Today millions of people take Prozac, but Lauren Slater was one of the first. In this rich and beautifully written memoir, she describes what it's like to spend most of your life feeling crazy--and then to wake up one day and find yourself in the strange state of feeling well. And then to face the challenge of creating a whole new life. Once inhibited, Slater becomes spontaneous. Once terrified of maintaining a job, she accepts a teaching position and ultimately earns several degrees in psychology. Once lonely, she finds love with a man who adores her. Slater is wonderfully thoughtful and articulate about all of these changes, and also about the downside of taking Prozac: such matters as dependency, sexual dysfunction, and Prozac "poop-out."
"The beauty of Lauren Slater's prose is shocking," said Newsday about Welcome to My Country, and Slater's remarkable gifts as a writer are present here in sentences that are like elegant darts, hitting at the center of the deepest human feelings. Prozac Diary is a wonderfully written report from inside a decade on Prozac, and an original writer's acute observations on the challenges of living modern life.
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WHERE HE WAITS
To get there, you turn left off the highway and drive down the road bordered on one side by pasture. And then, a radio song or so later, you turn right into the hospital's gated entrance, easing your car up the slope that leads to the turreted place where he waits. Safety screens cover all the windows. The stairs are steep, and exit signs cast carmine shadows on the concrete floors. Four flights you must travel, and then down several serpentine corridors, before you finally come to his office.
I had never been here before. I had never heard the word Prozac before. It was 1988, the drug just released. I was to be one of the first to take Prozac, and, even though I didn't know this then, one of the first to stay on it for the next ten years, experiencing what long-term existence on this new medication is actually like.
The Prozac Doctor is a busy man. He sees thirty, forty, sometimes fifty patients a day. He is handsome in ways you don't expect your medicine man to be. He has shining black hair and beautiful loafers made of leather so fresh you can practically see the hide still ripple with life. He wears one simple gold band on a finger as tapered as a pianist's, topped with a chip of nacreous nail sanded to perfect smoothness. He is host as well as doctor, and that first time, as well as every time thereafter, he invites me in, standing behind his desk and ushering me forward with stately sweeps of his hand, bowing ever so slightly in a room where you half expect caterers carrying platters of shrimp to emerge from the shadows.
"Sit, Ms. Slater," he said to me the morning we met. He gestured to a deep seat, and I sat. There was a silence between us then, a kind of weighted silence, a grand silence, like the sort you hear before a symphony begins.
And that day was the beginning, the bare beginnings of a story very little like the popular Prozac myths-a wonder drug here, a drug that triggers violence there. No. For me the story of Prozac lies not between these poles but entirely outside of them, in a place my doctor was not taught to get to-the difficulty and compromise of cure, the grief and light of illness passing, the fear as the walls of the hospital wash away and you have before you this-this strange planet, pressing in.
But that first day, there was just Prozac pressing in. I looked around me at the office. On the doctor's desk I saw a Lucite clock with the word prozac embossed across the top. I saw a marble mount holding four pens with prozac etched down their flanks. The pads of paper resting on his bookshelf were the precise size and shape of hors d'oeuvre napkins, and all had prozac in fancy script across their borders, like the name of some new country club.
"What is this stuff?" I asked. I heard my voice repeat itself in my ears, as so many sounds seemed to do lately, the screech of brakes, birdsong nipping at my brain.
The doctor leaned back in his seat. "Prozac," he said, "is the chemical compound fluoxetine hydrochloride." He told me it had a three-ring chemical structure similar to that of other medications I'd tried in the past but that its action on the body's serotonin system made it a finer drug. He told me about the brain chemical serotonin and its role in OCD-obsessive-compulsive disorder-the most recent of my many ills, for me the nattering need to touch, count, check, and tap, over and over again. He told me about synapses and clefts, and despite the time he took with me that day, I felt him coming at me across a gulf.
He had all the right gestures. His knowledge was impeccable. He made eye contact with the subject, meaning me. But still, there was something about the way the Prozac Doctor looked at me, and the very technical way he spoke to me, that made me feel he was viewing me generally-swf, long psych history, five hospitalizations for depression and anxiety-related problems, poor medication response in past, now referred as outpatient for sudden emergence of OCD-as opposed to me, viewing me, in my specific skin.
