Fraser, M - Nature of Prozac, (2001) 143 Hist Human Sciences 56

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HISTORY OF THE HUMAN SCIENCES
Vol. 14 No. 3
2001 SAGE Publications (London, Thousand Oaks, CA and New Delhi)
pp. 5684
[0952-6951(200108)14:3;5684; 019532]
The nature of Prozac

MARIAM FRASER
ABSTRACT
This article addresses the relations between nature and culture (and
those characteristics associated with the natural and the cultural) in
the context of the debates about Prozac. Following Marilyn Strathern,
I focus specifically on the contested issue of enablement that is, on
what Prozac does or does not enable, and on the relation between
enablement and enhancement, normality and pathology. I argue that the
implications of the model of the brain that accompanies explanations of
Prozac are such that commentators are obliged to address not only the
nature of normality but also the nature of nature itself. Through a close
analysis of these debates, I suggest that critiques of Prozac should be
understood not as objections to reductionism to a biology that closes
things down but rather to one that opens things up: that opens up the
relations between nature, culture, biology and the individual, relations
that are now cross-cut and thrown about by artificiality. Objections to
Prozac, then, might be characterized as an attempt to put these concepts
back into their proper positions, to re-establish the relationality
between them. In conclusion, I argue that the biology put forward by
proponents of psychopharmacology, regardless of the desirability of
the latter, challenges not only the frequent assumptions that are made
about the claims of materialist science, but also some of the terms and
concepts that are commonly deployed in the social sciences.
Key words: artificial, biology, natural, normal, Prozac
. . . a new set of representations is taking shape; one that places us as an
experimenting living being among always-already-experimented-upon
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THE NATURE OF PROZAC
living beings. Hence scientific interventions appear not as unique acts

of power interpreted as the domination of nature but as a search for an
appropriate use of power as capacity, enablement. (Rabinow, 1998: 177)
If there is nothing that is not created by choice, one has to take away
the given status of the materials themselves. Take away the independence of the background against which the choices are made.
(Strathern, 1992: 42)
The day after Eli Lillys main patent on Prozac expired, on 8 January 2000,
an article appeared in the Independent on Sunday with the headline AFTER
PROZAC (Kohn, 2000: 1416). A rash of competitors is anticipated; Lilly is
expected to lose its stranglehold on the antidepressant market; a third generation of antidepressants as selective as magic bullet mythology ever could
have wished them to be (Healy, 1997: 175) will target not serotonin, but
noradrenaline (Reboxetine), or serotonin and noradrenaline (Venlafaxine), or
. . . While Lilly may have lost part of its patent, the wonder drug has nevertheless delivered, and continues to deliver, its wonder sales. Despite muted
expectations following its launch on the US market in 1988, by 1990 Prozac
had generated more revenue than the combined amount spent on all types
of antidepressants preceding it (Lyon, 1996: 58). By 1994, it was said to be
the second most commonly prescribed drug in the United States, after
Zantac, an ulcer remedy (Wurtzel, 1998: 296). The 1994 figures, which suggested that 11 million people were taking Prozac worldwide six million of
them in the USA (Lyon, 1996: 58) had risen to 38 million by 1999 (Boseley,
1999: 13).
Despite the number of available or promised smart drugs which currently
proliferate, Prozac maintains not only its sales figures, but also its iconic
status as the first of this recent wave of designer drugs, the handmaid of a
new era (Kramer in James and Camden, 1993: 14). It is for this reason that
I take it as my starting-point. Icons, Aaron Betsky (1997) argues, are magnets
of meaning, objects around which meanings cohere.1 Like other contemporary icons, Prozac was made rather than born2 and it has a wow factor,
creating as much noise as it does communication (Betsky, 1997: 239).
Indeed, Prozac has had a very noisy career to date, a celebrity career, Peter
Kramer argues: renown, followed by rumors, then notoriety, scandal, and
lawsuits, and finally a quiet rehabilitation (Kramer, 1994: xvi). The interest
and controversy surrounding Prozac extend from its relation to what Peter
Breggin (Breggin and Breggin, 1995), in conspiratorial tones, calls the psychopharmaceutical complex (an association of government agencies,
pharmaceutical companies and professional and philanthropic organizations,
as well as insurance companies) to the part it might play in the contested
relation between psychopharmacology and psychotherapy.3 Like other
icons, Prozac creates what stands in for a sense of community (Betsky, 1997:
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39); it is the vehicle, for example, through which the Prozac generation a
brand rather than a breed, as Elizabeth Wurtzel puts it (Wurtzel, 1998: 32)
constructs and analyses itself, and through which it is constructed and
analysed by others. This is a generation whose characteristics are defined, as
others have been, at least partly in relation to the state of the (in this instance,
US) economy (Brown, 2000).4 Climbing unemployment and rising inflation
have given way, Margaret Lyon argues, to a parallel psychic slump (Lyon,
1996: 60), and so too to Prozac persons (Slater, 1999: 56) who populate a
Prozac Nation, the United States of Depression (Wurtzel, 1998: title and
297). These are people schooled in the language of biochemistry and for
whom biological notions have provided badges of identity. . . . People
identify themselves as catecholamine persons or 5HT persons and as biologically oriented rather than socially oriented (Healy, 1997: 164).
But Prozac has not simply enabled another handful of identities to be marshalled under the auspices of biosociality (Rabinow, 1992).5 Perhaps more
significantly, this green and creamy pulvule (as Eli Lilly describes it) has contributed to the emergence of the brain as an organ of public fascination and
to the wide dissemination of a particular understanding of the brain, one
whose implications extend well beyond an analysis of depression. As David
Healy argues, since the link between neurotransmitters and mood and behaviour was first outlined in 1955, and was consolidated (particularly in relation
to depression) in 1965, a great many researchers poured over this bridge
(Healy, 1997: 148) with more or less startling claims as to the relation between
the brain, biochemistry and the self. It is for this reason that I begin not just
with Prozac, but specifically with Peter Kramers Listening to Prozac (1994),
because this is the book that most notoriously established just such a relation
and that has galvanized a great number of critics and commentators to ask
again what it is to be human6 and to ask, in particular, whether humanness is located in the sphere of nature or of culture.
Certainly, in the context of Prozac, biological and sociological (as well as
other) analyses of identity proliferate, and many of these explanations frequently rely on notions of nature and culture.7 What is of particular interest,
however, is that references to nature and to those characteristics traditionally associated with the natural are not confined to biological explanations
just as, conversely, references to culture and to those characteristics traditionally associated with the cultural are not confined to sociological (or
other, non-biological) explanations. As Marilyn Strathern argues, trying to
sort out the relative weight to give to things cannot work because it would
fail to register a most significant cultural feature of present life: there is more
of everything (Strathern, 1996: 46). That is, [t]here is both more nature
and more culture in peoples discourses. I would even say that what lay
people regard as science seemingly produces both more certainties and more
uncertainties (Strathern, 1996: 46). It is not my aim, therefore, to explain
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away the biological elements in these debates. On the contrary, it is the biological dimension of Prozac, and especially the (popular scientific) theory of
the brain with which it is associated, that is integral to some of the most
challenging debates and implications that the drug has given rise to. This is
neither to ascribe a truth-value to this dimension (because it is biological),
nor is it to bracket off that value (either because it is biological or because it
is popular).8 Conversely, it is clear that it is not just social scientists but a wide
variety of commentators and I would at the very least add journalists and
scientists to Stratherns commercial managers who address themselves to
how persons are constructed (Strathern, 1996: 46).
My intentions are not to try to establish the boundaries of the relationship
between nature and culture therefore, but rather to consider the different
ways that these concepts (and the concepts that are traditionally perceived to
be associated with them) are deployed in explanations of Prozac, and to what
effects. I want to suggest that on account of the nature proposed in these
debates, it is precisely the distinction between nature and culture that is
disturbed. And because it is this distinction specifically that is subject to
agitation, the claims made by materialist science, and especially the claims it
makes for and about the self, demand more than a constructionist/constructivist rejoinder (the kind of rejoinder that often amounts to a rejection of
science and/or its absorption into the social and cultural). In short, the
problem that I am interested in (if it is a problem) concerns the status of some
of the props that support even the idea of a relation between nature and
culture, the props that constitute and maintain the distinction between them
and on which their relationality depends. It is this that I want to explore in
this article.
My point of entry will be the different ways that commentators who
address the implications of Prozac understand, collapse, challenge and/or
seek to distinguish between two terms in particular enablement and
enhancement. I have chosen this focus in part because, if the controversy
around Prozac can be summarized at all, it seems to me to turn on the question of what Prozac is perceived to be able to do, that is, what it does (or does
not) enable. This is an especially fraught issue where Prozac is concerned
because it is often characterized not as a medication but as a mood brightener. Indeed, situated somewhat provocatively in the already opaque (and
perhaps arbitrary) area between a medical and a recreational drug, Prozac has
licensed entry to a group of therapies or treatments sometimes dubbed
enhancement technologies (see, for example, the Enhancement Technologies Group and especially Parens, 1998). For Peter Kramer, this association
with enhancement is relatively unproblematic because, for the most part, he
assumes that enhancement and enablement are synonymous. Prozac, he
argues, makes people better than well (Kramer, 1994: xvi). Not so for his
critics, however, who question not only what constitutes well but also what
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exactly it is that Prozac is said to enhance. They question whether the

