Pharmaceuticals and Healing

Since its conception, psychology has shared a desk with the medical doctor, the psychiatrist. For every cure the analyst put forth, the white coat trailed closely behind, offering fixes for the brain to accompany the talking cure. The 1950s had the sedative Miltown, the 1960s had “Mother’s little helper” (Valium), the 80s had Prozac. Even Freud himself was unable to escape the chemical temptation, and often used cocaine in his practice with patients. Psychology and medicine are tethered together, for better or for worse. And every few decades, we can expect a new magic cure for despair. Every age has its wonder drug.

Today’s wonder drug is less obvious than previous generations. No single drug has defined the early 2000s, but antidepressants remain on top, with at least one-in-ten Americans taking them. Yet similar rates are seen for benzodiazepines for anxiety, and increasingly also ADHD meds, which around six percent of Americans now take (CDC). Overall, around 17% of Americans are taking some sort of psychiatric drug, often combining multiple to form a mental health cocktail. Perhaps today’s miracle cure is the cocktail; a drug for each diagnosis, a pill for each problem.

As prescription rates rise, rates of mental disorder follow, now steadily rising for years, reaching new peaks in every report. It seems that something about these drugs is failing us. Mental disorder is winning. In all our efforts to be healed, the promise of cure seems evermore distant. Is our faith in pharmaceuticals dwindling? Have pills lost their magic? This phenomenon deserves further exploration.

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The word “pharmaceutical” is derived from the Ancient Greek pharmakon: a word paradoxically meaning both medicine and poison, something that can heal or kill depending on the context. It is often associated with magic or witchcraft, which can embody an object with either brilliance or malevolence. Of course, Ancient Greece did not have “pharmaceuticals” in the modern sense, nor did they have a scientific understanding of how substances affect the brain. Still, this paradoxical definition of pharmakon is intriguing when applied to modern life. We rely on pharmaceuticals to heal us, yet we must bear their often debilitating side effects. With the healing power of antidepressants comes sexual dysfunction, suicidality, and a general numbing of emotion. With the increased ability to focus that stimulants provide comes stunted growth, gastrointestinal distress, and irritability. Pick any drug from the psychiatrist’s handbook and the story will be the same: every drug has a dual nature, and it heals and poisons simultaneously.

The pharmakon is closely related to the Greek word for ritual sacrifice, pharmakos. In these rituals, a person—always a societal outcast of some sort—would be chosen to be expelled from society (sometimes through death), thereby purifying the rest of the community. Scapegoating this individual allowed the rest of society to go on carefree, unbothered by the social ills now cast onto the victim. The pharmakos, in effect, was the symbolic healing of society—a collective pharmaceutical, if you will. But this healing came with a sacrifice: the Lord giveth and the Lord taketh away.

Let us meditate on the shared root of pharmakon and pharmakos. In our enlightened world, we have no sacrificial lamb, nor do we have elaborate rituals of purification. Upon first glance, our pharmaceuticals have nothing to do with ritual sacrifice. At the same time, I have already touched upon the minor sacrifices that come neatly packaged in the pill bottle in the form of side effects. But we may extend this fantasy even further: What if the ritualistic taking of pharmaceuticals—25 milligrams, twice a day, seven days a week—is the modern pharmakos? If so, who is the sacrifice?

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I would like to return to the roughly 50 million Americans who now take a psychiatric drug. Of course, these drugs have pharmacological effects: they increase serotonin or tinker with dopamine, each with its own specific mechanism. In doing so, they can heal. At the same time, when we use these drugs, we cast off our symptoms onto the pill, and when feelings of depression or anxiety come up, like magic, the symptoms are taken from us. So in a sense the modern pharmaceutical acts as the subject of a pharmakos. By displacing our emotions onto the contours of the pill-body, we collectively expel our pathology from society, thereby purifying ourselves from discomfort. Society’s “chemical imbalance” is corrected. Indeed, the word “sacrifice” means also “making sacred”; whether this works through science or magic is irrelevant—in either case a sacred cleansing takes place through a powerful external agent, the pill. However, recall that the pharmakon was a force for both good and evil. We know the benefits of pharmaceuticals: “Symptom relief”, “Mental health”, “Remission”, but what about their shadow side? If pharmaceuticals can do harm—and not just through side effects—then how?

