrage, anxiety, revulsion, or justified anger. At the same time, however, such effects seem particularly well attuned to the postmodern moment that seems to precisely require a constant “adiaphorization”, 50 a “narcosis of the senses”. 51

Like those TV commercials showing happy family members dancing around a bucket of greasy fried chicken which so frequently interrupt and displace important and unpleasant news, SSRIs may very well chemically interrupt and displace important, unpleasant and emotionally trying experiences, thoughts, realizations or events which inevitably punctuate our daily existence, consciousness, and more generally, the human condition.In both cases, these “feel good” spectacles, commodities, or pills produce a sense of mild euphoria which conveniently eliminates the real and difficult work which we must often undertake in order to implement necessary changes in both macro and micro social spheres. Thus, if the Prozac website recommends, as part of our “feel-good” self-discovery therapy, that you “avoid people who make you feel bad”, 52 it is only a short while before these recommendation will also be extended to other difficult aspects of our environment that also make us feel a little “too” guilty, sad, anxious, or panicked; those that seem too demanding, those that spoil our mood, or those that threaten our newly FDA-approved right to self-love and emotional escape. Judging by the vertiginous increase in the number of children who are unwillingly medicated with Ritalin, 53 it is difficult not to imagine a future when we might also be increasingly and firmly advised to take Prozac, Paxil or Zoloft “for our own good”, to enhance our emotional performance and “fitness” at the office, at home, on vacation, or on business trips. As Lyon observes,

The boundaries of the category of depressive disorders thus continues to expand…as does the list of other types of ‘disorders’ for which Prozac is prescribed. According to some commentators, Prozac is commonly prescribed for persons who do not at all fit the criteria for depression, but who are labeled as ‘dysthymic’, or even ‘sub or borderline dysthymic.’ Dysthymia, meaning emotion appropriate to the circumstances, surely a social judgment, is, in the words of one review, jargon for those who are ‘perpetually crabby, under the weather, insecure, malcontent’ or simply ‘people who realise they’re more unhappy than the situation call for’… 54

Although it is hard not to fall into clichés after Huxley’s Brave New World, we should also consider the political implications of the increasing chemical pacification of the middle and professional classes which have, overall, remained rather complacent in the face of daily news of a growing “body count” in Iraq, of the mass slaughter and torturing of civilians, of deportations, of the erosion of civil rights in the name of “freedom and security”, of increasing ecological devastation, and of a long list of other crises. It is similarly difficult to resist the conclusion that the new drugs so celebrated on these websites constitute an individualistic psychochemical solution to the seemingly unsolvable and always violent crises that daily terrorize us on the high-definition screens of the mediascape. Bombarded daily with news of anthrax and high-school shootings, of plane crashes and random murder, of sudden poverty and mutant viruses, of terrorism and lethal dangers lurking in everything we eat, breathe, drink and drive, the description of generalized anxiety disorders as “worry when there is no sign of trouble” 55, or of panic attacks as intense fear “in the absence of any external threat” 56 sound almost comical. Whereas these websites use complex diagrams, animations, pictures chemical formulas and fancy-sounding words to explain why so many of us may be suffering from depression, social anxiety disorders, panic attacks, or post-traumatic stress disorders, they cannot allow themselves to ask different questions. They cannot (and choose not to) discuss all the threats which we must confront daily without any sense of community, solidarity, a belief in a viable future, enduring institutions, guidance or inspiration from any form of leadership -- threats that would trigger, in any normal person, precisely these emotional reactions which SSRIs propose to treat by promoting self-satisfaction, mellowness, and emotional detachment in the face of constant disaster.

At some level, this emotional bluntness, this decreasing ability to feel with the appropriate human intensity is the price we pay for enjoying an easier social and emotional life under conditions of “fun” capitalism. More spectacles and better visuals; more bargains at the mall and sexier cars; bigger burgers and more free toppings on your pizza; the rewarding of mediocrity; the legendary 15 minutes of fame for everyone; and a self-righteous arrogance and destructiveness on the international scene that is fueled at home by a facile and self-indulgent patriotism. In this respect, the seemingly delusional claims on the SSRIs websites and other media texts that the chemically–regulated enhanced self is indeed one’s true self is not only narcissistic but also ideological. In other words, this self is not only preferable at the individual “feel good” level but also at a more macro-social one. In such a light, this mellow, attractive and satisfied “me” who hails us from the computer terminal and other media screens might perhaps become the ideal role model, the preferred disposition we should all emulate in order to fit more smoothly and cheerfully in the brave new postmodern world.

