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

by Jonathan M. Metzl

Pills replaced the couch; neuroscience took the place of talk therapy; and as psychoanalysis faded from the scene, so did the castrating mothers and hysteric spinsters of Freudian theory. Or so the story goes. In Prozac on the Couch , psychiatrist Jonathan Michel Metzl boldly challenges recent psychiatric history, showing that there’s a lot of Dr. Freud encapsulated in late-twentieth-century psychotropic medications. Providing a cultural history of treatments for depression, anxiety, and other mental illnesses through a look at the professional and popular reception of three “wonder drugs”—Miltown, Valium, and Prozac—Metzl explains the surprising ways Freudian gender categories and popular gender roles have shaped understandings of these drugs. Prozac on the Couch traces the notion of “pills for everyday worries” from the 1950s to the early twenty-first century, through psychiatric and medical journals, popular magazine articles, pharmaceutical advertisements, and popular autobiographical "Prozac narratives.” Metzl shows how clinical and popular talk about these medications often reproduces all the cultural and social baggage associated with psychoanalytic paradigms—whether in a 1956 Cosmopolitan article about research into tranquilizers to “cure” frigid women; a 1970s American Journal of Psychiatry ad introducing Jan, a lesbian who “needs” Valium to find a man; or Peter Kramer’s description of how his patient “Mrs. Prozac” meets her husband after beginning treatment. Prozac on the Couch locates the origins of psychiatry’s “biological revolution” not in the Valiumania of the 1970s but in American popular culture of the 1950s. It was in the 1950s, Metzl points out, that traditional psychoanalysis had the most sway over the American imagination. As the number of Miltown prescriptions soared (reaching 35 million, or nearly one per second, in 1957), advertisements featuring uncertain brides and unfaithful wives miraculously cured by the “new” psychiatric medicines filled popular magazines. Metzl writes without nostalgia for the bygone days of Freudian psychoanalysis and without contempt for psychotropic drugs, which he himself regularly prescribes to his patients. What he urges is an increased self-awareness within the psychiatric community of the ways that Freudian ideas about gender are entangled in Prozac and each new generation of wonder drugs. He encourages, too, an understanding of how ideas about psychotropic medications have suffused popular culture and profoundly altered the relationship between doctors and patients.

Genres: Nonfiction, History, Psychology, Gender, Mental Health, Disability, Drugs

296 pages, Paperback

First published April 1, 2003

About the author

Professor and Director of the Center for Medicine, Health, and Society at Vanderbilt University; a Psychiatrist; and the Research Director of The Safe Tennessee Project, a non-partisan, volunteer-based organization that is concerned with gun-related injuries and fatalities in America and in Tennessee.

Reviews

[teresa · Rating 3 out of 5]

still haven't finished it. i couldn't get a grip on what exactly he was driving at, other than saying that meds and gender have a history together, but other dots are not really connected. i suppose i'm more interested in a radical critique/perspective on said topics, this book did not offer that. i'm more interested in his other book on how schizophrenia became a black disease.

[Andy · Rating 3 out of 5]

The literary section I felt was poorly structured, and parts of his argument could definitely be tighter. For example, his reliance on advertisements in the AJP is useful, but not the best indicator of patient treatment as meta-analytical data could be. Also, Metzl's argument about fluoxetine being used as a defense of the patriarchic nuclear/marital family is, I think, correct, but doesn't have to be. It would be useful for the reader to have Metzl explore its potential in a feminist world that is not based in fiction literature. Another example is that capitalism and the market certainly exploit patients through marketing; capitalism encourages proletarian pscyhological insecurity; the capitalist class benefits from dysthymic (depressed) and hyperthymic (excited to the point of being highly productive) individuals. But the advertising department of Bayer isn't necessarily contemplating or even that conscientious of the psychopharmacology of antidepressants on worker productivity, nor would these white collar workers be direct benefactors of its use as a hyperthymic agent or stimulating/reinforcing sexist insecurities. I agree with his over-arching theses in the book, but I felt there were ends that could have been tied tighter throughout the book, especially in the second half. He's on to quite a bit that seems correct, but at times it seems either haphazardly structured or patched together as multiple intriguing arguments that are not clearly clarified throughout the book.
Also, spelling out the role Metzl sees antidepressants, talk therapy, and even psychoanalysis should, could, or might play in an anti-sexist psychiatric practice would be useful. As someone in the field, I would like to hear some direction.

