Reviews: Lauren Slater – Welcome to My Country & Prozac Diary

I have written elsewhere about psychotherapy “insiders”, which refers to therapists and patients/clients who have written memoirs, or case studies/ case stories about their experiences with the therapy process and mental illness. One of the best insiders for providing an appreciation and understanding of the experiences of both a person suffering from mental illness and a therapist working with those who suffer from mental illness, is Lauren Slater, I reviewed her most recent book, “Blue Dreams” earlier. For this post I will refer to her books, “Welcome to My Country” (1997) and “Prozac Diary” (1999).

“Welcome to My Country” is both about Lauren’s own breakdowns and ongoing depression and the various issues and insights about her clients in her psychotherapy practice, while “Prozac Diary” is all about her own history with depression and her “relationship” with Prozac. This is the best account, among many, of an inside view of depression and reactions to psychiatric medicines. I have used Slater’s book, along with Andrew Solomon’s “The Noonday Demon” for my “insiders” material on depression, which also interrogates the relationship between bio-chemical treatments and psychotherapy. “Prozac Diary” and “The Noonday Demon” are best for discussing the “illness-treatment”relationship and identity issues. Also, the issues of creativity, productivity, and self-worth, which may include the illness (depressions) or at least the dynamic of dealing with the “edge” – pain is worth investigating. Once Prozac or other psychotropic drugs may have removed the pain, what happens to the self or an identity which was previously known and which may have required some “pain” for the creative “whole” person? Both Solomon and Slater discuss this. Does Prozac create a different person? When influenced on a regular basis by a psychotropic drug, will it affect the person as a self – the psychology of one who is in the world and relationships with other people?

Slater comments on people who said something like, “Prozac helped me become the person I was meant to be”. But Slater says, “And yet for me it was not that simple. My personality, yes, had always consisted of suppressed energies and curiosities, but also of depressions, echoing intensities, drivenness that tipped into pain, With the exception of the counting and touching obsessions, which I was only too happy to be rid of, I missed these things, or parts of them anyway, for they were familiar to me as dense fog and drizzle, which had its own sort of lonely beauty, as does a desert or the most mournful of music.”(p. 44).

I will post other material on depression later. There are quite a number of excellent accounts from other insiders, to include William Styron’s “Darkness Visible”, Anthony Storr’s “Churchill’s Black Dog”, Kathy Cronkite’s “On the Edge of Darkness”and several books by Kay Redfield Jamison.

In reflecting on both her being with depression and her role as a therapist, Slater, in “Welcome to My Country”, makes an observation which goes to the heart of the psychotherapy “enterprise”:

“What after all, is therapy, if not a story of progress? Such a story could be harmful to people who are bound to feel like failures in a  milieu where the expectation of improvement is so clearly etched. Perhaps the therapist’s job is not to help grow but to help shed, chipping away at the marbled mind until the original nubs and spurs emerge. Instead of thinking in terms of development, maybe we should be thinking in terms of sloughing, making the padded self thinner and thinner, until a true skeleton juts out.”(pgs 140-141)

Blue Dreams – Lauren Slater

I will be reviewing a number of memoirs by psychotherapists and people who have experienced psychotherapy as clients or patients. For a book that I originally conceived as “The Culture of Psychotherapy” one of my chapters is devoted to what I refer to as the “Insiders” – those on both sides of the couch, so to speak. I will share some comments and interpretations of various memoirs in future posts, but I want to begin with reviewing a recent book by my favorite insider memoirist, Lauren Slater. “Blue Dreams: The Science and Story of the Drugs that Changed Our Minds” (2018) is only part memoir. It is primarily about mind drugs and mental illness. Lauren Slater knows both better than most, as she has been both a long time patient both on and off various drugs, as well as a psychotherapist, helping others navigate their challenges with mental illness. Later I will comment on a few of Slater’s previous memoirs, particularly “Welcome to My Country” (1997)    and “Prozac Diary” (1998).

