Personality Disorders

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A Bright Red ScreamAntisocial Behavior in Children and AdolescentsAs Your Desire MeBorderline Personality DisorderBorderline Personality DisorderBorderline Personality Disorder and the Conversational ModelChildren of the Self-AbsorbedCoping with BPDCoping with Infuriating, Mean, Critical PeopleDangerous and Severe Personality DisorderDealing with a NarcissistDissociative ChildrenDistancingEnough About YouEvidence-Based Treatment of Personality DysfunctionFatal FlawsFirst Person PluralGet Me Out of HereGirl in Need of a TourniquetGirl, InterruptedHandbook of Personality DisordersHandbook of PsychopathyHidden SelvesHigh RiskI Hate You-Don't Leave MeLet Me Make It GoodLiving with Our GenesLost in the MirrorLoving Someone with Borderline Personality DisorderLyingMapping the Edges and the In-betweenPassionate DeliberationPersonality Disorder: Temperament or Trauma?Personality Disorders in Modern LifePractical Management of Personality DisorderPractical Management of Personality DisorderProzac NationPsychopathyPsychotherapy for Personality DisordersSilencing the VoicesSkin GameStop Caretaking the Borderline or NarcissistStop Walking on EggshellsStop Walking on EggshellsSurviving a Borderline ParentThe Angry HeartThe Buddha & The BorderlineThe Clinical and Forensic Assessment of PsychopathyThe PsychopathThe Psychopath TestThe Siren's DanceThe Sociopath Next DoorThe Survivor PersonalityThrough the Looking GlassUnderstanding and Treating Borderline Personality DisorderUnderstanding the Borderline MotherWhy Is It Always About You?Without ConscienceWomen and Borderline Personality DisorderWomen Living with Self-InjuryWomen Who Hurt Themselves

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Prozac NationReview - Prozac Nation
Young and Depressed in America
by Elizabeth Wurtzel
Riverhead Books, 1994
Review by Christian Perring, Ph.D.
May 13th 2002 (Volume 6, Issue 20)

Prozac Nation tells the story of Elizabeth Wurtzel’s childhood, her troubled relationship with her father who left her and her mother and refused to accept his responsibilities to his family, her move to Harvard, and her mental decline leading to several stays in hospital and a suicide attempt.  Finally, after trying many different psychotherapists, psychiatrists, and medications, she tries Prozac and it helps her rise above her despair.

In the Afterword to Prozac Nation, written for the paperback edition in 1995, Wurtzel asks the question that will have occurred to many of her readers.

What on earth makes a woman in her mid-twenties, thus far of no particular outstanding accomplishment, have the audacity to write a three-hundred page volume about her own life and nothing more, as if anyone else would actually give a shit? (p. 354)

She gives a long answer, the crux of which is:

I wanted this book to dare to be completely self-indulgent, unhesitant, and forthright in its telling of what clinical depression feels like: I wanted so very badly to write a book that felt as bad as it feels to feel this bad, to feel depressed.  I wanted to be completely true to the experience of depression—to the thing itself, and not to the mitigations of translating it.  I wanted to portray myself in the midst of this mental crisis precisely as I was: difficult, demanding, impossible, unsatisfiable, self-centered, self-involved, and above all, self-indulgent. (p. 356)

Wurtzel certainly succeeds in her aim to portray herself as capricious and self-preoccupied.  Indeed, according to her own description, she seems so impulsive, self-preoccupied, needy in relationships, and manipulative that readers will probably wonder whether depression is indeed Wurtzel’s most basic problem.  It’s very tempting to speculate that Wurtzel has just as much claim to a diagnosis of borderline personality disorder as she does to depression.  Wurtzel says that her psychiatrists gave her a diagnosis of atypical depression, and DSM-IV-TR tells us that personality disorders may be more common in those with atypical depression. 

            Of course, even if I were a psychiatrist, which I’m not, would be ridiculous to offer a diagnosis based on an autobiography.  What is clear, however, is that Wurzel’s goal of telling some general truth about clinical depression is not accomplished.  Reading Prozac Nation is a very different experience from reading other memoirs of depression such as Tracy Thompson’s The Beast and Martha Manning’s Undercurrents because Wurtzel manages to provoke such a mixture of conflicting feelings in her reader, while other authors of depression memoirs provoke far more consistent sympathy. By the end of the book, one feels far more sympathy for Wurtzel’s mother and her friends than one does for her.  Normally, I count myself as able to identify and empathize with people who suffer from serious mental illnesses, but I have to confess that, given the way she describes herself, unless she has changed dramatically, I’d recommend her friends to run a mile rather than put up with her manipulation.

            Note that one gets a similar impression from Wurtzel’s second memoir, More, Now, Again, (reviewed in Metapsychology April 2002) in which she becomes addicted to Ritalin and cocaine, and spends most of her time lying and hiding her addiction from her friends, mother and publisher.  In Prozac Nation, Wurtzel several times suggests that she was addicted to depression and makes clear that her self-defeating behavior was often willful.  What makes it so hard to sympathize with her is that that her problem seems to be her personality, rather than some affliction she has to overcome. 

            To be more precise, Wutzel describes herself sometimes as the agent of her predicament, and other times as the victim of it, and it’s unclear for the reader what reasons there are for these switches.  She manipulates people close to her: for instance, she tells calls her therapist at all times of the day and night, and then tells her therapist that if she does not listen to her problems, her (Wurtzel’s) blood will be on her (the therapist’s) hands.  Sometimes even her crying seems like a deliberate action.

But at other times she feels immobile, and can’t get out of bed.  Consider, for example, how she feels after her brief romance with a man called Rafe, during which she was miserable, clingy, and insecure, and she explicitly ignored his request that he spend time away from her, since he needed to be with his family, who had their own needs. 

I couldn’t move after Rafe left me.  Really.  I was stuck to my bed like a piece of chewing gum at the bottom of somebody’s shoe, branded with the underside, adhering to someone who didn’t want me, who kept stamping on me but still I wouldn’t move away.  (250)

            Wurtzel’s alternating acceptance and denial of her agency bemuses the reader, and ultimately makes Wurtzel a less credible witness to her own mental states.  Far from knowing exactly how it was for Wurtzel, even though it is clear that she was desperately unhappy for most of the time, readers will be confused and exhausted by her narrative. 

Far from undermining the work, these features are what make Prozac Nation so distinctive, standing out among other memoirs.  It is a tour de force, and a powerful evocation of Wurtzel’s experience, although it’s not so clear whether that experience is depression, borderline personality disorder, or some other mental disorder.

 © 2002 Christian Perring. First Serial Rights.

Christian Perring, Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island. He is editor of Metapsychology Online Review. His main research is on philosophical issues in psychiatry. He is especially interested in exploring how philosophers can play a greater role in public life, and he is keen to help foster communication between philosophers, mental health professionals, and the general public.


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