Prozac Nation (42 page)

There was a nervous edge to our giggling.

“I think this Prozac thing has gone too far,” Olivia said.

“Yes.” I sighed. “Yes, I think it has.”

 

I never thought that depression could seem funny, never thought there'd be a time when I could be amused thinking that of the $1.3 billion spent on prescriptions for Prozac last year (up about thirty percent since 1992), some of them might even be for our household pets, who are apparently as susceptible to mental trauma as the rest of us. I never thought I would amazedly read about Wenatchee, Washington, a town known as “The Apple Capital of the World,” a place where six hundred out of its twenty-one thousand residents are all on Prozac, and where one psychologist has come to be known as “The Pied Piper of Prozac.” I never thought that the
New York Times,
reporting on the eleven million people who have taken Prozac—six million in the United States alone—would declare on its front page that this consitituted a “legal drug culture.” I never thought there would be so many cartoons with Prozac themes in
The New Yorker,
illustrating among other things, a serotonin-happy Karl Marx declaring, “Sure! Capitalism can work out its kinks!” I never thought that in the same week I would stare down at both a
Newsweek
cover with a large missile-like capsule beneath the caption “Beyond Prozac” and a
New Republic
cover of some shiny, happy people enjoying their sunny lives above the headline “That Prozac Moment!”

I never thought that this antidote to a disease as serious as depression—a malady that easily could have ended my life—would become a national joke.

Since I first began taking Prozac, the pill has become the second most commonly prescribed drug in this country (behind Zantac, the ulcer remedy), with one million orders filled by pharmacists each month. Back in 1990, the story of this wonder drug made the covers of many national periodicals.
Rolling Stone
deemed Prozac the “hot yuppie upper,” and all the major network newsmagazines and daytime talk shows began to do their Prozac-saved-my-life segments. In 1993, when
Listening to Prozac,
Peter Kramer's book of case studies and meditations on Prozac as a pill that could transform personality, entered the
New York Times
bestseller list for a six-month stay, a new crop of cover stories and television pieces appeared all over again. Dr. Kramer even referred to the publicity jaunt for his book as the “Three Degrees of Separation Tour” because it seemed that no one was more than three people removed from someone on Prozac. While a backlash of reports, mostly promulgated by the Church of Scientology, linked Prozac with incidents of suicide and murder, the many people that it relieved from symptoms of depression had nothing but praise. Cheryl Wheeler, a New England folkie, even wrote a song called “Is It Peace or Is It Prozac?”

But all this coverage is not just about Prozac. It's about the mainstreaming of mental illness in general and depression in particular. It is about the way a state of mind once considered tragic has become completely commonplace, even worthy of comedy. It seemed that suddenly, some time in 1990, I ceased to be this freakishly depressed person who had scared the hell out of people for most of my life with my mood swings and tantrums and crying spells, and I instead became downright trendy. This private world of loony bins and weird people that I had always felt I occupied and hid in had suddenly been turned inside out so that it seemed like this was one big Prozac Nation, one big mess of malaise. In a quote in
Good Housekeeping
(good God, a magazine your grandmother reads), the psychologist Ellen McGrath described dysthymia as “the common cold of mental experience,” noting that this form of chronic low-grade despair afflicts three percent of Americans (roughly the same number of people who have taken Prozac). I realize that to say that we live in the United States of Depression would surely indicate a skewed perception—the twelve million people said to be suffering from the illness is still a minority—but talk of depression as the mental disease of our times has been very much in the air these last few years, and has almost become a political issue. When Hillary Rodham Clinton campaigned on behalf of what a cover story in
New York Times Magazine
deemed “The Politics of Virtue,” it was hard not to notice that her references to a “sleeping sickness of the soul,” to “alienation and despair and hopelessness,” to a “crisis of meaning,” and to a “spiritual vacuum” seemed to imply that the country's problems have less to do with taxes and unemployment than with the simple fact that we were in one big collective bad mood. It almost seemed as if perhaps the next time half a million people gather for a protest march on the White House green it will not be for abortion rights or gay liberation but because we're all so bummed out.