My skin: had little white lines on it from where I used to cut. It had always crisped easily in the summer sun.
My ears: knew the difference between real and imaginary sounds. That said, they sometimes heard voices, which doctors in the hospitals had told me was a sign not of psychosis but of dissociation. There was a blue baby who cried in my ears. There was a girl in a glass case, who talked to me. The world was full of many sounds-rushings, whirrings, soft and thunderous-and this was both a pleasure and a problem.
My hands: had become a problem. Once they had been conduits for pleasure. When I was a child they had held leaves and rabbits. Today, however, they were one of the reasons I was here. They were the part of me that seemed to have the OCD, tense and seeking, tapping things forty, fifty, sixty times. Not people, thank God, but objects, like stove switches, gas dials. Sometimes I looked at my hands and remembered them as they used to be, fine-boned, indigo-veined, lined with the tracery of all they had touched. Not now, though. From my hands I had learned grief. I had learned how the body can leave you, before you have left it.
I wanted to tell the Prozac Doctor about my hands. I wanted to splay them across his desk and say, "Look at them. What are they seeking?" I wanted him to touch my hands, not really an odd desire, the laying on of hands a practice as ancient as the Bible itself. The Prozac Doctor was biblical to me. I invited him to take on that role, the role every sick person needs her healer to play-not only technician, but poet, priest, theologian, and friend. I know this was asking a lot, poor man, but few people are as full of need and desire as the patient.
Instead, he reached down, opened a desk drawer, and pulled out a sample pill packet. He did not need to ask me many questions, as he had my entire chart before him, thick as an urban phone book. The packet was rather unimpressive, plain white, with a perforated top. To my surprise, he lifted it to his lips and tore at it with his teeth, then gently tapped at it until a smooth pill slid from its foiled pouch into the clean cup of his palm.
There it lay, cream and green. Tiny black letters were stamped down its side-dista-which sounded to me like an astronomy term, the name of a planet in another galaxy. On and on my mind went, making from this small capsule many private metaphors-it was candy, no poison; protein, no plastic.
I wanted to say these things to the Prozac Doctor. But he held himself so politely, angled away from contact. And, after all, he was a busy man, pressured by insurance companies to see throngs of patients, all with their own little paint box of multiple metaphors. Where would he have found the time to explore with me the private poem of the medicine that would soon be mine, a poem that had, as its first stanza, some song about failure? Having tried for the past three years to achieve stability on my own, determined to do it, I was here again, sick with this OCD. How could that be? I was incomplete, apparently, without the pill that was, among other things, a plug to stopper some hole in my soul. Perhaps the hole came from a neuronal glitch, the chemical equivalent of a dropped stitch in the knitted yarn of my brain. Or maybe the hole was between my mother and me. Because when I looked at the pill I also saw her, the little capsule of her sports car we would speed in, clean and compact, screeching to a halt in front of the florist's, where she bought armloads of orchids. And then to the butcher's, where she purchased great red wheels of beef. Nothing was ever enough, for there was no plug to stopper the hole in her soul, no pill.
My pill. Sitting, still, in the Prozac Doctor's palm but moving me backward in time, forward into hope. Much has been said about the meanings we make of illness, but what about the meanings we make out of cure? Cure is complex, disorienting, a revisioning of the self, either subtle or stark. Cure is the new, strange planet, pressing in. The doctor could not have known. And that made me, as it does every patient, only more alone.
"We will start," he said to me, "with twenty milligrams a day, a single capsule, although OCD, unlike depression, usually requires a higher dose." He showed me how, if the dose made me nauseous, I could split the pill and try half, and when I asked him what, exactly, was inside, he told me the story of the drug's design. He told me about Eli Lilly's campus in Indiana, where Prozac was first made, how a man raised rats and then ground their brains into something called a synaptosome, which became this medicine. He told me how Prozac marked a revolution in psychopharmacology because of its selectivity on the serotonin system; it was a drug with the precision of a Scud missile, launched miles away from its target only to land, with a proud flare, right on the enemy's roof.
