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Listening to Prozac
Since it was introduced in 1987, Prozac has been prescribed to nearly five million Americans. But what is Prozac—a medication, or a mental steroid? A cure for depression, or a drug that changes personality? Reported to turn shy people into social butterflies and to improve work performance, memory, even dexterity, does Prozac work on character rather than illness? Are you using it "cosmetically," to make people more attractive? More energetic, more socially acceptable? And what does it tell us about the nature of character and the mutability of self?
480 pages, Paperback
First published January 1, 1993
101 people are currently reading
2546 people want to read
About the author
Peter D. Kramer
16 books74 followersPeter D. Kramer is the author of eight books, including Ordinarily Well, Against Depression, Should You Leave?, the novels Spectacular Happiness and Death of the Great Man, and the international bestseller Listening to Prozac. Dr. Kramer hosted the nationally syndicated public radio program The Infinite Mind and has appeared on the major broadcast news and talk shows, including Today, Good Morning America, The Oprah Winfrey Show, Charlie Rose, and Fresh Air. His essays, op-eds, and book reviews have appeared in the New York Times, Wall Street Journal, Washington Post, and elsewhere. For nearly forty years, Dr. Kramer taught and practiced psychiatry in Providence, Rhode Island, where he isEmeritus Professor of Psychiatry and Human Behavior at Brown University. He now writes full time.
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Displaying 1 - 30 of 96 reviews
August 22, 2013
In desperate need of a cognitive scientist
JDB 2456527 PDT 10:52.
A review of Listening to Prozac by Peter D. Kramer.
This was a book with great potential, but it failed to live up to most of that potential. The fundamental idea is a profound one that I wish more people would think about: What does cognitive science say about human nature?
The problem is that Kramer is not a cognitive scientist, he is a practicing psychiatrist. All of his understanding of the brain and mind is filtered through that lens; he spends most of the book explaining particular case studies in minute—sometimes excruciating—detail.
I had expected the title, Listening to Prozac, would be merely metonymous for psychopharmacology in general, or at least SSRI antidepressants in general; but in fact Kramer spends most of the book singing the praises of Prozac in particular, lending the entire book a strange parochial feeling—we are trying to assess the totality of human nature based on experiences with a single medication?
Kramer obviously struggles with the mind-body problem (as do we all I suppose); when he sees a drug affecting someone's behavior or personality, he suffers a kind of crisis of faith: If our minds can be affected by chemicals, how are they really minds? Are we just chemical automatons?
No, I say; that is what everyone gets wrong about cognitive science. The Basic Fact does not say that our minds are false; it does not say that our lives are meaningless; it does not say that we are automatons. The Basic Fact of Cognitive Science says that we are our brains, that everything we are—the things we really are, our thoughts, our feelings, our desires, our hopes, our fears—is made by our brains. The rainbow unweaved is still a rainbow.
Likewise, when he sees a homologue between humans and other animals, he fears that it reduces people to animals—instead of considering the possibility that it elevates animals to people. When he learns that rats and monkeys show the same behaviors and neurotransmitters we do under stress, depression, and loneliness, instead of realizing that this means they feel what we do, he instead tries to understand how it can be that human thoughts and feelings aren't real because they are made of animal parts.
That is the message that I get from listening to Prozac, and it is the message we should have gotten from Listening to Prozac. Altering the chemistry of our brains can alter our conscious experiences? Of course it can, for it is the chemistry of our brains that makes our conscious experiences! This fact should be no more surprising to us than the fact that running a magnet over your hard drive can erase your files, or the fact that smacking the side of an old UHF TV can sometimes clear the picture.
Indeed, the crudeness of medication shouldn't surprise us either; the numerous side effects, risks, and unpredictable results are exactly what you'd expect from running a magnet along a hard drive or smacking a UHF TV. You're trying to resolve a complex, subtle software problem with a brute-force hardware solution.
By comparison, the crudeness of psychotherapy is much more disappointing. It's obvious that it should be the right kind of solution—you fix software problems with software solutions—but we know so little about the underlying function of the human brain that we can't make it work. I guess we're better than cats walking across the keyboard, but we're something like EECS 101 students who keep forgetting to close their parentheses.
It's also possible that some more conventionally medical solution would be effective, but even then it won't be so "conventional"; we're talking about nanobots that deliver precision doses of serotonin reuptake inhibitor to particular nuclei in the amygdala. To use another machine analogy, filling your whole system with Prozac to treat depression is like fixing an oil leak by covering your car in oil.
Indeed, if there is anything surprising about our current psychiatric medicines, it is that they work at all; they are so hopelessly crude that the only way they could possibly be working is if the brain is already equipped with extremely powerful self-repair mechanisms that only need a nudge in the right direction. Further support for this view comes from the fact that electroconvulsive therapy sometimes works; it's the neurological equivalent of when a tech support intern tells you, "Have you tried turning it off and turning it back on?"
While the issues it raises are very compelling, I can't really recommend reading this book; Kramer's handling of these deep questions is just too haphazard.
JDB 2456527 PDT 10:52.
A review of Listening to Prozac by Peter D. Kramer.
This was a book with great potential, but it failed to live up to most of that potential. The fundamental idea is a profound one that I wish more people would think about: What does cognitive science say about human nature?
The problem is that Kramer is not a cognitive scientist, he is a practicing psychiatrist. All of his understanding of the brain and mind is filtered through that lens; he spends most of the book explaining particular case studies in minute—sometimes excruciating—detail.
I had expected the title, Listening to Prozac, would be merely metonymous for psychopharmacology in general, or at least SSRI antidepressants in general; but in fact Kramer spends most of the book singing the praises of Prozac in particular, lending the entire book a strange parochial feeling—we are trying to assess the totality of human nature based on experiences with a single medication?
Kramer obviously struggles with the mind-body problem (as do we all I suppose); when he sees a drug affecting someone's behavior or personality, he suffers a kind of crisis of faith: If our minds can be affected by chemicals, how are they really minds? Are we just chemical automatons?
No, I say; that is what everyone gets wrong about cognitive science. The Basic Fact does not say that our minds are false; it does not say that our lives are meaningless; it does not say that we are automatons. The Basic Fact of Cognitive Science says that we are our brains, that everything we are—the things we really are, our thoughts, our feelings, our desires, our hopes, our fears—is made by our brains. The rainbow unweaved is still a rainbow.
Likewise, when he sees a homologue between humans and other animals, he fears that it reduces people to animals—instead of considering the possibility that it elevates animals to people. When he learns that rats and monkeys show the same behaviors and neurotransmitters we do under stress, depression, and loneliness, instead of realizing that this means they feel what we do, he instead tries to understand how it can be that human thoughts and feelings aren't real because they are made of animal parts.
That is the message that I get from listening to Prozac, and it is the message we should have gotten from Listening to Prozac. Altering the chemistry of our brains can alter our conscious experiences? Of course it can, for it is the chemistry of our brains that makes our conscious experiences! This fact should be no more surprising to us than the fact that running a magnet over your hard drive can erase your files, or the fact that smacking the side of an old UHF TV can sometimes clear the picture.
