Prozac in the Closet

A post from guest contributor, Liz Oloft

Just recently, I had two conversations with colleagues about my research on psychiatric meds. During the first, I described my project to a colleague with whom I have not been in touch for a while. He responded by admitting that he had “joined the Prozac Nation” while he was in graduate school. The manner in which he said this—including the reference with the quotation marks around it—suggested that he would not normally have done so, but the exceptionally brutal stress at his Ivy League grad school factory forced him to join up. The reference to “Prozac Nation” also shows how he and more generally we feel it’s safer and not as scary when we are ironic and sincere at the same time about this stuff.

In the second conversation, I was struggling with conceptualizing an article I have to write before the end of summer. One of my favorite ways to think about my writing is by talking my ideas through with peers, and this particular colleague always has great ideas and questions that help to push and clarify my thinking. As we were talking, I found myself suspended in a moment of anxiety and hesitation, which always precedes a “confession” about my own experiences with psychiatry and meds. I had a personal anecdote that seemed useful to thinking through my work that I decided to just go ahead and share. This small disclosure (she is a friend after all, not my BFF, but nevertheless a very kind and trustworthy person I consider a friend, and hell, 11% of American women take antidepressants, so what’s the big deal) yet monumental disclosure (she is a colleague at an elite academic institution and god knows we don’t talk about these things with colleagues) led to a slight bowing of the head, a blush and then the quiet admission from this colleague that she too, has taken antidepressants.

These two incidents stirred up an old stifling anger I have felt for several years now as a social scientist among social scientists who study things like biomedicine, psychiatry, mental illness and the pharmaceutical industry. (Is “anger” too strong of a word? Will all my words and thoughts now be suspect since I admitted I TAKE ANTIDEPRESSANTS?) For people who write about taboo, why is it so taboo for us to disclose our personal participation in this world we study? Why do we not use our inside/outside position to tell our ethnographic stories, the way in which scholars have spoken from their own positionality for other topics or problems? Is it that these disclosures are too personal by cultural standards? (That’s part of it, surely, but aren’t we all about de-stigmatization?) If we do use our positionality to more fully engage with our research and to reflexively produce knowledge, then do we risk becoming identified with our disclosure and not with the body of our work? David Karp and Emily Martin are two scholars that come to mind who have integrated their own medication and illness experiences in their work in interesting and important ways. I have not read all of Karp’s work (however I do admire him tremendously) so it’s possible he has addressed this topic, but I have imagined what it was like for him to “come out” to the academic community. Was he afraid? Did colleagues encourage or caution him? Did some people then treat him in stigmatizing ways? I believe his public disclosures have invited many others to share with him their own experiences, but this is almost always done privately. And finally I wondered, do you have to have tenure first or must you be so clever and prolific that you are above the doubt and judgment of your peers and students?

After presenting at a conference on the topic of neuroenhancing medications, colleagues gathered around and we laughed as they asked me where they can get some of those drugs (Ritalin, modafinil, beta blockers, etc). Many of our fellow academics already take these drugs for performance enhancement or at least that appears to be the case according to a 2008 survey in Nature. I am sure that many of our fellow academics, including the readers of this blog, have taken a psychiatric medication at some point (most likely an antidepressant or anti-anxiety medication). It’s kind of fun and thrilling to talk about modafinil, maybe less fun to talk about Wellbutrin, but neither category of drugs would many of us willingly talk about publicly with regard to our own experiences. This is true despite greater cultural acceptance of psychiatric meds and psychological problems. Of course stigma persists, and each disorder and type of intervention has its own place in the stigma hierarchy and particular judgments and values attached to it. For example, depending on who you ask (this is an ethnographic question), to engage in Lacanian psychoanalysis for neurotic problems of living might be cool, to take an antidepressant for depression without psychotherapy is less cool, and to take a cocktail for bipolar might be even less so (although bipolar disorder may be more legitimate than depression because it seems to be more widely accepted as a “real biological disease”).

Speaking as a researcher and as a subject, many of us who take antidepressants take them with a dose of ambivalence. What’s really interesting though is that our ambivalence as academic users is also shaped by the knowledge we have of these medications and our critiques of them. Knowing what I know about how clinical trials and the pharmaceutical industry work creates yet another turning wheel of ambivalence in my mind. I would venture to say that our very experiences of antidepressants are shaped by our critical reflections on them. Our experiences are further affected by this: given our political agenda of fostering social justice, we users are caught in a strange bind in which we try to dismantle power structures in small ways as part of our work, but we cannot speak about how we bind and oppress one another.

I cannot close without addressing the irony of choosing a pseudonym for this piece. Some of you will easily figure out who I am, others will try to guess, and others might wonder why I would not just use my real name especially since it seems I am partly writing this in protest. I don’t really think about my meds too much. They have become part of the fabric of my life. And taking meds is not as stigmatizing or painful as the suffering that lies at the heart of their use. Maybe I resist being too closely identified with my meds because that is neither what I want, nor is it true to how I experience myself. I am wondering too if the stigma I imagine or perceive is stronger than any actual social stigma I might face. Am I making a bigger deal of this than I should? Perhaps, but for now, I will stick to my pseudonym.

Liz Oloft, Ph.D., is trained as an anthropologist. Currently she takes Celexa, 40 mg. per day.

16 Responses to Prozac in the Closet

  1. A very interesting article. I take antidepressants and do Lacanian psychoanalysis. So far I have been very opened about my problems. Like you I would be interested in the experiences of other people.

