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Dr. Samuel Barondes

Dr. Samuel Barondes is a professor and director of the Center for Neurobiology and Psychiatry at the University of California. He's also the author of the new book, Better than Prozac: Creating the Next Generation of Psychiatric Drugs. In the book he traces the history and analyzes the effectiveness of the current crop of antidepressants and considers the drugs of the future.

20:06

Other segments from the episode on June 23, 2003

Fresh Air with Terry Gross, June 23, 2003: Interview with Samuel Barondes; Interview with Rosanne Cash.

Transcript

DATE June 23, 2003 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Dr. Samuel Barondes on his new book "Better Than
Prozac" about medications for psychiatric disorders
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

About 35 million Americans suffer from depression severe enough to warrant
treatment at some time in their lives, according to a study that was released
last week sponsored by the National Institutes of Health. The study also
found that 60 percent of the people who seek treatment for their depression
don't receive adequate care. My guest, Dr. Samuel Barondes, is the director
of the Center for Neurobiology and Psychiatry at the University of California
in San Francisco. His new book is about anti-depressants, how they were
created, how they work and how they may be improved in the future. The book
is called "Better Than Prozac: Creating the Next Generation of Psychiatric
Drugs." Dr. Barondes is also the author of a previous book about the genetic
links to mood disorders.

You point out in your book that not all drugs work for all patients...

Dr. SAMUEL BARONDES (Director, Center for Neurobiology and Psychiatry,
University of California, San Francisco): Right.

GROSS: ...and about one out of three people with major depressions don't get
much benefit from the first anti-depressant that they're given. Why is there
such variation?

Dr. BARONDES: We don't know. I think that's one of the real puzzles about
this disorder. One can speculate that different people have different
underlying biochemical abnormalities, and so the different drugs might control
them differently. But the answer--it's simple--is that we really don't know.
The fact, though, is that some people won't respond to one drug and will then
respond to another, and we don't really understand why that happens.

GROSS: So you're often in the position of trying one drug for a few weeks or
a few months and then changing it...

Dr. BARONDES: Yes.

GROSS: ...until you get results.

Dr. BARONDES: That's right. There's a lot of trial and error in the
treatment of this disorder, although a lot of people respond to the standard
drugs very well so that it's not completely haphazard. But if one drug
doesn't work, the experience says don't give up; try another one.

GROSS: Often with anti-depressants, you need to take them for a period of
weeks before you get any positive effect, if, in fact, you're going to get a
positive effect. Why does it take so long for the anti-depressants to begin
working?

Dr. BARONDES: That's one of the great mysteries about these medications. We
have a general answer for this, which says that it takes a while for the brain
to adapt to the changes in its chemistry which the drug produces because the
drug does produce chemistry changes very promptly; that is, Prozac, for
example, changes the way that the brain deals with serotonin very quickly, but
then over the course of weeks, the brain adapts to this disturbance and its
change in its chemistry, and that, presumably, is where the therapeutic effect
comes from. But that's just speaking in great generalities. The reality is
that we don't know the specifics of this therapeutic effect, and finding out
those specifics would be enormously valuable in making for better treatments
for this disorder.

GROSS: Now you say that, you know, originally doctors believed that drugs
should be prescribed only for disabling depressions.

Dr. BARONDES: Yes.

GROSS: How much has that changed? It seems to me a lot of people who don't
exactly have disabling depressions are still taking anti-depressants.

Dr. BARONDES: It's changed a great deal. It used to be that only people who
were suicidal or were just so completely depressed and incapacitated were
treated with medications. The notion was in the '60s, for example, that
everybody else should be treated exclusively with psychotherapy and that
tampering with people's brain chemicals was something that should be avoided
at all cost. Over the years and particularly as drugs with lesser side
effects were developed, Prozac being the most stunning example, although it's
certainly not free of side effects--as drugs with lesser side effects, which
people were more willing to take without complaints were developed, the
severity kept going down. So that now people with mild to moderate depression
are frequently treated and frequently with considerable benefit by these
psychiatric drugs.

GROSS: What are the side effects that cause your patients the most trouble?

Dr. BARONDES: Well, initially people complain of nausea sometimes, difficulty
sleeping sometimes, even increased nervousness sometimes. It varies from
person to person. Over longer periods of time the most common complaint is
some sort of sexual dysfunction. A significant, but by no means all,
percentage of people complain of either some loss of interest in sex or sexual
incapacities of various kinds.

GROSS: This is men and women?

Dr. BARONDES: Men and women, yes.

GROSS: And does their sexual feelings return when they stop taking the drugs?

