HOOKED ON A CURE?

If you want to write a memoir, the odds for success are good if you've (1)
lived a "tortured" past, (2) spent time in mental hospitals and (3) can
write about all of this with "unflinching" or "searing" honesty.

Memoirs about mental illness are enjoying great popularity these days, from
Kay Redfield Jamison's "An Unquiet Mind" to Marya Hornbacher's "Wasted" to
Elizabeth Wurtzel's "Prozac Nation: Young and Depressed in America." There
are so many of these confessions in circulation and they are so dark, so
brooding, one has to wonder if doctors haven't missed an important side
effect of drugs like Prozac: self-preoccupation.

But this is unfair. Memoirs about mental illness are only part of a larger
body of memoirs, and those in turn are part of a larger cultural trend: the
mania for the disclosure of painful secrets. It is everywhere, from talk
radio to the Internet to Calvin Klein commercials.

Where is this confessional trend coming from? Academics say it has to do
with the diffusion of knowledge, with relativism. These days people do not
look to a singular source of knowledge and understanding--a teacher, a
minister, a president. Now one guy's story can offer as much enlightenment
as the next, and "guy" here includes everything from overcaffeinated
Generation Xers to aging housewives to clinical psychologists.

If this trend seems unsettling or a little too easy, you won't find any help
from the academics who so aptly describe it. They will not condemn it. In
politically correct discussions of knowledge, meaning is always "negotiated"
and knowledge is "socially constructed." Therefore, the thinking goes, it is
only fitting that the books by experts sit alongside the personal accounts,
the memoirs by people who have lived out what the experts are studying.
Together, in a very social way, doctors and patients are "constructing" the
meaning of mental illness.

It sounds messy. With such a range of viewpoints, who can make sense of the
"construction?" Most of the authors are well-educated, upper-middle-class
women who battled eating disorders or some form of depression. And the
majority of them have benefited from a new class of psychotropic drugs.
Their attitudes about the helpfulness of these drugs vary: Prozac and its
cousins are considered by some writers the savior; by others the enemy; by
many, a troubling combination of the two.

Despite their differences, these writer-patients make convincing cases for
their beliefs about medication. This is where the confusion sets in. Such a
variety of well-defended and "deeply felt" positions--in the end, who is
right? And if no one is right, if everyone has a valid point, what does it
all mean? What are we to think of these drugs?

It was much easier in the days of electroshock therapy and lobotomies to
write about mental illness. Psychotherapy was on the wrong track, and books
like "The Bell Jar" and "One Flew Over the Cuckoo's Nest" helped convince us
of that. Back then, there were good guys and bad guys. Now, with the advent
of wonder drugs like Prozac, things aren't so simple. The bad guys have some
good ideas, and the good ideas bring with them some existential problems.
One memoir, Lauren Slater's "Prozac Diary" (Random House, $21.95), deserves
attention for its attempt to address these problems.

Slater is both a patient and a psychotherapist, a prescriber and taker of
Prozac. Her book is a collage of literary forms: cogent argument, fluid
recounting, less fluid diary excerpts and dreamlike reflections written in
her own "language of loss." (In one such reflection she describes herself as
a young girl who develops a personification for emptiness: a blue baby in
her stomach.) Through this patchwork of forms, Slater brings out the
problems embedded in psychopharmacology.

To what extent, she asks, is a person's identity attached to a mental
illness? What happens when a drug comes along and mysteriously dissolves the
illness, destroys, in her case, the blue baby? What has she lost? And in the
process of reinventing herself, how much of her new identity must she
attribute to the drug?

Slater resists clear and easy answers to these questions. Every solution in
her treatment brings with it another problem. With the help of Prozac she
can function, can finally "get used to health," but the tradeoff is nothing
less than drug dependency. "I am linked," she writes, "hooked at the hip,
stitched in the skin to a primordial relationship, to Eli and Lilly, who
rock me and feed me and, late at night, come to my bedside and sing me songs
that disturb my sleep and descend to the deepest level of dreams that are
not quite mine."

Despite her qualified acceptance of Prozac, and despite the range of
viewpoints on psychotropic drugs in general, Slater and her contemporaries
do converge on one axiom: These strange drugs work. Kind of. People who were
trying to kill themselves are now more interested in living, in cooking,
earning degrees, getting married.

But the success has not been a resounding one. The drugs have curtailed the
hallucinations, the voices, the twitching and tapping and self-mutilation.
But they have left a deeper kind of confusion. It's as though the wonder
drugs have shown us the door to our own minds. We have stumbled inside and
it is darker than we expected. We have in this darkness a cacophony of
well-intentioned voices. They have been through quite a lot. They are here
to help us. Or warn us. Or distract us. All these voices, in the dark, and
the light switch is beyond easy reach.

Checked-by: Rolf Ernst