pill 9781501341946, 9781501341977, 9781501341960

Citation preview

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 e Object Lessons series achieves something very close Th to magic: the books take ordinary—even banal—objects and animate them with a rich history of invention, political struggle, science, and popular mythology. Filled with fascinating details and conveyed in sharp, accessible prose, the books make the everyday world come to life. Be warned: once you’ve read a few of these, you’ll start walking around your house, picking up random objects, and musing aloud: ‘I wonder what the story is behind this thing?’” Steven Johnson, author of Where Good Ideas

Come From and How We Got to Now

“

 bject Lessons describes themselves as ‘short, beautiful O books,’ and to that, I’ll say, amen. . . . If you read enough Object Lessons books, you’ll fill your head with plenty of trivia to amaze and annoy your friends and loved ones—caution recommended on pontificating on the objects surrounding you. More importantly, though . . .  they inspire us to take a second look at parts of the everyday that we’ve taken for granted. These are not so much lessons about the objects themselves, but opportunities for self-reflection and storytelling. They remind us that we are surrounded by a wondrous world, as long as we care to look.” John Warner, The Chicago Tribune

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 esides being beautiful little hand-sized objects B themselves, showcasing exceptional writing, the wonder of these books is that they exist at all . . . Uniformly excellent, engaging, thought-provoking, and informative.” Jennifer Bort Yacovissi,

Washington Independent Review of Books

. . . edifying and entertaining . . . perfect for slipping in a pocket and pulling out when life is on hold.” Sarah Murdoch, Toronto Star

. . . a truly terrific series of meditative reads.” Megan Volpert, PopMatters

 ough short, at roughly 25,000 words apiece, these Th books are anything but slight.” Marina Benjamin, New Statesman

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 e joy of the series, of reading Remote Control, Golf Th Ball, Driver’s License, Drone, Silence, Glass, Refrigerator, Hotel, and Waste . . . in quick succession, lies in encountering the various turns through which each of their authors has been put by his or her object . . . The object predominates, sits squarely center stage, directs the action. The object decides the genre, the chronology, and the limits of the study. Accordingly, the author has to take her cue from the thing she chose or that chose her. The result is a wonderfully uneven series of books, each one a thing unto itself.” Julian Yates, Los Angeles Review of Books

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 e Object Lessons series has a beautifully simple Th premise. Each book or essay centers on a specific object. This can be mundane or unexpected, humorous or politically timely. Whatever the subject, these descriptions reveal the rich worlds hidden under the surface of things.” Christine Ro, Book Riot

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. . . a sensibility somewhere between Roland Barthes and Wes Anderson.” Simon Reynolds, author of Retromania: Pop Culture’s

Addiction to Its Own Past

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A book series about the hidden lives of ordinary things.

Series Editors: Ian Bogost and Christopher Schaberg

Advisory Board: Sara Ahmed, Jane Bennett, Jeffrey Jerome Cohen, Johanna Drucker, Raiford Guins, Graham Harman, rené e hoogland, Pam Houston, Eileen Joy, Douglas Kahn, Daniel Miller, Esther Milne, Timothy Morton, Kathleen Stewart, Nigel Thrift, Rob Walker, Michele White.

In association with

BOOKS IN THE SERIES Remote Control by Caetlin Benson-Allott Golf Ball by Harry Brown Driver’s License by Meredith Castile Drone by Adam Rothstein Silence by John Biguenet Glass by John Garrison Phone Booth by Ariana Kelly Refrigerator by Jonathan Rees Waste by Brian Thill Hotel by Joanna Walsh Hood by Alison Kinney Dust by Michael Marder Shipping Container by Craig Martin Cigarette Lighter by Jack Pendarvis Bookshelf by Lydia Pyne Password by Martin Paul Eve Questionnaire by Evan Kindley Hair by Scott Lowe Bread by Scott Cutler Shershow Tree by Matthew Battles Earth by Jeffrey Jerome Cohen and Linda T. Elkins-Tanton Traffic by Paul Josephson Egg by Nicole Walker Sock by Kim Adrian Eye Chart by William Germano Whale Song by Margret Grebowicz Tumor by Anna Leahy Jet Lag by Christopher J. Lee Shopping Mall by Matthew Newton Personal Stereo by Rebecca Tuhus-Dubrow Veil by Rafia Zakaria Burger by Carol J. Adams Luggage by Susan Harlan Souvenir by Rolf Potts Rust by Jean-Michel Rabaté  Doctor by Andrew Bomback Fake by Kati Stevens Blanket by Kara Thompson High Heel by Summer Brennan Pill by Robert Bennett Potato by Rebecca Earle Hashtag by Elizabeth Losh (forthcoming) Train by A. N. Devers (forthcoming) Fog by Stephen Sparks (forthcoming) Wheelchair by Christopher R Smit (forthcoming)

pill ROBERT BENNETT

BLOOMSBURY ACADEMIC Bloomsbury Publishing Inc 1385 Broadway, New York, NY 10018, USA 50 Bedford Square, London, WC1B 3DP, UK BLOOMSBURY, BLOOMSBURY ACADEMIC and the Diana logo are trademarks of Bloomsbury Publishing Plc First published in the United States of America 2019 Copyright ©  Robert Bennett, 2019 For legal purposes the Acknowledgments on pp. 147–48 constitute an extension of this copyright page. Cover design: Alice Marwick All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system, without prior permission in writing from the publishers. Bloomsbury Publishing Inc does not have any control over, or responsibility for, any third-party websites referred to or in this book. All internet addresses given in this book were correct at the time of going to press. The author and publisher regret any inconvenience caused if addresses have changed or sites have ceased to exist, but can accept no responsibility for any such changes. A catalog record for this book is available from the Library of Congress. ISBN: PB: 978-1-5013-4194-6 ePDF: 978-1-5013-4196-0 eBook: 978-1-5013-4195-3 Series: Object Lessons Typeset by Deanta Global Publishing Services, Chennai, India To find out more about our authors and books visit www.bloomsbury.com and sign up for our newsletters.

CONTENTS

Introduction: Pharmageddon  1 1 Thorazine (C17H19CLN2S): The psychopharmacological revolution  31 2 Valium (C16H13CLN2O): The psychopharmacology of everyday life  47 3 Lithium (Li2CO3): The psychopharmacological thriller  69 4 Prozac (C17H18F3NO): Existential quagmires  101 5 Adderall ((C9H13N)2• H2SO4 + (C9H13N)2• H2SO4 + (C9H13N)2• C6H10O8 + (C9H13N)• C4H7NO4• H2O): Psychopharmacology unbound  115

Coda: Waiting for Brad Pitt  131 Acknowledgments  147 List of illustrations  149 Selected sources  152 Index  158

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Contents

INTRODUCTION: PHARMAGEDDON

We live in a cluttered world, surrounded by stuff, preoccupied by too many things. And yet, even inundated by so many objects, we still fumble clumsily to find some specific, concrete item that really matters to us personally, even intimately. Nothing stands out; everything lies buried beneath piles of modern junk. No text, perhaps, captures this predicament more poignantly than William Carlos Williams’s micropoem: “so much depends / upon / a red wheel / barrow / glazed with rain / water / beside the white / chickens.” For our lives do rely “so much” on the most immediate things, on ubiquitous quotidian objects—wheelbarrows or chickens for a previous generation; cell phones and coffee cups for our own—that we organize our actions, our identities, and our lives around just these kinds of everyday flotsam and jetsam, until we ultimately come to “depend” upon them. They become the hooks, the hinges, the nails and screws, even the duct tape of our existence—often in extraordinary ways. For we all have some secret object, some hidden thing, some

clandestine artifact, some personal wheelbarrow to which we literally tether our lives. Moreover, in our modern world these personal wheelbarrows, the objects upon which we now depend so much, have increasingly become various kinds of everyday medication—simple nondescript pills, capsules, or tablets—which momentously shape, alter, or even extend the course of our lives 1 mg, 10 mg, or 500 mg at a time. For as Paul Kalanithi suggests, we often confront life at its most elemental, at its most exposed, at its most immediate in “medical contexts” where we are forced to peel back the superficial layers of existence and instead confront deeper “questions intersecting life, death, and meaning.” My central thesis is simply that medications—from the most seemingly insignificant children’s aspirin to the most obviously lifesaving chemotherapy—collectively constitute a profoundly significant, but often underappreciated, aspect of life in the modern world. Consequently, our medications warrant more prolonged meditation upon how they stretch and pull our lives in new directions one pill at a time, often without us fully knowing—or at times even seriously contemplating— how or why. We all know that medications make a medical difference, lowering our blood pressure or increasing synapse formation between hippocampal neurons by depleting phosphoinositides, but what are the larger personal and existential implications of these medical interventions? How has the widespread proliferation of pills altered the nature 2

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and texture of modern life, how it is lived day to day, or even what it ultimately means to be human in an increasingly hypermedicated world? How have simple nondescript pills become a central pivot, an existential wheelbarrow, around which our modern lives now revolve? Ultimately, then, Pill advances a diminutive manifesto or micro-treatise about how modern life is now increasingly measured out not in T. S. Eliot’s proverbial coffee spoons, but in 1 mg, 10 mg, or 500 mg pills, simple nondescript objects which profoundly alter the course of our lives. More specifically, Pill explores how modern psychopharmacology’s recent proliferation of a vast arsenal of new psychotropic medications has pervasively reshaped the lived experience of modern life: its quotidian rhythms, its tangible qualities, its existential surfaces and textures, its quiddity, its facticity, its plasticity, and its longevity, perhaps even transforming what it ultimately means to be human in the modern world. It argues, forcefully even, that we now live—both for better and for worse—in what Nikolas Rose (2003) refers to as a “‘psychopharmacological’ societ[y]” where the “modification of thought, mood and conduct by pharmacological means has become more or less routine.” Exploring the complexities and contradictions of this brave, new, topsy-turvy, pill-popping world, Pill analyzes the new zeitgeist of an emerging age in which human identities— thoughts, emotions, moods, and personalities—are only bounded by, and increasingly determined by, the everexpanding powers of simple pills. In short, it analyzes INTRODUCTION

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the ongoing, and rapidly accelerating, existential, and even ontological, transformation of human subjects into “neurochemical selves” who are increasingly understood not in terms of their souls, their psyches, or even their minds, but instead by the interactions of chemicals within their brains at a molecular level: for it is “now at the molecular level that human life is understood, at the molecular level that its processes can be anatomized, and at the molecular level that life can now be engineered” (Rose 2007). After all, Xarelto can prevent blood clotting or Praluent can lower cholesterol, thereby correcting some physical deficiency, but neither truly alters one’s core self or identity. Psychotropic medications, however, are different. As Bebe Moore Campbell notes in her novel, 72 Hour Hold, we commonly say that a person “is bipolar, not she has bipolar disorder. You are cancer. You are AIDS. Nobody ever said that.” And certainly, something similar can be said of psychotropic medications as well: Ingesting psychopharmaceuticals raises profound questions about modern pharmacology’s ability to mold our very identity—not just a disease that we may have, but who we actually are—in profound ways that our society is only beginning to understand. In the most literal sense, psychotropic pills do much more than simply alter our body’s physical chemistry. By re-engineering the neuro-circuitry of our brains they also reconfigure our minds: our thoughts, our emotions, even our very selves. In this sense, psychotropic pills reconstruct our selves in ways that Lipitor does not, simultaneously transforming 4

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the biochemistry of how our brains think epistemologically and literally reconfiguring who we are ontologically in the most fundamental existential sense. Increasingly, it is the “self ” itself that has become “subject to transformation by biomedical technology,” opening up “cognition, emotion, volition, mood, and desire . . . to intervention” (Rose 2007). Consequently, psychotropic pills, in particular, have increasingly come to be those rare nondescript objects which have the most far-reaching impact on how our actual lives palpably unravel in real time. For today nothing—neither alcohol, nor recreational drugs, nor religious meditation, nor even psychoanalysis—alters the human mind on a global scale as profoundly or pervasively as the psychotropic medications found in common everyday pills. We, as a nation, are developing an insatiable appetite for pills of all kinds, but especially psychotropics. As Allen Frances explains, an “excessive proportion of people have come to rely on antidepressants, antipsychotics, antianxiety agents, sleeping pills, and pain meds. We are becoming a society of pill poppers.” Just consider for a moment the following statistics: ll

“Psychiatric meds are now the star revenue producers for the drug companies—in 2011, over $18 billion for antipsychotics (an amazing 6 percent of all drug sales); $11 billion on antidepressants, and nearly $8 billion for ADHD drugs. Expenditure on antipsychotics has tripled, and antidepressant use nearly quadrupled from 1988 to 2008” (Frances). INTRODUCTION

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“In 2010 the global market for pharmaceuticals was worth over $900 billion, more than the government bailout of the US economy following the 2008 financial crisis . . . Aside from treatments for cancer, in the global market for pharmaceuticals that year the best sellers were the antidepressants, mood stabilizers, and other central nervous system drugs ($50 billion)” (Healy 2012). “The markup on these drugs is on the order of several thousand percent, so they are now worth more than their weight in gold. There simply are no other goods in any part of the economy that produce returns like these, and the profit margins of the companies that produce them far outstrip those of any other companies” (Healy 2012). In 2013, the top 25 psychiatric medications collectively notched more than 350 million prescriptions in the United States alone. That is on average more than one prescription for every man, woman, and child (Grohol). “One out of every five U.S. adults uses at least one drug for a psychiatric problem; 11 percent of all adults took an antidepressant in 2010; nearly 4 percent of our children are on a stimulant and 4 percent of our teenagers are taking an antidepressant; 25 percent of nursing home residents are given antipsychotics” (Frances). PILL

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“Similarly, it is common in the mental health domain to find people on cocktails of four or more drugs rather than just an antidepressant. People with two conditions may be on seven to eight drugs. And ten drugs or more is fast becoming the norm for the elderly especially in the United States” (Healy 2012).

As a result, our voracious collective consumption of psychiatric pills has begun to raise significant, even troubling, practical and ethical questions about how modern psychopharmacology radically transforms—modifies, designs, manipulates, molds, bends, twists, manufactures, and engineers—human identities one pill at a time. Written in 1954, at the very dawn of modern psychopharmacology, Aldous Huxley’s The Doors of Perception celebrates, albeit with perhaps a dangerously Pollyannaish optimism, how “chemistry and physiology are capable nowadays of practically anything. If the psychologists and sociologists will define the ideal, the neurologists and pharmacologists can be relied upon to discover the means whereby that ideal can be realized or at least . . . more nearly approached.” Or in other words, simple pills can increasingly be used to reconstruct human experience, reshaping and reorganizing the brain’s hardwired biochemistry and transforming its infinitely complex neuro-circuitry into something resembling a mental marionette. According to Nikolas Rose (2007), now our “moods, emotions, desires and intelligence” can seemingly be redesigned almost “at will”: for we can INTRODUCTION

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take varying doses of diverse medications to pull the neural strings that operate our brains, opening and closing the valves—the neurotransmitters—through which our ideas and emotions flow, making and remaking not only our minds but also our very identities in the process. As an ideal, this seemingly science fiction fantasy may still be very far away, but Huxley’s Brave New World (1932) was not far off in suggesting that the modern world would increasingly seek to develop this almost god-like power to manipulate the human mind through neuropsychopharmacology, with little pills, gram by gram. Moreover, Rose continues that once “one has witnessed the effects of psychiatric drugs in reconfiguring the thresholds, norms, volatilities of the affects, of cognition, of the will, it is difficult to imagine a self that is not open to modification in this way.” It should come as no surprise, then, that this biochemical micro-engineering of the human self—together with the profound issues that it raises—has emerged as one of contemporary culture’s major preoccupations. With a growing awareness of the increasingly significant role that pills now play in shaping the human experience, we have begun to see a related rise, almost an outpouring, of recent interest in narratives about both mental illnesses and their treatment with pills. As our experiences with minds and pills have grown, so has the accuracy and complexity of our narratives about them. For we undoubtedly sense, though perhaps only through a glass darkly, the enormous magnitude of psychopharmacology’s widespread and rapid expansion, its 8

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pushing of pills, into modern life. Depicting characters who take psychotropic pills as diverse as Xanax, Prozac, lithium, clozapine, Ativan, clonazepam, nortriptyline, Seroquel, Abilify, Effexor, Klonopin, Trazodone, Paxil, Zoloft, Celexa, Depakote, and more—trend-setting television shows like The Sopranos and Homeland together with popular movies such as Silver Linings Playbook and Garden State have begun exploring the inner psychopharmacology of their characters’ medicine cabinets and the very neurochemistry of their brains as an integral component of who their characters are—and by extension who we are, too. These texts show—with an ever-growing sophistication—how modern selves are increasingly adjusted and augmented, enhanced and engineered by an almost bewildering array of psychiatric medications that raise profound questions about what it means to live in a society that biochemically manufactures human selves en masse. Moreover, these more contemporary and more realistic texts now raise these issues with less of the inaccuracies and stigmatization that have long marred and marginalized mental health narratives. For example, while the short-lived show Wonderland (2000) was canceled in part because of criticism of its inaccurate portrayal of mental health, more recently even mainstream shows—ranging from Huff, Monk, and Scrubs to ER, Law & Order: Special Victims Unit, The Sopranos, and Homeland— have all been recognized for their positive and reasonably accurate portrayals of characters with various mental health conditions. INTRODUCTION

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This rapidly increasing interest in mental health and its treatment with pills can be seen in films such as August: Osage County (2013—based on Tracy Letts’s 2007 play), which opens with Beverly Weston (Sam Shepherd) introducing his wife, Violet (Meryl Streep), but Beverly does not describe Violet’s appearance or her personality, her location or her history. He does not even describe the illness which she is suffering. Instead, he counterintuitively introduces his wife (twice) by explicitly referring to the medication that she takes, the nondescript objects that she hides (not so well) in bottles stashed throughout their house, her simple everyday pills: “The facts are: my wife takes pills. . . . My wife, she takes pills, sometimes a great many,” including “Valium, Vicodin, Darvon, Darvocet, Percodan, uh, Xanax for fun, Oxycontin in a pinch, and, of course, Dilaudid. Can’t forget Dilaudid.” And in many ways Beverly’s description is spot on. For it is, in fact, Violet’s pills that perhaps have most come to define her day-to-day quotidian existence: her struggles with addiction, her erratic behavior, her reckless candor, and the diverse emotional and physical burdens which have over time become inextricably intertwined with the medications supposedly designed to help her precariously bear them. Initially, it might seem that Violet’s pills have been prescribed to treat her mouth cancer, but the sheer quantity, diversity, and nature of these medications suggest otherwise. In fact, none of these pills actually have anything to do with Violet’s cancer per se; not one is designed to cure the disease itself. Instead, her medications are entirely psychotropic in nature, 10

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designed solely to manage her mind, to ease her pain, to adjust her emotional equilibrium. Consequently, Violet’s medications do much more than treat her physical ailments; they also alter her mind, her emotions, her thoughts, and her personality, essentially recreating her very identity itself. Locked in an existential struggle with her medicine cabinet, Violet has become—or at least has become inseparable from—her Valium, Vicodin, Darvon, Darvocet, Percodan, Xanax, Oxycontin, and, of course, her Dilaudid. Moreover, her inner demons are in many ways her own creations: for they are paradoxically both at least partly caused by and at best only imperfectly cured by the selfsame pills. “You are what you eat,” Nietzsche famously opined; never is this truer than when we take medications, especially psychotropic ones that transform our minds as well as our bodies. In our emerging psychopharmacological world, it increasingly makes ever more sense to define the human experience biomedically, like Beverly does, in terms of the pills that we take. Perhaps the iconic example of this brave, new psychopharmacological world can be found in The Matrix (1999) when Morpheus (Laurence Fishburne) asks Neo (Keanu Reeves) to choose between a red and a blue pill, warning him that each pill will open the gateway to an alternative reality. While the film ultimately unfolds into a larger information-age, science fiction dystopia, it is important to note that Neo’s fundamental decision is initially presented in stark pharmacological terms as a simple choice INTRODUCTION

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FIGURE 1  Morpheus offers Neo a choice between a red pill and a blue pill. The Matrix, dir. The Wachowskis, 1999.

between two seemingly ordinary, but reality-altering, pills: “This is your last chance. After this there is no turning back. You take the blue pill the story ends. You wake up in your bed and believe whatever you want to believe. You take the red pill and you stay in Wonderland, and I show you how deep the rabbit hole goes.” An even starker example of such psychopharmacological determinism is presented in Jonathan Lethem’s Gun, with Occasional Music (1994). In this novel, all of the characters obsessively take make, which initially appears to be simply a slang term for cocaine or some other illicit drug. The novel later reveals, however, that make is a psychotropic compound individually crafted for each character out of some personal blend of chemicals such as “Acceptol,” “Forgettol, Avoidol, addictol,” or “Blanketrol”; all of the characters use make with a unique “chemical formula” that individually shapes their thoughts, emotions, personality, and memories. This whole process is still imperfect—a “delicate balancing act” 12

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which someday “they’ll work out, but they haven’t yet”—but augers a new psychopharmacological world in which human identities are individually bioengineered, neurochemically manipulated, cooked up in pharmacies, and ingested in simple, perhaps red or blue, pills. Similarly, Neil Burger’s film Limitless (2011)—based on Alan Glynn’s 2001 novel, The Dark Fields—depicts Bradley Cooper as Edward Morra (Eddie Spinola in the novel), a struggling writer who takes a fictional nootropic (smart drug), NZT-48 (MDT-48 in the novel), which enables him to completely access his brain’s full capacities, thereby unlocking extraordinary cognitive and creative powers: He rapidly cleans his disheveled apartment, finishes his novel, learns multiple languages, masters the piano, becomes an analytical wizard at the stock market, gets hired by a high-powered brokerage firm, negotiates a high-stakes merger—which the novel describes as “the biggest merger in the history of corporate America”—hires a laboratory to reverse engineer NZT-48, and ultimately runs for the US Senate with his eyes on the presidency itself. In the novel, he also completes a technical telecommunications manual, plans a series of books on iconic developments in twentieth-century culture, masters modern Italian history, debates the contemporary relevance of eighteenth-century musical performance, writes a paper on the art of Thomas Cole, writes a screenplay about the Russian mafia, and learns “how to arrange flowers . . . cook risotto, keep bees, [and] dismantle a car engine.” Driven frenetically by a mind supercharged by a “rapid chemical INTRODUCTION

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reaction unlike anything I’d ever experienced,” Morra is always “moving forward, moving up . . . transmuting, transmogrifying, morphing into something else.” While the drug is far from perfect and initially causes debilitating side effects, ranging from blackouts to homicidal tendencies, Morra ultimately learns how to carefully manage his doses in a way that accesses the drug’s mind-enhancing powers without experiencing its incapacitating side effects. Having learned to perfectly titrate his own brain, gram by gram, Morra discovers the Holy Grail of psychopharmacology: the near perfect neurochemical manipulation of his own mind. This trope achieves its apotheosis, even reductio ad absurdum, however, in Stanislaw Lem’s utopian/dystopian novel, The Futurological Congress (1974), which describes a future “psychemized society” in which people always have some “drug appropriate to the occasion” in order to “assist, sustain, guide, improve, resolve” whatever used to be their minds, the “old cerebralness.” In particular, Lem’s world is specifically enabled by the development of “psycholocalizers” that, unlike earlier psychotropic drugs, now have a “specificity . . . so great, they can actually influence isolated sites of the brain.” Benignimizers—such as Felicitine, Placidol, Superjubilan, Hedonidal, Euphoril, Inebrium, Empathan, Esctasine, Halcyonal, Optimistine, Seraphinil, and Equanimine—produce various pleasurable states of mind; just as phrensobarbs—such as Furiol, Antagonil, Rabiditine, Sadistizine, Dementium, Flagellan, and Juggernol—cause diverse vicious behaviors. Uncompromil 14

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and rebellium rile people up, while sordidan, practicol, and obliterine calm them down. Constabuline curbs criminal tendencies, caucasium changes your race, zooformalin causes you to experience the world from the perspective of animals, amnesol induces forgetfulness, edifine allows you to build entire cities in your mind, and strategine, tactical, maneuvrium, and commanderil are used to train soldiers. Meanwhile, polysymphonicol contrapuntaline produces symphonic hallucinations, lyristan, sonnetol, and rhapsodine provide a chemical muse for would-be poets, and theoapotheterias—such as sacrosantimonium, deitines, lo-cal allah-all, polyunsaturated brahmanox, nazarine anointium, apocryphyll, glory hallelucinujah, sugar-free decaffeinated kingdom-come, and paternostrums—all evoke various religious states of being. Having found “liberation” through chemistry, “everything is possible now” as “all perception” is reduced to molecular neurochemistry: “a change in the concentration of hydrogen ions on the surface of the brain cells,” a “disturbance in the sodium-potassium equilibrium across your neuron membranes,” or the activation of the “right neurohumoralsynaptic transmission effector sites.” In this world of “psychem supermarket[s],” “psychotropic grocer[ies],” and even “psychedelicatessen[s],” one can purchase any kind of mental state, ranging from “low-calorie opinionates” and “gullibloons—credibility beans?” to “iffies, argumunchies, puritands and dysecstasy chips.” One can even buy dantine, which makes the user have the “deep conviction that he has INTRODUCTION

