Book Review

Prozac Nation
Young and Depressed in America:
A Memoir

by Elizabeth Wurtzel

(Riverhead Books, New York, 1995)

reviewed by Douglas A. Smith

I read this book because a psychologist told me it would convince me psychiatric drugs such as Prozac help people. After reading every word of all 368 pages of this book, I can tell you it did not.  Furthermore, the author, Elizabeth Wurtzel, did not intend for her book to convince people of anything.  In a 1995 Afterword published after the original 1994 edition of the book, she says "Prozac Nation is, as far as I'm concerned, a memoir with no particular thesis or point, nothing in it championing any cause ...  telling only a small personal tale of one girl's mental hell" (p. 355).
        The author's detailed description of the circumstances that caused her dispair makes clear the causes were entirely events in her life, not biological abnormality such as the mythical, elusive "chemical imbalance" on which many people foolishly blame their so-called depression.  Primary among the causes of her deeply sorrowful feelings were being in the crossfire of her battling, divorced parents, and loss of her relationship with her father after custody was granted to her mother.  Her relationship with her mother as she grew up wasn't good either.  For example, she says that although she absolutely hated summer camp, "my mother sent me here [to summer camp] for an eight-week reprieve from single motherhood" (p. 14).
        Her self-esteem was probably harmed by her father telling her, when she was about ten years old, that once her mother became pregnant with her, she "wanted to have an abortion, that she'd gotten as fas as the gynecologist's office and was all set to have a D and C, and that he physically restrained her to prevent the process.  Later, when I told my mother about that conversation, she began to cry and said that the opposite was true" (p. 28).  Each parent claiming the other didn't want her was shortly before the onset of her so-called depression.
        She summarized her upbringing as follows: "My parents are divorced, I grew up in a female-headed househould, my mother was always unemployed or marginally employed, my father was always uninvolved or marginally involved in my life.  There was never enough money for anything, my mom had to sue my dad for unpaid child support and unpaid medical bills, my dad eventually disappeared" (p. 33).
        Other causes were disappointments in life that make anyone extremely sad, such being rejected by a boyfriend she loved after a long relationship with him.  Her description of her life is a classic and undeniable example of despondency or "depression" being caused by what she experienced in life rather than by some as-yet-undiscovered biological cause of depression (or some known cause, of which there are none).
        What's more, she says "To ask anyone how he happened to fall into a state of despair always involves new variations on the same myriad mix of family history.  There is always divorce, death, drunkenness, drug abuse and whatnot in any of several permutations" (p. 34).  Of course, to family members of those mired in a state of dispair or so-called depression or other so-called mental illness, such as members of the misnamed National Alliance for the Mentally Ill (NAMI), this is horrible news.  They prefer to believe so-called mental illness including depression is caused by a "chemical imbalance" or other physical illness that, as they often say, "is no one's fault."
        Another cause of her despondency or so-called depression is what I sometimes call the curse of high expectations: She says "I somehow managed to win the school Brochos Bee, the Jewish equivalent of a spelling bee, five years in a row.  ...  as a child I was completely convinced that I could do anything on earth I wanted to" (pp. 39-40).  Much of her story is about the time she was a student at Harvard University, one of the most selective and perhaps the most prestigious insititution of higher learning in the USA if not the world.  High expectations make anyone more likely to feel disappointed or sad, even very sad, for the reason shown in the following "equasion":

