Listening to Prozac: The Landmark Book About Antidepressants and the Remaking of the Self, Revised Edition

447 Pages·1997·21.539 MB·English

by  Peter D. Kramer

Praise for Listening to Prozac
"Intelligent and informative." -The New York Times
"One of the most important and provocative books on psychology
I've seen in years ... asks us co question all our assumptions about
what che self is, what therapy has been and can be, and about che
role of drugs in affecting behavior and personality."
-Owen Lipscein, Psychology Today
"Dr. Kramer seems co be writing about che therapeutic credos of our
time. The resulc is entertaining, provocative, irritating, and often
originally insightful." -The New York Times Book Review
"Kramer is a wonderful writer, and his readers will learn much
about che new research on temperament and personality, biological
theories of mood disorders, and che behind-the-scenes stories of how
psychiatric drugs were discovered or invented."
-Los Angeles Times Book Review
"[Kramer] has caken on in a lucid and informed manner, issues that
many clinicians and academics have been unwilling co cackle . . ..
His book will be truly heuristic ... it will generate agreement or
disagreement but, most importancly, it will generate thought and
discussion. This is what one hopes for, but coo rarely gets, in the
public discussion of science and medicine."
-The Washington Post
"Peter Kramer deals brilliantly wich che complex issue of personal
ity and questions whether a commonly used antidepressant can alter
the very essence of a person's character."
-Abraham Verghese, Nat11re
"Kramer presents a lucid and convincing demonstration chat Amer
ican psychiatry is not brain dead . . .. le demonstrates that concep
tual brilliance and innovative chinking are alive and well in our field
today." -American }011rnal of Psychiatry
"Kramer fruitfully examines many questions that are relevant co
everyone in this post-Freudian age of medication."
-San Francisco Chronicle
"Debunks the hysteria about {Prozac], fanned by pop Journalism
and talk shows, and gives us instead a multifaceted exploration of
what the drug can do, cannot, and perhaps should not do."
-The Houston Post
"A wise and unflinching examination of the ramifications for soci­
ety-and for the individual-when the capsule replaces the couch."
-Kirkus Reviews
"Tackles the complicated implications and assumptions of modern
psychiatry." -New York Daily News
"It is enlightening, enjoyable, and provocative."
-Robin Cook
"Extremely well-written, easy co read, serious, erudite and highly
stimulating ... an important and essential addition to psychiatric
literature. We are fortunate to have Peter Kramer, a teacher and
writer par excellence." -The Philadelphia Inquirer
PENGUINB OOKS
LISTENITNOG P ROZA C
PetDe.Kr r amreerc ehiivMse. dDfr .o mH arvaAr cdl.i nical
profeosfps soyrc haitBa rtorwUynn ivehrsehi aatsp y r,i vate
pracitnPi rcoev i,dR ehnocdIees laTnhdae.u thoofMr o me nts
ofE ngageImnetnitPm:sa ytceh oitnha e Trceahpnyo lAoggei cal
(PengauniSdnh )o,uY loLdue avheiw?sr, i thianvgaesp pe ared
inT he YoNrekTw i mTehsWe,a shiPnogsattnoo,dnt her national
publicHaeta ilolsneosc .ti unrteesr naotnti oopnriaecllsla yt ed
top sychainatdth rmeyo desrenno sfse e lf.
ISTENING TO
ROZAC
PETER D. KRAMER
PENGUIN BOOKS
PE,.;G[;IN BOOKS
Published by the Penguin Group
Pengmn Putnam Inc., 375 Hudson Street,
New York, New York 10014, U.S.A.
Penguin Books Led, 27 \X'righrs Lane, London W8 5TZ, England
Penguin Books Australia Led, Ringwood, Victoria, Australia
Penguin Books Canada Ltd, 10 Alcorn Avenue.
Toronto, Ontario, Canada M4V 3B2
Penguin Books (N.Z.) Ltd, 182-190 Wairau Road,
Auckland 10, New Zealand
Penguin Books Ltd, Registered Offices:
Harmondsworch, Middlesex, England
First published in the United Stares of America by Viking Penguin,
