Listening to Prozac by Peter D. Kramer New York:  Viking, 1993,  xix + 409 pp., $23.00

Psychiatrist Peter D. Kramer, whose 1989 book Moments of Engagement illustrated his commitment to psychodynamic thinking, tells us in his introduction how listening to Prozac—that is, observing the powerful effect of medication on such psychosocial phenomena as interpersonal sensitivity, the capacity for enjoyment, and self-esteem—has changed many of his assumptions about human nature, human motivation, and, inevitably, how to treat people in pain. Reading Listening to Prozac will surely do the same for its readers, even those who lean toward “pharmacological Calvinism” (p. 274) as I most sternly do—or perhaps did, until reading this book.

Faithful to his general style of introducing new ideas through case vignettes, the author starts his book with his observations of almost miraculous cures in response to Prozac among, not all, but a sizable number of his patients. These cures, he explains, were not simply matters of overcoming some troubling symptoms or getting back to one's old self. They seemed to be veritable transformations of identity, a transcendence of an old self that had perhaps been somewhat shy, or risk averse, or excessively self-conscious, or not very self-confident, with occasional periods of muddled thinking, to a new self that was socially adept, quick witted, properly assertive, and autonomously outgoing. We feel little surprise that these patients, with their shiny new selves find husbands, get promotions, and generally are rewarded by a technocratic society that, according to the author, happens to prefer Prozac-liberated personality styles. We are left uncertain whether Prozac brings out Fairbairn's true “pristine self” before its contamination by the hazards of negative living experiences or creates a new self, be it true or false. The striking cover illustration in which a person takes off her own dispirited head to reveal a blank face underneath does not help us with that question.