Indeed, the crudeness of medication shouldn't surprise us either; the numerous side effects, risks, and unpredictable results are exactly what you'd expect from running a magnet along a hard drive or smacking a UHF TV. You're trying to resolve a complex, subtle software problem with a brute-force hardware solution.
By comparison, the crudeness of psychotherapy is much more disappointing. It's obvious that it should be the right kind of solution—you fix software problems with software solutions—but we know so little about the underlying function of the human brain that we can't make it work. I guess we're better than cats walking across the keyboard, but we're something like EECS 101 students who keep forgetting to close their parentheses.
It's also possible that some more conventionally medical solution would be effective, but even then it won't be so "conventional"; we're talking about nanobots that deliver precision doses of serotonin reuptake inhibitor to particular nuclei in the amygdala. To use another machine analogy, filling your whole system with Prozac to treat depression is like fixing an oil leak by covering your car in oil.
Indeed, if there is anything surprising about our current psychiatric medicines, it is that they work at all; they are so hopelessly crude that the only way they could possibly be working is if the brain is already equipped with extremely powerful self-repair mechanisms that only need a nudge in the right direction. Further support for this view comes from the fact that electroconvulsive therapy sometimes works; it's the neurological equivalent of when a tech support intern tells you, "Have you tried turning it off and turning it back on?"
While the issues it raises are very compelling, I can't really recommend reading this book; Kramer's handling of these deep questions is just too haphazard.
February 22, 2008
This excellent book, written when Prozac and other SSRI antidepressants were relatively new, is at times a little dated but still extremely interesting. Kramer is a phsychiatrist who had been treating patients with depression and other problems for years when Prozac became available. Prozac did not have the same severely limiting side effects that plagued the other antidepressants then available, which made it easier and safer to prescribe for patients who might normally have avoided medication. Kramer and other psychiatrists soon began to notice something interesting and disconcerting: patients who took Prozac for one condition often experienced a change across the board. Previously painfully shy, one patient discovered that she suddenly was able to date and flirt. Many patients reported feeling "better than normal" -- happier, brighter, more confident. For Kramer and other psychiatrists, this raised a multitude of questions about what constitutes mental illness, and what the implications are when a medication can change a person's personality so drastically. Had these people who now felt "better than normal" been ill all their lives, and were now well? Where does one draw the line between illness and personality?
Kramer explores all sides of the issue here, and while he is clearly impressed by the positive changes Prozac has wrought among his patients, he is also curious and concerned about the power of this antidepressant. One of the things I liked about this book is that I got the impression that Kramer is willing to have his mind changed -- he has formed ideas and philosophies about the use of antidepressants, but he seems to be constantly looking at and weighing the evidence, and monitoring how his methods of treating patients have changed since the advent of Prozac. I would like to locate a copy of the revised edition of this book, so I can read some of his commentary on this ever-changing issue in mental health.
Kramer explores all sides of the issue here, and while he is clearly impressed by the positive changes Prozac has wrought among his patients, he is also curious and concerned about the power of this antidepressant. One of the things I liked about this book is that I got the impression that Kramer is willing to have his mind changed -- he has formed ideas and philosophies about the use of antidepressants, but he seems to be constantly looking at and weighing the evidence, and monitoring how his methods of treating patients have changed since the advent of Prozac. I would like to locate a copy of the revised edition of this book, so I can read some of his commentary on this ever-changing issue in mental health.
March 10, 2021
به فرمان فلوکستین
کتاب این سوال اساسی را مطرح می کند که آیا با داروی پروزاک می توان شخصیت را جراحی زیبایی کرد؟ اینکه داروهای افسردگی و رواندرمانی چگونه اخلاق ، معنای زندگی و رفتار و جهان بینی ما را تغییر می دهند
واژه پروزاک همان نام تجاری فلوکستین است
شرح و بررسی کامل این کتاب ارزشمند را دکتر ایمان فانی تحت عنوان "اساس بیوشیمایی مغز" در چندین پادکست بررسی کرده که می توانید اینجا بشنوید که حتما ارزش شنیدن دارد
https://imanfani.com/%d9%be%d8%a7%db%...
https://podcasts.apple.com/us/podcast...
کتاب این سوال اساسی را مطرح می کند که آیا با داروی پروزاک می توان شخصیت را جراحی زیبایی کرد؟ اینکه داروهای افسردگی و رواندرمانی چگونه اخلاق ، معنای زندگی و رفتار و جهان بینی ما را تغییر می دهند
واژه پروزاک همان نام تجاری فلوکستین است
شرح و بررسی کامل این کتاب ارزشمند را دکتر ایمان فانی تحت عنوان "اساس بیوشیمایی مغز" در چندین پادکست بررسی کرده که می توانید اینجا بشنوید که حتما ارزش شنیدن دارد
https://imanfani.com/%d9%be%d8%a7%db%...
https://podcasts.apple.com/us/podcast...
November 7, 2022
درحقیقت سلسله برنامه های پادکست خوب " مدرسه زندگی فارسی " را در نُه قسمت شنیدم .
کتاب دردهه نود میلادی درباره "فلوکستین " یا پروزاک داروی ضد افسردگی نوشته شده . خوب وجامع . حتی برای کسانی چون من که آشنایی وزمینه علوم تجربی و پزشکی ندارند. تنوع مطالب و کثرت سوالات مطرح شده و مقایسه ها به حدّی است که زندگی هرکسی درهرسن وموقعیتی با گوشه ای و قسمتی وداستانی ازاین کتاب همپوشانی خواهد داشت . من شحصا" همیشه همراه با نوعی از وسواس فکری تن به استفاده ازاین داروها نداده ام حتی دربدترین ایام زندگی وبخشی از مطلب کتاب درباره آدمهایی چون من است . سوالات و قیاسهای بسیارمفید وخوبی مطرح میکند ونتیجه گیری قطعی هم ندارد .
تعجب میکنم که هنوزپس از سالها ازانتشارچنین کتابی ، ونظربه کثرت استفاده از انواع داروهایی ازاین دست ، این مباحث گسترده درکشورما هنوزچندان مطرح نیست یا شاید من اطلاع ندارم.
کتاب دردهه نود میلادی درباره "فلوکستین " یا پروزاک داروی ضد افسردگی نوشته شده . خوب وجامع . حتی برای کسانی چون من که آشنایی وزمینه علوم تجربی و پزشکی ندارند. تنوع مطالب و کثرت سوالات مطرح شده و مقایسه ها به حدّی است که زندگی هرکسی درهرسن وموقعیتی با گوشه ای و قسمتی وداستانی ازاین کتاب همپوشانی خواهد داشت . من شحصا" همیشه همراه با نوعی از وسواس فکری تن به استفاده ازاین داروها نداده ام حتی دربدترین ایام زندگی وبخشی از مطلب کتاب درباره آدمهایی چون من است . سوالات و قیاسهای بسیارمفید وخوبی مطرح میکند ونتیجه گیری قطعی هم ندارد .
تعجب میکنم که هنوزپس از سالها ازانتشارچنین کتابی ، ونظربه کثرت استفاده از انواع داروهایی ازاین دست ، این مباحث گسترده درکشورما هنوزچندان مطرح نیست یا شاید من اطلاع ندارم.