Dr. BARONDES: Yes.

GROSS: Or is this a more permanent side effect?

Dr. BARONDES: No, it's not a permanent side effect. It is reversible if the
drug is stopped.

GROSS: Do you ever see cases where you think somebody has changed too
extremely, that they're no longer themselves?

Dr. BARONDES: Well, I think that that does happen. In fact, there can even
be very distressing changes in people who have a propensity to not only have
depression but manic episodes. Some people who take these medications can
actually become manic, can become irresponsible and start spending money all
the time, can start being hypersexual, in that sense can be no longer
themselves. Of course, what a `self' is is not a constant matter. We all are
somewhat different selves in the course of the day, and in the course of our
lifetimes. We have a large repertoire of behaviors. But these drugs can push
one in certain directions, and sometimes that result is extremely pleasing or
relieving to people. But in other circumstances it can be quite distressing
actually.

GROSS: If you're just joining us, my guest is Dr. Samuel Bardones. He's the
author of the book "Better Than Prozac: Creating the Next Generation of
Psychiatric Drugs." He's the director of the Center for Neurobiology and
Psychiatry at the University of California in San Francisco.

Anti-depressants are pretty new. Before the 1950s what we had mostly was
sedatives, like phenobarbital. What did the sedatives do, and what were they
prescribed for? What kind of psychological problems were they prescribed for?

Dr. BARONDES: Phenobarbital was used for everything in the '30s and '40s.
It was sort of the wonder drug at the time. So whatever ails you, whether you
were nervous or depressed or psychotic, phenobarbital was a very common
medication. And there were lots of people taking elixir of phenobarbital or
phenobarbital pills. It was an extremely widely used, one-size-fits-all
medication for mental distress. And family doctors were amongst the biggest
prescribers. So it was sort of the drug that one used whenever anybody
complained about some sort of problem.

GROSS: Like what kind of problem?

Dr. BARONDES: Well, like being nervous or like being tired or like being
worried, like staying up all night and worrying, which can be a symptom of
depression, or like being reluctant to go to work. That is, whatever bothered
you, the medicine that was most readily available to family doctors was
phenobarbital. Psychiatrists, of course, were extremely reluctant to use
phenobarbital, except as a sleeping medication, because they, in that period,
believed that the great treatment for whatever ails you is psychotherapy, so
that there was a real split in the way that the medical profession was
organized.

GROSS: Now how do the anti-depressants of today, you know, the Prozac-type of
drugs...

Dr. BARONDES: Yes.

GROSS: ...relate to the earlier anti-psychotics and anti-anxiety drugs?

Dr. BARONDES: Well, the interesting thing about the anti-depressantsthat
they--or the ones that we use today, is that they can trace their origins to
the desire by a pharmaceutical company to make a drug as a competitor for the
phenothiazines, like Thorazine, chlorpromazine. So the story goes this way.
Thorazine was originally designed as an antihistamine, as a cold remedy, and
it was only by chance that it was discovered to be useful in the treatment of
psychosis.

And so as soon as that was discovered and as soon as thorazine became an
enormously popular and profitable drug, other pharmaceutical companies became
interested in copying it. And so a company named Geigy in Switzerland looked
in its storehouse and found a drug that looked very much like chlorpromazine
called imipramine. And so they said to psychiatrists, `Try this out. Maybe
we, too, can gain a large share of the market for this important new
medication.' But, amazingly enough, it did not work on psychosis or
schizophrenia. It did, however, also amazingly, relieve depression. And so
out of the desire to make a `me, too' drug for the treatment of schizophrenia
came imipramine, which is the progenitor of most of the anti-depressants that
are used right now, including Prozac.

GROSS: How does it work?

Dr. BARONDES: It was an accidental--how does it work? OK. Well, we know a
little bit of how it works. We know that when imipramine is given to people,
that it increases the effectiveness of certain brain chemicals, namely the
chemicals called serotonin and norepinephrine, which are normally present in
our brains and which we normally use to communicate all kinds of signals, many
of them of an emotional content. So when you take that original drug,
imipramine, what happens is that norepinephrine and serotonin hang around
longer, work more effectively in the brain.

So once that was discovered, the pharmaceutical companies started looking
around to see if they could perhaps try drugs which affected one or the other.
And the driving force in that instance was to reduce side effects; that is,
the more specific the drug--that is, the more specific its effect on
individual brain chemicals--the better it might be. And in the quest to find
a drug that was very specific for serotonin, the Lilly Company discovered
Prozac.

GROSS: I guess I don't feel like I really understand what serotonin does in
the brain.