Whereas critical theorists such as Marcuse and Fromm proclaimed that citizens of “civilized” societies would be “brainwashed” into conformity and submission by mindless media spectacles, a more tolerant approach to sexuality, and the promises of increasing consumption for all, this concept of “brainwashed” has now taken an eerily literal meaning. 57 ForMarcuse, the purpose of this “brainwashing” was to manipulate our sense of reality in order to ensure our willing resignation to, and satisfaction with everyday life under capitalism. In Marcuse’s time, however, such a metaphorical brainwashing necessitated the coordinated efforts of the mass media, the economic, and the political institutions. Today, this project is much more easily achieved through the individual’s voluntary swallowing of pills which –chemically-- promote the same credo of adaptation to the existing system, absorption in infantilizing spectacles, ever-escalating consumption of all the toys the economy turns out (at reduced prices), and above all, the self-satisfied and cheerful resignation that there is simply no alternative. And while Marcuse still pinned some hope on the discontent permeating such advanced societies – a discontent emerging out of the contradictions between the real possibilities brought about by advanced technology and existing social conditions-- SSRIs eliminate this critical potential. Chemically.

This situation has, of course, profound consequences for the kinds of people we will become, how we will socialize our children, the kind of emotional guidance and tolerance we will have at our and their disposal, and the social-emotional environment we prepare for them. While “soft” environmentalists have long condemned our criminally voracious lifestyle which requires the increasing release of toxic substances in our natural environment, an exponential depletion of its precious resources, and hence a de facto rip-off of the next generations, the parallel with the emotional environment is obvious. The medically-recommended decision to maximize one’s level of serotonin in order to enjoy the promises of an individualistic and instant emotional utopia follows the same destructive logic. 58 It means that we are also depleting, at both individual and social levels, rich “natural” emotional resources without thinking too much about the effects of such “fast food” solutions on the near and distant future.Thanks to Prozac, I can get now satisfaction.

In this sense, the medically sanctioned turn towards SSRIs might very well constitute a sort of abdication of social and emotional responsibility in the face of worsening social crises. It is the chemical version of the increasing retreat behind the exclusionary fences of gated communities. Pleasant, subdue, orderly, daily landscaped by an invisible cheap minority workforce, they offer relaxing spaces, security, and the welcome architectural/neurochemical exclusion of unpleasant realities in the public space outside and the private space within.

But…you do look glum! What you need is a gramme of soma (Huxley, 1969, p. 40).

Because SSRIs weaken our emotional sensitivity, we must seriously contemplate the conclusion that, as chemically-regulated citizens, we will increasingly lose the ability to correctly assess our decisions and their consequences --from the personal to the international level. Since interactions at all these levels always include an emotional dimension, an inability to properly attend to this dimension means that our decisions will be permanently misguided by a very incomplete and distorted information. And while we would reasonably refuse to be driven around by a person inebriated by alcohol or other substances that impair his perception, we should also consider that (to use the Prozac metaphor of liking oneself as “the vehicle” on the road to self-knowledge, and life generally) the SSRI-regulated self is no less impaired. 59 Since it is emotionally desensitized and suffers from a weakened capacity for empathy, care, and understanding, it should not be entirely trusted for important decisions. But while an alcoholic can decide to sober up and stop drinking, the chemical recalibration of our brains seems more permanent.

Whereas the social and psychological effects of SSRIs are problematic enough in terms of “proper” emotional intensity and ability to care, Stephen Braun adds another important variable to the neurochemical equation:

If SSRIs not only blunt our emotional sensitivity but also impair our ability to make intelligent decisions about their very use, we are indeed confronting a most unusual paradox, crisis, and danger about which the SSRIs websites remain conveniently silent.

It is too early to really comprehend and anticipate all the revolutionary changes that SSRIs have introduced, and in any case, such changes cannot be fully examined without also taking into consideration a plethora of other permanent revolutions we currently experience as a matter of routine. Still, as scientists of the self and/in society, it is imperative and urgent that we do so. To quote CW Mills one last time,

1 PR Breggin and GR Breggin, Talking Back to Prozac, New York, 1994; PD Kramer, Listening to Prozac, New York, 1993; ML Lyon ‘C. Wright Mills meets Prozac: the relevance of ‘social emotion’ to the sociology of health and illness’, in V James & J Gabe eds., Health and the Sociology of Emotions, Oxford, 1996, p. 60-61.

