Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs

I want to be fair here. Despite its title, I don’t think this book was written with an audience of psychiatrists in mind. It derives from the psychiatrist-author’s Ph.D. thesis in feminist cultural studies. It displays his broad reading and his narrow language form, which is typical of this genre of theorists. I am not an expert in this area. When I read his declaration that 40% of people on Prozac have impotence as a side effect, however, I wondered how many of his other facts were wrong.

Metzl describes the far-reaching paradigm shift in psychiatry from the predominance of psychoanalytic to biological assumptions. He argues that during the 1950s golden era of psychoanalysis in the United States, the predominant thinking about women and minorities was fundamentally wrong. The analysts’ ability to describe, but not relieve, suffering set the stage for the new assumptions that mental suffering is attributable solely to neurochemical difficulties. This, too, is in error, he says, because mental disorders are embedded in social, political, and historical forces.

Metzl offers a “psychoanalysis” of meprobamate, diazepam, and fluoxetine. He synthesizes drug marketing efforts, declarations of psychiatric ideologues, psychiatrists writing for lay publications, and journalistic pieces about psychiatry. He finds that during the psychoanalytic era there were dramatic, recurrent representations of a female patient and a male psychiatrist. He asserts that each of the psychotropic wonder drugs in its own era promised to help women to find a life mate, become better lovers, or restore their maternal nurturance and thereby restore men to their rightful effectiveness in the family. He concludes that traditional patriarchal gender hierarchies have inconspicuously reappeared within biological psychiatry and that the new paradigm, ironically, is as antifeminist as the previous one.

His analysis of advertisements, which is quite illuminating, is selective rather than quantitative or systematic. He gives no consideration to advertisements that promise to help men and finds parallels between Oedipal dynamics of individuals and society. He seems relatively unaware of the limitations of his ideas and methods. The audience for this book might be interested in an empirical study that found equal numbers of men and women represented in the psychiatric advertisements of 1981 and differing gender trends in 2001 for the American Journal of Psychiatry and the British Journal of Psychiatry (1).

Prozac on the Couch never represents psychiatric thinking as richer than the gross oversimplifications of clinical reality that are inherent in psychoanalytic, biological, or gender-centric paradigms. Psychiatrists can be more sophisticated than Metzl perceives in this work (2). “Prescribing Gender” in the subtitle derives from his observation that in the meprobamate era the male doctor used to be represented as the therapy agent. Now there is no doctor in the advertisements, just the medication. Medication, therefore, has a male gender; it is phallic because modern advertisements still portray distressed young adult women. Get it?