I pictured the proud flare. I pictured the grounds of Eli Lilly, green and winding. Inside, the labs were clean. White-coated technicians were plucking the gray matter from rats, extracting the liquid transmitters, some kind of healing wet.
I hoped then.
I hoped to be helped.
And yet, I did not take this new pill. Back at home, in the basement apartment where I lived, I looked and looked at it. I touched it to the tip of my tongue, then moved it away. This was not a tease, the drawn-out flirtation that will later come to love. This was fear. Maybe more than anything else, taking a pill, especially a recently developed psychotropic pill about which researchers have more questions than answers, is always an exercise in the existential, because whatever happens happens to your body alone. Each time you swallow a pill you are swallowing not only a chemical compound but yourself unmoored; you are swallowing the sea, the drift and the drown. A pill makes the inscrutable Sartre solid, brings to life the haunting solitude of a Munch painting. It is not the doctor's job to populate the painting, but if he has a flair for the medical arts, maybe he will. The Prozac Doctor, for all his style, couldn't. Psychopharmacology is the one branch of medicine where there is no need for intimacy; neither knives nor stories are an essential part of its practice. And in its understandable glee that it might finally move psychiatry into a position as respectable as surgery, it risks forgetting, or maybe never learning, what even many a surgeon knows: that you must smooth the skin, that you must stop by the bedside in your blue scrub suit, that language is the kiss of life.
I had a dream one night about the Prozac Doctor. This was four or five days after our first visit in what would become over a decade-long relationship. I dreamt I saw him in the supermarket and he was buying bread. He was in a dark suit with brass buttons, and he approached several loaves, newly baked, lying on wooden boards, each with a scar down its center. I knew the Prozac Doctor was hungry, because I could feel his pangs in me. I could feel how he wanted to crack the caul of his professional persona. I thought I should help him, that because I was a patient and knew about proneness and heat, I could, maybe, instruct. Perhaps this is the patient's task. Perhaps in every good medical encounter each party must try to save the other.
So I showed the Prozac Doctor the bread. I showed him how to test it for firmness, how to split it down its scar and spread the salve of butter on it. He lifted a loaf-honey-wheat, I think-and from the hidden folds of his jacket pocket took out a stethoscope. I nodded at him, and he pressed the stethoscope against the breast of the bread, eyes half closed, listening, listening, and then the bread breathed back-a rush and a whir-sounds both thunderous and soft in my ears. I woke up.
And later on that day I got up the courage to take my first dose. A dream doctor, apparently, can bear witness and hold out the promise of tenderness almost as well as a real doctor. It is very fashionable in medical science these days to talk about the power of visualization in healing. Your cancer cells are turning fresh as healthy heartland apples; your tumor is bearing milk. Although I say this tongue in cheek, I am serious too. Perhaps we should instruct patients, especially psychiatric patients, to visualize not only the transformation of their illness but the transformation of their doctors as well. Maybe out of such visualizations-insistent, intense, articulated-we will help to midwife our medicine men.
I held the pill in my hand and then washed it down with water. Afterward, things seemed so quiet. My eyes and ears were tilted inward, listening, looking. I felt what might have been a burning in my chest, something scampering up around my heart. Side effect? Serious? A start? It was too early to know. So I sat on a stool in my kitchen, and I conjured up the Prozac Doctor with his hand on a curve of crusty bread, the hide of fresh whole wheat. I stroked my own arm. I tried for calmness. I thought of yeast and how it works, bubbles of fermentation, little spheres of oxygen that must be kneaded, how maybe every good rising is a combination of chemicals and touch.
Reading Group Guide
Lauren Slater wakes up one morning to find "the world as I had known it my whole life did not seem to exist."The commonplace things in her scruffy, barely furnished basement apartment and the familiar scene outside her kitchen window have been transformed, smoothed out, slowed down. The "nattering need to touch, count, check, and tap, over and over again"—a manifestation of the obsessive-compulsive disorder that has controlled her life—has disappeared. For Slater, each transformation represents a small miracle. At the age of twenty-six, after five incarcerations in mental hospitals "pursuing and pursued by one illness after another,"she is experiencing the world from a healthy perspective for the first time in years. A pioneer patient in an era of cutting-edge psychopharmacology, Slater owes her miraculous awakening to Prozac. Released on the market by Eli Lilly in 1988, Prozac promised to revolutionize the treatment of everything from chronic depression to anorexia to OCD. As Slater's doctor proudly put it, it "was a drug with the precision of a Scud missile, launched miles away from its target only to land, with a proud flare, right on the enemy's roof."
