By Scott Stossel

SEPTEMBER 21, 1998: 

PROZAC DIARY, by Lauren Slater. Random House, 203 pages, $21.95.

Why is Boston so overrepresented in the Memoir of Madness genre? Is there something about New England's repressed Puritan culture that induces melancholia and anxiety? Something about the outsize egos around Harvard that leads not only to nervous breakdowns but also to the need to brag about them? Or does it have something to do with the toxic sludge polluting the Charles River?

Whatever the reason, the Boston-Cambridge area has been the setting for a disproportionate number of those books that might be described as "autopathographies": think of Susanna Kaysen's Girl, Interrupted, Caroline Knapp's Drinking: A Love Story, and Elizabeth Wurtzel's Prozac Nation. The seminal book in the genre, Sylvia Plath's fictionalized memoir The Bell Jar (1963), is set here, too. Given the similarities not only in setting but in the writers' backgrounds, one would expect that a certain sameness would be inevitable. Yet these books range widely in their style and quality. Lauren Slater's Prozac Diary ranks among the best.

The most obvious point of comparison is with Wurtzel's Prozac Nation; and in that context, Slater, who first revealed her mental health problems in 1996's Welcome to My Country, almost can't help but fare well. Prozac Nation was a bad book: it was readable only because it was impossible to stop watching such self-indulgence, such an overbearing ego on voluntary public display. While I have no doubt that Wurtzel sincerely meant to convey the depth of her pain, what came across was only the arrogant preening of a world-class bitch.

Slater, on the other hand, manages to describe her pre-Prozac suffering without seeming to wallow in it. And as she recounts how the Prozac began to work, we begin to understand depression and mental illness as she does -- by understanding its absence. When the drug kicked in, Slater says, she felt "as though I'd been visited by a . . . piano tuner who had crept into my apartment at night, who had tweaked the ivory bones of my body, the taut strings in my skull, and now, when I pressed on myself, the same notes but with a mellower, fuller sound sprang out."

For Slater, Prozac has an almost magical effect. Her depression and anxiety and compulsive behavior recede and, for the first time in her life, she can travel and work and have relationships and eat and do all the things that most people do without even thinking about them. Yet for all that, Slater has a profoundly ambivalent relationship with the drug. She worries not just about its long-term side effects but about what she's lost by taking it. Having been on Prozac since 1988, Slater is one of the cohort that serves as the collective canary in the Prozac coal mine. True, 12 million Americans take the pill without significant problems. But what about over the long haul? Will these people have to be medicated forever? What happens after you've taken the drug for 10 or 20 years? Slater notices she has trouble remembering things that she used to recall easily. Is loss of memory a long-term symptom? What's more, for the entire time she's been on the drug she has been unable to have an orgasm; indeed, her sex drive and sexual sensitivity overall have declined, common side effects of the drug.

Her most resonant fears are not sexual or medical but existential. What gets lost when you elide suffering? What happens when yearning gets muted by pharmacological dampers? She's happier, yes; she can function, yes. But is it necessarily a good thing that staring into the abyss has been replaced by the quotidian, by the errands and small pleasures of everyday life?

Slater, appropriately, doesn't give clear answers to these questions. Her overall view of Prozac is implicit in her continuing to take it. She needs it to survive and thrive (she's a psychologist and a teacher of writing). But her uncertainty comes across in the ambiguous portrait of the unnamed Prozac Doctor. One might expect she would regard him as her savior; yet from the way she describes his blasé reduction of all suffering to the neurochemical (when she worries about side effects, he considers this a symptom of her illness and raises her dose), it is clear she feels the pharmaceutical bargain he has offered her is a Faustian one.

Prozac Diary is a rich and provocative little book; its evocation of the trajectory of mental illness under chemical assault is as good as Kay Redfield Jamison's in An Unquiet Mind and William Styron's in Darkness Visible. The haunting thing about these books is that all -- including The Bell Jar -- end on a note of cautious optimism; yet we all know what happened to Plath, which raises questions about whether this optimism is merited. Will Slater, Styron, and the rest end up better off than Plath because they live in the age of pharmacological therapy? What if Plath had taken Prozac? Would she have been as brilliant and creative? If she had found herself wrestling with diapers, say, or a bank job (instead of the abyss), would it have made her poetry worse? Most important, would she have lived? Slater doesn't pose these questions about Plath, but it's clear she knows she is not home free just because she has hitched herself to a chemical capsule.

Scott Stossel, the executive editor of the American Prospect, has written political and cultural criticism for the Atlantic Monthly, the New Republic, and the New Yorker.

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