He sets the stage for his argument by considering a woman who came from a somewhat alienating backgroud, and describes why she might wanth to take Prozac. He mentions that her behavior is similar to depression, but that her psychiatrist can not find evidence of what has traditionally been regarded as disease. She just wants to be happier. He then poses the question, "Is either the goal of major self-transformation or the means of using a prescription drug morally problematic? If so, why?" (35)
He begins his answer be noting "Elliott's thesis suggests that it would be inauthentic, ...". However, he says, this relies on the principle of a original "given", authentic, self. He responds, "In fact, a tranformation such as marina proposes can be a perfectly authentic piece of what I call self-creation."
DeGrazia goes on to break down Elliot's argument into three parst, only one of which e disagrees with: "... that the self is 'given', a pre-existing reality that might be discovered and to which one's actions should conform or 'be true', ...". He then tries to define the "sense of personal identity". He describes it as "what we consider most important to who we really are, our self-told narratives about our own lives." He analyses the definition of the self, showing that the "given" self might have come from society or from or from previous concious personal choices. He explores the limited power of the human self.
DeGrazia goes on to note that many people make choices that lead to reshaping their selves. He also describes another hypothetical case of two women who are smokers; they both consume the same amount of nicotine and show the same symptoms of physical addiction, but one has chosen to continue to smoke because she likes flaunting social custom, while the other has some desire to quit. The second has defined herself as a "smoker" while the first is a "tobacco addict" and wants to change. DeGrazia extends this analogy to his original case, where the client (so far as we know) has no addiction nor mental nor physical illness, but merely wants to change herself.
DeGrazia's case is not directly relevant to the case of Stan. Marina is considering taking Prozac. Stan has been prescribed Prozac, and his self-defining choice, were he to make one, would be to stop taking it so he could find pleasure in his socially unacceptable activities again. Alternatively, he might be able to realign his desires and actions by breaking old habits that are contrary to societal standards.
I suspect that when people admonish others, "be true to yourself", they seldom want it to carry all of the philosophical implications that Elliott and DeGrazia have been reading into it. Sometimes it simply represents honesty and reliability. Other times it means conforming to a proven social identity, such as of the prince, the Viking hero or the doctor who takes care of all of his patients. In times past a mother might have hugged her son and admonished him, "Remember to make your Daddy proud" as he boarded a train to enter college or military service. Of course, in all these cases, the social good and the individual good are interrelated.
I aggree with Elliott that self-definition cannot happen in a vaccuum and that alienation is a problem in modern society. I also agree with DeGrazia that drugs without demonstrated significant harm are a reasonable way to pursue a course of self-improvement, and that, if they enhance the social good as well, society should encourage their use.
On the other hand, drugs often have side effects. At one time, it was suggested that I take Ritalin, so I was given a prescription, but I stopped it the first day because of certain side-effects. Lack of sleep and high-sugar foods also have intteresting psychic effects; I don't know how doctors could prevent people from pulling an all-nighter now and then. I don't think they should.