happiness   =         success      

Looking at this "equasion" you can see that if your expectations are low, say a value of 1, then with success equalling a value of 10 your happiness equals a value of 10.  But if your expectations are high, say a value of 100, with the same success your happiness equals a value of only 0.1.
        She does present the following theory - repeat, theory - of how her despondency could be biological and be helped by a so-called antidepressant drug: "In the case of my own depression, I have gone from a thorough certainty that its origins are in bad biologiy to a more flexible belief that after an accumulation of life events made my head such an ugly thing to be stuck in, my brain's chemistry started to agree.  ...  What many people don't realize is that the cause-and-effect relationship in mental disorders is a two-way shuttle: It's not just an a priori imbalance can make you depressed.  It's that years and years of exogenous depression (a malaise caused by external events) can actually fuck up your internal chemistry so much that you need a drug to get it working properly again" (p. 345-346).  She of course offers no scientific evidence to sustain this belief, and she acknowledges, as honest advocates of the concept of biologically caused (or biologically sustained) depression must, that "There's no way to know any of this for sure right now.  There isn't some blood test, akin to those for mononucleosis or HIV, that you can take to find a mental imbalance" (p. 345).
        She also acknowledges that when her life went well, her despondency or so-called depression lifted without any help from psychiatric drugs or other supposed psychiatric therapy: "Every so often there's a reprieve, like when Nathan and I first fell in love, or when I first started writing for The New Yorker" (p. 10).  Speaking of her first sexual expereince when she was only 12 years old she says, "I do nothing at all but sit there and take in the sensation because it feels good, it is the only thing that has felt nice to me at all in so many months, maybe even years.  I have never had a feeling quite like this before ...  And I can't imagine what I've done to deserve anything so nice.  And I feel blessed.  I feel that if God has given me this capacity for pleasure, then there must be hope.  ...  This physical contact brings me such happiness that I want to tell everybody I know about it ...  as if only I am privy to it" (p. 59).  She also says "When I was in the worst way with my depression, I found solace in music, in Bruce Springsteen, in Joni Mitchell, in Bob Dyan, and in so many other fleeting bits of rock 'n' roll, from Pink Floyd to Flipper to the Joy of Cooking to Janis Joplin" (p. 359).
        From the title of the book one might assume she ends her story saying her despondency or so-called depression was miraculously cured by Prozac.  However, that really isn't what her story reveals.  Although she does claim that "Prozac was the miracle that saved my life and jump-started me out of a full-time state of depression" (p. 343) and that "Proazc [is] a pill that doesn't make you happy but does make you feel not sad" (p. 340), she simultaneously admits that the drug didn't really work for her.  Like a true believer, convinced by psychiatry's propaganda and the drug companies' advertisements claiming benefit for those who take psychiatric drugs, she says "I filled my prescritions, and believed that was enough.  ...  it seemed, that with occasional lapses, drugs really were the answer" (p. 346). 
        She found out otherwise: She says that because she was no longer taking Mellaril, "I felt like hell in the beginning of my Prozac days" (p. 301).  She says, "Yes, I think, any minute now ...  the insight will come.  Clarity.  The truth will set me free, and all that.  Of course, it never happens.  Years of therapy, and it never happens.  Psychotrotropic drugs, and it never happens" (p. 313).  Her only ever suicide attempt was shortly after she started taking Prozac.  She says, "The secret I sometimes think that only I know is that Prozac really isn't that great" (p. 343).  She says that she's been taking Prozac "since the F.D.A. first approved it" (p. 342) and "I am not just on Prozac but lithium too" (ibid).  She says "lithium ... is a draining, tiring drug to take" and that "At times, even on both lithium and Prozac, I have had severe depressive episodes, ones that kept my freinds in a petrified all-night vigil while I refused to get up off the kitchen floor, refused to stop crying, refused to relinguish the grapefruit knife I gripped in my hand and pointed at my wrist" (p. 345).  She also says: "But then, as I found myself ruining relationships, alienating employers and other people I worked with, and falling all too frequently into depressive blackouts that would go on for days and would feel as desolate and unyielding as the black wave scares I'd spend much of my pre-Prozac life running from, I realized I needed therapy" (p. 346).  In other words, Prozac - and lithium - weren't the answer after all.
        In summary: When Elizabeth Wurtzel's life went well, she was happy.  As Sigmund Freud said, two of the most important aspects of anyone's life are love and work.  When Elizabeth Wurtzel did well in these areas of her life, she was happy - and with no help from psychiatry.  When her life went poorly, she was despondent or "depressed," whether or not she was taking Prozac and lithium or other psychiatric drugs or undergoing other psychiatric "therapy."  Whether she realizes it or not, her 368 page memoir illustrates that her salvation, both before and after Prozac, came from living a life she enjoyed, not from any of psychiatry's so-called therapies.

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