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written The Divine Comedy” or a drug called “duetine which doubles your consciousness in such a way, that you can hold discussions with yourself on any topic.” In this upside-down world where “pharmac[ies]” have replaced “churches” and “pharmicists” replaced “priests,” murder is now simply a petty crime—because resurrecting the dead is so easy—but the “willful deprivation of an individual’s private psychem supply” is a “capital offense.” With so many “drugs to study, drugs to love, drugs to rise up in revolt, drugs to forget” the very “distinction between manipulated and natural feelings has ceased to exist.” Human subjects have simply become indistinguishable from their psychopharmacological manipulations, and democracy has been superseded by “pharmacocracy.” The moral lesson of Limitless and The Futurological Congress is clear: Psychopharmacology is fast becoming our destiny as an ever-proliferating array of new psychotropic medications offers us increasing opportunities for altering our minds—and hence our selves and even our realities— in almost any conceivable direction. As Matthew Quick explains in The Silver Linings Playbook, “A trip through this world can be a wildly different experience depending on what chemicals are raging through one’s mind.” Or as Jefferson Airplane’s “White Rabbit” puts it somewhat pithily: We now live in a through-the-looking-glass world where “one pill makes you larger, and one pill makes you small.” Only in today’s voraciously pill-popping world, the choices presented to latter-day Neos are both more nebulous and more multifarious. It is perhaps Andrew Largeman (Zach 16

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Braff), the protagonist of Zach Braff ’s Garden State, then, who best exemplifies modern pharmacology’s proliferation of psychotropic medications. Waking from a nightmare of a plane crash to find himself in a near catatonic state in a white-on-white bedroom, clearly evoking images of a mental asylum, Largeman lethargically rises from his bed to face his own reflection in an oversized, double-mirrored medicine cabinet. As he slowly peels it open, his face is reflected in a massive wall of no less than 45 prescription pill bottles, the majority—if not entirety—of which are presumably psychotropic in nature. Largeman’s gargantuan medicine cabinet provides a telling hyperbole for today’s widespread use, overuse, and at times even abuse of psychiatric medications: for few images capture psychopharmacology’s outright invasion of modern life better than Largeman’s oversized, overstuffed medicine cabinet. But with so many pills to choose from, where do we even begin? Surely Garden State is something of a cautionary

FIGURE 2 Andrew Largeman’s oversized medicine cabinet. Garden State, dir. Zach Braff, 2004. INTRODUCTION

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tale, warning us of the dangers of overmedicalization, but Largeman’s decision to ultimately turn away from his psychiatric pills—the lithium, Paxil, Zoloft, Celexa, and Depakote prescribed by his psychiatrist father— offers no simple panacea either. For Largeman’s excessive prescriptions may not cure, and might even contribute to, his psychological problems, but simply going off his medications offers no certainty of a cure either. Moreover, Largeman may, like Allen Frances, be fighting to “protect normality from medicalization and psychiatry from overexpansion,” but he is also largely fighting “a mostly losing battle.” He may win his own small, personal battle against excessive psychopharmacological interventions, but he is still unlikely to win the larger “civil war for the heart of psychiatry” at large. The ever-increasing use of psychotropic medications will continue apace. There are few signs that, pace Largeman, it could even conceivably be reversed anytime in the near future. More importantly, other texts, such as Maya Forbes’s Infinitely Polar Bear (2014), offer an equally compelling counterpoint, demonstrating the equally significant dangers of not properly taking much needed psychiatric medications. This movie depicts Cam Stuart (Mark Ruffalo) as an endearingly manic, happily married father of two whose life and marriage have begun to unravel largely due to his bipolar illness. In fact, Cam is literally introduced in terms of his illness as his daughter’s voice opens the film, “My father was diagnosed manic depressive [i.e., bipolar] in 1967. He’d 18

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been going around Cambridge in a fake beard calling himself Jesus John Harvard.” And, at least initially, Cam is depicted appealingly; he may be a little impulsive and quirky, but he is also fun and carefree, even ecstatically joyful, sucking the marrow of life. Consequently, his family accepts, even embraces, the eccentricities of his condition. The film quickly shifts, however, to emphasize the darker side of Cam’s illness and the serious strains that it puts upon his family. Keeping his daughters home from school so that they can help him “celebrate” his recent firing from his job, Cam remarks unequivocally that “mommy’s going to be so happy that I kept you out of school”—only for his bold declaration of manic freedom to be immediately followed by mommy’s attempt to flee their home precisely to escape Cam’s madness. When Cam rides up on a bike in nothing but a red bathing suit and a red bandanna, in winter weather no less, he does little to help his cause, sealing his fate perhaps with his hysterical outburst: “I am a man. Men like to live free. That’s what we do, Maggie. To hunt and mate. That’s what we do. That’s why we have balls.” By nightfall the police have been called to transport Cam to a psychiatric hospital, and lovably eclectic as he may be, the film quickly reveals that behind his family’s “happy” faç ade there is “more to it than that. There always is.” But Infinitely Polar Bear isn’t just about Cam’s illness; it is equally about lithium, the simple pills that he takes to treat it. It is Cam’s daughter who first places Cam’s pills at the front and center of the narrative when she suggests to INTRODUCTION

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Cam that if he will just “stop drinking and take [his] lithium then mommy would let [him] come home.” And ultimately, lithium, together with Cam’s adherence or nonadherence to taking it, provides the film’s principal barometer of Cam’s progress as a character—as a husband, as a father, as a patient, and as a person; when he takes his pills he is generally more stable, though admittedly not his most vivacious self, but when he stops taking them he unravels or even explodes. Eventually, Cam’s refusal to take his lithium comes to a crisis when he calls his wife at five in the morning to tell her that he has stayed up all night sewing his daughter a flamboyantly eclectic flamenco skirt. When Cam adds that he doesn’t need to go to sleep because he isn’t even tired, Maggie asks him point-blank if he is taking his lithium. Then when he replies, “Actually, I haven’t taken my lithium since you left. I find that if I take small, steady sips of beer all day I stay on even keel,” the central conundrum of the film is starkly presented: It is the same manic qualities, the very manifestation of his illness itself, that simultaneously enables Cam to be a good, even great, father, to stay up all night frenetically sewing a fanciful and beloved skirt for his daughter, and yet, Cam’s refusal to take his lithium ultimately compromises both his own health and the stability of his family. Like Violet he is both saved and damned by the selfsame pills. Sitting at his sewing machine at five o’clock in the morning sans lithium, however, we see Cam simultaneously at both his best and his worst with his most loving and most unstable selves fusing into one, but without his lithium altogether Cam doesn’t seem to stand a 20

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chance. It is the only thing that can help him hold it all—self, health, sanity, marriage, and family—together. While rejecting medication completely is not an outright impossibility for some, Cam proves time and time again that refusing lithium as a treatment is ill-advised for his own personal situation. And yet, even after declaring himself “nothing more than a Guinea pig,” Cam still returns one last time to his medicine cabinet—for his family if not quite for himself—to reluctantly take his daily dose of lithium, narratively paving the way for Maggie to decide that she can leave their daughters with Cam in Boston when she goes to take a job in New York City, keeping the family, if not the marriage, intact. Thus, the film plots its final twist, inescapably intertwining Cam’s family troubles with his difficulties taking his lithium. But if Cam has proven himself

FIGURE 3 Cam Stuart’s daily existential confrontation with his medicine cabinet. Infinitely Polar Bear, dir. Maya Forbes, 2014.

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both an unreliable parent and a habitually nonadherent patient, his final trip to his medicine cabinet suggests that he remains capable of progress. He has not ultimately given up on either his medicine or himself altogether, but we need to read the profound ambivalence—which permeates the entire film—into Cam’s final existential look into his medicine cabinet. Here Cam’s final dose of lithium represents less some psychopharmacological conquest of health over illness than just one small step in an ongoing, never-ending daily struggle with a disease that may have palliatives but no cure, a reminder that Cam needs to return every day—difficult and uncertain as it may be—to renew his daily sacrament of lithium. Cam may not have given up entirely, but his last trip to his medicine cabinet represents less some final cure than a quick stare into the existential abyss opened up by the complex, unresolved interplay—at a molecular level— between the biochemistry of his brain and the psychotropic medications that he uses to attempt to control it. A victory for a day perhaps, but Cam’s Sisyphean struggles with both his illness and his pills remain far from over, and his continued dependence on his medicine cabinet represents just the first and most obvious symbol of that. This curious phenomenon of nonadherence—of deliberately not taking one’s pills because one, in some sense, actually desires one’s own illness itself—is perhaps paralleled by the album cover of Kanye West’s most recent album, ye (2018). Over a majestic shot of the Grand Teton 22

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mountain range this cover scribbles, “I hate being Bi-Polar its [sic] awesome.” With the same ambivalence as Cam, Kanye seemingly cannot decide whether he “hates” his bipolar disorder or whether he finds it “awesome” because at times there can be a certain manic high or heightened creativity associated with bipolarity. For every overmedicated Largeman, then, it seems that there is also another undermedicated, and often nonadherent pill-Noper, like Cam. At the same time that we are “making patients of people who are basically normal,” we are also “ignoring those who are really sick,” argues Allen Frances. Ultimately, then, psychiatric pills are a double-edged sword, and the decision to take or not to take them is rarely some simple, clear-cut choice between good and evil, or even between health and illness, but instead it frequently represents something more closely resembling what David A. Karp refers to as “an awkward dance with medications”: As we increasingly become “married to [our] medications,” taking pills, especially psychotropic ones, can reflect everything from “love at first sight” and a “lifelong commitment” to “disillusionment,” “unhealthy dependencies,” or even “divorce.” Taking pills can represent everything from a precarious balancing act and an uncertain crossroads to a necessary evil, a pyrrhic victory, or even an unwinnable catch-22. In many, if not most, cases patients must undergo a complex process of trial and error, trying out diverse pills and combinations of pills over an extended period of time before INTRODUCTION

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an appropriate drug regimen is discovered. Unfortunately, as Andy Behrman laments in Electro Boy: A Memoir of Mania, his experience of having “seven psychotherapists and psychiatrists misdiagnose” him is perhaps closer to the norm than the exception. Consequently, his life unfolds as a psychotropic merry-go-round: he fires one psychiatrist for medicating him “like an absolute lunatic,” the next psychiatrist “stabilize[s]” him with a “Prozac, lithium, and Anafranil cocktail,” and the third psychiatrist, diagnosing him as “overmedicate[ed],” immediately removes him from all medications “cold turkey.” Yet another psychiatrist tries him on Klonopin, then Depakote, then lithium, then Risperdal, then Tegretol. Ultimately, he cycles through “endless combinations,” including Neurontin, Wellbutrin, Zyprexa, Trazodone, Effexor, Zoloft, Paxil, Serzone, Artane, Ativan, Lamictal, Topamax, BuSpar, and Luvox. Throughout, he suffers diverse side effects—weight gain, dullness, paranoia, walking with a shuffle, hand tremors, lost facial expression, itchy hands, diarrhea, dry mouth, muscle stiffness, and failure to “urinate in a straight line”—some of which are, in turn, treated with Propranolol and Symmetrel. Meanwhile, his bipolar life continues to careen out of control, oscillating manically from wild sex, drugs, and partying to profligate international travels, prodigal spending, and a bevy of illconceived “business” ventures, including a criminal trial for art forgery—all punctuated by bouts of depression; even his bevy of medications, which at one point increases to “thirtytwo pills and capsules per day,” makes little more than a dent. 24

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He tries “every possible combination of medicine available,” but his “condition is still not stabilized.” Similarly, Kristin Hersh’s Rat Girl explains, “‘Drug cocktail’ actually means ‘no easy answer.’ No one knows what to do about brains and chemistry, so they try all sorts of recipes and weigh benefits against side effects, trying to get the combination and dosage right.” In Madness: A Bipolar Life, Marya Hornbacher concurs, “He’s just going to change my meds again. And then the side effects will get worse, and he’ll change the meds again, and the side effects will change but they won’t go away.” In the end, Terri Cheney’s Manic: A Memoir admits that after carting around a “pharmaceutical cornucopia” of some “dozen mood stabilizers, antidepressants, antianxiety agents, and atypical antipsychotics” she has simply “long lost track of all the psychotropic medications I’ve had to take over the years, or the nature and number of their side effects.” This process of adjusting one’s meds can be extremely long, convoluted, and seemingly, if not outright, never-ending. At times this process can even prove tragic. It is quite possible that David Foster Wallace’s suicide may have been triggered, at least in part, by his unsuccessful attempt to adjust his psychiatric medications. Ultimately, it seems almost impossible not to ask whether this psychopharmacological revolution has begun to overextend itself, spiraling out of control and dragging us down a psychotropic vortex. Does the “medical-industrial complex” now push what Allen Frances describes as the “massive overuse of psychiatric drugs” and “massive INTRODUCTION

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overtreatment with psychiatric medication”? What will be the psychological, social, and existential consequences of treating an ever-escalating plethora of “new diagnoses that would turn everyday anxiety, eccentricity, forgetting, and bad eating habits into mental disorders” in need of constant medication? As Peter D. Kramer’s best-selling Listening to Prozac explains, we have now begun to stretch the use of psychiatric pills so ubiquitously that we are quickly moving “beyond treating illness to changing personality” itself, creating a new “cosmetic psychopharmacology” for those who “prefer pharmacologic to psychologic self-actualization” and consequently turn away from psychotherapy, choosing instead to use “chemicals to modify personality.” Like Patrick McMurphy in One Flew Over the Cuckoo’s Nest, we now seem to be confronted by a battalion of modern-day Nurse Ratcheds who—armed with their “muzzle-loading shotgun[s] . . . loaded with Miltowns! Thorazines! Libriums! Stelazines!” (and now so much more)—are out to “tranquilize all of us completely out of existence.” The wide-ranging implications of this “biochemical turn,” which sees the human self as fundamentally the malleable byproduct of biochemical, even pharmacological, reactions, is still further extended in Lisa Miller’s “Listening to Xanax.” For, as Miller points out, Xanax is now routinely prescribed to treat such “low-grade,” “situational,” “functional,” and “quotidian” anxieties as a child’s poor report card, an uncomfortable dinner party, a parent’s separation anxiety after dropping a child off for school, a difficult encounter 26

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with the boss, a potential job loss, or the fear of flying—all experiences traditionally treated with a variety of nonpharmaceutical remedies. Having come to depend so much on so many pills for so many different reasons, have we not begun to accept a “wholesale medicalization of normality” (Frances) which could lead to what David Healy (2012) describes as some kind of apocalyptic “Pharmageddon” or state of hyper “pharmaceuticalization, which increasingly sees our identities as a series of behaviors to be managed by drug use”? Haven’t we already begun falling down the psychopharmacological rabbit hole when we begin talking “about our neurotransmitters rather than our moods,” start “turning lifestyle choices into mental disorders,” and decide that pills can “help achieve a better way of life through chemistry” (Healy 2012, Frances)? Ultimately, this rapid and pervasive explosion—not just of psychiatric drugs themselves, but of an entire psychopharmacological paradigm, of a casual acceptance of pharmaceuticals as a way of life—forces us to directly confront the fundamental existential quandary of our age: What does it even mean to be a human self in a biochemically engineered age of ubiquitous psychiatric pills? Who are we really now: the psychology of our minds or the neurochemistry of our brains? Our analyzable Freudian psyches or their pharmacological manipulations and augmentations? As Hilary Rose and Steven Rose explain, the brain has increasingly been redefined “as the centre of the self ” and “persons” increasingly “reduce[d ]” to their INTRODUCTION

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“neurons” and “synapses,” transforming selfhood into what Fernando Vidal describes as “brainhood,” the “brain-self,” or the “cerebral subject.” We are fast becoming Jean-Pierre Changeux’s Neuronal Man or Joseph LeDoux’s Synaptic Self. Reducing human life in toto to a series of neurochemical reactions in our brains—through an ever-escalating “biological reduction of secularism”—has our increasing reliance on pills, then, not changed “the ways we experience our selves,” perhaps even putting our very “ideas of what it means to be human . . . at stake” and inaugurating a fundamental “shift in human ontology—in the kinds of persons we take ourselves to be” (Healy 2012, 2002, 2004; Rose 2007)? As Brett L. Walker explains, confronting human life at the molecular level—on the plane of microbes and neurochemistry—ultimately “destabilizes our understanding of the autonomy of selfhood.” Taken to its extreme, Rosi Braidotti’s The Posthuman explores an ongoing “qualitative shift in our thinking about what exactly is the basic unit of common reference for our species,” calling into question the “relevance and mastery” of the “dominant vision of the human subject” and championing instead “alternative ways of conceptualizing the human subject.” While Ann Cvetkovich, a prominent affect theorist, personally takes a resolute stance against treating depression with psychotropic pills, she nonetheless shares Braidotti’s aim to “generate new ways of thinking about agency,” seeking to explore broader notions of “embodiment and what it means to be human.” With new developments in the neurosciences, evolutionary psychology, 28

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deep history, genetics, bio-technologies, artificial intelligence, robotics, cybernetics, informatics, animal studies, feminism and queer studies, postcolonialism, environmental theory, ecology, affect theory, and object-oriented ontology, the once dominant model of the self-contained autonomous self is quickly being replaced with more porous models of relational, transversal, non-unitary selves in contact and collaboration with the diverse material and social worlds that surround them, including neurochemical ones. Within such a “posthuman” framework, taking psychotropic pills raises profound questions about how modern psychopharmacology radically alters—refashions, adjusts, shapes, sculpts, recreates, manages, curves, transforms, and even reprograms—human identities at a fundamental neurochemical level. Pills can alternatingly help people “discover at last the person they were meant to be,” or they can cause “distress about losing a sense of the self,” but either way David A. Karp argues that they frequently involve a “radical transformation of self ”: “To take a pill [is] to cross an important identity line.” Consequently, pills profoundly reconfigure our very understanding of human identity, subjectivity, embodiment, and agency by challenging simplistic formulations of what a “real,” “authentic,” or “natural” identity—let alone an autonomous universal self— might look like in our brave, new psychopharmacological age. As someone who has, as Chuck Palahniuk puts it in Fight Club, had my meals brought to me “on a tray with a paper cup of meds,” however, Violet’s, Neo’s, Morra’s, Largeman’s, INTRODUCTION

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and Cam’s dilemmas are no mere science fiction fantasies nor simple melodramatic plot twists, but instead they reveal a common everyday lived experience, a daily sacrament even, a recurring choice to chemically manipulate (or not) one’s own everyday reality, one’s very self itself, titrated pill by pill in an uncertain quotidian existential confrontation with one’s own personal medicine cabinet. Like Neo’s pills, the brave, new creations of modern psychopharmacology— our simple pills, our Thorazine, Valium, lithium, Prozac, or Adderall—reflect the conscious and subconscious anxieties of an emerging psychopharmacological world in which human identities—thoughts, emotions, moods, and personalities— are increasingly determined, both for better and for worse, by simple pills. Our pills are literally becoming us, and we are becoming them in return. Consequently, our ordinary, everyday pills now tell a profound and poignant story about who we are as a people increasingly reliant upon, if not outright addicted to, pills: because Violet’s dilemma—of being defined by the pills that she takes—is fast becoming our own.

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1 THORAZINE (C17H19CLN2S): THE PSYCHOPHARMACOLOGICAL REVOLUTION

Mary Jane Ward’s 1946 semi-autobiographical novel, The Snake Pit—later adapted by Anatole Litvak into a 1948 film of the same name—depicts the deplorable state of mental asylums in the 1940s. Its protagonist, Virginia Cunningham (Olivia de Havilland), is repeatedly frustrated by an understaffed, regimented medical bureaucracy of unresponsive psych nurses and intrusive psychiatrists, including the “sneer[ing]” Nurse Davis (Helen Craig), and she is repeatedly treated with electroconvulsive “shock” therapy (ECT), a common “cure” of the day administered as nonchalantly as if it were an everyday “commodity like the morning milk.” Initially, Virginia describes the hospital as a “zoo” or even a “jail” full of “queer women” who are treated

like “criminals,” frequently prohibited from talking because it’s “against the rules,” and routinely forced to “stand in line”: “At first I didn’t notice the cage but then I saw it and I smelled the animals.” As the novel unfolds, Ward describes a seemingly unending series of petty humiliations that illustrate the then current state of psychiatric treatment: Virginia is poorly fed (when not force-fed through a tube), stingy psych nurses ration her toilet paper sheet by sheet (when the toilet paper is not out altogether), her toilets and dormitory have no doors for privacy, she is forced to do menial chores like mopping or polishing the floor, the hospital dé cor is “ugly” if not “hideous,” she is forced to bathe together with other women, the women all smell badly because their clothes are never washed, and many of the women have sores caused by some mystery disease going around the hospital. Ultimately, Virginia is confined to the “snake pit” where the incurably insane are essentially herded into a padded cell and frequently constrained by physical restraints such as straightjackets: It was strange. Here I was among all those people, and at the same time I felt as if I were looking at them from some place far away. The whole place seemed to me like a deep hole and the people down in it like strange animals, like snakes, and I’d been thrown into it. Yes, as though, as though I were in a snake pit.

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Additional insight into the deplorable state of psychiatric treatment in the 1940s will undoubtedly be further presented in Netflix’s forthcoming series, Ratched, which will retell the story of One Flew Over the Cuckoo’s Nest from the perspective of the monstrous Nurse Ratched. In addition to ECT, 1940s asylum patients were also frequently treated with metrazol—induced convulsions and insulin coma therapy or even lobotomies—à  la Patrick McMurphy in Cuckoo’s Nest: all brain-damaging treatments designed to cure mental illnesses by purposely damaging the brain itself. As Robert Whitaker explains, lobotomists, in particular, purposely sought to “continually increase the scope of brain damage. The greater the damage, it appeared, the better the results.” Routinely described as “harmless” at the time, lobotomies were nonetheless specifically designed to “permanently destroy a part of the brain thought to be the center of human intelligence.” In fact, despite its macabre overtones psychosurgery was considered such a significant medical breakthrough that Egas Moniz received the 1949 Nobel Prize in medicine for his pioneering work on lobotomies. Moreover, in an industry shaped in part by eugenicist paradigms, Franz Kallmann deemed asylum patients not “biologically satisfactory,” the American Eugenics Society labeled them “cancers in the body politic,” and a 1927 US Supreme Court case authorized their compulsory medical sterilization. At its most extreme, in the case of Nazi Germany, the mentally ill were even considered part of the

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final solution itself and sacrificed to gas chambers or lethal injections together with Jewish victims of the Holocaust. It cannot be underestimated, then, how profoundly Henri-Marie Labroit’s 1950 discovery of chlorpromazine—a neuroleptic best known by its trade name Thorazine— revolutionized the treatment of the mentally ill. As Richard J. Miller explains, this discovery, the “result of an extremely long and convoluted series of events,” began with extensive experimentation with industrial dyes in the textile industry which, in turn, later evolved into the early stages of the pharmaceutical industry as chemists began “testing dyes for any potential therapeutic activities,” including as antihistamines, anesthesia, antiemetics, treatments for burns, and eventually as antipsychotics. For example, Prontosil Red, a red azo dye called sulfamidochrysoidine, was shown to protect mice from streptococcal infection, while methylene blue (a phenothiazine) was proven to have antimalarial properties. When it was later found that methylene blue “selectively stained nerve cells,” psychochemists began to examine whether there might also be “effects of the dye on patients with psychiatric disorders,” a process that would reach its full fruition with Labroit’s successful demonstration that chlorpromazine’s “greatest utility” was in the “treatment of psychotic illnesses,” most notably schizophrenia and manic depression. This discovery helped launch a full-fledged “psychopharmacological revolution” as psychotropic pills, simple chemical compounds, rapidly began to replace more draconian physical treatments such as ECT and lobotomies. 34

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As Allen Frances explains, before the 1950s the “psychotropic drug business was small,” and medications such as opiates and barbiturates were “nonspecific in their effects,” “caused big-time problems with addiction and overdose,” and were largely “useless” in treating actual mental illnesses. With the advent of Thorazine, however, everything changed almost overnight: Pharmacotherapy began to “spread like wildfire” as biochemists and neurologists developed new “chemical theor[ies] of mental illness” and started isolating particular drugs as “act[ing] on specific chemical processes in the brain” (Healy 2002, Valenstein). For the first time it became widely believed that mental illnesses could be cured with simple pills. Time magazine and U.S. News and World Report quickly proclaimed chlorpromazine a new “wonder drug,” while the New York Times declared that it would “revolutionize” the treatment of mental illnesses. Soon, both the popular press and the medical literature began to depict what Robert Whitaker describes as a rosy picture of “hopeless patients suddenly being returned to normal”—all by the power of simple pills. Ultimately, then, the significance of Thorazine extends far beyond the medication itself: The discovery of Thorazine did not simply create a new medication to treat a specific illness, but more significantly it led to a much wider epochal paradigm shift in our understanding of the relationship between chemicals and the human mind in toto. As David Healy (2002) explains, “With chlorpromazine and reserpine a new science was born”: “For the first time a bridge had been built between behavior and neurochemistry,” and consequently the “possibility THORAZINE (C17H19CLN2S)

