Existential Fright or Ferocious Market Forces?: A Critique of Mark Rego's "Existential Loss Hypothesis"

Keywords
enhancement, drug cartography, depression, antidepressants

The rise in antidepressant treatment, particularly prescriptions for new genera-tion antidepressants or selective serotonin reuptake inhibitors (SSRIs) has indeed set off public alarm. What concerns the public about the rise antidepressant treatment is hard to lump into one category. Some consumer watch groups are critical of the amount of money that pharmaceutical companies pour into direct-to-consumer (DTC) advertising, drug lobbyists, and "incentives" for physicians to adopt and prescribe their drugs (Rosenthal et al. 2003). Others are concerned that physicians spend too little time with patients before writing out prescriptions for SSRIs, or that general practitioners are writing these prescriptions rather than psychiatrists. Many consumers are concerned over reports that some SSRIs are connected with patient suicides (Healy 2004) or the rise in prescribing SSRIs to young children. Recently, many leading medical journals have asked the pharmaceutical industry to set up a public database, in which they make available the results of all clinical trials on new medications so that physicians as well as consumers do not get distorted information about the efficacy and safety of medications (Meier 2004). Finally, there are many who worry that liberal prescribing of SSRIs, especially to patients who do not meet the criteria of major depressive disorder, unnecessarily tampers with nature, legalizes recreational drug use, and encourages an unhealthy technological trend toward making humans "better than well."

Existential Loss Hypothesis and Pharmacological Calvinism

This last camp has traditionally been dubbed the "pharmacological Calvinists," which was coined by Gerald Klerman (1972) and most recently invoked by Peter Kramer (1993) and S. Nassir Ghaemi (1999). Pharmacological Calvinists, so the charge goes, criticize technological innovations in psychiatry by appealing to pseudoscientific arguments that depression is integral to existential struggles for an authentic identity and/or an authentic relationship to the divine. Although writers throughout the history of medicine have associated depression with creativity or moral development (Graham 1990; Radden 2000), current medical thinking has it that most patients with depressive illnesses suffer needlessly, and without any accompanying insights (Rego 2005). Moreover, some pharmacological Calvinists are psychoanalysts, and therefore cling to outdated psychiatric approaches. Failing to offer the very best treatment to depressives, such as SSRIs, would mean that psychiatrists were neglecting their primary duty. Ghaemi (1999) implies that psychiatrists, who withhold medication and exhort patients to build up their psychological resources to handle depression or anxiety border on unethical practice.¹

Mark Rego's essay, "What Are (and What Are Not) the Existential Implications of Antidepressant Use?" (2005) carries forward the criticism that some public concern over antidepressant use follows from unfounded existential worries, and hence amounts to pharmacological Calvinism. Rego's article, however, does not appeared to be geared toward fellow physicians or policy debates, but rather to the general public. His primary aim is to show the public that their worries over the rise in antidepressant use among physicians is "misapplied" and "misplaced" (2005, 119).

My main criticism of Rego's argument is that he focuses the bulk of his argument discrediting the pharmacological Calvinists, those who are likely to offer up technophobic arguments based largely in pseudoscientific thinking. Rego is careful to point out that existential worries are only "one area of concern" over the "proper relationship between human psychic suffering and the medical treatment of such states" (2005, 119). However, the fact that he dedicates his article to exposing misapplied and misplaced existential concerns suggests that he considers this the most powerful argument against the rise in antidepressant treatment. Below, I consider the importance of defending technological innovations in psychiatric practice as an important goal in the wake of current policy debates over the regulation of biotechnology. It is clearly an important strategy for the psychiatric profession to refine their counterarguments to pharmacological Calvinism if indeed this view creeps into regulatory bodies. Yet, beyond this strategic function, arguing against pharmacological Calvinism...