Dr. BARONDES: Right. Well, it does an enormous number of things. Serotonin
is one of these chemicals that controls a variety of behaviors, and it does
this by affected 14 different receptors that are scattered throughout the
brain, which means that its effects are enormously complicated. Lots of
chemicals affect only one receptor located in one specific place. Serotonin
spreads out all over the brain--that is, is released from the terminals of
nerve cells all over the brain--submits signals to various nerve cells that
are scattered hither and yon, that have different receptors, all of which
respond to serotonin. And the net effect of all this serotonin output can be
enormously complicated.

And when you take Prozac, you augment all those effects, and, amazingly
enough, the outcome of this great change in the brain chemistry is
therapeutic, especially over the course of weeks, as you pointed out before.
So in very well-controlled clinical studies, the drug has been shown to be
effective and helpful for a large number of people, although not without some
side effects.

GROSS: My guest is Dr. Samuel Barondes, author of "Better Than Prozac:
Creating the Next Generation of Psychiatric Drugs." We'll talk more after a
break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is Dr. Samuel Bardones. He's the
author of the new book "Better Than Prozac: Creating the Next Generation of
Psychiatric Drugs." He's the director of the Center for Neurobiology and
Psychiatry at the University of California in San Francisco.

Medicine is still in its, like, early stages of understanding brain chemistry.
Does it make you nervous, as a doctor, to prescribe drugs when scientists
still know so little about how they work and scientists know so little about
the chemicals within the brain?

Dr. BARONDES: Yes, it does, but this is true not only of psychiatry. It's
true of all medicine. You may recall that the wonder drug that's in
everybody's medicine cabinet, aspirin, which was discovered by chance in the
latter part of the 19th century, was a completely mysterious drug until its
mechanism of action on the body was discovered in the 1970s. So that for 70
years or so, people were taking aspirin by the bucket full, and doctors were
prescribing it glibly and people were prescribing it themselves, that is were
going to the local drugstore and buying this stuff. And nobody really
understood how it worked. I mean, much of pharmacology is based on
observations which, in recent years, are supported by carefully controlled
clinical trials, that it works and that the benefit exceeds the downside. But
taking a complicated chemical and putting it into the body does all kinds of
things, and figuring out all of them is, really, extremely difficult.

So this is the state of the art in medicine, in psychiatry but also in
medicine in general. Now there are some exceptions. There are some drugs
that we understand rather well, but even today, even in this modern era that
we are so proud of, many of these medications work in poorly understood ways.
So psychiatry is not at all exceptional in that regard.

GROSS: You write in your book "Better Than Prozac" that pharmaceutical
companies are focusing on improving the current anti-depressant and
anti-anxiety drugs as opposed to finding new ones. Why is that?

Dr. BARONDES: Well, I think they are trying to do both. But improving the
current ones is a much surer thing; that is to say once a market for a
specific kind of drug is established, if you can just tweak it a little bit
and get slightly better side effects or slightly more efficacy, you can gain
huge market share. And doctors will be eager to prescribe the new variant, if
there's reasonable evidence that it's better, without the reluctance that
might come from trying a new medication. It's also really hard to find
something new. Remember, the Prozac-like drugs came from tweaking imipramine,
which was discovered by accident. It was an antihistamine.

Finding, really, new classes of drugs is extraordinarily difficult. And so
pharmaceutical companies are very inclined to make big investments in getting
something that's a little bit better than what's already out there and are
worried about trying to find something completely new, A, because it might be
more difficult to market, but more importantly because it might be very
difficult to find something from scratch that's really new and that really
works. On the other hand, in instances where that happens, they've got a new
blockbuster on their hands.

GROSS: You think that the next frontier for anti-depressants and anti-anxiety
drugs will be genetic-oriented drugs. What are some of the possibilities for
the future?

Dr. BARONDES: Yes. I think, in the long term, genetics is going to help us
enormously in understanding why certain people are prone to become depressed
whereas others in the same life circumstance go on their merry way; that is,
there's clearly a difference amongst people in their propensity for depression
or anxiety or obsessive compulsive disorder or schizophrenia or whatever
psychiatric disorder you may think of. In each case there's clear evidence
that there's some familial component to this, that it runs somewhat in
families and that there's some genetic variation that makes people vulnerable
to the particular condition.

