Monday, January 19, 2015

Book Review: Prozac Nation

A Fair Trade Book

Title: Prozac Nation
Author:  Elizabeth Wurtzel
Date: 1994, 1995
Publisher: Riverhead / Penguin
ISBN: 1-57322-512-6
Length: 368 pages
Quote: “Could family dynamics possibly account for all this trouble? Was my brain chemistry part of the prob­lem too?”
Elizabeth Wurtzel defines herself as depressed. In an afterword in the paperback edition, she says, “I hated...being in­troduced or described as ‘the author of the controversial book,’ because Prozac Nation is, as far as I’m concerned, a memoir with no particular thesis or point.”
Some readers might have replied, “Baloney,” because Wurtzel’s previous potboiler appeared under the title Bi*ch, and Prozac Nation is full of words that would snag “family filter” software too, and if you don’t want a book to be described as “controversial” the first thing you do is remove all the family-filter-activating words. Randomly open Prozac Nation five times: page 28, “Hell” appears without a capital letter or any mention of Michigan; page 83, “dope,” twice, as an insult to an individual without a chemical reference; page 140, one unchristian reference to Jesus and four F-words; page 239, one blasphemous reference to God and another F-word; page 335, another “Hell” that’s not the town in Michigan. There may be two consecutive pages in this book that wouldn’t activate the family filter, but I couldn’t guess where...and she’s not trying to be controversial?
“Controversial” gets attention, and although it’s classier for those Internet writers who are literally paid per view to find fresher controversies, to write about the choice not to get a flu shot or the merit of some old obscure book the library discarded after it had been untouched for thirty years, the facts in Prozac Nation are in fact controversial. We have no choice but to believe that what Wurtzel’s telling us—she felt miserable, annoyed the daylights out of people, hounded her boyfriend until he dumped her and then refused to get over him, and at the time of writing, although it’s not been long enough for her to explain how, Prozac seems to be helping her feel better—but there’s plenty of room for debate about what she’s left out.
Wurtzel offers that perhaps the controversial part is the question of whether someone in her early twenties is entitled to publish a memoir. Bah. At any age when a person is able to write a medical memoir, that history can be useful, at least to medical science.
I think the controversial part is the way Wurtzel’s depressive memories read like things the rest of us can relate to. There’s a line between her mood swings and the rest of ours; it’s not easy to say where that line is.
For myself, I’ll say that whenever I have dreaded morning and really felt too lousy to get out of bed, an identifiable disease process has always been involved...and yet, while I was an undiagnosed celiac, eating whole wheat because if my colon was spastic with all this healthy wheat in it I didn’t want to imagine how I’d feel without it, it was also possible for fair-minded observers to observe that I had an awful lot of identifiable disease processes going on, and most of them weren't serious enough to justify missing school or work. Maybe (according to late twentieth century thinking) my brain was unconsciously telling my immune system to let all these infections immobilize me, because I enjoyed solitude, which was probably evidence of a fundamentally depressive personality, because according to late twentieth century thinking an introvert was simply a depressed extrovert. My real-world observation was that the only time I felt emotional pain, all by itself without reference to bowel function, was during the months when I was passing for an extrovert, but late twentieth century thinking was closed to this idea until about 1990.

In 1985 I decided to add a B.S. in psychology to a B.A. in English, because I was already helping people through all kinds of emotional crises. I knew that the mood swings of real mental patients were more complicated than those of college students, but I figured they probably had physical causes too, and who knew what a naturopathic approach might not do...this was the year when even schizophrenia seemed to be responding to vitamins.

I never got the B.S. in psychology, or even the B.A. in English. Psychological counselling went out of style. I found other day jobs. I went on reading psychology, though. I know why my emotions don’t reach mood-disorder proportions; I have some guesses why Wurtzel’s did, and “fluoxetine deficiency” is not a prime suspect. I have a guess that, if I’d been living in Wurtzel’s body and lifestyle, I would have been depressed in some way similar to her way. I have a guess that, if Wurtzel were to adopt my drug-free lifestyle now, after all those drugs, she’d feel much, much worse...but I still have to raise some questions about all the things Wurtzel apparently never tried while she was trying alcohol, XTC, cocaine, lithium, Mellaril, Prozac, and other dangerous chemical sources of temporary relief:
1. Exercise. Wurtzel lives mostly in New York , travels only to other grossly overcrowded cities in the course of Prozac Nation, doesn’t mention any outdoor activity. She does mention how much she liked sex. Could this have been partly  because sex was the only aerobic activity she was giving herself?
2. Quality time alone each day.(Not to be confused with naps.)
3. Sleep...when it's dark outside.
4. Food and/or chemical sensitivities. 
5. Sugar and simple carbohydrates. (I would urge any young person who identifies with Wurtzel to read Kathleen Desmaisons’ Potatoes Not Prozac.)
6. Mold and dampness. Humans rarely get aspergillosis, but often develop candidiasis.
7. Hormone imbalances are part of a physical condition that may get worse, and cause worse problems than depression. See It's My Ovaries.