In Plato’s Phaedrus, the pharmakon is closely tied with an unusual activity: writing. In Plato’s telling of the myth, the Egyptian god Thoth (or Theuth as it is spelled in his work) introduces the concept of writing to King Thamus, telling him it is a gift used to enshrine memory, allowing it to be preserved forever. However, King Thamus refutes that writing will poison natural dialogue, in particular through equating words with knowledge:

For this invention will produce forgetfulness in the minds of those who learn to use it, because they will not practice their memory. Their trust in writing, produced by external characters which are no part of themselves, will discourage the use of their own memory within them. (Phaedrus, 275a). 

To understand why writing—of all things—is equated with the mysterious dual nature of the pharmakon, we may have to look at writing less literally. Writing, after all, is itself a process of turning the abstract into something concrete; it is taking intuitive thought and giving it the stamp of permanency. The consequence of this—as suggested King Thamus in the Phaedrus—is that we fail to practice our own memory. That is, we rely on external words to tell us what to think; thus writing can inhibit thought just as much as it can embody it.

In our modern psychological institutions, the psyche is known largely through works of writing. We have a book dedicated to its discontents—the DSM—and psychology has no shortage of research papers, scholarly articles, and theory textbooks. The result of this is a population of well-read psychologists who have learned to experience the psyche second-handedly. They are not practicing their own “memory” in the Platonic sense, but relying solely on external characters.  Enter the pharmakon. If our goal is to know the psyche through direct experience of psychic reality, writing that aims to make the psyche into something objective represents the evils of the pharmakon. Clinically this is seen in the various diagnostic labels, XYZ complexes, personality disorders, etc.—such things inhibit imagination of our problems by abstracting them onto a label. And the literal pharmakon may do precisely the same thing. Faith in the psyche is transposed into faith in the pill; trust in writing discourages memory. By curing the psyche of its lamenting, we lose the ability to hear its voice. We fall into psychological amnesia: a forgetfulness of the soul.

We might take away from Plato’s myth that writing should not overshadow memory; that is, intellectual abstraction should not take precedence over felt experience. When we say such things as “I have depression”, or “I need treatment”, we are merely trying out the doctor’s fantasy of medical cure. Behind this is the belief that modern medicine has the answer to our problems, and that our problems themselves are at least in part medical issues. This is the disease model of mental disorder: mental illness, psychopathology. Pharmaceuticals are an extension of this lineage of thought.

Next time we reach for the pill we might remember that magical healing comes with a sacrifice. There can be no pharmakon without the pharmakos. The modern sacrifice of the pharmaceutical approach may well be the soul. In exiling the soul, we protect the community from its complaints. But this cure is only temporary—thus we have phenomena such as “Drug tolerance”, “Loss of response”, “Desensitization”. The soul does not like to be suppressed. What we wish to forget, it remembers. Perhaps this is why the drug-based approach seems to be failing: the magic has worn off. The writing has gone stale. Our symptoms are learning to read between the lines. If our pharmacological institutions are working on a new pharmakon, they’d better hurry—for the soul has begun to escape the translucent orange container, and it may be too late to screw the lid back on.

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What comes after the pharmaceutical age? Only time will tell. Our psychological institutions continue to point to our brains, but have been unable to locate our faulty wiring which medication claims to fix. Every year people seem less inclined to define themselves in terms of neurochemical imbalance or brain disease. We are at a crossroads. The soul has grown out of its clothes and needs a new outfit. Has psychology anything left to tailor? Having exhausted the Oedipus complex, behaviorism, and now maybe the brain, it is in desperate need of a new pharmakon. Remember: Psychology never steps in the same river twice. Whatever the new pharmakon, it will arrive veiled in the same magical allure, a force for good slowly turned sour, until the snake bites its own tail once again.