So now that we know so much about the human genome, and now that we're in a
position to learn more about the genetic variations that each person has, a
huge effort is being exerted to find out why certain people are prone to the
various psychological ailments, just as a huge effort is being put out to find
out why people are more prone to develop diabetes or high blood pressure or
whatever. Just as those diseases have genetic underpinnings, so too do all
the psychiatric diseases, including the lesser ones, like moodiness, etc. So
in the end, as we learn more about genetic variations among people, we will be
in the position to learn what the genetic circuits in people's brains are like
as well as the genetic circuits in their bodies and how they make these
vulnerabilities exist. And that, in turn, will lead to the development of
new, specific medications for people who have specific kinds of genetic
vulnerabilities.

GROSS: This is going to be a difficult question to answer 'cause it's so
broad. But when you're seeing a patient for the first time, what criteria do
you use to decide whether the person should receive medication or not?

Dr. BARONDES: Well, assessing a person is a complicated thing. My
inclination when seeing people is to assess their strengths and weaknesses and
not intervene at all if it's not necessary; that is, I don't assume when I see
a person that they need either psychotherapy or pharmacological therapy, my
hope is that a small amount of conversation is all that's necessary to have
them reoriented and get on their way. I don't sit there expecting that this
person has a brain chemical problem that I've got to fix, or this person has a
deep-seeded psychological problem that I've got to fix. I hear out what the
problem is and then try to respond accordingly.

GROSS: Dr. Barondes, I want to thank you very much for talking with us.

Dr. BARONDES: Thank you very much, Terry.

GROSS: Dr. Samuel Bardones is the author of "Better Than Prozac: Creating
the Next Generation of Psychiatric Drugs." He directs the Center for
Neurobiology and Psychiatry at the University of California in San Francisco.

I'm Terry Gross, and this is FRESH AIR.

(Soundbite of music; announcements)

GROSS: Singer/songwriter Rosanne Cash performs a duet with her father, Johnny
Cash, on her latest CD "Rules of Travel." Coming up, we talk with Rosanne Cash
about the CD, why she couldn't sing for two years, her anti-war stance and her
fans' response and the recent death of her stepmother, June Carter Cash.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Rosanne Cash on her latest CD, her career, family and
politics
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Rosanne Cash recently released her comeback CD after losing her voice for two
and a half years as a result of a polyp on her vocal cord. It's called "Rules
of Travel." Our rock critic Ken Tucker describes it as first-rate music.
"Rules of Travel" is Cash's first album of new material in 10 years. During
that time she got married, had a baby, wrote a book of short stories and a
children's book. The CD features duets with Steve Earle and Jacob Dylan as
well as this track, "Beautiful Pain" with Sheryl Crow.

(Soundbite of "Beautiful Pain")

Ms. ROSANNE CASH: (Singing) Do you want to be honest? Do you want to win?
You could have it all if you could gracefully give in, like when a martyr
knows he's a martyr. And looking in the mirror makes you cry harder about
your glittering ball and chain...

Ms. SHERYL CROW and Ms. CASH: (In unison) ...in love, in love with your
beautiful pain.

Ms. CASH: Excuses and old theories keep themselves in ...(unintelligible).
Even when they don't hold water, you try to keep them safe and dry. You trade
your moan for a positive tone, reassured by ads about things you own. And so
we go through this again.

Ms. CROW and Ms. CASH: (In unison) In love, in love with your beautiful
pain.

Ms. CASH: Everything...

GROSS: Rosanne Cash with Sheryl Crow from Cash's new CD "Rules of Travel."

The CD also features a duet with Rosanne Cash's father, Johnny Cash, on the
song "September When It Comes." I asked Rosanne if she wrote the song with
her father in mind.

Ms. CASH: No, I didn't, although he was indirectly the inspiration for the
song because he got very ill about 10 years ago for the first time. And that
first glimpse of a parent's mortality, you know, it's a bit of a shakeup. And
just the train of thought that it propelled me on--you know, my own mortality,
the unresolved issues with my parents, all of that--was kind of up for me. So
I wrote this song, not intending to have him sing on it at all. And, in fact,
I recorded it by myself.

GROSS: So how did your father end up duetting with you?

Ms. CASH: My husband, John Leventhal, who produced this record, after it was
finished, you know, after we had recorded it, he said, `You really should ask
your dad to sing on this. You know, we'll overdub it and put him on.' And I
resisted for the first few months that he kept bringing it up. He brought it
up several times, and I said, `No, I don't want to invite people, you know, to
think that I'm using him or that it's a novelty 'cause the song is too
important.' And John finally said, `Exactly, the song is too important. It's
the right song. It's the right time. You should do this.' So I asked my
dad, and I said, `Dad, I have this song I'd love for you to sing on.' And he
said, `Well, I have to read the lyrics first.'

GROSS: Well, you know, I think that's interesting. He didn't want to hear
the music. He wanted to read the lyrics.

