April 21, 2008

Who Are We?

A recent article in the New York Times, written by Richard Friedman, MD, is called Who Are We? Coming Of Age On Antidepressants.

The article can be summarized: "I've been on antidepressants for most of my life. How do I know who the real me is?"

It's an interesting question, and many have attempted to answer it.  But the question is faulty, because it assumes there is a "you."

And, of course, there isn't.

A medication doesn't alter your core personality; your personality constantly changes, adapts, to stimuli.  Why do some people go all Zimbardo at the drop of a hat, while men married of 20 years become infuriatingly repetitive in their behaviors?

It's no different than the antidepressant question, which is no different than anything else. You're confused because it's a medication, but there are other things more powerfully transformative than a pill. For example: divorce. You may think the "real you" married your wife or husband, but I am confident that if you had married someone else, you would have been a different person-- sometimes dramatically different. Example: a gazillion women who are in their second (happier) marriage have told me that they don't even recognize the woman that they were in the first marriage. "I can't believe the things I did-- in some ways, I was actually a bad person." And they describe being manipulated-- and manipulating; being selfish, etc. Circumstances made them "bad," and the healthier second marriage has made them into a healthier, better person.

Or whatever. I'm not saying all first marriages are bad, and you are bad for being in them-- I'm giving an example of how an external event that you chose drastically alters your identity.  The pill is no different.

The reason so many people can't accept this existential position is because many parts of personality seem to remain consistent despite significant events, meds, etc.  But much of the consistency has to do with consistencies in other environments. e.g. You had two marriages, but the same job; or you still saw your parents every weekend; etc, etc. Those anchors fix parts of your identity.

Friedman offers the example of a woman who has been taking Zoloft for 8 years, and has had a decreased libido.

She had understandably mistaken the side effect of the drug for her "normal" sexual desire and was shocked when I explained it: "And I thought it was just me!"

This is an exceptionally good example, because it shows why Friedman's logic is wrong. Why is it Zoloft's fault? How do you know she just doesn't have a low libido?

I know Zoloft has sexual side effects. But he jumps to the conclusion that because they have side effects, that must be why she has a low libido. But do sexual side effects happen in everyone? The package insert says 6-11%. I'll spot you 20 points. If 30% of patients have decreased libido, is it logical to blame her low libido on Zoloft, and not on anything else?  She doesn't say she has a decreased libido; she says she has a low libido. See the difference?

But even that explanation is a distraction.  Friedman misses the point altogether: she has a low libido. Period. Maybe it's the Zoloft, maybe it isn't, but unless she is coming off the Zoloft; unless she just started it that you are noticing a change from before; then the point is moot. Low libido is her identity.  Perception isn't reality, behavior is reality. 

What people want is there to be a core, perceived identity-- "I'm X"-- that can be pharmaceuticalized into existence without the requisite behavioral effort. "I should be happy." Well, actually, no. You shouldn't. You may want to be happy, but there shouldn't be an expectation of it.

If you are normally a happy person, and then become depressed, then you can say the meds are returning you to normal. But if you have always been depressed, and the meds have changed that, you are not returning to normal, you are moving further away from normal. I'm not going to judge this as good or bad-- I'm simply saying that you're not returning to core, you are different.

The key here is that early childhood if of huge importance in creating anchors, which will allow some consistency of personality throughout life.   Consequently, the extent to which you have some personal traits will determine how easily you change the others.  e.g. narcissists can be relied upon to become violent even when they "are" not violent people.

But, ultimately, you get to choose who you are. Choose.


Take a pill and become some... (Below threshold)

April 21, 2008 9:35 PM | Posted by Demodenise: | Reply

Take a pill and become someone else? That's a really scary way of looking at things.

Generally, (even in mental health!) we tend to fuss at people for defining themselves in terms of their environments--although that may be a symptom of Western psychology's obsession with the "individual,"--so the idea of personality being a fluid and adaptable construct goes over kind of like a pregnant pole vaulter.

But--and I'm playing devil's advocate here, 100%--if there's not a core personality, a "me" or a "you", who's doing the choosing? And how can one consistently make choices in their life if they're always a different person? What's the difference between "right for me" and "right for me RIGHT NOW?" :D

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Have you considered this? <... (Below threshold)

April 22, 2008 8:15 AM | Posted by pssrisd: | Reply

Have you considered this? http://en.wikipedia.org/wiki/Post_SSRI_Sexual_Dysfunction

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One of the central messages... (Below threshold)

April 22, 2008 7:21 PM | Posted by Epi Wonk: | Reply

One of the central messages of Buddhism is that there is no "self," or rather that the self is a kind of convenient fiction. After ten years of daily meditation (which I started in order to deal with severe chronic pain) I've found this to be essentially true, although the issue is obviously complex. I highly recommend David Loy's book, "Lack and Transcendence: The Problem of Death and Life in Psychotherapy, Existentialism, and Buddhism," which discusses the topic of "self," or lack thereof, in extremely interesting detail.

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A little to left-field here... (Below threshold)

April 22, 2008 10:07 PM | Posted by Diane Abus: | Reply

A little to left-field here the self in flux and the paradox,a point of position but no magnitude-a "portrait "of the spiritual self.Best,

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Man, you are always so sure... (Below threshold)

April 27, 2008 3:05 AM | Posted by Marco Maggi: | Reply

Man, you are always so sure that, if we want, we can pick an identity! There is at least the way human learning goes: if we experience another person taking a behaviour, that behaviour becomes a possibility for us; if we never experience it, it is very difficult to do it.

And there is also the reason why advertisements work; we are open to stimuli: we have are range of possibilities and we are influenced by events.

We do not choose an identity like switching electric light on or off, we live a process; but few have the power to make a process happen (mostly economic power, in the western culture of today).

We can choose among a limited range of possibilities.

I would agree with you if you were saying that we can try to choose, we can search, we can look for another behaviour; and in searching lies the responsibility, the blame, the sin.

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Good post, Marco.H... (Below threshold)

April 27, 2008 4:29 AM | Posted by Sasha: | Reply

Good post, Marco.

Humans can choose a direction in which to move, but they can't flip a switch on identity.

Somehow the doc denies "human essence", boundaries on the rate of change that our physical and mental entities can support.

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I take Welbutrin to make my... (Below threshold)

May 23, 2008 2:37 PM | Posted by David: | Reply

I take Welbutrin to make my brain feel better. Sometimes I take Prevacid to make my stomach feel better. I take Requip to make my legs feel better.
I don't see how any of these drugs alter my identity at all. Except that if I wasn't able to pay for them I would either become a thief and steal them or become a raving maniac without them.

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What is human essence? Are... (Below threshold)

June 17, 2008 12:40 PM | Posted by Cash McCallister: | Reply

What is human essence? Are you an avacado with a core or an artichoke with layers to peel? Yes, an avacado has a heart, but have you ever been eating one and had trouble deciding when it was time to stop peeling layers and actually get to the heart?

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OOps, that was supposed to ... (Below threshold)

June 17, 2008 12:41 PM | Posted by Cash McCallister: | Reply

OOps, that was supposed to say that even an artichoke has a heart.

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Having moved around a lot d... (Below threshold)

November 17, 2008 6:24 PM | Posted by Philip Fortuna: | Reply

Having moved around a lot during childhood (continent hoping), I can look back and say the half dozen or so different groups of people that know me from different periods have distinct interpretations of who I am. Mobility free's you from anchors, habits and preconceptions.

I can only agree with your blog entry.

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