Melancholic Biology: Prozac, Freud, and Neurological Determinism

One of Peter Kramer’s central case histories in his 1993 bestseller Listening to Prozac is the story of a young woman named Lucy. Kramer tells us that her history is dominated by one event: “When Lucy was ten and living in a third-world country where her father was stationed, she came home to find her mother dead, shot by a young manservant—a beloved and trusted member of the household—who had become crazed and violent. Lucy showed no immediate reaction to this ghastly occurrence. She remained a productive, well-liked girl.” ¹ As an adult, Lucy developed a heightened sensitivity to loss and rejection, and she came to see Kramer in order to deal with this crippling oversensitivity. Her treatment with Kramer involved both psychotherapy and the use of the SSRI (selective serotonin reuptake inhibitor) antidepressants Prozac and Zoloft.

In summarizing her case, Kramer opens up a key question about psychobiology:

Lucy had harbored a kernel of vulnerability that the psychotherapy did not touch. It was as if psychological trauma—the mother’s death, and then the years of struggle for Lucy and her father—had produced physiological consequences for which the most direct remedy was a physiological intervention. But how does psychic trauma become translated into a functionally autonomous, biologically encoded personality trait? How can a mother’s death become a change in serotonergic pathways? ²

It is this last question—how can a mother’s death become a change in serotonergic pathways?—that strikes me as pivotal, not simply to Kramer’s project, but also to a number of contemporary critical and political considerations. In asking this question, Kramer invokes a series of long-familiar debates about the relation of psychology to biology. For many critics, his intimate juxtaposition of a mother’s death and serotonergic pathways indicates a dangerous tendency to neurological determinism; many of us suppose that we already know what the answer to Kramer’s question will be. ³ Inevitably, we suspect, the complex psychological trauma of a mother’s death will be brought under the sway of synapses, neurotransmitters, and cortical pathways—a process that Kramer himself names “the remarkable imperialism of the biological.” ⁴

In this paper I would like to show how Kramer’s hypotheses concerning the neuropsychology of depression lead in entirely different directions, both biologically and analytically. Specifically, I am interested in his interpretation of depression as a weakened neurological state. By juxtaposing Kramer’s Listening to Prozac with Freud’s theories of neurasthenia (nervous weakness), I am seeking to amplify the generative neurological ontologies that these authors advocate. If the relation between neurology and psychology is now near-unanimously declared to be a complex one, the nature of these interrelating components has been less carefully examined. Are they two discrete forces that enter into a complex, yet fundamentally straight, relation? Or is their relationality somehow integral to their very nature? Moreover, what relations of influence operate between such co-implicated domains?

Kramer’s and Freud’s elucidations of the neuro/psychological interface suggest that the interaction of neurological and psychological forces is an “originary” and constitutive structuration. It is this that marks their accounts as both distinctive and instructive; for within such a structure, forces of influence and determination are more mutually entangled than the critics of neurological determinism have hitherto acknowledged. Kramer’s and Freud’s accounts of neurology are illuminating for a critical assessment of the biopsychological sciences because they restage the routine critical claims that neurological theories are always politically dangerous or imperialistic, that biology is a discursive ruse, or that the final word on any biopsychological event must always lie in the domain of social or cultural analysis. Importantly, this restaging is accomplished, not through the re-citation of long-familiar antideterminist axioms, but through the iterative repositioning of the neurological hypotheses themselves.

Nervous Weakness

Neurasthenia means “nervous weakness,” and it is a disorder commonly associated with “civilized” culture at the end of the nineteenth century. Speaking clinically, neurasthenia is a debility of the nerves causing fatigue, headaches, indigestion, constipation, listlessness, and impoverishment of sexual...