Ms. CASH: Well, you know, he...

GROSS: Why were the lyrics more important than the music?

Ms. CASH: Well, he wanted to make sure that what he was saying was something
that was authentic to him. So when I took the tape down there and he read the
lyrics, he said, `Yes, I can do this.'

GROSS: Did he say anything else about the lyrics?

Ms. CASH: Not then. It was so obvious, you know. He's not one to belabor a
point, and he's also not one to oversentimentalize things. And he has kind of
a ruthless vision of the truth. So, you know, he knew what the song was
about, and he knew it was the right time for us to do this. He told me
actually not long ago--he said, `I'm really proud of this song in the context
of the whole record.' And that meant more to me than if he had just said,
`I'm really proud of this song.'

GROSS: I really like the way you both sound on it. You really hear the
vulnerability in his voice on this song, and, of course, the song is about
vulnerability and aging.

Ms. CASH: Right.

GROSS: At least it's in part about that.

Ms. CASH: Yeah.

GROSS: How does he feel, do you know, about the age and weakness that you
hear in his voice now?

Ms. CASH: He hears it as kind of less than he could do professionally. He
said, `Oh, I could have sung that better.' You know, I don't think he hears
himself and thinks, `Oh, I sound aged and infirmed.' He just thinks, `Oh, my
voice isn't the best it could be,' because, you know, truth is he does go in
cycles. And the next recording he made of his own recording, his voice was
very strong again. You know, it does go in cycles for him, his health.

GROSS: Was he able to record his part in the studio?

Ms. CASH: Yeah, but in his own studio. I took it down to Nashville, and he
has a studio in the woods. It's a really sweet, little cabin in the woods.
It's a studio near his house, and that's where we recorded it. That was a
very sweet day. It was just me and him and my brother, who did the recording.

GROSS: Let's listen to Johnny Cash and Rosanne Cash singing "September When
It Comes" from Rosanne Cash's latest CD, "Rules of Travel."

(Soundbite of "September When It Comes")

Mr. JOHNNY CASH: (Singing) I plan to crawl outside these walls, close my
eyes and see and fall into the heart and arms of those who wait for me. I
cannot move a mountain now. I can no longer run. I cannot be who I was then.
In a way, I never was.

Ms. CASH: (Singing) Watch the clouds go sailing, watch the clock and sun.
Oh, I watch myself depending on...

Mr. CASH and Ms. CASH: (In unison) ...September when it comes.

GROSS: Your father is very vulnerable now. He's been sick with--I'm not sure
exactly what the illness is. I think it's...

Ms. CASH: He has...

GROSS: Yeah, go ahead.

Ms. CASH: ...autonomic neuropathy and he's diabetic, and they're related.

GROSS: So what is autonomic neuropathy?

Ms. CASH: Well, it's a degenerative nerve disease.

GROSS: Does that mean he's in a lot of pain?

Ms. CASH: If he is, he doesn't say so. He's an incredibly stoic person, and
he's of that generation that believes that you do your suffering in silence
and that, you know, there's a certain nobility and honor in not complaining.
You know, I'm certainly not of that generation.

(Soundbite of laughter)

GROSS: You know, your father, who's such an image of strength, is very
vulnerable now. Your stepmother, June Carter, died last month. I mean,
you're at that stage in life where you're watching parents become
vulnerable...

Ms. CASH: Yes.

GROSS: ...or pass away. And it's something that so many people in their 40s
and 50s are going through now.

Ms. CASH: Well, I would say 90 percent of my friends are going through the
same thing. You know, it's kind of startling. You realize, `Oh, this is a
developmental stage or something; everybody goes through this.' You know, you
don't think about it when you're younger. But, boy, it really rearranges
everything, your priorities. It's really changed what I've held on to that I
didn't have to be holding on to. You know that saying that after the age of
25 it's unseemly to blame your parents for your life? I would have to agree
with that.

GROSS: My guest is Rosanne Cash. Her latest CD is called "Rules of Travel."
We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is singer and songwriter Rosanne Cash. Her latest CD is
called "Rules of Travel." When we left off, we were talking about her father,
Johnny Cash, and the recent death of her stepmother, June Carter Cash.

Were you very close with June Carter?

Ms. CASH: Mm, I was very close with June. I always said that my mother gave
me structure and June gave me wings, and both were essential for my life. And
I really would not have become a performer had it not been for June.

GROSS: Why not? What did she do that encouraged you?