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abruptly opened up that psychiatry could become scientific.” While today ideas of brain chemistry, chemical imbalances, a “biochemical theory of mental disorders,” and a “growing reliance on drugs to treat all psychological and behavioral problems” are more or less taken for granted, even de rigueur, before the 1950s most neurologists still believed that the interactions in the brain were electrical rather than chemical in nature, and psychoanalytic “talk” therapies which focused on dissecting early family experiences clearly dominated more biochemically oriented approaches to psychiatry and neuroscience (Valenstein). In fact, in sharp contrast to today’s thinking, the very “possibility that a drug could repair a defective brain or undo the effects of life experiences seemed unrealistic and to some, absurd” and “many thought treatment of psychosis was in principle impossible” (Valenstein, Healy 2002). As Scott Stossel notes, as late as “midcentury the notion that psychiatric drugs could be widely and safely prescribed— let alone scientifically measured—was novel.” Now, however, the situation is reversed: Today “all pathways through the brain seem to end in the use of pharmaceuticals” as “physicians are increasingly being pressured to neglect everything but drugs and chemical explanations in treating patients with mental disorders” (Rose 2007, Stossel). Thorazine, then, marked a profound psychopharmacological turning point in the history of psychiatry, placing simple pills for the first time at the front and center in the treatment of mental illnesses. And, in many ways, Thorazine—together with the psychopharmacological revolution that it helped 36

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produce—lived up to, at least some of, the hype. New pills helped empty psychiatric hospitals, initiating a decades-long decrease in the number of institutionalized patients, pills enabled ever-growing numbers of the mentally ill to receive effective treatment outside of institutions, and pills also helped institutionalized patients themselves became markedly more manageable. Ultimately, Thorazine revolutionized the course of psychiatry, initiating a process that to this day continues to transform the discipline of psychiatry ever and ever closer to something that increasingly resembles a mere branch of psychopharmacology. Supplanting psychoanalysis and psychosurgery as the new treatment du jour, pills emerged as psychiatry’s next big thing. With the advent of Thorazine, psychiatric pills now promised a brave, new future for the entire field of psychiatry: “Most commentators on the period are happy to portray the era as a deep dark age, from which the discovery of chlorpromazine emerged to lead us to the sunny uplands of modern psychopharmacotherapy” (Healy 2002). The story of Thorazine—like the stories of so many other psychotropic medications—however, is no simple psychopharmacological fairytale. Thorazine may have revolutionized the treatment of mental illness, introducing the very possibility of the psychotropic pill itself, but psychiatric medications have offered no simple panacea. Far from presenting some linear metanarrative of inevitable scientific progress, a clear understanding of the brain’s complex neurochemistry, or even an isomorphic one-cure-for-onedisease model of medicine, the psychopharmacological THORAZINE (C17H19CLN2S)

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revolution that Thorazine helped launch has proven to be nothing less than a Pandora’s box. It has opened troubling new epistemological and ethical questions, produced constantly shifting and at times even contradictory scientific theories, and offered at best only partial and imperfect remedies, which often cause side effects as troubling as the diseases they purport to cure. In short, Thorazine helped revolutionize a new psychopharmacological paradigm shift that profoundly influenced the course of psychiatric medicine, opening the floodgates to an ever-escalating array of new psychotropic pills, but these pills themselves have proven not only complicated and uncertain but also imperfect and unreliable, contradictory and convoluted. Pills have indeed become the new wave of psychiatry’s future, but like waves themselves the emerging field of psychopharmacology has ultimately proven to be both turbulent and tumultuous. To begin with, Thorazine has at times proven to be an effective remedy, but it offers no certain guarantees, and studies of its effectiveness perhaps suggest that its net benefits are inconclusive at best. Initially, studies rapidly accumulated demonstrating noticeable, even notable, success rates with Thorazine, at times even declaring it nothing short of miraculous. For example, Heinz Lehman pioneered a series of papers in the 1950s which concluded that chlorpromazine “had a dramatic effect on acute schizophrenia,” while a 1964 study by Philip May demonstrated that “chlorpromazine on its own produced better results than any other treatment” (Breggin, Healy 2002). Meanwhile, a 1961 National Institute 38

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for Mental Health analysis found its own encouraging results: 50 percent of patients treated with chlorpromazine and other phenothiazines were deemed cured, 75 percent were considered much or very much improved, and as high as 95 percent showed some improvement. More recently, however, studies have proven far less sanguine. In fact, Gordon Paul’s 1972 analysis, Maurice Rappaport’s 1978 study, and T. J. Crow’s 1986 report all actually found negative correlations between drug treatment and improved health, suggesting that psychiatric patients may actually perform worse when treated with Thorazine and other neuroleptics. Moreover, an extensive 1980 metadata analysis performed by Paul Keck and Ross Baldessarini, both advocates of psychiatric medications themselves, concluded that “drug efficacy in the long-term treatment of chronic patients is equally unconfirmed,” with neuroleptics often performing no better than simple sedatives and narcotics or even placebos (Breggin). In the end, the initial euphoria surrounding Thorazine now seems misguided. However significant and effective Thorazine has been, it has fallen far short of being the miracle pill or wonder drug that it was once proclaimed. Much more than a simple drug itself, Thorazine opened the floodgates for widespread psychopharmacological experimentation with pills of all kinds, even though its own ability to “cure” mental illnesses has been neither guaranteed nor unproblematic. In fact, Thorazine’s promise of restored mental health in a simple pill may actually offer little measurable improvement THORAZINE (C17H19CLN2S)

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over previous physical therapies. Like ECT and lobotomies before it, Thorazine and other neuroleptics actually “work” by blocking three prominent dopaminergic pathways in the brain: the nigrostriatal pathway which controls motor movement, the mesolimbic pathway which regulates emotion, and the mesocortical system, which enables communication between the ventral tegmentum and the brain’s frontal lobe. Consequently, neuroleptics simultaneously function as “chemical restraints” by curbing the “neurotransmitter activity that underlies motor movement,” as “tranquilizers” by dampening emotional responses, and as a kind of “pharmacological lobotomy” by limiting communication between the frontal lobe and the rest of the brain (Whitaker). In many respects, then, Thorazine offers little more than neurosurgery in pill form, and Peter Sterling even argues that a “psychiatrist would be hard-put to distinguish a lobotomized patient from one treated with chlorpromazine” (quoted in Breggin). The method of delivery may have changed to appear seemingly more humane, but Thorazine itself may not offer all that significant of an improvement over the shock treatment and lobotomies it has largely replaced. In addition, Thorazine has been demonstrated to produce numerous side effects, at times even as debilitating as the diseases it attempts to cure. Even from “very early on, physicians in Europe and the United States realized that chlorpromazine frequently induced Parkinson’s disease symptoms—the shuffling gait, the masklike visage, and even drooling” (Whitaker). In fact, even early studies showed that 40

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as many as 37 percent or even two-thirds of patients treated with chlorpromazine developed Parkinson’s-like symptoms. In addition, other patients treated with neuroleptics have shown “signs of basal ganglion dysfunction,” “deficits similar to those caused by encephalitis lethargica,” “apathy, disinterest, and other lobotomylike effects,” “psychic indifference,” and “psychomotor retardation” or the “enforced paralysis of mind and body that routinely results from treatment with neuroleptics” (Whitaker, Breggin). Most importantly, Thorazine has been strongly, almost inextricably, linked to the development of tardive diskenesia, a permanent movement disorder that causes abnormal muscle twitching. Ultimately, Peter R. Breggin suggests that “rather than treating a disease, the neuroleptics create a disease,” making neuroleptics not miracle pills but rather “highly toxic drugs” that are “among the most dangerous medications ever used in medicine.” Consequently, when the anti-psychiatry movement of the late1960s began to emerge, Thorazine’s effectiveness was boldly challenged: “Where chlorpromazine had been hailed as liberating the mad from their chains sixteen years earlier, it was now seen as the dreaded camisole chimique (or chemical straightjacket) and its self-professed creator was a target for the revolutionaries” (Healy 2002). In fact, Robert Whitaker goes so far as to argue that “all of the traits that we have come to associate with schizophrenia— the awkward gait, the jerking arm movements, the vacant facial expression, the sleepiness, the lack of initiative—are symptoms due, at least in part, to a drug-induced deficiency THORAZINE (C17H19CLN2S)

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in dopamine transmission” caused not by the normal course of the disease itself, but instead as the iatrogenic side effects of its pharmacological treatment. Consequently, the emergence of psychopharmacology may not have been a revolution as much as a rabbit hole. Instead of providing clear, definitive answers, psychiatric pills may have only opened up a series of brave, new questions, the most significant of which may be the “potentially unmanageable problem . . . that it becomes impossible once patients have taken antipsychotics for some time to know where the treatment ends and the disease begins” because many of the “neurotic and dysthymic features that are considered negative features of schizophrenia” are actually “treatment-induced phenomena rather than manifestations of the illness” (Healy 2002). Ultimately, then, Thorazine did help inaugurate a novel psychopharmacological theory of medicine—that mental illnesses can be cured with simple pills—but the complexities and contradictions of Thorazine and its fellow neuroleptics also challenged traditional, simplistic models of medicine itself. For medications, especially psychotropic ones, do not work like Coke machines: You cannot simply plop in a pill and wait for your desired cure to come out with no strings attached. Instead of offering a simple, even simplistic, isomorphic model of medicine as one pill for one disease, Allen Frances contends that mental disorders are “too heterogenous in presentation and in causality to be considered simple diseases”: It is more likely that “our currently defined disorders will eventually turn out to be 42

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many different diseases.” Consequently, psychiatric diseases today are most commonly treated with a complex “cocktail” of diverse medications each with its own unique profile and set of complications. Instead of simplifying the treatment of mental illness, then, psychiatric pills have seemed to only make it all the more confusing. The field of psychiatry has never turned back from its newfound reliance on, even addiction to, psychotropic pills, but creating the right pill has proven both complicated and elusive. In fact, Peter R. Breggin notes that by the early 1990s, the neuroleptics alone had proliferated to include Haldol (haloperidol), Thorazine (chlorpromazine), Stelazine (trifluoperazine), Vesprin (trifluopromazine), Mellaril (thioridazine), Proloxin or Permitil (fluphenazine), Navane (thiothixene), Trilafon (perphenazine), Tindal (acetophenazine), Taractan (chlorprothixene), Loxitane or Daxolin (loxapine), Moban or Lidone (molindone), Serentil (mesoridazine), Orap (pimozide), Quide (piperacetazine), Repoise (butaperazine), Compazine (prochlorperazine), Dartal (thiopropazate), and Clozaril (clozapine). And in My Age of Anxiety, Scott Stossel describes how his anxiety has been treated with “lots of medication,” including “Thorazine. Imipramine. Desipramine. Chlorpheniramine. Nardil. BuSpar. Prozac. Zoloft. Paxil. Wellbutrin. Effexor. Celexa. Lexapro. Cymbalta. Luvox. Trazodone. Levoxl. THORAZINE (C17H19CLN2S)

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Propranolol. Tranxene. Serax. Centrax. St. John’s wort. Zolpidem. Valium. Librium. Ativan. Xanax. Klonopin.” As Stossel’s example dramatically illustrates, modern psychiatry has come to rely on a bewildering array of pills of all kinds, but this certainly does not mean that these pills can be straightforwardly described as simple cures in any ordinary sense of the term. Instead, patients often feel like little more than lab rats as doctors prescribe an endless merry-go-round of different medications, trying pill after pill until eventually something resembling a “right” combination is found. In the end, Thorazine helped transform psychiatry into a “science,” or perhaps alchemy, of pill popping, but psychiatric pills themselves have proven to be less magic bullets than the blinding spray of semi-automatic pharmaceutical weapons, making psychopharmacology’s never-ending proliferation of pills something like the medical equivalent of a drive-by shooting. Ultimately, then, the story of Thorazine marks a revolutionary moment, a turning point without which the field of psychopharmacology itself would remain almost unthinkable, but it also offers a starkly cautionary tale: Pills have transformed the treatment of the mentally ill, but pills themselves remain complex and imperfect at best. As Richard D. Lyons notes, the “consensus seems to be that the more intelligent approach to the overall problem is to realize both the limitations and value of the drugs.” Pills do, and should, occupy a central place in our collective modern lives— and thanks to Thorazine they now do—but like Thorazine itself they remain limited, complex, uncertain, elusive, and 44

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potentially even harmful. They open brave, new possibilities, but they offer few clear or simple panaceas. Will Self ’s Man Booker Prize–shortlisted experimental novel, Umbrella, confronts this paradox directly, simultaneously suggesting that modern pills have produced an “amazing breakthrough” and “rapid advance” in what used to be little more than “trench warfare against mental illness”—with draconian remedies such as ECT and lobotomies—at the same time that it acknowledges that “in my heart of hearts I know: there are no such things as miracle drugs.” Finding himself in a world in which it is almost “unthinkable” that patients “shouldn’t be dosed with some form of chlorpromazine—everyone is,” Self ’s protagonist, the psychiatrist Dr. Zack Busner, still ranks among the “few isolated voices” who “while not doubting its efficacy, its . . . humanity” still “questioned its necessity” in no small part because of its potential for side effects such as “tardive dyskinesia.” In his novel set against the backdrop of the historical transformation of insane asylums into more modern psychiatric hospitals, chlorpromazine and the seeming “cureall” L-Dopa, an early proto-neurotransmitter, produce a new environment in which “terrific strides [are] being made with chemical therapies,” giving a “calm clinical picture of the reborn” whose “diseased blood” is now “replaced with champagne,” but patients still sometimes stagger under the heavy “neuropharmacological load[s]” that they must carry. In this world where “the surf of chlorpromazine [is] up,” and it is perhaps only “more medicine that helps the medicine THORAZINE (C17H19CLN2S)

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go down,” the “busy pushers” of pills create a hospital now full of either occasionally “over-tranquillised patient[s]” or alternatingly unresponsive patients for whom “the strongest drugs make no impression.” Even Dr. Busner himself imagines a world with a “still larger compartmentalized [pill] box, divided into four, within which to place his weekly boxes. Twelve of these might then be housed in an annual box, a certain number of which could reside in a small crate, optimistically provided with sections for the years 2011, until, say, 2025, and labeled: The Rest of My Life.” Another life reduced to a new portable version of Largeman’s oversized medicine cabinet.

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2 VALIUM (C16H13CLN2O): THE PSYCHOPHARMACOLOGY OF EVERYDAY LIFE

While it would have been completely unthinkable for Mike and Carol Brady to light up a joint or get rip-roaring drunk on screen, the very first episode of the first season of The Brady Bunch (1969) unproblematically opens with the couple, the very paragons of middle-American morality, casually popping pills on their wedding night: taking a couple tranquilizers to calm their prenuptial jitters. When Mike complains to Carol that he is nervous about their impending ceremony, she immediately replies that he should just take a tranquilizer, presumably a Valium (diazepam). Then when he responds that he has already taken one, she nonchalantly tells him to just take a second. This apparent ease with which Americans have come to accept Valium—along with its fellow

FIGURE 4  A crowd volunteers their Valium bottles. Starting Over, dir. Alan J. Pakula, 1979.

benzodiazepines, from Librium (chlordiazepoxide) and Klonopin (clonazepam) to Ativan (lorazepam) and Xanax (alprazolam)—is comically illustrated in Alan J. Pakula’s Starting Over (1979). When Phil Potter (Burt Reynolds) has a panic attack in a furniture store, his brother asks the gathered crowd if anyone has a Valium, and the crowd immediately replies with virtually everyone pulling out their own bottle of pills to offer the panicked Phil. As these simple media examples demonstrate, the widespread use of Valium rapidly extended the range and scope of psychiatric medicine as pills were increasingly prescribed to treat a wide range of common everyday anxieties, thereby transforming psychotropic pills into a commonplace staple of modern American life. Everyone from suburban housewives and aspiring celebrities to 48

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corporate men in their grey flannel suits all began to turn to Valium for an anxious fix. Quickly establishing itself as a basic “staple in medicine cabinets, as common as toothbrushes and razors,” Valium became what Andrea Tone describes as the world’s first blockbuster drug, “the first $100 million brand in pharmaceutical history, and between 1968 and 1981, the most widely prescribed medication in the Western world.” At its peak sales, in “1978 alone, Valium’s manufacturer, Hoffman-La Roche, sold nearly 2.3 billion tablets, enough to medicate half the globe.” Like Thorazine before it, then, Valium is much more than just a new medication prescribed to treat another psychological illness. More importantly, it dramatically extended the reach of psychopharmacology itself. Whereas Thorazine and early antipsychotics (i.e., major tranquilizers) were used to treat seriously mentally ill patients suffering from schizophrenia and other readily identifiable psychoses, generally in asylums, a new generation of benzodiazepines or minor tranquilizers, such as Valium, began to “confuse the typical perturbations that are part of everyone’s life with true psychiatric disorder” (Frances). No longer limited to treating major psychoses, Valium offered a new pill for everyday life: for the home, for the office, for the classroom, for the airplane, for the stage, for suburbia, and for public life at large. Everyone can take it and seemingly for almost any everyday anxiety, from prenuptial jitters to performance anxiety at work or social anxiety at a cocktail party with the neighbors. Consequently, “psychiatrists in the 1960s VALIUM (C16H13CLN2O)

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were faced with the alienation of everyday life in a way that no earlier generation of practitioners had been” with the result that psychotropic drugs became widely available to the masses, en masse, to treat an ever-increasing array of everyday anxieties and minor psychological disturbances for the first time (Healy 2002). Pills were no longer restricted to treating major illnesses; they became new panaceas for almost every imaginable form of quotidian distress, spilling out of psychiatrists’ specialized offices and the halls of asylums into patients’ common medicine cabinets. As the Rolling Stones put it in “Mother’s Little Helper,” in the emerging age of Valium whenever “mother needs something today to calm her down” she goes “running for the shelter of a mother’s little helper / And it helps her on her way, / gets her through her busy day.” Here the Stones are not proselytizing for the illicit, mind-bending drugs of the sex, drugs, and rock ’n’ roll revolution, but instead they are more modestly merely chronicling the emerging psychopharmacology of everyday life, the ever-increasing proliferation of seemingly benign quotidian pharmaceuticals, especially as these medications were often gendered and prescribed specifically to sedate modern housewives. What is perhaps most striking about the Stones’ song, however, is not simply that mother needs her little helpers, or even that she has such easy access to them, but that she needs so many: First she takes one, then two more, followed by two more sets of four. That’s a full eleven Valiums just to get her through her day, and when it is the Rolling Stones who are giving 50

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you a sermon about your drug abuse you probably do have a problem even if it is a problem that you share with many of the other mothers—or even fathers, if not children—on your cul-de-sac. In addition to extending psychopharmacology into the realm of everyday life, Valium also, more broadly speaking, provided a new generation-defining pill, an anxiolytic, for a newly anxious generation. W. H. Auden’s The Age of Anxiety (1947) was one of the first texts to discern the emerging anxieties of a new Cold War era or the “incomprehensible comprehensive dread” of a new “future, / Odorless ages, an ordered world / Of planned pleasures and passport-control, / Sentry-go, sedatives, soft drinks and / Managed money,” a world that will be conquered by a “new barbarian” who is “no uncouth / Desert-dweller; he does not emerge / From fir forests; factories bred him; / Corporate companies, college towns / Mothered his mind, and many journals / Backed his beliefs.” And Arthur M. Schlesinger Jr.’s The Vital Center (1949) was not far behind, diagnosing mid-twentiethcentury America as “tense, uncertain, adrift,” a “time of trouble, an age of anxiety.” Soon these personal and social anxieties would find lucid expression in everything from James Dean’s performance of Jim Stark in Rebel Without a Cause (1955) to Dustin Hoffman’s portrayal of Benjamin Braddock in The Graduate (1967) and Barbara Parkins, Patty Duke, and Sharon Tate’s performances in Valley of the Dolls (1967), and Valium would provide the perfect anxiolytic for this anxious age, promising peaceful VALIUM (C16H13CLN2O)

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respite in a pill form. Consequently, there is almost a kind of cultural history to psychotropic pills with each distinct historical moment gravitating toward its own characteristic medication, a pill for its time, and Valium seemed the perfect pill for what Andrea Tone describes as Cold War America’s “quintessentially anxious age.” Scott Stossel has even suggested that Valium and its fellow travelers may have been “aimed less at treating actual psychiatric disorders than at treating the age itself—at mitigating the effects of what Berger in this talk called ‘today’s living pressure.’” With new pressures and rapidly growing anxieties, Cold War America needed a new drug, and Valium gave it its angry fix. In many respects, however, Valium—and the new everyday psychopharmacology that it helped unleash—was perhaps imagined in literature long before it was actually created in a scientific laboratory. After all, Valium was not invented until 1963 by Leo Sternbach who was working for the pharmaceutical company Hoffman-La Roche, but Aldous Huxley’s 1932 novel, Brave New World, more or less anticipated its discovery, describing the emergence of a revolutionary new psychotropic pill, soma—which could cure virtually all mental disturbances, from anxiety and depression to alienation and anger—at a time when the emerging field of psychopharmacology itself barely even existed. As David Knott explains in Richard Hughes’s The Tranquilizing of America, the similarity between soma and Valium is almost uncanny: “Roche created the idea—and doctors bought it— that you can have better living through chemistry. They have 52

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created what Aldous Huxley envisioned in Brave New World. They have given us soma, and it is called Valium.” Huxley, then, truly stood at the vanguard of an emerging psychopharmacological revolution which would soon begin to explore how human minds can be controlled by psychoactive chemicals contained in simple pills, titrated gram by gram, making him far more of a groundbreaking pioneer than a mere interloper as far as his thinking about psychopharmacology was concerned. More perceptive than his peers, Huxley recognized almost avant la lettre that psychotropic pills would be the wave of the future. Not only would they soon be invented, but they would also be distributed on an almost unimaginable scale—not unlike his own soma—and they would come to exert a pervasive, almost all-encompassing, impact on people’s day-to-day lives and how they would deal with quotidian anxieties and stresses. Huxley’s soma was not simply a drug for the demonstrably sick. It was even more importantly consumed most avidly by the seemingly working well, who simply sought to optimally maximize tranquility and minimize distress with chemicals. In a sense, Huxley may have even invented the first true psychotropic pill, albeit only as a literary trope. Certainly, he was the first to write an entire novel perceptively focused on exploring the new possibilities opened up by the emerging field of psychopharmacology, or to predict the scale and scope with which psychopharmacology would soon rapidly transform everyday life in the modern world. VALIUM (C16H13CLN2O)

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At its core, Huxley’s novel depicts a brave, new dystopian world in which the “principle of mass production,” the Fordian assembly line, is “applied to biology” at all levels of human existence: A new reproductive technology called the “Bokanovsky process” is used to manufacture human beings in test tubes and incubators, multiplying each human embryo into 96 identical genetically engineered individuals; extensive “neo-Pavlovian” conditioning—with hundreds upon hundreds of “electric shocks”—is administered to “indissolubly” forge “instinctive” psychological reflexes in infants; and hypnopaedia techniques brainwash older citizens in their sleep, cementing their minds with “suggestions from the state.” Taken collectively, these bio-engineering processes ultimately mass produce an “elementary class consciousness” which conditions every individual to accept the state’s official ideologies “not merely as true, but as axiomatic, self-evident, utterly indisputable.” The fruits of this bio-engineering can be seen in the state’s complete indoctrination of its citizens to accept such sociopolitical bromides as: Alpha children wear grey. They work much harder than we do, because they’re so frightfully clever. I’m really awfully glad I’m a Beta, because I don’t work so hard. And then we are much better than Gammas and Deltas. Gammas are stupid. They all wear green, and Delta children wear khaki. Oh no, I don’t want to play with Delta children. And Epsilons are still worse.

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Bolstered by these psycho-biological means of production, the state’s complete control over the human mind is considered virtually foolproof, producing a citizenry that functions as a single seamlessly integrated machine: And, in effect, eighty-three almost noseless black brachycephalic Deltas were cold-pressing. The fiftysix four-spindle chucking and turning machines were being manipulated by fifty-six aquiline and ginger Gammas. One hundred and seven heat-conditioned Epsilon Senegalese were working in the foundry. Thirty-three Delta females, long-headed, sandy, with narrow pelvises, and all within 20 millimetres of 1 metre 69 centimetres tall, were cutting screws. In the assembling room, the dynamos were being put together by two sets of Gamma-Plus dwarfs. The two low work tables faced one another; between them crawled the conveyor with its load of separate parts; forty-seven blonde heads were confronted by forty-seven brown ones. Forty-seven snubs by forty-seven hooks; fortyseven receding by forty-seven prognathous chins. The completed mechanisms were inspected by eighteen identical curly auburn girls in Gamma green, packed in crates by thirty-four short-legged, left-handed male Delta-Minuses, and loaded into the waiting trucks and lorries by sixty-three blue-eyed, flaxen and freckled Epsilon Semi-Morons.

