Prozac Culture: How Did It Happen?

Tens of millions of Americans, adults and children, have a prescription for one or more psychiatric drugs. Something like one in six adult women, for instance, takes an antidepressant. On some college campuses, up to 25 percent of students without a prescription report taking a prescription stimulant such as Adderall or Concerta to help them study. Even preschoolers, as young as 2 or 3, are being treated with stimulants, antipsychotics, and other medications for disruptive behaviors.

How did this happen? Every January, I teach an intensive, two-week course here at the University of Virginia that takes up this question.

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I call the class “Prozac Culture.” Prozac here serves as a metonym for the cornucopia of psychiatric medications that people now use, whether antidepressants, stimulants, or sedatives such as Xanax. Although Prozac itself is now off-patent and available in generic form as fluoxetine, it remains (even without advertising) one of the most widely prescribed drugs and, thus, retains the iconic status that newer antidepressants and other medications lack. All the students know about Prozac.

By Prozac culture, I mean the therapeutic ethos that has emerged in response to the demands, expectations, and norms of our late-modern world.

Profound, largely technologically driven changes have transformed norms governing our social lives, eroding the old social roles and rules and creating an enlarged space of “choice” that valorizes autonomy and self-realization above other ideals and normative obligations. The demands for self-mastery and self-optimization inform the standards by which most of us now measure ourselves and take our place in society. The pressure to meet these demands, combined with fuzzy criteria to measure relative success in doing so, generates new strains, forms of distress, and tribulations of the self. To these struggles, Prozac culture is a response.

Background

Historically, the launch pad of Prozac culture was the therapeutic revolution of the 1950s. In short order, a host of existing compounds were discovered to have beneficial psychotropic properties. First antipsychotics, then new anxiolytics, sedatives, stimulants (Ritalin), and antidepressants came on the market. With Miltown (1955) for anxiety and nervousness and then the similar benzodiazepine class of drugs, beginning with Librium (1960) and Valium (1963), we get the first psychiatric blockbusters.

Looking back further, we see the 19th-century popularity of various elixirs and tonics (patent medicines) promising relief for maladies like anxiety and fatigue and offering a new lease on life. We also see in this period the definition of new conditions for the worried well, including neurasthenia (“tired nerves”) and the neuroses, as well as the establishment of professional office-based practices to treat them.

Returning to the 1950s, we see the domain of medicine begin to expand as various forms of antisocial and deviant behavior are redefined as psychiatric illnesses in need of treatment. Called “medicalization,” this extension of medical management would spread in the following decades to every conceivable form of suffering and problem of living. When the 1980 edition of psychiatry’s diagnostic manual was published, hundreds of new or reconceptualized disorders appeared. Since then, the boundaries of disorders, including depression, attention-deficit/hyperactivity disorder (ADHD), and autism, have grown ever more elastic, grouping together ever more amorphous symptoms.

Medicalization has from the beginning involved a complex interplay between the understanding of the drugs and what they treat. Medicalizing common forms of distress—tension, lack of energy, feelings of inadequacy or isolation—promoted use of the drugs. The everyday use and marketing of the drugs in turn promoted further medicalization and more use of the drugs. The success of the drugs (biochemical agents) promoted new theories of biological causation, which then fostered even more use of the drugs, including with children. And so began an interacting, self-reinforcing circle that continues to this day.

From the 1950s on, the pharmaceutical industry played an active role. In my class, we consider its many marketing strategies: the “detailing” practices of its drug reps, direct-to-consumer advertising, sponsored medical research, and sponsored “thought leaders.” We also briefly examine the role of other popularizers, including the media, patient advocacy groups, celebrity sufferers, and the new genre of personal pathography.

Now, virtually everyone, even high-school students, can speak the language of symptoms and disorders, rattle off the names of medication brands, and imagine their brains as "imbalanced," “neurodivergent,” or “dysregulated.”

The Other Half of the Story

Professional activity is one part of the Prozac culture story. But, it doesn’t help us understand what made diagnoses, drugs, and neuro-talk so convincing to ordinary people. For this, we have to focus on the new norms of self and the demands they imply.

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In class, I point to the disappearance of public mourning practices to illustrate how some of the big sociological shifts—erosion of traditions, secularization, increased mobility—have expanded the scope of individual choice while also making it harder to know what to do.

At the level of everyday life, I ask the students to write a short reflection on the question of what sort of person it is good to be. In a highly competitive environment, they write, they must have both approved achievements and key personal qualities, from intelligence to confidence to the right body. And they must carry all this off with just the right self-presentation, a task that could not be more complicated or indeterminate. “Good at everything,” wrote one young man, but “without making it seem like we are trying, or even care.”

We also see the new norms in other ways. We examine the pressure to perform that people feel justifies their use of prescription stimulants without a prescription (on this topic we watch the Netflix film "Take Your Pills"). We explore how the definitions of disorder categories, like ADHD, have changed to mirror failures in the dominant self-realization ideals. No longer centered on inattention, ADHD symptoms now include any contextually problematic behavior that suggests a lack of individual motivation, self-control, or self-interest regarding future goals or consequences.

The new norms constitute the chronic stress factor driving Prozac culture, with drugs and neurobiology offered as the solutions.

In recent years, nonprofessionals, especially as influencers, expert patients, and content creators on social media, have played a growing role in spreading Prozac culture. Watching online videos in class, we discuss why having a diagnosis has become so popular and how it plays a role in identity narratives. The psychiatric labels help to ease the stress of falling short. It’s “OK to be imperfect,” one student observed, “if you have the explanation of a diagnosis.” OK, he means, because, with the scientific-sounding brain account, the cause of the difficulty is shifted to the body and away from the self.

Conclusion

In a course on Prozac culture, ethics is inescapable. At every turn, we talk about our ideals, our norms, our aspirations, and our images of a good human life. A presumption behind the course is that if we can bring these often unarticulated values more clearly into view, we might put ourselves in a position to consider an alternative relationship with the world. To stimulate our thinking, our final readings include chapters from German social theorist Hartmut Rosa’s provocative little book The Uncontrollability of the World. Rosa argues that if we can approach the world receptively, as a gift, rather than as a series of objects to master or manipulate, then perhaps it might just come alive for us in a new way.