Prozac as a Way of Life (review)

Prozac has become much more than just a particular psychotropic medication or a generic term for a class of medications: it is now, as the title of Carl Elliott and Tod Chambers's book indicates, "a way of life." This book joins the astonishing 6,492 results that Amazon.com shows for "Prozac," including Prozac Nation, Prozac Diary, Let Them Eat Prozac, Prozac on the Couch, Talking Back to Prozac, Beyond Prozac, Prozac Backlash, and the stimulus for all of these books, Peter Kramer's Listening to Prozac. Prozac did not create the widespread medicalization of human problems at the beginning of the twenty-first century: millions of people (especially women) took the tranquilizers Miltown during the 1950s and Valium and Librium in the 1960s and 1970s. But the 1990s brought unprecedented growth in the use of psychotropic medications—persons treated for depression were about four and a half times more likely to have received Prozac or another selective serotonin reuptake inhibitor (SSRI) in 1997 than in 1987. The central argument of the contributors to Prozac as a Way of Life is that a distinctive cultural phenomenon underlies the sheer number of people taking these medications. Prozac, they claim, may have altered the relationship between selfhood and society.

The distinctive aspect of Prozac as a Way of Life is that it takes seriously Kramer's original claim that Prozac was not just a drug that could treat mental illness, it could actually enhance individuals' psychological well-being and make them "better than well." The contributors examine what Prozac with its extraordinary popularity says about modern life and, in particular, about people's sense of themselves in the modern world. In his excellent chapter, Elliott questions whether the condition that Prozac supposedly treats is not a mental disease but instead reflects justifiable alienation from contemporary social life. He aptly quotes Wittgenstein: "The sickness of a time is cured by an alteration in the mode of life of human beings, and it was possible for the sickness of philosophical problems to get cured only through a changed mode of thought and of life, not through a medicine invented by an individual" (pp. 128–29). Treating alienation through medication, he claims, can diminish, rather than enhance, the authenticity of selfhood. Other chapters grapple with such provocative questions as "What is the condition that Prozac supposedly cures?" "Where do we draw the line between personality and medication?" and "How is Prozac shaping the nature of contemporary culture?" Several authors relate the state of mind that Prozac presumably induces to the thoughtful state of detachment found in Eastern religions.

The strength of this collection lies in its raising these broad questions about the relationship between Prozac and the nature of the self in contemporary societies. Its weakness stems from the credence that most of the authors place in Kramer's original claim regarding the remarkable improvement that people experience after taking Prozac. They take this claim at face value, and discuss what it could mean that a drug helps one discover a previously unknown self that is more authentic than the self it replaced. Some mention the "extensive transformations of personality" (p. 36) that the drug brings about, and others rave about "the remarkable effects of this medication" (p. 61)—none mentions the placebo effect that routinely accompanies the introduction of new medications. Indeed, a plethora of studies shows that the SSRIs are no more effective than the older medications they replaced, although they are better tolerated, are less addicting, and, arguably, have fewer side effects. There is simply no credible evidence that Prozac produces any fundamental changes in the self, as opposed to alleviating distressing psychiatric symptoms in some people.

Contemporary events may already have overtaken the cultural phenomenon that this book discusses. Widespread discussions regarding the negative aspects of taking SSRIs, such as their potential to create suicidal ideation...