December 21, 2012
For years and years, I believed the negative hype about anti-depressants. Even though I have friends who have benefitted from the use of the drug, I stayed skeptical.
I am glad I came across this book. There was so much I didn't know about the history of the drug, how it came to be, how it works. The author also covers the background of psychotherapy in great depth, as well as research being done on the brain and how much of our anxiety and depression is a result of biological factors. Fascinating.
And of course he covers the ethical questions behind the drug as well - that is a main theme of the book. He leaves the reader to make their own decisions based on the research and evidence. I love an author who admits that we don't have all of the answers. When it comes to the complexity of the human brain, we may never have all of the answers.
It's not the easiest read, but most scientific books aren't easy to read. I walked away from this read feeling much more informed and with a much better perspective on anti-depressants (which is a misnomer) and how the brain works.
I am glad I came across this book. There was so much I didn't know about the history of the drug, how it came to be, how it works. The author also covers the background of psychotherapy in great depth, as well as research being done on the brain and how much of our anxiety and depression is a result of biological factors. Fascinating.
And of course he covers the ethical questions behind the drug as well - that is a main theme of the book. He leaves the reader to make their own decisions based on the research and evidence. I love an author who admits that we don't have all of the answers. When it comes to the complexity of the human brain, we may never have all of the answers.
It's not the easiest read, but most scientific books aren't easy to read. I walked away from this read feeling much more informed and with a much better perspective on anti-depressants (which is a misnomer) and how the brain works.
July 2, 2025
به فرمان فلوکستین.
این کتاب رو به روایت و خوانش دکتر ایمان فانی، در پادکست ″مدرسهی زندگی فارسی″ شنیدم. کتاب خوبی بود و خوانش و توضیحات دکتر فانی هم به فهم بهتر کتاب کمک کرد.
این کتاب رو به روایت و خوانش دکتر ایمان فانی، در پادکست ″مدرسهی زندگی فارسی″ شنیدم. کتاب خوبی بود و خوانش و توضیحات دکتر فانی هم به فهم بهتر کتاب کمک کرد.
August 3, 2024
مجموعه درس گفتار های 《مدرسه زندگی》درباره این کتاب رو گوش دادم
December 7, 2011
An interesting exploration of how drugs like Prozac change personality in some patients (making shy people not shy in some cases) and how human beings are biological creatures who can be changed by chemistry. Most interesting for me (since the book may be some what dated science wise) were the passages about how contemporary life requires a certain kind of personality--outgoing, quick thinking, multi-tasking--that is a relatively recent development. Considering how certain personality types might be more valued in contemporary culture but others not (for instance, how a melancholiac personality was appropriate in certain Victorian circles) was pretty interesting. His arguments that relate prozac and similar drugs to optional surgeries like breast enhancement were a little weak. Just because it makes an individual person "happier" doesn't mean we should necessarily use a drug in this way (especially when the verdict on long-term effects is still a bit out). I am not recommending that people with serious depression not take medication--these SSRIs seem great for that for many people--but when he equites a mood enhancing drug with plastic surgery I am struck by the underpinnings of gender in his analysis. What are the statistics on women on SSRIs? Is depression and thus medication more of a female thing? Would this "problem" be mitigated in a less misogynist culture? Should we be working on changing the culture or the individual people in it? I want a feminist sequel to this book. (To give him credit, he does mention gender, but while most of his patients are female, he doesn't go far enough in his analysis.)
July 25, 2016
I appreciate the depth to which Kramer dove into the ethical questions surrounding Prozac and other "anti-depressants" (he deconstructs this term in order to explain these drugs without preconceived notions). While it wasn't the easiest read (many detailed case studies and scientific terms), he does a great job keeping an open mind and helping you to develop your own opinion.
Something I had not thought of before reading this is that different societies and eras prize different personality types. For example, a melancholy personality could have been more valuable in Victorian era than it would be today, where fast moving, quick-witted, outgoing personalities thrive. (Would Prozac be as sought-after then as it is now?)
This book was written awhile ago, but the interesting questions it asks about psychotropics are still very relevant today. This book left me with more questions than answers, which I consider to be a good thing.
Something I had not thought of before reading this is that different societies and eras prize different personality types. For example, a melancholy personality could have been more valuable in Victorian era than it would be today, where fast moving, quick-witted, outgoing personalities thrive. (Would Prozac be as sought-after then as it is now?)
This book was written awhile ago, but the interesting questions it asks about psychotropics are still very relevant today. This book left me with more questions than answers, which I consider to be a good thing.
September 19, 2021
قبلا از تاثیر و تاثر متقابل متابولیتهای شیمیایی بر وضع روانی انسان مطلع بودیم. این کتاب با توضیح بیشتر بر پایهی داروی جدیدا ساخته شدهی فلوکستین به ما نشون میده چقدر قضیه از چیزی که فکر میکردیم پیچیدهتره، و چطوری یک دارو میتونه کل شخصیت انسان رو عوض کنه. من که بینهایت لذت بردم.
October 11, 2019
Dr. Peter D. Kramer doesn't know how Prozac works, or even exactly what it does, and he's not 100% sure it doesn't have any side effects, but he really, really, really thinks you should be taking it.
April 16, 2025
biased review. i think kramer er en af de psykiatere der i forlængelse af deres medicinerfaglighed synes de er eksperter i alle facetter af menneskehedens eksistens. “i study ill humans so i know what makes a healthy one” headass. i will not go into detail on every scientific presumptions simply because ingen burde læse en bog om SSRI fra 90’erne. antag at alt er forældet. ikke mindst det psykiatriske regime, kramer taler ind
Read
April 16, 2025I was 2/3rds of the way through listening to Listening to Prozac when I realised I was listening to Listening to Prozac Abridged 😔
January 3, 2012
I heard this author interviewed on NPR when the book first came out. I was fascinated by the concepts that he brought up regarding the ethical, philosophical, and sociological ramifications of treating minor mood disorders with psychopharmaceuticals (Prozac just being one). I finally found the book in a used book store and enjoyed it very much.
Some portions are more intersting than others, but that's SOP for a book of this type. Different readers won't agree on the good/bad parts. It depends on what experience and interest you bring with you. I especially enjoyed the parts about how some users were made "better than well." In other words, they much preferred their new, 'brighter' personality to their pre-depression personality. Therefore, they wanted to stay on the drug even after their depression was alleviated. Is being more self-confident, out-going, and socially secure, a bad thing if it's the result of a pill and not of your basic temperament? What if the only difference is your body's natural brain chemistry, and the pill just help regulate that chemistry into the upper range of natural variation?
After you read this, you won't look at people (including yourself) who take mood-altering substances quite the same as before; whether it's alcohol, pot, or Prozac. Is it bad to take a mood-altering drug like Prozac, but acceptable to need a drink (or two) at a party to get in the swing of things? How about that obligatory caffeine in the morning? Interesting questions always seem to have subtle implications and no simple answers.
