This is an excerpt from a recently completed paper, written in reaction to a piece by Jacquelyn Zita that I had a strong reaction to, mostly because it covers a lot of things I am interested in: feminism, queer theory, anti-capitalism, and bioethics. I welcome any comments, as usual.
PROZAC FEMINISM: REINFORCING OPPRESSION
In 1993, Dr. Peter Kramer released a book called Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self. The book chronicles Dr. Kramer’s experiences with the psychotropic antidepressant Prozac in his psychiatric practice. Kramer muses on how Prozac impacts self-identity, and the ways in which the drug seems to indicate that psychiatric problems have a biological nature. While Kramer poses some questions about the morality of using prescription medication as a way to achieve a health status that is “better than well” (Kramer, 1993, pg x), he ultimately advocates the drug, encouraging psychiatrists to “listen to Prozac”.
Jacquelyn Zita’s feminist analysis of Kramer’s work is held in stark contrast to the rave reviews the book received. In “Prozac Feminism”, Zita’s critique sheds light on problematic aspects of Kramer’s work that support patriarchal structures, further oppressing women and working counter to the goals of feminism. This paper will discuss how Zita’s analysis critiques Kramer’s positioning of Prozac as a feminist drug. I will argue that Kramer’s support of Prozac undermines the goals of feminism in four important ways: 1) by supporting a capitalist, patriarchal model of the medical treatment of illness; 2) by reconstruing feminism as “superwomanism”; 3) by ignoring the collective history of women’s struggles by placing the problems of feminism in the bodies of individual women; and 4) by reinforcing heterosexual institutions of marriage and the nuclear family. I will also discuss the concept Zita thinks may be instructive for feminists in responding to Kramer’s work, the “pharmorg,” and whether it is helpful in addressing these concerns.
Capitalism and the Treatment of Illness
Contemporary society has been overrun with the effects of global capitalism, and the treatment of illness is no exception. Prescription medications are produced by large corporations, and marketed as products. These medications are marketed to doctors through a large team of “representatives” (salespeople) who provide doctors with information about drugs as well as samples to pass along to patients. One estimate puts drug companies’ spending on physician-directed marketing at 14 billion US per year – approximately $30,000 US for each physician in that country (Wilkes and Hoffman, 2005). In this way, doctors become expert middlemen, without whom drug companies could not make a profit. Drug companies often offer incentives to doctors, tacitly encouraging doctors to recommend and prescribe the company’s products. Drug corporations also market directly to patients through increasingly visible television, Internet and print advertisements, situating patients as consumers – vulnerable consumers at that, because they are relatively uneducated about medicine and illness and in questionable states of health.
Patients are bombarded with advertisements for a specific drug that treats their illness or perceived illness – some ads provide means for patients to self-diagnose with quizzes and rating systems (see www.prozac.com, www.zoloft.com, www.wellbutrin-xl.com). Patients find out information about the drug through advertising materials, and then go to their doctors armed with information obtained directly from drug companies. By marketing directly to patients, drug companies are reinforcing their marketing efforts to doctors: patients who go to see their doctors and ask about a particular medication send a silent reminder about the previous marketing doctors have been exposed to by the drug company’s representatives. Patients are often given a sample and try the medication for free; if it works, the patients are already loyal to the drug because the company has made it so easy for them to receive the drug. Patients are reliant on the recommendation of their doctors, and as long as the medication keeps working they will be loyal consumers.
What is wrong with this picture? Drug companies use marketing materials to “educate” patients, so patients are getting one-sided, non-neutral information about their illness or symptoms that paints the drug company’s product as “the” solution to their problem. Patients see themselves as being “informed”. Meanwhile, doctors are also being subjected to undue influence from drug companies to sell their product for them. The diagnostic role of doctors is reduced so that pharmaceutical companies are the ones doing the diagnosing by way of the patient who self-diagnoses according to skewed information provided by those same drug companies. A recent survey of family physicians found 71% felt patient-directed marketing was responsible for pressuring doctors to prescribe drugs they otherwise would not have chosen. (Rosenthal, Berndt, Donohue, Frank, and Epstein, 2002). It is a picture of marketing circularity.