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What could possibly go wrong in such an assiduously programmed world? As Huxley himself suggests, “What man has joined together nature is powerless to put asunder.” But the crown jewel of Huxley’s dystopia, the lynchpin which secures its infallibility, is a brave, new psychopharmacological wonder drug, soma, which chemically fills in any and all remaining cracks in the state’s meticulously bioengineered ideological armor. For social stability in this new society does not become “practically assured” until AF (After Ford) 178 when “two thousand pharmacologists and bio-chemists were subsidized” to produce the “perfect drug,” soma, an allpurpose psychotropic drug with tranquilizing, anxiolytic, sedative, hypnotic, stimulant, psychedelic, and anti-depressant properties all rolled into one. Whenever individuals encounter any kind of psychological obstacle whatsoever— from sorrow to rage, from alienation to despair—the state always offers them the exact same universal solution: “What you need is a gramme of soma.” For a single gram of soma can shine the “inner light of universal benevolence” across “every face in happy, friendly smiles,” a second gram can raise an “impenetrable wall between the actual universe and [the] mind,” and a third gram will produce a “complete and absolute holiday,” lasting at least “eighteen hours.” Soma, then, is the psychopharmacological icing on the State’s ideological cake, providing instant relief for any quotidian psychological stress, thereby calming, pacifying, and even sedating citizens into a state of perfect tranquility and hence of perfect compliance at all times. As Huxley concludes, soma’s power is all-pervasive: 56

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And if ever, by some unlucky chance, anything unpleasant should somehow happen, why, there’s always soma to give you a holiday from the facts. And there’s always soma to calm your anger, to reconcile you to your enemies, to make you patient and long-suffering. In the past you could only accomplish these things by making a great effort and after years of hard moral training. Now, you swallow two or three half-gramme tablets, and there you are. Like the Bradys who would later turn to the tranquilizing effects of Valium to solve the most mundane trials of everyday life, Huxley’s characters can chemically resolve any possible psychological stress just by taking a little soma, precisely titrated to perfectly fit each personal psychological need. Ultimately, however, Huxley’s novel depicts not a utopia but a dystopia. Huxley may describe a world in which all quotidian troubles are chemically ameliorated through perfectly designed, infallible psychotropic pills, but that does not mean that he advocates for such a world. On the contrary, Huxley depicts soma as a destructive crutch which props up the authoritarian state by creating docile, directionless, and even dehumanized citizens incapable of feeling or expressing— much less living—the full range of human emotions, especially any that might be considered dangerous or subversive. Cocooned in a state of chemically induced stupor, Huxley’s characters lack ambition, curiosity, or even any meaningful understanding of the human experience. At its most extreme, Huxley’s characters become mere addicts like Linda Cooper VALIUM (C16H13CLN2O)

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who “greedily clamoured for ever larger, ever more frequent doses. Dr. Shaw at first demurred; then he let her have what she wanted. She took as much as twenty grammes a day.” Moreover, Huxley’s soma addicts are not enlightened human beings who achieve some superior state of neverending peace and tranquility, but rather they are powerless pawns manipulated and constrained by chemical forces beyond their own control. In Brave New World Revisited Huxley even explicitly describes soma as “one of the most powerful instruments of rule in the dictator’s army.” Soma is not a drug of the people but of the state—and the authoritarian state at that. What Huxley offers us, then, is not some unquestioned validation of psychopharmacology as an upward ascent on some ever-improving path toward scientific and humanistic progress but rather a damning critique that our soon-to-be psychopharmacological future might eviscerate our very humanity—even, or perhaps especially, if psychopharmacology’s promise of being able to malleably mold human identities can be fully realized. According to Huxley, the more daunting problem posed by psychopharmacology is not that it might fail in its Promethean ambitions, but rather that it might succeed. As Huxley reminds us in Brave New World Revisited, the biochemical state, in its “drug induced euphoria,” can only lead to a “new medieval system” which “for the majority of men and women” will still remain a “kind of servitude” with this servitude only being rendered “acceptable by regular doses of chemically induced happiness.” 58

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Consequently, the novel focuses not simply on the incredible power of the bio-State itself—with its seemingly invincible arsenal of psychopharmaceuticals—but rather more perceptively on the individual forces who eventually, albeit unsuccessfully, oppose it: principally the novel’s rebel protagonist, Bernard Marx, and his fellow traveler, John Cooper, a “savage” who was raised on a native reservation in New Mexico and hence outside of the long reach of the bio-state. Longing to be “more on my own,” Bernard tries to imagine what it would be like “if I were free—not enslaved by my conditioning.” Consequently, Bernard refuses to take soma: “I’d rather be myself . . . Myself and nasty. Not somebody else, however jolly.” Rather than regulating his every thought and emotion with soma, instead of manipulating his individual identity and reality through chemistry, Bernard desires instead to “try the effect of arresting my impulses,” to “know what passion is,” to “feel something strongly,” and ultimately to stand “alone, embattled against the order of things,” preferring even “persecution” and “affliction” over soma’s never-ending holiday. Like Bernard, John also rebels against the State, and his rebellion is figured precisely by his rejection of soma. Like Bernard, John also “refuses to take soma,” and when John explains to Bernard how he spent an afternoon standing with his arms held out, so he could “know what it was like being crucified,” Bernard replies that there is “after all, some sense in it. Better than taking soma.” Ultimately depicting the victory of mind over medicine cabinet, John VALIUM (C16H13CLN2O)

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FIGURE 5  John Cooper (Tim Guinee) liberates bottles of soma. Brave New World, dirs. Leslie Libman and Larry Williams, 1998.

attempts to bring “freedom” to the people by “throw[ing] the little pill boxes of soma” by “handfuls through the open window” while shouting, “Don’t take that horrible stuff. It’s poison, it’s poison.” John’s rebellion, however, is short-lived and quickly aborted when men with “spraying machines . . . pumped thick clouds of soma vapour into the air” and a “fresh supply of pill-boxes [is] brought in from the Bursary.” Ultimately, soma aids and abets—even ensures—the victory of the police state, rendering its citizens docile and powerless before their chemical master. The only truly human characters in the novel then—the only ones with agency, will, imagination, passion, and determination—are the ones who oppose the state, refuse its soma, and rebel against its biochemical determinism. 60

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Huxley’s message is clear: Psychopharmacologists may, in the imminent future, soon be able to devise new pills that can manipulate and mold human identities, like biochemical marionettes, but this future does not bode well for real human beings whose lives will inevitably be diminished rather than augmented by these neurochemical interventions. Whatever side we may personally take in this debate for or against the widespread expansion of psychopharmacology, however, Huxley’s novel does perceptively situate psychopharmacology at the vanguard of scientific “progress,” or regress if you prefer. If nothing else, Huxley prophetically anticipates that in his near future, the world of today, there are few things which shape—both for better and for worse—the human brain and human beings’ quotidian psychological battles more profoundly than psychotropic pills. Contemporary society may only be beginning to tentatively explore Huxley’s broader vision of genetically engineering or psychologically conditioning human lives, but soma—and its avatars—have long since widely permeated the fabric of modern life, and they are without question here to stay. Whereas Huxley’s soma-saturated world existed as a dystopian science fiction fantasy, it has for all practical purposes become our world. The only difference is that psychotropic pills have proven both less effective and more unpredictable than soma, but Huxley’s prophesy of pills’ ever-increasing pervasive influence was spot on: People do ubiquitously and voraciously consume a wide range of psychotropic pills on a daily basis, not just to cure VALIUM (C16H13CLN2O)

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serious illnesses but also to help them at least try to manage a bewildering array of common, every-day, and quotidian psychological distresses of all kinds. Curiously, however, Huxley’s own attitude toward psychopharmacology would evolve dramatically—even outright explicitly reverse course—over his intellectual career. By 1954, two decades after Brave New World, Huxley’s The Doors of Perception would optimistically celebrate how “chemistry and physiology are capable nowadays of practically anything.” Meanwhile, his Brave New World Revisited (1958) would praise how a new “tidal wave of biochemical and psychological research” was beginning to “alter the chemistry of the brain and the associated state of the mind without doing any permanent damage to the organism as a whole.” While he admits that new drugs such as Thorazine and Miltown, a precursor to Valium, still fall short of being “perfectly harmless” and are not yet capable of perfectly “curing mental illness” outright, he now argues that these new psychiatric pills are “remarkably effective” remedies, even going so far as to claim that they now “come fairly near to being” his idealized “imaginary synthetic,” soma, offering ever increasingly powerful new psychotropic elixirs with ever decreasing negative side effects. With “pharmacology, biochemistry, and neurology . . . on the march,” he boldly proclaims that “new and better chemical methods” will continue to be developed with “far-reaching effects on our mental and physical functions.” In the Annals

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of the New York Academy of Sciences in 1957, he would still more brazenly, and perhaps presciently, exclaim that recent advances in psychopharmacology would prove “more important, more genuinely revolutionary, than the recent discoveries in the field of nuclear physics.” Nowhere is Huxley’s volte-face more evident than in his later utopian novel, Island (1962), which reverses course entirely to embrace psychopharmacology without reserve, ecstatically praising how the condition of humanity can be improved through the pervasive and enlightened use of a new drug, moksha-medicine—also known as “the reality revealer” and “the truth-and-beauty pill”—which offers its own brave, new “chemical answers” to the problems of modern life. While the scientists of Huxley’s fictional island paradise, Pala, “haven’t yet found out” exactly how moksha works, a mere 400 mg of it promises to “liberate” anyone “from his bondage to the ego” and “open one’s eyes and make one blessed and transform one’s whole life.” Rejecting religion with its empty “words about sibling rivalry and hell and the personality of Jesus” as “no substitutes for biochemistry,” the inhabitants of Pala believe that “three pink capsules a day” provide a more coherent and certain path to “eventual wisdom and compassion.” Moreover, instead of hollowing out people’s individuality and humanity, moksha reveals one’s true self, illuminating “what it’s like to be what in fact you are, what in fact you always have been.” Whereas soma is mechanical and mind-

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numbing, moksha is transcendent and life-affirming. In fact, the entire philosophy, religion, law, and ethics of Pala are fundamentally grounded in biochemistry—rooted in the “glands and the viscera, the muscles and the blood”— with proper medication offering solutions to a wide array of human predicaments based simply on “human physiology.” Aside from true proselytizers such as Timothy Leary and Ken Kesey, few intellectuals in the 1950s and 1960s would come to celebrate psychotropic drugs as avidly or as unabashedly as Huxley, but Huxley’s evolving, even oscillating, fictional explorations of psychopharmacology offer a wide range of perspectives on the psychopharmacological revolution—and its discontents. Ultimately, then, if we trace the complex arc between Huxley’s dystopian Brave New World (1932)—which critiques psychotropic pills’ power to manipulate and control human thought—and its utopian counterpart, Island (1962), which celebrates these same pills’ abilities to resolve the tensions and contradictions of modern life, we can see how the evolution of Huxley’s positions about psychotropic drugs—from antagonistic gadfly to fervent proselytizer—in many ways mirrors society’s own evolving—and frequently ambivalent—attitudes about the extraordinary power of ordinary pills. Like Huxley, the modern world has by and large come to accept, even celebrate, the new possibilities opened up by modern psychopharmacology, but it has perhaps not altogether forgotten the brave, new dystopian

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undertones and warnings of Huxley’s own earlier cautionary tale—and with good cause. In fact, if anything what Huxley got most wrong was not the idea that powerful psychotropic drugs could—and indeed would—soon be developed to shape the human mind, nor even his paradoxical if not outright contradictory positions first against and then in favor of psychiatric pills, but rather his now seemingly quaint idea that any single drug such as soma alone could ever suffice to satisfy human beings’ complex range of psychological needs, thereby producing a one-size-fits-all model of psychiatric medicine. Our world today is not just psychotropically soma-tic with its widespread use of pills, it is also far more poly-somatic than Huxley could have ever imagined. What is perhaps most remarkable is not simply that we have indeed developed psychotropic pills as Huxley foresaw, or that we have come to accept them as Huxley himself would, including with his own nuanced reservations about their effectiveness and desirability, but that we have produced such a bewildering array of pills with the ever-increasing production of evernew psychotropic drugs seeming to endlessly spiral ever more out of control. Yesterday’s Thorazine and Valium have become today’s lithium, Prozac, and Adderall—not to mention Celexa, Lexapro, Ritalin, Ativan, Zyprexa, Xanax, Klonopin, Seroquel, Abilify, Effexor, Trazodone, Paxil, Zoloft, Depakote, and whatever pill du jour tomorrow may bring—as each new generation strives to treat not only its

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ever-increasing quotidian psychological maladies but even its evolving generational psyches and the existential quandaries of the human condition itself with an ever proliferating, almost blinding, arsenal of ever-new psychotropic pills. As Brian Thill points out in his Object Lesson volume, Waste, our production and consumption of pills has become so pervasive that even the “Great Lakes have been absorbing tons of residual chemicals from our flushed pharmaceuticals,” enough to leave discernible traces of carbamazepine (Tegretol) in the lakes as they are flooded by “an enormous pharmaceutical cocktail filled with the detritus of drugs designed to help us endure many of the terrible realities of our moment,” the “chemical offal of our anxious, terrified, medicated age.” We are literally drugging the planet itself. Moreover, this rapid proliferation of psychiatric pills has proven conclusively that there are few medical panaceas. Modern psychopharmacology may expand our biochemical toolkit by offering us new “chemical answers” for modern living, but few of these pills has proven to be anything resembling simple and straightforward. Cures, especially neurochemical and psychotropic ones, remain partial at best, if not outright illusory; the scientific basis for psychopharmacology has proven hazy, when not troublingly contradictory; pharmaceutical progress is dogged by setbacks; and pills frequently come at the cost of significant, if not staggering, side effects. Like the magical creatures who inhabit Prospero’s own island, the pills that now overpopulate

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the ever-changing, shifting psychogeography of modern psychopharmacology’s own ever-expanding neurochemical archipelago have proven to be nothing if not both brave and new—with all of the irony, satire, and double meanings intended by both Huxley and Shakespeare before him.

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3 LITHIUM (LI2CO3): THE PSYCHOPHARMACOLOGICAL THRILLER

Given psychopharmacology’s rapid expansion into the psychogeography of everyday life, it is not surprising that we should find that the psychodynamics of people’s personal experiences with psychotropic medication is emerging as one of contemporary culture’s new central preoccupations. The most recent generation has seen a rapid expansion of memoirs, novels, films, television shows, and popular music which explore in depth characters’ everyday experiences with mental illnesses and the pills they use to treat them. I refer to this rapidly emerging genre as the psychopharmacological thriller, or a new kind of narrative in which not only characters’ mental illnesses and quotidian psychological stresses, but more specifically how those illnesses and stresses are treated with psychotropic medications, occupies a central place in

the text. Or to put it more simply, psychopharmacological thrillers are texts in which characters’ psychiatric pills, medicine cabinets, and ongoing pharmacological treatment are central themes of the narrative. The rising popularity of this genre is evidenced by the recent onslaught of memoirs, novels, films, and television shows that explicitly explore the complexities of mental health disorders—at least in part—from the perspective of the psychotropic medications used to treat them, with recent examples of this new genre pitting Prozac against depression (Prozac Nation memoir 1994, film 2001), Valium against borderline personality disorder (Girl, Interrupted memoir 1993, film 1999), pentobarbital against dissociative disorder (Frankie & Alice 2010), Thorazine and insulin against schizophrenia (A Beautiful Mind biography 1998, film 2001), or a whole slew of medications against bipolar disorder in The Silver Linings Playbook (novel 2008, film 2012). Often these psychopharmacological subplots play out only barely visible as anonymous psych nurses dispense undefined pills to long lines of generic patients suffering from unspecified maladies (as in One Flew Over the Cuckoo’s Nest), or characters with unmistakably disturbed minds take repeated trips to the medicine cabinet to self-administer some unnamed, but clearly psychotropic, medication (as in Donnie Darko). Whether or not these texts specify the precise nature of each pharmaceutical conflict, taken collectively their point is clear: The psychotropic meds dispensed on any given day, day after day, play a central role in shaping the 70

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inner psychological conflicts faced by those who take them, as their psychologies and their biologies interact to play out grand psychopharmacological dramas. In each case, the biochemical conflict between a protagonist’s troubled mental state and the psychopharmacological tools used to treat it becomes a central feature of the text, shaping its characters, its plot, its imagery, its emotional conflicts, its dramatic tension, and at times even its metaphysics. Moreover, psychopharmacological thrillers almost invariably emphasize the complexities, rather than the certainties, of treating mental health disorders, depicting psychotropic medications as imperfect at best, if not at times outright harmful. In fact, in most cases today, both for real and for fictional patients, the situation is rapidly becoming far more complex as psychiatrists now routinely treat mental health disorders by prescribing complex combinations of medications, or psychotropic “cocktails,” frequently adjusting diverse amalgamations of prescriptions and dosages as patients struggle for years, if not entire lifetimes, to manage their conditions. In Side Effects (2013), for example, Emily Taylor (Rooney Mara) is treated with Wellbutrin, Prozac, Effexor, and Ablixa. In Gothika (2003), Chloe Sava (Penelope Cruz) is treated with Elavil, Mallorol, and Haldol. Meanwhile, Pat Solitano (Bradley Cooper) and Tiffany Maxwell (Jennifer Lawrence) swap stories about being on lithium, Seroquel, Abilify, Xanax, Effexor, Klonopin, and Trazodone in Silver Linings Playbook—not implausible courses of treatment that vividly illustrate how the simple isomorphic one-to-one LITHIUM (LI2CO3)

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correlation between a single disorder and a single medication is now more the exception than the rule. It is arguably bipolar disorder—and its treatment with lithium—however, which provides the psychopharmacological thriller with many of its most memorable narratives, ranging from Mr. Jones (1993) and Pi (1998) to Garden State (2004), Premonition (2007), The Silver Linings Playbook (novel 2008, film 2012), Homeland (2011–), and Infinitely Polar Bear (2014). There are several reasons for this, starting with lithium’s remarkable, yet imperfect, success as a psychotropic medicine. Widely touted as psychopharmacology’s gold standard, lithium provides one of the best illustrations that modern pharmacology can indeed cure, or at least alleviate, the effects of mental illnesses, and yet even lithium’s efficaciousness is limited at best, thereby setting the stage for a dramatic struggle in which people with bipolar can realistically expect lithium to improve their condition, and yet even lithium itself still offers few guarantees. Consequently, the lithium-bipolar narrative does not present pharmacology as a solution but rather as a drama, an unfolding tension, even conflict, between medications and their hoped-for cures. Add to this the fact that bipolar patients, especially when manic, are notoriously nonadherent to taking their prescribed medication—largely because it dulls their manic highs—and the drama is further heightened: Not only is it uncertain whether or not lithium will cure someone, but it is not even clear if they will take their medication in the first place. This raises the curious dilemma of characters 72

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deliberately refusing to take the very medication designed to cure their illness, an illness which at some level they often paradoxically desire. Moreover, an additional layer of drama is provided by the intriguing nature of bipolar characters’ irregular mood swings, their biochemical Sturm und Drang, with the possibilities for dramatic action still further extended by the manic mind itself with its overexcited, unpredictable temperament and its expansive, chaotic, divergent thinking. When creatively portrayed, this manic mind offers fascinating insight into the upside-down world on the other side of sanity. In fact, the manic phase of bipolar often curiously attracts, even fascinates, both those who suffer from it—and are consequently reluctant to relinquish even their illness itself—and also outsiders looking in upon the eccentricities of bipolar characters’ elevated moods, grandiose thoughts, and often erratic behavior. In fact, few psychopharmacological dramas present more compelling theater than the attempt to calm, without suffocating, the psychogeography of mania. And if, as Emily Martin argues, there exists a deep “affinity between contemporary American culture and the characteristics of manic depression [or bipolar disorder],” should we really wonder why such prominent, iconic characters as Carrie Mathison (Homeland) are turning specifically to lithium looking for an angry fix? If our age has indeed become bipolar, manically spinning out of control, then lithium promises, if not to alter that reality itself, then at least to better adjust ourselves to it, taking LITHIUM (LI2CO3)

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its edge off, offering us shelter, helping us along our way, and getting us through our bipolar days. What Thorazine, Valium, and soma were to previous eras, lithium is now to ours: a “mother’s little helper” for more manic times. It is the Showtime television series Homeland (2011–), therefore, which perhaps best demonstrates how recent mental health narratives have begun to depict more realistic, and less stigmatized, portrayals of mental illness. In addition, Homeland extends its surprisingly realistic portrayal of bipolar disorder and its treatment with medication into nothing less than a full-blown psychopharmacological thriller. A thriller in the fullest sense of the word, Homeland’s plot involves the inner workings of CIA espionage, Islamic terrorism, drone strikes, torture, money laundering, rogue hitmen, illicit affairs, and a “turned” American marine who has converted to Islam and become a suicide bomber hoping to assassinate the vice president while having an affair with an intelligence analyst—all amidst a full panoply of double and even triple agents. At the center of all this stands Carrie Mathison (Clare Danes), a high-level CIA operative specializing in post9/11 anti-terrorism in the Middle East. Carrie, however, is also bipolar, a condition that she treats with lithium—and clozapine, clonazepam, nortriptyline, Seroquel, and ECT (electroconvulsive “shock” therapy). Consequently, the crux of the narrative arises from this disjunctive confluence between Carrie’s intelligence work and the diverse ways in which her work is complicated—sometimes aided and other 74

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times frustrated—by both her bipolar condition, which itself flares in and out of control, and the medication that she precariously uses to treat it. Ultimately, then, Homeland triangulates a threefold plot which interweaves high-wire national security issues, a realistic depiction of Carrie’s mental illness, and a surprisingly wide-reaching examination of the psychopharmacology of her convoluted medicine cabinet, a medicine cabinet which can almost be seen as a primary character itself as the show repeatedly represents pills in dramatic ways. In the simplest sense, Danes’s portrayal of Carrie simply depicts, in a realistic and compelling manner, the complex realities of bipolar disorder and its medical treatment, and Danes has been highly praised for the verisimilitude of her performance. As an actress, she has garnered the entire gamut of television acting honors, including multiple Emmys, Golden Globes, and Satellite Awards as well as a Screen Actors Guild, TCA, and Critics’ Choice Award. In addition, her performance has also been recognized by mental health advocates such as Courtney Reyers, the Publications Manager for the National Alliance on Mental Illness (NAMI), who describes Danes’s performance as “one of the best jobs of portraying mental illness in modern television today with compassion, clarity, and responsibility attached.” Similarly, Dr. Ellen Leibenluft, chief of the Section on Bipolar Spectrum Disorder in the Emotion and Development Branch of the National Institute for Mental Health (NIMH), concurs that Danes’s character is “extremely well played” and a “very good LITHIUM (LI2CO3)

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portrayal of mania” (quoted in Nazareth). From a psychiatric perspective, then, what stands out most about Homeland is both Danes’s ability to realistically portray the heightened intensity of bipolar states and the series’ broad recognition that however debilitating Carrie’s illness may be her illness is nonetheless an integral part of who she is, and at times it is her very illness itself which enables her to do extraordinary things, even earning her praise from her boss, David Estes (David Harewood), as a “bit of a folk hero” among her fellow analysts. From a psychopharmacological perspective, however, Carrie’s illness is accurately portrayed as deeply intertwined with the pills that she does (or does not) take and with how well those pills are working on any given day—with the centrality of Carrie’s medication being circuitously revealed by the fact that viewers are actually first introduced not to

FIGURE 6 Carrie Mathison’s clozapine hidden in a nondescript aspirin bottle. Homeland, Showtime, season 1, episode 1, 2011. 76

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her bipolar illness itself but to her pills. Early in the first episode, “Pilot,” long before any mention is made of Carrie’s mental health issues themselves, she agitatedly reaches into her medicine cabinet to remove an ordinary bottle of aspirin. Only when Carrie dispenses the medication does the pill’s oblong shape and slightly off-greenish color immediately reveal that this is not aspirin, a fact soon confirmed by Carrie’s co-worker, Max (Maury Sterling), who when he inadvertently discovers her medication describes it as “what she hides inside her aspirin bottle instead of aspirin.” And the episode returns to the same trope a third time when Carrie’s other co-worker, Virgil (David Marciano), does a little sleuthing and discovers that Carrie’s pills are actually clozapine, an atypical antipsychotic clearly indicative of a serious mental health condition. It is only at this point that Virgil finally confronts Carrie, asking her point-blank if she is “crazy.” Forced to confess, Carrie reluctantly admits that she has a secret “mood disorder” that nobody at the agency can know about. Note, however, that Carrie’s illness is inferred backward from her pills, rather than directly observed from her behavior. Add to this the fact that Carrie returns to her medicine cabinet two additional times during the episode, making five distinct references to her pills compared to a lone reference to her illness itself, and it is almost as if the episode is suggesting that you can begin to reveal characters’ inner lives, at least if they are mentally ill, by simply ascertaining what is hidden—and in this case doubly hidden—inside LITHIUM (LI2CO3)

