Institute. Peter Kramer: Thank you. Sally: Very excited that you're here to talk
about your new book, "Ordinarily Well." Peter Kramer: Yes. Sally: And of course, people know you, I think,
most as the author of the 1986 "Listening to Prozac." Peter Kramer: '93.
Sally: '93. Peter Kramer: We go back to '86, you and I. But... Sally: "Prozac" came out in 80...Okay.
Peter Kramer: Yeah. Sally: Right, of course. And yes, in fact, we go back even before that,
because everyone knows you're the author of "Listening to Prozac," but they don't know
that you were one of my favorite teachers at Brown Medical School. Peter Kramer: Right.
Exciting. Sally: We were both together. Peter Kramer: It's good to have such an accomplished
student. Sally: Well, thank you.
I mean, you saved me from radiology. Remember I was almost headed in that direction? Peter Kramer: I remember. You thought you'd be better with people. Sally: With people.
Peter Kramer: Right. Sally: Okay. So, great. So here we are to talk about, as I said, "Ordinarily
Well," which is about antidepressants.
Peter Kramer: Right. That controversy about antidepressants. Sally: And there is a lot of controversy. So, just before we get to the controversy,
just let me ask you a basic question.
What are antidepressants for, and what is
depression? Peter Kramer: Right. So let's start with depression. People feel hopeless, sad, they don't experience
pleasure, they have low energy. Lots of other symptoms.
Sleep appetite, maybe suicidal, and at a level
that really interferes with their lives. And those are sort of the modern definitions,
but we know depression when we see it. Depression used to be diagnosed years ago
by doctors just feeling that these patients were really sad in a way that the person sitting
across from the experience as very burdensome. And it turns out that that condition which
has been recognized by humans as a disorder forever, going back to Hippocrates and melancholy,
forever, is a multi-system disease.
If you have it long enough, it interferes
with the way you make bone, the way you make blood elements. It interferes with your hormonal glands. It is a true bodily multi-system disease,
you know, seen at that level, and it's a disorder of the mind, you know, as we experience it
between people. Sally: Right.
So the brain and the mind. Even though everyone knows they're effectively
the same thing, but different levels of analysis. Peter Kramer: Right. Sally: And different language and different
ways of entering those frameworks.
So, say a little bit about the history of
antidepressants, and what are the antidepressants, at least that most people use today? Peter Kramer: So, for all of medical history,
going back to Hippocrates, doctors have wanted to have some substance that would combat melancholy. You know, this terrible, leaden, flat, you
know, death of the soul where people just can't get moving, can't engage in life, think
about killing themselves. And in 1957, using a couple of different substances,
different doctors got the idea that they actually had something to hand that did this. There was this doctor I write about at length
in the book, Roland Kuhn, in Switzerland, who had a medicine that was supposed to treat
psychosis, gave it to patients.
Wasn't very good, but some of the patients
got less depressed and he got permission to give it to depressed in-patients, out-patients,
more and less seriously ill people, and he realized he had an antidepressant. And pretty soon there were some sense of what
this medicine was doing in the brain and how that might relate to mood disorders. So, you know, 1957 is sort of the conventional
date. Sally: What was that called? Peter Kramer: That medicine was Imipramine.
Trade name was Tofranil. There were others. So those were in use. They're still in use now, but I mean, they
were widely in use up through the 1980s and we started getting this new group of antidepressants
that had more affect on a chemical use for transmission in the brain called Serotonin,
that has more effect on the transmission that uses that medicine.
And they were medicines like Prozac and Zoloft,
later Celexa, which was earlier in Europe, and Lexapro. So, a lot of the medicines you might have
heard of as antidepressants started coming into use in the late '80s and 1990s, and they're
the ones that are mostly given now. Sally: You know, I worked in a clinic... I mean, I work in a methadone clinic all the
time, but I did some extra work last year in a more general psychiatric setting.
And I was referred so many people who are
given the label of "depression." Peter Kramer: Right. Sally: And yet, they actually...They didn't
strike me as that depressed. They struck me as demoralized. Peter Kramer: Yeah.
No, I think your gut, the experienced doctor's
gut, is really a good way of understanding depression. I think we have lots of trouble studying it
because no one wants to say, "Well, doctor, what's your gut call on this patient?" And
study that patient. Everyone wants these catalogs of symptoms. But yes, I think the quality of stuckness,
the sense that the person's perspective really is distorted, that something goes well, they
can't see it as going well.