enhancement or intensification of well-ness necessarily leads to enablement
or whether, by contrast, Prozac might offer too much of a good thing so
much of a good thing, in fact, that its effects should be understood to be disenabling. Prozac, it seems, can certainly do something, but what that something is, is a point of considerable contention. It is here that the debate around
Prozac meets that of normality (is it normal to be better than well?) and
what is or is not natural (is it natural?). These issues are further exacerbated
in the context of Kramers account of biological processes in the brain, which,
along the way, rather casually knocks nature from its natural place. It is
this, I would argue, the knocking out and about of concepts from their
natural positions, that lies at the heart of the Prozac debates.
B E H I N D E V E RY C R O O K E D T H O U G H T . . . L I E S A
CROOKED MOLECULE
Modern psychopharmacology, Steven Stahl begins, is largely the story of
chemical transmission (Stahl, 1996: 1). Perhaps it is not surprising, therefore,
that in seeking to account for the widespread use, if not efficacy, of Prozac
commentators should draw attention to a biochemical theory of depression.
Briefly, this story suggests that the play of chemical neurotransmitters in the
brain affects moods in the individual; specifically, that moods are determined
by amines and particularly by noradrenaline and serotonin.9 As a theory, it
combines a compelling measure of simplicity and ambiguity (Healy, 1997:
160), as witnessed, for example, in Peter Kramers ingenuous explanation of
the amine hypothesis through an analogy between depression and other diseases whose mechanisms are familiar: A person who has too little insulin
suffers from diabetes; an excess of insulin causes low blood sugar (hypoglycemia [sic]). . . . An excess of amines was thought to cause mania . . . and
a deficiency, depression (Kramer, 1994: 53).
In their different ways, antidepressants are thought to work by increasing
the influence of the naturally occurring amines, often by ensuring that they
are available for longer periods of time in the brain.10 Unlike the first generation of antidepressants (tricyclics and monoamine-oxidase inhibitors),
which affect many neurotransmitter systems at once, fluoxetine hydrochloride (Prozac) is said to be a clean drug because it selectively targets the
serotonin system, hence the acronym SSRI serotonin selective reuptake
inhibitor (Fuller, 1986). Where the former tend to cause non-specific and
wide-ranging side-effects, those of Prozac are perceived to be comparatively
mild11 and include nausea, shakiness, insomnia, and . . . anorgasmia
(Griggers, 1997: 129). Prozac, tested on patients with major depression (on
whom it is said to be barely more effective than Imipramine), is thus
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reputedly prescribed to adults with, as Camilla Griggers puts it, minor

