Ask Your Doctor!

So a college student walks into a doctor’s office and they start talking meds.  The student had been deeply troubled in the past, had been acting out, drinking too much, failing classes, etc., but he had seen his life turn around after he started taking Prozac a year or so ago.  It was a miracle, he told the doctor.  But at the same time he was worried:  was the whole new him dependent on the pill?  What if he stopped taking it, or if it stopped working?  Would he lose all the wonderful new attitudes and capabilities he’d developed?  He wasn’t overly frightened, mind you, just mildly nervous.  He didn’t directly ask what to do about it, but the question still hung in the air, waiting for the doctor to advise him.

Office Hours for the Wrong Kinda Doctor

A typical moment from psychiatry’s wonder-drug era, right?  Except the doctor wasn’t an MD.  The doctor was me:  a historian with a PhD, or, as we like to say in my family, WkD—the Wrong kinda Doctor.

Two other recent examples of this kind of situation, which seems to crop up fairly often (details changed to protect privacy, as with the Prozac story above):

  • A friend came to talk to me about her Xanax prescription.  She’d been taking it for a month or two for panic attacks, and had refilled the prescription as authorized by her doctor.  At her next appointment, the doctor had apparently forgotten about the refill authorization and launched into a dire warning about addiction.  He advised her to cut back immediately.  But my friend was about to go on a two-week family trip to faraway lands and didn’t want to change her meds abruptly before leaving.  What should she do?
  • A student I’ll call Ed began asking pointed questions about a friend of his who used Adderall to fuel two or three nights out on the town each week.  His friend had a legitimate prescription for the drug, Ed said, but apparently did not use it medicinally at all; instead he saved every pill for recreational use.  Ed had been reading about amphetamine addiction and had even watched the classic 2006 scare flick from National Geographic, “World’s Most Dangerous Drug.”  Did I think his friend was in trouble?

So what should a humanities person—a WkD—say in such situations? What can we tell people who ask us about what they should or shouldn’t be taking; whether and/or how to stop taking what they are already taking; what their boyfriends, girlfriends, mothers, cousins, etc. should or shouldn’t be taking; whether they are depressed, bipolar, addicted, alcoholic, cured, oppressed, etc. etc.?

My guess is that most of us at least begin by taking the obvious steps:  make sure that the person is not in immediate crisis; try to get a sense of whether they are connected to medical and non-medical support networks; and make clear that you are not a physician and can’t stand in for one.  None of this calls for any special historian jujitsu.

But then what?  Is there something we can or should say that does call on our professional expertise?  Especially because some people seem to be asking specifically for a historian’s thoughts.  Improbable, I know, but I swear I’m not making it up.  Someone even said those exact words to me once:  “but I want to know what you think as a historian.”  I’m pretty sure I wasn’t dreaming.

So the moment comes, and how do we rise to meet it?  Or should we?  What, if anything, do we have to offer?  Is this the sort of thing that historians who want to challenge their “assumed subordinate position… to the sciences in the hierarchy of academic knowledge production” (as per Joe Gabriel in this blog) should be able to say something coherent and useful about?  Can our “context” be more than a decorative interest catcher in brass-tacks conversations about how best to apply (or not apply) the latest technologies?

I thought about what I’ve said in the past, and it usually goes something like this: I don’t tell anyone what to do, or even what I think they should do.  (If I had a lawyer I’m sure she or he would be relieved.)  Instead—big surprise—I act like a historian.  I situate and contextualize the medical advice or wisdom the person has received so that he or she can think and make decisions rather than simply obeying or rejecting it.

For the Xanax and Adderall situations, we talked about how and under what conditions prescription drug addiction becomes visible as a medical and social problem.  There have been drug panics; but there have also been pharmaceutical company cover-ups.

The Historian Uses Tools Wisely

Both exerted a profound influence even on those earnestly dedicated to establishing objective truths about addiction.  It is easy to understand and even be grateful for a doctor’s concern about the risks associated with a prescription drug—a crucial bit of consumer advocacy hard-won from a powerful corporate adversary.  At the same time, it is easy to be skeptical of panicky scenarios where addiction is portrayed as the inevitable result of exposure to drugs, especially if it is described as hinging on moral transgressions such as disobeying a doctor’s orders, obtaining too much relief from suffering, or having too much fun (with the wrong kind of person).  The complexities of history can create room for making informed decisions about drug use, ones that reckon seriously with medical advice while also reckoning seriously with the political legacy of American drug wars and wonder drugs.

For the Prozac question we talked about the student’s good fortune in having a medication work for him, as they clearly do for many people.  We also talked about the intellectual and commercial history of modern pharmaceuticals (and modern psychiatry) as a way to dethrone pills as the magical, totalizing substances he was worried Prozac might be.  We touched, gingerly, on the likelihood that despite the latest brain sciences we may never know why Prozac works for him, or doesn’t work for someone else.  As it turned out it wasn’t Prozac’s effectiveness that was scaring him; it was the cultural framing of that success as something coming entirely from the drug, completely disconnected from the many admirable life changes he had undertaken with the drug’s help.  If it was all about serotonin and Prozac, who cares what he did other than take his pills?  The uncertainties of history gave him room to make an informed decision about how to engage with the pharmaceutical determinism he found so unnerving.

In both cases the conversation was not about uncovering a medical truth which could then be obeyed or rebelled against; it was about identifying the forces and people that constrained and shaped the available medical truths, with the goal of making those truths as useful as possible in making good decisions.  And they can be very useful indeed, as long as their constituting logics (and politics) are clear.

Or at least that’s what I hope.  What do you tell people?  Do you think historians have, or should have, a role to play here?

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