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The Plague of Polypragmasy Ó American Sociological Association 2014 DOI: 10.1177/0094306114539452 http://cs.sagepub.com EDITOR’S REMARKS THE PLAGUE OF POLYPRAGMASY the time they reach campus, as some admin- ‘‘The ultimate causes of mental disor- istrators have noted, they have become either der, it would seem, have to be sought ‘‘crispies’’ (burned out from anxiety and over- in the social order itself’’ (Sullivan work) or ‘‘teacups’’ (hyper-fragile and fearful 1953: 294). of life’s normal strains) partly in response to, and reflecting, their dependence on Because The New York Times has become psychotropics. There used to be a word for the lingua franca of academic chatter world- this situation: ‘‘Polypragmasy: simultaneous wide, you may recall not long ago seeing administration of many drugs or of an exces- ‘‘The Antidepressant Generation’’ (Iarovici sive quantity of drugs’’ (Thompson et al. 2014). The author is a psychiatrist whose 1955: 618). Revealingly, current medical dic- patients are Duke University students, and tionaries treat the word differently than was who seems genuinely concerned about their the case during the apogee of Freudianism in welfare. Her piece quickly garnered 280 the United States. Segen’s Medical Dictionary responses, many of them replete with names (2012) calls it ‘‘an obsolete term for the use and city of residence. Most wrote at length of multiple therapeutic modalities to man- and passionately about the connections age a single condition.’’ Notice that the they had discovered among pills, talk thera- term ‘‘modalities’’ has been substituted for py, and mental health. Everybody has a story ‘‘drugs.’’ Polypragmasy has lost ground to pol- and is not afraid to ‘‘share.’’ The general con- ypharmacy: ‘‘administration of many drugs clusion from this varied testimony is this: together’’ or ‘‘administration of excessive pills can be useful, sometimes necessary to medication’’ (Dorland’s Medical Dictionary prevent suicide, but talk therapy is also for Health Consumers, 2007). required for longterm ‘‘cure,’’ for learning This change in vocabulary, the alleged ‘‘coping mechanisms’’ when dealing with ‘‘obsolescence’’ of polypragmasy meaning today’s harsh socio-economic world. But a drug-induced condition, illustrates the because insurance companies do not want depth of our society’s mainstream shift to pay for longterm talk therapy, and since from discourse, discussion, dialogue, or chat- patients want quick fixes, and Big Pharma ting—from paying for an attentive, presum- has over 600 lobbyists in DC who push their ably caring listener—to the isolating and cure-alls as hard as they can—all within the often costly dominance of drug-based thera- shadow of constant televised commercials py. ‘‘Mere’’ talk can indeed be frustrating in promising pill-based cures for newly duration and effectiveness, but unlike pills, invented ailments—talk therapy has been it does not rearrange brain chemistry, partic- abandoned in medical psychiatric training. ularly among those whose gray matter is still Its practice has migrated to lower-status developing. One nurse who responded to the social workers and other counselors who Times piece had this to say: ‘‘Resiliency stud- by law cannot prescribe pills. As one of the ies: Yes, after working with very high risk respondents put it, psychiatrists now must youths and doing some research on resilien- argue forcefully with insurers on behalf of cy, we are shown that sometimes it only those patients who could benefit from con- takes a relationship with one effective per- versational analysis, since pills are the son that can make a difference to create resil- expected ‘‘therapy.’’ iency. That person does not, by the way, have Iarovici repeats what is widely known: to be a psychiatrist. in the population I ‘‘From 1994 to 2006, the percentage of stu- worked with, grandparents were extremely dents treated at college counseling centers influential in well being.’’ who were using antidepressants nearly tri- Her point of view is nothing new, of pled, from 9 percent to over 23 percent.’’ By course. In fact, sociologists long ago were 453 Contemporary Sociology 43, 4 Downloaded from csx.sagepub.com at ASA - American Sociological Association on July 2, 2014 454 Editor’s Remarks routinely taught to think along these lines, to massive, longitutinal data, in concert with view mental disturbances as the product of clinical experience that led apparently to social life far more often than pathological high success rates, all of it tied to talk thera- imbalances in brain chemistry. It was not py and a virtuosic empathic sense. Whereas just ‘‘Mom’s fault’’ that people suffered emo- Sullivan was well-known to most sociolo- tional problems, but ‘‘our entire way of life’’ gists in the 1930s through the 1960s, his that was culpable. Karen Horney, Erich name and influence dispersed thereafter, Fromm, Paul Goodman, Herbert Marcuse, partly no doubt to the developing psychiat- and others of that era pounded this message ric penchant for drug-dependent therapeutic into the cultural subconscious for decades. procedures for which Sullivan had no use. R.D. Laing was the extreme case. However, His principal biographer calls one chapter the micro-theoretical analyses of Charles ‘‘Discovering the Chicago School of Sociolo- Horton Cooley, George Herbert Mead, or gy,’’ which details Sullivan’s close intellectual Jean Piaget, had plainly indicated long before connections with Edward Sapir and from that humans in fortunate circumstances him, W. I. Thomas, Louis Wirth, and other (within an attentive, adoring, often affluent famous sociologists of the period, in addition family) are more likely to mature into ‘‘well- to the political theorist Harold Lasswell (Per- adjusted’’ adults than those who learn about ry 1982: 251–60). Wirth commented on an being human from abusers or under condi- article Sullivan published in AJS (Sullivan tions of deep poverty. Nothing is guaranteed 1938–39): ‘‘he comes to the problem of the in these matters, of course, but the odds lie in individual and society with a rich clinical favor of the former, lucky child. experience which might be expected to pre- Sociologists used to read one particular dispose him to a view which emphasizes psychiatrist whose clinical work revolved the primacy of the organism. It is therefore around the vital role that intimate social con- gratifying to note that the universe of inter- tact plays in mental health. He has been personal relations, which constitutes his cen- called ‘‘the most original, creative Ameri- tral field of interest, is almost identical with can-born psychiatrist’’ (Chapman 1980: vii) the modern sociological approach’’ (Sullivan and ‘‘the psychiatrist of America’’ (Perry 1964: 66). 1982). He was a fierce empiricist, and based Having studied the writings of Cooley, his theories on clinical work with patients Mead, William James, and other students of at St. Elizabeth’s Hospital (DC) and the micro-analysis, but with the augmented sen- Sheppard-Pratt Hospital (MD) between sitivity to patients’ dilemmas that only a long- November 12, 1921 and June 30, 1930 (among term clinician can possess, Sullivan became biographical accounts, see Perry 1982: 179, ‘‘the sociologist’s psychiatrist’’ for reasons 284; also Wake 2011: 13ff). One reason why that become obvious after reading the essays Hans Gerth and C. Wright Mills quoted Har- collected posthumously in The Fusion of Psy- ry Stack Sullivan in Character and Social Struc- chiatry and Social Science. Like Erich Fromm, ture (Gerth and Mills 1953: xvii, 12, 84, 143, Karen Horney, and the later Freud, Sullivan 147, 149), and why David Riesman also was not content to think only about the sin- invoked him in Faces in the Crowd (Riesman gular pain of schizophrenics or obsessional with Glazer 1952: 7n, 50n, 210–211, 527n, neurotics. As a medical corps Captain in 663) is because Sullivan and his staff at the First World War, and witnessing the rap- Sheppard-Pratt carefully collected extended id advance of World War II, Sullivan began to interview data on 1,696 patients, many of wonder in the 1930s if psychiatry might not whom personally known to Sullivan, who help analyze human aggression of the largest was director clinical research. These inter- scale. To that end he wrote essays like ‘‘Anti- views, involving a group of psychiatrists, Semitism,’’ ‘‘Propaganda and Censorship,’’ the patient, and several note-takers, were ‘‘Psychiatry and the National Defense,’’ ‘‘Lead- scrupulously recorded and typed up by pro- ership, Mobilization, and Postwar Change,’’ fessionals (Wake 2011: 20–21). His theories ‘‘Psychiatry and Morale,’’ and ‘‘Tensions Inter- and practical therapeutic advice, unlike personal and International: A Psychiatrist’s those of Freud and many other therapists View.’’ Some of these works shocked his of the period, were therefore based on more clinically-bound colleagues. Contemporary Sociology 43, 4 Downloaded from csx.sagepub.com at ASA - American Sociological Association on July 2, 2014 Editor’s Remarks 455 These essays and much of his other work 1972: 20–25). Anxiety meant ‘‘the product are saturated with sociological underpin- restraints on freedom. used in the teaching nings, as for instance when he writes in one of some of the personal habits that the cul- of his most famous essays, ‘‘The Illusion of ture requires. a disintegrative tendency’’ Personal Individuality’’ (much of it in italics): (Sullivan 1953: 113; 95). Sign: ‘‘A particular ‘‘The self is the content of consciousness at all pattern in the experience of
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