Prozac Nation (43 page)

 

And yet, I can't escape the icky feeling I get every time I'm sitting in a full car and everyone but the driver is on Prozac. I can't get away from some sense that after years of trying to get people to take depression seriously—of saying, I have a
disease,
I
need
help—now it has gone beyond the point of recognition as a real problem to become something that appears totally trivial. One of the creepiest moments for me was discovering that six million Americans had taken Prozac. As a Jew, I had always associated that precise number with something else entirely. How would I come to reinterpret
six million,
to associate it with something quite different, a statistic that ought to be frightening but instead starts to seem rather ridiculous?

Every so often, I find myself with the urge to make sure people know that I am not just on Prozac but on lithium too, that I am a real sicko, a depressive of a much higher order than all these happy-pill poppers with their low-level sorrow. Or else I feel compelled to remind people that I've been on Prozac since the F.D.A. first approved it, that I've been taking it longer than anyone else on earth, save for a few laboratory rats in cages, trapped but happy. I don't know if I ought to be more dismayed by my need for Prozac one-upmanship, or by the fact that it isn't entirely unwarranted. After all, the media phenomenon of Prozac is such that it's turning a serious problem into a joke at a point when that really should not be happening: By most accounts, two-thirds of the people with severe depression are not being treated for it. And they are the ones who are likely to get lost in the rhetoric.

As Prozac becomes viewed as a silly drug for crybabies, an instrument of what Dr. Kramer calls “cosmetic pharmacology,” the people whom it might really help—the ones who
need
it—will start to think that Prozac won't help them. In the rape-crisis debate that currently rages, many feminists argue that too loose a definition of rape results in not taking “real” rape seriously, while others claim that anyone who feels violated
was
violated—and what tends to get lost in all the screaming and yelling is that there are all these real people who are raped and are in terrible pain. It seems entirely possible to me now, given the tone of so many of the articles about Prozac, that people will forget how severe, crippling, and awful depression really is.

And I'm not the only one who's concerned. Eli Lilly and Company, the manufacturer that has profited bountifully from the excesses of Prozac, recently launched an advertising campaign in medical trade journals that begins with the headline “Trivializing a Serious Illness.” The ad first appeared in
Psychiatric News,
with copy that derides Prozac's “unprecedented media attention in recent weeks,” and declares that “much of this attention has trivialized the very serious nature of the disease Prozac was specifically developed to treat—clinical depression.” In an article in the
Wall Street Journal,
Steven Paul, M.D., the head of central nervous system research at Eli Lilly, explains that the point of this ad is simply to help Prozac reach those who need it most. “Anything that confuses the appropriate use of Prozac or any of the antidepressants in the mind of the public might scare people away from using the medication, or perhaps even scare physicians from prescribing it,” Dr. Paul is quoted as saying. He adds that all the debate about whether Prozac can be used for subtle personality changes has “bogged down” efforts to get the drug out to the truly, deeply depressed.

While many of the people commenting in the
Journal
article suggested that the advertisement was the result of Eli Lilly's fear of liability suits as Prozac is overprescribed, or even because the corporation is concerned that the drug will be excluded from a national health care plan because it is seen as too frivolous, I'd like to believe that its aim might be honest. At two or three dollars a pill, at the rate of two pills a day, over a span of six years, I feel that I have already mortgaged my life to Eli Lilly. For the $11,000 worth of business I've given the company, I wouldn't mind believing that they're doing a little bit of public service.

 

The secret I sometimes think that only I know is that Prozac really isn't that great. Of course, I can say this and still believe that Prozac was the miracle that saved my life and jump-started me out of a full-time state of depression—which would probably seem to most people reason enough to think of the drug as manna from heaven. But after six years on Prozac, I know that it is not the end but the beginning. Mental health is so much more complicated than any pill that any mortal could invent. A drug, whether it's Prozac, Thorazine, an old-fashioned remedy like laudanum, or a street narcotic like heroin, can work only as well as the brain allows it to. And after a while, a strong, hardy, deep-seated depression will outsmart any chemical. While Prozac kept me pretty well leveled for the first several months I was on it, shortly thereafter I had a fight with my boyfriend in Dallas over Christmas. I took an overdose of Desyrel, an antidepressant I'd been given to supplement the Prozac, and ended up back in the emergency-room milieu that had once been so familiar to me. I hadn't poisoned myself terribly seriously (I'd taken about ten pills), and the hospital released me into the care of my boyfriend's parents. When I got back to Cambridge, Dr. Sterling put me on lithium, both to augment the effects of Prozac and to even out some extreme mood swings. Regardless of my diagnosis of atypical depression, she was starting to think I was maybe cyclothymic or manic-depressive after all, going from gleeful revelry one day to suicidal gestures the next.

I stopped taking Desyrel once I started on lithium, but all my attempts to lower my Prozac dose have resulted in an onset of the same old symptoms. I have occasionally tried to go off of lithium altogether, because it is a draining, tiring drug to take, but those attempts to cut it out inevitably lead to scenes like the one that found me spilled across my bathroom and wrecked out in tears and black chiffon after we'd had that huge party at our house. At times, even on both lithium and Prozac, I have had severe depressive episodes, ones that kept my friends in a petrified all-night vigil while I refused to get up off the kitchen floor, refused to stop crying, refused to relinquish the grapefruit knife I gripped in my hand and pointed at my wrist. After these difficult scenes, when I finally come to enough to seek medical help, the psychopharmacologist invariably will decide to put me on some additional drug like desipramine, or he will suggest I try taking Desyrel once again, or he will even ask if occasional use of Mellaril might not be what I really need.