Some portions are more intersting than others, but that's SOP for a book of this type. Different readers won't agree on the good/bad parts. It depends on what experience and interest you bring with you. I especially enjoyed the parts about how some users were made "better than well." In other words, they much preferred their new, 'brighter' personality to their pre-depression personality. Therefore, they wanted to stay on the drug even after their depression was alleviated. Is being more self-confident, out-going, and socially secure, a bad thing if it's the result of a pill and not of your basic temperament? What if the only difference is your body's natural brain chemistry, and the pill just help regulate that chemistry into the upper range of natural variation?
After you read this, you won't look at people (including yourself) who take mood-altering substances quite the same as before; whether it's alcohol, pot, or Prozac. Is it bad to take a mood-altering drug like Prozac, but acceptable to need a drink (or two) at a party to get in the swing of things? How about that obligatory caffeine in the morning? Interesting questions always seem to have subtle implications and no simple answers.
October 13, 2023
Very well written book. The references are a little sophisticated, but that should probably be expected given the writer's background. The cases are interesting and are relevant to the chapter albeit, sometimes it takes awhile make the connection. All in all, it is a very interesting book and offers a first person perspective from a psychiatrist about the Prozac in the context of other antidepressants, anxiolytic, history, and notoriety that are often overlooked and occur in the background.
October 9, 2023
A fascinating look at the debut of Prozac on the national stage from one of its early champions. Reading it now for historical context, it’s stunning how rapidly medical technology has moved and what we have learned and still have left to discover.
There are also some beautiful examinations of the human psyche that are a joy to read for their insight as well as their applicability onto the universal experience.
There are also some beautiful examinations of the human psyche that are a joy to read for their insight as well as their applicability onto the universal experience.
December 28, 2019
Fascinating book on thymoleptics, especially on SSRIs, and on the questions they evoke about the nature of the self. What properties are intrinsic to self? Are unsavory aspects of personality like high rejection-sensitivity so essential to one's person that it'd be wrong to medicate that away without a clear diagnosis of a recognized mental illness? Will these drugs pressure folks who aren't in need to take them to conform to societal standards that the drugs help one come into conformity with? What about the question of biological reductionism?
A very thoughtful book that engages with these kinds of questions.
A very thoughtful book that engages with these kinds of questions.
January 18, 2008
In exploring the role of experience on mood, in chapter five Kramer turns to various observations on "rapid-cycling." Certain people have been observed to swing back and forth between dark depression and wild euphoria in a matter of hours, seemingly with very small (or no) external provocations (pp.108-109).
Kramer applies three models, which he sees are interconnecting, to this issue. First, Kramer summarizes the finding of Robert Post and his "kindling model." Post's work concluded that rapid-cycling was often the end stage of a long-term recurring problem. "The general pattern was a decrease in the interval between episodes and an increase in the severity and complexity of the episodes, until finally rapid cycling set in" (p.109). As time passes, Post's studies seem to indicate, ever smaller stimuli are needed to provoke ever severe episodes. While many biological processes operate in the opposite way, requiring ever greater amounts of stimulus (street drugs, etc.), others (epilepsy; bipolar conditions, etc.) are "kindled." Interestingly, two seemingly unrelated conditions that are "kindled" seemed to respond positively to the same medications (pp. 112f.).
The second model Kramer discusses here is that suggested by stress research in rats (pp.116-118). The rat studies "impl(y) that a variety of psychosocial stressors can serve as triggers" for the biologically encoded factors "kindled" in depression (p. 122).
The third model examined in chapter five is the monkey-separation studies (pp.118-122). Rhesus monkeys seem especially helpful in reflecting on human problems due to similarities between the species (p.118). Kramer concludes from these studies that in the early stages of stress-induced kindling subjects will appear very normal, except that they will have a somewhat heightened sensitivity to loss (p. 122).
Kramer concludes that pain brings scars, even when it does not seem to immediately result in depression (p. 123). He explains, "What distinguishes this view of depression from, say, traditional psychoanalytic models is the recognition that the scars are not, or not only, in cognitive memory. It is not merely a question of inner conflict or of `growing up': `Stop fussing over what your parents did to you!' as skeptics command patients in therapy. The scar consists of changed anatomy and chemistry within the brain (emphasis added)" (p. 123). Kramer notes the implications of his neurobiological conclusions: "It seems that the neural pathways are like the joints in the musculoskeletal system. They are worn down over the years by inevitable trauma... Age alone seems a trauma... if we live long enough we will all become depressed" (p. 135).
The point of this is that Kramer believes that Prozac can have a key role in the treatment of relatively `minor depressive illness' (p. 126). If diagnosed early enough, Prozac and SSRIs "can help prevent the progression of early mood disorder into florid illness" (p. 127).
I do not know what to conclude about this. There are many who dispute this view of neurobiology. But even if Kramer is partly correct in these conclusions, as Ed Welch points out in Blame it on the Brain (1998), the body is the mediator of moral action, not the initiator. It is the `equipment of the heart' (p. 40). Bad thoughts and actions, in response to the temptations presented by stressful circumstances, can impact the body. Perhaps my failures to deal with trauma help cause the depression I suffer, and this depression may have permanent physiological effects. The returning feelings of depression that I now wrestle with may be, as Welch contends, `body' rather than `heart' problems (Welch, p. 45), but my response to those feelings is still a spiritual issue not a brain issue. Prozac, or any other treatment that seeks to address the brain alone, can not hope to get at the critical heart issues involved in depression.
Kramer applies three models, which he sees are interconnecting, to this issue. First, Kramer summarizes the finding of Robert Post and his "kindling model." Post's work concluded that rapid-cycling was often the end stage of a long-term recurring problem. "The general pattern was a decrease in the interval between episodes and an increase in the severity and complexity of the episodes, until finally rapid cycling set in" (p.109). As time passes, Post's studies seem to indicate, ever smaller stimuli are needed to provoke ever severe episodes. While many biological processes operate in the opposite way, requiring ever greater amounts of stimulus (street drugs, etc.), others (epilepsy; bipolar conditions, etc.) are "kindled." Interestingly, two seemingly unrelated conditions that are "kindled" seemed to respond positively to the same medications (pp. 112f.).
The second model Kramer discusses here is that suggested by stress research in rats (pp.116-118). The rat studies "impl(y) that a variety of psychosocial stressors can serve as triggers" for the biologically encoded factors "kindled" in depression (p. 122).
The third model examined in chapter five is the monkey-separation studies (pp.118-122). Rhesus monkeys seem especially helpful in reflecting on human problems due to similarities between the species (p.118). Kramer concludes from these studies that in the early stages of stress-induced kindling subjects will appear very normal, except that they will have a somewhat heightened sensitivity to loss (p. 122).
Kramer concludes that pain brings scars, even when it does not seem to immediately result in depression (p. 123). He explains, "What distinguishes this view of depression from, say, traditional psychoanalytic models is the recognition that the scars are not, or not only, in cognitive memory. It is not merely a question of inner conflict or of `growing up': `Stop fussing over what your parents did to you!' as skeptics command patients in therapy. The scar consists of changed anatomy and chemistry within the brain (emphasis added)" (p. 123). Kramer notes the implications of his neurobiological conclusions: "It seems that the neural pathways are like the joints in the musculoskeletal system. They are worn down over the years by inevitable trauma... Age alone seems a trauma... if we live long enough we will all become depressed" (p. 135).