“Blue Dreams” is an engaging and  thorough tracing of the history of using various psychiatric drugs to deal with various mental illnesses. Slater has experienced numerous medications to treat bipolar and obsessive-compulsive disorders. She draws on both her own experiences and the research on the efficacy in trials and with ongoing patients in psychiatric care. Her conclusions are decidedly mixed about long term efficacy of any drugs, to include the once considered “miracle drug” – Prozac. The book’s chapters follow a general chronological path from Thorazine and Lithium through SSRIs to MDMA (Ecstasy) and Deep Brain Stimulation. Slater wants psychiatry to move toward discovering answers to “why” and not just “how”. She says: “I’d rather see psychiatry come up with a few theories that finally pan out, theories that illuminate the pathophysiology or etiology of depression, the structure of schizophrenia, the reason for the retreat that autism so often is.” “What, for instance, causes schizophrenia? How durable is the dopamine hypothesis, and what does it mean that when it comes to schizophrenics, drugs which dampen dopamine seem to diminish hallucinations and drugs that increase dopamine appear to make schizophrenic symptoms worse, even though, when researchers compare dopamine levels in so-called normal subjects with those in schizophrenic subjects, they find no correlation between high dopamine levels and psychiatric problems in the general population? Perhaps more compellingly, the low-serotonin story suffers the same fate. We have been told that depression and OCD are the results of too little serotonin in the brain, and that this is the reason why serotonin boosting drugs such as Prozac work. But some depressed people have a lot of serotonin while some well-adjusted people have less.”

Slater sums up her view of the possible future of psychiatry in her chapter ” Where We’re Headed”: “I think the future of psychiatry is, strangely enough, right here, in tiny tabs of acid and chalices of psychedelics such as ayahuasca, psilocybin, and MDMA. ” She also reviews the newest psychedelic that psychiatry has turned to – ketamine, a drug typically used by anesthesiologists during surgeries, but now being used (ketamine infusion therapy) only for those patients who are treatment resistant.

In a favorite passage of hers which looks back and points forward in psychiatry, Slater says, “Our next golden era of psychopharmacology, I predict, will be with psychedelics, drugs not discovered, but rediscovered. And in some strange way they reunite us with the father of psychoanalysis, Sigmund Freud, who believed that awareness was the vehicle by which we could be cured of our ills. At once brand-new and ancient, psychedelics allow us a radical awareness of our place and purpose in the universe; they actually seem to set us straight, these tie-dye drugs of the long-gone hippiedom.” Whether Slater is right about this or not we may be opening back up to psychedelics and we may approach them quite differently from our hippie past. We may also discover the “why” of some mental illnesses in the process?

 

Labyrinths: Emma Jung

There have been plenty of biographies of Carl Jung and plenty as well of other leading figures in the history of psychotherapy. I will be reviewing a number of them later, but because “Labyrinths: Emma Jung, Her Marriage to Carl, and the Early Years of Psychoanalysis” (2016) by Catrine Clay is the first biography of Emma Jung and her role in Carl’s life and the psychoanalytic movement, I feel it is fitting to feature her now. During this time in 2018 when we are gradually recognizing and giving credit to women who have contributed so much in many different fields, Emma Jung, as the wife of Carl has rarely been mentioned in literature about the psychoanalytic movement. Emma. She was a wealthy heiress and fell in love with Carl when she was just seventeen. Her wealth enabled him to accomplish a number of things he would otherwise not have done. But it was her steadfastness, tolerance and intelligence which withstood his various affairs and long time quasi marriage to Toni Wolff, that helped Carl succeed. She supported him and her children, and acted as Carl’s thinking partner during the early years of his relationship with Freud. She traveled with Carl for some of his trips to Vienna to work with Freud and she had a series of personal letter exchanges with Freud herself. She stood by Carl when he finally broke with Freud. She eventually embraced his relationship with Toni Wolff. She became an analyst herself in her forties and one of her first analysands was Barbara Hannah, who was Carl’s first biographers. Emma’s approach as an analyst was different from most others: one analysand said, “She approached the problem you brought to her quietly, even tentatively, but there was no fumbling. To be “right” did not appear to interest her. She met you where you were at”.

I have read quite a number of works about the various figures in the psychoanalytic movement and the social/political rifts which were part of the early years. Reading about Emma’s role in helping Carl and herself in shaping the movement, regardless of the split with Freud, is essential in contextualizing what we already know. It really wasn’t all Carl.

Reviews

I will be posting occasional reviews of books, articles, films and television programs about psychotherapy. These reviews will be in random order and not in time sequence – in other words, some reviews will be about books from many years ago, while others will be very current. An example of a current review will be of the book by Catherine Clay (2016), “Labyrinths: Emma Jung, Her Marriage to Carl, and the Early Years of Psychoanalysis”.