depression and anxiety, funk and malaise (Griggers, 1997: 113).12 Peter
Kramer suggests that it might also be prescribed to those who are not
depressed at all. For his critics (to whom I will return in the following section)
the implications of this are profound (or at least profoundly worrying),
hinting as they do of what is to come: that Kramer will extend his analysis of
Prozac beyond its role in the biological mechanisms of depression, to the
role it might play in shaping the personality, the self, and even the human
species and/or society. Because these peculiarly ambitious claims proceed
precisely on the basis of Kramers understanding of the brain on which
Prozac is said to act, it makes sense to begin here: with the biological explanation of depression that Kramer has played so pivotal a part in delivering to
the public arena, the ramifications of which at least in the first instance
pertain to who it is that can or should be prescribed Prozac.
Behind every crooked thought . . . lies a crooked molecule (Slater, 1999:
108). This is what Lauren Slater learns when she reads the latest in psychopharmacological literature. Slaters Prozac Diary is something of a sequel
to Wurtzels Prozac Nation: it is an account of a decade on Prozac. Towards
the end of the book Slater writes: Prozacs view, and now mine, that history
is meaningless, stories no more than convenient construction. That the
person, a mere concoction of chemicals, is programmed from birth. Pure
beast (Slater, 1999: 114). And indeed, Kramer claims that it is through listening to Prozac that he has become so attentive to the phylogenetic origins and
biological underpinnings of free-floating anxiety and melancholy that I have
trouble understanding them as special communications that make humans
distinct from beasts (Kramer, 1994: 294). They are both referring, with
different degrees of equivocality, to a materialist understanding of depression,
that is, the belief that mood, personality and psychological preoccupations
(conscious or not) are informed by a biological infrastructure.
In his exegesis of Prozac and its effects, Kramer calls upon a number of
disciplines and sub-disciplines including, in particular, what is sometimes
called a neuronal model of the brain. This approach begins with the cellular
level, with the most basic component, the neuron (Greenfield, 2000: 87),
and works its way up to our personalities, hopes, and fears (ibid.: 85). The
cell theory of the nervous system was established at the end of the 19th
century, alongside visual technologies such as microscopy and tissue-staining.13 Electron microscopy played its part in confirming that brain cells were
contiguous. From the first discoveries of biochemicals in 1905 and 1914,14
to the tentative suggestion that transmission might be chemical in the 1930s
and 1940s and its reluctant acceptance in the early 1960s, neuroscientists
now believe that there are about 50 neurotransmitters in the brain which
together provide a rich grammar of interactions between neurons
(Robbins, 1998: 35).15 The recent interest in psychopharmacogenetics (and
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pharmacogenomics) is informed by the belief that the production and activities of these chemical neurotransmitters may be partly genetic, although this
is not determining in itself: genetic material can be modulated by physiological adaptations, by drugs, and by diseases (Stahl, 1996: 18).
In Peter Kramers account, it can also be modified by life-experiences.
Although Kramer makes much of this point (his argument depends on it) this
is not in fact an unusual claim, especially in view of the notion of synaptic
(sometimes neuronal) plasticity, the plastic ability of the synaptic connections in the brain to modify themselves according to internal or external conditions (almost throughout the entire life-course).16 Thus it is that Gerald
Edelman will argue that each brain has uniquely marked in it the consequences of a developmental history and an experiential history (Edelman,
1998: 42; Greenfield, 2000: 14751).17 While Edelman is careful, at least on
occasion, to underscore the limitations of his theory of neural Darwinism,
and despite Kramers own recognition that [t]he biological study of the self
is so primitive as to be laughable (Kramer, 1994: 283), the reader who listens
to Kramer will meet a variety of individuals whose personalities are revealed
to be less a manifestation of a unique self, and more the result of a unique
pattern of neural pathways. Sam, for example, finds that after a course of
Prozac what he had nurtured and defended for years now seemed not a part
of him but an illness. What he had touted as independence of spirit was a biological tic (Kramer, 1994: x). How so?
Briefly, Kramer moves between, and extends his argument from, medicalized terms such as stress, trauma and depression to the more general
and inclusive notion of experience. Chapter 5 with the simple and ambiguous title Stress is indicative of this oscillation. It begins with an account of
the effects of kindling. Here, Kramer argues that the repeated application of
electric shocks to, in this instance, rats causes their postsynaptic cells to go
through a series of chemical reactions that affect the nucleus of the cell, and
therefore the chemical substances produced by the cells DNA and RNA:
These substances include hormones that determine whether the cell makes
new connections with other neurons or allows old connections to wither.
Some cells die; others sprout, or change shape. Kindling rewires the brain
(Kramer, 1994: 112). In other words, physiological stress can have a material
affect at the cellular level (Kramer, 1994: 11517). So too, Kramer continues,
can psychological stress. Meshing the results of kindling studies and animal
ethology experiments on rhesus monkeys with insights based on research
into postsynaptic-hypersensitivity, Kramer concludes that the vagaries of
life experiences in other words leave a scar, and that [t]he scar consists
of changed anatomy and chemistry within the brain (Kramer, 1994: 123). In
Elizabeth Wurtzels inimitable words, years and years of exogenous depression (a malaise caused by external events) can actually fuck up your internal
chemistry (Wurtzel, 1998: 306).
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In the struggle to compensate for stress, Kramer argues, the individual may
implement a variety of defensive mechanisms (biological and/or psychological), but however efficiently these mechanisms are deployed, trauma will
be making its mark, all the while, in the neural architecture of the brain.
Trauma, which, as Ian Hacking (1994) notes, was, in the 19th century a physical wound but which was later dematerialized18 is here, at the end of the
20th century, rematerialized. For Kramer, all abuse is physical abuse: An
unreliable lover enrages us he is doing not just psychic but physical harm;
we assume the two are much the same (Kramer, 1994: 296). Trauma may be
the result of poverty, of being in a concentration camp, of sexual abuse, of the
ageing process: Or we see our spouse as a sort of first neurotransmitter in a
cascade of chemicals, one who keeps our serotonin levels high (Kramer, 1994:
296). The resonance with that 19th-century physical theory of memory, where
everything that happened was preserved in some little spot of the brain
(Hacking, 1994: 46), is clear.19 Conversely, as Greenfield puts it, [e]xperiences we have never had can play no part in framing our personality (Greenfield, 2000: 156). A curious re-emphasis then, on a materialism that suggests
that it is what is literally engraved on the brain (memorized), rather than
what is forgotten, that forms our character, our personality, our soul
(Hacking, 1994: 33). Personality, Kramer writes, may be directly encoded by
trauma (Kramer, 1994: 124; emphasis added).
It is precisely because experiences (we have had) leave their biochemical
and anatomical mark, or scar (as Kramer claims), on the brain, that their
effects, at least in theory, are available to be managed: [e]arly and prolonged
intervention, Kramer argues, is crucial (Kramer, 1994: 114). The uninterrupted continuity between the psychological and the biochemical that
Kramer assumes suggests that Prozac should be understood not as a drug that
acts on and may cure a specific malfunction, which is at the root of an illness,
but rather as one that contributes to a general reshaping of personality. Personality, shaped by experience at the neuronal level, can also be reshaped at
this level. Indeed, Kramer argues that although the individual cannot be cured
of an illness, his or her personality can be transformed (Kramer, 1994: xix).
This, ultimately, is the significance of the particular model of the brain on
which he depends. In Kramers view, it has given rise to the kind of research
that produces not medicines that correct particular illnesses but medicines
that affect clusters of functions in the human brain, often both in well and ill
persons (Kramer, 1994: 64; emphasis added). In his commentators view, this
is one of Peter Kramers most controversial claims: that anyone can take
Prozac, and they can take it regardless of their medical status.
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E N H A N C E M E N T, E N A B L E M E N T, D I S E N A B L E M E N T
We are entering an era, Kramer writes, in which medication can be used to
enhance the functioning of the normal mind (Kramer in James and Camden,
1993: 14). As I will illustrate, Kramer clearly assumes (for a number of
reasons) that such enhancement is desirable, is indeed enabling. It is a presupposition that many of his critics choose to contest. In this section I will
also therefore consider some of their objections specifically, by way of a
closer examination of this notion of enhancement, which appears to bring
with it not only opportunities for the individual, as Kramer claims, but also,
according to his critics, a high price in obligations and demands.
Prozac, it is said, induc[es] mental agility where before there was none,
impart[s] confidence to the timid, optimism to the habitually pessimistic,
flexibility to the rigid of habit (Slater, 1999: 188). In Listening to Prozac it
enables Gail to work, Tess to play and Allison to improve her sense of selfesteem. From this perspective, cosmetic psychopharmacology (Kramers
term) might be seen as a source of biological force which can give one a
leg up in the modern world (Lyon, 1996: 60). Lyon writes that the popular
image of Prozac
. . . in America especially, is associated less with specific disorders than
with its reputed ability to enhance performance. . . . Its reported effect
in enhancing confidence, enabling one to focus better, and so apparently
to be more successful, makes it in demand by professionals who wish
to succeed or just cope with the realities of contemporary life.
(Lyon, 1996: 59)
But Kramer makes a larger claim for Prozac than simply enhanced performance at work and in life. Insofar as it emboldens the inhibited and the
injured (Kramer, 1994: 272), Kramer suggests that the transformative
powers of Prozac (ibid.: xviii) should be celebrated for their contribution to
the liberal goals of equality and freedom. All men are created equal at least
in our political and moral ideal, he writes, but they are created biologically
heterogeneous (Kramer, 1994: 298). With Prozac, as well as its newer psychopharmacological playmates, biological heterogeneity which seems to
imply biological inequality, at least for some is no longer a barrier to equality of opportunity. Indeed, it is a means to such equality insofar as it chips
away at the limits to human malleability [which are] disturbing to our
political tenets (Kramer, 1994: 298). As Camilla Griggers succinctly (if
sarcastically) describes it, psychopharmacology promises to be the great
democratizer for people made vulnerable by trauma or by innate neural
chemistry (Griggers, 1997: 129). The result, in Kramers eyes, is the extension (even the completion) of the democratic project.
Prozac, then, acts not just on serotonin, but on the inequalities meted out
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both by the vagaries of life and by the individuals biological makeup.20

Particularly with regards the latter, Prozac also appears to overcome a further
and some argue final impediment to what Colin Campbell (1996) identifies as the modernist dream: nature itself. For Campbell, biology represents the inherent, natural limits to an individuals power of agency
(Campbell, 1996: 149), it is the barrier that stands between gods and humans
(Campbell, 1996: 157). And yet when Kramer asks Who is Ms. B.?, he finds
that
. . . [t]he change Prozac brings about in her is so profound that there
are almost two different persons in the story, one discontented and
driven, the other contented and complacent. . . . Instinctively, we might
want to say that the unmedicated woman has priority . . . [but] if she
reported she felt fully herself both on and off medication . . . the personality she chose would be purely a matter of preference. (Kramer,
1994: 268; emphasis added)
Drawing on Weber, Campbell argues that during the 18th and 19th centuries
the programme of reconstructing society through the reconstruction of the
person . . . was a moral crusade to turn behavers into actors; something
which lies at the very centre of the modernist dream of using reason and
science to create a utopia (Campbell, 1996: 150). According to Campbell,
behavers and actors map roughly onto personality and character: where the
former pertains to reactive behaviour, over which no intentional meaning can
be attached, the latter, character, denotes all those qualities that are believed
to be capable of being controlled by will.21 To the extent that science has
created a drug that renders the personality of the individual a matter of
preference, personality is absorbed into character (Lury, 1998: 2203). Utopia
beckons. Prozac, Kramer writes, represents a revolution in mankinds
relationship with itself (Kramer in James and Camden, 1993: 14).
In extending to biology the sphere of conscious calculation, strategic
decision-making (Lury, 1998: 1) and the apparently never-ending exercise
of will (ibid.: 2), Prozac finds a home in what Celia Lury calls prosthetic
culture. Through technologies of visualization in particular, Lury argues that
prosthetic culture renders experimentation a technique of the self such that
aspects of the self that were once assumed either because of nature or
because of social organization to be fixed, immutable or beyond will or
self-control (Lury, 1998: 1) are now a matter of potential or technologically
assisted choice or selection (ibid.: 19). Understood as a prosthesis, Kramers
claims for Prozac amount to the bold suggestion that the relation between an
individual and its biology is loosened insofar at least as some of (the effects
of) the individuals neuronal architecture whether this is shaped by experience or genetics are no longer understood to be inevitable or irreversible.
Prozac is the means by which biology too becomes a possession of the
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possessive individual. Individuals, in Kramers world, have a choice: they can