The point of this is that Kramer believes that Prozac can have a key role in the treatment of relatively `minor depressive illness' (p. 126). If diagnosed early enough, Prozac and SSRIs "can help prevent the progression of early mood disorder into florid illness" (p. 127).
I do not know what to conclude about this. There are many who dispute this view of neurobiology. But even if Kramer is partly correct in these conclusions, as Ed Welch points out in Blame it on the Brain (1998), the body is the mediator of moral action, not the initiator. It is the `equipment of the heart' (p. 40). Bad thoughts and actions, in response to the temptations presented by stressful circumstances, can impact the body. Perhaps my failures to deal with trauma help cause the depression I suffer, and this depression may have permanent physiological effects. The returning feelings of depression that I now wrestle with may be, as Welch contends, `body' rather than `heart' problems (Welch, p. 45), but my response to those feelings is still a spiritual issue not a brain issue. Prozac, or any other treatment that seeks to address the brain alone, can not hope to get at the critical heart issues involved in depression.
October 19, 2025
A PRACTICING PSYCHIATRIST GIVES A BROAD SURVEY OF THE DRUG AND ITS INFLUENCE
Psychiatrist Peter Kramer (who teaches at Brown Medical School) wrote in the Introduction to this 1993 book, “I was used to seeing patients’ personalities change slowly, through painfully acquired and hard practice in the world. But recently I had seen personalities altered almost instantly, by medication… Prozac---the new antidepressant---was the main agent of change… Prozac was transformative for patients … it made them want to talk about their experience. And what my patients generally said was that they had learned something about themselves from Prozac… they believed Prozac revealed what in them was biologically determined and what merely … experiential. I called this phenomenon ‘listening to Prozac.’” (Pg. xiv-xv)
He continues, “I write a monthly column in a trade paper for psychiatrists, an in it I began musing aloud about Prozac… my mnemonic for this effect was ‘cosmetic psychopharmacology.’ That two-word phrase … made me instantly popular … in March 1990, the drug was hot… I was the psychiatrist who had written about Prozac---I had said out loud what thousands of doctors had observed---and as a result, I was due my fifteen minutes in the limelight. I was … finally referenced in … 'The New England Journal of Medicine.’ After that flurry of activity, I continued to track Prozac’s fame.” (Pg. xvi)
He goes on, “I have focused on this phenomenon because I find it intriguing and because I believe it has the power to influence the way we understand human nature. As a result, I have all but ignored certain issues. Side effects, for example, though they should play an important role in anyone’s decision to take or forego Prozac… The controversy over Prozac and suicide and violence… I treat in an appendix... I have limited myself to exploring the impact of mood-altering drugs on the modern sense of self… it has been my own patients’ responses to medication that has shaped my conjectures. These stories of people experiencing inner change will, I hope, take the reader… [to] a point at which such concepts as mood, personality, and self become at once unstable and fascinating.” (Pg. xix)
In Chapter 1, he states, “Pharmacotherapy, when looked at closely, will appear to be as arbitrary… as psychotherapy. Like any other serious assessment of human emotional life, pharmacotherapy properly rests on fallible attempts at intimate understanding of another person.” (Pg. 6)
He suggests, “we are edging toward what might be called the ‘medicalization of personality.’ … once we say that traits on both the depressive-to-manic and the obsessional-to-hysteric continua respond to medication, we are over the edge. The two spectra cover a good deal of what makes different people distinctive.” (Pg. 37)
He observes, “The embarrassing truth about clinical work with antidepressants was that it was all art and no science. Various combinations of symptoms were said to be more serotonin- or norepinephrine-related, and various strategies were advanced for trying medications in logical order for particular sorts of patients. But these strategies varied from year to year, and even from one part of the country to another. It was true that a given patient might respond to one antidepressant after having failed to respond to another, but the doctor would have to manufacture a reason to explain why.” (Pg. 59)
He cites one of his patients: “The medicine [Prozac], he said, gave him the will and the means to continue to face himself, and he soon left psychotherapeutic treatment again, to continue his private exploration, returning to see me only for brief, infrequent meetings to discuss medication management. This statement of independence, Paul felt, differed from the others. In the past, he had wanted therapy but denied himself; now he felt just beyond the need for psychotherapy. He did consider Prozac a ‘crutch,’ but said, ‘What the hell. Some people need a crutch to walk.’” (Pg. 219-220)
He states, “The various models of self-esteem remain to be integrated. But with the belief that self-esteem is as much physiological and psychological, we have moved a long distance toward ending the hegemony of mind over brain in our concept of the self… As regards such issues as self-esteem, the contemporary mind is like a stroke victim who had lost both recognition of the physical self and memory of its own past but is now, with the help of medication, regaining both the proprioception and an awareness of its history.” (Pg. 222)
He explains, ‘The treatment of anhedonia with Prozac helps to clarify the distinction between drug use and drug abuse. Prozac does not provide pleasure; it restores the capacity for pleasure. It is neither excitatory like cocaine nor satisfying like heroin. The drug taker does not crave Prozac and does not feel relief when Prozac enters the system. The desired effect, a change in responsiveness to ordinary pleasures, occurs gradually and is unrelated to the daily act of consuming the drug.” (Pg. 233)
He notes that for some therapists, “Cure by pill is seen as dehumanizing when compared with psychotherapy, even the parts of psychotherapy that provide support rather than insight. The problem is not that the medicine fails to confer affect tolerance or fails to move people toward an adaptive interaction with reality but, rather, that it succeeds. In doing just what psychotherapy aims to do, Prozac performs chemically what has heretofore been an intimate interpersonal function.” (Pg. 259)
He asserts, “Prozac … induces pleasure in part by freeing people to enjoy activities that are social and productive. And, unlike marijuana or LSD or even alcohol, it does so without being experienced as pleasurable in itself and without inducing distortions of perception. Prozac simply gives anhedonic people access to pleasures identical to those enjoyed by other normal people in their ordinary social pursuits.” Pg. 265)
He acknowledges, “On the one hand, Prozac supports social stasis by allowing people to move toward a cultural ideal---the flexible, contented, energetic, pleasure-driven consumer. In the popular imagination, Prozac can serve as a modern opiate, seducing the citizenry into political conformity.” (Pg. 271-272)
He reports, “That phrase [‘pharmacological Calvinism’] was coined … by the late Gerald Klerman, a pioneering researcher into … both drug treatments and psychotherapy. Thinking about psychotropics in the late sixties and early seventies inevitably was influenced by the mushrooming use of street drugs … Klerman characterized the contrasting reactions as psychotropic hedonism and pharmacological Calvinism. He defined the latter as ‘a general distrust of drugs used for nontherapeutic purposes and a conviction that if a drug "makes you feel good, it must be morally bad.’’” (Pg. 274)
He states, “The personality-altering pill is high technology, something unknowable, foreign, perhaps even hostile. Prozac arises from the science of twenty years ago; even that science is so complex it is beyond the reach not just of lay people but of most practicing doctors. Psychoanalysis was criticized for creating a cult or expertise, but analysis is at least a joint effort, a journey of self-exploration for the patient, with feeling, insight, and intuition as guides. In this context, pharmacology may be experienced as self-alienating even when, in particular instances, it restores people to themselves. Having diminished the power of psychoanalysis, we are all the more at the mercy of professional knowledge. In this regard, we may recognize in ourselves a certain prejudice, in favor of humanism… and against science.” (Pg. 299)
He summarizes, “None of the ethical concerns about Prozac---its influence on affect tolerance, autonomy and coercion, cultural expectations, evolutionary fitness, transcendence---have disappeared. But once we have lived with Prozac for a while, once we have taken the measure of the drug, and once it has worked on [us], those worries may seem less urgent. Our worst fear… was that medication would rob us of what is uniquely human: anxiety, guilt, shame, grief, self-consciousness. Instead, medication may have convinced us that those affects are not uniquely human, although how we use or respond to them surely is.” (Pg. 299)
He continues, “Like psychoanalysis, Prozac exerts influence not only in its interaction with individual patients, but through its effect on contemporary thought. In time, I suspect we will come to discover that modern pharmacology has become, like Freud in his day, a whole climate of opinion under which we conduct our different lives.” (Pg. 300)
This book will be of great interest to those studying Prozac as well as modern pharmacology.
