© 2017 by Lauren Slater. 

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Welcome to my country, Anchor Books, 1997

"We see her running a group therapy session for several men with schizophrenia, when one suddenly drops his pants to illustrate his pain. Ms. Slater never misses a beat as she guides the group from feeling to feeling. After weeks listening to a sociopath talk about his sadomasochistic videos and his reasons for slapping around his girlfriend, Ms. Slater blurts out, ''I wonder if you ever think that I might be uncomfortable with your sexual talk.''

Her portraits help make a wide range of disorders more accessible, including schizophrenia, depression and borderline personality disorder. Joseph, a former Boston Latin and Princeton University student, struggles mightily against his schizophrenia to tell her about his background, but is betrayed by his damaged brain. What comes out instead is: ''I am Joseph D'Agostino, of the Teddy Bear Lounge.'' Marie articulately explains how little her depression is a reaction to what goes on around her, and how much it is the product of a brain with messed-up chemistry. ''I'm living with a remote control inside my head,'' she says. ''It doesn't feel like I have a choice. A person I can't see presses the up button and I feel better.''

After Marie tries to kill herself, Ms. Slater visits the hospital seeking answers. No memory of something bad? the psychologist asks.

''Marie shook her head. She had just woken up that morning and felt the dread of that depression back on her.''

The book is seamlessly written, more like fiction than nonfiction, and this goes to the heart of my misgivings. Ms. Slater explains in an introductory note that some ''individuals represented are complete composite portraits, made up of many different images and from the many different stories I have heard in my practice as a psychologist.'' Susan Sheehan, in her Pulitzer Prize-winning account of a schizophrenic woman, ''Is There No Place on Earth for Me?'' (1982), showed us how to stick to the facts when writing about serious mental illness and yet respect an individual's privacy. ''Welcome to My Country'' does not come close to this standard. Ms. Slater has an excellent ear for dialogue. She quotes a man with schizophrenia saying: ''Watch out for her. She's an alien. She has no bones in her neck.'' But how do you quote a composite?

Ms. Slater's text is also weakened by her tendency to generalize: ''The words of the schizophrenic are terribly skewed,'' she writes. ''The schizophrenic speaks a mumbo-jumbo language psychologists call a 'word salad,' nouns and verbs, fragments from the past, snippets of dreams.'' But many people with schizophrenia are plain-spoken and as understandable as the next person -- even while they might be fighting off voices in their heads or delusions. In addition, she seems to give serious weight to the theory that schizophrenia can be caused by bad parenting. Most experts agree that it is an organic brain dysfunction that has little or nothing to do with an individual's environment.

She has kept the descriptions of the settings fuzzy, I assume for privacy reasons, but this often obscures important information. ''I'd been working on a residential unit for chronic schizophrenics,'' she writes. Is this the wing of a hospital, where treatment would be based on a medical model? Or a group home relying on behavioral therapy?

Still, there is much in this book to admire. Ms. Slater is a lovely writer, easily read, often poetic. ''My patients,'' she tells us, ''are foreign, tropical, green roses and striped plants that are hard to understand.''

She is compassionate and caring. In the final chapter, she visits the clinic where she herself had been treated as a teen-ager and reflects on what helped her. ''Ultimately it was not their treatments or their theories that helped me get better, but the kindness lodged in a difficult world.''

Michael Winerip's review from the New York Times
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prozac diary, penguin press, 1998

D.T. Max's review from the New York Times

"Is it cheating to take a pill that replaces the hard work of therapy? If you are on Prozac, are you your true self? What does it mean to be ''on Prozac'' anyway? Wouldn't it be as true to say you are ''off depression''? These are the sorts of questions invited by Lauren Slater's ''Prozac Diary,'' a gentle, illuminating memoir of what it's like to be cured by America's pre-eminent selective serotonin reuptake inhibitor. Slater is in an unusual position to ask and answer her own questions, because thanks to Prozac she has gone from patient to therapist: since 1994 she has been a psychologist working with schizophrenics and depressives (a story she tells in her wonderful earlier book, ''Welcome to My Country'').

''Prozac Diary'' begins in 1988 at McLean Hospital in Belmont, Mass., where the 26-year-old Slater encounters the substance she will soon think of, only somewhat jokingly, as a willful and powerful lover. Her psychopharmacologist, whom she calls ''the Prozac Doctor,'' has no interest in the talking cure. He is so psyched by Eli Lilly's then-new antidepressant that he has a Lucite Prozac clock, Prozac pen set and Prozac stationery in his office. 