suffer, or they can change (Kramer, 1994: 275).
If, for Kramer, enhancement and enablement are one, for many of his
critics they must be distinguished. The stark dichotomy to suffer or to
change is almost impossible to maintain in the context of a set of critiques
which, broadly, claim that while change may (or may not) improve the life of
the individual in the short term, change without suffering (and especially
spiritual suffering), as well as, particularly, change that erases suffering, will
ultimately militate not only against the life of the individual, but against life
itself. Or to put that differently: enhancement should not be mistaken for
enablement, nor suffering for disenablement. When people try to convince
me that the depth of their suffering proves that they have a disease, Peter
Breggin writes, I say just the opposite that it proves they are alive (Breggin
and Breggin, 1995: 246). Disenablement properly understood that is,
separated from enhancement can be enabling in itself: Suppose we could
relieve all of us our sense of spiritual emptiness or alienation, of our feeling
of being disoriented and lost in the world. Would that be a good thing? Or
is it sometimes better to feel bad than to feel good? (Elliott in Parens, 1998:
S11).
The suspicion that Prozac enforces mundane and banal social norms over
and above a more authentic creativity and crisis is neatly captured in Lauren
Slaters autobiographical account of an exchange with her Prozac doctor:
Look, I said. I dont know if youll understand this, but lifes become
too good. . . . I feel so damn relaxed. I cant get anything really creative
done in this state.
And what, may I ask, he said, folding his elegant hands and leaning
back in his seat, did you get done in your prior state? If you dont mind
my being so direct.
Well, I said.
Well, he said, jumping right in, you are not getting as many crises
done. You are not accomplishing as many hospitalizations. You are not
accomplishing as much unemployment, given that you report to me
you have, for the first time, a steady job as a teacher. (Slater, 1999: 77)
It is not difficult to conclude from this extract that while Prozac might make
for good enterprising subjects, subjects who can gain and perhaps even maintain productive employment, for example, it does not make for good humans.
As Kramer rather succinctly summarizes this position: mood brighteners
might decrease true autonomy by distancing man from an aspect of his
humanity his legitimate despair and by reinforcing dehumanizing cultural
expectations, such as the requirement always to be happy and productive,
even in the face of a world that deserves a more complex emotional response
(Kramer, 1994: 2567).
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Just as Canguilhem argued that it is possible for an organism to mistake a

social norm for a vital norm, so a number of critics imply that it is possible
to mistake a particular kind of enhancement for enablement. While a
mistake of this kind might be quite complicated enough in relation to the
body even though some argue that when it comes to the body . . . there is
a remarkable amount of agreement about the values we wish to pursue
(Osborne, 1998: 92) it is more complex still in relation to the soul, and
especially in relation to an analysis that situates itself, as Kramers does, so
ostentatiously between body and soul: for some critics, to impose a mental
norm can go against what it means to have a vital norm at all (ibid.: 93). Ironically then, although one might be tempted to describe depression as the
opposite of life if life is defined, as it is by Canguilhem, as the opposite of
indifference to ones surroundings (Canguilhem, 1994a: 72) for many
critics it is in fact the cure for depression that opposes and even negates life:
what about the unfelt life?, Peter Breggin asks. Is it a life at all? (Breggin
and Breggin, 1995: 249).
The debates addressing the implications of Prozac, and of the model of the
brain on which Kramer draws, are numerous and diverse, and I do not want
(nor could I) to pursue all of their nuances here. As Marilyn Strathern notes
in the conclusion of her discussion of the new reproductive technologies, it
is not that advantages do not exist to be evaluated, but that there are other
things of interest to consider (Strathern, 1996: 49). One example of this would
be how much value Euro-Americans place on their ability to do things,
including doing things to their sense of identity (Strathern, 1996: 49). Prozac
is certainly an illustration that things can be done to identity or at least
ones sense of it but for many critics this is not an unproblematic achievement. Indeed, the ability to do things to, or to transform, identity is often
not in itself perceived to be sufficient reason to do it: [p]sychiatric residents,
one psychiatrist complains, are no longer trained to observe and try to
understand human behavior, but only to change it. They are . . . armed to alter
emotions which filled volumes by James and Proust (Dumont in Markowitz,
1991: 27). In this respect the Prozac debates also illustrate, as Strathern goes
on to add, that Euro-Americans enhance their abilities only to enhance their
critiques of them at the same time (Strathern, 1996: 49). In this context, that
enhanced critique turns precisely on the question of enhancement itself (and
its relation to ability).
But is this an enhanced critique? One of the principal objections to
Kramers account, as I have illustrated, is that his understanding of the brain
fills (with biology) the ephemeral gap between body and soul, the gap in
which a transcendental human nature is traditionally located. By contrast,
for Kramer, spiritual anxiety is no more than an affect, not evidence of a
natural, unique, human-ness but rather a symptom of a nature shared with
animals: Kierkegaards fear and trembling and sickness unto death, are . . .,
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Kramer writes, quite ordinary spectrum traits of mammals, affects whose

interpretation in metaphysical terms is wholly arbitrary (Kramer, 1994:
296). For sure, this is a well-established response to the collapse of body and
soul, brain and mind a collapse that is itself hardly unfamiliar (as witnessed
by the long-standing debates that continue to address the implications of
other, particularly hallucinogenic, drugs). And it is not as if, as Nikolas Rose
argues, suffering has not been demythologized and sickness disciplined for
over 200 years (N. Rose, 1994: 69). Perhaps, if the implications of Prozac
have been subject to an especially intense scrutiny (one that exceeds the
critique of an unhappy meddling with identity), it is on account of what
Prozac is perceived to meddle with that is, with nature itself, regardless
of whether this nature refers to humans or to animals, and which, being a
most ambiguous concept, additionally overlaps with the tricky question of
what constitutes normality.
T H E N O R M A L , T H E N AT U R A L A N D N AT U R E
Does Prozac act on an abnormality in the brain, and so return the individual
to what is normal/natural? Or does it bring about an enhanced normality
that is abnormal/unnatural in its effects? I want to pause for a moment
now, to consider these questions in the context of debates that are concerned
with the relation between the natural and the normal more broadly. As noted
above, the nature in the critical appeal to human nature differs from
Kramers animal (and human) nature in a most fundamental way, insofar as
the latter is not really natural at all, but rather (almost) wholly artificial. The
implications of this shift have a bearing not only on the individual, but also
on the concepts that are defined through and against a more conventional
understanding of nature. I will begin to explore the nuances of these implications here, in relation to the concept of normality, before continuing, in
the following section, to address their impact across a range of terms that are
commonly deployed in the Prozac debates.
To recap: what Prozac offers the individual, as Nikolas Rose might put it,
is the chance to exploit the productive optimization of her biological capital
(N. Rose, 2000). This is the significance of Prozac, according to Kramer: its
ability not so much to transform personality, but to transform what Kramer
understands to be the infrastructure of personality, the internal workings of
the brain itself. The cascade of transmitters that flush the brain and that keep
flushing it is no longer wholly determining, but is, rather, open to interventions based on choice. This individual might be primarily biological then,
and animal, but it is not by any means a natural kind of entity not if nature
is understood as that which is given and immutable. In Kramers analysis, the
frequent assumption that the neurobiological body is a politically and
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materially static body, while the cultural body is politically and materially
malleable (Wilson, 1998: 203), no longer holds fast.
When nature no longer appears to be natural it displaces other categories
with which it has relations. Evelyn Fox Keller argues that in the light of the
mutability of biology, the distinction that had earlier been made by the
demarcation between culture and biology (or between nurture and nature) is
now made by a demarcation between the normal and the abnormal (Fox
Keller, 1993: 298).22 Given the tangled relation between the natural and the
normal, however, this is hardly a straightforward displacement of one set of
terms and its replacement with another. As Linda Birke writes: the statistical meaning of natural is quite often confounded with a normative
meaning (Birke, 1986: 13). But while normality is sometimes considered
natural what is right (Hacking, 1998: 168) and should be preserved on
the other hand it is also only average, and so is something to be improved
upon (Hacking, 1998: 168). In the context of genetics this uneasy tension fails
to be resolved, Fox Keller argues, except by negation normal is the
absence of those alleles said to cause disease (Fox Keller, 1993: 298). Peter
Kramer, however, does offer a definition of normality, if only by default.
Prozac returns the individual to what is socially acceptable and therefore,
he implies, to what is normal. It offers the individual an additional avenue
of response to social imperatives whose origins have nothing to do with
progress in pharmacology (Kramer, 1994: 275).
For his critics, however, the progress in pharmacology, and certainly the
perceived success of drugs such as Prozac, has everything to do with social
imperatives. As noted above, the work of enhancement is perceived in fact
to be disenablement in disguise; enhancement, in this context, is said to
bring about a stultifying normality characterized by compliance with a gamut
of Euro-American advanced capitalist values: These drugs are not good for
simply any life project. They are good for a particular sort of life project
(Parens, 1998: S12). And there are some social groups, commentators argue,
who bear the burden of that particular project more than others groups such
as women, for example.23 Most obviously, the criticisms targeted at Prozac
have something in common with those aimed at mothers little helpers, the
amphetamines and barbiturates that were prescribed mainly to women in the
1950s, 1960s and 1970s. These were the pills that kept women in their place,
that place being the home and, specifically, the kitchen and the bedroom. Certainly it wasnt out protesting on the streets, as Kate Milletts account of
lithium in The Loony-Bin Trip (2000) suggests. Ms Prozac, as one of
Kramers patients calls herself, brings the popular image of the Stepford wife
up to date:
A daunting creature when all her systems run, she is a hyperthymic
overachiever, technologically loaded with electronic-prosthetic
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memory, neurochemical-prosthetic personality, and media-prosthetic