It only reinforces the hopelessness. So it's both stuckness in terms of the fixed
negative perspective. That's very hard to emerge from, even in the
course of, you know, a conversation. And then the longitudinal stuckness, it just
remains day after day.
And good things happen and it stays there
despite... Sally: So the lack of reactivity is more diagnostic
as it were of depression. Peter Kramer: Right. Sally: Whereas so many of my patients were,
as I said, I think more demoralized.
Their life circumstances were so chaotic. A lot of these people were inner city folks. Peter Kramer: Yeah, I mean, there's a whole... Sally: It doesn't mean those folks can't get
depressed.
Peter Kramer: ...Complicated discussion we
could have, because, you know, there's this dispute in the field about grief. And you know, if there's a good reason for
you to be depressed and you have all the symptoms of depression, they last and last. Is that depression or is it not? And I would say, and I think the field more
and more is saying, it is. If you do these complicated, you know, genetic
studies, the studies come out better if you count that as depression.
So just the mere fact of having a cause, I
think doesn't get you out of the category. But yes, people sort of slip in and out, and
they have good days and bad days. We don't want to call that depression. Sally: Yeah.
Well, you know, you just hit on a major theme
of your book, which is that gut instinct, that clinical experience, the clinical encounter,
versus the randomized control clinical trial. Peter Kramer: So we have these very objective
ways of looking at depression, ways of measuring it, ways of doing studies where you compare
treatments to non-treatments, or proxies for treatment, and then inert proxies. And then we have sort of what doctors see
every day. And the question is, you know, what counts
as evidence? And of course, nowadays, and maybe forever,
we value the more objective stuff more.
But there's sort of a benign dialectic between
the two, right? If the research shows something, doctors try
it. If doctors try it and it's working, there's
more research. So that really we have kind of a complicated
form of information. But what I like to think about is, if you
are meeting with a doctor, and you're depressed or your relative whom you love is depressed,
and you want that to change, what do you want to inform that encounter? And to some extent it's objective research,
to some extent you probably want some experience.
So, I think we could have a more complicated
notion of what counts as evidence. Sally: The essence of a randomized clinical
trial, just to go back to that, is something that it's hard to assess in the clinical encounter,
and goes to the virtue of these trials, which is placebo. And the placebo issue is one with lots of
resonance for your book. Let's just start with the fact that I think
it inspired your book.
Peter Kramer: Right. There was all this talk about these medicines
just being placebos with side effects, which means dummy pills that make you feel like
you're on a drug, and you're not getting better because of the inherent efficacy of the drug
because of the way the drug interacts with your brain, it alters it and allows you to
behave differently, the whole complicated series of things that may inform recovery. No, the claim was, any pill, a sugar pill
would do the same thing, if you believe it was an antidepressant. And that claim, I think, started causing doctors,
even though these medicines are widely prescribed in critical situations, not to turn to the
medicines when I would say they should.
I think that is a canard. I don't think depression is very placebo responsive. I mean, I think we want to distinguish two
things. To know that the medicines work, what we'd
like to do is set up a situation where we see how people do on the medicine and we see
what's causing the hypothetical counterfactual "What would have happened if they had the
same weather, the same spouse, the same contact with doctors, but didn't get the active ingredient
in the drug?" So, how would they do without treatment? How do they do with treatment? And that gets confused with this much more
particular idea, which is people get better because they have faith in a pill.
That seems to me a much narrower belief, and
there's a lot less evidence for that. Sally: But some people do get better, surprisingly
better, with social stimulation and connection. Peter Kramer: Right. Sally: I remember seeing a patient who I thought
for sure would need shock therapy.
I mean, that's how almost immobilized this
woman was. She lived with her mother. It was almost like a "Now, Voyager" situation
where she lived with her mother well into her adult life, and the mother died. And on the one hand, of course she found it
liberating, but there was an enormous burden that came with it.
That was the first visit and then she of course
was coming back, and I thought "For sure we need hospitalization." She was living with a sister otherwise. I thought maybe we'd need it that day. But I was shocked at how she could rally a
bit. Now, I hate to admit, she dropped out.
So, she may well have relapsed into that. Peter Kramer: Yeah. But maybe not, right? I mean, I think we see this. The reason we as psychiatrists like to sit
with people a while is that if you can...You know, it's not urgent, you don't have to worry
about suicide immediately or loss of a job, or divorce, whatever it is, and you have a
little time to sit, sometimes you find listening, supporting, teasing things apart, passage
of time, people get remarkably better.
