Post-Prozac: American Psychopharmacology, the Morning After

COMFORTABLY NUMB: HOW PSYCHIATRY IS MEDICATING A NATIONBy Charles Barber Pantheon, 280 pages, $26 It’s hard to believe it, but

By Charles Barber
Pantheon, 280 pages, $26

It’s hard to believe it, but our little baby is growing up. Prozac has just turned 20.

It’s been quite a heady two decades for our favorite mood-boosting pill, a regular Drew Barrymore kind of childhood, with books and articles and wanton declarations accompanying each stage of its precocious life. There were the wide-eyed Listening to Prozac years, the wild and fawning Prozac Nation years, even the troubled teenage years when it was dogged by accusations that it caused everything from suicide to impotence.

Now, as Eli Lilly’s famed mood-booster prepares to enter its third decade, a new book has emerged from the pharmaceutical haze to weigh in our modern drug obsession: Charles Barber’s Comfortably Numb: How Psychiatry Is Medicating a Nation. As the title suggests, it has little in common with the lusty exuberance of the early pro-Prozac anthems that promised heaven in a little green-and-ivory pill.

This is a morning-after kind of book, a sober, light-of-day treatise determined to puncture the myths behind our love affair with “cosmetic psychopharmacology.” If its conclusions are not always as fresh or mind-shattering as one might hope, it nonetheless arrives in our pill-happy midst not a moment too soon.

As Mr. Barber writes, “The current environment is such that a twenty-one-year-old college student can delineate, with a curious combination of pride, shame, and indifference, the last five years of her life by the drugs she was taking in the pages of New York magazine. No longer does one measure out life with coffee spoons, as did T. S. Eliot’s Prufrock, but with Adderall and Percocets.”

Mr. Barber comes by these observations honestly enough, through a mix of observation and vicarious experience. A lecturer in psychiatry at the Yale University School of Medicine, he honed his mental-health skills in New York City’s homeless shelters, where he worked for 10 years with some of the city’s most desperate and tortured mentally ill. These were not your typical neurotic New York types suffering from “garden-variety existential angst,” but the deeply, relentlessly unmoored. And yet, Mr. Barber noticed, they weren’t the ones who were being lavished with psychiatric attention. Instead, it was the “worried well”—the striving Upper East Side professional, the Soccer Mom from Winterset, Iowa—who were being bombarded with Zoloft ads and prescription slips as if their psyches, success and eternal happiness all depended on it.

Mr. Barber explains: “As the SSRI revolution has worn on, it has become increasingly clear that the wrong people are taking the medications.” (For the record: SSRI is shorthand for Selective Serotonin Reuptake Inhibitor and refers to the class of depression-busting drugs that burst onto the market with Prozac in 1988.)

Mr. Barber dedicates a good chunk of Comfortably Numb to proving and re-proving this disconnect between the people who should be taking antidepressants and the ones who actually do—call it the Prozac paradox. Citing a dizzying torrent of statistics, he douses readers with facts like “in 2006, 66 percent of the global antidepressant market was accounted for by the United States” and “the [pharmaceutical] industry spends an unholy $22 billion a year to market directly to doctors, which is the equivalent of about $25,000 per physician per year.” It’s enough to make you wonder whether the nation should just check itself in to the Cirque Lodge rehab center for a couple of months.

Not surprisingly, pharmaceutical companies take a good chunk of the blame for our pill mania, but modern-day “biological psychiatry,” with its belief in brain-chemistry-as-destiny, also comes in for criticism, as does managed care, suburban alienation, “emotional entitlement” and that distinctly American desire to feel, in Pink Floyd’s words, “comfortably numb.” In fact, if there’s any criticism to be lobbed at this section, it’s that Mr. Barber throws too many variables at readers, delving in minute detail into some while glossing over others with a few well-chosen clichés.

The idea, for instance, that women are twice as likely as men to be taking antidepressants is intriguing, disturbing and well worth exploration. But creating a cipher patient named “Julie” who “examines her face in the mirror and sighs” as she pops her nightly antidepressant as a way of explaining the phenomenon does little for the reader beyond making her want to roll her eyes.

Lapses like this are unfortunate, because Comfortably Numb has valuable information to impart, not just about our collective pharmaceutical drug addiction but also about promising non-drug therapies that have been largely overlooked because, let’s face it, they are neither as sexy, simple or lucrative as prescription mood-fixers. Drawing on a mix of history and science, Mr. Barber delivers a useful survey of these therapies, followed by some philosophical musings about our flawed approach to suffering in this country. In another era it might have been called “A Valediction Permitting Mourning.”

“We’ve embarked on a uniquely American process of emotional sanitation,” he writes. And he adds, pointedly, “A certain measure of depression is absolutely appropriate to this world.”

If this final section sometimes sounds a bit preachy, it’s preaching with a worthy purpose, at least. When 16 percent of the inhabitants of a small town in Iowa start taking antidepressants, as was reported by the state’s largest insurance company in 2002, it’s worth wondering whether some part of our cultural psyche is seriously out of whack. And when traces of Prozac and Valium begin showing up in our reservoirs, as has reportedly happened at Lake Mead, in Nevada, we probably should feel a bit freaked.

Besides, any book that helps diminish the chance that we’ll be subjected to another Elizabeth Wurtzel-style SSRI opera should be lauded and applauded.

Happy birthday, Prozac nation.

Lizzy Ratner, now a freelance writer, was formerly a reporter at
The Observer. She can be reached at

Post-Prozac: American Psychopharmacology, the Morning After