In Prozac Diary, a rich and beautifully written memoir, Slater describes what it is like to experience the heady high of Prozac's bright flare, to spend most of your life feeling crazy and then to find yourself in the strange state of feeling well. Interweaving the chronicle of her cure with glimpses of the events and emotional turmoil that led her to embrace comforts of "being ill"even as a young girl, she recounts the difficulty and compromise that accompany her return to health, the grief she feels for the passing of the symptoms that once defined her and for the final silencing of the eight inner voices which had been her constant companions for as long as she could remember. She re-creates in vivid detail the terrors of "Prozac poop-out,"when, without warning, the medication fails and symptoms of OCD return, and the small but vital victory she wrests during her frightening relapse with the emergence of "bits of self that manage to rise above the chemicals of illness, the chemicals of cure, and . . . for a moment take in the world."
Slater's first packet of Prozac works its wonders in only five days, less time than even her doctor, a staunch advocate of its powers, predicted. Liberated from the debilitating anxiety and pain that had circumscribed her life, Slater ventures into the world with the innocence and enthusiasm of a child. She wanders joyfully through Boston's Faneuil Hall, captivated by its irresistible array of foods, its extraordinary street performers, and the crowds of ordinary people pursuing ordinary pleasures. She allows herself the luxury of sleeping late for the first time in her life, attends her first rock concert, spends long, languid afternoons drinking lattes at outdoor cafs with newly acquired friends. Her body confirms the transformation: "I was the picture of health, as though I had finally come into the body meant for me."Armed with new found confidence, she sends out her rsum ("to date, one of my finest pieces of fiction") and gets her first real job, as a teacher in a literacy center. After almost a year on Prozac, she is accepted at Harvard, where as a student in psychology she eventually earns a doctorate in record time. She falls in love with Bennett, a chemist who is willing to accept her simultaneous "love affair"with Prozac.
Like all love affairs, however, Slater's infatuation with the small green-and-cream pills demands sacrifices. There are practical repercussions: her creativity ebbs, her sex drive dwindles, and she learns that Prozac is an inconstant lover when she suddenly experiences a horrifying descent into "crazy,"obsessive behavior. The emotional toll is at once more elusive and more profound. In the early months of her treatment, Slater is torn between her enthusiasm for the rewards and possibilities of health and a deep-seated fear of abandoning her "illness identity.""There was no more depression, which had felt like the stifling yet oddly comforting weight of a woolen blanket, or anxiety, which lent a certain fluorescence to things, or voices, which had always been there, sometimes louder, sometimes softer, some North Star of sound in the night."As time passes, she adjusts to Prozac's cool and calming effects and to the sporadic imperfections in its chemistry that allow odd bits of illness to break through. Now, after a decade on Prozac, she is resigned to her dependency on Eli Lilly and at the same time determined to exercise her freedom to reenvision the past and the present, to choose who she is and wants to be. "Prozac is not my lover any longer,"she writes, "but over the long haul has become a close friend, a slightly anemic, well-meaning buddy whose presence can considerably ease pain but cannot erase it."
Today, Prozac has become the legal drug of choice of a whole generation, used by millions of people all over the world. It's been hailed as a wonder drug and condemned as a drug that triggers violence. While 40 to 50 percent of patients on Prozac experience sexual dysfunction, a group of Prozac-taking British women reported a rather more stimulating side effect: whenever they sneeze, they have orgasms. As one of the first people to take the drug and among the few who have stayed on it for ten years, and as a psychologist who has also been a psychiatric patient, Lauren Slater is in a unique position to shed light on both Prozac's immediate impact and its long-term effects. Her book supports neither the generally positive position found in Dr. Peter Kramer's widely acclaimed Listening to Prozac nor the backlash against it expressed in Peter Breggin's Talking Back to Prozac. Her territory lies outside and beyond the noisy controversy. With elegance and humor, she takes us directly inside the strange new world Prozac has created, and using the language and images of poetry, reveals its gifts and its burdens.