2 PR Breggin and GR Breggin, Talking Back to Prozac, New York, 1994; N Crossley, ‘Prozac nation and the biochemical self: a critique’, in SJ Williams, L Birke & GA Bendelow eds., Debating biology: sociological reflections on health, medicine and society, London, 2003, p. 249; ML Lyon ‘C. Wright Mills meets Prozac: the relevance of ‘social emotion’ to the sociology of health and illness’, in V James & J Gabe eds., Health and the sociology of emotions, Oxford, 1996, p. 58; PD Kramer, Listening to Prozac, New York, 1993.

3 NK Denzin, ‘The Postmodern Sensibility’, Studies in Symbolic Interaction, vol. 15, 1993, pp.179-188; D Dickens and A Fontana, (eds.), Postmodernism and social inquiry, Guilford Press, New York, 1994; M Featherstone, Consumer Culture andPostmodernism, London, 1991; M Gottdiener, M, ‘Alienation, everyday life, and postmodernism as critical theory’, in F Geyer, ed, Alienation, ethnicity, and postmodernism, Westport, 1996, pp. 139-148; S Gottschalk, ‘Uncomfortably numb: countercultural impulses in the postmodern era’ Studies in SymbolicInteraction, vol. 21, 1997a, pp. 115-146; S. Gottschalk, ‘The pains of everyday life: between the D.S.M. and the postmodern’, Studies in SymbolicInteraction, vol. 21, 1997b, pp. 115-146; S. Gottschalk, ‘Videology: video-games as postmodern sites/sights of ideological reproduction’, Symbolic Interaction vol. 18, no 1, 1995a, pp. 1-18; S. Gottschalk ‘Ethnographic fragments in postmodern spaces’, Journal of Contemporary Ethnography vol. 24, no 2, 1995b, pp. 195-238; D Harvey, The condition of postmodernity, London, 1989; R Hollinger, R, Postmodernism and the social sciences: a thematic approach, Thousand Oaks, 1990; F Jameson, ‘Postmodernism and consumer society’,” in H. Foster, ed., The anti-aesthetic, Port Townsend, 1983, pp. 111-125; F Jameson, ‘Postmodernism, or the cultural logic of late capitalism’, New Left Review, 146, 1984, pp. 53-92; E Kaplan, (ed.), Postmodernism and its discontents, London, 1988; D Kellner Media culture,New York, 1995; . MD Levin, ‘Clinical stories: a modern self in the fury of being’, in MD Levin, ed., Pathologies of the modern self: postmodern studies on narcissism, schizophrenia and depression, New York, 1987, pp. 479-530; DB Morris, Illness and culture in the postmodern age, Berkeley, 1998; S Seidman, ed., The postmodern turn: new perspectives on social theory, New York, 1994; R Williams, Marxism and literature, New York, 1977.

4 I am referring here to the information appearing on the webpages of the three main SSRIs -- Prozac, Paxil and Zoloft.

5 M Chayko, ‘What is real in the age of virtual reality?: reframing frame analysis for a technological world’, Symbolic Interaction, vol. 6, no 2, 1993, pp. 171-181; M Poster, The second media age, Cambridge, 1995; M Poster, The mode of information, Chicago, 1990; H Rheingold, Virtual reality, New York, 1991; S Turkle, The second self: computers and the human spirit, New York, 1984.

7 E Lilly and Company, Florida , 2005, viewed 1 March 2005 , <http://www.Prozac.com>

22 N Crossley, ‘Prozac nation and the biochemical self: a critique’, in SJ Williams, L Birke & GA Bendelow eds., Debating biology: sociological reflections on health, medicine and society, London, 2003, p. 248.

26 C Lasch, The Culture of Narcissism, London , 1978. See also: J Friedman, ‘Narcissism, roots and postmodernity: the constitution of selfhood in the global crisis’, in S Lash & J Friedman eds., Modernity and identity, Oxford, 1992, pp. 331-336; MD Levin ed., Pathologies of the modern self: postmodern studies on narcissism, schizophrenia and depression, New York, 1987.

28 J Baudrillard, Simulations, New York , 1983. Hyper-reality refers to a condition where simulations (such as TV representations) seem more real than what they are representing.

30 Prozac website, “Disease Information” section, p. 1. That Marilyn Monroe might have died from an overdose of antidepressants is conveniently glossed over.

