The New Normal
I read “Pill Culture Pops” [by Ariel Levy, June 9] with amusement. I take a cocktail of nine medications just to function and be one of the “normal” people. And now you’re telling me the normal people are trying to be like me?
-Lisa Marie Garrison, Philadelphia, PA.
As a psychoanalyst practicing in New York City, I was saddened by “Pill Culture Pops.” It is no surprise that a nation addicted to fast food is now becoming dependent upon a “fast mood” approach to managing the issues of life. I appreciate the positive effect a carefully prescribed and monitored course of medication can have when someone is suffering and unable to meet the demands of life. However, these drugs can be dangerous when used recreationally, no matter how cleverly one rationalizes their use. To depend upon self-medication during a time of increased stress—both from an increasingly dangerous world and from an economy that leaves many at risk—may in fact make us less able to use our abilities to master the world. This is where a well-trained therapist can usually be of help, in facilitating the process of encountering ourselves in a manner that supports both self-knowledge and the capacity to achieve more pleasure and success in life. However, this would require asking another question: “Who am I?”
-Jeffrey Werden, manhattan
She Wants A New Drug
As a woman who was unwilling to sacrifice her libido to Celexa, I was disappointed that Ariel Levy’s discussion of the sexual side effects of antidepressants was oblivious to the problems faced by women, who cannot resort to Viagra to keep “both erect and depression-free.” Ms. Levy’s neglect sadly reflects the medical community’s disregard for the effects of drugs on female subjects, which is apparent in the fact that most studies are conducted with males. Women are not small men, and we need our own version of Viagra (preferably covered by insurance).
-E. M. Shave, Manhattan
A Day In The Life
Since joining the working world, I have kept my ADHD condition under wraps to most people, and have done my best to conceal the fact that I am very well-medicated during the day. The problem is that Adderall is a very strong drug, and, as with any drug, coming down is extremely difficult to deal with both mentally and physically. I have since added Klonopin to my regimen, and Ambien to guarantee that I can get a decent night’s sleep. I don’t always follow my doctor’s orders, and often take my meds as I deem necessary. A recent experience of mine is a prime example of how being a self-medicated New Yorker can really pay off. After a long and stressful day on the trading floor, I found myself on an overcrowded subway train. It had been several hours since my second dose of Adderall for the day, and I was crashing hard. I popped .5 mg. of Klonopin and made it home feeling pretty good. I showered and put on my tux and headed out. After several hours of schmoozing and boozing, I finally made it home around 2:30 a.m., three sheets to the wind. I threw my tux on the floor, washed my face, brushed my teeth, and finished my bedtime routine by taking 20 mg. of Ambien. I was back on the train by 6:45 a.m., well-rested and ready to conquer the world.
-Thomas Anderson, Manhattan
Rx For Respect
While I had been working under the assumption that buying, selling, trading, and using prescription drugs without a prescription was dangerous, irresponsible, and illegal, I have now learned that it is “totally respectable.”
-Deborah Schiff, San Diego, Calif.
Confessions Of A Drugstore Junkie
I’ve been on prescription mood-altering drugs for five years. I even popped a Klonopin just for the hell of it while reading “Pill Culture Pops.” It’s nice to know that I am not the only “drugstore junkie” out there who self-medicates for recreational, as well as medicinal, purposes.
-Lauren M. Brown, Hoboken, N.J.
A Four-Point Plan
For those who are unable to find the right balance between their Percocet, Xanax, and Zoloft, I suggest the following: a regular workout schedule, a strong church community, a vacation somewhere other than the Hamptons, and time for personal reflection.
-David Sisco, Astoria
As a psychiatrist specializing in addiction treatment, I was shocked and dismayed by your glorification of pill addiction. These people are playing with fire—one that will burn out of control for many. I receive calls from the addicted detailing their descent into the hells of addiction to Vicodin, Percocet, Ativan, Valium, and the like. Many can be helped, but some never return to wellness. Your piece makes such misery seem as chic as having a few cocktails on a sunny summer afternoon in the Hamptons.
-Stephen Gilman, Manhattan
Practitioners Make Perfect
‘Pill Culture Pops” neglects to mention the therapeutic approach to psychotropic drugs. We have come a long way in treating depression and anxiety with new drugs, but that isn’t the whole picture. Responsible practitioners also recommend psychotherapy in conjunction with taking medication.