ABOUT LAUREN SLATER
Lauren Slater is a Harvard-trained psychologist who is also the director of AfterCare Services, a mental health clinic. She teaches creative nonfiction writing for Goucher College's M.F.A. program. Her work was included in The Best American Essays of 1994 and 1997. The author of Welcome to My Country (1996), she lives with her husband in Boston.
A CONVERSATION WITH LAUREN SLATER
Much has been written about Prozac, from both negative and positive points of view. What does Prozac Diary add to this ongoing dialogue?
To this dialogue Prozac Diary adds the voice of the consumer—myself—telling the story of pharmacological "cure"from an intimate, and, I hope, authentic stance. Writing about Prozac, as so many people have done, is really not at all the same as writing through Prozac, as I have done, and the portrait that emerges, although no more or less honest than the more distant, "objective"portraits, is a singular story with singular details that no amount of detached research could have uncovered.
In addition, Prozac Diary is meant to address directly the issues involved in long-term Prozac use, which are in many ways different from the issues and ethical dilemmas involved in relatively short-term Prozac use. I wrote my book with the partial intention of portraying what this drug is like when taken over a lifetime, the difficulties, the dangers, and the blessings; and my hope is that it will speak to other people considering, or already embarking on, long-term usage.
Your first book, Welcome to My Country, was primarily about patients you worked with, while Prozac Diary is a much more personal book. Which book did you find easier to write? How did the writing processes differ?
At some essential level, the writing process is always the same for me, no matter how different the project is. Writing, whether about myself or others, demands a rigorous imaginative stretch, a reach for lyricism that conveys emotion, as opposed to covering it. This is always my struggle.
That commonality aside, the two books did present different artistic problems. I think I found it easier to write about other people, about patients, because I could portray the enormity and dignity of their suffering without risking self-absorption, or blatant narcissism. In writing about myself, I feel much more constricted. I worry about solipsism, shortsightedness, self-aggrandizement, self-denigration, and all the other treacherous territories that come with the fascinating pursuit of autobiography.
You offer readers glimpses of your childhood in passages interspersed within the running narrative. Why did you choose this method, rather than presenting a straight chronology from the onset of your illnesses through your experiences with Prozac?
There is a fairly simple answer to this. I intended for Prozac Diary to be a book about cure, not illness. Thus, I self-consciously set out to avoid a linear illness narrative, a structure that would have placed as much weight on sickness as on health. Instead, I chose to give quick glimpses of the illness—enough, I hope, to convey its essential character, but not so much that it obscures my main purpose: to write about an emergence, not a descent.
In retrospect, what was the hardest part of crossing into "the landscape of health"?
The hardest part for me was, and continues to be, my concern that I have lost some of the honesty and intensity that illness, which by its nature places one at the periphery of society, brought to my life. In Freud's famous essay "Mourning and Melancholia"he articulates this conflict extremely clearly. "The depressive has a keener eye for the truth than people who are not melancholic . . . we only wonder why a man has to be ill before he can come to truth of this kind."
Memories of your mother play a large role in your descriptions of your childhood. What was your relationship to your father like? How did your two sisters react to the atmosphere at home?
My relationship with my father was placid but fairly distant. His way of coping with the crises on the homefront was to absent himself, physically and emotionally. I don't remember him around a lot. As for my two sisters, they were treated quite differently than I. My mother adored my younger sister and treated my older sister with respect. However, they did not escape the trauma that comes from witnessing the cruelty she inflicted on myself and others. Their scars are different, but, I'm sure, deep.
One of the "side effects"of Prozac you experienced was a new interest in religion and spirituality. Did this help you adjust to the changes you were undergoing? Can you describe the spiritual aspects of mental illness—and of mental health?