Psychiatrist Peter Kramer (who teaches at Brown Medical School) wrote in the Introduction to this 1993 book, “I was used to seeing patients’ personalities change slowly, through painfully acquired and hard practice in the world. But recently I had seen personalities altered almost instantly, by medication… Prozac---the new antidepressant---was the main agent of change… Prozac was transformative for patients … it made them want to talk about their experience. And what my patients generally said was that they had learned something about themselves from Prozac… they believed Prozac revealed what in them was biologically determined and what merely … experiential. I called this phenomenon ‘listening to Prozac.’” (Pg. xiv-xv)
He continues, “I write a monthly column in a trade paper for psychiatrists, an in it I began musing aloud about Prozac… my mnemonic for this effect was ‘cosmetic psychopharmacology.’ That two-word phrase … made me instantly popular … in March 1990, the drug was hot… I was the psychiatrist who had written about Prozac---I had said out loud what thousands of doctors had observed---and as a result, I was due my fifteen minutes in the limelight. I was … finally referenced in … 'The New England Journal of Medicine.’ After that flurry of activity, I continued to track Prozac’s fame.” (Pg. xvi)
He goes on, “I have focused on this phenomenon because I find it intriguing and because I believe it has the power to influence the way we understand human nature. As a result, I have all but ignored certain issues. Side effects, for example, though they should play an important role in anyone’s decision to take or forego Prozac… The controversy over Prozac and suicide and violence… I treat in an appendix... I have limited myself to exploring the impact of mood-altering drugs on the modern sense of self… it has been my own patients’ responses to medication that has shaped my conjectures. These stories of people experiencing inner change will, I hope, take the reader… [to] a point at which such concepts as mood, personality, and self become at once unstable and fascinating.” (Pg. xix)
In Chapter 1, he states, “Pharmacotherapy, when looked at closely, will appear to be as arbitrary… as psychotherapy. Like any other serious assessment of human emotional life, pharmacotherapy properly rests on fallible attempts at intimate understanding of another person.” (Pg. 6)
He suggests, “we are edging toward what might be called the ‘medicalization of personality.’ … once we say that traits on both the depressive-to-manic and the obsessional-to-hysteric continua respond to medication, we are over the edge. The two spectra cover a good deal of what makes different people distinctive.” (Pg. 37)
He observes, “The embarrassing truth about clinical work with antidepressants was that it was all art and no science. Various combinations of symptoms were said to be more serotonin- or norepinephrine-related, and various strategies were advanced for trying medications in logical order for particular sorts of patients. But these strategies varied from year to year, and even from one part of the country to another. It was true that a given patient might respond to one antidepressant after having failed to respond to another, but the doctor would have to manufacture a reason to explain why.” (Pg. 59)
He cites one of his patients: “The medicine [Prozac], he said, gave him the will and the means to continue to face himself, and he soon left psychotherapeutic treatment again, to continue his private exploration, returning to see me only for brief, infrequent meetings to discuss medication management. This statement of independence, Paul felt, differed from the others. In the past, he had wanted therapy but denied himself; now he felt just beyond the need for psychotherapy. He did consider Prozac a ‘crutch,’ but said, ‘What the hell. Some people need a crutch to walk.’” (Pg. 219-220)
He states, “The various models of self-esteem remain to be integrated. But with the belief that self-esteem is as much physiological and psychological, we have moved a long distance toward ending the hegemony of mind over brain in our concept of the self… As regards such issues as self-esteem, the contemporary mind is like a stroke victim who had lost both recognition of the physical self and memory of its own past but is now, with the help of medication, regaining both the proprioception and an awareness of its history.” (Pg. 222)
He explains, ‘The treatment of anhedonia with Prozac helps to clarify the distinction between drug use and drug abuse. Prozac does not provide pleasure; it restores the capacity for pleasure. It is neither excitatory like cocaine nor satisfying like heroin. The drug taker does not crave Prozac and does not feel relief when Prozac enters the system. The desired effect, a change in responsiveness to ordinary pleasures, occurs gradually and is unrelated to the daily act of consuming the drug.” (Pg. 233)
He notes that for some therapists, “Cure by pill is seen as dehumanizing when compared with psychotherapy, even the parts of psychotherapy that provide support rather than insight. The problem is not that the medicine fails to confer affect tolerance or fails to move people toward an adaptive interaction with reality but, rather, that it succeeds. In doing just what psychotherapy aims to do, Prozac performs chemically what has heretofore been an intimate interpersonal function.” (Pg. 259)
He asserts, “Prozac … induces pleasure in part by freeing people to enjoy activities that are social and productive. And, unlike marijuana or LSD or even alcohol, it does so without being experienced as pleasurable in itself and without inducing distortions of perception. Prozac simply gives anhedonic people access to pleasures identical to those enjoyed by other normal people in their ordinary social pursuits.” Pg. 265)
He acknowledges, “On the one hand, Prozac supports social stasis by allowing people to move toward a cultural ideal---the flexible, contented, energetic, pleasure-driven consumer. In the popular imagination, Prozac can serve as a modern opiate, seducing the citizenry into political conformity.” (Pg. 271-272)
He reports, “That phrase [‘pharmacological Calvinism’] was coined … by the late Gerald Klerman, a pioneering researcher into … both drug treatments and psychotherapy. Thinking about psychotropics in the late sixties and early seventies inevitably was influenced by the mushrooming use of street drugs … Klerman characterized the contrasting reactions as psychotropic hedonism and pharmacological Calvinism. He defined the latter as ‘a general distrust of drugs used for nontherapeutic purposes and a conviction that if a drug "makes you feel good, it must be morally bad.’’” (Pg. 274)
He states, “The personality-altering pill is high technology, something unknowable, foreign, perhaps even hostile. Prozac arises from the science of twenty years ago; even that science is so complex it is beyond the reach not just of lay people but of most practicing doctors. Psychoanalysis was criticized for creating a cult or expertise, but analysis is at least a joint effort, a journey of self-exploration for the patient, with feeling, insight, and intuition as guides. In this context, pharmacology may be experienced as self-alienating even when, in particular instances, it restores people to themselves. Having diminished the power of psychoanalysis, we are all the more at the mercy of professional knowledge. In this regard, we may recognize in ourselves a certain prejudice, in favor of humanism… and against science.” (Pg. 299)
He summarizes, “None of the ethical concerns about Prozac---its influence on affect tolerance, autonomy and coercion, cultural expectations, evolutionary fitness, transcendence---have disappeared. But once we have lived with Prozac for a while, once we have taken the measure of the drug, and once it has worked on [us], those worries may seem less urgent. Our worst fear… was that medication would rob us of what is uniquely human: anxiety, guilt, shame, grief, self-consciousness. Instead, medication may have convinced us that those affects are not uniquely human, although how we use or respond to them surely is.” (Pg. 299)
He continues, “Like psychoanalysis, Prozac exerts influence not only in its interaction with individual patients, but through its effect on contemporary thought. In time, I suspect we will come to discover that modern pharmacology has become, like Freud in his day, a whole climate of opinion under which we conduct our different lives.” (Pg. 300)
This book will be of great interest to those studying Prozac as well as modern pharmacology.
