Book Review

Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs

N Engl J Med 2003; 349:2369-2370December 11, 2003

Article

Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs
By Jonathan Michel Metzl. 275 pp., illustrated. Durham, N.C., Duke University Press, 2003. $24.95. ISBN: 0-8223-3061-X

Prozac on the Couch is a creative, intelligent, and provocative challenge to the notion that biologic psychiatry has replaced psychoanalysis as the dominant therapeutic model in psychiatry. Tracing treatments for depression, anxiety, and other mental illnesses from the 1950s to the early 21st century, psychiatrist Jonathan Metzl builds an argument that “the history of Freud is specifically the history of Prozac” by showing how “psychoanalytic themes and psychoanalytic notions of gender keep showing up in representations of biological psychiatry.” He does so through closely reading representations of psychotropic medications in popular news and fashion magazines from the mid-1950s through the early 1960s (e.g., Newsweek, Time, and Cosmopolitan), in psychopharmaceutical advertisements from professional journals from 1964 to 1997 (e.g.,the American Journal of Psychiatry and Archives of General Psychiatry), and in selected works of American literature between 1990 and 2002 (dubbed the “Prozac narratives”). These periods correspond roughly to the heydays of psychiatry's three American “wonder drugs” — Miltown, Valium, and Prozac.

The book has six chapters. In the first, Metzl develops the intriguing premise that the shift from psychoanalysis to biologic psychiatry was, and is, incomplete, by exposing “those pieces of the prior regime that remain imbricated after the shift . . . [and that] can govern the form and function of the regime that takes its place.” Metzl constructs his argument with a fascinating compendium of print images that show how both psychoanalytic and biologic constructs are often similarly engaged in “maintaining traditional gender roles” and how the uses of “psychotropic medications often redeploy all the cultural and social baggage of the psychoanalytic paradigm.”

In case readers need a refresher in the various theoretical orientations psychiatry has embraced during the past half-century, Metzl traces the “alleged demise” of psychoanalysis from 1955 through the present. In subsequent chapters, he explores the “marriage of mothers and medications” through the rhetoric of Miltown, America's “first psychopharmacological wonder drug,” showing how, in the visual construction of patienthood in advertising, a woman's sanity was connected to her marital status, and mental illness was “presented as a threat to the nuclear family.” His analysis of Prozac as depicted in popular memoirs such as Elizabeth Wurtzel's Prozac Nation (New York: Riverhead, 1995) and in Persimmon Blackbridge's novel Prozac Highway (Vancouver, B.C., Canada: Press Gang, 1997) is particularly illuminating. In his conclusion, Metzl challenges psychiatry to “expose its own synapses and dendrites with the same vigor with which it has exposed those of its patients . . . [and to] become more aware of its own, uniquely biased spectator positions.”

Prozac on the Couch is an intriguing and challenging work standing at the intersection of medicine, history, culture, and “gender studies.” Metzl — who holds a Ph.D. in American studies and directs the Program in Culture, Health, and Medicine at the University of Michigan, in addition to seeing patients — writes for an audience willing to think beyond traditional categories and to engage in serious cultural criticism. His arguments cross academic disciplines, and readers who are used to traditional medical discourse may struggle at times with Metzl's theoretical perspectives and language, which draw heavily from cultural studies. But for those who are looking for fresh perspectives, and who are willing to have their assumptions questioned, this book will be a real education and a pleasure to read.

Delese Wear, Ph.D.
Northeastern Ohio Universities College of Medicine, Rootstown, OH 44278
dw@neoucom.edu