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by Samuel H. Barondes
Oxford University Press, 2003
Review by Christian Perring, Ph.D. on Sep 5th 2003

Better Than Prozac

Better Than Prozac is a short book summarizing the current state of psychopharmacology, combined with a brief history and speculation about its future.  It is admirable in both the clarity of its writing and its frankness about the limits and potential of psychiatric drugs.  Samuel Barondes uses a couple of his patients as central examples to illustrate his ideas.  Clara was a 26-year-old Philosophy Ph.D. student working on the seventeenth-century British scientist and philosopher Francis Bacon.  She was filled with self-doubt about her studies, and had taken a leave of absence from her studies.  She came to Barondes after having tried psychotherapy, saying she felt hopeless and suffering from severe insomnia.  He prescribed a small bedtime dose of the sedating antidepressant Elavil which helped her sleep, but did not remove her moderate depression.  She was interested in trying Prozac, and after some deliberation Barondes agreed to give her a prescription.  It started to help, and she soon revealed to him that she had other anxieties concerning her appearance, since she believed that she had a deformed nose.  The Prozac seemed to alleviate her irrational feelings and her mental health improved enough for her to be able to complete her Ph.D. thesis and get a job teaching at a women's college.  Nevertheless, the medication also has some unwelcome side effects and has not completely removed her depression or her fears about her face.

In subsequent chapters, Barondes briefly outlines the discovery of the helpful psychiatric effects of anti-psychotic drugs, antidepressants, and anti-anxiety drugs.  His account takes a positive view of this history, placing it in a narrative of scientific progress and exciting research.  His account is in stark contrast with some other recent accounts, such as Robert Whitaker's Mad in America, who puts the use of psychiatric drugs in the context of the eugenics programs of the early twentieth century and argues that medications such as Thorazine are brain-damaging chemical straightjackets with no real therapeutic effects.  While Barondes acknowledges the severe side effects of some medications, he emphasizes their great benefits.  His account is not a piece of scholarly research, but he does have a reasonable bibliography for those who want to pursue his sources. 

The second half of the book starts with the case of Martha, who experienced symptoms of panic, but who was diagnosed with the rare condition Graves disease.  This leads Barondes to discuss the importance of genetics for psychiatric diseases, and this is the cornerstone for his suggestions about the future of psychopharmacology.  He moves on to discuss experimental trials with laboratory animals with different chemical formulations, and the reasons why different people can have very different reactions to the same medication.  Strikingly, he reports cases in which people have become murderously violent after taking medications, and he expresses no skepticism about this possibility. 

Barondes himself has served as a consultant for pharmaceutical companies, and some may think that he is insufficiently critical of big pharma.  He does acknowledge that sometimes the policies of these corporations are driven mostly by the desire to financial profit rather than to provide the most useful medications, although it's clear that in many cases, providing a great drug will of course help to create profit.  The value of Better Than Prozac is not primarily in its social commentary but in its ability to explain psychiatric neuroscience in relatively simple terms.  Ultimately, Barondes does not believe that we will make great advances in new medication until we make some significant progress in understanding of the biology of mental illness.  So this is a more cautious book than its title might suggest. 


© 2003 Christian Perring. All rights reserved.

Christian Perring, Ph.D., is Academic Chair of the Arts & Humanties Division and Chair of the Philosophy Department at Dowling College, Long Island. He is also editor of Metapsychology Online Review.  His main research is on philosophical issues in medicine, psychiatry and psychology.