Wurtzel, E. (1994). Prozac nation: Young and depressed in America. Boston: Houghton-Mifflin Company.

OVERVIEW

That’s the thing I want to make clear about depression: It’s got nothing to at all to do with life. In the course of life, there is sadness and pain and sorrow, all of which, in their right time and season are normal—unpleasant, but normal. Depression is in an altogether different zone because it involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature’s part (nature, after all, abhors a vacuum) to fill up the empty space. But for all intents and purposes, the deeply depressed are just the walking, waking dead. (p. 19)

I started to get the feeling that something is really wrong. Like all the drugs put together—the lithium, the Prozac, the desipramine, and Desyrel that I take to sleep at night—can no longer combat whatever it is that was wrong with me in the first place. I feel like a defective model, like I came off the assembly line flat-out f----d and my parents should have taken me back for repairs before the warranty ran out. But that was so long ago. (p. 1)

Prozac Nation is a woman’s autobiographical account of what it like to be young, "full of promise," and struggling with clinical depression. She speaks of her experiences with a voice that is fresh, urgent, and compelling: she spares no details nor softens any blows. Melanie Themstrom, author of The Dead Girl, states, " ‘In punchy, sexy prose, Elizabeth Wurtzel plummets you into the darkness of her innermost experience to emerge once again into medicine, daylight, insight. Whatever you are doing, this book may make you abandon it.’ "

The author, Elizabeth Wurtzel, a Harvard graduate and free lance journalist, begins her memoir into madness with a story which took place in her life just prior to its publication. We first meet twenty-five year-old Elizabeth Wurtzel at a hip, chic, twenty-something party taking place in her own apartment. Picture a young, lovely woman in a black chiffon cocktail dress "curled up in a fetal position" on her bathroom floor, sobbing inconsolably and suffering immeasurably because she is coming down from a cocaine high and is chemically a mess. A few weeks prior to the party, Elizabeth decided she needed to take herself off the lithium she was taking to stabilize her mood swings because her blood tests revealed an unusually high concentration of thyroid stimulating hormone (TSH). Elizabeth feared that the lithium was wreaking permanent havoc on her glands:

I really needed my lithium. But I was determined to cold-kick it. If cocaine would help, so be it. Coke may be really bad for you in every possible way, but it wouldn’t give me thyroid disease, thereby turning me into a younger version of my hysterical, exhausted, overwrought mother. (p. 5)

So begins the tragic tale of a woman described as "young, gifted, and black of spirit." Following the description of this episode, we are taken back into the life of a bright, eleven-year-old girl living with her mother in the Upper West Side of New York City. She is a child of a bitter divorce and is trying to have some semblance of a relationship with her father who—for all intents and purposes—has emotionally abandoned her as a casuality of a bad marriage. Unfortunately, he has maintained a very volatile relationship with her mother and sees nothing wrong with waging a continual war against her, using Elizabeth as a weapon or a trump card.

Apparently, the constant state of familial upheaval coupled with the physical one in her body and mind—adolescence—left Elizabeth vulnerable to feelings of despair and confusion. She describes the situation this way:

By the time I made it to eighth grade, my parents, were ready to kill each other. For the first time since their divorce, they had to talk pretty regularly about what to do with me. These were hopeless and frustrating discussions, no doubt, because every little thing seemed to make me worse. I was like an already over spiced stew, and all the chefs adding all their condiments were only making it more foggy and muddled and bad. (p. 57)

By the time Elizabeth was twelve, she was in therapy with a high-profile, Manhattan psychiatrist named Dr. Isaac. By the time she is twenty-five she will have attended scores of therapy sessions with nine different therapists (with a number of visits to the hospital’s psychiatric ward). Her years at Harvard are marked by a "series of breakdowns, suicide attempts, and hospitalizations." From behavior therapy, crisis management, and psychoanalysis, Elizabeth’s on-going treatments do little to stop the subversive behavior (drugs, alcohol, and promiscuous sex), feelings of alienation, and the overall malaise which has overtaken her life and that she feels powerless to stop.

