The prescriber as moralist: values in the antidepressant debate

The past decade has seen a growing debate about the expanding use of psychotropic medications. Of particular concern are current antidepressants, as well as hypothetical "mood brighteners" that could modify affect and behavior in people heretofore classified as being within the normal range. This paper argues that objections to such pharmacologic applications are based on appeals to cultural values--authenticity, diversity, inwardness, and stoicism among others--that are viewed as being under increasing threat in contemporary American culture. Critiques of mood brighteners, like critiques of technological, consumer-driven culture, repudiate the ideals of shallow satisfaction and of the self as commodity. The decision to prescribe or not to prescribe a psychotropic medication in any given case is based on cultural values as well as clinical judgment.