PROVIDENCE — During his seven months at the Chestnut Lodge mental hospital, Dr. Ray Osheroff lost 40 pounds. He spent 16 hours a day pacing up and down the hall of his locked ward. His despair was so great he couldn’t even sit still to eat, instead snatching food off a plastic tray as he walked.
In early 1979, suffering from anxiety, depression, and suicidal thoughts, the successful 41-year-old kidney specialist entered Chestnut Lodge. He requested psychoactive medication to treat his symptoms, but his doctors said that medication wasn’t the answer. Ray, they said, had a narcissistic personality disorder stemming from his relationship with his mother. Their work with him was to “restructure” his personality, a process which could take as many three years.
A friend, seeing how pathetic Ray had become in his time at Chestnut Lodge, checked him out and into Silver Hill Foundation, another mental hospital. At Silver Hill, Ray was put on medication, as requested. He improved in three weeks, and was discharged within three months. But the damage was done: Ray had lost his $300,000-a-year practice. His marriage had ended. He lost custody of two children. So he sued. Osheroff v. Chestnut Lodge became a landmark case in American psychiatry.
The medication cocktail—an antidepressant plus antipsychotic—Osheroff received at Silver Hill was not yet a common one in 1979. But doctors were willing to try it, likely based off promising case reports that came out that year. Ray’s hospitalization is a study in the debate between psychotherapy and psychopharmacology, but also an example of doctors practicing on the bleeding edge of medicine.
“It was the grapevine—case reports, anecdote—that saved Ray Osheroff,” Dr. Peter Kramer concludes in his new book Ordinarily Well: The Case for Antidepressants, an argument for the use of psychoactive medications in depressed patients.
Sitting across an oriental rug from me in his Providence, Rhode Island office, Dr. Peter Kramer seems like an unlikely proponent of controversial medicine. His office, on the second floor of one of those classic shingled New England homes, is a 20-minute walk from the campus of Brown University, where he is a faculty member. And if pedigree is any matter, Kramer, a graduate of Harvard College and Harvard Medical School, is certainly no establishment outsider.
And yet, because of his strong belief in the efficacy of SSRIs (selective serotonin reuptake inhibitors), he finds himself against the current. As Kramer points out in his book, evidence-based medicine is very much in vogue, and in the past few years, a slew of studies, articles, and books have cast doubt on whether or not antidepressants do indeed work. Books with titles like The Emperor’s New Drugs: Exploding the Antidepressant Myth and articles with headlines such as “Antidepressant Lift May Be All in Your Head.”
“It is strange to have a book that ends up titled Ordinarily Well to make a sort of forceful argument for things being fairly good,” he quips, making light of state of affairs that might make others depressed.
The point these books and articles raise is that if clinical trials are right, it seems like antidepressants may not work much better than placebo sugar pills. They are also informed by a hostility toward the drug companies that manufacture the antidepressants—there’s a sort of anti-commercial-capitalism posture that informs some of these works.
Though he might not put it so bluntly, Kramer is a victim of our culture’s fickle attitude toward medication. In the early 1990s, Kramer became something of a minor celebrity for his best-selling book Listening to Prozac, which detailed a phenomenon Kramer had witnessed in his own practice: formerly depressed men and women taking Prozac became social butterflies, a major change in personality. He became “that Prozac man,” as one New York Times review called him. But this was fine, as by the end of the decade even a television crime boss was on an SSRI.
Now, however, the tide has turned against his perspective. Twitter, especially, has become a hostile environment. “I think it will be trolls wall to wall,” he says when I ask him how the Twittersphere will respond to the publication of Ordinarily Well. But it seems like Kramer might enjoy the intellectual controversy his book could spark. Is he dismayed that the culture has turned against medications that are, to him, so evidently useful? Yes. But it seems like part of him also likes to be a contrarian—his “odd pragmatism,” as he puts it, sets him apart.
“In the face of cheap, snarky, or quick attacks on antidepressants, I wanted to give a sense that thoughtful people have approached these matters,” Kramer says.
And this motivating impulse is evident in his book, which explores not only the history of the antidepressant (the first of which was discovered in 1956) but also how a drug comes into the modern marketplace. Kramer takes a visit to a drug trial facility, where he observes tests using many non-representative patients—people, for example, who do not have jobs.
“The candidate-drug-testing enterprise is built on failures in our social enterprise,” he writes. And he spends even a greater amount of time on parsing study after study on antidepressants, pointing out flaws in the evidence-based mindset. Though he doesn’t go so far as to say this, nothing in medicine is as objective as some would make it seem.
But despite this, Kramer is steadfast in his support for antidepressants, writing, “For all that critics cavill, there’s little doubt that doctors should and will use medication to shorten profound depressive episodes.” And: “Antidepressants provide dabs of light in what remains a gray pointillist canvas.”