Of course, one of the striking elements of this depression breakout is the extent to which it has gotten such a strong hold on so many young people. The Miltown and Valium addicts of the fifties and sixties, the housewives reaching for their mother's little helpers, the strung out junkies and crackheads who litter the gutters of the Bowery or the streets of Harlem or the skid row of any town—all of these people were stereotyped as wasted, dissipated, and middle-aged, or else young and going nowhere fast. What is fascinating about depression this time—what is unique about this Prozac Nation—is the extent to which it is affecting those who have so much to look forward to and to hope for, who are, as one might say of any bright young thing about to make her debut into the world, so full of promise. These are people about whom one cannot say that life is over, that it's already too late, but rather young people for whom it has just begun.

On December 8, 1992, an article appeared in the science section of the
New York Times
under the headline “A Rising Cost of Modernity: Depression.” The piece tells of a report published by the
Journal of the American Medical Association,
which delivered the results of a long-term, international, multigenerational study of depression. The main point: Those born after 1955 are
three times
as likely as their grandparents' generation to suffer from depression. In fact, of Americans born before 1905, only one percent had experienced a depressive episode by age seventy-five, while of those born after 1955, six percent were already depressed by age twenty-four. Apparently, the trend is global, with studies in Italy, Germany, Taiwan, Lebanon, Canada, France, New Zealand, Puerto Rico, and elsewhere yielding similar numbers. While women are thought to be two or three times as likely as men to get depressed, the article concludes that “the gap between men and women in rates of depression is narrowing among younger generations, with the risk in young men beginning to rise to the levels seen in women.” In the end, the article concedes that the increased incidence of depression could be partly explained by a greater openness about the topic, but these statistics are so alarming that experts think candor is not much of a factor.

In the meantime, the anecdotal evidence would seem to bear out the point that a lot of people are either truly depressed, or they believe themselves to be. And many think that Prozac is the answer. We've all heard stories like the one about the burglar who left the computer, VCR, and stereo equipment untouched, but ran off with the bottle of Prozac. Or perhaps, like me, you've been in the unfortunate position of being in the back seat of a taxi while the driver confesses that a few months ago he tried to kill himself with a hundred Valium pills and a whiskey chaser, but now he's on Prozac and life couldn't be better. Maybe you find out that the guy who fixes your plumbing is on Prozac, that your gynecologist is on Prozac, that your boss is on Prozac, that your mother is on Prozac, maybe your grandmother too. Even if Prozac has not seeped into your personal life in some way, many of the famous and infamous have confessed to being users. Gary Hart was on Prozac for a while. Jim Bakker has tried it. Roseanne Arnold is on it. Jeffrey Dahmer just took himself off it.

How is it possible that so many are so miserable?

I know there are people who get a kick out of this kind of thing. They enter twelve-step fellowships so that they can find others afflicted with the same demons: alcoholism, narcotics addiction, eating disorders, and a plethora of imaginary illnesses like shopping, loving, or fucking too much. But it seems to me that there's something wrong with a world where all these pills are circulating, floating around the atmosphere like a spreading virus or bad information or mean gossip. I have no way to be certain of this, but my guess is that most of the people on Prozac haven't taken the circuitous path to this drug that I did. Many general practitioners give Prozac to patients without much thought. In a 1993 study, researchers at the Rand Corporation found that more than half of the physicians they surveyed got out their prescription pads after discussing depression with a patient for
less
than three minutes. Sometimes I find myself resenting the ease with which doctors now perform this bit of pharmacologic prestidigitation. By the time I was put on Prozac they'd tried everything else possible, I'd had my brain fried and blunted with so many other drugs, I'd spent over a decade in a prolonged state of clinical despair. Nowadays, Prozac seems to be a panacea available for the asking.