People got better from depression, sometimes,
before anyone invented... Sally: Yeah, and that doesn't mean it's any
less real. Peter Kramer: No, no. And that's why...
Sally: Although, I think people can think
it's any less real. Peter Kramer: That's why you want to do these
trials, right? Because when you have people come in, you
take their blood pressure, you talk to them, you ask them about their depression, do a
long inventory, spend a lot of time with them week after week in the course of a drug trial,
maybe it's all that human contact that's helping. Maybe I take people in the book to a drug
trial center and I go out in the van. You know, the van picks people up where they
live and brings them to the center.
And just the conversation in the van is very
supportive. So, lots of things go on in a drug trial and
we don't want to attribute that kind of benefit, if it's beneficial, to the drug. We want to know what is the drug doing beyond
all that human contact. Sally: So when you see a patient, unless you
think someone is suicidal and you have to act in an emergent way, do you have kind of
an intuitive algorithm? I mean, I don't think you rip out your prescription
pad on the first visit.
Or maybe you do sometimes. Peter Kramer: I mean, I do. I think that, to some extent, I'm the instrument. And I ask myself, "How worried am I?" If I, as the conversation progress, get more
and more alarmed, you know, I take that to be a reason for a question or possibly action.
Whereas if things look bad at first and as
we talk I get a sense of some reasons why things are happening and some flickers of
responsiveness, some human connection, then I think, "Well, we can...If we're to be a
little patient, maybe we're gonna do some good along the way." And not to say that I may not reach for the
prescription pad at a certain moment, to me, you know, we know that this is a disorder
that is destructive in itself, that people start losing memory. There are extraordinary studies you don't
wanna know the answer to, where people stay depressed for a long time and their risk of
the next episode is greater, the downstream episodes tend to be more complicated, they
need more treatment. You'd like to interrupt an episode of depression. And I think, to me, the measure of the utility
of a treatment is that it works.
I know that sounds, you know, sort of circular,
but it's remarkable how often people don't appreciate that. They say, "I believe in yoga and meditation." Well, that's fine, but is your depression
retreating or is it progressing? If it's progressing, maybe it's time for one
of these much better tested remedies like psychotherapy or medication, or both. Sally: Right. And the ideas...
Well, I thought you challenged this a bit
in your book. The idea was that they actually had a synergistic
affect. Peter Kramer: Yeah. Sally: And you seemed a little skeptical of
that.
Peter Kramer: Well, you know, I think the
main thing I'm doing in the book... First of all, I want to say this is a complicated
book, I hope, in a good way. It has a lot of history. Sally: It's very readable.
It's incredibly readable. Peter Kramer: That's what I want to hear. I worked so hard at getting it readable. And there's some technical things in it but
I do a lot of storytelling, both from the history of psychiatry and for my practice,
and sort of the intersection, my time spent with some of the pioneers in the field who
were developing understanding of depression and depression treatment.
So I tried to put everything in a very humane,
I hope, context. But also to look at some of the fallacies. It seems to me that there are a lot of attacks
on antidepressants, some of them very legitimate, based on things drug companies have done that
cross ethical lines. But attacks that really come, I think, from
a misguided sense that attacking antidepressants defends psychotherapy or defends humane approaches
to illness, which I think is not the case.
And so that a lot of the book is saying, if
we were going to talk about objective evidence, what's objective? What's good evidence? And the truth is, if you like the evidence
for exercise, diet and whatever, you're gonna love the evidence for psychotherapy. It's much stronger. I'm sorry, I was gonna say for pharmacology,
true for psychotherapy also. And that particular question of the intersection,
does it help to combine medication and psychotherapy, I think it does.
It's what I do. If I'm medicating patients, I'm seeing them
often, I'm trying to puzzle out what's going on in their lives with them. But it turns out to be actually very hard
to show that the combination is a lot better than medication alone, partly because medication
does pretty well. Sally: Actually, that brings me to my next
question, which is, can you actually put a number on the effectiveness? Peter Kramer: It turns out to be very hard.
Let me tell you the main problem with putting
a number on these drugs work. And when you have a drug that works, and they're
generic and you can get them on Medicaid, and you can get them in HMOs and so on, a
doctor who's ethical, facing a patient with serious depression, where the moment arises
to prescribe, will prescribe a medicine, not send the person to a drug trial where he or
she might get a placebo. So it's very hard to get a good collection
of patients. There's some astonishingly good effects.