My own belief is that spirituality, the idea, the feeling of a greater moral coherence to our world, is essential for people, in illness and in health. Health was a crisis for me, a new world, and I partially relied on my sense of spirituality to guide me through. This "sense"for me is rooted in moral conviction. We are, I believe, morally obligated to navigate the complexities of living with as much grace and courage as we can muster. So yes, my spiritual leanings certainly helped me adjust to the adventure that was, and is, Prozac.
As for the spiritual aspects of mental illness and health, that's a big question, one which would be answered differently by every person to whom the question was posed. For me, the spiritual aspects are the same whether in the sanguine or pathological state. Spirituality transcends illness and health. It is, for me, a fixed yet oddly fluid set of beliefs that serve as a guide. However, in illness I am less capable, in some ways, of responding to the moral challenge that spirituality is, while in health, I have more stamina and, perhaps, more courage. On the other hand, in health, in the pastel glow of good days, I often catch myself becoming slack, letting myself loose from the discipline that a spiritual life requires. Illness represents, in many senses, a reminder, a calling back to attend to all I've let slide.
In what ways have your own experiences as a psychiatric patient helped you as a psychologist?
I don't think my experiences as a psychiatric patient have been much help to me as a psychologist. I don't believe the suffering induced by mental illness necessarily makes a person more empathic to others. In fact, it may be just the opposite. Mental illness, for me, can be a painfully self-absorbed state that shuts out the world, and one's ability to connect to it.
Memoirs, particularly by women with dysfunctional or difficult family histories, have become quite popular today. Why do you think this is true? Did any of them influence your own memoir, and if so, in what way?
I have always been an autobiographical/biographical writer long before the "memoir"craze. I have had a powerful urge to document "real lives,"as a means of directly communicating with other people. I love fiction, but it can feel like a veil to me, like a slanted way of saying something. Because, perhaps, I grew up in a home of lies and denial, I consistently crave art that is balder and somehow more stripped. So I actually don't think my own autobiographical writing was influenced by other memoirs, as I've been charting my life and the lives of others since I was a child. However, I do think the publication of my books, and any measure of publicity they have received, is probably entirely dependent on the popularity of the memoir in general.
As for the first part of the question, I don't know. I can hazard a few guesses. I can say for sure that I am fascinated by the phenomenal interest in the autobiographical form. Perhaps the public interest in this form has something to do with a collective sense that we are, as a culture, becoming increasingly less direct and honest, that we are ever more image-driven, that we know the media to distort and even lie, that we know our figureheads to distort and even lie. There is, perhaps, an ever-increasing sense that our world is warped, a place of funhouse mirrors and ever-shifting ground. In response, we want something solid, we want a real glimpse into real lives, and thus we grasp these books. That "these books"appen to contain much dysfunction in them is simply because any honest account, from Saint Augustine's Confessions to The Liars Club, will, by necessity depict dysfunction. Real life is difficult, and difficulty leads to dysfunction. It's not the dysfunction we're after. It's the sense of truth, of authenticity.
What message does your book have for people who are not prescribed Prozac or other Selective Serotonin Reuptake Inhibitors?
I think, I hope, my book is about the search for and struggle with identity, about what constitutes a "real self,"and these are questions that are pertinent to any sentient human being. In addition, there is no person in the developed world today who is not a part of the "Prozac Nation."SSRIs, and Prozac in particular, have influenced the brains and souls of everyone—those who swallow the pills, those who don't. We all know someone who is on Prozac, or think about going on it ourselves, or see it seep into our communities in ways both alarming and amusing. Prozac, for these reasons alone, is a remarkable drug. It is perhaps the only drug to have seeped so far out of its plastic shell, to have been absorbed by the bloodstreams of so very many, even those who have never had any tactile relationship with it. I would go so far as to say we are all "on"Prozac, in that we all must grapple with its presence, its meaning, and its implications for our lives.
Has your relationship with Prozac changed since writing the book?
My relationship with Prozac has changed somewhat since writing the book, although the change has nothing to do with the book's publication or creation. Since that time, however, I have had more trouble with the dreaded tolerance, and have had to increase my dose to levels so high they are over what the FDA recommends. Of course, this is frightening for many reasons—side effects, toxicity, permanent cognitive damage, no one really knows. I will wait and see what the future holds.