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|The Rise and Fall of PaxMedica - Page 2|
But traditional psychoanalysis already was becoming something of a dinosaur, replaced by a buzzing, blooming confusion of different therapies, many led by therapist-celebrities—Carl Rogers, Fritz Perls, R. D. Laing, Milton Erickson, Virginia Satir, Salvador Minuchin—who held their distinct approaches—client-centered, existentialist, humanistic, Gestalt, narrative, cognitive, and variants thereof—as distinct fiefdoms, without much attempt at real dialogue or integration. By the 1970s, with the growth of cognitive-behavioral therapy and the proliferation of different therapeutic approaches, it began to look as if anybody who wanted to do anything anytime in the name of "psychological healing" could claim to be doing therapy. The field was beginning to resemble a kind of Woodstock Nation for psychotherapists.
To this therapeutic melee, Pax Medica brought a sense of order, discipline, coherence, and professionalism.
The Rise of Pax Medica
The Pax Medica originated with three signal events that happened within a few years of each other: the invention of Prozac, the blockbuster drug that appeared to offer a quick, dependable, chemical fix for depression; the publication of DSM III, establishing a formal diagnostic classification system for emotional and mental problems conceived as illnesses; and the advent of evidence-based therapies, which required treatments to have clear, reproducible guidelines and solid, empirical support.
While the first tricyclics were mildly successful, it was the advent of Prozac in 1974 that changed everything. Prozac shifted psychiatry away from a focus on memories, fantasies, dreams, and projective identifications toward a fascination with all things pharmaceutical. Part of Prozac's success was based on the appealing, somehow biological-sounding notion that it corrected "chemical imbalances" in the brain, and at first glance, controlled trials appeared to prove the theory behind the product. Even today, more than 30 years after its first appearance, Prozac remains hugely popular around the world. In the U.S. alone, millions of prescriptions annually are written for the drug's generic version—and newer antidepressants are even more widely prescribed. In the U.S., 1 in 20 men, and almost 1 in 10 women, uses an antidepressant.
The concept of medical treatment for psychological problems had wide support in the popular culture. There was an obvious appeal for a simple pill to "fix" one's depression, rather than enduring endless therapy. The idea that, along with your yearly physical, your primary care doctor could tweak your "chemical imbalance" and put an end to your depression was virtually irresistible. Medicinal cures for psychological problems are a quintessentially American solution—fast, easy, simple, efficient, and new. Psychodynamic psychotherapy, by contrast, appeared quaint, slow, tedious, and old-fashioned—a bit European.
After Prozac, psychotherapy itself had to change in order to survive in competition with a magic, little pill. What would save the therapy enterprise from sinking like a stone?