LISTENING TO PROZAC

A provocative volume that sets up the mood-altering Prozac as a tool to examine the growing—and often troubling—use of drugs in the treatment of psychological illness. Brown University professor Kramer (Moments of Engagement, 1989—not reviewed) is a practicing psychiatrist who uses traditional techniques of therapy but also prescribes Prozac and other psychopharmaceuticals for his patients when they seem appropriate. Thanks to exposure on TV talk shows, Prozac is associated in many people's minds with suicide and violence, but only in the last chapter here—an appendix, really—does the author argue directly against these charges. What he explores instead are the far-reaching implications of the generally positive changes in temperament triggered by Prozac and other drugs prescribed to relieve anxiety and depression, and what these medications have taught us about how character and temperament are shaped. Prozac relieves mild depression, for instance, by elevating levels of serotonin in the brain. Knowledge of that fact opens the door to further investigation of chemical pathways in the brain, individual variations in levels of serotonin and other neurotransmitters, and perhaps even to early diagnosis and treatment of mood disorders. But, as Kramer points out, it also opens the possibility of altering brain chemistry to order, perhaps transforming a shy, sensitive individual into a sociable, assertive personality—the kind that present society most values. Acquisition of such a temperament, in fact, is the effect that Prozac has on many of Kramer's patients. But what has been lost when sensitivity is replaced by assertiveness? What is the ``real'' personality? Such thoughtful questioning is supported throughout by case histories and meaty reports on recent research. Some of the material suggests that if Freud was wrong about the content of childhood trauma (the Oedipal attachments), he was not wrong about its far-reaching effects. A wise and unflinching examination of the ramifications for society—and for the individual—when the capsule replaces the couch.