There was an open trial in Sweden, in primary
care clinics, and it was sort of a select group of people. They weren't suicidal, they weren't alcoholic. They just had, you know, probably fairly easy
to treat depression. And at the end of six months...Over 90% of
people on a routine antidepressant.
It was Celexa. Citalopram. Had at least half of their symptoms remit. So they were somewhat better.
So, you know, probably numbers in the 60%,
70% range for the first thing offered or more reasonable. There's a funny number, 30%, that we read
a lot. That 30% came from a study of patients who
had been depressed 15 years, they were in the seventh or eighth episode of depression,
they were two years into an episode of depression, they hadn't responded to other treatments. Most of them were also alcoholic or had another
mental illness.
And 30% of them, in the first medicine given,
ended the episode of depression. Which was considered not a good outcome, but
I think it's a pretty good outcome. Sally: And it's a pretty refractory group. Peter Kramer: In that tough group there are
other studies...There's another wonderful study where doctors were allowed to do their
worst.
Just, you know, change the medicine, add medicine,
just do whatever you need. And you could take a group that looks like
that, and most of them would leave an episode of depression and stay well for six months. Sally: The initial excitement, and the continued
popularity of these Selective Serotonin Reuptake Inhibitors, which is the class that Prozac
belongs to, and other inhibitors, like Celexa and Zoloft, was that their side effect profile
and their dangerousness in overdose was a lot less. Peter Kramer: Right.
So when these medicines became available,
in Europe and here, in the late 1980s, it wasn't thought that they were gonna be such
terrific antidepressants, but was thought they would be better tolerated and maybe better
for parts of depression that the traditional drugs had missed a bit, like social anxiety,
social isolation, and so on. Those little factors, being better tolerated,
not making you feel like you were on a medicine, not giving you dry mouth and constipation,
and allow you maybe a little more social comfort, those turned out to be much more important
than doctors had imagined. Patients really liked these medicines better
and you could leave them on them longer, which leads to a whole complicated discussion of
how long. But people just didn't want to get off them
right away.
Sally: And you think...In your book, you clearly
tried to get to the bottom of this, because there are really no good data available, but
that severe major depression, what used to be called melancholia in the old DSM, but
is not designated that anymore, now would be called severe depression, which is marked
by immobilization, sometimes even psychotic ideas about rotting, feeling dead inside,
being dead...Gosh, almost a pseudo kind of dementia profile. Peter Kramer: Yeah, that terrible thing you
see in Drer etchings, you know, the person who's rubbing his hands and looking at the
ground, and swaying and very thin, almost to the point of dying. You know, that depression. Sally: Yeah, that species, at least in this
country, may have started to fade because we've gotten in sooner with these medications.
Peter Kramer: Yeah, I mean, I don't wanna
live or die as a thinker, based on that observation, but I think we see less of it than we did
even early in my career which goes back - I. Hate to say it - 40 years. But, yes. Sally: Which is different from some of the
cultural distinctions.
Like, we may not see hysteria anymore, or
recognize it as such because we've... Peter Kramer: I mean, we don't know why we
see less. It might be that there have been some cultural
changes. And we certainly don't have less suicide,
so it's not like we've done this perfect job with mood disorders.
I mean, I think suicide did go down probably
after these medicines came in and it's come up a bit for complicated reasons. But I do think that particular very disturbing
form of depression that you really would hate to see - anyone would hate to see it - I think
we see less of it, and I think likely it's because we interrupt depression in its course
with these medicines. Sally: Do you think... Some say - I'm echoing a political candidate
here - that antidepressants are over-prescribed.
Peter Kramer: Right. Folks say that. Sally: What do you say? Peter Kramer: You know, it's a complicated
story. I have what I think is a fun chapter in the
book where I look at different ways of looking at the same study where one group looks at
it and says, "We don't have this specific diagnosis.
We need... Doctors are prescribing people who don't really
have this core problem, depression." Another group says, "Yeah, but these people
have been hospitalized for depression before. They had terrible events in their lives. They have other illnesses alongside." On the whole, the group prescribed for is
a pretty acute and chronic group.
It's a group with a lot wrong with them. So I think it's hard to know. I think probably both things are happening,
that people who don't need the medicine are on them. And certainly it's the case that maybe people
who could benefit from the medicine have never been on antidepressants.
So I think we need to get a little more precise
in prescribing and educating doctors about how to prescribe. Sally: Yeah, and the keyword there is doctors,
because most of these medications are actually prescribed... Psychiatrists are doctors, of course. But they're prescribed by primary care doctors
who don't have the kind of followup that you have.
