Prozac and Medical Marijuana

Everybody who knows the history of the medical marijuana movement knows that Dennis Peron started the San Francisco Cannabis Buyers Club in response to the AIDS epidemic circa 1990. It was also the beginning of the Prozac epidemic (which is less well known). Eli Lilly’s brilliant, pervasive marketing scheme would change how US Americans thought about “Depression,” and what constitutes a “serious illness,” and the “medical use” of drugs to improve mood.

I was working at UCSF and writing “Notes From the City” for the Anderson Valley Advertiser. At one point I wanted to get Dennis’s take on Prozac and went over to his club on Church Street. (I went there rarely. I was afraid to share a joint with people with AIDS, but I didn’t want to hurt anybody’s feelings by not taking a hit. In ’96, when I started covering the Prop 215 campaign and hanging out at 1444 Market St., the club’s ultimate site, I would pinch a proffered joint ‘twixt thumb and forefinger so that it didn’t actually touch my precious lips as I drew in. After a while I gave up the awkward maneuver and started taking normal hits.)

 “Half the people I talk to are on Prozac,” said Dennis with amused astonishment. “I can almost always tell because they get so chattery. People who used to never say a word, suddenly they’re talking talking talking… ‘Are you on Prozac?’ ‘I was but now I’m on Paxil…’” This is the context in which Dennis said, “In a country that pushes Prozac on shy teenagers, all marijuana use is medical.” It was a brilliant line that simultaneously questioned and exploited the definitions of illness that Big PhRMA and the medical establishment were promoting. Political jiu-jitsu!

Dennis’s detractors snipped off his prefatory clause and then mocked him for making an absurd overstatement. Dennis being a rapscallion, instead of protesting, started using the shorter version: “All marijuana use is medical!”  His original line, with its reference to Prozac and shyness, was and is the best response to the cynics who have put down the medical marijuana movement all these years.

Federal Depression Guidelines mirrored Eli Lilly’s Prozac graphics.

The Accidental Beneficiary

The medical marijuana movement-that-became-an-industry has been the accidental beneficiary of Eli Lilly’s campaign to vastly expand the definition of the “medical use” of drugs. The goal of that campaign, Alexander Cockburn and I wrote in a book proposal  in 1995, was “convincing the American people that there is a medical illness called clinical depression that results from a chemical imbalance in the brain and that is treatable by drugs. The campaign is advanced by the psychiatric establishment and the federal government. Its goals include encouraging physicians to diagnose clinical depression more frequently and keeping the American people convinced that the spreading mass misery is just so many individual cases of ‘chemical imbalance,’ correctable by drugs.”

Eli Lilly underwrote “National Depression Screening Day” and flooded the media with quizzes to identify untreated depressives. Five yesses meant you had a serious-but-treatable illness and should see your doctor.The symptoms were worded to widen the Prozac catchment area.What US American grown-up could answer these questions honestly and not come up with fives yesses?

1. “Changes in appetite and weight” is vague, contradictory, and all embracing. Whether you’re gaining weight or losing weight, you’re a potential customer.

2. “Disturbed sleep”  is similarly vague, contradictory and all-embracing —sleeping too much and sleeping too little. In any case, it’s a common symptom of aging.

3. “Motor retardation or agitation”  is contradictory, vague and all-embracing. Going too slow or too fast? We have a pill for that.

4. “Fatigue and loss of energy.” Fatigue results from overwork and/or lack of sleep. Loss of energy can be the result of the sedentary lifestyle that most Americans are forced into. Our work is “increasingly remote from physical effort,” psychoanalyst Joel Kovel points out, “and more and more a matter of supervising technical processes, watching over the sales, distribution and wasting of commodities, and dealing with human interaction itself.”

5. “Depressed or irritable mood” To say that feeling depressed is a defining symptom of clinical depression is a syllogism. And even when the real-world causes of a patient’s “depressed or irritable mood” may be very obvious —loss of a job, a relationship on the rocks, kid trouble, etc.— the resultant diagnosis, “Clinical Depression,” implies that his or her internal psychological condition was causal.

Frederick Goodwin, formerly the U.S. government’s top psychiatrist, said in an interview (with this FG) that an episode of major depression is one of “relentless duration —week after week. You can have a grief reaction that can be every bit as intense as a clinical depression. But it doesn’t last. Depressions stick around…” A key to defining depression, he reiterated, was “Duration. Duration measured in weeks and months rather than days.”

A few weeks? A few months? Is that ‘relentless duration’ in your world, doctor? In our world grief reactions last for years, decades, lifetimes, generations!

  6. “Loss of interest or pleasure in usual activities” This can be associated with physical aging and/or deteriorating quality of life. For example, you may no longer take pleasure in swimming at a beach after you’ve noticed raw sewage bobbing in the waves. You may not find driving as pleasurable now that there’s bumper-to-bumper traffic and the commute that once took 20 minutes takes an hour.

7. “Feelings of worthlessness, self-reproach, excessive guilt”  Such feelings are the lot of millions in an economy characterized by “downsizing.”  Men who can’t afford to provide for their families tend to feel worthless. Women who leave their infants in day care tend to agonize over the decision and feel self-reproach. People living from pay-check to pay-check tend to feel hopeless about the future.

8. “Thoughts of suicide or death” A suicide attempt is obviously a sign of major depression; but occasional “thoughts of… death” are inescapable.

9. “Difficulty thinking or concentrating”  A function of the speed and stress of our culture. Social media hasn’t helped.

Is Anybody Happy?

People exist —we thrive or suffer— in families and other groups. “Clinical depression” is almost always rooted in some form of loneliness and/or insecurity. Alfred Adler nailed it: happiness is a function of having friends, family and meaningful work. By taking a pill that leaves more serotonin in their synapses —or a dab that augments cannabinoid tone— individuals may achieve a substitute “happiness” without changing the conditions that made them miserable.

Loneliness and economic insecurity can be diminished only by political means. If we had an system that didn’t encourage so much moving around and a culture that valued the extended family, millions of people wouldn’t feel isolated. If the economic goal was to produce life’s necessities in a sustainable way, millions of people wouldn’t be impoverished and hopeless.