In a situation where an individual is not well adjusted, the underlying cause behind the adverse conditions must be taken into account in order to determine whether the prescription of a psychotropic medication is necessary. What is the factor that is causing the problem? To what extent is the environment responsible for adverse reactions in the patient? If a patient is given medication in order to cope with a difficult environment, and no effort is made to change the environment, this may be considered unethical. If the cause of distress is family conflict, and the treatment does not involve a solution to the distress, treatment with medication may be an avoidance of the true problem.

In cases where the cause of the distress is environmental but unchangeable, a different question is provoked. When distress is caused by something such as the death of a close relative, the distress is considered to be natural. In this society and many others, people are expected to mourn after tragic events. It would be considered detrimental to take away this time of remorse.

A contrast must now be made between the social effects of tranquilizers and Fluoxetine. Whereas tranquilizers may make a person complacent, passive and more accepting of adverse circumstances, Fluoxetine may have the opposite effect. Fluoxetine has been reported to improve decisiveness, increase self-esteem and quickness of thoughts. Instead of creating a blunted affect, Fluoxetine may create a higher tolerance for levels of affect (Kramer, 1993). People taking the drug do not have a loss of moods or motivation, but an enabling effect which allows them to see their problems in a more objective manner and actively seek solutions to them (Kramer, 1993).

It may be that the condition of depression that is better suited to social control. The loss of motivation and self esteem may inhibit constructive reactions to the problems encountered. in life. It would be the depressed person who would be less likely to make an effective resistance to the forces of social conformity. Fluoxetine has aroused much attention because it has had an effect on the personality of its users. Besides relieving depression, fluoxetine has also diminished obsessions, compulsions and other negative aspects of behavior (Kramer, 1993). An analogy has been made, that a person's quirks are the wrinkles in a shirt, and fluoxetine is the iron that straightens the wrinkles out (Kramer, 1993). Although it is difficult to argue that clinical depression is an integral part of one's personality, other traits do distinguish us as individuals. The removal of personal characteristics would have a generalizing effect that would make people more similar. What traits would users of fluoxetine share? They may become more positive in mood, more social and have a greater desire to perform tasks, such as career work (Kramer, 1993). Would this be such a bad thing, to be in the company of these enthusiastic people? Society as a whole would be allowed to be more productive. Would the motivation exist for a powerful organization to dispense neuroleptics? A study by the Analysis Group, the Sloan School of Management at MIT and the National Bureau of Economic research concluded that American suicides in 1990 caused a seven and a half billion dollar loss in productivity (Cockburn, 1994). Sixty percent of those suicides were attributed to depression. This information may lead organizations that value productivity to look favorably on anti-depressant use, especially if that anti-depressant is reported to increase motivation. It should be noted that the study was financially backed by Eli Lilly, the company that produces Fluoxetine (Cockburn, 1994).

The cost of widespread use of neuroleptics would be a loss of several types of personalities. Morgan Schow has noted that patients on lithium report that their lives are flatter and more colorless after taking medication (Jamison, 1993). The contribution to society by people with "undesirable" traits such as depression has been enormous. Also, there have been people who actually prefer their depressed emotional state to that induced by fluoxetine (Kramer, 1993). There are some who would rather not have Dr. Pangloss as the surgeon general.

In the first major psychiatric treatise in the United States, Benjamin Rush recorded observations of the relations of mania, mental acuity and artistic talent. William James and Emil Kraepelin both emphasized the positive features of certain kinds of madness, speculating how these features could produce an extraordinarily creative or accomplished person (Jamison, 1993). Jamison has compiled a list of hundreds of famous artists, musicians and writers that are believed to have had affective disorders (1993). Studies have even shown a positive and significant relationship between creative ability and recorded mental illness (Andreasen, 1987.; McNeil, 1971). Edvard Munch remarked "A German once said to me: 'But you could rid yourself of many of your troubles,' to which I replied 'They are part of me and my art. They are indistinguishable from me, and it would destroy my art. I want to keep those sufferings,'" (Jamison, 1993 p 241). At the opposite pole from the widespread use of neuroleptics to regulate mood would be the forced maintenance of a depressed state in a individuals in order to maintain creativity or some other desirable trait. This might be accomplished by prohibiting the use of pharmaceuticals that may alleviate the depression.

Fieve (1994) has argued that it is during the manic stage that creativity is expressed. For example, Vincent VanGoh painted 200 canvases in two months during a manic phase. Fieve (1994) believes that if an artist was prescribed fluoxetine, their creativity would be unchanged but their productivity would increase.