Ms. CASH: Well, it wasn't overt. It was just being around her and being on
the road with her for a few years, actually. And, you know, she had been on
the road virtually her entire life. She had been a performer since she was a
preteen. And she had a naturalness about it, and she just incorporated--being
in front of an audience and performing and singing and playing music, she
incorporated it into her life. It wasn't separate. She didn't change
personalities when she was backstage and then when she walked on stage. It
was all the same. And that kind of natural affinity for it made me rethink it
because, you know, as a child I thought, `Well, being a performer is just the
worst thing you could possibly do. It invites fame, and that's the worst
thing that could happen to you,' because from my point of view as a child, you
know, it destroyed your family, and it made you take substances to stay awake
and it was exhausting and, you know, the whole thing. So to see June the way
she did it was--I rethought it. You know, I thought, `Well, this might not be
such a bad life after all.'

GROSS: You said that she was the same person on stage as off.

Ms. CASH: She was.

GROSS: And what about your father? Is he different on stage?

Ms. CASH: No. He's the same guy, too.

(Soundbite of laughter)

Ms. CASH: In fact, he's more himself on stage. It's interesting, any
distractions fall away once he's under the lights. He becomes very focused.
He becomes kind of his essential self. He becomes timeless when he's on
stage.

GROSS: Can you share some memories from when you started performing with
Johnny Cash and June Carter? And I think this was, like, after you graduated
from high school?

Ms. CASH: Yeah, when I went on the road with him after high school, it was a
way to see the world. I wasn't interested in being a singer or a performer.
I just wanted to be with my dad and travel, and, you know, that's what that
was about. It was later that I kind of grew into that life.

GROSS: So what were you doing on the tour when you weren't really interested
in performing?

Ms. CASH: I think they put me down as laundress on the manifest, so that they
could write me off their taxes.

(Soundbite of laughter)

Ms. CASH: So I do remember washing out some black pants in a bathtub a couple
of times, but that was about the extent of it. But, you know, I was
traveling. I was doing what they did. I was learning how to order in really
great restaurants and find the best hotels, and, you know, it was a great
life, a wonderful life for a young girl.

GROSS: Were there certain generational differences that you realized
existed...

Ms. CASH: Oh, yeah.

GROSS: ...between you and Johnny Cash and June Carter, things that affected
you personally but also as a performer?

Ms. CASH: Yes. Well, it was different partly and, actually, in a very large
part because of their upbringings, which were very different from mine. You
know, I was raised in Southern California. I grew up on rock 'n' roll. I was
profoundly imprinted by The Beatles, and, you know, I was a modern, kind of
semi-urban girl. And they both grew up in very rural surroundings, my dad in
Arkansas in cotton fields and June in Appalachia. So their lives were
transformed by becoming performers and by becoming public people, but they had
that kind of very Old World notion about it: that the fans are part of their
life, and they're very accepting. And I have never once in my entire life
seen June or my dad be rude to a fan who came up to them, no matter how, you
know, disturbing it was or how unwelcome it was. They're unfailingly polite.

So, you know, just the upbringing was very different. That provided a
generational difference, a huge one. And I don't exactly feel that way. I
mean, I like my private life. There are choices they've made about being
public people that I would not have made.

GROSS: Like what?

Ms. CASH: Well, June's funeral is the first thing that comes to mind, the
fact of my dad wanting it to be public, you know. I mean, we all understood
why: because their lives have been lived in public, because their fans are so
much a part of their lives, because it's a very Southern thing to do for
public people in the South. Me and my sisters and my brother were just, `Oh,
you know, please, we just don't want to do this.' But we totally respected
and understood that. That would not have been a choice we would have made.

GROSS: Let me play another song from your latest CD, "Rules of Travel." This
is a song you wrote called "I'll Change For You," and songwriter and singer
Steve Earle duets with you on this. You want to say a few words about the
song before we hear it?

Ms. CASH: Well, I wrote this song as kind of a nose-thumb to this being
therapeutically correct all the time in relationships. You know, this idea
of, `Oh, no, you can't change for anyone. You must only change for yourself,'
and blah--`No one can make you happy,' you know. I thought, `Well, that's not
really the way the human heart works a lot of times.' And, you know, it was a
rebellion. And, also, you know, I do love obsession, and I particularly love
erotic obsessions. That's really what this song's about.

GROSS: OK. So this is Rosanne Cash's song "I'll Change For You" sung by
Rosanne Cash and Steve Earle from her latest CD "Rules of Travel."

(Soundbite of "I'll Change For You")

Ms. CASH: (Singing) I'll change for you. I'll change for you. I'll change
for you. I'll turn night into day. And I'll change for you...

Mr. STEVE EARLE: (Singing) I don't care what the books say.

