Would You Take Botox To Cure Depression?

I recently saw Sam Raimi’s Oz the Great and Powerful, a prequel to the classic 1939 film The Wonderful Wizard of Oz. While I expected more of the director of the Evil Dead movies, Spider-Man, and Spider-Man 2, I forgot Raimi also directed Spider-Man 3. The film is at first luscious to look at, but the characters are depressingly flat and James Franco can only mug at CGI creations so much before your saliva tastes like vomit. Mila Kunis was good.

At the end of film, Franco’s Oz decides to hand out symbolic gifts to those who have helped him attempt to cheat an entire and hopeful empire out of their money. One of these characters is Knuck, a stern munchkin played uneventfully by Tony Cox (of Bad Santa fame). Knuck spends most of the film attempting to either play a bugle fanfare or correcting Oz when he calls him “Sourpuss.” To counter this misanthropic attitude, Oz gives Knuck a smiling mask which he can place over his face to make him appear happier. “You look nice with a smile,” says another character. The implication is — by a simple change of outward appearance and visible attitude — other people will be nicer to Knuck and Knuck will therefore be nicer to other people.

Science has shown this largely to be true. Studies have found that, if one even forces a smile, they will view what is in front of them with more favorable and a lighter attitude. However, there are extremes to this. Eric Finzi, a dermatologist with a new book studying the physiology of facial expressions, has been doing the media rounds actively advocating for the use of Botox to make people smile in order to fight depression.

The initial reaction to using a botulinum injection to literally force a smile on the faces of the clinically depressed is clearly horrifying. It is a Stepfordian solution to a disorder that is already filled with existential dread. However, the science is behind the effectiveness of Dr. Finzi’s Frown-No-More Magic Needle. But should it even be an option?

Functionally, a specialized Botox treatment would be rather similar to the antidepressants 1 in 10 Americans currently take. Whereas the treatments would halt the face from recognizing negative emotions (by limiting the face’s ability to show those emotions), SSRIs like Prozac, Welbutrin, and Zoloft essentially block the brain from experiencing those emotions by overloading the brain with serotonin, a brain chemical involved with positive feelings. The Botox injections serve a similar function, limiting the face’s ability to produce a frown simply because it alters the muscular structure to create a smile. Either way, you are limiting the range of emotions you can feel.

The history of “curing” mental illnesses is littered with invasive, outright-shameful practices. Electroconvulsive therapy (the practice of sending volts of electricity into the prefrontal cortex to simulate a seizure) has been used for 60 years as a treatment for a wide array of mental health disorders, ranging from bipolar disorder to schizophrenia. Only recently, however, have doctors bothered to research the memory loss and cognitive dullness many patients experience. But as one researcher noted, such findings do not “significantly change the risk–benefit ratio of this notably effective treatment.” Or perhaps more eloquently stated by Sylvia Plath, “I wondered what terrible thing it was that I had done.”

And here is where we return to Dr. Finzi. Finzi has the science and studies to prove a Botox treatment would be an effective method of treating depression. However, would we not all be like Knuck, a smile plastered on our face in an effort to hide our own anger and depression?

When Finzi was asked by Here & Now’s Robin Young about the adverse effects of his treatment — “Don’t we need to frown? Is it maybe not a good thing that you aren’t frowning?” — Finzi retorted “every medicine has a potential side effect.”

What would you be willing to give up in return for happiness? While I have no doubts about the effectiveness of Botox, would I really be ready to sacrifice the full range of emotions I can experience today? Depression can be awful; I watched my mother struggle with it throughout her life and struggled with it in mine as well. But I want a full range of emotions. To imagine losing the backwards and cathartic joy of crying all so I can smile, my face convincing my brain that everything is okay, is a thorough pain. Even at the cost of depression, I’d prefer the intimate warmth of sadness to the cold, dispirited happiness provided by freezing the world’s best window into your mind.