But when I unfurl myself from a fetal position and uncurl my way out of bed, there is still an ocean breaking inside my brain. The brief relief of seeing other people when I leave my room turns into a desperate need to be alone, and then being alone turns into a desperate fear that I will have not friends, I will be alone in this world and in my life. I will eventually be so crazy from this black wave, which seems to be taking over my head with increasing frequency, that one day I will just kill myself, not for any great, thoughtful existential reason, but because I need immediate relief, I need this horrible big muddy to go away right now. (p. 96)

It was only after the many frustrating years of talk therapy, increased episodes of severe emotional outbursts, and reoccurring thoughts of suicide did Elizabeth finally receive a diagnosis for her severely melancholic and perpetually disordered "state of mind." Instead of it simply being a problem of environment and defective thought processes, the psychiatric team at MacLean Hospital determined Elizabeth to have a an organic form of depression classified as atypical.

This form of depression, unlike the typical depression (which is more severe but, paradoxically enough, easier to treat), is long term and chronic. A person with atypical depression can live a seemingly normal life and experience many long periods of productivity. This, however, is the problem with the disease as the frequent and sporatic upswings can prevent the suffer from getting help before it is to late. Elizabeth explains:

The atypically depressed are more likely to be the walking wounded, people like me who are quite functional, whose lives proceed almost as usual, except that they’re depressed all the time, almost constantly embroiled in thoughts of suicide even as thy go through their paces. Atypical depression is not just a mild malaise—which is known diagnostically as dysthymia—but one that is quite severe and yet still somehow allows an appearance of normalcy because it becomes, over time, a part of life. The trouble is that as the years pass, if untreated, atypical depression gets worse and worse, and its suffers are likely to commit suicide out of sheer frustration with living a life that is simultaneously productive and clouded by constant despair. (pp. 263-264)

It was only after this diagnosis was established could her psychiatrist, Dr. Sterling, begin drug treatment. Since the fluctuating seratonin levels within Elizabeth’s brain were apparently causing her particular symptoms, Prozac, a new drug on the scene, was prescribed because of its direct effect on that specific neurotransmitter. Unlike the other drugs used to treat depression (i.e., Imiprimine or the NIAOIS), Prozac was chosen for Elizabeth because it goes directly to the neurotransmitter. This makes the drug more effective for the atypical and less likely to cause side effects.

Shortly following the diagnosis and soon after taking Prozac, Elizabeth’s mental state began to improve significantly. What she did not foresee were the issues and concerns she would face regarding her treatment. How would she cope, she wondered, with the reality of the diagnosis, getting well, and being drug dependent for the rest of her life? She describes a new and surprising mindset this way:

Before I knew this, I was so scared to give up depression, fearing that somehow the worst part of me was actually all of me. The idea of throwing away my depression, of having to create a whole personality, a whole way of living and being that did not contain misery as its leitmotif, was daunting. Depression had for so long been a convenient—and honest—explanation for everything that was wrong with me, and it had been a handicap that helped accentuate everything that was right. Now, with the help of biochemical cure, it was going to go away...And after all these years, who was that person anyway? (pp. 290-291)

As indicated by the description of the "party experience" at the beginning of this review, the author, Elizabeth Wurtzel, was far from having her disorder "go away." To her disappointment, she discovered that the drug alone was not a miracle cure after all. Without ongoing therapeutic support and guidance, she found herself in similar states as before. In her own words:

...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...had turned me into a person who had no idea how to function within the boundaries of the normal, non-depressive world. (p. 307)

In the epilogue of the book, Elizabeth discusses the implications of a nation becoming obsessed with the drug Prozac and the current mainstreaming of depression. She states that in 1993, in the United States alone, $1.3 billion was spent on prescriptions for Prozac, with six million people prescribed to the drug. newspapers, talk shows, and magazines were all, at the time, touting the drug as a proverbial panacea ridding America of depression. This disorder, at one time considered a rare and serious malaise, was now being described, "the common cold of mental experience."

Depression is a disease, one that not only can, but probably should, be treated with drugs. But a low-grade terminal anomie, a sense of alienation or disgust and detachment, the collective horror at a world that seems to have gone so very wrong, is not a job for antidepressants...Just as our parents quieted us when we were noisy by putting us in front of the television set, maybe we’re learning to quiet our own adult noise with Prozac. (p. 302)

This minimization and (even the glorification) of the disease is ultimately what frightens Elizabeth. She fears that the commonality of the experience and a "quick fix" mentality may prevent people from truly exploring the deep reasons why it exists at the phenomenal level that it does. She states that we live in a culture that is so familiar with the condition that we almost celebrate it. Movies, music, and TV, seem to reflect this culture of depression which has so thoroughly entrenched the mainstream with films such as "Slacker," and "sex, lies, and videotape" and bands like Nirvana whose album "Nevermind" sold one-million copies in 1994.