a division of Penguin Books USA Inc. 1993
Published in Penguin Books 1994
This edition with a new afterword by Peter D. Kramer
published in Penguin Books I 997
3 7 9 10 8 6 4 2
Copyrighc © Peter D. Kramer, 1993, 1997
All righcs reserved
Pt:BLISHER's ,.;on:
The ideas, procedures, and suggestions contained in chis book are not intended as
a subscicuce for medical rreatment by a physician. The reader should regularly
consult a physician in maccers relating co health.
Graceful acknowledgment is made for permission co reprint excerpts
from the following copyrighted works:
"Anxiety Reconcepcualized" by Donald F. Klein, M.D., appearing in Anxiety: Neu· Research and
Changing ConceptJ, edited by Donald F. Klein and Judith G. Rabkin, Raven Press, 198 l.
By permission of the publisher and the author.
"Self-Porcrait in TyvekHf Windbreaker" by James Merrill. Reprinted by permission;
© 1992 James Merrill. Originally in The 1,eu· Yorker. All rights reserved.
"On the So-Called Good Hysceric," reprinted from The Capacity/or Emotional Grou·th by
Elizabeth R. Zetzel. By permission of International U niversicies Press, © 1970.
THE LIBRARY OF COtsGRESS HAS CATALOGI.:ED THE HARDCOVER EDITION AS FOLLOWS:
Kramer, Peter D.
Listening ro Prozac: a psychiarrisc explores antidepressant drugs and
the remaking of the seIOPecer Kramer.
p. cm.
Includes index.
ISBN 0-670-84183-8 (he.)
ISBN O 14 02.6671 2 (pbk.)
I. Fluoxetine-1.foral and ethical aspects. 2. Fluoxetine-Social aspects.
3. Fluoxerine-Psychotropic effects. 4. Personality change. I. Tide.
RC483.5.F55K7 1993
6!6.85'27061-dc20 92-50733
Printed in che United Scares of America
Set in Garamond No. 3
Designed by Brian Mulligan
Except in the United Stares of America, this book is sold subject to the condition
char ic shall nor, by way of trade or otherwise, be lenc, re-sold, hired out, or otherwise
circulated wichouc che publisher's prior consent in any form of binding or cover
ocher than char in which ic is published and without a similar condition
including chis condition being imposed on che subsequent purchaser.
for Eric and Lore
CONTENTS
Introduction ix
Makeover I
2 Compulsion 22
3 Antidepressants 47
4 Sensitivity 67
5 Stress 108
6 Risk 144
7 Formes Frustes: Low Self-Esteem 197
s
Formes Frustes: Inhibition of Pleasure,
Sluggishness of Thought 223
9 The Message in the Capsule 250
Appendix: Violence 301
Afterword to the 1997 edition JI5
Notes 333
Acknowledgments 397
Index 400
VII

Introduction
Toward the end of I 988, less than a year after the antidepressant
drug Prozac was introduced, I had occasion co treat an architect who
was suffering from a prolonged bout of melancholy. Sam was a charm
ing, quirky fellow, inclined co sarcasm, who prided himself on his
independent style in sexual matters. He was of Austrian descent,
cultivated a continental, nonconformist manner, and would not have
been ashamed co be called a roue. A central conflict in his marriage
was his interest in pornographic videos. He insisted his wife watch
hard-core sex films with him despite her distaste, which he attributed
to inhibition and narrow-mindedness.
As he neared forty, Sam fell inco a brooding depression set off
by a reversal in his business and the death of his parents. He consulted
me, and we began to talk. Though he had fought with his parents,
Sam had dreamed of reconciliation, of making their farm his crowning
design project. But time overcook these plans. First his father, then
his mother died, and the farm was sold. As we talked, Sam began
to believe he understood his depression in terms of the events that
preceded it, bur his feelings of paralysis and deep sadness persisted.
I prescribed an antidepressant; Sam responded only partially, able to
function at work bur left with a constant feeling of vulnerability.
IX