desires. But breakdowns are common, and when they happen, one can
glimpse the (dys)functional organs ordering her as a feminine social
subject. (Griggers, 1997: 105)
As a new psychopharmacological arsenal joins a long history of technological interventions into normality, the debate is returned to precisely what it is
that Prozac enables, and to the value (or not) of the enhancement. An ethics
of complicity (Little in Parens, 1998: S10) seeks to adjudicate between
enhancement and enablement, questioning as it goes at what point one turns
into another turns into disenablement. What is life on Prozac like? Diminished, answers Lauren Slater. And in its place? Ice cream (Slater, 1999: 29).
Ice-cream, then, as a substitution for life, compensation for life as it should
properly be lived.24
Canguilhem argues that one of the conditions that is enabling of life is the
maintenance of a proper relation between the environment and the living
thing (Canguilhem, 1994b: 354), a relation that determines what is normal
in both (ibid.). In order to be normal, the living being must be able to exercise a little bit of abnormality so to speak; Canguilhem writes of a margin of
variation, a latitude of deviation, which ensures that it can respond flexibly
to changes in the environment. Without this elasticity, a situation may arise
in which neither the environment nor the living thing can vary without compromising the viability of the living thing irreparably (Canguilhem, 1994b:
354). Should this occur, then the apparent normality of adaptation is in fact
pathological (Canguilhem, 1994b: 354). If the implications of Prozac were to
be read in the light of Canguilhems analysis of the normal and the pathological (and I would argue that they often implicitly are) then Prozac, in
enabling the individual to conform to (and confirm) the status quo (in
enhancing normality), also simultaneously disallows an opportunity for the
establishment of normativity (which includes flexibility).25 This is a deeply
ironic state of affairs. For centuries, Nikolas Rose argues, we have come to
celebrate normality, but simultaneously to live under the constant dread of
all that would threaten it (N. Rose, 1994: 69). Yet when normality (as it is
understood by many of Prozacs critics) is itself enhanced, it spills over into
pathology. Or to put that differently, Prozac is said to usher in a normality
that is pathological in its effect, in effect, a pathological normality. Malcolm
Lader, Professor of Psychopharmacology at Maudsley Hospitals Institute of
Psychiatry, is clearly not alone when he suggests that the only question [with
regards to Prozac] is just how much normality we allow to be treated with
drugs (Lader in James and Camden, 1993: 14).
It is possible to situate the debates outlined above in the context of the
medicalization or pathologization of everyday life (Burr and Butt, 2000:
186). Where Prozac is concerned, the normal heartburn of living is being
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medicalized . . . the burden of self-consciousness is pathologized (Shorter,

1999: 25). Critics object that this medicalization involves a misunderstanding of the distinction between not having enough serotonin and thinking
the world is stale, flat and unprofitable (Kaysen, 1996: 137); they claim
that when spiritual or emotional pain is ascribed a material foundation and
understood as an illness, a medical cure is frequently promised and increasingly expected. To the extent that this is seen to be problematic, these objections might also be cast as part of a long history of resistance to the methods
of materialist science (Canguilhem, 1994a: 73). Canguilhem writes: If such
resistance often reflects emotional hostility, it may also stem from a
reasoned judgment: namely, that it may be paradoxical to attempt to explain
a power such as life in terms of concepts and laws based on the negation of
that power (Canguilhem, 1994a: 73). Arguably, these are commentators
who share a desire to maintain the boundaries between the body as lived
in by the subject and the body as described by the biologist (Spelman,
1990: 67, references omitted), between life with its rich and complex
texture and biology with its narrow and proscribed field. If this difference
is confused and collapsed, commentators argue, then medication is prescribed not just for suffering but also for personality and even for human
nature itself.
A resistance to biological materialism then, but not necessarily a resistance
to nature per se. The distinction itself suggests that this is a debate obliged to
address not only the nature of normality, but the nature of nature itself.
Indeed, in the face of an overtly biological account of moods and emotions,
many critics are wont to (re)assert some other, rather more fundamental,
notion of nature. Perhaps, ultimately, the issue at stake here concerns not
what is being enabled or even the value put on enablement itself (Strathern, 1996: 37), but rather the grounds on which the debates that seek to
answer such questions are formulated grounds, I would argue, that are
subject to disruption and change.
C H A N G I N G R E L AT I O N S
At first glance, I have argued, these criticisms might be characterized in terms
of an objection to the series of closures on which Kramers analysis is based.
Kramer begins by conflating the biological with the psychological (or, as it is
sometimes cast, material body and ephemeral soul), proceeds to collapse
experience, trauma and personality, medication and enhancement, and ends,
finally, with an inability to distinguish between the normal and the pathological. In short, this is a reductionist account of psychological processes
which, as noted above, is neither new nor unfamiliar. Critiques of reductionism (both analytic and methodological) are also well established and I will
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not rehearse them in depth here. Suffice to say that Kramer depends on what
Steven Rose calls statements of causality and identity statements (S. Rose,
1998a: 89). With regard to the former, Kramer assumes a unidirectional and
linear chain of causality whereby neurochemical events in the brain are
believed to determine particular moods. In this instance, reductionism overlaps with determinism, roughly on a time scale of immediate preceding causes
(Birke, 1986: 66). It is a claim which also assumes a direct correspondence
between levels, with events at the lower level taking priority. Thus: whatever
higher-order properties emerge and however they do so, they are always
somehow secondary to lower-order ones (S. Rose, 1998a: 93). With regard
to identity statements, here Kramer collapses the activities of neurochemical
transmitters with moods themselves. Feeling bad about oneself, he argues,
is an affective, not a cognitive, state (Kramer, 1994: 210; emphasis added).
In effect, Kramer is suggesting that neurochemicals are moods, just as rapid
heartbeat is fear (Kramer, 1994: 211).
There is no escaping Kramers reductionism. However, on the basis of the
above analysis, I want to argue in this final section that it is to more than
reductionism that Kramers critics object. I am taking my lead here from
Elizabeth A. Wilson, who astutely notes that: [w]hat is reduced in biologically reductionist theories of psychology is not only the psychological
phenomena involved but also biology itself (Wilson, 1998: 96). She asks too,
that biology be rescued from such circumstances by critiques of reductionism (Wilson, 1998: 96). In the spirit of rescuing biology therefore, it is
worth pointing out that it is precisely Kramers reductionism that enables him
to release biology from at least some of its determinist and determining
connotations; that it is the collapse of the psychic with the neurobiological
that allows for the possibility of intervention at, and transformation of, the
biochemical level that demands, indeed, an active intervention. From here,
Kramer is able to pry apart the once ostensibly intractable relation between
the individual and its biology, such that that relation is no longer understood
to be given in nature but rather requires mediation by choice.
Thus rather than understand these critiques in terms of an objection to a
biology that closes things down (that closes down reduces the relation
between body and soul, for example), they might be conceived in terms of an
objection to one that opens things up. Kramers understanding of the brain,
on which his account of Prozac rests, opens up the relations between the individual, its biology, nature and culture relations which are now cross-cut
with, and thrown about by, artificiality. Mutability, a characteristic that is frequently associated with culture, now appears to be a property of the objects
of biological study.26 For Kramer, perhaps perversely, biology is again destiny
but now destiny (biological or other) is a perceived resource in the hands
of the individual, one that enables the past to be perfected (Lury, 1998: 3) and
the future [to be brought] into the present (N. Rose, 1998b: 180). In this
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context, even not intervening . . . becomes a kind of intervention (N. Rose,

