January 14, 2010 — Tens of millions of Americans take anti-depressant medications like Paxil and Prozac. On some college campuses, as many as 25 percent of students use drugs such as Adderall and Ritalin to help them study. Some parents are medicating their 3-year-olds for attention-deficit hyperactive disorder with drugs whose long-term effects on children are completely unknown.

How did we get to this point? That's the subject of a January term class at the University of Virginia, "Prozac Culture," led by Joseph E. Davis, a research associate professor of sociology, director of research at U.Va.'s Institute for Advanced Studies in Culture and author of a forthcoming book tentatively titled, "After Psychology: Medication and the Quest for Control of Life."

The answer is "not merely a matter of new medical treatments; it is a cultural phenomenon that is changing the ways we think about ourselves and experience the world," he said.

Teaching this class for the first time, Davis appreciates how the January term format –four hours a day of class over 10 days – allows him to screen complete documentaries or movies and have plenty of time for discussion afterward. This week the 30 students watched two PBS "Frontline" documentaries, on "Medicating Kids" and "The Medicated Child," as well as the movie "Prozac Nation."

It is understood that those with serious mental illness, such as schizophrenia, clearly should receive psychoactive drugs that have been empirically shown to be effective treatment, he said. The class is interested instead in the gray area outside of clear cases. For instance, where is the line between shyness and social anxiety disorder?

Such gray areas are culturally shaped, Davis said. In Japan, reticence is valued, so there is no significant diagnosis of "social anxiety disorder." But in American culture, with its emphasis on unrelenting self-improvement, being shy is seen as an impairment that someone should not simply accept – especially if there is a pill to help overcome it.

Pharmaceutical marketing has certainly played a role in blurring the boundaries between mental disorders and the normal vicissitudes of life, Davis said. On Monday, he outlined for the class the companies' two-pronged marketing strategy: increasing demand for a particular drug with ads aimed directly at consumers, while subtly influencing doctors' prescribing habits, as one doctor explains from firsthand experience in an assigned reading, a New York Times Magazine article "Dr. Drug Rep."

Pharmaceutical marketing has combined with wider social and cultural changes to give rise to a "medicalizing" of normal human conditions and variability, Davis said. To explain, Davis discussed a hypothetical classroom of 10-year-olds. Among them, there will be a spectrum of personalities and behaviors, from very docile to very rambunctious.

When there is a drug available that can make the rambunctious kids more docile, the 10 percent of kids who are most rambunctious may be viewed as a problem because they are disruptive. If that 10 percent are medicated into a calmer state, the next rowdiest 10 percent may be seen as a problem, and the teacher may recommend they also consider medication, Davis said.

"There's a worry that we're not treating illness, but treating the normal range of variability, and thereby shrinking it down," he said

This cultural shift is addressed in reading assignments with titles such as "Better Than Well: American Medicine Meets the American Dream," "Prozac as a Way of Life" and "The Antidepressant Era."

Meredith Aronson, a third-year transfer student interested in working in health care administration, attributes the rise of Prozac culture to people looking for a "quick fix" for mental issues. However, she observed, we don't know how this approach will impact people in the long term.

As a second-year double major in biology and sociology, Steph Sweitzer gets both sides of the "nature versus nurture" debate on whether mental issues are a matter of chemical imbalances in the brain or the product of cultural expectations, or some combination of the two.

Sweitzer, who plans a career in medicine, used to favor the biochemical explanation, she said. But now she believes the answer is relatively unknown, as she has become aware of the lack of empirical evidence linking conditions like depression with observable biochemical changes.

The idea of "medicalizing" ordinary problems like sadness or shyness, Sweitzer said Monday, is the most interesting thing she learned so far. If she becomes a doctor, she predicts that she will be reluctant to prescribe drugs for such issues.

There are no simple answers to the big questions raised by this class, noted fourth-year student Alfred DiRosa.

"It's the most multi-dimensional class I've taken," he said.