-Patrick J. Suraci, Manhattan
I was surprised that Ariel Levy made no mention of Brave New World, in which the inhabitants of a utopian society maintain their happiness through the use of mind-altering drugs. After reading the article, I’d agree with her that this is a “golden age of self-medication”—a new world, if you will. But it’s definitely not brave.
-Joshua Dym, Bronx
You quote clinical psychopharmacologist Darwin Buschman as saying, “When one is addicted to benzodiazepines, withdrawal can be life-threatening.” Absolutely true, but even tapering off slowly isn’t risk-free. After years of taking one benzo after another, I slowly withdrew from Klonopin … and suffered through seven months of hallucinations, insomnia, and a whole range of horrible side effects. I wouldn’t go through it again for all the money in the world.
-Lesley Zimmermann, Great Neck, N.Y.
These pills, cool as they may be, don’t in the slightest address the real causes of people’s anxiety or depression. Funny, I don’t recall Socrates saying “Drug thyself.”
-Jeffrey Gross, Brooklyn
“Pill Culture Pops” by Ariel Levy tells an important story. We do not have to cry in our room. Life is a choice. Choices made through one’s Heart, not one’s mind. Cheaper, no unknown (future) side effects, balance without insulting our bodies. What a novel concept.
-Joan Bunney, Seattle
Check Richard Shindell’s great 2000 song “Confession”, it’s right there with ya:
“…Reminds me of confession
When I used to go to church
I used to go to therapy
But who needs all that work?
The one is too much reading
The other too much pain
Now I’m happy
So hey Doc, how’s about a refill?
Hey Doc, the pretty little blue pill…”
Good work also New York for your recent Music coverage of Richard Thompson.
-Glenn Fredericks, Nine Mile Falls, WA
New York Magazine brought in their June 9 issue a feature story on New Yorkers turning to self-medication, mixing everything from Ambien to Zoloft—including the the drugs Paxil, Prozac, Percocet, Valium, Viagra and Vicodin. “Using prescription drugs to work a little harder, sleep a little better, relax a little faster, has become a given in the city’s mainstream. A friend of mine coined the term cosmetic psychopharmacology…” is what Ariel Levy quotes people saying. As a medicinal chemist, I cannot approve of this. People think it’s cool to self-adjust your moods, but I contend that there is a reason these prescription drugs aren’t OTC (over-the-counter). Besides possible drug-drug interactions in these pill cocktails, there is always the specter of addiction. And last not least, anybody that starts messing with the natural balance of their brain chemicals is certainly going to harvest one thing: a life-long alteration of your capacity to experiencing emotions. There is no going back to how it was before you started self-medicating…
-Ulrich Iserloh, Hoboken, N.J.
In reference to the article “Pill Culture Pops” than ran in your June 9th issue: A friend of mine forwarded this article to me. While this article was informative and entertaining, as a pharmacist, I must point out several glaring errors in Darwin Bushman’s quotes. First error: “When one is addicted to benzodiazepines, withdrawal can be life-threatening- particularly with Xanax. Heroin withdrawal is very uncomfortable but not life-threatening; same for coke. But with benzodiazepines, you can die.” There are no physical withdrawal symptoms from benzodiazepines. There are only two drugs with withdrawal symptoms than can kill you and cause seizures; alcohol and barbiturates. This is why benzodiazepines have in large part completely replaced barbiturates. Secondly: “Meanwhile, Vicodin isn’t a controlled substance, and it’s infinitely more dangerous than Ativan,” Vicodin is a controlled substance in New York. In fact, Vicodin (which is a Controlled Substance III) is in a class that is more strictly regulated than benzodiazepines (which are Controlled Substance IV’s).
-Daniel Shin RPh, B.S., PharmD.
IRRESPONSIBLE and MISINFORMED is your cover for June 9, 2003. I am a physician in the state of Virginia and treat patients with chronic pain. Percocet when it’s time to relax? Vicodin for class reunion? These are narcotic medications prescribed for pain, in case you didn’t know. Your magazine is reduced to a comic book with this cover. Nothing to say of the disservice it does to patients who are legitimately taking these medications and the care that their physicians take to ensure appropriateness of the use of these medications. Even though you say that Vicodin is not a controlled substance in your state, Percocet is in the same category and is a controlled substance. I am appalled by the cover and effective immediately will be canceling my subscription to your worthless misinformed irresponsible rag of a magazine!