[Katherine · Rating 3 out of 5]

The main flaw in this book is the heavy reliance on post-modernism/post-structuralist critique, but it is still worth it. Metzl is a psychiatrist and has had his share of male patients insisting that the real cause of their problems is that their wife/girlfriend engages in behavior X, which means the wife/girlfriend has mental illness Y and if he just prescribes drug Z, she'll stop doing X and the patient's life will be fine, so this is not idle philosophizing. He traces the use of psychotropic drugs from the fifties onward, showing how the profession advocated medicating women so that their behavior did not cause pathology in men or children. There is also some interesting commentary on how psychiatry reacted to the feminist movement -- feminists were yet another population that could be helped with meds. He also examines how the drug companies have marketed psychotropic medications to women as agents to help you be the woman society wants you to be, whether the housewife of the '50's or the career woman with the beautiful kids of the '90's, and how frequently the "SSRI Success" narratives featuring women ended with the woman either married or finding that the conflict has disappeared from her marriage. The book's focus is on psychotropic drugs in the "worried well", that is to say those who are not suffering from a severe mental illness, where this sort of analysis is relevant. Unfortunately, this book was published in 2002, before it was recognized that with the exception of OCD, severe depression and perhaps severe panic disorder or GAD, the SSRIs are merely placebos; it would be interesting to see what he has to say about this finding.

[Caty · Rating 3 out of 5]

Not quite critical enough of psychiatry, but its combo of psychoanalysis & psychopharmacology is riveting, & of course, it analyzes the books I love & love to hate--Prozac Highway & Prozac Nation, to name two. & the way it exposes the gendering of pharmaceutical ads from the very beginning is just vital.

[Beth · Rating 4 out of 5]

Not bad...but I found his use of sources to be a bit narrow.

[Alicia Marie Combs · Rating 3 out of 5]

I thought it would be a much more intellectual analyzation of ...everything, but it was really ...boring, and kept reiterating the same points over and over again. Disappointed.

[Wesley Vaught · Rating 4 out of 5]

Metzl’s argument centers around stationing Prozac and other psychoactive medications (pre-psychedelics) as having a recursive form — replicating gendered hierarchy from Freud’s psychoanalysis that dominated the psychiatric space with its effort to alleviate both men and women’s anxiety (1950s to 1970s) and depression (1990s - present). I’m convinced, and that’s why I gave it 4 stars. My critiques, however, is his writing tends to be long winded about the primary source that I think could have been structured better. Like a 1, 2, 3, punch type format for the chapters would have worked best. Some may say that is basic and rigid; I say it’s not convoluted and confusing. Pick your poison!

A great read for anyone interested in biopolitics of mental health and DEF a read for anyone entering a mental health profession.

[D]

Fascinating, if dense, even by academic publishing standards. The central argument is that pharma advertising served to reify Freud, not to counteract him. Which is a point well made and well taken by this writer, in terms of gender norms, but as someone who has found immense value in other aspects of Freudian theory (specifically On Mourning & Melancholia) I don’t see big pharma as a reification of all Freud, just the bad parts-ha! I already knew how troubling and misogynist tranquilizer and antidepressant ads were, but this book has a solid compendium of some of the worst offenders and it was helpful to see them in context with the articles of women’s magazines of the 50s/60s etc. Some of the analysis left me unconvinced, especially in the section on 90s Prozac literature. But certainly a good starting place for research/analysis.