March 28, 2021
برای کسانی که بیس علمی پزشکی و روانپزشکی دارند...می تواند کتاب خوبی باشد.
November 8, 2022
I did not realize this was the abridged version but it is fine as I could not take any more of this book than the abridged version. This was recommended to me by an older colleague and other than it being an interesting snapshot into the beliefs of psychiatrists in the early 90's, reading it now is just bizarre.
First off I have seen probably thousands of people on SSRIs and no one responds in the way described in the book. SSRIs are described as "mood brighteners" and "personality changing" and "cosmetic psychiatry" and that they can take away "anxiety, grief, melancholia, rejection sensitivity..." so the entire premise of the book is a philosophical pondering on whether or not this is good for us as society and us as people. It is very Brave New World which is an interesting conversation to have, except I have never seen these incredible effects he is talking about. What is he talking about? That Prozac alleviates grief? That you can give Prozac to a euthymic person and they will feel brighter? What was in the Prozac of the 90s? Then there was this section about Prozac being a "feminist drug" basically because it alleviates hysteria and allows women to be higher functioning and after that I was so turned off though now that I think about the colleague who recommended this to me, it tracks.
First off I have seen probably thousands of people on SSRIs and no one responds in the way described in the book. SSRIs are described as "mood brighteners" and "personality changing" and "cosmetic psychiatry" and that they can take away "anxiety, grief, melancholia, rejection sensitivity..." so the entire premise of the book is a philosophical pondering on whether or not this is good for us as society and us as people. It is very Brave New World which is an interesting conversation to have, except I have never seen these incredible effects he is talking about. What is he talking about? That Prozac alleviates grief? That you can give Prozac to a euthymic person and they will feel brighter? What was in the Prozac of the 90s? Then there was this section about Prozac being a "feminist drug" basically because it alleviates hysteria and allows women to be higher functioning and after that I was so turned off though now that I think about the colleague who recommended this to me, it tracks.
February 27, 2013
Dr. Peter D. Kramer explores an important question: "Is the person who is anxious and confused less pathological than the one who is complacent and tranquilized?" In layman's terms, what is real and what is not? Dr. Kramer's in-depth look at the before and after pictures of real-case histories are helpful, but not all inclusive evidence for or against such pharmacological methods. Other questions are raised. Can the here-to-fore pathological murderer be stopped before he starts with chemical methods? Is it even ethical? In lieu of the fact that technology is changing the world faster than the human psyche is able to adjust ethically, more questions will rise and need to be answered. "Prozac" is a good start, one in which even a layman can understand. Kramer does not impose his will, he shares his observations and he informs. I recommend this book to anyone interested in human nature, modern ethics and/or the divisions of character, temperament, and personality in the human species.
October 10, 2008
Absolutely superb and incisive foray by one psychiatrist into how SSRI's have turned psychiatry on its head - patient transformations that previously took 5 or 10 years of therapy can now be accomplished with a pill in 2 weeks.
You don't have to be sick to benefit from this technology either. One can now mix and match neuropharmacological agents to induce near any kind of state - tailor made to achieving material results, friendships, or just the kind of mental state one might want.
Of course, Dr. Kramer would jump out of his skin if he read this; but there's the truth nonetheless.
Very enlightening. If I doubted that peak emotional experiences can manifest in permanently altered neurochemistry before I read this book, I no longer labor under that misconception.
You don't have to be sick to benefit from this technology either. One can now mix and match neuropharmacological agents to induce near any kind of state - tailor made to achieving material results, friendships, or just the kind of mental state one might want.
Of course, Dr. Kramer would jump out of his skin if he read this; but there's the truth nonetheless.
Very enlightening. If I doubted that peak emotional experiences can manifest in permanently altered neurochemistry before I read this book, I no longer labor under that misconception.
August 6, 2018
this is a rather old book that came out within several years of the emergence of Prozac. it raises some interesting questions about mind and brain as well as gives a lot of history into the making of medications for depression and anxiety.
having been on Prozac for five years it misses some huge aspects of taking it. the side effects are not minimal as this book declares them to be.
I look forward to reading "Talking back to Prozac" but am glad to have read this book first.
having been on Prozac for five years it misses some huge aspects of taking it. the side effects are not minimal as this book declares them to be.
I look forward to reading "Talking back to Prozac" but am glad to have read this book first.
April 19, 2008
starts of interesting then just gets padded to book length.
December 17, 2024
a fascinating book about how prozac overhauls some people’s entire personalities, and the grave responsibility doctors should be more concision of in prescribing it
February 11, 2025
Sophocles and Philoctetes
trauma and pain gives you insight and wisdom, but medication helps you find a baseline after fucking around and finding out
Medications are so well developed to treat certain presenting symptoms with such mechanistic precision, that when they are taken off the drug they go back to their old selves... We are providing medications that treat things we dont fully understand, creating drug dependency without rehabilitation
The more we understand, the more we view existence as being biologically determined rather than learned and nurtured
Art and neurosis
Anxiety as the basis of psychological disorder
is the anxious person less alienated than the sedated via medication; is anxiety a summons to authentic existence?
Dominance hierarchy
you release more happy chemicals when you are with other people and when you are at the top of the chain of command
Percy's theory: Wissenschaft(professional knowledge) and information (like reading the news and raw data from the environment)
Unhappiness is the stimulus to search for authenticity
Animal studies are not a good way to understand human behavior
medications are archaeological digs to better understand the mind
dysthemic / hyperthemic
traditional psychoanalysis uses Oedipal complex, not examination of temperament
psychopharmacology
descriptive psychiatry
psychoanalysis
cosmetic psychopharmacology
21st century neurosis - risk and stress
20th century neurosis - castration anxiety, unanalyzed self
psychotherapy
phylogenetic
anhedonia -- lack of feeling any pleasure
existential anxiety and self alientation -- loss of identification with moral guideposts and animal selves
dominance does not mean aggression -- higher testosterone is not more aggressive -- low serotonin increases aggression
biochemical relationship between suicide and aggression
trauma and pain gives you insight and wisdom, but medication helps you find a baseline after fucking around and finding out
Medications are so well developed to treat certain presenting symptoms with such mechanistic precision, that when they are taken off the drug they go back to their old selves... We are providing medications that treat things we dont fully understand, creating drug dependency without rehabilitation
The more we understand, the more we view existence as being biologically determined rather than learned and nurtured
Art and neurosis
Anxiety as the basis of psychological disorder
is the anxious person less alienated than the sedated via medication; is anxiety a summons to authentic existence?