  2. I take an antidepressant, and as a lifelong clinical depressive, cheerfully admit it when the subject comes up.

    If people are sheepish about taking these drugs, might it be because they aren't sure whether they truly need them? The notion that somehow taking Prozac will make you do better on a grad school test is of course untrue.

  3. This is interesting because I thought that most of the people wouldn't be ashemed of taking antidepressants anymore, but one third of those who suffer the disease will never seek treatment due to shame to be labeled of having a mental illness. I take them and it is hard for me to imagine felling ashmed for taking Prozac, I think I never did felt ashemed because I understand it is an illness, like any other one, and it's not your fault to have it, but you must fight for getting better. This applies to having mental or physical illnesses of any kind, during the state when you can still fight cause the illness did not won, when you are there there is always hope!cancer,

  4. Depression and addiction are still frequently viewed as disorders which are the fault of the patient. As Franz Kafka once said of his tuberculosis: "Secretly I don't believe this illness to be tuberculosis, at least not primarily, but rather a sign of my general bankruptcy."

    Sadly, such stigmas still attach to diseases of the mind.

  5. Most psych meds are enmeshed in ongoing experiences that are just too painful to describe to others, much less to publish upon. I know these experiences have left an indelible mark on my work, but I’m not convinced that I could articulate this effect with the same precision/fairness that I try to describe in the population with whom I work. Maybe this comes in time (with drugs & therapy). My conflicts of interest of being a certain age/gender/marital status/etc. are far more pronounced, in any case.

  6. It seems that psychiatric meds and the problems they are used to treat are two entangled but also distinct issues. I would be more comfortable saying I take antidepressants than to explain why. The comments also suggest that if you take medications for something you consider a biological problem or illness, then its easier to be open about them (although adopting a biological explanation also suggests that there must be something REALLY wrong if its biological). I have interpreted my struggles primarily in psychodynamic terms, so taking meds might be more fraught for me. There is room of course to incorporate a neurochemical explanation but it gets complicated sometimes, especially because I can "function" without meds (but at a cost that right now I consider too high. What does it mean to "function" anyway?). To Dirk: medications CAN help you do better in grad school, or at least they can help you get through it.

  7. "To Dirk: medications CAN help you do better in grad school, or at least they can help you get through it."
    Of course they can–if you are talking about SSRI antidepressants and you happen to suffer from depression, bulimia, or OCD. In which case they can literally save your life. What I meant was that "normal" people, who do not have the mental disorders the meds act upon, are not likely to benefit from them. In fact, all they are likely to feel are the negative side effects.

  8. PS–

    Should mention a potential conflict of interest here:

    Zoloft, 100mg/day 🙂

    PPS–You have to come out of the closet and show your support for mental health awareness. Take your pills with pride; untreated mental illness is a cryin shame.

  9. I think the empirical question of whether and how our critical reflections on pharmaceuticals shape our experience of taking them is an important one. It echoes the same questions about when psychiatrists need to see psychiatrists, right? In my case, I am reluctant to abstract medications or a diagnostic label from my day-to-day experiences, relationships, occupation, etc. and I am rarely comforted by “just neuro-chemical” explanations for my moods (I am much more complicated than that!). This is a gift from my anthropological education. On another level, though, I do worry about the stigma of these abstractions. I was terrified (and didn’t listen) when a psychiatrist suggested to me that if given the choice of multiple jobs, I might want to opt for the less competitive one, which she said she advises her “high functioning” medical student patients. I know that my distress comes and goes, and if I cry in front of my computer, I could always close my office door, but if a well-intended doctor perhaps over-estimated my “disability,” what might someone with less knowledge (and more authority) assume? I recognize the need for greater awareness, but I also worry that there is an awful lot at stake in these seemingly small disclosures.

  10. " I am rarely comforted by “just neuro-chemical” explanations for my moods (I am much more complicated than that!)."

    I truly don't understand this statement. What could be more complicated than neurochemistry and its effect on mood? How does establishing a neural substrate for emotions simplify or trivialize them?

  11. I think Liz really captured the core issue by differentiating the comfort level associated with being open about the use of psychiatric meds without having to explain why they are being used. Joining Prozac nation without the need to explain the affiliation allows a person to grow comfortable that meds are simply a tool for growth and once comfortable with that concept I believe a person realizes there is no need to explain why they are taken, simply that they are with no shame or stigma. Perhaps the point is that we all need to extend our ability to be empathic to a person's desire to grow and change regardless of what works and the stigma of "shame" would gradually go away.

  12. As a clinical psychologist, like LEDR, I take a pragmatic view and see medication as a means of learning and growth. I believe it likely that, psychologically and physiologically, medication helps us learn, or unlearn, toxic, destructive behaviors, thoughts, feelings and associations. It help create conditions that can override old fears and habits which keep us stuck; it allows new patterns (perhaps even new neural pathways) to be established and reproduce if/when medication is ever stopped.

  13. I didn't mean to suggest that neurochemistry as a substrate of emotions was trivial, but that I feel comforted by the fact that the things that exacerbate & mend my mood swings are complicated (interpersonal, environmental and so forth). I find it easier to disclose my use of and ambivalence surrounding psych meds and diagnoses around people who know me well enough to appreciate this (my own particular) complexity. Talking openly about meds might be one way to open up spaces for these more difficult conversations, but there might be other ways to begin. e.g., it might also be productive to start disclosing & challenging what it is about grad school (family, work..) that drives so many to the "prozac nation."

  14. Pingback: On Psychiatric Cool | Brain and Head Health

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