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)

Tribal Gatherings

Some of my fieldwork as an ethnographer studying the culture of psychotherapy included attending various psychotherapy conferences, conventions, meetings to get a sense of the participants and their behavior patterns. Two of the largest conventions/conferences I attended were the American Psychological Association (twice) and the Evolution of Psychotherapy (once in Hamburg, once in Anaheim). The attached file is based on an article I wrote describing my experiences with each gathering and making some observations about how they were distinct.


Interviews: Excerpts from Frankl, Ellis, Minuchin

Excerpts from Transcripts of Voices of the Elders in Psychotherapy

The following excerpts are from responses to an initial question about what motivated each interviewee to become a psychotherapist. Follow-up questions probed their early upbringing, education and other influences.

Albert Ellis

RM: The first question is what, in terms of your own personal background, motivated you to become a therapist or to do what you’ve ended up doing?

AE: I started out being a writer and I’ve got a BA in Business Administration, because I thought I would have to make money that writing might not. I worked with various kinds of things to keep my writing going and could make a little money. I had to earn a living. But I kept the writing going – first poetry, which didn’t sell. It was good, maybe it wasn’t. But it didn’t sell.

And then I got into nonfiction and wrote several books up to the age of 28. I think I had about 20 completed manuscripts of fiction, nonfiction, everything under the sun. But the nonfiction, which was about organizational and political issues, wasn’t selling either. So I decided to write on sex, love, and marriage.

My hobby had always been love, as against sex, and I do subscribe to Kinsey somewhat, but he was mainly into sex and not love. I actually did my first thesis on love relationships of college women. A little later Columbia University got uptight about having a student do anything like that. So I had to throw that out.

But in the meantime, as I read hundreds of books and articles on sex, love, and marriage, my friends and relatives came to me with their problems for failing sexually in relationships, and I knew a lot of the answers and could give it to them quickly, especially about sex, as they came to quickly or too slowly. I could tell them exactly what to do. I was an authority, one of the leading authorities, even though I had no training in the field, but I had read everything under the sun.

So then I decided to go into the field. I was 27 years of age or so and decided to get a Ph.D. in psychology because there wasn’t any in sex, love, or marriage, not even marriage counseling.

RM: In those days it might have been a more academicpsychology degree and then psychoanalysis or –

AE: Well, no, no, no. first there was clinical psychology.

RM: Clinical, right.

AE: That had gone back to 1910, but was mainly testing and some psychotherapy, and the main analysis was done by a psychiatrist because the Freudian people here didn’t allow lay people in.

So I got my degree in clinical psychology in 1947 after I wrote a thesis on personality, and I published the first material and several articles in psychological and sociological journals – the American Sociological Review – apparently because my study was of love, interpersonal relationships.

And then I became a psychologist who specialized right from the start in sex, love and marriage problems and who was quite active/directive because the original sexologists were physicians and they told people what to do. People came with a problem and they’d diagnose them and tell them what to do. So that’s what I could do better than they could, because I was specializing in sex, love, and marriage, and it was very active.

But then I foolishly thought that psychoanalysis was deeper and more intensive that other forms of therapy, so I got to analyze and practice it for six years and said, as I say in my workshops today, that psychoanalysis intensively does into every irrelevancy under the sun and misses and the philosophical relevancies. People don’t get disturbed by their early childhood experiences of our culture. They get disturbed by what they tell themselves. So I went back to philosophy after I got disillusioned with psychoanalysis. I went back to philosophy and wedded it to behavior therapy, which I’ve used on myself. Do you want to know how I used it on myself?

RM: Uh huh

AE: I had a phobia of public speaking at 19 before I was famed to be a psychologist. I made myself speak and speak and speak in public, despite my phobia – in vivo desensitivization – and got used to it and good at it, and now you can’t keep me away from the public speaking platform.

But then I decided to get over my fear of approaching women, which I never did, and the Botanical Garden is where I spent 200 days a year and always copped out on – I flirted with them but never talked to them. So I gave myself a homework assignment in June when I was off college. I would go every day to the park and whenever I saw a woman sitting on a park bench alone I would sit right next to her on the same bench and I would make sure I would talk to her in one minute, no debate, no horse shit or anything like that – in vivo desensitization. So I found 130 women sitting on park benches alone and sat next to all of them. 30 got up and waltzed away, but that left me with an even sample of 100.