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their medicine cabinets. And, in the psychopharmacological thriller at least, this claim proves largely true. Carrie’s clozapine is just the tip of the iceberg, the first thread that begins to unravel her broader story, and hidden inside an aspirin bottle her medication provides a telling metaphor for the larger secret bipolar life which she hides from the CIA. We all have little secrets, but Carrie’s secret is not just her bipolar condition but also the medications which she uses to treat it. Virgil is just the one who lets the pill out of the bottle. Sure, plenty of clues are dropped, obliquely hinting at the possibility of Carrie’s bipolar condition: She is full of constant nervous energy, practically frenzied; she is emotionally high strung, if not outright volatile; she rates high on both impulsivity and insubordination; Virgil describes her as “intense;” her closest confident, Saul Berenson (Mandy Patinkin), admits that she can be a “little obsessive;” and her boss wants to know if there is “something” wrong with her, complaining, “It’s not her ré sumé  I have a problem with; it’s her temperament.” And she repeatedly engages in clearly reckless behavior: dangerously rushing into an armed Iraqi prison, illegally wiretapping Nicholas Brody’s (Damian Lewis’s) house against the explicit orders of her superior, initiating a promiscuous relationship, and betraying Saul, her best friend, and thereby jeopardizing his 35-year intelligence career—all in the first episode. By the sixth episode she has already knowingly started an affair with a suspected terrorist. There is even a vague suggestion that Carrie has some uncanny intuition or alternative rationality, ingenious 78

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perhaps but bordering on paranoia. When she tells Saul that “no one expects a thing,” he replies, “Except you,” correctly pointing out that she is literally the only analyst who even remotely, but correctly, suspects that Brody is a terrorist. Carrie, however, sees signs of Brody’s possible terrorist connections everywhere—both where they are and where they are not—and yet, Carrie’s bipolar illness itself cannot yet be openly read and deciphered; it will only be revealed later in retrospect or inductively inferred backward from her medication. Carrie’s actual behavior reveals nothing more conclusive than a hunch that “something” might be wrong, a something that Carrie has managed to hide, from the CIA no less, for more than a decade—only to finally be outed by her pills. Both her illness and its psychopharmacology are quickly becoming her destiny, however, as her clandestine aspirin-pill bottle betrays the bipolar spook. Through the next couple of episodes Carrie’s pharmaceutical activities continue, haunting her as she repeatedly returns to her medicine cabinet, searching— often with noticeable agitation—for her clozapine in aspirin drag. The second episode, “Grace,” for example, ominously opens with Carrie clearly taking her last pill, suggesting the precariousness of her pharmacological situation, a precariousness replicated by her psychiatric care. Needing to keep her condition, like its medication, under wraps, Carrie’s sister, Maggie (Amy Hargreaves), doubles as her off-the-books psychiatrist. With her aspirin-pill bottle and her sister-psychiatrist, Carrie’s medical care is practically as LITHIUM (LI2CO3)

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black ops as her day job, and the instability of this situation is further illustrated when Maggie informs Carrie that she can only provide her with seven pills at a time because she has to raid her own samples to get them, thereby jeopardizing her license. Playing the role of sister-shrink, Maggie keeps tabs on Carrie, repeatedly reminding her to take her meds and chiding her for refusing “to go to regular therapy and get treatment.” Carrie may take her medication—for the moment at least—but she does so precariously, often resenting her meds and systematically resisting the wider range of therapeutic measures at her disposal. Moreover, Carrie also has the “same illness” as her father, suggesting—again plausibly—an additional hereditary component that adds even more fuel to Carrie’s fire. Carrie may have managed to keep her demons at bay, to hide them from the CIA even, but her bipolar mind is still a ticking time bomb just waiting to go off. And in the eleventh episode, “The Vest,” it finally does. Shell-shocked by an explosion from a terrorist bomb, Carrie is thrown into a full-blown manic episode, putting her bipolar condition on open display. Initially hospitalized for her physical wounds, Carrie’s highly erratic behavior immediately suggests that she is experiencing mental health problems as well. Saul quickly realizes this when he greets a frantic, irrational, and wildly gesticulating Carrie who is demanding that someone give her a green, not a black or a blue, pen. “My kingdom for a fucking green pen!” Carrie exclaims before barging headlong into her far-flung theories 80

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about the “methods and patterns and priorities” of Abu Nazir’s latest terrorist plot. Rapidly spiraling out of control, Carrie’s hyperactive manic mind quickly spins a paranoid plot, insisting that there are “many, many, many more” facets to be explored; describing Tom Walker (Chris Chalk), a marine turned terrorist, as “just a part, a piece, a pixel, a pawn” in Nazir’s much larger plan; and imploring that the agency immediately “code . . . collide . . . collapse . . . [and] contain” her newly perceived threats posthaste. By the time Carrie protests that we’ve got to go “to work; we’ve got to hop to; we’ve got to haul ass to Langley,” it is clear that Carrie isn’t going anywhere near Langley. In fact, by the end of the episode Carrie loses both her job and her security clearance, defeated by her mental illness. Meanwhile, Carrie’s visibly pressured, rapid and out of control, speech and divergent, even delusional, thinking clearly indicate that she is in a manic state, bordering on paranoia and psychosis, as she cryptically warns that “Nazir’s movements in green, after fallow yellow, always creeping towards purple are methodical, meaningful, momentous, and monstrous.” Anything but methodical herself, Carrie is forced to confess that her psychiatric caregiver is actually her sister who quickly arrives to consult with Saul. When Saul questions Maggie, “So what do we do?” Maggie replies, “Up her lithium. Start giving her clonazepam,” throwing us back into the jaws of the psychopharmacological thriller: it’s bipolar vs. lithium, psychosis vs. clonazepam, the mind vs. the medicine cabinet, the spook vs. the shrink all over LITHIUM (LI2CO3)

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again. Meanwhile, her doctor prescribes her Ativan, and down the pharmacological rabbit hole we fall once more: clozapine, lithium, clonazepam, Ativan, the pharmaceutical rap sheet grows; the dosages increase. Where will it end this time? Carrie’s problems are clearly biochemical. She needs medication for sure, but that doesn’t mean that chemistry alone can simply cure her. It is certainly going to take more than a little lithium to put this manic Humpty Dumpty back together again. Much like the depiction of John Nash’s insanity in A Beautiful Mind, Homeland also depicts Carrie’s descent into mania through the evolution, or better devolution, of her manic corkboard. Throughout the first ten episodes we are shown repeated glimpses of this corkboard which she uses to organize the most critical information pertinent to her current case. In the first episode, well before Carrie

FIGURE 7 Carrie Mathison’s pre-manic corkboard. Homeland, Showtime, season 1, episode 1, 2011. 82

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has become manic, this corkboard is clearly presented as coherent and well organized. It can be read, much like a book or a graph, coordinating information in recognizable sequences, hierarchical patterns, and easily visible sections. Over the course of the series this corkboard is routinely reorganized, waxing and waning a bit in complexity and occasionally even being wiped clean to start over, but for all of this variation the corkboard’s fundamental principle of rational order is preserved, offering a window into the analyst’s mind at work. In episode eleven, however, after Carrie becomes manic the growing disorganization of her corkboard reflects her unraveling mind. The very picture of a mind turning insane, Carrie begins hastily scribbling cryptic, color-coded messages on piles of papers and files scattered willy-nilly across her furniture and floor. Disheveled and disorderly, the piles of rapidly proliferating and seemingly random paperwork reflect her increasingly paranoid attempt to find the most subterranean, clandestine connections between anything and everything else. And yet, there is method to her madness: Her wildly chaotic thinking leads her to perceptive new insights about her current case. Only Langley never got the memo. For no sooner than Saul reconstructs Carrie’s manic timeline than the Director of the CIA Counterterrorism Division himself shows up to remove it. Stripping Carrie of her job both for improperly using classified documents and for being mentally unstable, David Estes orders Carrie’s room to be cleared, her “very important,” “very meaningful” manic corkboard to be LITHIUM (LI2CO3)

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FIGURE 8 Carrie Mathison unsuccessfully fights to defend her reconstructed manic corkboard. Homeland, Showtime, season 1, episode 11, 2011.

dismantled, and her office at Langley to be emptied. In a fit of emotionally distraught manic rage—brilliantly played by Danes and later cleverly spoofed by Anne Hathaway on Saturday Night Live—Carrie fights back, albeit unsuccessfully, in a vain attempt to defend the fruits of her madness. Now Carrie’s bipolar, like her clozapine before it, is finally out of the bag, and she admits that she has been bipolar since college when she “wrote a 45-page manifesto declaring [she’d] reinvented music. The professor [she] handed it to escorted [her] to student health. It wasn’t even his class.” And yet, the conundrum posed by Carrie’s corkboard is not whether or not Carrie is bipolar—she clearly is—but what exactly to do about it. And here is where the pharmacology of Carrie’s medicine cabinet comes most strikingly into focus: Somehow Carrie needs to medicate herself just 84

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enough to keep sane, but not so much as to squash her uniquely manic talents as an analyst, making taking her meds unequivocally less a cure than a balancing act. “Up the lithium,” Maggie, the sister-shrink, warns. “Maggie upped my meds, I shouldn’t have let her,” Carrie retorts with her also bipolar father sympathetically complaining as well that Carrie’s “lithium levels are too high.” The show returns to this same balancing act theme more explicitly in “Super Powers” (season five, episode three) when Carrie deliberately—and under the supervision of her boyfriend, Jonas (Alexander Fehling)—stops taking her medications in order to try to self-consciously access the inner super powers of her bipolar mind to help her figure out who is trying to kill her. Initially, this seems to work as Carrie begins to see visions and make connections between aspects of her past. Her visions quickly turn to hallucinations and delusions, however, so Jonas forces her to resume taking her medication. This scene realistically portrays how “balancing” one’s manic illness/gift with one’s medications is potentially possible but never simple or easy. By the seventh season, Carrie is outright titrating her brain’s neurochemistry with an ever-growing personal apothecary. With her lithium starting to lose its efficacy after years of prolonged use, Carrie is once again veering off into mania, so she starts taking the sedating antipsychotic Seroquel (quetiapine fumarate) to calm her frenzied mind. At the same time, however, she wants to keep her mind sharp, so she simultaneously takes a series of cognitive enhancers: She has a prescription for Adderall (amphetamine/ LITHIUM (LI2CO3)

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dextroamphetamine) in her medicine cabinet, and she buys methylphenidate (generic Ritalin) and Strattera (atomoxetine) on the street out of the back of some dealer’s car. Now armed with an antipsychotic in one hand and a phalanx of stimulants in the other, Carrie revs her mind up and down, constantly shifting gears in the never-ending quest of achieving some kind of equilibrium that will keep her mental acuity at its feverish hypomanic apex without spiraling out of control into the abyss of outright clinical mania. With this push-me, pull-you neurochemical juggling act, Carrie does not so much manage her illness as she exploits it—together with the diverse medications she uses alternatingly to treat it and to self-consciously exacerbate it—in hopes of ultimately profiting from her disorder itself. She actively struggles to actually keep her hypomania alive without letting it engulf her, simultaneously using pills both to accelerate and decelerate her manic mental activity. Like Kanye West’s description of his bipolar condition in his recent song, “Yikes” (on his 2018 album ye), Carrie also often sees her “bipolar shit” not as a “disability” but rather as some kind of “superpower.” Taking (and not taking) pills simply enables Carrie to attempt to regulate this superpower without letting it spin out of control. Throughout the entire series Carrie repeatedly plays this psychotropic game of balancing her meds except when she ups the ante even further. By the end of the “Marine One” episode, for example, Carrie begins losing her psychopharmacological battle, so she turns to heavier 86

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artillery, choosing to begin electroconvulsive “shock” therapy (ECT). Electrodes strapped to her head, Carrie bites down on the rubber gag, beginning a six-week, biweekly program of treatment. Like lithium, clozapine, clonazepam, and Ativan before it, ECT helps, but does not cure, Carrie’s bipolar. For the rest of the series Carrie wanders in and out of various manic states, alternating between periods of adherence and nonadherence to her medications. By the first episode of the third season Carrie’s father discovers that she is off her meds again, having turned instead to alternative treatments: running, yoga, and meditation. Almost immediately, Carrie begins to become unstable and reckless, going to a reporter to reveal agency secrets at which point the agency retaliates by committing her to a psychiatric hospital, holding her on a 24-hour hold, and forcing her to go before a competency hearing. When off her meds Carrie rages until restrained and returns to scribbling frantic notes. Back on her meds she apologizes contritely, and once more we seem to be on the nonadherence merry-go-round. Only this time, the plot thickens well beyond the verisimilitude of merely depicting mental illness and its treatment. Now Carrie’s precarious psychopharmacology enters into the plot itself. Knowing that Carrie is willing to do just about anything to get released from the hospital, and that the agency has betrayed her by publicly announcing her illness—not to mention her tryst with a terrorist—Leland Bennett (Martin Donovan), a DC lawyer with ties to Iranian terrorists, exploits Carrie’s illness, attempting to recruit her LITHIUM (LI2CO3)

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into double agency by securing her release. Only the plot twists again when it is revealed that Langley itself had already exploited Carrie’s illness, designing her mental breakdown itself to present the faç ade of weakness, so that the CIA could use Carrie as a triple agent to infiltrate the Iranian terrorist circles who were attempting to recruit her. Now Carrie’s illness is no longer simply a matter of a realistic portrayal of mental health but rather a plot device that enables Carrie to plausibly play the role of triple agent in a manner only made possible through her illness—and her deliberate decision not to take her medication. Her illness and its treatment literally become her cover for further espionage. And psychopharmacology returns again with a vengeance in the show’s fourth season when Carrie’s medicine cabinet makes another appearance as the site of a terrorist act itself. In the fifth episode, “About a Boy,” Dennis Boyd (Mark Moses),

FIGURE 9  Psychopharmacological espionage. Homeland, Showtime, season 4, episode 5, 2011. 88

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the husband of the ambassador and a recently turned secret agent for the Pakistani ISI, breaks into Carrie’s apartment and photographs the contents of her medicine cabinet: lithium, clozapine, clonazepam, and now nortriptyline. Recognizing that such medications would indicate that Carrie is “at least bipolar, possibly beyond that,” Dennis designs a dastardly act of psychopharmacological terrorism. Replacing Carrie’s medication with phenethylamine, a psychedelic drug also known as 25I, he hopes to induce another debilitating bipolar episode that will get Carrie released from her position as the Station Chief in Islamabad. And initially his ruse works: Carrie is thrown into a dangerously psychotic state which causes her to stumble incoherently through the streets of Islamabad at night before she is luckily rescued by the forces of Nimrat Kaur (Tasneem Qures), an officer in the ISI. At this point Carrie discovers the deception and is cured when she returns to taking her prescribed medications, but not without the series first introducing new possibilities for psychopharmacological terrorism. We have come a long way since Carrie’s first trip to the medicine cabinet, but her pills— and the psychopharmacological spy-thriller possibilities that they open up—have dogged us all along the way with the spy using her manic mind itself, carefully titrated by a phalanx of pills, to spy, using her illness and her refusal to take her medication as a cover for her spying, and having the pills in her medicine cabinet be spied upon in return. In the final episode of season seven, “Paean to the People,” Carrie’s pill bottle makes one more appearance, LITHIUM (LI2CO3)

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arguably its most dramatic yet. Having been captured while on a covert mission in Russia, Carrie is held captive by Yevgeny Gromov (Costa Ronin), a senior operations officer in the Russian GRU. Yevgeny, however, discovers that Carrie is taking psychiatric medication and correctly intuits that withholding her medication will literally drive her insane. Deprived of her medication, Carrie does descend into insanity, and the episode ends seven months later with a stark, raving mad version of Carrie being returned to American control in a prisoner exchange. No longer properly titrated with psychotropic pills, Carrie’s brain becomes completely untethered as her bipolar condition overwhelms and destroys her. Once again, however, Carrie’s pills themselves take center stage, serving this time as the plot device which enables her captors to control and punish her. With this final plot twist, Homeland once again demonstrates its willingness to go far beyond mere verisimilitude portrayals of mental illness: Pills—or rather their denial—literally become a site of espionage and an instrument of torture, the psychotropic equivalent of psychological waterboarding. Mennan Yapo’s Premonition (2007) offers yet another example of how the showdown between mental illness and lithium can be developed into a complex psychological, even metaphysical, thriller that extends far beyond verisimilitude portrayals of mental illness. In fact, it is not even clear whether the film’s protagonist, Linda Hanson (Sandra Bullock), has a mental illness—and hence is hallucinating— 90

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or whether she is caught in some kind of larger science fiction time warp. Not unlike Donnie Darko (2001), another psychopharmacological thriller in which a character’s experience of time travel is made plausible by the fact that he is taking psychotropic medications, Premonition presents itself, on the surface, as simply a supernatural tale. The story of Linda’s deteriorating marriage is abruptly interrupted when a sheriff appears at her door to inform her that her husband, John (Julian McMahon), has died in a car crash, but this tragic event is complicated when Linda begins experiencing her life non-chronologically, skipping forward and backward in time as the story alternates between days occurring before and after her husband’s accident. Consequently, the day after Linda finds out about her husband’s death she wakes up on the day before his death to see him downstairs drinking coffee. Dazed, Linda returns to her regular life assuming that her husband’s death was just a bad dream. That is, until events from the first day start reoccurring and she continues

FIGURE 10 Linda Hanson (Sandra Bullock) finds lithium in her sink. Premonition, dir. Mennan Yapo, 2007.

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to jump forward and backward in time, causing her to begin questioning what is and what isn’t real. Taken at face value, this story is simply a supernatural narrative, an inexplicable tale of time travel. On the third day, however, this science fiction narrative is abruptly transformed into a psychopharmacological thriller when Linda wakes up to find a spilled bottle of lithium in her bathroom sink. Having skipped across both the first day of her husband’s death and the second day of his miraculous return, Linda now finds herself a few days later preparing for her husband’s funeral. The presence of the lithium in her sink, however, complicates the narrative by raising the distinct possibility that Linda is actually mentally ill and hallucinating the entire thing, including both her husband’s death and her own time traveling, or that her husband has perhaps died with her grief producing a psychosis that is causing her to experience the event within a fractured chronology. That key sequences are filmed with slightly blurred vision and voices—to suggest that Linda might be experiencing hallucinations or other sensory impairment—only further heightens the possibility that Linda is, in fact, mentally ill not supernatural. Ultimately, the film’s psychological tension holds the viewer in suspense, not knowing whether the medical or the supernatural explanation is correct, but the presence of this second psychiatric possibility renders the supernatural narrative both palpable and plausible, extending the viewer’s willingness to suspend disbelief about an alternative 92

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metaphysical world and enticing the audience to consider that the mentally ill may experience life in just such a jarring, non-linear manner. Juxtaposed in such close proximity to each other, the psychopharmacological and supernatural narratives lend each other a compelling cohesion and coherence, not to mention dramatic tension, that either one alone might lack. Moreover, the presence of the lithium in Linda’s sink raises a secondary medical subplot: Now Linda not only needs to ascertain whether or not her husband has died, but she also needs to figure out who prescribed her the lithium and why and how it might be affecting her perception of events. Once again, however, Linda’s illness is inferred backward from her medicine cabinet: her diagnosis from the lithium found in her sink, her psychiatrist, Dr. Norman Roth (Peter Stormare), from the name on her pill bottle. After Linda’s initial attempt to call her psychiatrist proves unsuccessful, he subsequently shows up at her doorstep. Linda, however, cannot remember him—because she has not yet experienced the day on which she first meets him—and the doctor is forced to restrain, sedate, and hospitalize her, once again reinforcing the probability that some kind of prior or subsequent mental illness might explain Linda’s abnormal experiences. The only question is which came first: the tragedy or the psychosis? Maybe this is not a supernatural, but a psychopharmacological, thriller after all, and Linda’s medical experiences might further corroborate this. It is not at all unlikely that a mentally ill person might completely LITHIUM (LI2CO3)

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misperceive, misunderstand, or misremember the medical help that they are given. The fragmented manner in which Linda misperceives and misunderstands her medical care itself, then, adds another layer to the film’s attempt to perhaps realistically portray a psychological breakdown. Over the second half of the film, Linda battles, simultaneously, with both her abnormal, non-linear experience of time and with her medicine cabinet, her days bouncing back and forth achronologically as she fights to piece her life, her diagnosis, and her prescription back together again. One day she frantically ransacks her medicine cabinet unsuccessfully searching for the lithium she has yet to be prescribed. Another day she contemplates taking a handful of lithium tablets only to ultimately decide to wash them down the sink—thus explaining how the lithium got into her sink in the first place. One day she finds Dr. Roth’s phone number in her waste basket; the next day she tears his phone number out of the yellow pages and throws it away. Another day she goes to see Dr. Roth when he makes her original prescription for the lithium, which he believes is the “best thing” for her right now, but this comes only after she has found the lithium in her sink and after Dr. Roth has already carted her away to the hospital. At one moment, she fills her hand full of lithium tablets, threatening to overdose and perhaps suggesting that taking her lithium is causing her hallucinations; the next moment, she throws the entire handful down the sink, refusing to take her prescribed medication at all and thereby suggesting— 94

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even more plausibly—that not taking her lithium is causing her psychosis. Consequently, at the same time that Linda is piecing together her fragmented life, she is also struggling to understand the illness that she may be suffering from and how and why it is being treated with pills. Ultimately, this psychopharmacological dimension of the film plays a crucial role in complimenting its science fiction time travel narrative. After all, the only non-supernatural explanation given in the film is that Linda might be psychotic because she is suffering from some kind of mental breakdown, and the more that the film interweaves its explicit depiction of time travel with repeated images of lithium, psychiatrists, and psychiatric wards, the more likely this natural psychopharmacological interpretation seems plausible. That we are first introduced to Linda’s possible illness through a depiction of a bottle of lithium being flushed down the sink— the very trope of medical nonadherence—offers perhaps the

FIGURE 11 Linda Hanson (Sandra Bullock) tosses her lithium down the sink. Premonition, dir. Mennan Yapo, 2007.

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most compelling evidence that Linda’s break with reality is more psychopharmacological than supernatural in nature. It is not so much the lithium itself—but rather the fact that the lithium has been discarded untaken—which most definitively points to a terrestrial interpretation of the film’s seemingly supernatural events. Certainly, a traumatic event can produce a mental breakdown that, especially if untreated, can lead to psychoses and hallucinations not dissimilar from Linda’s experience of time travel. Consequently, Linda’s untaken lithium, sedation, and hospitalization are all events that can actually explain, in a way that time travel cannot, the events depicted in the film. Certainly, the thrill of Premonition is precisely that it never definitively answers the question of whether Linda is mentally ill or a time traveler, but the presence of the psychopharmacological lithium subplot renders the time traveling all the more meaningful in that it provides a context in which such experiences are possible at the same time that the time traveling provides a compelling, accessible, and accurate metaphor for what it might actually feel like to experience a mental breakdown. Given this context, this final image of Linda tossing her lithium down the drain is telling. If, in fact, Linda is a time traveler then discarding her lithium is, of course, a moot point. Neither lithium nor any other psychotropic medicine can do her any good. If, on the other hand, however, Linda is simply experiencing a psychotic episode—either in response to her husband’s death or as a psychotic delusion of his death—the fact that she is deliberately nonadherent to her 96

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prescribed medication raises a red flag, signaling that she could very well be experiencing her world as if caught in a time warp with her refusal to take her medication further compounding her condition. That such episodes can indeed be triggered by traumatic events such as the unexpected death of a loved one only adds one more layer to the possible verisimilitude of what otherwise appears to be mere science fiction fantasy. Ultimately, the growing sophistication and accuracy of recent psychopharmacological thrillers is perhaps, first and foremost, exemplary of the emerging field of the medical humanities and an illustration of how mental illnesses and their treatments are beginning to be depicted more realistically and more positively in the popular media. It illustrates how art can teach us powerful lessons about illnesses and their treatments, illuminating issues ranging from the reasons behind nonadherence and insightful illustrations of the psychodynamics of mania to the possible side effects of treating mental illnesses with psychotropic medications. Consequently, health care professionals have a lot to learn from these cultural texts, including both diagnostic measures and a greater sympathy for the suffering of their patients after seeing how their conditions are depicted in the mirror of art. But the psychopharmacological thriller also extends far beyond mere verisimilitude as writers, filmmakers, and other artists have begun to use mental health scenarios and their treatments with pills to devise new narrative possibilities: LITHIUM (LI2CO3)

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the character of the chaotic but lovable or insightful manic, the dramatic battle between illness and medication, science fiction analogies for abnormal psychological experiences, the manic mind as genius, mental illness as espionage cover, or the medicine cabinet as terrorist target or instrument of torture. In each of these examples, art is not simply illustrating the nature of medicine, but medical conditions and practices provide new material for the artistic imagination itself, extending the tradition of the medical drama—from M.A.S.H. to Grey’s Anatomy or Scrubs—in ways that go beyond the mere treatment of medicine as subject matter to intertwine the medical and the artistic in innovative new ways. At the center of this all often stands a simple pill—or say, a handful of 300 mg lithium capsules—that dramatizes the complex ways in which the lives of the mentally ill are powerfully transformed by the complex biochemistry of not only their minds but also their medicine cabinets. Their central moral perhaps being that psychotropic medications should not be seen as some kind of psychopharmacological Coke machine—where you simply plop in a pill and out comes a cure—but rather as the site of an existential crisis, a Sisyphean struggle, or at times even a Pandora’s box. If there is a true verisimilitude that is to be found in the psychopharmacological thriller it is this: Psychotropic medications frequently play a vital, but also complex and uncertain, role in individuals’ quotidian struggles with mental illness, often catalyzing a long and unpredictable 98

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chain of events that meanders or tacks—more than simply leads—toward some elusive, if not illusionary, final cure. More a lengthy journey than simple destination, psychotropic medications, in their complexities and even contradictions, perhaps mirror nothing so much as the convoluted illnesses they are designed to cure. They mark less the end than the beginning of the long path toward something resembling, though often never more than approximating, a cure—a byzantine chess match often played out amidst the almost unfathomable biochemistry and neural circuitry of the human brain 300mg at a time.