Those patients who may not be exposed to marketing (perhaps due to economic reasons) are kept out of the picture of the “informed” consumer-patient the drug companies are working to construct, and are left at the mercy of doctors who are influenced by the drug company’s salespeople and the patients who are asking for the drug. These economically deprived patients may be given free samples because they cannot afford the prescription on a regular basis, but this is subject to sample availability and the doctor’s discretion. If the “right” sample is not available, they may be given something else that is similar – the sample might not be a perfect match for their illness, but is made on the basis of what sample is available. If the drug representative has done his/her job, the doctor will have plenty of samples of the drug company’s product on hand and may pass it out rather than try to get the patient another drug that might be more appropriate.
Prozac, which is produced by Eli Lilly Pharmaceuticals, has been heavily marketed since its release in 1987. Lilly has marketed the product through television and print ads, as well as its own Internet site. At www.prozac.com, patients can “learn” about specific illnesses that Prozac can help treat, and take a self-diagnosis test to find out if they have depression. Patients can print off a list of questions to take to their doctors, and economically deprived patients can apply for Lilly-funded financial help in meeting prescription drug costs. Lilly makes every effort to make Prozac accessible, as well as to ensure that patients think they need Prozac as opposed to other antidepressant medications rather than leaving the diagnoses up to doctors. It should be noted that other drug companies employ the same tactics to promote their products.
Kramer discusses a trend in medicine he calls “diagnostic bracket creep” (Kramer, 1993, pg 15), the phenomenon of using medication to diagnose illness: simply, if Sally responds to Prozac, and Prozac is used to treat depression, then Sally must have depression. Using medication as a diagnostic tool in this way can increase the scope of a particular illness by discovering a new set of patients who might not have been diagnosed with that illness according to traditional methods of diagnosis. Kramer describes this in the case of Julia, a woman who “bore little resemblance to the patients a psychiatrist ordinarily labels as having OCD [obsessive-compulsive disorder]… she did not fit the standard definition” (Kramer, 1993, pg 26), but whose mild compulsions disappeared in response to Prozac. Kramer is hesitant to make a full diagnosis in Julia’s case (at least in his book) because of this tension. In combination with increasing the scope of illness, diagnostic bracket creep may also increase the scope of a particular medication by discovering new uses for the drug in question. This is one of the ways that Kramer encourages his colleagues in the psychiatric field to “listen to Prozac”. Either way, diagnostic bracket creep can be criticized for “putting the cart before the horse” in diagnosing and treating illness. In effect, it helps secure the capitalist model of the treatment of illness. This method of diagnosis is highly problematic in that it leaves open the door for drug companies to control the diagnoses of illness in ways that are morally suspect and more related to increasing corporate profits than treating illness properly and safely.
Prozac Feminism and “Superwomanism”
“There is a sense in which antidepressants are feminist drugs, liberating and empowering.” (Kramer, 1993, pg 40)
“Prozac feminism” is a term that Zita uses to describe Kramer’s positioning of Prozac as a “feminist drug”. Kramer does this by contrasting the effects of Prozac on women with medicine’s past history of tranquilizing women to alleviate feelings of depression: “mother’s little helpers… pills [tranquilizers] that were used to keep women in their place, to make them comfortable in a setting that should have been uncomfortable, to encourage them to focus on tasks that did not matter” (Kramer, 1993, pg 39). Prozac is a stimulant, and has the opposite effect, providing women with energy and regulation of emotion. In Kramer’s eyes, Prozac allows women afflicted with depression and other mental illnesses to become bright, spirited, energetic women – women who are capable of keeping up with the pressures of modern life with zest to spare. Kramer thinks this makes Prozac a feminist drug. Kramer’s placement of Prozac positions women, and feminists, as superwomen: “Prozac is marketed to women as a way to keep up with the multiple demands and rapid pace of family, career, sex, and relationships. Kramer’s feminist drug normalizes feminism as superwomanism” (Zita, 1998, pg 63).