But anyway, then I gave up psychoanalysis, about the most inefficient form of therapy ever invented, almost as bad as Rogerian therapy, and would help practically nobody and help people get sicker and sicker, nondirective therapy. And then I put the ancient philosophers together with behavior therapy and formulated the first cognitive behavior therapy and a little later added an emotive element. So it’s really the first multimodal therapy that we used, very clear-cut cognition, very direct and very clear-cut, very many emotive techniques and many behavioral over in vivo desensitization techniques.

Salvador Minuchin

RM: To begin, if you could, give some indication of what motivated you to become a therapist, and what sort of path you followed to get where you are now. I remember one of the things you said is that you had some early training in the 1950s at the William Allenson White Institute in psychoanalysis, but what you are doing now is quite different from that.

SM: I really don’t know why I became a therapist. Some things are probably very sequel. I was a physician.

RM:  So you did not start out wanting to be a therapist when you were young?

SM: I started out wanting to be a tango singer. That’s what I wanted to be.

RM: A tango singer?

SM: Yeah, in Argentina, people sing tangos, and that’s what I wanted to be.

RM: You tried, huh? That’s good.

SM: I suppose that some of these things are functions that one has in all families. If born into a large extended family with hundreds of cousins and parents that are central in the family. The sense of family was important in my extended family. If we needed buttons, we would go to a cousin that sells buttons. If we wanted to buy suits, my uncle Salvador had suits. We travel through a geography that was the geography of family members. So that says something of being a member of a club is very much the form of family therapies. Family ties, and being a Jew also makes me a member of a club, because as a minority, you have a sense of club that you don’t have as a majority. As a majority you are like a fish trying to define water. You don’t define it. As a minority, you do.

RM: This is over and against the Jews in Argentina?

SM: No. It’s Ashkenazi Jews. The fact that we speak Spanish is because the country speaks Spanish. My parents and grandparents came from Russia. I was also an immigrant and that is an important consideration, ethnicity, the culture, also, I think. I started as a pediatrician, doing some pediatric psychology and then I became a psychiatrist. And as I became a child psychiatrist, just by happenstance I came to the United States. I had an internship in a school for delinquent children. I needed a place to live and some money, so I got to stay in a residential place for delinquent children. That directed me to an interest in juvenile delinquency. I then worked with juvenile delinquents in Israel. So, you know, the idea that one starts in a particular way is a construction.

So after all these things then, the component of ethnicity and the component of differences, and the component of culture, form a significant part of why psychoanalysis as I studied it, became insufficient. In my time, if you were curious in psychiatry, you became a psychoanalyst. If not there was not really an identity.

RM:  And if you had an M.D., it was much easier. If you didn’t have an M.D. in the 1950s it was still difficult to go to psychoanalytic training.

SM: So I finished psychoanalytic training and began to work again in the school of juvenile delinquents and that then became a confluence of a number of trends: ethnicity, poverty, juvenile delinquency, families. So I became involved in working with black families in Harlem, and so on. That’s it.

Viktor Frankl

R.M.            As a reminder, my initial question is what drew you to becoming a psychotherapist?

VF: I was interested both in psychotherapy and in medicine and psychiatry and beyond that in philosophy. And so I found that I could combine both directions of interest, professional interest, in one profession, and that is psychiatry. In order to be a psychiatrist, in a wholistic sense, you have to take into consideration or include in your studies medicine and philosophy.

And so I was interested in psychiatry as something which combines both fundamental interests  and this interest has established itself within my personal life. I was, of course, mostly attracted to two classical figures, the founder of psychoanalysis, Sigmund Freud, and the founder of  Individual Psychology, Alfred Adler.

R.M.            Excuse me a moment. And Jung was not considered at the time a classical figure?

V.F.            No. frankly speaking, Jung has always been too vague in his declarations and this isn’t standard, the fact that Jung was occupied with tracing human problems, human psychopathology back to inherited –

R.M.            Collective unconscious?

