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Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6945.1724 (Published 25 June 1994) Cite this as: BMJ 1994;308:1724
  1. C Elliott

    Imagine yourself transformed by a pill. Where once you were hesitant, shy, and self critical, now you are confident and self assured. Once driven by guilt and obligation, prone to doomed, self destructive relationships, now you find yourself relaxed and composed, able to joke and laugh at yourself.

    Now you stop taking the pill, and you change again. Your self returns. But it's not the same as before. You don't feel like yourself, despite the fact that these habits and traits of character were yours for a lifetime before you took the drug. What would this experience tell you? Which is your “self” - the one on the drug, or the one off it? Is there any value in staying the way you were before the drug, when your life was harder and you were unhappy with yourself?

    These were the sort of questions psychiatrist Peter Kramer began asking himself when he started to see how his patients were affected by the antidepressant Prozac (fluoxetine). The result is his exceptionally thoughtful Listening To Prozac, a book that is equal parts philosophical meditation, psychopharmacology lecture, and case study. Kramer presents a series of patients who, while not always clinically depressed, were troubled enough to seek psychiatric help, and who responded in a remarkable way to Prozac.

    A nurse sees her failing marriage rescued when Prozac frees her from her obsessive concern with neatness and control. An Ivy league student finds that, on Prozac, she is no longer hypersensitive to slights and insults. One clinically depressed man finds that not only is his depression reversed by Prozac but also he loses his taste for hard core pornographic videos.

    What is disturbing about the case studies is just how well Prozac seems to work. Many of Kramer's patients seem to gain the insight and perspective that years of psychotherapy would aspire to achieve, but in a fraction of the time. Yet while Kramer ultimately defends what he half ironically calls “cosmetic psychopharmacology,” he is no evangelist for the drug. His aim is rather to explore what the effects of Prozac mean for larger philosophical questions about the self and how we come to be who we are.

    Kramer has written an admirable book, one that manages the difficult trick of speaking to the broadest possible readership without making intellectual sacrifices. His reflections are so understated, and so obviously rooted in genuine concern for human suffering, that even the most hardened sceptic is likely to come away from the book with a more sympathetic attitude toward Prozac. And yet one wonders. Do we not lose sight of something essential about ourselves when we see things like alienation and guilt as symptoms to be treated rather than clues to our condition as human beings? Prozac may eliminate pathology, but in so doing it may also eliminate what is a perfectly sensible response to the very strange times in which we live. One could hardly put it better than Walker Percy in Lost in the Cosmos, who asked, “Consider the only adults who are never depressed: chuckleheads, California surfers, and fundamentalist Christians who believe they have had a personal encounter with Jesus and are saved once and for all. Would you trade your depression to become any one of these?”

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