2001 forthcoming).
Paradoxically then, it is through closure that Kramer is able to open up a
series of seemingly unyielding relations that the stability once ascribed to
nature contributed to holding in place. Or perhaps this is not so paradoxical
after all: drawing on Strathern, Lury argues that in a postplural world, relationality will be lost . . . will no longer be deemed to be inherent in things
(Lury, 1998: 16).27 Arguably, it is exactly this, relationality, that Kramers
opponents seek to re-establish that is, the ability to calibrate the differences
and similarities (Lury, 1998: 16) between terms (such as enhancement and
enablement, nature and culture, normality and pathology) that are perceived
to have been evacuated of meaning. Indeed, although I have focused on only
the most familiar critiques of Prozac (the ones most frequently found in the
press and which draw on a notion of the self, an existential understanding
ultimately, which has long been a point of philosophical debate in EuroAmerican thought), they are nevertheless indicative of a widespread concern
from commentators located across a range of disciplines.
Attempts to replace concepts in their proper relations are hardly confined
to those who address themselves to nature, for example. Sociological critiques
of Kramers account of the brain and the self, while they may be concerned
with (but more usually bracket off the question of the truth of) the biological
reductionism it entails, are more likely to focus on its reduction of social and
cultural problems to the problems of the individual.28 For Vivien Burr and
Trevor Butt it is not biological materialism that is partner to the pathologization of everyday life, but psychologization that is, the casting of
difficulties and problems into psychological frameworks and therefore locating them at the level of the individual (Burr and Butt, 2000: 186; see also
Lyon, 1996; Griggers, 1997). While the effects of Prozac might lead, as indicated above, to more nature in peoples discourses (more animal nature,
more human nature), as well as to more culture (more choice, another
prosthesis) conversely, from the sociological perspective, they may also lead
to less of everything and more, only, of the individual. Now, [t]he individual
is judged by no measure outside itself. It is not to be related to either nature
or society. . . . It is not analogous to anything. The individual is all there is of
society (Strathern in Lury, 1998: 16).
But as Lury points out, it is not even that the individual is all there is of
society. In a process of what she identifies as outcontextualization, individuals, if they are acknowledged as units of analysis at all, are seen not as
wholes but as the sum of diverse factors amenable to analysis and manipulation by specialists (Lury, 1998: 19). This point would not be lost on Peter
Kramer who worries that change will become ever less a matter of selfunderstanding and ever more a matter of being understood by an expert
(Kramer, 1994: 298). Indeed, critiques of outcontextualization which is not
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just a question of de- and re-contextualisation, but a reconstitution or