Ms. CASH: (Singing) Oh, I'll change for you.

Mr. EARLE: (Singing) And I don't care what my friends say.

Ms. CASH: (Singing) I'll change for you, and I won't make you pay.

Mr. EARLE and Ms. CASH: (Singing) 'Cause everything reminds me of you: a
baby's feet, an old man's smile, silent scream, a lover's cry.

Ms. CASH: (Singing) Till I can't do nothing but change for you.

Mr. EARLE: (Singing) And all the rules that were lies.

Ms. CASH: Well, I'll change for you.

GROSS: Rosanne Cash with Steve Earle from Rosanne Cash's latest CD, "Rules of
Travel."

Well, this is a record you almost didn't get to make because you had a polyp
on your vocal cords that...

Ms. CASH: Right.

GROSS: ...affected your talking and singing for--What?--a couple of years?

Ms. CASH: Two and a half, going on three years I lost my voice, right.

GROSS: How much of it did you lose?

Ms. CASH: All of it. I sounded like Tom Waits with laryngitis. You know,
some days I couldn't even speak. It was related to pregnancy. I got the
polyps when I was four or five months pregnant, and we didn't know it was
related to pregnancy. My doctor had not heard of that. And she did some
research on it and found that it was possible. I was scheduled for surgery,
and so she canceled it and she said, `I just want to wait and see what happens
after you have the baby, after you stop nursing, once you're back to normal.'
And, sure enough, about six months after I stopped nursing, the polyps went
away.

GROSS: So you couldn't sing and you could barely talk?

Ms. CASH: That's right.

GROSS: I mean, what did you do to communicate?

Ms. CASH: Well, I would kind of squeak out, you know, this hoarse, kind of
froggy voice. And I definitely couldn't yell at my kids. That was very
disturbing. But, no, the most disturbing was I couldn't sing lullabies to
this newborn. That was very sad.

GROSS: But you probably just couldn't pass the time by talking to people who
you liked either?

Ms. CASH: Yeah, it was torture to be on the phone. In fact, that's kind of
been a holdover since I lost my voice--is I really don't like talking on the
phone anymore.

GROSS: Do you start to feel erased after a while because, I mean, part of
what defines you is what you say to people? They don't even know what you
think unless you tell them.

Ms. CASH: Well, that's very insightful, Terry. I did. That is exactly the
right word, erased. I started to feel like I was nothing, that I was just not
important, that I had no opinions because I couldn't express them, that I had
no means of expression and I didn't count in the world. I mean, I really had
a full-blown identity crisis in the second year of losing my voice. The first
year I wasn't paying attention too much because I had a new baby. The second
year it was kind of a crisis.

GROSS: Do you sing any differently than you did before?

Ms. CASH: I think I do sing differently, and I can't tell you exactly how. I
feel less anxiety when I'm singing. I feel less of a need to monitor myself.
You know, `How's my pitch? OK, how am I going to get to that note? Is this
working? Is there some scratchiness there?' You know, all of that kind of
continual monitoring, which drives me crazy. I've let go of most of that.

GROSS: Why? Why do you think you did?

Ms. CASH: Because I had this realization when I lost my voice that I had been
taking for granted and, in fact, I'd kind of been abusing something that was
really precious. And I thought to myself, `If I get my voice back, I'm not
going to take back the anxiety. I'm going to try to experience the joy of
it.' And I did. I feel like I did. And, you know, it was a classic thing of
you don't realize what you have until you lose it, and I realized how
important it was to me. The sense of loss was tremendous, so much greater
than I imagined it would be, when I couldn't sing.

GROSS: So when you go out to perform on stage now, are you worried about
whether your voice will be there, or are you confident that it will be?

Ms. CASH: No, sometimes I'm worried. You know, sometimes I go through,
`Well, what if the polyp comes back?' I mean, you know, I'm obsessive by
nature, I told you, so I do go through it. But once I get out there, I can
let go more than I used to be able to do.

GROSS: My guest is Rosanne Cash. Her latest CD is called "Rules of Travel."
We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is singer and songwriter Rosanne Cash. Her latest CD is
called "Rules of Travel."

Now I want to ask you about something else that's happened to you lately.
Before the war in Iraq, you were part of this group Musicians United to Win
Without War.

Ms. CASH: Yeah.

GROSS: And, you know, you made some public statements about why we shouldn't
be going to war with Iraq. Now that the fighting part is over, at least most
of the big fighting part is over, can you reflect on that experience a little
bit of being, you know, a singer-songwriter making public statements about a
political cause?