Zita refers to Kramer’s conception of Prozac-fuelled feminists as “hyperthymic babes”: “quick, vivacious, and resilient… the kind of woman who is in demand in the contemporary world of work and sex” (Zita, 1998, pg 62). Kramer defines hyperthymic personalities as: “distinct from mania and hypomania, the disorders in which people are grandiose, frenetic, distractible, and flawed in their judgement. Hyperthymics are merely optimistic, decisive, quick of thought, charismatic, energetic, and confident” (Kramer, 1993, pg 17). Kramer goes on to describe how the hyperthymic personality can be an asset in business, and how many of the world’s leading politicians and executives have this type of persona (Kramer, 1993, pg 17). The implication here is that these leaders are male, and that creating a hyperthymic personality in a woman allows her the opportunity to “play with the big boys” – an opportunity she wouldn’t otherwise have. In this construction, men are firmly at the top of the patriarchal capitalist hierarchy, and women are plainly both opposite and inferior to men. As Zita says, Prozac “gives women enough energy to be equal to men” (Zita, 1998, pg 68).
Dr. Kramer’s “Prozac feminism” is spoken in tones of subtle condescension, through his own voice as a white upper class Western male. Zita points out how Kramer co-opts both the language of feminism and a feminine voice in his writing (Zita, 1998, pg 64) to engage female readers and draw them into his vision of Prozac feminism. While Kramer seems sympathetic to the pressures of contemporary society on women, he advocates the use of Prozac in helping women who experience depression enhance their personalities so that they can participate in the new demands society holds for women: “Prozac highlights our culture’s preference for certain personality types… Prozac does not just brighten the mood; it allows a woman with traits we now consider “overly feminine”, in the sense of passivity and a tendency to histrionics, to opt… for a spunkier persona” (Kramer, 1993, pg 270); and again: “We admire and reward quite a different sort of femininity, which… contains attributes traditionally considered masculine: resilience, energy, assertiveness, an enjoyment of give-and-take” (Kramer, 1993, pg 270). These examples clearly depict women as being unequal and subordinate to men, and Kramer claims that Prozac essentially helps women to be more like men. This is a drastic misrepresentation of feminism. Feminism is a struggle against systematic oppression as the result of social structures – not a fight to find ways to be more like men.
Prozac and the Female Body
“Pharmaceutical discipline is an expectation that calls for physical rearrangement of body’s most intimate matter – that of a self that matters” (Zita, 1998, pg 70).
Dr. Kramer discusses his concerns with “treating” what is traditionally seen as conditions of personality with Prozac. His concern is that some patients experience an enhancement of personality while taking Prozac, which seems to indicate that Prozac places personality on a biological plane instead of being subject to social conditions such as emotional trauma. Kramer seems puzzled by this tension between the evidence Prozac seems to provide supporting personality as biological and the traditional psycho-therapeutic approach that treats personality as influenced by social conditions. Ultimately he accepts the empirical evidence Prozac provides by asserting that Prozac is beneficial for women whom are “overly feminine” (Kramer, 1993, pg 270). This seems to discount the possibility that such women may express these traits due to social conditioning rather than a biological tendency.
“Prozac feminism” places emphasis on the individual woman’s body and sees personality as the biological source of the dysfunction, aiming to correct that dysfunction through controlling a woman’s personality and emotional life and creating a superwoman who is energized and can easily manage all the daily tasks of modern life with a smile (Zita, 1998, pg 68, 70, 72-73, 76). In talking about Prozac in this way, Kramer places the problem of womanhood in each individual woman’s body, in the neurochemistry that makes up her personality, and ignores traditional feminism’s historical collective struggle against larger systems of social oppression. “Prozac feminism” places the burden of correcting her personality, located in her body, on the individual woman, separating her from the solidarity and support of other women as a collective body: “In Prozac feminism the problem is in the body; the solution is individual” (Zita, 1998, pg 76). Therefore, Kramer’s Prozac feminism offers an individual solution, based on a capitalist framework, to the systematic oppressive social structure of femininity without addressing the structure or the society.