Just as many germs have outsmarted antibiotics such that diseases like tuberculosis, once thought to be under control, have reemerged in newer, more virulent mutant strains, so depression manages to reconfigure itself so that it is more than just a matter of too little serotonin. As Susanna Kaysen points out in
Girl, Interrupted,
her memoir of a stay at McLean Hospital, “It's a long way from not having enough serotonin to thinking that the world is ‘stale, flat and unprofitable'; even further to writing a play about a man driven by that thought. That leaves a lot of mind room. Something is interpreting the clatter of neurological activity.” Of course, those interpretations may well be the result of still more neurological activity, but it might be the kind that is not amenable to outside scientific intervention. I believe, perhaps superstitiously, although my experience completely confirms it, that brain cells will always outsmart medical molecules. If you are chronically down, it is a lifelong fight to keep from sinking.

In the case of my own depression, I have gone from a thorough certainty that its origins are in bad biology 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 chemicals started to agree. 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. And the anecdotal evidence leads only to a lot of chicken-and-egg types of questions: After all, depression does run in my family, but that might just be because we're all subject to being raised by other depressives. Where my depression is concerned, the fact that Prozac in combination with other drugs has been, for the most part, a successful antidote, leads me to believe that regardless of how I got started on my path of misery, by the time I got treatment the problem was certainly chemical. 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 that 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. Had I been treated by a competent therapist at the onset of my depression, perhaps its mere kindling would not have turned into a nightmarish psychic bonfire, and I might not have arrived at the point, a decade later, where I needed medication just to be able to get out of bed in the morning.

As it stands, for a few years after I first began taking medication, after leaving Cambridge and coming back to New York, I stayed away from psychotherapy. I saw a psychopharmacologist who was basically a drug pusher with a medical degree, I filled my prescriptions, and believed that that was enough. After Dr. Sterling, I could not imagine ever being able to find a therapist who was good enough. And besides, it seemed that with occasional lapses, drugs really were the answer. 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 spent much of my pre-Prozac life running from, I realized I needed therapy. Years and years of bad habits, of being attracted to the wrong kinds of men, of responding to every bad mood with impulsive behavior (cheating on my boyfriend or being lax about my work assignments), had turned me into a person who had no idea how to function within the boundaries of the normal, nondepressive world. I needed a good therapist to help me learn to be a grown-up, to show me how to live in a world where the phone company doesn't care that you're too depressed to pay the phone bill, that it turns off your line with complete indifference to such nuances. I needed a psychologist to teach me how to live in a world where, no matter how many people seem to be on Prozac, the vast majority are not, and they've got problems and concerns and interests that are often going to be at odds with my own.

It has taken me so long to learn to live a life where depression is not a constant resort, is not the state I huddle into as surely as a drunk returns to his gin, a junkie goes back to her needle—but I'm starting to get to that place. At age twenty-six, I feel like I am finally going through adolescence.

 

On April 8, 1994, as I was completing this book, Kurt Cobain shot himself in the head and was found dead in his Seattle home. His suicide was quickly reduced by much of the media into an example of a more general generational malaise gone completely amok, and references were made to “the bullet that shot through a generation.” Grunge, the musical style that Nirvana did so much to invent and popularize, was described in
Newsweek
as “what happens when children of divorce get their hands on guitars.” Cobain's suicide, despite the extremely private nature of his decision or compulsion to hide himself alone in a room and blow his brains out, quickly came to be seen as greatly symbolic.

There is a part of me that understands why. In the last several years, as so many people have started to fall into some version of a dysthymic category, it has become clear that depression is no longer just a private, psychological matter. It is, in fact, a social problem, and an entire culture of depression has developed around it. One of my favorite examples of this brand of artistic endeavor was the underground movie hit
Slacker.
Made for just $23,000, director Richard Linklater's debut film showed young people in Austin, Texas, all of them in school or just out, who preferred to idle away their hours debating the differences between Smurf culture and Scooby-Doo culture, living cheaply on the wages of menial jobs that didn't require a college degree and allowed them plenty of time to lie in bed, watch TV, and slack around. One character, in a moment of truth, admits he doesn't have a job, saying, “I may live badly, but at least I don't have to work to do it.” Another film about desperation,
sex, lies and videotape,
won the Palm d'Or at the Cannes Film Festival, and revolved around the strained, alienated relationships of four people in Baton Rouge, Louisiana, centering on a young man so disillusioned with love that he'd replaced actual sex with videotapes of women describing their sexual experiences and fantasies. This character wears only black (at one point, his lawyer buddy tells him he looks like “an undertaker for the art world”), and his lack of affect became a symbol for many young people of a hopelessness and battle fatigue that could make someone stop even trying to make human connections.

But of course, a peak moment in depression culture arrived with the tremendous success of Nirvana, whose hit single “Smells Like Teen Spirit” was a call to apathy. This song was so delighted with its passivity that its central demand was, “Here we are now, entertain us.” In fact, the band's whole album,
Nevermind,
seemed to be a long list of the many things that they
didn't
care about. Of course, rock and roll has had a long and proud history of songs devoted to the downward spiral of life, but Nirvana would seem to mark the first time this kind of punk music delivered both a number-one album and a number-one single. (To put this in perspective, it took the Sex Pistols'
Nevermind the Bollocks
album
fifteen
years to sell a million copies.) Even though
Nevermind
was extremely poppy and melodious in some ways, it was sufficiently abrasive, cynical and angry that it was never expected to sell very well outside of the alternative-lifestyle circles that had made
Generation X
and
Slacker
into cult hits. When the album did take off, Geffen, the record company behind Nirvana, was caught so far off guard that it didn't have the stock to fill store orders fast enough to meet the demand.