Dominance hierarchy
you release more happy chemicals when you are with other people and when you are at the top of the chain of command
Percy's theory: Wissenschaft(professional knowledge) and information (like reading the news and raw data from the environment)
Unhappiness is the stimulus to search for authenticity
Animal studies are not a good way to understand human behavior
medications are archaeological digs to better understand the mind
dysthemic / hyperthemic
traditional psychoanalysis uses Oedipal complex, not examination of temperament
psychopharmacology
descriptive psychiatry
psychoanalysis
cosmetic psychopharmacology
21st century neurosis - risk and stress
20th century neurosis - castration anxiety, unanalyzed self
psychotherapy
phylogenetic
anhedonia -- lack of feeling any pleasure
existential anxiety and self alientation -- loss of identification with moral guideposts and animal selves
dominance does not mean aggression -- higher testosterone is not more aggressive -- low serotonin increases aggression
biochemical relationship between suicide and aggression
to-keep-reference
August 27, 2018In Listening to Prozac, Peter Kramer presents case studies of his patients whose long-standing depression or anxiety was cured by Prozac, and whose personalities then bloomed— greater self-confidence, greater resilience in the face of setbacks, and more joy, all of which sometimes led
to big changes in careers and relationships. These cases conform to an idealized medical narrative: person suffers from lifelong disease; medical breakthrough cures disease; person released from shackles, celebrates new freedom; closing shot of person playing joyously with children; fade to
black. But Kramer also tells fascinating stories about people who were not ill, who met no diagnostic category for a mental disorder, and who just had the sorts of neuroses and personality quirks that most people have to some degree—fear of criticism, inability to be happy when not in a relationship, tendency to be too critical and overcontrolling of spouse and children. Like
all personality traits, these are hard to change, but they are what talk therapy is designed to address. Therapy cant usually change personality, but it can teach you ways of working around your problematic traits. Yet when Kramer prescribed Prozac, the offending traits went away Lifelong habits, gone overnight (five weeks after starting Prozac), whereas years of psychotherapy
often had done nothing. This is why Kramer coined the term “cosmetic psychopharmacology,” for Prozac seemed to promise that psychiatrists could shape and perfect minds just as plastic surgeons shape and perfect bodies.
The Happiness Hypothesis Pág.41
to big changes in careers and relationships. These cases conform to an idealized medical narrative: person suffers from lifelong disease; medical breakthrough cures disease; person released from shackles, celebrates new freedom; closing shot of person playing joyously with children; fade to
black. But Kramer also tells fascinating stories about people who were not ill, who met no diagnostic category for a mental disorder, and who just had the sorts of neuroses and personality quirks that most people have to some degree—fear of criticism, inability to be happy when not in a relationship, tendency to be too critical and overcontrolling of spouse and children. Like
all personality traits, these are hard to change, but they are what talk therapy is designed to address. Therapy cant usually change personality, but it can teach you ways of working around your problematic traits. Yet when Kramer prescribed Prozac, the offending traits went away Lifelong habits, gone overnight (five weeks after starting Prozac), whereas years of psychotherapy
often had done nothing. This is why Kramer coined the term “cosmetic psychopharmacology,” for Prozac seemed to promise that psychiatrists could shape and perfect minds just as plastic surgeons shape and perfect bodies.
The Happiness Hypothesis Pág.41
June 11, 2025
"Listening to Prozac" is a good book overall on psychopharmacology for intelligent laymen. The problem is that it over-hypes SSRIs like Prozac; in reality only 15% of people are good responders (ie much better improvement than via placebo). The phrase "better than well" refers to what is called hyperthymia, the opposite of dysthymia (low level chronic depression). People who attain a hyperthymic state of mind from Prozac are rare; otherwise SSRI's would be tightly controlled rather than currently being over-prescribed for almost everything in the DSM.
A useful corrective is a 1998 journal article by Irving Kirsch titled "Listening to Prozac but Hearing [only] Placebo: A Meta-Analysis of Antidepressant Medication". There is even a follow up in 2019: "Twenty years after ‘Listening to Prozac but hearing placebo’. Do we hear placebo even louder?".
The book needs to be updated now with, at the very least, a chapter on psychoplastogens like nitrous oxide, ketamine and psilocybin. And possibly one on bio-technological treatments like trans-cranial magnetic stimulation and electrical vagus verve stimulation (tapping your vagus nerve - mechanical stimulation - won't do anything; the 2 branches of the vagus are easily accessible at the side of the neck between the carotid artery and the jugular vein).
A useful corrective is a 1998 journal article by Irving Kirsch titled "Listening to Prozac but Hearing [only] Placebo: A Meta-Analysis of Antidepressant Medication". There is even a follow up in 2019: "Twenty years after ‘Listening to Prozac but hearing placebo’. Do we hear placebo even louder?".
The book needs to be updated now with, at the very least, a chapter on psychoplastogens like nitrous oxide, ketamine and psilocybin. And possibly one on bio-technological treatments like trans-cranial magnetic stimulation and electrical vagus verve stimulation (tapping your vagus nerve - mechanical stimulation - won't do anything; the 2 branches of the vagus are easily accessible at the side of the neck between the carotid artery and the jugular vein).
June 29, 2025
What makes those thirty-year-old antidepressants special- why we still use them, or ones like them- is this broad set of effects on mood, cognition, and temperament.
In Listening to Prozac, Peter Kramer does an excellent job at exploring the effects of Prozac and how these effects are vital in the fight against depression. Though I may not agree with Kramer's opinions on animal research and believe that Prozac's effects aren't quite profound as creating a new self, I do believe in the positive outlook Kramer has for Prozac and other antidepressants. This book stands the test of time in a lot of ways, especially in its readability, as many concepts can be applied to the modern world. After all, Listening to Prozac's core question of How is the self constituted? is a core question throughout the history (and probably future) of humanity.
I recommend this book to all mental health practitioners, anyone who has taken an SSRI, and anyone with an interest in mental health.
In Listening to Prozac, Peter Kramer does an excellent job at exploring the effects of Prozac and how these effects are vital in the fight against depression. Though I may not agree with Kramer's opinions on animal research and believe that Prozac's effects aren't quite profound as creating a new self, I do believe in the positive outlook Kramer has for Prozac and other antidepressants. This book stands the test of time in a lot of ways, especially in its readability, as many concepts can be applied to the modern world. After all, Listening to Prozac's core question of How is the self constituted? is a core question throughout the history (and probably future) of humanity.
I recommend this book to all mental health practitioners, anyone who has taken an SSRI, and anyone with an interest in mental health.
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