-Tushar U. Gajjar, M.D.
I am the first to admit that I have a bottle of Ativan in my medicine cabinet. I am the first to admit that it has helped me get through some very difficult times. But I must say this it was my life partners withdrawal from Prozac and effexor that added ativan to my morning dose of vitamins. The cavalier tone of Ariel Levy’s story horrified me. In the world Levy describes people trade medication as casually as e-mail addresses. Many of the drugs once taken need several weeks to start working. If not stopped “properly” the results are devastating both for the patient and his or her family. I can not begin to describe what it is like when someone stops taking an SSRI “cold turkey.” They are delusional,experience electronic brain sensations, become extremely enraged and violent. The monitoring of a patient on an SSRI is paramount and I must say that my partners primary care doctor who prescribed the drug was not very interested in refining his dosage. When another doctor asked him if he thought he really needed it, the fuse was lit. He decided to stop without consulting the prescribing physician. I don’t mean to sound dramatic but I am amazed that we survived the many months of his withdrawal. I am not saying that he didn’t need the drug. In fact I think he did. But the chance of ever going through the withdrawal horrifies me so that I would rather him stay away from them forever. These drugs were not developed to accompany cocktails. They are serious medications that need to be carefully prescribed by caring physicians.
Pop a pill and the whole world will be okay—this is what are our armed forces are defending?
-Natalie Levine, Oakland Gardens, N.Y.
I read the article “Pill Culture Pops,” and was quite angered by it. I am a 24-year-old who has had a lot of stress in my life. Much of this stress stems from a painful condition which I have had since I was 18. The subjects of the article are obviously emotionally and physically spoiled, because if they knew what real pain was and understood what it was to be dependent on medication they would stop their pill-popping self-indulgence and do something to fix their problems and handle the stress of their work environments. Their actions and words make me think that they really are a bunch of self-pitying people who cannot deal with reality. I worked hard and went to a highly competitive college, graduated with honors, went on to successfully write as a freelance journalist in Europe and have recently gotten into a top level business school. I did this all while dealing with awful pain, emotional hardship, and social isolation of my illness everyday of my life, in addition to occupational and financial stresses felt by everybody else. And, no I am not handicapped and get no federal benefits! Knowing too well the effects of heavy medication, I keep it to a bare minimum and have recently ceased to take medication all together. I think they should get a grip and deal with their lives. Those of us who know what is like to actually need medication don’t want to hear the whining of self-pitying people who can’t deal with reality.
-Elizabeth Press, Westport, Conn.
In the realm of addiction, I think we should all be worried about the numbers of us who are self medicating, and let’s not forget how many people do it with alcohol. In my life I’ve watched my mother, and my grandmother suffer through loving men who were addicted to alcohol. I also have a close friend who has been drinking in excess since high school. We shouldn’t be accepting addiction as part of our culture because so many are seeking relief in it. Maybe pill popping is more dangerous than drinking only because it is a neater and faster process than getting drunk, so it is easier to hide pill taking from friends and family and partners (as distinguished from “friends” who trade and take pills with you). A pill takes all of a few seconds to swallow, while getting drunk can take up whole evenings in a bar, in which case someone might notice your absence. Pills also don’t make you wake up with your breath and your sweat smelling sour, a common occurrence in having a hangover that is real unpleasant, especially for the person who wakes up with you—who would realize what you had been doing to end up smelling that way. So in some sense, an addict of drink is easier to spot if you are involved with one or live with one, which hopefully could lead to the person getting some help. No mention is made in your article of significant others in the lives of the pill popping people you describe. That is likely because not one of them can sustain a relationship. Of all the sad consequences of drug and alcohol addictions, the saddest and scariest is the inability to care about anyone in any lasting, consistent way. Addicts, no matter what method they use, break a lot of hearts, because given a choice between getting high and connecting with another person, they always choose the high. Ask any one of us who has tried to love someone who turned out to be addicted, and you will hear stories of intense pain, but not the pain of the addicted. The addicted feel no emotional pain, which is what makes them so dangerous to others.
Getting a surgical lift for any sagging body part has found its counterpart in popping a pill for any falling mood. We can indeed become perfect in body and in spirit. But watch out for unpleasant little side effects. These drugs are powerful and when taken in combination can be even more powerful. For starters, have you checked your teeth lately? Tooth decay associated with decreased salivation (more commonly known as “dry mouth”) is a not uncommon side effect. But not to worry. Your teeth can be replaced too.