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4 PROZAC (C17H18F3NO): EXISTENTIAL QUAGMIRES

Widely praised as resembling what Emily Nussbaum describes as “nothing else on television,” HBO’s The Sopranos (1999– 2007) narrates the infamous deeds of a notorious mob family whose lives overflow with murders, drug deals, carjackings, fraud, money laundering, racketeering, extortion, gambling, and prostitution. And yet, the series does not open in medias res, during a ruthless firefight between heavily armed hitmen or even in some seedy New Jersey strip club, but instead with Tony Soprano (James Gandolfini) simply walking into a nondescript psychiatrist’s office, seeking professional help for a recent panic attack. No one-off gag or mere comic juxtaposition between grisly mob violence and touchy-feely psychoanalysis (as in Analyze This and Analyze That), Tony’s “talk therapy” sessions with Dr. Jennifer Melfi (Lorraine Bracco) arguably provide the series’ central narrative framing device, using

FIGURE 12 Opening scene of The Sopranos. Tony Soprano visiting his psychiatrist, Dr. Jennifer Melfi. The Sopranos, HBO, season 1, episode 1, 1999.

the analyst’s chair to reveal the depths of its protagonist’s character, to explore his broader social relationships with family and friends, to simultaneously dissect both criminal and suburban life, and ultimately to probe the very psyche of America itself. In the end, Tony Soprano may be just one more run-of-the-mill gangster, but as an analysand he is almost unparalleled in American culture. Not since Woody Allen’s Alvy Singer (Annie Hall) has a character been so thoroughly—and entertainingly—psychoanalyzed on screen. The Sopranos’ grand psychoanalytic narrative, however, is itself shadowed by a second psychopharmacological one that represents mental illnesses and their treatments in an increasingly realistic and less stigmatized manner. For Dr. Melfi treats Tony not only with talk therapy but 102

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also with psychotropic medications, most prominently the SSRI (selective serotonin reuptake inhibitor) Prozac (fluoxetine)—so in certain respects the series plays itself out on a subterranean level, through a biochemical subplot, as a psychopharmacological thriller even, always in the background and constantly exploring how the complex psychology of the human mind interacts with the hardwired neurochemistry of the human brain. From this psychiatric perspective, The Sopranos is not simply a psychoanalytic exploration of the ideas inside Tony’s head, or even the feelings inside his heart; it is also a pharmacological examination of what’s inside his medicine cabinet, for in the very first episode Dr. Melfi throws down a psychopharmacological gauntlet, brazenly declaring that “with today’s pharmacology, no one

FIGURE 13 Tony Soprano pulls out his prescription of Prozac. The Sopranos, HBO, season 1, episode 1, 1999.

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needs to suffer with feelings of exhaustion and depression.” To this Tony retorts, “Here we go. Here comes the Prozac”; thus begins the unfolding battle, even mano a mano showdown, between the Don’s deeply troubled, but not so easily cured, psyche and the shrink’s vast, but less than invincible, arsenal of psychotropic medications. If only it were as simple as Dr. Melfi suggests: Then all Tony would need to do is swallow the right pill and out would come the cure, which is essentially what Dr. Melfi’s Cokemachine model of the human brain implies. And, initially, her psychopharmacological ruse even seems to work. First, we see Tony on the golf course as he reaches into his pants and pulls out a bottle of Prozac. Then, only minutes later Tony runs into Dr. Melfi at a restaurant, and he tells her—via a coded message given their public setting—that her “decorating tips” really worked. Meanwhile, Tony’s wife, Carmella (Edie Falco), notes how Tony seems to be in good spirits, and finally, near the end of the first episode, Tony confides to Dr. Melfi that the Prozac seems to be working. At this point, however, the show sets up the first of numerous roadblocks on any simple path to Tony’s biochemical cure. For as Dr. Melfi points out, Tony’s improved moods cannot simply be a result of the medication since patients need to take Prozac for several weeks before it builds up a therapeutic level in their blood. In other words, psychotropic medications do not work so simplistically and unproblematically. They take time to work, and here The 104

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Sopranos deserves praise for its verisimilitude representation of the complexities of psychopharmacology. If Tony has achieved some remission of his depression so quickly, then, he has done so as a result of talking through his issues, not through medication alone. In this sense, The Sopranos is notable in that it explicitly emphasizes how psychotherapy and psychopharmacology need to work together, and throughout the remainder of the series Tony continues to meet with Dr. Melfi for both talk therapy and pharmaceutical interventions, thereby illustrating a more realistic and preferable course of treatment. As Edward Shorter notes, “The combination of psychotherapy plus medication represents the most effective of all approaches in dealing with disorders of the brain and mind.” And this is only the first of the many ways in which The Sopranos complicates our understanding of psychopharmacology. In only the second episode Tony is quickly back on his onagain, off-again depression merry-go-round, moping around the house in his disheveled bathrobe, thereby showing that Prozac is no simple panacea. Instead, both Tony’s depression itself—and its medical treatment with pills—prove to be long, complex processes that unfold unpredictably over the course of several seasons. For no sooner did Dr. Melfi boast that she can cure Tony’s suffering with modern pharmacology than she already seems to only drag him deeper into pharmaceutical quicksand, prescribing him Prozac in the first episode, Xanax in the fourth. By the twelfth episode, the emerging mob kingpin is taking lithium, too, and when Dr. PROZAC (C17H18F3NO)

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Melfi asks him if he is “still taking the lithium,” he replies, “Lithium, Prozac. When’s it gonna end?” Tony is already onto Dr. Melfi’s pharmacological game, and when lithium itself produces adverse side effects, causing Tony to hallucinate a beautiful woman named Isabella (Maria Grazia Cucinotta), one begins to wonder if Dr. Melfi isn’t curing Tony so much as she is dragging him down a psychopharmacological rabbit hole, turning his medicine cabinet—and his mind itself—into a psychotropic funhouse. Once again, however, The Sopranos strikes a note of verisimilitude in that it correctly suggests that many patients are now treated not with a single pill but with a complex, and at times even bewildering, combination of pills, frequently mixing a range of antidepressants, mood stabilizers, and antipsychotics. And not only is there no guarantee that these pills will work; they can also cause diverse side effects. From beginning to end, then, The Sopranos represents not the certainties but the complexities of psychopharmacology. To begin with, it immediately suggests that a surprising number of people take psychotropic pills. In the first episode alone, both Tony and one of his associates are being treated for depression. Only Tony’s associate is taking Zoloft instead of Prozac, thereby showing that there is no single cure for any mental illness. Halfway into the first season, Tony’s son, A.J. (Robert Iler), is treated for ADD (attention deficit disorder) for which he is eventually prescribed Lexapro. Consequently, Tony’s treatment is far from an anomaly. Taking psychotropic pills is repeatedly depicted not as an exceptional but as an 106

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everyday occurrence—even for hardened mobsters. In another scene Tony “confesses” to his wife that he is taking Prozac almost as if he were confessing a marital infidelity, thereby representing the stigma often attached to taking psychotropic pills. At times Tony forgets to take his pills, at times he takes too many. At times his pills seem to work; other times they demonstrably do not. He goes from taking one pill to taking many. Occasionally, his pills produce side effects ranging from hallucinations to sexual dysfunction. At times he needs therapy; other times he needs pills. Usually he needs both. But the process is always presented as complex, convoluted, and uncertain. Throughout this process, Prozac, in particular, plays a central role, offering Tony help with both his depression and his panic attacks, but it never offers some kind of easy or complete panacea. Always, Prozac is depicted as a complex circuitous journey rather than a simple destination. And this complexity is true not just of fictional accounts. As it becomes immediately clear in memoirs such as Elizabeth Wurtzel’s Prozac Nation: Young and Depressed in America (1994) or Lauren Slater’s Prozac Diary (1998) both mental illnesses and their treatments are complicated, ongoing, messy processes. They are rarely short, decisive battles; instead, they are long, protracted, and often neverending wars. As one of the first patients to take Prozac when it was released in 1988, Slater starts us off at the ground floor of her long-term struggle with Prozac. Initially, Prozac makes her feel “shockingly fine”: She begins to sleep better, PROZAC (C17H18F3NO)

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her body and mind feel new, as if retuned by a “piano tuner;” her obsessive compulsions suddenly become “flexible;” her appetite returns to normal; and she even loses the “desire to read Kierkegaard,” turning instead to “play,” “imagining,” and “going out late at night.” Yet, at the same time that Prozac brings tangible, palpable relief, mitigating her depression and compulsions, its healing powers remain “messy and incomplete,” allowing “bits of old illness” to seep “through the cracks in its chemistry”: the “sick me is still somehow here. She is hiding behind the branches of my bones. She is peeking out, playful, coy, and pained. Her voice must mix with mine.” At times her Prozac even “simply stop[s] working,” causing her mental illnesses to come “rushing back in.” More palliative than panacea, then, Slater’s Prozac works only partially, intermittently, and unreliably—as she raises and lowers her dosage—feeling “betrayed” by this “two-timing pill” which she ultimately rejects as a “lover,” embracing it instead in a more diminutive sense as merely a “close friend, a slightly anemic, wellmeaning buddy whose presence can considerably ease pain but cannot erase it.” Far from a wonder drug, Prozac is merely an unsteady psychological crutch, almost even a clumsy new neurochemical cyborg appendage, a second brain, that provides an aide in the healing process but never a definitive cure. Consequently, instead of experiencing the “cure called Prozac” as a simple transition from illness to health, Slater redefines health itself as an ambivalent, Janus-faced, double108

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edged sword. At the same time that Prozac eases her depression and OCD, the “drug also drain[s] something larger from my life,” making the very process of healing itself ambiguous: “a bit of a blessing, a bit of a pity” as her “medicated self drift[s] down, and down,” simultaneously “fearful of and longing for the level ground.” In the same way that illnesses are complex, then, cures themselves are equally “complex, disorienting, a revisioning of the self, either subtle or stark. Cure is the new, strange planet, pressing in.” And it is not even simply that Prozac produces numerous side effects, ranging from nausea, vomiting, and headaches to a loss of creativity and decreased sexual desire. In an even more existential sense, Slater describes taking Prozac as a more complex process of always redefining the very core of her personality, of constantly “barter[ing]” or “exchang[ing] one essential self for another,” causing her to feel “torn between my desire for my old self and my enthusiasm for the new.” Prozac may help lift the “grand dense darkness” of her depression, but Slater also finds herself almost a new person altogether: “reading Glamour” and “shopping at Ann Taylor” instead of writing poetry. Troubled by this existential uncertainty, Slater fears that the very “health [Prozac] spawned” itself could simultaneously “take away not only my creativity but my very identity.” In this heightened sense of existential crisis, Prozac “tweak[s] the deeper proclivities of [her] personality,” recreating her very self: “I was a different person now, both more and less like me, fulfilling one possibility while PROZAC (C17H18F3NO)

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swerving away from another. There is loss in that swerving.” Ultimately, then, Slater concludes that the simple act of “taking a pill,” especially a psychotropic one, is “always an exercise in the existential” because “each time you swallow a pill you are swallowing not only a chemical compound but yourself unmoored; you are swallowing the sea, the drift and the drown.” Taking psychotropic pills, then, does not simply cure mental illnesses in any straightforward sense. Instead, it initiates a far more complex process not simply of restoring the mind to health, but of redesigning identity itself, of reinventing the self and re-manufacturing the personality, blurring the “old lines between treatment, correction, and enhancement” (Rose 2007). Prozac does not simply cure depression. In a more profound sense, it opens up new technologies for experimenting with and hopefully optimizing the self. In such an existentially intrusive process, it can become difficult to tell where one self begins and another ends, and Slater spends the latter part of her memoir asking probing questions about whether or not there even is such a thing as an “authentic” self and about whether or not pills are the biochemical equivalent of cosmetic surgery or even doping up on psychotropic steroids. But the way that Slater tells it, Prozac seems to be less cosmetic psychopharmacology than an all-out existential quagmire. She keeps taking her Prozac, but she does so cautiously, hesitantly, reluctantly—with gratitude, to be sure, but also with deep, intractable reservations about how Prozac re110

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engineers her deepest core self, or whatever used to be her soul before its biochemical retrofitting. And the process of healing is even more convoluted in Wurtzel’s memoir, for Wurtzel’s story extends backward a generation to her father, a “daily Valium doser” who “began loading up on tranquilizers”: “Valium. Librium and Miltown and whatever else too.” So psychiatric pills already have a long history in her family. Moreover, at the same time that Wurtzel is—like Tony Soprano—taking both Prozac and lithium, she is also cycling on and off of desipramine, Desyrel, Inderal, Halcion, Dalmane, Xanax, Valium, Thorazine, and Mellaril, doing her stations of the psychopharmacological cross, filling out her own psychotropic rap sheet. Consequently, even the name Prozac Nation itself is misleading, almost a misnomer, allowing a single metonym, only the most prominent symbol of one psychotropic generation, to stand in for two generations of extensive, serial, even promiscuous, psychiatric drug use. We can little be surprised, therefore, when Wurtzel laments that she is “going to be on drugs forever if I just want to be barely functional”—for her own family history has already conditioned her to accept psychopharmaceuticals as a way of life. Less focused on existential quandaries (who am I?) and more on pragmatic quagmires (how can I pull it all together just long enough to pass Comp Lit?), Wurtzel’s on-again, off-again, revolving-door approach to psychotropic pills resembles less a merry-go-round than a roller coaster: She overdoses on Atarax at summer camp, she later overdoses PROZAC (C17H18F3NO)

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on Desyrel; she is in and out of mental hospitals, psych wards, and emergency rooms, and she cycles through a bevy of therapists in between suicide attempts; she is prescribed Prozac (an SSRI) for depression, Mellaril (an antipsychotic neuroleptic like Thorazine) for schizophrenia, and lithium (a mood stabilizer) for manic depression, only to abruptly stop taking her lithium against her doctor’s instructions, thereby throwing herself into another episode. At one moment, she is prescribed Xanax for anxiety disorder, then when that doesn’t work she is given Valium, and when that, too, fails she is given Thorazine. At another moment she is prescribed Desyrel or Dalmane to help her sleep; and through it all she constantly, continuously, voraciously gobbles down pills “like M & M’s” in a “pretty constant flow, a portable intravenous dripping into my arm.” She even acts as her own clepto-pharmacist, going through her acquaintances’ “medicine cabinets, stealing whatever Xanax or Ativan I could find, hoping to score the prescription narcotics like Percodan or codeine.” Moreover, each of her pills seems to cause diverse side effects: Mellaril makes her feel dull and affectless; lithium causes her hands to shake and puts her at risk for Grave’s disease, a hyperthyroid condition. Over all, her medications work sporadically, but never more than imperfectly, intermittently, and inconclusively. At one moment some combination of pills basically keeps her “functioning as a sane human being, at least most of the time;” at another moment there is “no pill, no potion, no serum, no shot, nothing under the whole big black sun” that provides 112

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relief. On the whole, however, she ultimately concludes that pills are largely just a quagmire: “Taking drugs breeds taking more drugs”; “I can’t believe anyone in his right mind would deny that these are just too damn many pills.” Here we go again: once more down the psychopharmacological rabbit hole. Neither psychotropic ascetic nor true believer, Wurtzel approaches pills agnostically, “Who’s to say that there’s too much Prozac? Maybe there isn’t enough”: Maybe we all just need “some kind of chemical buffer zone.” Even though Prozac is a “miracle that saved my life,” however, it never offers simple, definitive solutions, let alone a panacea. In the end, it “really isn’t that great”: “after six years on Prozac, I know that it is not the end but the beginning. Mental health is so much more complicated than any pill that any mortal could invent.” In this never-ending battle between mental illnesses and medicine cabinets, Wurtzel sides more with Tony than with Dr. Melfi, concluding pessimistically that “a strong, hardy, deep-seated depression will outsmart any chemical” and that “brain cells will always outsmart medical molecules.” Less with the shrink’s “no one needs suffer” braggadocio and more with the Don’s snarky “when’s it gonna end?” psychopharmacological nihilism, it is only with a certain weariness, if not outright budding cynicism, that Wurtzel repeats the mantra that “Prozac is the answer,” that “Prozac seems to be a panacea,” or that with Prozac “there is a sense that at long last there is a chemical antidote” for depression. Unlike Slater, this isn’t Wurtzel’s first ride at PROZAC (C17H18F3NO)

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the rodeo. Her faith in Prozac is more ironic than sincere. Despite its undeniable usefulness, at times, she sees Prozac as more hype than reality: at times even little more than a “national joke.” Ultimately, then, Wurtzel’s narrative is less about how Prozac cures depression—however imperfectly or unreliably—than it is a critical interrogation of whether there is “something wrong with a world where all these pills are circulating, floating around the atmosphere” and a critique of the “ease with which doctors now perform this bit of pharmacologic prestidigitation.” Turning Dr. Melfi’s optimism on its head, Wurtzel concludes that she “want[s] out of this life on drugs” because—after all of the lithium and Prozac and “all the drugs put together”—she is “start[ing] to think there really is no cure for depression.” After years of being treated with both psychotherapy and psychopharmacology, she is really no closer to anything as definitive as a cure. For every Slater who is saved by Prozac, however precariously, there is another Wurtzel who feels more damned by it: “Of course, it never happens. Years of therapy, and it never happens. Psychotropic drugs, and it never happens.” At best, Prozac—even when aided by therapy—seems to provide little more than a never-ending psychopharmacological purgatory: perhaps something better than hell, but just as far short of heaven, too.

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5 ADDERALL ((C9H13N)2• H2SO4 + (C9H13N)2• H2SO4 + (C9H13N)2• C6H10O8 + (C9H13N)• C4H7NO4• H2O): PSYCHOPHARMACOLOGY UNBOUND

Stephen Elliott’s observation that we are now “living in the most medicated era humanity has ever known” is, of course, a truism. In terms of sheer volume, not only our own generation but every generation has produced—and consumed—more pills than the one that preceded it, and for the most part we take this ever extending proliferation of pills in stride, nonchalantly. We see nothing particularly special—neither remarkable, nor nefarious—in the seemingly unending expansion of pills into modern life. But what if, instead, we

took Elliott’s observation as a philosophical provocation: What if we asked more deliberately what it means to live in this, the most medicated of all eras? Why do we consume so many pills, and how have they altered the course of our collective lives? Why do we keep consuming pills in everincreasing numbers, and what does this portend for our future? Is this endless expansion of psychopharmacology simply inevitable, an irreversible trend? If so, what does this say about us as human subjects or even as a human species? Does our ultimate telos, our evolutionary unraveling, simply lie in the plasticity of our neurochemistry and the increasingly brazen ways in which we are willing to experiment with it? Has anyone foretold our collective fate more presciently than Huxley, and which of his accounts is most prophetic: Brave New World, Island, or both? With each new generation we continue to extend the reach of psychopharmacology in new directions, and the recent influx of ADHD medications—principally Adderall (amphetamine and dextroamphetamine) and Ritalin (methylphenidate)—in particular, raises troubling ethical, even existential, questions in no small part because these pills are so easily prescribed to children, or even to toddlers. As Alan Schwarz explains in ADHD Nation: Fifteen percent of youngsters in the United States—three times the consensus estimate—are getting diagnosed with ADHD. That’s millions of kids being told they have something wrong with their brains, with most of them 116

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placed on serious medications. The rate among boys nationwide is a stunning 20 percent. In southern states, such as Mississippi, South Carolina, and Arkansas, it’s 30 percent of all boys, almost one in three. . . . Some Louisiana counties are approaching half—half—of boys in third through fifth grades taking ADHD medications. As at the band Green Day puts it in their song “The Jesus of Suburbia,” today’s youth now subsist “on a steady diet of soda pop and Ritalin.” Between physicians over-relying on simplistic diagnostic checklists, educators looking for a quick fix to students’ behavioral problems, students faking ADHD symptoms to gain easy access to performanceenhancing stimulants, teenagers selling their meds to peers after school, parents seeking an easy scapegoat for their children’s educational underperformance or poor behavior, and pharmaceutical companies aggressively marketing both the disease of ADHD itself and its treatment with psychostimulants, the “ADHD assembly line” and “Ritalin mills” have produced “outrageous rates” of ADHD diagnoses, resulting in a “national disaster of dangerous proportions” (Schwarz, Diller). And with bipolar disorder, anxiety, and depression diagnoses in children also on the rise, while “25 percent” of our nursing home residents are now taking antipsychotics alone, with “ten drugs or more . . . fast becoming the norm for the elderly,” are we not moving rapidly toward some kind of cradle-to-grave psychopharmacology (Frances)? Has Oedipus’s riddle of the PSYCHOPHARMACOLOGY UNBOUND

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sphinx—What goes on four feet in the morning, two feet at noon, and three feet in the evening?—been replaced by what takes Adderall in the morning, Prozac at noon, and Risperdal (and nine other drugs) in the evening? Isn’t our very definition of what it means to be human itself rapidly being redefined in neurochemical terms? If we simply follow Elizabeth Wurtzel’s life—and Prozac Nation already describes her taking Prozac, lithium, desipramine, Desyrel, Inderal, Halcion, Dalmane, Xanax, Valium, Thorazine, and Mellaril—should we be surprised that with the turn of the millennium she is now chronicling— in her follow-up memoir, More, Now, Again: A Memoir of Addiction (2002)—how she has begun taking, and even become addicted to, Ritalin? With each new generation it seems as if there emerges some new psychotropic wonder drug—in no small part because previous medications go off patent, sending pharmaceutical companies endlessly searching for new drugs to increase profit margins— and for the Millennial Generation these new drugs have increasingly become psychostimulants: first Ritalin, followed by Cylert (pemoline), followed by Adderall, followed by Concerta (methylphenidate), followed by Focalin (dexmethylphenidate) followed by Adderall XR, followed by Metadate (methylphenidate), followed by whatever Steve Bird describes as the next “cognitive enhancing” form of “brain Viagra” du jour: maybe Provigil (modafinil) or Vyvanse (lisdexamfetamine dimesylate).