Ms. CASH: I've given a lot of thought to that because I got enormous backlash
from speaking out against going to war, you know.

GROSS: From who?

Ms. CASH: Just from--I don't know. Just people sending e-mails to my Web
site or writing me, you know. And it wasn't people saying, in a very
thoughtful manner, `I disagree with you, and here's why.' It was people
calling me every name in the book and being very abusive about it. And at
first I wrote some of them back, and I was respectful and I said, `Well,
here's why I believe this, and I've actually thought about this and tried to
become well informed about this, and here's why I think this.' But it didn't
work. You know, they didn't want to have a dialogue.

And, in fact, something really funny happened. My daughter, who's 21, she was
the one who sorted through the e-mail on my Web site, and she, you know, got a
little scared because some of it was actually threatening. And I said, you
know, `Chelsea, do not write anybody back. If anyone will write back, it will
be me.' Well, apparently one e-mail was so abusive that she wrote back
without my permission, and she said, `If you ever talk to my mother like that
again, I will hunt you down. I am not peaceful like she is.'

(Soundbite of laughter)

Ms. CASH: So they...

GROSS: Did they respond back to her e-mails?

Ms. CASH: No, thank God. But I had a model from my childhood about being an
artist and being an activist, and it was my father. He spoke out against the
Vietnam War, and it was not popular to do so. He took on the Ku Klux Klan.
He was an advocate of Native-American rights and prisoners' rights, you know,
very unpopular subjects in the '60s. And he taught me that if you don't say
what you believe, you're not worth your weight. You know, you have to say
what you believe.

GROSS: Did you run into--you know, like, on a lot of radio stations, they
banned the Dixie Chicks' records...

Ms. CASH: Yeah.

GROSS: ...because the Dixie Chicks spoke out against the war. Did you run
into that on any radio stations that play your music?

Ms. CASH: No, radio stations don't play my music anyway, so that was not a
problem.

(Soundbite of laughter)

GROSS: Earlier you said that, you know, your father and June Carter were
never rude to fans.

Ms. CASH: Never.

GROSS: And you thought that that was one of the generational differences.

(Soundbite of laughter)

GROSS: Were people rude to your father because of his stand on Vietnam, and
how did he handle that?

Ms. CASH: Oh, my God, they burned a cross in our front yard when I was, you
know, 9, 10 years old because he publicly took on the Ku Klux Klan. So, yeah,
it was beyond rudeness. I mean, he's had death threats. You know, he's
encountered all of it.

GROSS: How did he handle that?

Ms. CASH: Oh, I just can't tell you how unshakable he is, really. If he has
a belief and a faith, then people could say anything to him, it really doesn't
shake him.

GROSS: Another question about your music. We talked a little bit about how
your voice and your singing have changed since the polyp problem--the polyp on
your vocal cord. Do you think your songwriting has been changed by the whole
experience?

Ms. CASH: My songwriting has definitely been changed by this and mainly
because I didn't write any songs while I had lost my voice. And I started
writing a lot of prose, and I wrote for New York Magazine and I wrote for The
New York Times Magazine and Oxford American, and even Martha Stewart Living I
wrote a piece on lullabies and lots of other periodicals. And I edited a book
of songwriters' prose, and, you know, I was doing a lot of prose, and it
changed me as a songwriter, definitely. It gave me a wider sandbox to play
in, in a way.

GROSS: In what way?

Ms. CASH: Well, you know, as a songwriter, you're bound to melody, you're
bound to a rhyme scheme, you're bound to a three- or four-minute format, you
know. And usually because I'm a very structured person, I really loved that.
I love knowing the perimeters and setting up the internal rules of each song
and then just staying in that. It feels very safe, and, you know, I have all
the freedom within that box. But when writing prose, you know, it's a lot of
rope to hang yourself with, but it's also a lot of freedom and relief.
There's no rhyme. There's melody, but it's very subtle. You know, you can go
on as long as you want. You don't have to stop after three minutes. So I
brought some of that freedom back to songwriting, I think. At least it feels
like I did.

GROSS: Well, Rosanne Cash, thank you so much for talking with us.

Ms. CASH: Thank you, Terry. It's a pleasure.

GROSS: Rosanne Cash's latest CD is called "Rules of Travel."

(Soundbite of music)

(Credits)

GROSS: I'm Terry Gross.

(Soundbite of song)

Ms. CASH: (Singing) It's all coming back to me now to try, as I have, to keep
the taste of you off of my tongue, your face from my fitful sleep. And I
plead, hope against hope like before. And I wait, hoping I won't anymore.
This won't stop till I do, until I learn to...
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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