And Slater is obviously in need. Nothing has eased the severe depression that first came over her in her teens. She lives alone in a basement apartment in Cambridge, having dropped out of a creative writing program. She has never held a real job or had a significant relationship. Recently, she has begun to exhibit obsessive-compulsive symptoms too. She taps and counts things repeatedly. While once she was the kind of person you didn't notice -- a pale, anxious, anorexic-looking girl -- now she is the kind of person you move away from on the bus. So down go the cream-and-green pills, first one a day, then ultimately four, for 80 milligrams total; ''the Big Mac of medicine,'' as she says. 

The results are immediate and spectacular, and make the most moving reading in the book. ''Those first few mornings,'' Slater writes, ''were fairy tales, tall tales, replete with all the bent beauty of a new world.'' Miranda in Cambridge. She is a woman whose life -- or at any rate her view of that life -- tends toward the symbolic. A magician at Faneuil Hall calls her out of the audience to take part in a magic trick. She begins browsing real estate give-away papers, as if shopping for her new life. She learns how to set an alarm clock, goes to her first rock concert, gets a new apartment, takes her first road trip, enters her first real relationship. It turns out that despite having had sex several times, she is still technically a virgin. At a clinic a doctor surgically breaks her hymen.

I was glad to read this book. It reminds me of the base-line truth about Prozac. During the decade in which it has gone from wonder drug to one of the dominant medications of our time (almost 10 million prescriptions a year in the United States alone), a considerable and obdurate backlash has formed. True, the walking worried take Prozac. True, so do their dogs and cats. No doubt ''cosmetic psychopharmacology'' -- the phrase comes from Peter D. Kramer, the author of the best-selling ''Listening to Prozac'' -- is a concern. If the natural self isn't perfect, take a pill. But Slater didn't just have the sniffles. She was more like someone with pneumonia waiting for the invention of antibiotics. And the life she has gone on to have with Prozac as her constant companion is remarkable. Surely no one would wish her back buried alive in a Cambridge basement. 

Yet Slater is too capable an observer of her own psyche not to ask, in living this momentous and very American tale of hardship overcome with technology, what she may have lost. ''Much has been said about the meanings we make of illness,'' she writes, ''but what about the meanings we make out of cure? Cure is complex, disorienting, a revisioning of the self, either subtle or stark.'' Her cure took away her sex drive, as it does to many users of Prozac. And at some point the drug became less effective. The brain apparently adjusts, trying to return to its old ways. In her case, Prozac also suppressed her creative self, at least at first. Since childhood she had had voices in her head that took her over when she sat down to write, inducing a mad scribbling over sheets of paper. Prozac smothered these voices, and the breaking of her hymen finished them off. The prose style that replaced those voices is self-conscious, deliberate, nervous about taking on too much. Which style is really Slater's? Last, Prozac took away her belief in God. Depression, anorexia -- these were surely ambiguous gifts. But if 80 milligrams of fluoxetine hydrochloride is all it takes to change who you are, then we are all, obviously, just so many chemical compounds. 

 

Does Slater worry about these questions too much? Perhaps, but as anyone who has experienced the eerie relief of modern psychopharmacology can tell you, such thoughts are never far from the (remade) mind. Does Prozac make you who you are or who you were never meant to be? For Slater, in the end it's enough to be, almost and at last, well. 

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LYING, penguin press, 2000

Rebecca Mead's review from the New York Times

"Stranger Than Fiction"  

 

Sickness demands compassion, but even so, one can be forgiven for wanting to throttle the narrator of Lauren Slater's latest book, ''Lying.'' This must be her intention, because ''Lying'' is a willfully slippery book. It doesn't so much wink at its own unreliability -- the provocative subtitle, the way the first chapter consists simply of the words ''I exaggerate'' -- as it does hold up a big neon sign reading ''I Am Not to Be Trusted.'' This, depending on the extent of your literary indulgence, is either postmodern fun and games or pure exasperation between hard covers. 

Slater is the author of two earlier memoirs -- Prozac Diary,'' in which she gave a thoughtful and lyrical account of her stumbling decline into psychological disarray as an adolescent, and her restitution with the help of Prozac, and ''Welcome to My Country,'' an earlier account of her experience as a psychologist working with the mentally ill. Though ''Prozac Diary'' was an argument in favor of psychopharmacology -- Slater was relieved of her crippling obsessive-compulsive disorder, and won not just a place at Harvard but also a husband -- it also described the losses that she experienced on Prozac: her vanished libido, the disappearance of the thrilling flashes of creativity that occasionally broke through the gloom and dysfunction. ''Prozac Diary'' was Slater's exploration of what she was to understand as her self, given the fundamental alterations caused by the drug, and it was justly praised for its frankness and honesty.