-Jo-Ann Townsend, Manhattan
While there clearly are a large number of people in Manhattan who have a legitimate need to be on anti-depressant or anti-anxiety medication, there also are plenty of people taking them on a recreational or “performance-enhancing” basis, as the article notes. When people use prescription drugs as party favors or recreational mood enhancers, it makes life more difficult for those who have a legitimate medical need for them. When doctors are deluged with requests for Ambien, Valium, Xanax and Viagra, they can have a hard time sorting out the people who genuinely need those medications to function normally from those who plan to party with them or sell them on the street. There are many points in life where it is perfectly normal to feel anger, sadness, or anxiety. Being nervous on a first date or at a job interview is normal; being too afraid to ride in an elevator or on an escalator is not. The people who self-medicate with sedatives and tranquilizers are not allowing themselves to feel and express a normal range of human emotions, which I feel is unhealthy in the long run. For some people, a better approach to anger or anxiety management would be to close their eyes, count to ten, and then shout, “Make it go away. Make it go away.” By the way, the illustrations for the article make it seem like Vicodin and Percocet are sedatives or tranquilizers. They’re not. Those drugs are opioid analgesics used for moderate to severe physical pain (not emotional pain). While some people feel drowsy or “floaty” on them, people are more likely to turn to Valium or Xanax for relaxation.
-David Kleinbard, Jersey City, N.J.
As a psychopharmacologist currently in private practice in New York City I was quite concerned and rather offended by the article entitled “Pill Culture Pops” by Ariel Levy in the June 9, 2003 issue. I think it is important to understand that often abuse of drugs begins with inaccurate media publication. It peaks curiosity in those otherwise naive to knowledge of various pharmaceutical agents. Antidepressants have been available for many years, but as the older drugs were associated with often intolerable side effects and could be lethal if used inappropriately they were not as widely prescribed. The advantage of the SSRI class was that they were easy to use and safer. Depression and anxiety are very serious illnesses that if untreated have an associated 15% mortality rate. SSRI’s have been found to be very effective agents in treating these illnesses when used appropriately. That is not to say they should be taken by anyone who “is stressed out.” They can be quite dangerous if taken without appropriate monitoring by a skilled clinician and it is important that the public is aware of this. There are interactions with other agents that can be lethal as well as side effects that can present themselves after being on the medications for several months. Psychopharmacologists, rather than being “Park Avenue Drug Dealers” are skilled clinicians that have both graduated from medical school, completed an accredited residency in psychiatry, and then completed further post graduate training in psychopharmacology. They have extensive clinical experience and expertise in diagnosing psychiatric disorders, and in deciding which, if indicated, psychopharmaceutical agent would be most beneficial for which patient. A psychopharmacologist is also aware of interactions of agents which could be dangerous, and what agents are safe if the patient has a concomitant medical illness. With regard to some of the other medicatio ns listed in the article, again the associated problems were omitted. Ritalin which has been approved to treat ADD does not always improve concentration or ability to focus in those without the illness. It could however cause someone to become psychotic and loose touch with reality as a result of increasing dopamine concentrations in the brain. In addition, in certain patients and in combination with other drugs, including some over the counter agents, cause significant increases in blood pressure which could lead to a stroke or another complication. Viagra, which is an agent used to treat erectile disorders can be very dangerous, even lethal, if used in a patient with a history of cardiovascular problems. Overall, I think as a publication it is important not to misrepresent pharmaceutical agents and associate them almost entirely with recreational agents. The goal is to inform the public that these agents if used appropriately, under the care of a skilled clinician, can be very helpful in alleviating symptoms and improving quality of life. They however can be dangerous and should not be taken without proper monitoring. Psychopharmacology is a highly specialized field of medicine requiring many years of study and it should not be compared to drug dealing.