Peter Kramer: Right. However, I do think they're...And I'm, you
know, maybe out on a limb or not in the mainstream in this, that the main problem with primary
care prescribing is that people go off the medicine. They aren't followed up well, they aren't
encouraged, they don't know how to translate some little progress and greater progress,
they go off the medicine. The other problem that doctors are simply
over-prescribing I think is counterbalanced by the enormous tendency to under-prescribe
before these medicines became popular.
So a lot of depression was missed diagnostically,
and most of what was diagnosed wasn't treated, and what was treated wasn't treated thoroughly. So I think probably on the better/worse side,
we do a little better than prior generations did. Sally: That's certainly not unique to depression. It's the story of ADHD and other things as
well.
I'll just ask one more question. This sort of echoes something I asked you
before. When a patient comes to you and they've sort
of suffered what we call an acute insult, like, they just got a divorce, or they lost
their job or there's a death in the family. And clearly they're presenting with sadness,
they're crying, they've lost interest.
Maybe they're not eating as much. Assuming again it's not an acute situation
where you feel they're a danger to themselves, how long might you wait? I mean, I know there's not an "Oh my gosh,
it's been three weeks. Time to start the Prozac." Peter Kramer: No, Im not looking at my
watch or the calendar. First of all, with these cataclysmic events,
most people have fairly varied psychological responses.
So they may be a little depressed, a little
anxious, a little angry, irritable, a little isolated. So there's lots of things going on, and most
of the responses don't have this syndromal form of looking just simply like an episode
of depression. So, one thing that catches my attention is
if this just looks like depression, I'm interested if there's a family history of depression,
if there's past episodes of depression, if there's suicides around, you know, in the
family history, say. That has my attention.
Sally: If they're drinking or using drugs. Peter Kramer: If they're drinking or using
drugs. I'm not happy. That doesn't necessarily make me rush to use
the antidepressants.
Sally: It gets your attention. Peter Kramer: It gets my attention. And then I think, if the depression...Speaking
about it as a sort of syndromal thing, the lack of ability to experience pleasure, a
loss of interest in ordinary activities. Difficulties at work are a good marker.
We like people to be able to get up in the
morning still and go to work and be seen by their coworkers as doing an ordinary job. Yeah, if things start going wrong in that
way and staying wrong, I start thinking "This is not just a normal response to bad news. This is starting to worry me." And as I say, worry is kind of my deep marker
for having a discussion about medication. Sally: So what's been the reception to the
book, if you were to make a distinction, or maybe there isn't a distinction, between how
your colleagues reacted to it and how the reviews in the popular venues reacted? Peter Kramer: I was very worried about responses
to this book.
I just kept saying to people I knew, "I'm
just gonna be attacked mercilessly," because there's such, I think, a leaning in the press
to reporting things that are negative about drugs, underreporting things that are confirmatory
about they're working. And that didn't happen. I think I got lots of thoughtful reviews. Some were...You know, had some skepticism.
But I also got these really rewarding reviews:
the Sunday New York Times' Scott Stossel, the Book Review, the Atlantic, Jonathan Rosen. These are just the kind of reviews that look
at my career as a whole, say where this book fits in, and I think give me the sort of benefit
of the doubt that this is a humane, thoughtful, caring person... Not to pat myself on the back, I'm just saying
what I always hoped would come through in the book anyway. Someone who wants to get it right, probably
getting it right.
Sally: You have a literary background. Peter Kramer: Yes. Sally: You did post graduate work in English
Literature? Peter Kramer: Yeah. Sally: At...
Peter Kramer: University College in London. Sally: And you've written... Peter Kramer: A novel. Sally: A novel.
Peter Kramer: By Scribner. My baby, what I recommend to people, yes. Sally: So you've got a...I guess I'd call
it a kind of... I almost think, frankly, the novelist where
you learn the most about...
Peter Kramer: Yeah, I do, too. Sally: About people's inner life. Peter Kramer: I did one of these round up
reviews and got people angry at me back when the first slew of sort of psycho autopathography,
the memoirs of depression were coming out. And the New York Times Book Review had me
write about six.
And I said, you know, it's probably good in
terms of stigma, that people are writing this, but here are these novels that have come out
and collections of short stories lately that I think really capture depression. So, Tom Gun. I forget what the list was. Yeah, I'm a great respecter of literature.