8. Toxic beliefs from your cultural heritage. Like the one about women not being meant to be achievers (duh). Or the various forms of “If you’re happy, people will resent you, or the gods will punish you; never show real pleasure in anything or anyone.” Or the one about “Mind-blowing sex proves that it’s True Love, so I can’t be happy without him/her no matter how poisonous the relationship is.” “Or the one about “Happiness is a duty, not a pleasure; feeling sad, angry, or even just tired has to be either a sin or a sickness.” Or the one about “Showing the way I really feel, even by the expression on my face, harms other people.” All of these are still common among several demographic groups in North America. Wurtzel mentions some specifically Jewish ideas of a kind that send some evangelical Protestants into rants on the theme of “If only you would convert to my religion...” I’m not going there, because my religion, as practiced by the body of believers, has been hijacked by its own toxic beliefs. We all have to come to terms with our own religious identities, ethnic identities, maybe even our demographic-generation identities, by finding ways to affirm what we have in common with others while discarding the toxic beliefs some of those others may have adopted.
9. Any drugs. Wurtzel documents that each legal or illegal drug provided only partial or temporary relief and left her more depressed after a year had passed. Potatoes Not Prozac provides a precise, concise chemical explanation of why many Prozac users get only partial relief from this drug, and how they need to phase out Prozac and replace it with a cheaper, safer, naturopathic approach.
In 1995, Wurtzel wrote that “a backlash of reports, mostly promulgated by the Church of Scientology , linked Prozac with incidents of suicide and murder." Peter Breggin was not working for the Church of Scientology. Neither was Joseph Glenmullen at Harvard Medical College. Large amounts of money have been spent to suppress these reports from the mass media; newspaper reports that someone who suddenly attacked strangers “had been seeing a psychiatrist for depression” were common in the early 1990s, but now this useful piece of information is likely to be censored even when known. Awareness that serotonin boosters like Prozac can produce horrific pseudomemories has, however, helped people like Lauren Slater, who’s written a book about living with her pseudomemories and even programming herself to generate pleasant ones. My opinion is that serotonin boosters should be used only in a hospital setting, and the first week of withdrawal from these semi-psychedelic drugs should also be monitored in a hospital setting...but those who do use Prozac should at least be prepared to enjoy any unexpected “trips” they find themselves taking.
10. Respect your temperament. Depressed extroverts may act like introverts; depressed introverts may act like extroverts. Neither introversion nor extroversion is the same thing as depression. Wurtzel doesn’t actually present evidence of a strong genetic predisposition to either temperament; writing as self-expression is typical of HSP introverts; writing commercially successful nonfiction is typical of people with good verbal skills and bills to pay, regardless of temperament. During the twentieth century the United States became a grossly unbalanced nation, valuing salesmanship over creativity, productivity, or character, and perceiving any of the hereditary introverted traits as weaknesses. In other times and places extroverts were at least equally as likely as introverts to get toxic messages like, “All that whirring about and useless chatter, no commitment to anything serious, no inner resources...something must be wrong with that child!”  We are who we are. I personally feel that extroverts are obnoxious, but respecting what you are is the first step toward developing the respect for others as they are that extroverts so annoyingly lack.
11. Beware of too much attention to emotions. Bogging down in any thought process that begins with “How do I feel about myself today?” is likely to lead to discouraging navel-gazing, rather than purposeful activity.

12. Not taking mood swings too seriously. If mood swings seem to go beyond what’s appropriate in the situation, bearing in mind that it’s normal to cry at funerals and hit back if you’ve been hit and so on, that’s something to take seriously. Heed the feeling; listen to what your body is trying to tell you. All people who chronically feel sick and tired are sick, but usually the sickness is something as easy to cure as lack of rest or up-and-down blood sugar.