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In the eleventh season of The Simpsons, an episode titled “Brother’s Little Helper” parodies the unstoppable train(wreck) that ADHD medications have become, now extending the Rolling Stones’ mother’s little helpers to her children. After displaying his typical unfocused and hyperactive behavior, Bart ups the ante by flooding the school gym with a fire hose, causing Marge and Homer to be summarily summoned to the principal’s office where principal Skinner coerces the Simpsons to force Bart to take Focusyn, a “radical, untested, potentially dangerous” new ADD medication. Marge is initially hesitant to give Bart the drugs, but when Focusyn labs shows her the medication’s effectiveness on lab rats she relents. After taking the drug himself, Bart suddenly becomes compliant and well behaved, focusing on his studies, reading books, and even helping tutor a classmate. Ultimately, however, the Focusyn produces side effects, causing Bart to commandeer a tank because he paranoidly fears that Major League Baseball is surveilling his mind. When Marge declares that she wants to stop Bart’s drug treatment, the Focusyn lab technicians reply that you “can’t just go off Focusyn”; they will have to switch Bart instead to one of Focusyn’s “sister drugs,” like chlorhexonal or phenylbutimaine. The episode’s punchline finally strikes its coup de grâ ce, however, when Marge declares that she is “not going to be giving [her] baby any more dangerous drugs” like Focusyn; from now on, Bart’s healthy new future will be filled with “nothing but fresh air, lots of hugs, and

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FIGURE 14  Marge gives Bart Ritalin. The Simpsons, Fox, season 11, episode 2, 1999.

good old-fashioned Ritalin.” As for Sartre, there seems to be no exit from this psychotropic merry-go-round. This trope repeats itself with a twist in the “Speed Trap” episode of Family Ties when Alex (Michael J. Fox) uncharacteristically gets his sister’s friend to supply him with Dexedrine to help him improve his studies. After finally confessing to his parents that he has learned his lesson not to take the drugs anymore, Alex protests, “You gotta admit it, dad, this stuff works.” To which his father replies, “I know it does. I took them myself when I was in school.” As these two episodes suggest, the question of whether or not to take pills is increasingly being replaced more simply by the question of which ones, as parents pass down their psychotropic pills 120

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to the next generation and the solution to one drug’s side effects is simply a quaint good old-fashioned home remedy like Ritalin. What separates Elliott’s and Wurtzel’s current mental health memoirs from previous ones, however, is not simply that they have turned to new medications, but rather the way in which they now depict their relationship to ADHD medications as an addiction. In their Prozac narratives, Wurtzel and Slater describe complex, even convoluted, relationships with their medications, but they never present these relationships as outright addiction. A clear line remains separating medical pharmaceuticals from street drugs, but in Elliott’s memoir and Wurtzel’s later memoir the distinction is far from clear, if not outright rejected altogether: “Pills are my everything,” Wurtzel admits; “I keep upping my dosage with diminishing effects,” muses Elliott. Crushing up her Ritalin pills into powder that she snorts through rolled dollar bills, Wurtzel provocatively reminds us that there is only a fine line separating Ritalin—or Adderall and other ADHD medications—from simple speed, making it an easily and often abused drug. As Elliott points out, Adderall is simply a compound of “four amphetamine salts,” each metabolizing at different rates, “so the amphetamine uptake is smoother and the come down lighter.” Consequently, Wurtzel and Elliott—both snorting their ADHD pills—are practically indistinguishable from Elliott’s description of William Burroughs and Joan Vollmer equally abusing prescription medicines and illicit street drugs, PSYCHOPHARMACOLOGY UNBOUND

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“cracking inhalers, soaking the amphetamine sheets in their coffee, or popping amphetamines and meta-amphetamine tablets, sometimes taking more than a hundred milligrams at a time.” They also share a common psychotropic legacy with Jack Kerouac who “cranked out one hundred twenty feet of single spaced, Benzedrine-induced prose.” After all, Elliott continues, Adderall is “really just speed, no different from the original amphetamine salts Gordon Alles injected in June 1929” and “almost identical to the Pervitin used by German paratroopers in World War II as they dropped behind enemy lines in a state the British newspapers described as ‘heavily drugged, fearless, and berserk.’” Like with the current opioid crisis, ADHD medications frequently blur the line between taking pills as prescribed by a physician and abusing them illicitly for some kind of recreational high or some competitive advantage at school or work. In this respect, however, Adderall and Ritalin are perhaps more representative than anomalous for psychotropic medications have a long history of being potentially addictive and at times abused. This fear of addiction has been raised before, most notably with the minor tranquilizers of the 1960s whose use eventually decreased after they were found to be addictive in the 1970s. With the widespread media coverage of prominent individuals who became addicted to prescription pills—perhaps most notably First Lady Betty Ford—and the release of memoir/film addiction exposé s such as Jacqueline Susann’s roman à  clef, Valley of the Dolls (1966, film 1967) and Barbara Gordon’s autobiographical 122

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I’m Dancing as Fast as I Can (1979, film 1982), a wide range of psychotropic medications became suspect, and their use—and abuse—gradually declined, at least briefly, though these pills have largely now been replaced by new classes of drugs, such as anti-depressants, ADHD medications, or new generation benzodiazepines purporting to be less addictive. This struggle to unleash the vast power of psychotropic pills while simultaneously limiting their negative side effects, especially addiction, has been a long-standing battle not on the periphery of, but at the very heart of, modern psychopharmacology, and the addictive properties of current ADHD medications have only further extended this ongoing war. It is Edward Spinola’s attempt to maximize his mental capacities with MDT-48, while limiting his exposure to addiction and other side effects, in Alan Glynn’s novel The Dark Fields, remade as the film Limitless—perhaps even more so than Elliott’s and Wurtzel’s memoirs—that provides us with the clearest insights into the dilemmas of Adderall and Ritalin, drugs which Lawrence Diller’s Running on Ritalin describes as providing a “proving ground for the premise of medicating to enhance performance.” Ever since Valium jumped the shark from pills used to treat psychoses in mental asylums to pills that assuage the psychopathologies of everyday life in common medicine cabinets, psychotropic pills have been used to enhance, augment, or otherwise attempt to optimize mental and emotional functioning— perhaps cosmetically or even recreationally—as much as PSYCHOPHARMACOLOGY UNBOUND

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they have been used to treat “true” mental illnesses per se. Consequently, contemporary neuroscientists like Nikolas Rose and Joelle M. Abi-Rached (2013) have begun to rethink “neurobiology not as destiny but opportunity” as pills increasingly enable us to attempt to redesign or re-engineer the human brain at will. As Glynn’s novel suggests, the question of whether or not to take Adderall, Ritalin, or any new cognitive enhancer du jour is not limited to children, or even adults, with ADHD. After all, ADHD drugs do increase—at least in the short term—the focus, attention, and general cognitive functioning of children, and adults, with ADHD, but they also equally increase, or at least seem to increase, the general cognitive functioning of all people—whether or not they have ADHD— just as Prozac can improve the mental outlook of people who do not have clinically diagnosable depression. Does that mean that we should all take Adderall or whatever may be the next generation of cognitive enhancers—something between Ritalin and Glynn’s fictional MDT-48? After all, why should we not all desire the “incredible energy and breadth of ambition that MDT so easily engendered?” Or why should everybody who wants to feel a little happier not take some Prozac just as a precaution? Is the only thing holding us back the threat of potential side effects, perhaps most notably addiction, or that we are still just tinkering with titrating a precise dose, or do we still desire inherent limitations to protect “normal” mental functioning from its constant psychopharmacological manipulation? Why or why not? 124

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The ever-increasing scope of psychotropic medications raises troubling questions about what it even means to be a “normal” or “authentic” human self, let alone to exercise free will and self-determination, in our dizzyingly pharmaceutical age as we must increasingly ask ourselves how willing we are to medically alter or augment our selves for reasons that extend far beyond the attempt to cure obvious psychological maladies such as psychoses and schizophrenia. With every new generation and its new arsenal of pills our ever-expanding psychopharmacology of everyday life becomes increasingly unbound, inching ever and ever closer to Huxley’s and Glynn’s, if not quite Lem’s, realms of science fiction. As Glynn puts it, we now constantly face the existential choice between “chemical determinism [and] moral agency”: between human behavior reduced to “synapses and serotonin” and some increasingly quaint notion of “free will” as we can no longer clearly distinguish between where “personal responsibility end[s] and brain chemistry begin[s].” And the controversies surrounding ADHD medications extend far beyond their addictive potential. Like most psychotropic drugs, the “science” behind their use is also suspect. As David Healy has argued persuasively, we rarely know the true impact of psychotropic medications because drug companies often refuse to make their so-called “scientific” data public, routinely withholding unpublished negative trial results, while exaggerating positive ones, sometimes inflating a handful of trials into hundreds of PSYCHOPHARMACOLOGY UNBOUND

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journal articles, often ghostwritten or heavily subsidized by pharmaceutical companies themselves with this “scientific” research systematically underreporting medications’ negative side effects and potentially addictive properties, the very properties that make ADHD medications so potentially harmful. Given that “access to the data of experiments is at the heart of what makes science,” Healy (2012) continues that pharmaceutical companies and their researchers mock science itself when they “refus[e] to make the raw data available,” “eliminat[e] . . . inconvenient data through coding bias,” or simply “spin” scientific facts into mere “marketing copy.” With pharmaceutical companies simultaneously “doctoring the evidence” of their research while wining and dining, in objectivity-compromising ways, the doctors and researchers who produce it, medical research is increasingly “designed to secure therapeutic niches rather than to advance medical knowledge,” producing a “crisis in the quality of our medical knowledge” and often making “‘scientific evidence’ . . . more like infomercials than disciplined science” (Healy 2012, Abramson). This lack of clear, accessible data is even more marked in the case of drugs, such as Adderall and Ritalin, that are marketed specifically to children in an effort to catch and treat illnesses, or at least capture niche markets, at an ever younger age. In fact, Healy notes that “studies of antidepressants in children offer the greatest known divide in medicine between what published reports in the scientific literature say on the one side and what the raw data in fact show.” 126

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Moreover, just as the “science” behind psychotropic medications is increasingly fuzzy, so is the line separating medical science from Big Pharma’s almost gluttonous profit-seeking as the effort to replace “boisterousness in children by ADHD” is “increasingly defined by the goals of marketers” whose “sleight-of-hand” methods frequently “involve a manipulation of the appearances of science” as “marketers cherry-pick from the language of the appropriate science to dress up their products”: for “science on its own, however artfully presented, would not have produced the comprehensive shift toward lifestyle drugs we have seen in the recent decades or permitted pharmaceutical companies to penetrate the inner sanctums of medicine and transform it from a profession deeply hostile to marketing into a marketer’s dream” (Healy 2012). As Loren Mosher warns, “psychiatry has been almost completely bought out by the drug companies,” creating what Nikolas Rose (2007) describes as an “unholy alliance between the pharmaceutical industry, university departments dependent on grants, and supposedly independent psychiatric researchers who actually had financial interests in the compounds they were evaluating.” With the recent advent of glossy direct-toconsumer advertising, Big Pharma’s phalanxes of drug reps, the proliferation of pharmaceutical ads in medical journals, profiteering off of prescription-only drug classifications, the constant tinkering with pills to create a highly lucrative “modest but patentable amount of novelty and therapeutic benefit,” the shiny allure of multi-million-dollar product PSYCHOPHARMACOLOGY UNBOUND

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branding, the incessant drive to “capture market niches” and “chase blockbuster profits,” the marketing of not only pills but also diseases themselves, and the ballooning of pharmaceutical companies’ marketing budgets, so that they are now “much greater” than their research and development budgets, “medicine seems to have become the home of the most sophisticated marketing on earth” (Healy 2012). One needs only glance cursorily at the ubiquitous print and television ads for new pharmaceuticals to realize immediately both that their so-called cures are often accompanied by equally significant negative side effects—sometimes as drastic as death and suicide—and that their allure is often as much the effect of glossy advertising copy as it is of hard-nosed science. Our medicine itself, or at least the way in which it is marketed, is becoming increasingly indistinguishable from niche markets for beer, cars, and athletic shoes. In the end, therefore, Healy asks us if we are taking these new drugs to save our own lives, or even to improve our own minds, or if we are taking these pills simply to “save the lives of companies who have a greater interest in the vitality of the diseases they market drugs for than in our well-being.” When we take psychotropic pills are we buying new, improved, almost bionic brains, or are our minds simply being sold to pharmaceutical hucksters dressed in pseudoscientific garb? As the “science” of psychopharmacology finds itself increasingly commodified, does that not make our brains themselves—the very locus of our identities—increasingly up for sale? Even the doomsday, sci-fi prophets of 128

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pharmageddon—Huxley, Glynn, and Lem—do not fully face the fact that modern psychopharmacology may not just be mad science; it may also be runaway capitalism careening off its rails: the molecular marketing of the human soul and the innocence of childhood. When Lem suggested that one day the priests would be replaced by pharmacists, he failed to consider that the pharmacists themselves might simply be pawns of neoliberal capitalism, bought by and sold to the highest bidder.

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CODA: WAITING FOR BRAD PITT

I have never waited for Godot, but I have waited for Brad Pitt. And like Vladimir and Estragon before me, I’m pretty sure that I just barely missed him. It was Spring 2013, and I had just finished presenting an academic paper—on Brad Pitt’s performance of madness in Fight Club no less—only by the time that I boarded my return flight I was already neck-deep in my own full-blown manic episode. Like the fictional madman, Tyler Durden, who I had just dissected on paper, I now stood, in reality, stark, raving mad before a deranged version of TSA protocol Wipeout. Frantically searching for documents to prove my identity, although I barely knew my own name, I haphazardly removed and replaced my shoes, emptying my pockets of a myriad of objects, most of which would never make it back in. Desperately, I struggled to decipher my boarding pass, scouring it for clues to guide me as I tacked precariously from security clearance to concourse to gate, erratically pilgrimaging my way through the stations of the TSA cross.

Already late, I furtively ducked into a bookstore to purchase a couple notebooks, absolutely needing somewhere to scribble my ideas for the three novels I had begun writing that weekend: Private Idaho: My Manic Mormon Childhood; Elder Lithium: Tales of a Manic Mormon Missionary; and Harry Potter Goes to B.Y.U. Luckily, my flight was delayed, or with all my psycho-stutter-stepping I would have missed it. It was only after reaching my gate, however, that my paranoid master plan fully took shape. Why was the plane held up? Obviously, it was for Him. Who else would they hold a plane for? It clearly wasn’t just for the weather as the intercom announced. I knew the secret truth: We were waiting for Brad Pitt. I literally thought that Brad Pitt would soon board my flight—together with the Los Angeles Alternative Latino hip hop group Ozomatli, of course, who I believed was coming to stage a benefit concert at the park next to my home. The proceeds, in turn, would raise money to send me, together with Brad Pitt himself, to launch a literacy campaign across North Africa. Dressed in flowing jellabiyas, Pitt and I would travel through the deserts of Morocco, Algeria, and Libya, handing out four-colored pens and shiny new notebooks to needy schoolchildren. I was literally waiting for Brad Pitt. He was my personal Godot and, like his predecessor, ultimately just a no-show. But this wasn’t the first time; all this had happened before. Once in my teens I wandered aimlessly through the desert outside Jerusalem waiting, again literally, for Christ— another no-show—to descend from the sky. That time I 132

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thought that I was Michael the Archangel, that I had slain the Serpent of Evil from the Garden of Eden, and that I personally had been chosen to usher in the end of the world. Two decades later I imagined a more creative doomsday scenario with the American playwright Tony Kushner descending—in Christ’s stead—to a psychiatric hospital in Billings, Montana, accompanied by a heavenly choir/small combo led posthumously by a resurrected Charles Mingus. Again, I literally believed that I had been called to DJ this far-fetched apocalypse. It is hard to explain, of course, what it is like to be bipolar, to have a manic episode, to go crazy, but I can offer a rough estimate by describing the hundred-some micro-texts that I produced during my single, two-hour flight home: a mad menagerie of frenzied crypto-documents hastily scribbled across every writing surface that I could find from the two green Moleskine notebooks that I purchased in the airport to an assortment of legal pads of varying sizes, dozens of index cards, a few loose sheets of office paper, and wads of crumpled stationary from my hotel. By the end of my flight I had burned through most of it, filling the pages with unending manic psycho-babble. What immediately stands out, however, even before the prolific, disjointed content, is the barely legible—in fact, often outright indecipherable— nature of the writing itself. Below is an example, reading, I believe, “Fucked up math,” followed by completely illegible nonsense, demonstrating how even my writing, like my mind, was fraying beyond recognition. Thinking faster than CODA

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FIGURE 15 Author’s handwritten note during a manic episode. April 21, 2013.

my hand could write, my frantic ideas literally raced out of control, my unsteady pen unable to keep their frenetic pace. And the rest of what can be deciphered is so chaotically organized and mercilessly revised, often in multiple colors of ink, that it generally amounts to little more than incoherent, topsy-turvy ideas colliding at random—a mental mid-flight plane wreck. The omnipresent numbered lists and bullet points, with their ancillary connecting lines and arrows, belie more than reveal any underlying sense of order. They 134

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are, from top to bottom, impassioned but overextended non sequiturs, straining to connect, on a single 5x8 page, haphazard references between topics such as philosophy, my college roommate, Zen and the Art of Motorcycle Maintenance, the Wind (with a capital W for some reason), mentoring students, Orpheus, Prospero’s broken staff, various

FIGURE 16  Author’s handwritten notes during a manic episode. April 21, 2013. CODA

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FIGURE 17  Author’s handwritten notes during a manic episode. April 21, 2013.

faculty senate debates, and some clandestine interconnection between myth, madness, and space/music. Often the writing is sideways or even upside down, constantly changing directions as it connects junkpiles of disjointed, terse, enigmatic crypto-phrases, excessively circled or starred for incessant emphasis: “Family first OK,” “explain in writing,” “write down experience first time,” “I’m 136

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safe,” “full prof,” “Austin Peay U,” “no more committees,” “party lose bags,” “make case,” “rise ranks,” “let him talk,” “argue for it or run with it,” and a few other indecipherable phrases, all interconnected by a series of a half dozen arrows. The first Moleskine notebook, alone, contains a surprising number of references to Celine Dion (I was going mad after all) together with a myriad of references to playing chess while listening to Bob Dylan, timelines of my childhood, Brad Pitt’s performance in Fight Club, Allen Ginsberg’s Howl, Napoleon Dynamite, Ludwig Wittgenstein and my father, Rem Koolhaas’s notion of junkspace, various new organizational models for postwestern studies, Wim Wenders’s Wings of Desire and Nick Hornby’s High Fidelity, innovative new data-driven performance funding models and a half dozen other faculty senate issues, my college comparative literature and philosophy professors, Antonio Gaudí , my family, Jorge Luis Borges, Wallace Stevens, plans for an academic conference (actually a series of them), my dissertation advisor, Thomas Pynchon, an elaborate colorcoded “pedagogically avant-garde” new curriculum for our English Department (based on the film Moneyball), Malvina Reynolds’s folk song “Little Boxes,” blank pages for Faith, Hope, and Charity, something called an “Eastward Rebound” project, multiple models for donating the proceeds of my unwritten novels to various charities (including the United Nations Palestinian Fund and the New York City subway system), a mini legal brief for a litigious tenure case at my university, the SLC ska band Stretch Armstrong, Christ’s CODA

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apostles, and, of course, numerous baroque schemata for connecting the music of the Ramones, The Clash, the B-52s, Madness, Led Zeppelin, U2, R.E.M., Nirvana, the Pixies, the Mormon hymn “Come, Come, Ye Saints,” and especially Ozomatli and Imagine Dragons, to the Islamic call to prayer. Just some scattered manic notes from a bipolar plane ride, but it all made sense at the time; it all fit together somehow inside the exploding supernova that used to be my mind. In fact, it’s not so much the range of references that is most disconcerting, but rather the profound, unwavering belief in the obvious interrelationships between them. And those were just the recuperable fragments from the first notebook;

FIGURE 18 Author’s handwritten notes, in Arabic, composed during a manic episode. April 21, 2013. 138

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then there was the second notebook, the legal pads, and the even more enigmatic scraps of paper, additional fragments of my imploding mind. As my chaotic thoughts raced toward their mad apex, or rather nadir, I even broke into Arabic, a language I had recently learned while on sabbatical in Morocco, declaring “Call me Ishmael. Call me Moroni [an angel in the Mormon faith]. It is the same because I am American, I am Muslim, and I am Mormon also.” Most curiously, the Arabic script is relatively clean and crisp: the eye of a psychic hurricane. I’m not making any of this up. This is exactly what it is like to be bipolar, to have a manic episode, to go crazy. And this was just the plane ride. When taken to its extreme, this kind of unmedicated manic thinking can lead to disaster, and few images capture the chaotic thought processes of mental illness as vividly as the frenzied, disorganized corkboard covered in paranoid scribblings, scattered newspaper clippings, and random connecting strings brilliantly depicted in Ron Howard’s A Beautiful Mind. This visual image of what psychiatrists refer to as divergent, or wildly scattered and even paranoid, thought processes can be seen on the office walls of the brilliant mathematician John Nash. With their chaotic and seemingly random (dis)arrangement of cryptically annotated newspaper clippings all interconnected by incoherent networks of disjointed strings, the corkboards on Nash’s office walls vividly depict a mind straining to find an alternative, but fundamentally irrational, esoteric knowledge CODA

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FIGURE 19 John Nash’s manic office corkboard. A Beautiful Mind, dir. Ron Howard, 2001.

hidden beneath, behind, or beyond the rational mind. When Nash’s wife sees his madness arrayed in all its splendor on his office walls, she remarks, “So is this all that he’s been doing every day? Cutting up magazines.” Well that, I guess, and arranging them in increasingly bizarre patterns, a practice which Nash himself describes as “isolat[ing] pattern reoccurrences within periodicals over time” in order to help crack imaginary ultrasecret military codes. Over time Nash’s schizophrenic corkboard grows ever more complex, spilling out of his office to take over an entire shed—the vestigial traces of a brilliant mind gone completely mad. But Pill isn’t a book about mental illness, at least not directly; rather, it is a philosophical exploration of how psychotropic medications, such as lithium, are used to treat mental illnesses and the larger philosophical implications of 140

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FIGURE 20  John Nash’s more manic shed. A Beautiful Mind, dir. Ron Howard, 2001.

these medications’ abilities (and inabilities) to reconstruct the neuro-circuitry of the human brain. Turning the issue of mental illness upside down, then, its real concern lies less with the fragmenting bipolar mind per se than with the diverse ways in which pills are—and aren’t—able to treat, tame, manage, stabilize, and even cure serious mental disorders. It is, therefore, a critical investigation of how pills’ abilities to shape human thought reveal a new sense of the human brain—and hence of human identity itself—as more plastic, elastic, and malleable: something that can be biochemically manipulated practically to the point of being pharmacologically fabricated out of whole cloth, all but created ex nihilo. But what exactly do psychiatric pills do? Once again the simplest way that I can demonstrate lithium’s powerful, restraining effect on the human mind is to return to my own writing, which clearly illustrates—again at the level CODA

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FIGURE 21 Author’s journal entry written while medicated on lithium. January 6, 1989.

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of writing itself—how lithium molds and confines erratic thoughts. Taken from a journal written a year after I began taking lithium, this passage reveals an entirely different thought process. I still had expansive thoughts, but as lithium reconfigured the neuro-circuitry of my brain, my thoughts were caged into neat, orderly, linear sets all bottled up in a fastidious, miniscule script almost as illegible as my manic rantings—only for the opposite reasons. The lithium worked like a funnel, or even like reinforced concrete, molding my thoughts into a solid form, keeping my ideas on the page, and organizing the chaos inside my mind. Here the numbered lists may be just as excessive, but now they are kept single file, numbered linearly, and stacked neatly in piles. And this tidy, disciplined script is mirrored in my clear, concise, hierarchically organized charts and diagrams. Gone are the random arrows, the emphatic diacritics, the ever-changing page directions, and the flights into foreign languages, replaced now by structural patterns, clean narrow boxes, and general overall coherence. In short, it is easy to see how lithium entirely restructured my mind: ordering its chaos, controlling its wild energy, and pruning its numerous stray tangents. In so doing, lithium literally remade my entire self, from my thoughts and emotions to my personality and moods, raising complex philosophical questions in the process. So what’s the problem here? How is this not a simple case of being cured by lithium, saved by a pill? To begin with, there is simply the ever present psychopharmacological CODA

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FIGURE 22 Author’s journal entry written while medicated on lithium. January 23, 1989.

paradox: It isn’t even entirely clear which is worse, the illness or the cure, the bipolar or the lithium. Without question lithium helped cure me of debilitating psychoses, reining in my runaway mind, but this came at a staggering price. Like Carrie Mathison in Adam Kaplan’s novelization of 144

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Homeland, I have also found lithium’s side effects confining: “It makes me stupid, logy,” erecting a “thick window” not just between me and the world but even between me and myself. It was, of course, nice to be sane, but the lithium often left me feeling like an emotional and intellectual robot, or even a caged neuro lab rat. It wasn’t easy to have my mind so neatly pressed and starched, so straightened out and chemically constrained. Perhaps not surprisingly, it would only be a few short years before I, like many others on lithium, would unprescribe myself from my own medication at the first real opportunity, unable to bear lithium’s heavy cross, unwilling to accept its restraining side effects. Ultimately, modern psychopharmacology offers many powerful new elixirs, but few panaceas. The process of prescribing and adhering to diverse psychotropic drug regimens offers exciting new possibilities, but psychopharmacological solutions are far from simple or straightforward. Often, nonadherent individuals, such as myself, ultimately choose the illness itself over the cure, only for the illness to eventually return and the cycle to begin all over again. Moreover, lithium’s powerfully constraining influence also poses troubling existential questions about the nature of identity. After all, who was really writing this? Was it me, myself, or just the lithium writing down these thoughts? And perhaps even more problematically, hadn’t the very line between the two—between myself and my medication, between my mind and the neurochemistry of my brain— been curiously blurred, if not erased altogether? In the most CODA

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literal sense, I was no longer certain who I was, where the boundaries of my true self ended and its biochemical avatar took over. Lithium had me trying to figure out who was the real me, just how malleable my self had become, and even what role lithium now played in the formation of my identity itself. Psychotropic pills, therefore, open up a Pandora’s box of existential questions about the nature, pliability, plasticity, and biochemical manipulation of human identity. In so doing, they force a deeper confrontation with life at the level of its most basic molecular neurochemistry: In the end, are we anything more than mere—and alterable—flows of chemicals along pathways of neurons, dendrons, axons, and synapses? Are we not simply the sum total of the various chemicals we choose to take—or not? And even if I choose not to alter my identity with pills, isn’t my identity itself already nothing more than my own natural biochemistry? Is there any “real” me outside of this biochemistry—whether pharmacologically altered or not? As I have argued before, what is at stake with the simple act of taking a psychotropic pill is nothing less than the very existential definition of what it means to have an identity, to be a human self, in our brave, new psychopharmacological age. To take or not to take our pills has become our generation’s brave, new question. Morpheus is our new Hamlet.

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ACKNOWLEDGMENTS

M

ost importantly, I want to thank Christopher Schaberg, whose insightful and spot-on editorial suggestions have guided and significantly improved this book throughout its various iterations. He has made writing this book an intellectually engaging and rewarding process, and it has truly been a pleasure to work with him. This book would have never become a reality without both his assistance and the freedom he afforded me to truly make this book the best version of the book I wanted it to be. No higher praise can be given to an editor. I also want to thank his editorial assistant, Augusta Elebash, who provided a thoughtful and thorough reading of the entire manuscript in its final stages. Her comments helped me to both strengthen and rethink several of my arguments and examples. Many thanks also to Ian Bogost and the crew at Bloomsbury, especially Haaris Naqvi and Amy Martin. They have helped shepherd this book through the complex details of publication. Anyone can write a book, but it takes a village to actually get it published.

