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

Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs provides an insightful feminist analysis of the cultural meanings of psychopharmacology and the enduring power of Freudian psychoanalytic assumptions concerning sexual differences. The book is part historiography of psychiatry and part cultural analysis of modern psychopharmacology and pharmaceutical advertising. Jonathan Michel Metzl begins by challenging the dominant medical and historical assumption of a paradigm shift in psychiatry from the 1950s to the 1990s in which biological psychiatry and pharmacology successfully replaced psychoanalysis as the gold standard for the treatment for mental disease. He argues that this narrative construction fails to show the multiple ways that biological psychology and psychopharmacology mirror and reproduce much of the ideological work performed by Freudian psychoanalysis. Metzl, a practicing psychiatrist and gender studies scholar, provides a much needed critical analysis of a medical practice that is increasingly biomedicalizing social life and social identities. He primarily uses discourse analysis of media representation to frame his argument that the biological revolution of the 1980s and 1990s in medicine enacts many of the gender characteristics not only of Freudian psychoanalysis but also of popular culture of the 1950s, a culture highly shaped by the language and assumptions of Freudian psychoanalysis. He constructs his argument through three case studies, marking key moments in the historical development of psychopharmacology. His methods rely solely on discourse analysis of representations and texts, beginning with a case study of news magazines and popular print sources, published from 1954 to 1960, announcing the discovery of the tranquilizer Miltown (meprobamate). In this case study, he reveals how the masculine rationality of psychiatry, represented in advertisements for Miltown, exerts order and control over women who are too anxious (and therefore, “lacking”) to find a man and participate in heterosexual marriage and reproduction. His second case study presents an analysis of pharmaceutical advertising and professional journals from 1964 to 1997 on Valium, Deprol, Librium, Prozac, and other outpatient medications. Here, he illustrates several gender stereotypes, such as Freudian notions of female anxieties, including women’s sanity as closely tied with her marital status and women’s illnesses as threats to doctors (i.e., men). Finally, his third case study analyzes works of American literature from 1990 to 2002 on the “wonder drug” Prozac, illustrating that Prozac can be read as a return of the repressed emotional woman who threatens the stability of culture. Together, these case studies provide a history and cultural critique of how changes in iconography of pharmaceutical advertising between the 1950s and the 1970s mirrored changes in a psychiatric practice that