Sally: I can't help but think that it influenced
you as a therapist. Peter Kramer: Absolutely. Honestly, I'm thinking about literature all
the time. Robert Kohls was one of my mentors.
He's written about, you know, teaching short
stories, thinking about short stories. And often I'll be sitting with a patient and
I'll think about, you know, some little snippet out of Tolstoy or something, and I'll think,
"That's where we are." I mean, it's just my way of thinking, and
I'm sure someone who's a pianist and a psychiatrist, as some of our colleagues are, or a student
of history, there are many things to bring to bear in psychotherapy. But I do think about literature and I think
about narrative as I listen. I think, "Oh, that's a false note.
We better go over that one again." I don't know that I'd be doing psychotherapy
at all if I hadn't been immersed in literature. Sally: Yeah. You still see medical students, right? Do you still supervise them? Peter Kramer: Less and less, I hate to say. Sally: But you still have, I'm sure, your
finger on, at least a weak pulse, of the kind of teaching in psychiatry that goes on now
in residency and medical schools.
Are you somewhat pessimistic? Because I worry a little bit. Peter Kramer: I do, I do worry. For 15 years I taught a basic psychotherapy
course. And at the end of 15 years, and this is maybe
15 years ago, the head of the program said, "This is too difficult for incoming students.
That's really a fourth year course instead
of a second year course." And I ended up actually never teaching it
again. I think it partly is that there's just less
time for psychotherapy in the residencies, partly it's that that whole framework of seeing
things is different. It used to be when it was a dispute with the
nurses and social workers, someone would sit everybody down and say what are the underlying
conflicts you had to process. I don't know that that goes on.
So psychotherapy has been a little marginalized
in psychiatry. Although I have to say I'm very encouraged
there are young people coming out of training, and I'm impressed with them, I refer to them,
I think they're here for patients. They're doing a good job. Sally: That's reassuring.
Peter Kramer: It is what some smart people
like a lot. Sally: So, what should the... You wrote the book to dispel some myths and
clear the air on the issue of antidepressants that's really been, I'd say, under...Attack
might not be too strong a word in the last few years. So, what would be the takeaway from "Ordinarily
Well"? Peter Kramer: Well, you know, I chose the
title "Ordinarily Well" because I wanted to say these medicines were ordinarily well,
they're not...
You know, there are all kinds of side effects. There are worries that antidepressants in
the early going may make people more suicidal. Same is true for some drugs for epilepsy. They may make people more suicidal in the
early going.
These are medicines doctors know how to use,
they're kind of in the range of effectiveness that tracks other treatments doctors use for
all kinds of other conditions, and they don't do something eerie. They take people who are depressed and make
them - this is another use of the phrase - ordinarily well. They bring them back to where they were, where
they wish they had been. You know, that said, there are a lot of other
questions that aren't efficacy questions strictly.
They're, you know, how long do you leave people
on? Are there alternative treatments? Are there side effects? So, you know, as with any medicine, you'd
like to have them in expert hands. But the one thing I think we don't have to
worry about is, in the first instance, are they working through the way they're supposed
to work? Yes, they are. They're not dummy pills, they're active chemicals
that make it easier for the brain to make more cells and make more connections between
cells. They allow learning to resume.
They unstick people a little from the two
kinds of stuckness we discussed before. Sally: And also, this book has interesting
reverberations of "Listening to Prozac," because in that book, you calling the term cosmetic
psycho-pharmacology. In other words, making oneself more attractive
than before, or better than well, which would be an improvement from baseline. In this book we're talking about returning
to baseline.
Peter Kramer: Right. I think "Listening to Prozac" was a worrying
book. It said we have medicines that maybe have
effects on personality, our doctor's gonna be tempted to use them in overenthusiastic
ways. And "Better than Well" was people who had
some episode, say of depression, got better, thought they did a better job at work, or
parenting, got over the episode and would come back into their doctor and say, "I was
better than well on that medicine.
Could you give it to me again?" And so, I think having raised those worries
about complicated uses of medicine, I wanted to say that the most straightforward, simple
uses for the treatment of depression are perfectly legitimate, and in fact necessary, and that
these are not, as I say, eerie substances. They make people ordinarily well. So, yes, it was in a way the reason I in particular
felt I should enter that discussion and make the correction against these debunking placebo-centered
studies' claims was that I had sort of raised some worries in a prior book. Sally: Well, there's nothing ordinary about
having you as one of my first mentors, and wonderful to see you today.
And thank you so much. Peter Kramer: Thank you..
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