regrouping in order to make visible the ability of a thing, an object, a part to
be taken out of context (Lury, 1998: 19) can be found across a range of
spheres bringing together the most unlikely commentators. Thus the neurobiologist Steven Roses objection to the reification of objects and organs,
which, he suggests, cease to be a property even of the individual but instead
become a property of part of the individual (S. Rose, 1998a: 288), will find
resonance with Rosi Braidottis Deleuzo-Guattarian critique of organs
without bodies (Braidotti, 1994: 64). But where Rose seeks to reinstall the
whole individual, arguing that we must speak not of schizophrenic brains,
genes or even urine but of brains, genes or urine derived from a person
diagnosed as suffering from schizophrenia (S. Rose, 1998a: 288), Braidotti is
more concerned with the power relations that may or may not inform processes of outcontextualization. The visibility of the object or organ, she
argues, is matched by an invisibilization of the body from which it is taken
which in its turn invisibilizes the unequal power relations that affect the
different roles that, for example, different women are called upon to play in
the reproductive industry. In short, not all members of Euro-American
societies participate equally or on the same terms in [prosthetic] culture
(Lury, 1998: 18).
These issues are also relevant to medicine and illness, which are as much
knocked about as they are informed by the concepts of nature and culture.
For some critics, Prozac comes wrapped in the promise of medical treatment and is therefore
. . . apt to be viewed by those who accept its promise not as producing
an artificial self, but as restoring or uncovering a self that had heretofore been damaged or concealed. . . . Prozac thus fosters a medicalized
self, one defined as desirable on the basis of criteria of health rather than
postmodern expressivity or adaptability. (Hewitt et al., 2000: 17880)
But there is no reason not to understand health and illness themselves as
resources through which the individual might both construct a prosthetic
auto/biography (Lury, 1998: 24) and attempt to return medicine to its
proper place, a place that belongs to the authentically ill. Indeed, the perceived loss of the distinction between medication and enhancement, pathology and normality, may lead some Prozac users such as Elizabeth Wurtzel,
for instance (although this is not at all uncommon) to (re)install their own
hierarchy of affect. Every so often, Wurtzel writes, I find myself with the
urge to make sure people know that I am not just on Prozac but on lithium
too, that I am a real sicko, a depressive of a much higher order than all these
happy-pill poppers with their low-level sorrow (Wurtzel, 1998: 303). Less
generously, one might also situate this kind of assertion within the debate
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around normality, and ask who it is that wants to be normal, or rather, who
it is that can afford not to be.
CONCLUSION
[T]he question of rights, Strathern argues, turns on the right to fulfil what
one wants, and in a much larger way that is the justification for the enabling
technologies. They help persons fulfil themselves (Strathern, 1992: 32).
Maybe so. Or maybe not. In the context of Prozac, the right to fulfil oneself
individual enablement is often perceived to come into conflict with the
rights of the species,29 of social groups of individuals, and even the rights of
the individual who may not really know what is good for him or her. It may
militate against human-ness, or on the other hand it may provide yet another
vehicle through which individuals are able to claim their rights as humans,
this time on the basis of life itself: a kind of biological citizenship based on
the universal human right to the protection, at least, of every human beings
rights to bare life (N. Rose, 2001 forthcoming). It may be that there is more
or less enhancement, which may mean more or less enablement. This is only
a handful of the many matters up for debate, debates that I have not pursued
directly here.
I have not done so in part because these issues can be framed not in terms
of whether individuals really are more independent of what has been understood as natural and social determination than in the past, but rather in terms
of how, and with what implications, the (perceived) changes to the relations
between these determinations make it possible for them to think and act as
if this was so (Lury, 1998: 224). Prozac, like other icons, is a repositor[y] of
meaning at a certain time and place and for a certain audience (Betsky, 1997:
31). As such, it is one of the vehicles through which individuals are enabled
to think and act as if . . . It is the vehicle through which certain relations are
challenged, confirmed and refigured.
These relations, I have argued, are not disrupted by biological materialism
or reductionism alone. Reductionist arguments tend to simplify and reify
complex processes, and if this were the substance of the claims made on behalf
of Prozac, then perhaps they would be relatively easy to refute. The reductionism in Kramers analysis, by contrast, has the effect both of reification
and of release: it enables Kramer to disconnect biology from things with
which it once had seemingly indissoluble relations, and to reconnect it to
others with which it should have perhaps no relation at all. In particular, it
challenges the relation between biology and nature: biology under control,
Strathern writes, is no longer nature (Strathern, 1992: 35). And when
nature loses its apparently natural properties, it destabilizes other categories
that have traditionally been defined through and against it. I have suggested
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that it is to this, rather than to any simple biological reductionism, that critics
in the main object; that the wide range of objections to Prozac seem to be
united, broadly, in their attempts to re-establish the relationality between
nature, culture, biology and the individual.
I do not want to celebrate Kramers analysis in its entirety, or to condemn
those who seek to re-establish the relations between various concepts.
Although Kramers account of Prozac opens up a particularly productive
understanding of biology, he does not himself pursue the implications of
this in any depth. For instance: seemingly bereft of any alternative theoretical tools, and immersed in conversation with commentators who base
their discussion on existential concepts, Kramers argument pivots around
the claim that the person on medication is just as authentic as the one who
is not. It is partly for this reason (his inability or unwillingness to move
away from an atomistic conception of the individual) that Kramers political and sociological analyses, such as they are, often come across as naive
and/or unduly optimistic. Nevertheless, the counter-claim that biological
explanations of the self are, for example, essentialist (as opposed, the implication goes, to the anti-essentialism of culture) itself seems inadequate to
the task not only of analysis, but of critique.30 What does essentialism mean
when it is viewed through the prism of Prozac? Or to put that another way:
What does the nominative biological or anatomical body actually refer
to? (Kirby, 1997: 70). This begs the question as to how it might be possible
to acknowledge and even condone Kramers revisions to the concept of
biology, while at the same time refashioning (and politicizing) their implications.
One option might be to insist, regardless of the proliferation of natures
and cultures in peoples discourses (as Strathern puts it), on a distinction
between the biological and social. It is a strategy shared by some social
scientists (see, for example, Margaret Lyon, 1996) and neuroscientists (see S.
Rose, 1998a), who suggest that a distinction such as this is especially necessary today insofar as understandings of identity, for example, are increasingly
often explained in terms of biology and, in particular, of genetics: there are
sociological implications that follow from the observation that we live in a
biologized culture (N. Rose, 2001 forthcoming). Another alternative might
be to address again the nature of ontology (Fraser, 2001 forthcoming). It is
beyond the scope of this article to consider even a fraction of the possible
responses and implications that this question inaugurates. What I hope I have
illustrated, however, is that it may sometimes be productive not to assume
immediately that so much of the quite extraordinary data that flows from
the sciences is . . . yet more evidence of an essential misdemeanour or failure,
but rather to consider it as a provocation whose full implications arent
straightforwardly evident (Kirby, 1999: 245). Attention to the details of
these data may challenge not only the frequent assumptions that are made
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about the claims of materialist science, but also some of the terms and concepts that are commonly deployed in the social sciences.
NOTES
I would like to thank the many people who read earlier versions of this paper,
including especially Elizabeth A. Wilson, and the History of the Human Sciences
referees for their helpful suggestions. Thanks also to participants in the Bios Research
Seminar Series (Goldsmiths College), and at the Policy and Ethics Research Institute
(University of Newcastle, University of Durham and the International Centre for
Life), where versions of this paper were presented. In particular, for their detailed
comments and constructive criticism, my thanks to Sarah Kember, Celia Lury and
Nikolas Rose. All errors, etc., are my own.
1 An on-line search of the broadsheets in Britain from 1990 to 1999 indicates that
while in the early 1990s only a handful of articles discuss Prozac (in articles that
are specifically about Prozac), by the mid-1990s a trawl for Prozac yields literally
hundreds of references across texts dealing with a wide variety of subjects. Prozac
becomes a synonym for happiness, for depression, for a lifestyle, for a generation.
2 Or so popular mythology has it (Kramer, 1994; cf. Healy, 1997 for a vastly more
complex analysis).
3 Giving way to commentaries with titles such as Drugs vs. the Couch (Gelman,
1990), Better Therapy through Chemistry? (Markowitz, 1991), Prozac v. Freud:
Medicine wins (Shorter, 1999: 20). The debate is hardly this simple, however, and
far from over (see Fraser, 2000).
4 Wurtzels Prozac Nation: Young and Depressed in America, first published in
1994, quickly became established as something of a bible for the so-called Prozac
generation, a generation abandoned and left to cope with their immature parents
problems (Gardiner, 1995: 511). The perceived contrast between these two generations (more broadly represented as the baby boomer generation and generation
X), and especially their (conflicting?) political ambitions, is neatly captured in
Wurtzels claim, with all its complex implications, that depression is the only
rightful protest today but that, depressingly, it too will soon be numbered among
what are perceived to be fashionable and imaginary illnesses like shopping,
loving, or fucking too much (Wurtzel in Gardiner, 1995: 510).
5 The organization of identities around disease, illness and even chromosomes
(Rabinow, 1992: 244) is not in itself surprising if it is the case that health has
replaced salvation in our ethical systems, that the doctor has supplanted the priest,
that the discourse of medicine has become saturated with questions concerning
the meaning of life (N. Rose, 1994: 68; see also Coward, 1989).
6 Listening to Prozac became a best-seller before it was reviewed or advertised and
it remained on the New York Times Book Review list of hardcover best-sellers in
the United States for 22 weeks (Lyon, 1996: 61). Indeed, [i]t has been said that the
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sales of the book and vastly increased sales of the drug are so closely intertwined
that it is impossible to discuss them separately (Lyon, 1996: 61).
Steven Rose argues that the force of biology today is such that we even use the
name given to the science, biology, to replace its field of study life itself and the
processes which sustain it; the science has usurped its subject. So biological
becomes the antonym not for sociological but for social (S. Rose, 1998a: 5).
Although I am sensitive to this distinction, my own use of the term will for the
most part be dictated by the commentators on Prozac. Unlike Rose, who seeks to
restrict the use of the word biology to its proper limits, the study of those processes
and systems (S. Rose, 1998a: 20 n), these writers are not always so careful.
See Hilgartner (1990) on the blurred boundaries between popular and genuine
science, and particularly on the value of popular science for genuine science and
scientists in general.
The two principal biological theories of depression are the monoamine hypothesis and the neurotransmitter hypothesis (Stahl, 1996; see note 15 below). David
Healy argues, however, that while these theories have become almost irrefutable,
there are many who would concede that they cannot be right (Healy, 1997: 159).
Thus imipramine, for example, (one of a handful of tricyclics, so-called because
they have three carbon rings in their chemical structure) is believed to slow the
reuptake of amines from the synapse into the transmitting cell. Monoamineoxidase inhibitors (MAOIs), as the name suggests, inhibit monoamine-oxidase,
the enzyme that oxidizes amines, which, again, extends their time in the synapse.
Although there is some considerable controversy surrounding Prozacs sideeffects. Debate has it that while the majority of Prozac users experience relatively
minor side-effects, the drug is nevertheless in some way linked to suicidal ideation
at the very least and to violence, suicide and murder at worst (see Breggin and
Breggin, 1995).
As well as to animals and children, its prescription to the latter being an area of
increasing controversy and concern (see, for example, Panorama, 2000).
The relation between developments in science and in visual technologies has been
well documented (Cartwright, 1995; Kember, 1995; and see N. Rose, 1998a on the
relation between visual technologies and biological psychiatry specifically).
Of what were to become noradrenalin and acetylcoline respectively. Serotonin,
the neurotransmitter on which Prozac is believed to act, was identified in the gut
wall in 1933, in blood platelets in 1947 and in the brain in 1953 (Healy, 1997:
1467).
Early reluctance might be due, Healy suggests, to the closer association of electrical (rather than chemical) communication with a more vital . . . spiritual
identity (Healy, 1997: 145). The basic principles of chemical neurotransmission
today are as follows (but see Stahl, 1996 for details): electrical impulses in the
neuron, arriving at the synapse, release chemical messages from the presynaptic
nerve cell into the synapse. These chemicals bind with specific receptors in the
membrane of the postsynaptic cell, which changes the properties of the receptor
molecules and triggers electrical and chemical activities in the postsynaptic neuron
(Robbins, 1998: 33). Neuromodulation enables the transmitter to bias the
reception of the chemical transmission. These processes, along with the important
14(3)
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16
17
18
19
20
21
22
role played by enzymes, are central to psychopharmacological understandings of