-Sheri Spirt, Manhattan
I’m shocked by Ariel Levy’s article on New York’s pill-popping pandemic. As someone who has never seen a shrink or taken pills, I’ve never “gotten it”—“it” being New Yorkers’ dependence on all things medical. It’s not as though I don’t get anxious or stressed, or that my family isn’t as lunatic as the next. However, I believe that too much impatience and too many doctors have Manhattanites missing the boat: You need to work hard at being better to get better, or your problems will be waiting for you when the bottle’s empty. Maybe then, conversations can turn from “What can I get you that helps…” to “What can I do to help…”
-Anthony Fieldman, Brooklyn
As a parent, I found your article in this week’s issue on pill popping by New Yorkers irresponsible, disturbing, and objectionable. The article read like a manual of how to use drugs to tweak one’s mood, and may serve to encourage those who read it, including young children, to experiment with drugs where they otherwise would not have. The article’s undertone also was one of condoning the drug use it described. In addition, the article failed to mention a key fact which people may not necessarily know—which is that swapping or using prescription drugs without a prescription is illegal. By failing to mention this point, your magazine may be exposing its readers to the risk of unknowingly engaging in criminal activity. As a magazine, you should serve your readers and act responsibly. I believe that you should publish a note in your next issue advising that much of the activity described in the article was illegal. If this letter is published, please do not put my address. You may publish my name. Thank you.
-Mary Hughes, Manhattan
As a current New Yorker, I read with horror and disgust, “Pill Culture Pops.” Does no one take responsibility for their own happiness? The lack of personal dignity is astonishing. I am a private yoga studio owner, so I am constantly exposed to individuals that respect their spirits. I also teach in a high-profile spa where many spoiled brat ingrates show up. However, if they stick through the entire class—it’s a tough one —they are either crying or laughing or thanking me profusely for teaching a method, a technology, to connect to their spirit. Kundalini Yoga is quick. The effects are felt immediately. It is elevating. Give all New Yorkers some good old fashioned Kundalini and the pills would go down the toilet where they belong. It balances the hemispheres of the brain, while strengthening the nervous system.Â The glands secrete better, the organs work better—every part of you functions better. But, the killer is you bliss out! So many happy chemicals are released during the practice, you float home, negative thought has become abstract. Spoiled brat New Yorkers, indeed. It should be mandatory to visit the ghettos of some third world country—I didÂ a few times. Maybe then these self-medicating brats would realize they have blessed lives. That a little Kundalini.
I usually read your magazine to find out about stimulating cultural events,new architectural spaces, and great restaurants Was it merely a coincidence that in your June 9th issue, there were no less than 3 articles about self-absorbed, mindless, emotionally vacant New Yorkers? Instead of complaining and taking drugs to deal with a myriad of tragic and life-altering occurrences in my life, I use my own resources to make things better. When everyone else was whining about all the snow this past winter, I bought snowshoes and looked forward to the next storm so I could enjoy the outdoors. At a recent wedding, even though I saw the demise of my own 25 year marriage, I didn’t hop into bed with one of the single guys there; I had a great time dancing and talking to everyone! At least Lizzie Grubman is beginning to realize, it’s not all about celebs and staying out until 4 a.m.; just a quiet dinner with friends is really what can help us with our woes and make our lives better.
-Joanne Schenendorf, Oyster Bay, N.Y.
Ariel Levy’s piece, “Pill Culture Pops,” in the June 9, 2003 issue definitely struck a nerve. As a person who legitimately takes some of the pills mentioned in the article, I was very offended that the recreational use of prescription pills could be reduced to something as the “new” popular thing to do in New York City. While several people may choose to use these drugs, despite not needing them, what happens when they might actually need to use them? Where were the medical opinions and the side effects (that constituted one measly paragraph)? Because all I could find were testimonials from people so drugged up on Xanax, Zoloft, Paxil, Viagra and the like, that it did not make me think that a praising pill popping culture is okay, if people do not have any reasons to take those pills at all. To top it off, the placement of the article was right next to one about kids with learning disorders, and several of these kids probably use some of the medications mentioned in Levy’s article, because they need to. Maybe next time you should think about what is really truly popular in this city besides making it sound so drug addicted with such a carelessly written article.
-V. Freedman, Manhattan
“Pill Culture Pops” by Ariel Levy was an utter waste of paper and ink. The Fashion Publicist whom you quoted (“Mood-stabilizing…little yellow pill)expressed all my fears. People with serious disorders like myself, were once thought of as having “some shit going on.” And now thanks to shallow people with nothing better to do than claim that every feeling or emotion is some disorder, we have been brought down to the level of all those posers. And what’s even worse is that these people have the nerve to deem pill popping as “chic and of the moment.” Next time they want to crown something as cool they should stick to what they know—material objects.Those of us who need medication DO take it in the morning, DO seek therapy. What we don’t do is hand out pills as party favors to be downed with martinis.
-Chloe Girault, Manhattan
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