I also want to thank Johns Hopkins University Press for kindly granting permission to reprint material published in their journal Literature and Medicine. Most of chapter three comes from my article “The Psychopharmacological Thriller: Representations of Psychotropic Pills in American Popular Culture.” Thanks is also due to my brilliant colleagues—Rob Wallace, Susan Kollin, Gretchen Minton, Rob Petrone, and Joseph Shelton—who graciously read various drafts of my manuscript, offering both encouragement and insightful suggestions. Lastly, as always, I want to thank my family: my wife, Chris; my children, Theo, Sage, and Nina; my daughterin-law, Mallory; and my parents, Guy and Linda. They have lived through my experiences with mental illness and the complex process of trying to treat it with psychotropic pills. They have given me the courage to speak more openly about my experiences, and they have provided me with the stability and support that I have needed to make it through what has at times been a rocky ride. They have helped me in innumerable ways to write my story both on and off the page.

148

ACKNOWLEDGMENTS

LIST OF ILLUSTRATIONS

Figure 1 Morpheus offers Neo a choice between a red pill and a blue pill. The Matrix, dir. The Wachowskis, 1999  12 Figure 2 Andrew Largeman’s oversized medicine cabinet. Garden State, dir. Zach Braff, 2004  17 Figure 3 Cam Stuart’s daily existential confrontation with his medicine cabinet. Infinitely Polar Bear, dir. Maya Forbes, 2014  21 Figure 4 A crowd volunteers their Valium bottles. Starting Over, dir. Alan J. Pakula, 1979  48 Figure 5 John Cooper (Tim Guinee) liberates bottles of soma. Brave New World, dirs. Leslie Libman and Larry Williams, 1998  60 Figure 6  Carrie Mathison’s clozapine hidden in a nondescript aspirin bottle. Homeland, Showtime, season 1, episode 1, 2011  76

Figure 7  Carrie Mathison’s pre-manic corkboard. Homeland, Showtime, season 1, episode 1, 2011  82 Figure 8 Carrie Mathison unsuccessfully fights to defend her reconstructed manic corkboard. Homeland, Showtime, season 1, episode 11, 2011  84 Figure 9 Psychopharmacological espionage. Homeland, Showtime, season 4, episode 5, 2011  88 Figure 10 Linda Hanson (Sandra Bullock) finds lithium in her sink. Premonition, dir. Mennan Yapo, 2007  91 Figure 11 Linda Hanson (Sandra Bullock) tosses her lithium down the sink. Premonition, dir. Mennan Yapo, 2007  95 Figure 12 Opening scene of The Sopranos. Tony Soprano visiting his psychiatrist, Dr. Jennifer Melfi. The Sopranos, HBO, season 1, episode 1, 1999  102 Figure 13 Tony Soprano pulls out his prescription of Prozac. The Sopranos, HBO, season 1, episode 1, 1999  103 Figure 14 Marge gives Bart Ritalin. The Simpsons, Fox, season 11, episode 2, 1999  120 Figure 15 Author’s handwritten note during a manic episode. April 21, 2013  134 Figure 16 Author’s handwritten notes during a manic episode. April 21, 2013  135 Figure 17 Author’s handwritten notes during a manic episode. April 21, 2013  136 150

LIST OF ILLUSTRATIONS

Figure 18 Author’s handwritten notes, in Arabic, composed during a manic episode. April 21, 2013  138 Figure 19 John Nash’s manic office corkboard. A Beautiful Mind, dir. Ron Howard, 2001  140 Figure 20 John Nash’s more manic shed. A Beautiful Mind, dir. Ron Howard, 2001  141 Figure 21 Author’s journal entry written while medicated on lithium. January 6, 1989  142 Figure 22 Author’s journal entry written while medicated on lithium. January 23, 1989  144

LIST OF ILLUSTRATIONS

151

SELECTED SOURCES

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“Brother’s Little Helper,” The Simpsons, season 11, episode 2, Twentieth Century Fox Television, 1999. Campbell, Bebe Moore, 72 Hour Hold (Anchor Books, 2005). Cheney, Terri, Manic: A Memoir (HarperCollins, 2009). Cvetkovich, Ann, Depression: A Public Feeling (Duke University Press, 2012). Diller, Lawrence H., Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill (Bantam Books, 1998). Donnie Darko, dir. Richard Kelly, Newmarket Films, 2001. Elliott, Stephen, The Adderall Diaries: A Memoir (Graywolf Press, 2009). Frances, Allen, Saving Normal: An Insider's Revolt against Outof-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (HarperCollins, 2013). Frankie & Alice, dir. Geoffrey Sax, Lions Gate Entertainment, 2010. Garden State, dir. Zach Braff, Miramax Films, 2004. Girl, Interrupted, dir. James Mangold, Columbia Pictures, 1998. Glynn, Alan, The Dark Fields (Time Warner Paperbacks, 2004). Gordon, Barbara, I’m Dancing as Fast as I Can (Beaufort Books, 1979). Gothika, dir. Mathieu Kassovitz, Warner Bros., 2003. The Graduate, dir. Mike Nichols, Embassy Pictures, 1967. Green Day, “The Jesus of Suburbia,” American Idiot, Reprise, 2004. Grohol, John M., “Top 25 Psychiatric Medication Prescriptions in 2013,” online. Healy, David, The Creation of Psychopharmacology (Harvard University Press, 2002). Healy, David, Let them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression (New York University Press, 2004). Healy, David, Pharmageddon (University of California Press, 2012). SELECTED SOURCES

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Hersh, Kristin, Rat Girl (Penguin, 2010). Homeland, developed by Howard Gordon and Alex Gansa, Showtime, 2011–present. Hornbacher, Marya, Madness: A Bipolar Life (Mariner Books, 2008). Hughes, Richard, The Tranquilizing of America: Pill Popping and the American Way of Life (Harcourt, 1979). Huxley, Aldous, Brave New World (HarpersCollins, 1932). Huxley, Aldous, Brave New World Revisited (Harper & Row, 1958). Huxley, Aldous, The Doors of Perception (Harper & Row, 1954). Huxley, Aldous, “The History of Tension,” Annals of the New York Academy of Sciences, Volume 67, Issue 10 (1957). Huxley, Aldous, Island (HarperCollins, 1962). I’m Dancing as Fast as I Can, dir. Jack Hofsiss, Paramount Pictures, 1982. Infinitely Polar Bear, dir. Maya Forbes, Sony Pictures Classics, 2014. Jefferson Airplane, “White Rabbit,” RCA Victor, 1967. Kalanithi, Paul, When Breath Becomes Air (Random House, 2016). Kaplan, Andrew, Homeland: Carrie’s Run: A Homeland Novel (William Morrow, 2013). Karp, David A., Is it Me or My Meds?: Living with Antidepressants (Harvard University Press, 2006). Kaysen, Susanna, Girl, Interrupted (Turtle Bay Books, 1993). Kesey, Ken, One Flew Over the Cuckoo’s Nest (Penguin, 2003). Kramer, Peter D., Listening to Prozac (Penguin, 1993). Lem, Stanislaw, The Futurological Congress (Continuum, 1974). Lethem, Jonathan, Gun, with Occasional Music (Harcourt, 1994). Limitless, dir. Neil Burger, Virgin, 2011. Lyons, Richard D., “How Release of Mental Patients Began,” New York Times online, October 30, 1984. Martin, Emily, Bipolar Expeditions: Mania and Depression in American Culture (Princeton University Press, 2007). 154

SELECTED SOURCES

The Matrix, dir. The Wachowskis, Warner Bros., 1999. Miller, Lisa, “Listening to Xanax: How America Learned to Stop Worrying about Worrying and Pop its Pills Instead,” New York Magazine online, March 18, 2012. Miller, Richard J., Drugged: The Science and Culture Behind Psychotropic Drugs (Oxford University Press, 2015). Mr. Jones, dir. Mike Figgis, TriStar Pictures, 1993. Nasar, Sylvia, A Beautiful Mind (Simon & Schuster, 1998). Nazareth, Monique, “From One Extreme to Another: Homeland’s Portrayal of Bipolar Disorder,” online, December 14, 2012. Nirvana, “Lithium,” Nevermind, DGC, 1991. Nussbaum, Emily, “The Long Con,” New York Magazine online, June 14, 2007. Palahniuk, Chuck, Fight Club (W. W. Norton, 1996). Pi, dir. Darren Aronofsky, Artisan Entertainment, 1998. Premonition, dir. Mennan Yapo, Tristar/Metro-Goldwyn-Mayer, 2007. Prozac Nation, dir. Erik Skjoldbjaerg, Miramax Films, 2001. Quick, Matthew, The Silver Linings Playbook (Farrar, Straus and Giroux, 2008). Rebel Without a Cause, dir. Nicholas Ray, Warner Bros., 1955. Reyers, Courtney, “Homeland: An Upfront Look at Bipolar Disorder,” online, September 27, 2012. The Rolling Stones, “Mother’s Little Helper,” London Records, 1966. Rose, Hilary and Steven Rose, Can Neuroscience Change Our Minds? (Polity Press, 2016). Rose, Nikolas and Joelle M. Abi-Rached, Neuro: The New Brain Sciences and the Management of the Mind (Princeton University Press, 2013). Rose, Nikolas, “Neurochemical Selves,” Society, November/ December 2003.

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Rose, Nikolas, The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century (Princeton University Press, 2007). Schlesinger, Arthur M. Jr., The Vital Center: The Politics of Freedom (Da Capo Press, 1988). Schwarz, Alan, ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic (Scribner, 2016). Self, Will, Umbrella (Grove Press, 2012). Shorter, Edward, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (John Wiley & Sons, Inc., 1997). Side Effects, dir. Steven Soderbergh, Open Road Films, 2013. Silver Linings Playbook, dir. David O. Russell, The Weinstein Company, 2012. Slater, Lauren, Prozac Diary (Penguin Books, 1998). The Snake Pit, dir. Anatole Litvak, Twentieth Century Fox, 1948. The Sopranos, created by David Chase, HBO, 1999–2007. “Speed Trap,” Family Ties, season 2, episode 6, NBC, 1983. Starting Over, dir. Alan J. Pakula, Paramount Pictures, 1979. Stir of Echoes, dir. David Koepp, Artisan Entertainment, 1999. Stossel, Scott, My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind (Vintage, 2013). Susann, Jacqueline, Valley of the Dolls (Bernard Geiss Associates, 1966). Thill, Brian, Waste (Bloomsbury, 2015). Tone, Andrea, The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers (Basic Books, 2009). Valenstein, Elliot S., Blaming the Brain: The Truth About Drugs and Mental Health (The Free Press, 2002). Valley of the Dolls, dir. Mark Robson, 20th Century Fox, 1967. Vidal, Fernando, “Brainhood: Anthropological Figure of Modernity,” History of the Human Sciences, Volume 22, Issue 1 (2009).

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Walker, Brett L., A Family History of Illness: Memory as Medicine (University of Washington Press, 2018). Ward, Mary Jane, The Snake Pit (H. Wolff, 1946). West, Kanye, “Yikes,” ye, Def Jam, 2018. Whitaker, Robert, Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Medically Ill (Perseus, 2002). Williams, William Carlos, “The Red Wheelbarrow,” online. “Wonder Drug of 1954?,” Time online, June 14, 1945. “Wonder Drugs: New Cures for Mental Illness,” U.S. News and World Report, June 17, 1955. Wonderland, dir. Peter Berg, ABC, 2000. Wurtzel, Elizabeth, Prozac Nation (Riverhead Books, 1994). Wurtzel, Elizabeth, More, Now, Again: A Memoir of Addiction (Simon & Schuster, 2002).

SELECTED SOURCES

157

INDEX

Page references for illustrations appear in italics 72 Hour Hold (Campbell)  4 Abilify  9, 65, 71 Abi-Rached, Joelle M.  124 Ablixa  71 ADD see attention deficit disorder (ADD) Adderall  30, 65, 85, 115–29 ADHD see Attention Deficit Hyperactivity Disorder (ADHD) ADHD Nation (Schwarz)  116–17 affect theory  29 Age of Anxiety, The (Auden)  51 AIDS  4 alcohol  5 Allen, Woody  102 American Eugenics Society  33 animal studies  29

Annals of the New York Academy of Sciences  62–3 Annie Hall (Allen)  102 antidepressants  5, 6, 25, 106, 123, 126 see also individual branded medications anti-psychiatry movement  41 antipsychotics  5, 6, 34, 42, 49, 106, 117 see also individual branded medications anxiety  47–50, 51–2, 112, 117 Artane  24 artificial intelligence  29 Atarax  111 Ativan  9, 24, 48, 65, 82, 87 attention deficit disorder (ADD)  106, 116–17, 119–27, 120

Attention Deficit Hyperactivity Disorder (ADHD)  5 Auden, W. H.  51 August: Osage County (Wells)  10–11 August: Osage County [play] (Letts)  10 Baldessarini, Ross  39 barbiturates  35 Beautiful Mind, A [book] (Nasar)  70, 82 Beautiful Mind, A [film] (Howard)  139–40, 140, 141 Behrman, Andy  24 benzodiazepine  123 bio-technologies  29 bipolar disorder  4, 23, 24–5, 70, 72, 74–90, 117, 131–46, 134, 135, 136, 138, 142, 144 Bird, Steve  188 Brady Bunch, The (TV show)  47, 57 Braidotti, Rosi  28 Brave New World (Huxley)  8, 52, 53–62, 60, 64, 116 Brave New World [film] (Libman, Williams)  60 Brave New World Revisited (Huxley)  58–9, 62

Breggin, Peter R.  41, 43 Burroughs, William  121–2 BuSpar  24 Campbell, Bebe Moore  4 cancer  4, 6, 10 Celexa  9, 18, 65 Changeaux, Jean-Pierre  28 Cheney, Terri  25 chlorpromazine see Thorazine clonazepam  9, 82, 87, 89 clozapine  9, 76, 77, 78, 79, 82, 84, 87, 89 Concerta  118 Crow, T. J.  39 Cvetkovish, Ann  28 cybernetics  29 Cylert 188 Dalmane  111, 112, 118 Dark Fields, The (Glynn)  13, 123, 124 Darvocet  11 Darvon  11 Dean, James  51 deep history  29 Depakote  9, 18, 24, 65 depression  28, 52, 73, 105, 109, 110, 112, 114, 117, 124 desipramine  111, 118 Desyrel  111, 112, 118 diazepam see Valium Index

159

Dilaudid  11 Diller, Lawrence  123 Donnie Darko (Kelly)  70, 91 Doors of Perception, The (Huxley)  7, 62 Duke, Patty  51 ecology  29 ECT see electroconvulsive shock therapy (ECT) Effexor  9, 24, 65, 71 Elavil  71 Electro Boy: A Memoir of Mania (Berhman)  24 electroconvulsive shock therapy (ECT)  31, 33, 34, 40, 45, 74, 87 Eliot, T. S.  3 Elliott, Stephen  115–16, 121–2, 123 environmental theory  29 ER (TV show)  9 eugenics  33 evolutionary psychology  28 Family Ties (TV show)  120–1 feminism and queer studies  29 Fight Club [book] (Palahniuk)  29 Fight Club [film] (Fincher)  131, 137 160

Index

fluoxetine see Prozac Focalin  118 Ford, Betty  122 Frances, Allen  5, 18, 23, 25–6, 27, 35, 42 Frankie and Alice (Sax)  70 Futurological Congress, The (Lem)  14–16 Garden State (Braff)  9, 16–17, 17, 72 genetics  29 Girl, Interrupted (Kaysen)  70 Glynn, Alan  13, 123, 124, 125, 129 Gordon, Barbara  122–3 Gothika (Kassovitz)  71 Graduate, The (Nichols)  51 Grave’s disease  112 Green Day  117 Grey’s Anatomy (TV show)  98 Gun, with Occasional Music (Lethem)  12–13 Halcion  111, 118 Haldol  71 Healy, David  27, 35, 125–6, 128 Hersh, Kristin  25 Hoffman, Dustin  51 Hoffman-La Roche  49, 52 Holocaust  33–4

Homeland (TV show)  9, 72, 73, 74–90, 76, 82, 84, 88 Homeland [book] (Kaplan)  145 Hornbacher, Marya  25 Howard, Ron  139 Huff (TV show)  9 Hughes, Richard  52 Huxley, Aldous  7, 8, 52, 53–65, 67, 116, 125, 129 I’m Dancing as Fast as I Can [book] (Gordon)  122–3 I’m Dancing as Fast as I Can [film] (Hofsiss)  123 Inderal  111, 118 industrial dyes  34 Infinitely Polar Bear (Forbes)  18–23, 21, 72 informatics  29 insulin coma therapy  33, 70 Island (Huxley)  63–4, 116 Jefferson Airplane  16 “Jesus of Suburbia, The” (Green Day)  117 Kalanithi, Paul  2 Kallmann, Franz  33 Kaplan, Adam  144 Karp, David A.  23, 29 Keck, Paul  39

Kerouac, Jack  122 Kesey, Ken  64 Klonopin  9, 24, 48, 65, 71 Knott, David  52–3 Kramer, Peter D.  26 Labroit, Henri-Marie  34 Lamictal  24 Law & Order: Special Victims Unit (TV show)  9 L-Dopa  45 Leary, Timothy  64 LeDoux, Joseph  28 Lehman, Heinz  38 Leibenluft, Ellen  75–6 Lem, Stanislaw  14, 125, 129 Lethem, Jonathan  12–13 Letts, Tracy  10 Lexapro  65, 106 Librium  48, 111 Limitless (Burger)  13–14, 16, 123 Lipitor  4 Listening to Prozac (Kramer)  26 “Listening to Xanax” (Miller)  26–7 lithium  9, 18–22, 24, 30, 65, 69–99, 105, 111, 112, 118, 134, 135, 136, 138, 141, 142, 143–6, 144 Litvak, Anatole  31 lobotomies  33, 34, 40, 41, 45 Index

161

Luvox  24 Lyons, Richard D.  44 Madness: A Bipolar Life (Hornbacher)  25 Mallorol  71 Manic: A Memoir (Cheney)  25 manic depression see bipolar disorder Martin, Emily  73 M.A.S.H. (TV show)  98 Matrix, The (Wachowski sisters)  11–12, 12 May, Philip  38 medical-industrial complex  25–6 medical sterilization  33 Mellaril  111, 112, 118 mental illness asylums/psychiatric hospitals  31–3, 37, 45–6, 49, 50, 87, 112, 123 cultural narratives  8–9, 69–99 cures  66, 72–3, 82, 96, 99, 104, 105, 108, 109, 110, 114 early treatment  31–9, 43, 44 misdiagnoses  24–5 see also psychopharmacology 162

Index

Metadate  118 metrazol  33 Miller, Lisa  26–7 Miller, Richard J.  34 Miltown  62, 111 Moniz, Egas  33 Monk (TV show)  9 More, Now, Again: A Memoir of Addiction (Wurtzel)  118 Mosher, Lauren  127 “Mother’s Little Helper” (Rolling Stones)  50–1 Mr. Jones (Mueller)  72 My Age of Anxiety (Stossel)  43 NAMI see National Alliance on Mental Illness (NAMI) Nash, John  82, 139–40, 140, 141 National Alliance on Mental Illness (NAMI)  75 National Institute for Mental Health (NIMH)  38–9, 75 Nazi Germany  33 Netflix  33 neurobiology  124 Neuronal Man (Changeaux)  28 Neurontin  24

neurosciences  28, 36 New York Times  35 Nietzsche, Friedrich  11 NIMH see National Institute for Mental Health (NIMH) Nobel Prize  33 nortriptyline  9, 89 Nussbaum, Emily  101 object-oriented ontology  29 obsessive-compulsive disorder (OCD)  109 Oedipus  117–18 One Flew Over the Cuckoo’s Nest (Kesey)  26, 33, 70 opiates  35 see also individual branded medications Oxycontin  11 Palahniuk, Chuck  29 Parkins, Barbara  51 Parkinson’s disease  40–1 Paul, Gordon  39 Paxil  9, 18, 24, 65 Percodan  11 pharmaceuticals addiction/dependence  2, 10, 23, 27–8, 50–1 global market  6, 25–6, 49, 50

interventions  2–3 nonadherence  22–3 US economy  6, 49, 50 pharmacology  4, 17, 84 see also psychopharmacology pharmacotherapy  33–8 phenethylamine  89 Pitt, Brad  131–3, 137 postcolonialism  29 Posthuman, The (Braidotti)  28 Praulent  4 Premonition (Yapo)  72, 90–7, 91, 95 Provigil  118 Prozac  9, 26, 30, 65, 70, 71, 101–14, 118, 121, 124 Prozac Diary (Slater)  107–11 Prozac Nation: Young and Depressed in America (Wurtzel)  70, 107, 111–14, 118 psychoanalysis  5, 37, 101 psychology  7, 27, 28, 103 psychopharmacology addiction/dependence  25–7, 50–1, 56–8, 118, 121–6 advertising and profits  127–9 in arts and popular culture  9–30, 12, 17, 21, 31–3, 44–8, 48, 50, Index

163

51–64, 60, 69–99, 76, 82, 84, 88, 91, 95, 102, 103, 118, 119–24, 120, 139–40, 140, 141, 145 biochemistry  4–5 children and teens  116–17, 119–21, 120, 124, 126, 127 clinical trials and data  125–7, 128 Cold War  51, 52 cosmetic  26–7 drug cocktails  7, 24–5, 43, 44, 71–2, 76, 85–6, 105–7, 111–12, 117 elderly  117 environmental impact  66 ethics  38, 116–18 experimentation and innovation  39, 45–6, 65–6 gender  50, 117 global market  6, 49, 118, 127, 129 human identity  3, 4–5, 7–30, 65–6, 69–99, 101–11, 116, 118, 124, 125, 128–9, 131–46, 134, 135, 136, 138, 142, 144 modern life  3, 5–7, 8–11, 44–6, 47–67, 69, 74–90, 101–14, 115–29 164

Index

overdoses  34, 94, 111–12 posthumanism  29–30 proliferation  2, 3, 17, 17, 44, 50, 65–6, 106, 115 side effects  66–7, 106, 107, 109, 112, 124, 145 toxicity  41 psychosurgery see lobotomies psychotherapy  26, 105, 112, 114 Quick, Matthew  16 Rappaport, Maurice  39 Ratched  33 Rat Girl (Hersh)  25 Rebel Without a Cause (Ray)  51 recreational drugs  5, 122, 123 religion  5, 63–4 Risperdal  24, 118 Ritalin  65, 86, 116, 117, 118, 120, 121, 122, 123, 124, 126 robotics  29 Rolling Stones  50–1, 119 Rose, Hilary and Steven  27–8 Rose, Nikolas  3, 4, 5, 7–8, 124, 127 Running on Ritalin (Diller)  123 Ryers, Courtney  75

Sartre, Jean-Paul  120 Saturday Night Live  84 schizophrenia  34, 38, 41–2, 49, 79, 112, 125, 139–40, 140, 141 Schlesinger, Arthur M. Jr.  51 Schwarz, Alan  116–17 Scrubs (TV show)  9, 98 Self, Will  45–6 Seroquel  9, 65, 71, 74, 85 Serzone  24 Shakespeare, William  67 Shorter, Edward  105 Side Effects (Soderbergh)  71 Silver Linings Playbook, The [book] (Quick)  70, 72 Silver Linings Playbook [film] (Russell)  9, 16, 71, 72 Simpsons, The (TV show)  119–20, 120 Slater, Lauren  107–11, 113, 121 Snake Pit, The [film] (Litvak)  31 Snake Pit, The [novel] (Ward)  31–2 Sopranos, The (TV show)  9, 101–7, 102, 103 Starting Over (Pakula)  48, 48 Sterling, Peter  40 Sternbach, Leo  52 stimulants  6, 56, 86, 117, 118 see also individual branded medications

Stossel, Scott  36, 43, 52 Strattera  86 Susann, Jacqueline  122 Synaptic Self (LeDoux)  28 Tate, Sharon  51 Tegretol  24 Thill, Brian  66 Thorazine  30, 31–46, 49, 62, 65, 70, 74, 111, 112, 118 effectiveness  38–41, 44–5 side effects  40–2, 45 and tardive diskenesia  41, 45 Time  35 Tone, Andrea  49, 52 Topamax  24 Tranquilizing of America, The (Hughes)  52–3 Trazodone  9, 24, 65, 71 Umbrella (Self)  45–6 U.S. News and World Report  35 Valium  11, 30, 47–67, 70, 74, 111, 112, 118, 123 Valley of the Dolls [book] (Susann)  122 Valley of the Dolls [film] (Robson)  51 Vicodin  11 Vidal, Fernando  28 Index

165

Vital Center, The (Schlesinger)  51 Vollmer, Joan  121–2 Vyvanse  118

Wonderland  9 Wurtzel, Elizabeth  107, 111–14, 118, 121–2, 123

Walker, Brett L.  28 Wallace, David Foster  25 Ward, Mary Jane  31–2 Waste (Thill)  66 Wellbutrin  24, 71 West, Kanye  22–3, 86 Whitaker, Robert  33, 35, 41 “White Rabbit” (Jefferson Airplane)  16 Williams, William Carlos  1

Xanax  9, 11, 48, 65, 71, 105, 111, 112, 118 Xarelto  4

166

Index

Yapo, Mennan  90 ye (West)  22–3, 86 “Yikes” (West)  86 Zoloft  9, 18, 24, 65, 106 Zyprexa  24, 65