the brain. The complex relay of electro-chemical signalling amounts to a
molecule-by-molecule transmission of messages that eventually alters the
biochemical machinery of [the cells] (Stahl, 1996: 47). While the basic elements of
this biochemical account of depression remain largely unchallenged, it is continually fine-tuned. Proponents now believe, for instance, that neurons use not one
neurotransmitter at all of its synapses, but several. And [i]f the neuron itself uses
polypharmacy, maybe occasionally so should the psychopharmacologist (Stahl,
1996: 13). In view of co-transmission, Prozac, with its selective targeting of a
single system, already seems somewhat past its sell-by date.
The accent on synaptic plasticity (and its perceived advantages) makes for interesting reading in the light of Emily Martins (1994) analysis of the privileging of
flexibility across a range of diverse discourses.
The contemporary focus on (the plasticity of) biochemical connections has by no
means displaced other understandings of the brain. Gerald Edelmans own neural
Darwinism (1998) attempts to develop a radical model of the brain as a complex
and dynamic system of interconnectivity which includes an analysis of neuroanatomy and physiology. For a more modest account of the relation between
different parts of the brain and brain functions, however, see S. Rose (1998b). As
Elizabeth A. Wilson argues, this is what much contemporary popular literature
on the brain attempts to address: this reticulating puzzle the brain is seen as
either one of the most complex structures in the universe, or as an organ delimitable to simple, localized constraints (Wilson, 2000: 33).
Drawing on Danziger, Hacking notes that psychology first patterned itself on
physiology, on the study of the body (Hacking, 1994: 37; emphasis omitted). By
the latter half of the 19th century, however, the way was cleared for [o]ne feature
of the modern sensibility [that] is dazzling in its implausibility (Hacking, 1994:
33), the notion that it is the forgotten that shapes personality (cf. Rosi Braidotti,
1999, who renders matters still more complex by arguing that we may have
memories of events that occurred before we were alive).
Which is not to say that they are identical. For example: while character was the
currency of 19th-century psychology, Kramer speaks, principally, of personality.
Of course he must, for he has a psychological legacy to address which, as a
Foucauldian reading would have it, is captured in the shift away from act-based
forms of governance and toward identity-based forms of governance (Valverde,
1998: 217). For more details on this distinction and its relation to the Prozac
debates, see Fraser (2000).
The relation between these two being the subject of much debate in the context
of genetics (see, for example, Karmiloff-Smith, 1998, on the relation between the
environment, genetics and the brain).
The distinction between character (which predates that of personality), personality and temperament is subject to some dispute. On the whole, Kramer moves
between and often collapses the three terms (personality, temperament and
character) (see especially Chapter 6).
In a different (although related) context, Ian Hacking writes: the Enlightenment
idea of Human Nature has been displaced by that of Normal People and normal
behaviour (Hacking, 1994: 38).
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23 Harvards School of Public Health Global Burden of Disease study reports that
major depression is the commonest illness among women in western countries
(Shorter, 1999: 20).
24 It is worth noting, however, that Prozac has also been represented as feminist
consciousness in a capsule: women on Prozac, Slater argues, are women who care
less about their bodies in general, who have aged prematurely and celebrate their
spinsterhood . . . Gloria Steinham [as] the spokesperson for Eli Lilly (Slater, 1999:
163; see also Kramer, 1994: 271). Slater is at her driest here, but perhaps in this
respect the effects of Prozac are similar to those that Germaine Greer claims for
the menopause (Greer, 1992).
25 Although, conversely, depression (and other conditions, such as obsessive
compulsive disorder, for example) may sometimes be understood to engender an
inflexibility on which drugs such as Prozac act. Thanks to Nikolas Rose for
pointing this out to me.
26 At least in this context and perhaps not surprisingly if, as Linda Birke argues, individual biology is at its most labile when it comes to internal biochemistry. Her
contrasting example is organ structure and anatomy which, she says, does not
seem to change very much (Birke, 1986: 95). However, in the light of recent
developments (such as the use of molecular biology to genetically engineer human
organs and tissues), this point might itself be open to question.
27 To take just one, related example of the loss of the naturalness of relationality to
things (Lury, 1998: 16): Prozac is said to give the individual absolute self-esteem,
an implication that requires some explaining given that social scientists have more
usually understood self-esteem to be a relational concept (Hewitt et al., 2000).
28 Although these two points often overlap. When the politics of interpretation
takes the formal expression of the science of symptomatology (Griggers, 1997:
115), more complex neural processes, Lyon argues, as well as their relation to the
ontology of suffering, [or] . . . the sense of the social connectedness of self (Lyon,
1996: 65) are displaced.
29 Although I have not addressed this issue, the debates around Prozac suggest that
disenablement as enablement has a value for those concerned with the individual
not only in its ontological aspect, but also in its phylogenic aspect. Randolph
Neese reminds the reader of the evolutionary value of misery, where pain and
negativity are to be understood as adaptive mechanisms which the human species
would be foolish to be rid of (Neese in Kramer, 1994: 2556; see also P. Martin,
1997). But while the evolutionist might share with the existentialist an objection
to a world in which our capacities to live are not natural and organic but artificial
(N. Rose, 2001 forthcoming), they do so not on the grounds that this displaces
another kind of nature, a singular and transcendental human nature, but because
it cleaves apart the relation between the species and its destiny. There is a resonance
here with the perceived implications of Prozac understood as biological prosthesis the fate of the species, like that of the individual, is its own.
30 There is no reason to believe that cultural understandings of the self, for example,
are any less reductionist or determinist than their biological opposites. It is often
the case, Vicky Kirby argues, that the explanatory force that can no longer be
ceded to the subject, or indeed to any identity, has nevertheless miraculously
resurfaced in the entity of culture itself. Causality and intention are happily
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rehabilitated, and the mantra that culture is constitutive is now intoned more
often than argued (Kirby, 1999: 21).
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Wilson, E. A. (1998) Neural Geographies: Feminism and the Microstructure of

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BIOGRAPHICAL NOTE
MARIAM FRASER is a lecturer in Sociology at Goldsmiths College, University
of London. She is currently working on a Wellcome Trust-funded project
titled Ethical Factors in Psychiatric Development.
Address: Department of Sociology, Goldsmiths College, University of

London, New Cross, London SE14 6NW. Telephone: 0207 717 2204 (direct);
0207 919 7707 (department). [email: m.fraser@gold.ac.uk]

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03 Fraser (dm/d)

HISTORY OF THE HUMAN SCIENCES

2001 SAGE Publications (London, Thousand Oaks, CA and New Delhi)

The nature of Prozac

THE NATURE OF PROZAC

living beings. Hence scientific interventions appear not as unique acts

HISTORY OF THE HUMAN SCIENCES

THE NATURE OF PROZAC

HISTORY OF THE HUMAN SCIENCES

exactly it is that Prozac is said to enhance. They question whether the

THE NATURE OF PROZAC

reputedly prescribed to adults with, as Camilla Griggers puts it, minor

HISTORY OF THE HUMAN SCIENCES

THE NATURE OF PROZAC

HISTORY OF THE HUMAN SCIENCES

THE NATURE OF PROZAC

both by the vagaries of life and by the individuals biological makeup.20

HISTORY OF THE HUMAN SCIENCES

possessive individual. Individuals, in Kramers world, have a choice: they can

THE NATURE OF PROZAC

Just as Canguilhem argued that it is possible for an organism to mistake a

HISTORY OF THE HUMAN SCIENCES

Kramer writes, quite ordinary spectrum traits of mammals, affects whose

THE NATURE OF PROZAC

HISTORY OF THE HUMAN SCIENCES

memory, neurochemical-prosthetic personality, and media-prosthetic

THE NATURE OF PROZAC

medicalized . . . the burden of self-consciousness is pathologized (Shorter,

HISTORY OF THE HUMAN SCIENCES

THE NATURE OF PROZAC

context, even not intervening . . . becomes a kind of intervention (N. Rose,

HISTORY OF THE HUMAN SCIENCES

just a question of de- and re-contextualisation, but a reconstitution or

THE NATURE OF PROZAC

HISTORY OF THE HUMAN SCIENCES

THE NATURE OF PROZAC

HISTORY OF THE HUMAN SCIENCES

THE NATURE OF PROZAC

role played by enzymes, are central to psychopharmacological understandings of

HISTORY OF THE HUMAN SCIENCES

THE NATURE OF PROZAC

HISTORY OF THE HUMAN SCIENCES

Fraser, M. (2000) Pathological Normality, in C. Campbell (ed.) Front. London:

THE NATURE OF PROZAC

HISTORY OF THE HUMAN SCIENCES

Wilson, E. A. (1998) Neural Geographies: Feminism and the Microstructure of

Address: Department of Sociology, Goldsmiths College, University of

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