Kramer’s Prozac feminism also contributes to societal notions of “natural” women not being enough. Great lengths are taken by women to conform to an internalized societal ideal of “woman” in regards to female bodies (Zita, 1998 pg 70). Kramer’s Prozac feminism now says that women’s personalities are not enough either: women must be the kind of woman that men desire (Zita, 1998, pg 70, 72-73), vivacious, spunky, energetic, assertive. This is problematic. As Zita says: “One can foresee a world where women are expected to discipline their bodies and modify their personalities into high-premium hyperthymic “first world babes” (Zita, 1998, pg 70). Personal identity can thus be seen as a biological condition, subject to redesign. With Prozac feminism, Kramer suggests that if a woman’s personality is getting in the way of her self-actualization, she now has the option to “improve” her personality with Prozac in order to gain a better sense of agency and compete in the male-dominated world of capitalism. Are we willing to allow drugs, based on a capitalist model, to define women in our society? Kramer certainly seems to be comfortable with this option.
Prozac Feminism and Heterosexual Institutions
Prozac feminism’s conception of the “hyperthymic babe” simultaneously accomplishes two major moves: first, it positions women as oppositional and inferior to men (as discussed at length above), and second, it positions women as tacitly heterosexual.
The “hyperthymic babe” reinforces the idea of woman as a sexual being in relation to man, ignoring lesbians and bisexual women: “Men now prefer sexually hyperthymic women to the hypothymic personalities of subservience, passivity, and male-dependency” (Zita, 1998, pg 72-73). This new “hyperthymic babe” persona that women are now free to choose on Kramer’s view is still the ideal as defined by men, and women medicated for the purpose of “enhancing” their personalities and controlling their negative emotions are still being subverted by men’s desires and structures. In a society that values heterosexuality and oppresses women, homosexual and bisexual people, is this “choice” really free?
The idea that Prozac “gives women enough energy to be equal to men” (Zita, 1998, pg 68) is a clear reinforcement of men at the top of the oppressive hierarchical structure, as discussed above. It also reinforces dichotomies of man/woman and masculine/feminine, which leads to the reinforcement of heterosexual institutions, that are oppressive not only to women, but also homosexual and bisexual people and differentially sexed and gendered people.
Prozac is used by Kramer to create an idea of modern woman as a privileged superwoman capable of managing the challenges of modern life (Zita, 1998, pg 63). This tacitly assumes that women’s lives involve work, marriage, children, and traditional feminine wifely duties such as being willing and energetic sexual partners for their husbands and taking care of the household work. This is an obvious reinforcement of heterosexual institutions of marriage and family built upon the dichotomy of masculine and feminine, ignoring gay men and lesbians, single women, childless women, bisexual women and men, and differentially sexed and gendered people. Positioning women in this way creates more societal pressure on those who don’t fit into Kramer’s typified categories of man and woman – the sort of pressure that can lead to the very illness he locates in the individual bodies of men and (especially) women as a biological dysfunction! Individual treatment of individual bodies based on a capitalist model is a much easier solution to social problems such as sexism and heterosexism than examining the social structures that enforce them.
Advances in medicine and pharmaceuticals must be celebrated for reducing illness, but the ramifications that capitalism has on the medical world have led to morally questionable marketing campaigns that serve to increase the medicalization of members of society, and especially women. This takes the emphasis away from social factors such as oppression and instead emphasizes individual bodies, making those bodies deviant and “other”. In the case of Dr. Kramer and Prozac, women in particular are being targeted as victims of their individual bodies, rather than a marginalized group oppressed by the very structures of society. The solution for this problem is not an easy one. Discourse such as that provided by Zita is a step toward increasing awareness of the problem of medicalizing women’s bodies in the interests of capitalism.
1.Wilkes, Michael S. and Hoffman, Jerome R. (2005)“The Truth About the Drug Companies: How They Deceive Us, and What to Do About It; On the Take: How Medicine’s Complicity With Big Business Can Endanger Your Health”, Journal of the American Medical Association, Vol. 293 No. 24, June 22/29, 2005, pg 3107-3108.
2. Rosenthal, Meredith B., Berndt, Ernst R., Donohue, Julie M., Frank, Richard G., and Epstein, Arnold M.(2002) “Promotion of Prescription Drugs to Consumers”, New England Journal of Medicine, Volume 346 No. 7, February 14, 2002, pgs 498-505.
3. Kramer, Peter (1993). Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self. New York: Viking Penguin.
4. Zita, Jacquelyn N. (1998). “Prozac Feminism”, Body Talk: Philosophical Reflections on Sex and Gender. New York: Columbia University Press.
*please note: this paper may not be used in full or in part in any form without the express permission of the author*