V.F.            Yes, collective unconscious. And so it was too vague a concept for me. But he certainly was a great man , no doubt, but much of his importance in the history of psychotherapy was certainly not equal to the importance of Freud.

When I was 17 or 18 in 1922-1923, I had to give a formal lecture in school and I did so under the title “psychotherapy”, totally in terms of psychoanalytic concepts, which I had already read a lot about.

R.M.            Were other people using the term “psychotherapy” at that time or were most people using “psychoanalysis”?

V.F.            It was psychotherapy. And I gave them a lecture at public school and I talked about psychoanalysis. I talked about the “Freudian Slip”.

Then at the age of 16 I already started a correspondence with Sigmund Freud. And within 72 hours, again and again he immediately reacted at least by sending a post card. “Mr Frankl, I received your letter. Thank you.” And so forth, just acknowledging receipt. But once, and I swear without any ambition attempts of publishing those, I included a one-and-a –half page typed manuscript about psychoanalysis and I was deeply surprised when two or three days later I received a response from Freud. “Mr. Frankl, thank you for your letter. As to the manuscript enclosed, I read it for what it would do to the editor of the International Journal of Psychoanalysis and sent it to him.” And two years later in 1924 it was published there.

And about the same time I noticed on my way to the university from the Anatomic Institute, walking across a small park, a gentleman, an old gentleman crossing my way. And I said to myself, “this guy looks somewhat like Sigmund Freud”, whose photos I had known from newspapers, “but of course it cannot be Sigmund Freud”. He was wearing an old hat and a worn out overcoat. So I said to myself, “let’s follow him and if he makes a turn at the next corner, it certainly must be Sigmund Freud.” That way I became what the Americans call a follower of Freud. And he made the turn, and I stopped him in the middle of the street where he was walking, little traffic, of course at that time, 1924, and I introduced myself. I said “excuse me sir, but I would be honored to speak to Professor Freud”. “Yes, that’s me”. And then I introduced myself formally. “My name is Viktor Frankl” “Wait a minute”, he said. “Viktor Frankl, Shanine street, number 6, apartment No. 25 of Vienna. Is that correct?” “Absolutely”, I said. He remembered from my correspondence the old address. I referred to a book I read about the sex drive and he wished me to write a book review, but I didn’t do that because I was already affiliated in some way with Alfred Adler.

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 biographer. 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.

Welcome to Psychotherapy & Culture

Welcome to what I hope will be an informative, stimulating, and possibly even provocative series of exchanges about the relationship between psychotherapy and culture. My intention is to provide background to this topic, along with reviews of books, films, and other representations of the way psychotherapy impacts culture and culture – in turn- impacts psychotherapy – particularly in the U.S. I will be including some of my own experiences as both an anthropologist and a psychotherapist. I will also be including some interviews I have done with a number of leading psychotherapists throughout the world. I will be investigating and interrogating a variety of different psychotherapy “tribes” and “lineages”, such as psychoanalysis , cognitive-behavioral therapy, family therapy, Jungian depth psychotherapy, humanistic and existential psychotherapy, as well as a number of indigenous therapies in other cultures. I invite you to comment on my posts. I look forward to exchanging ideas with you.

Robert McAndrews, Ph.D.


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”.


During the last 25 years I have interviewed more than forty leading psychotherapists around the world. I will be sharing parts of these interviews along with some of my commentary. I contacted each therapist ahead of my arrival for the interview with a summary of the three essential questions I would be asking them. So they were somewhat prepared in advance with the direction  the interview might take. Of course there were follow-up questions and some of my interviews were more like dialogues or conversations than straight interviews. The three essential questions were: 1) What were your background influences in your decision to become a psychotherapist and develop your particular approaches and contributions to psychotherapy?

2) How would you describe the distinctions between what you have developed and written about from any other approaches to psychotherapy?

3) What do you anticipate your legacy to be? How might your work be continued and who might be your heirs? Also, what do you believe will be the future of psychotherapy?

I have included in this post a list of the therapist I interviewed. I will share parts of the interviews in future posts.

Voices of the Elders in Psychotherapy