32 Zoloft website, “Depression” section, p. 3. In addition, the Zoloft page also mentions that:

Acknowledge that the person is suffering
Express affection, offer kind words, give compliments
Show that you respect and value the person
Help the person keep active and busy
Don’t expect the person to just “snap out of it”
Don’t criticize, pick on, or blame the person for his/her behavior
Don’t say or do anything that might worsen the person’s poor self-image
Don’t ignore any talk of suicide: notify a member of the person’s family or his or her doctor immediately

33 Zoloft website, “Panic Disorder” section, pp 2 and 3,“Obsessive-Compulsive” section, p. 3.

34 Prozac website, “Depression” section, “Caring for Others”, pp. 1 & 2. Family members and friends of the depressed person are also told to “encourage the person to stick with the treatment,” “give emotional support by listening carefully, being optimistic, and offering hope,” “invite the person to join you in activities he or she used to enjoy,” “keep in mind that expecting too much too soon can lead to feelings of failure,” “do not accuse the person of faking illness or expect him or her to ‘snap out of it’,” and “take comments about suicide seriously: seek professional advice.”

36 N Crossley, ‘Prozac nation and the biochemical self: a critique’, in SJ Williams, L Birke & GA Bendelow eds., Debating biology: sociological reflections on health, medicine and society, London, 2003, p. 253.

37 While still mostly alone, the faces appearing in the different “disorders” sections on the Paxil website seem to display the disorders being discussed. The cute Zoloft egg-shaped cartoonish figure is also drawn as showing emotions which evoke various disorders, and smiles on those sections of the webpage which describe Zoloft’s effects on various disorders.

38 A Hochschild, The managed heart: The commodification of human feelings, Berkeley, 1983.

39 JN Zita, Body talk: philsophical reflections on Sex and Gender, New York, 1998, p. 63.

40 I cannot, in the space of this chapter, offer a crash course in symbolic interaction theory. Interested readers should consult the founding texts such as: H Blumer, Symbolic interactionism, Berkeley, 1986; CH Cooley, Human nature and the social order, New York, 1922; E Goffman, The presentation of self in everyday life, Harmondsworth, 1959; Goffman, E, Behaviour in public places, New York, 1963; E Goffman, Interaction ritual, Pantheon, New York, 1967. E Goffman , Relations in public: microstudies of the public order, Harmondsworth, 1971; GH Mead, Mind, self, and society, Chicago , 1936. Other useful texts include: J Charon: Symbolic interaction: An introduction, an interpretation, an integration, New Jersey, 1985; K Plummer,e d., Symbolic Interactionism, Brookfield, 1991, for example as well as the journal Symbolic Interaction.

42 PR Breggin and GR Breggin, Talking back to Prozac, New York , 1994, p. 208.

44 T Grodin and R Lindlof eds., Constructing the self in a mediated world. London, 1996; JF Gubrium and JA Holstein, ‘Grounding the Postmodern Self’, The Sociological Quarterly vol. 35, no 4, pp. 685-703, 1994; S Hall, ‘Introduction: who needs identity?” in S Hall & P Du Gay eds.,Questions of cultural identity, London, pp. 1-17, 1996; S McNamee, ‘Therapy and identity construction in a postmodern World’, in D. Grodin and TR Lindlof, eds., Constructing the self in a mediated world, London, pp. 141-153,1996; L. Richardson, ‘Narrative and sociology’, in J Van Maanen ed., Representation in ethnography, Thousand Oaks, pp. 198-221, 1995.

45 PR Breggin and GR Breggin, Talking back to Prozac, New York, 1994, p. 210.

E Lilly and Company, Florida , 2005, viewed 1 March 2005, <http://www.Prozac.com>;

47 PR Breggin and GR Breggin, Talking back to Prozac , New York, 1994, pp. 210-218.

51 K Robbins, ‘Forces of consumption: from the symbolic to the psychotic’, Media Culture & Society vol. 16, 1994, pp.449-468. See also S. Gottschalk, ‘The pains of everyday life: between the D.S.M. and the postmodern’, Studies in SymbolicInteraction, 1997, pp. 115-146.

52 Prozac website, “Depression” section, “Practicing Self-Discovery”, p. 1

53 R De Grandpre, Ritalin nation: rapid-fire culture and the transformation of human consciousness, New York , 1999.

54 ML Lyon ‘C. Wright Mills meets Prozac: the relevance of ‘social emotion’ to the sociology of health and illness’, in V James & J Gabe eds., Health and the sociology of emotions, Oxford, 1998, pp. 60-61, 1996.

57 E Fromm, The Sane society, New York , 1956; H Marcuse, Eros and civilization, Boston , 1955; H Marcuse, One-dimensional man, Boston, 1968.

58 DB Morris, Illness and culture in the postmodern age, Berkeley , 1998, p. 237.

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