So my conclusion, after reading Prozac Nation, is still opposite to Wurtzel's. I still think any drug that causes even one out of a hundred users to become violently insane and start killing strangers, without warning, should be hard to get. It is helpful to know that her suicidal depressions had started by “the year I turned twelve,” when she overdosed on allergy pills while “trying to be not me for a little bit.” She insists over and over that her parents’ divorce and her mother’s hyperthyroid personality weren’t the primary cause of her depression, that even the break-up with the boyfriend merely aggravated something that had started at or before puberty. If there are people who need to medicate depression, rather than listening to depression and using it to help solve an underlying problem, this is the kind of history they’d have; this is what to look for before we risk hexing anyone by labelling him or her “depressive.” Wurtzel grumbles about having to spend “over a decade in a prolonged state of clinical despair” before being medicated. I believe that, for the good of all people who are and are not depressed, this should be necessary.
I believe that, for most people who are depressed, very likely including Wurtzel, the decade of despair would not be necessary. Along with “Let’s just talk about your parents’ divorce and see what you’ve learned about relationships so far,” bright young things like Wurtzel should also get, “Did you want to die, or did you just want to rest? Could you sleep better if you got more exercise?” (That’s still the first thing they’d get from me.) And, “What did you eat on the day when you felt so bad, and the day before that? Keep a food journal and see whether you can find any patterns.” And, “According to one interesting study, what a large group of young people who seemed to have everything, who were depressed, had in common was that their I.Q. scores were low relative to the standards for the kind of jobs their friends and relatives were doing. One wouldn’t expect a person in that category to get into Harvard, but is it possible that you’d be happier at a community college? Is journalism what you’ve always wanted to do, or would you have just as much fun chatting with the customers as a hairdresser or bus driver?”
And, “Do you take birth control pills? If that were what it took for you to feel better, could you stick to manual and oral sex only until you want a baby? If you really enjoy sex all that much, what do you think you might learn from a month or two of abstinence? Is it possible that, even if you’re consciously opposed to the ideals of abstinence, chastity, or waiting for marriage, you unconsciously respect those ideals more than you’ve been admitting?” (Wurtzel describes her spontaneous abortion on pages 186 to...well, the emotional impact of it goes on and on...there’s an interesting mental swerve around the primary subject matter of the novel Surfacing on page 228.) Since Prozac reduces the sex drive of a majority of patients, there’s even a possibility that the drug’s benefits for Wurtzel include relief from an emotional conflict between the counterproductive ideas of two of the cultural influences on her, though she doesn’t discuss this.
And, “Although we’ve learned by now that raging rarely helps people (even if they are physically strong enough to feel good while yelling at people), we’ve also learned that using anger to make changes, by sharing complaints and building strategies to oppose things that harm us, is a very good thing. Although you don’t have to shout unless you really want to, what are the things you could do without, and what are you doing about them?”
I’m glad Prozac helped Wurtzel, but I recommend reading the 1995 edition, which admits that Prozac didn’t actually cure her (she was hospitalized for a suicide attempt in between editions). The conclusion of Prozac Nation is that even effective antidepressant medication is a good analogy to a Band-Aid for a broken bone. If a small splinter of bone has made a Band-Aid-sized wound in the skin, then a Band-Aid can be said to help the patient with the broken bone...about as much as Prozac was helping Wurtzel.

Whew. Apart from that, what can be said about Prozac Nation as a book? Wurtzel's story is interesting because she's a talented writer; the story is well enough told to keep plenty of people reading all those pages about the depressive-girl experience. If you're a late baby-boomer or part of the next generation, you can relate to it. Prozac Nation is definitely Adult Content all the way, with those formerly unprintable words to qualify even the childhood memories as "adult," but it's the kind of Adult Content that's more likely to evoke sympathy, empathy, or pity than to upset most adults. It should probably be kept out of the reach of children...whether it's too embarrassing to store in a house occupied by teenagers is an individual judgment call. I don't mind letting The Nephews know I read it but some aunts might not want to share that information with their nephews.

If you're looking for a cheerful, inspirational read, or one that offers more solutions to your or your friend's depressive issues than "I've been there and not found a way out," you might want to consider reading one of those books by doctors mentioned in this review. All of them are more cheerful and more likely to work for a lot of people.

If you're interested in a very frank, very plausible, even publicly verifiable, memoir about what it's like to be depressive enough to need Prozac and what it's like when Prozac lets you down, Prozac Nation is for you, and you may buy it here as a Fair Trade Book. If you send $5 for the book + $5 for shipping, not only can you consolidate shipping charges for as many other things as can be shipped in the same package, but I'll even send you a copy in better condition than the one I'm offering cheaper to those who shop locally. And, out of this $10, Wurtzel or a charity of her choice receives $1.