Still, I can't ignore the compelling evidence presented in the
New York Times
article that would seem to indicate that maybe all this drug prescribing is not an overaggressive response, but actually a sane reaction on the part of doctors to a whole slew of people for whom simple existence is fraught with intense misery. According to a study done by the
Journal of Clinical Psychiatry,
in 1990 alone 290 million work days were lost to depression. The same report also states that depression costs this country $43.7 billion annually, a figure that includes the price of psychiatric care as well as losses incurred by impaired productivity and worker absence. If we added in the amount of money wasted by doctors requesting unnecessary lab tests because they've mistaken depression for some other disease, or if we tacked on the cost of adjunct treatments—drug abuse rehabilitation, for instance—the number would be much higher. Furthermore, on National Depression Awareness Day, when screening sites are set up all over the country to examine people for symptoms of major depression, fifty percent of those tested (admittedly a self-selected bunch) are found to be clinical cases. With all these statistics flying around, subjective though they may be, who's to say that there's too much Prozac? Maybe there isn't enough. Maybe this world is too difficult to negotiate without some kind of chemical buffer zone.

And while depression is a problem for any age group, the sense of it as a normal state of mind, as an average part of getting through the day, as so much ho-hum life-sucks-and-then-you-die, does seem unique to people who are now in their twenties and thirties. There is a certain shading to the dead-end depression of youth culture, some quality of fatalism about it, a resignation that makes it frighteningly banal. It is no wonder that something as similarly uninspired as Prozac, a pill that doesn't make you happy but does make you not sad, would become the drug of choice for this condition. No other substance feels quite so safe.

When I was reading a copy of
Lear's
in the Miami Beach sun, I chanced upon an article titled “The Plot Sickens,” in which Fanny Howe, a college writing instructor, says that the gruesome, pessimistic nature of her students' submissions is like nothing she's seen in twenty-one years of teaching. “To read their work, you'd think they were a generation that was starved, beaten, raped, arrested, addicted, and wartorn. Inexplicable intrusions of random tragedy break up the otherwise good life of the characters,” Howe writes. “The figures in their fictions are victims of hideous violence by accident; they commit crimes, but only for the hell of it; they hate, not understanding why they hate; they are loved or abused or depressed, and don't know why. . . . Randomness rules.”

And Howe seems surprised by what she's reading. For me, and for everyone I know my age, such stories seem normal, peculiarly ordinary. In the world that we live in, randomness does rule. And this lack of order is a debilitating, destabilizing thing. Perhaps what has come to be placed in the catchall category of depression is really a guardedness, a nervousness, a suspicion about intimacy, any of many perfectly natural reactions to a world that seems to be perilously lacking in the basic guarantees that our parents expected: a marriage that would last, employment that was secure, sex that wasn't deadly. It is a cliché at this point to make reference to the economic and social insecurity that is said to characterize a mass of people that's been known collectively as Generation X or twentynothings, but obviously there is a lot of unhappiness going around in this age group, and I can't blame journalists, sociologists, and other observers for trying to make sense of it, for rooting out the causes.

The trouble is that when we get around to solutions, it always seems to come down to Prozac. Or Zoloft or Paxil. Deep clinical 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. The trouble is, the big-picture problems that have so many people down are more or less insoluble: As long as people
can
get divorced they
will
get divorced; America's shrinking economy is not reversible; there is no cure for AIDS. So it starts to seem fairly reasonable to anesthetize ourselves in the best possible way. I would like so much to say that Prozac is preventing many people who are not clinically depressed from finding real antidotes to what Hillary Clinton refers to as “a sleeping sickness of the soul,” but what exactly would those solutions be? I mean, universal health care coverage and a national service draft would be nice, but neither one is going to save us from ourselves. Just as our parents quieted us when we were noisy by putting us in front of the television set, maybe we're now learning to quiet our own adult noise with Prozac.