Taking pills is part of our culture. From childhood on, medicine is associated with sickness and health. We may have often heard the injunction "Take these pills, they will make you better." For many receiving medication may seem to be the logical solution to health care problems (Klass, 1975). If we discover that we are mildly ill, we would most likely go to the medicine cabinet to see if there is anything to relieve our symptoms. More serious problems may require a visit to the doctor. In such a visit, we expect the doctor to; examine us, make a diagnosis, prognosis, and prescribe some medication.

This medication seems to be the goal of so much of the health care process; all other steps just lead up to that goal. The prescription medication is a tangible solution to the dilemma at hand. We feel relieved when it is known that the illness does not require something as drastic as surgery, but also that we have the power to perform a concrete action such as taking a pill, which would have a direct effect on the cause of the sickness. It may be disappointing to find out that the only treatment is time and rest.

Thus it is easy to conceive of a popular reliance on pills which would boost our mood. This is consistent with Lasch's belief that people are in pursuit of happiness, the pills would give them the immediate gratification that they seek (1978). If there was a pharmaceutical solution to the bad mood we are in, would we not take that option? The misuse of Benzodiazepines for the treatment of the most trivial symptoms of stress is one example (Sneader, 1985). We know that pills help our headaches, infections or injuries. Even the concept of taking the pill may boost our self-evaluation. This is demonstrated by the well known placebo effect. The use of a placebo involves giving the form but not the substance of treatment (Jospe, 1976). Honigfeld (1964) wrote that "placebo therapy seems to be consistent with the practice of the medieval physician whose concoctions were as foul-smelling and evil tasting as possible." Placebos seem to be most effective when given with a large component of "hocus-pocus" such as an extensive visit to a physician. Also, "active" Placebos that provide no therapeutic effect but do cause some discomforting effects are seen by the patient as more successful in treatment than regular sugar pills (Honigfeld, 1964, p. 151).

After chlorpromazine, thioridazine, and proclorperazine were found to be ineffective in relieving headaches, anxiety and insomnia in a schizophrenic patient, the physician decided to try a placebo. The patient was told that the pink and blue pills were a new major tranquilizer. The patient reported dramatic relief of symptoms, and developed a reliance on the pills (Vinar, 1968). This patient displayed four out of the five normal traits of dependence as described by Staehelin (1960): a tendency to increase the dose, an inability to stop taking the tablets without psychiatric help, and withdrawal or abstinence syndrome on sudden deprivation of the "medication" (Vinar, 1968). Mality and Kanzler (1971) warn "unless [a placebo group is included in drug evaluation studies] many drugs will continue to receive the credit for producing improvement that really reflects spontaneous remission, the natural course of the disorder, or perhaps, the psychotheraputic skill of the treating physician," (Mality, 1971). While dependence is possible, placebos produce little mean improvement in schizophrenic patients (Caffey, 1971). This may indicate that a pill believed to be helpful by the patient to the point of dependence may not really improve their situation. The caution in attributing behavioral changes to medication may not only apply when the drug is originally evaluated for effectiveness, but in individual cases as well.

In a group of 200 patients that were unsuccessfully treated with antidepressants for a long period of time, 18 improved soon after the antidepressant was replaced with a placebo (Vinar, 1968). If some of these spontaneous remissions occurred while a physician was prescribing a newly released antidepressant, beneficial effects may be falsely attributed to the new drug. Roger Greenburg believes that users of fluoxetine "tend to sit back and wait for the magic of the drug." The exposure in the media of fluoxetine as a wonder drug has led people to put their belief in the power of the drug, and cut back or quit psychotherapy prematurely (Sleek, 1995).

The media exposure of fluoxetine may have led many people to consider seeking out a physician in order to obtain fluoxetine to give them an improved temperament and personality. A new generation of magazine advertisements and promotional campaigns by prescription drug manufacturers contain a checklist of symptoms of the disorders for which their medication is prescribed. Rosenthal (1994) believes that the manufactures are trying to convince people that they are sick, and in need of medication. In a 1993 poll by Scott Levin Associates, this method was found to be effective in inducing visits to physicians. Before the advertisements, only thirty percent of patients asked about certain medications. After the promotional campaign, seventy eight percent of patients brought up the advertisements with their physicians. Eli Lilly, the manufacturer of Fluoxetine has used this form of promotion (Rosenthal, 1994).

While the products of pharmaceutical manufacturers have changed drastically, some of their promotional techniques may not be a far departure from centuries ago, such as the 1878 advertizement recommending a remedy of coca leafs (containing cocaine) for "young persons afflicted with timidity in society," (Breggin, 1994).

Many patients have walked into physicians' offices specifically asking for fluoxetine regardless of whether they truly need it (Fieve, 1994). Fieve (1994) believes that even if these people were prescribed fluoxetine, the majority of them would be disappointed if they were expecting a dramatic transformation in personality. The first reason for this is that less than ten percent of fluoxetine users experience a change to a personality they consider better than normal. Secondly, Fieve (1994) believes that those who are "hyperthemic" or "hypomanic" responders have a propensity towards this response. These people often have dramatic, rejection sensitive, histrionic personalities and tend to magnify the elements of their lives and make persuasive claims (Fieve, 1994). For these reasons, the general public may have unrealistic expectations of the ability of fluoxetine to effect the fulfillment of their lives.