Listening to Prozac

The patients whose stories Peter Kramer tells in this compulsively readable book are not representative of the whole spectrum of people for whom Prozac is prescribed. Kramer does not consider the use of Prozac to treat major mental illnesses; rather, he focuses on the “fairly healthy people who show dramatic good responses to Prozac, people who are not so much cured of illness as transformed.”

A typical case is that of a woman whom Kramer calls Tess. Overcoming a hard childhood in a public-housing project with an alcoholic father and a clinically depressed mother, she had achieved a highly responsible position in a large corporation. She was suffering from severe depression when a psychologist referred her to Kramer. Treatment with Prozac not only brought her almost immediately out of this prolonged depression but had other effects as well. She was more confident, able to handle conflict more easily, and much more energetic; in retrospect it seemed to her that she had been chronically exhausted for years. Her relations with men changed markedly too, as she broke a pattern of masochistic attachments to married men.

After some time, Tess went off medication, but within a few months she told Kramer that she felt she was “slipping” and needed to go back on Prozac. Framing her request, she said, “I’m not myself.” The new self that had come into being or had been released through Prozac now seemed to her to be her genuine self.

One purpose of Kramer’s book is to provide a context for informed discussion of the ethical and philosophical questions posed by “cosmetic psychopharmacology.” Clinical tales that show Prozac’s transformative power are interwoven with a brief history of the development of antidepressants, revealing the interplay and conflict between psychotherapy and biological approaches to human behavior. The issues raised here will be with us for a long time, soon in more acute form. Kramer’s text is supplemented by sixty-odd pages of meticulous and often absorbing notes, some of them amounting to miniature essays; in an appendix, he summarizes the charges that Prozac has been responsible for cases of suicide and murderous violence, finding that the accusations—promoted irresponsibly by the media—are largely unfounded.