The Pill of Pills

Listening to Prozac

by Peter D. Kramer
Viking, 409 pp., $23.00

“This man was addicted to moanin’,
Confusion, edema and groanin‘,
Intestinal rushes,
Great tricolored blushes,
And died from too much serotonin.”

As a third-year medical student forty years ago, I gratefully used this limerick to help me remember the signs and symptoms exhibited by patients harboring an unusual chemical-secreting tumor called carcinoid. The lines had been composed by the most nimble-witted of the great professors of medicine of that time, William Bean of the University of Iowa.

Dr. Bean was a physician renowned not only for a series of uniquely conceived contributions to medical knowledge but also for his enviable gifts for language and whimsy. Among the most celebrated manifestations of his literary talent was a seemingly instinctive ability to produce instantaneous and faultless rhymes to suit any and every clinical situation in which he found himself. When attending large meetings, Bean would customarily take a seat near the rear of the auditorium, so that he might best absorb a panoramic sense of the atmosphere. Called upon to comment (and he was always called upon to comment), he would slowly make his way to the lectern while silently composing an appropriate fragment of doggerel, which, when he began his remarks by reciting it, invariably sent his colleagues into transports of howling delight. In biblical and classical times, poetry was used to facilitate remembering, and so it has been for the cleverly couched cadenced wisdom of William Bean, still cherished by the generation of American physicians privileged to be exposed to it.

Were Bean alive today, he would read Listening to Prozac with an amused skepticism, and wonder what Peter Kramer was trying to do, beyond writing a best-selling book. The author’s uncertain gropings for proof of a fanciful theory of the self would doubtless inspire couplets, quatrains, and not a few limericks, the Iowa sage’s puckish way of dismissing an author who has played fast and loose with the most basic principles by which physicians evaluate clinical experience and propose new ways of explaining or treating illness.

Those principles require (1) meticulous and personally made observations of an illness or maladaptive state; (2) even-handed review of all pertinent publications that bear on the problem; (3) scrupulous attention to every fragment of clinical evidence, whether or not it supports the observer’s evolving hypothesis; and (4) a commitment not to speculate beyond what is justified by the accumulated data and its supportable implications. These are the criteria by which the work of any physician should be judged, whether he or she is making a diagnosis, recommending therapy, or introducing a new theory.

Nowadays, the human mind is no longer so unchartable a territory that its investigators should not be held to the same standard. Admittedly, this has not always been the case, especially during the period of pioneering psychological investigations when so little was known of the physiology of the nervous system. But even Sigmund Freud said he yearned for the day when his…

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