 

Maybe that praise was altogether too much for someone as complicated as Slater, because ''Lying'' is determined to be deceitful. In this new book, she describes the onset, in her middle childhood, of epilepsy: the way that it sneaked up on her through visions and hallucinations, and inflicted devastating seizures. She writes of being sent to a Catholic-run school for epileptics in the Midwest, where the nuns taught how to fall without injuries; she describes using those skills at a funeral to topple into a freshly dug grave. She gives an account of her long-running treatment at the hands of a Dr. Neu, who ultimately operates on her brain, severing its right from its left sides, buzzing through her skull with a saw while she, under local anesthetic, feels its thrumming vibrations.

She also suggests, with a heavy-handedness that indicates this is the kind of suggestion to which it would be wise to be receptive, that she's making the whole thing up. ''I have epilepsy. Or I feel I have epilepsy. Or I wish I had epilepsy, so I could find a way of explaining the dirty, spastic glittering place I had in my mother's heart,'' she writes. Epilepsy, Slater tells her reader, makes the sufferer prone to lying and exaggeration; epileptics are grandiose and charismatic, and also infuriating. Perhaps, she suggests, she's adopted the guise of an epileptic because only that disorder adequately conveys the sliding, fragmented sense she had as a child of not quite fitting into the world, and because only that disorder gives her license to lie. (Well, that and Munchausen's syndrome, the disease in which the sufferer pretends to have other diseases, and by which Slater also claims to have been afflicted.) 

Slater is a gorgeous writer, and she describes the dissolving hallucinations of the epileptic state with seductive grace. ''I had whole moments when the world went watery, when I saw the air break apart and atomize into dozens of glittering particles,'' she writes. ''I had not known, until then, that beauty lived beneath the supposedly solid surface of things, how every line was really a curve uncreased, how every hill was smoke.'' She's also capable of comedy, particularly when she gets to her account of joining an Alcoholics Anonymous group even though she doesn't have a drinking problem and hardly ever drinks. (After delivering a confessional ''drunk-a-logue'' that wows her group with its apparent honesty and clarity, she tries to tell them she's lying about being an alcoholic, but they won't listen to her: '' 'Denial,' Elaine said, squeezing next to me on the sofa. 'Denial always kicks in when we get too close to the truth.' '') 

 

Slater's hopscotch between veracity and deception concerning her supposed epilepsy is intended to convey the subjective truth about what it feels like to be her. ''My whole life has been a seizure,'' she writes, and this self-diagnosis makes literary, if not literal, sense. But she also has ambitions of delivering a critique of the memoir genre. She habitually interrupts herself in order to throw what she has just written into question. One chapter consists of a memorandum to the Random House marketing department and her editor, Kate Medina, about whether the book should be marketed as fiction or nonfiction, and there Slater writes of her intention ''to ponder the blurry line between novels and memoirs. Everyone knows that a lot of memoirs have made-up scenes; it's obvious. And everyone knows that half the time at least fictions contain literal autobiographical truths. So how do we decide what's what, and does it even matter?'' 

 

These are all good questions, but their execution makes the experience of reading ''Lying'' a disconcerting one, in which the reader had better be constantly on guard against the book in his or her hands. The wariness sets in early. Slater describes, with beguiling beauty, how the first manifestation of her epilepsy was a hallucinated smell of jasmine; but ''Lying'' reeks of rat from the very first page. In an introduction, one Hayward Krieger, a professor of philosophy from the University of Southern California, praises Slater's exploration of ''a new kind of Heideggerian truth, the truth of the liminal.'' I was on the telephone to U.S.C. to confirm my suspicion that there is no such person as Hayward Krieger before I'd even begun the first chapter. This is the kind of thing that might appeal to a dedicated deconstructionist; others, though, will find it unrewardingly wearing. ''Lying: A Metaphorical Memoir'' wants to be as charismatic and infuriating as an epileptic, which is a risky strategy, because when it does this most successfully, it is also at its most alienating. It's a tricky book -- a sick book, even, metaphorically speaking. 

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LOVE WORKS LIKE THIS, Bloomsbury, 2003

 

The idea behind Lauren Slater's book is simple but ingenious: pluck 10 leading experiments in 20th-century psychology from the pages of the scientific journals in which they were first published, dust off the painfully academic style in which they were written up, add some personal details about the experimenters and retell them as intellectual adventures that help us to understand who we are and what our minds are like.

How to select the experiments? Some select themselves. Slater starts, as her title suggests, with B. F. Skinner's animals in boxes, their behavior modified by food rewards to press levers, peck at a particular spot and behave in various bizarre ways. Then comes Stanley Milgram's research on obedience to authority. Milgram proved that people who have volunteered to take part in an experiment in learning will give what they believe to be severe electric shocks to others, if they are told by someone in a white coat that the experiment requires them to do so. Another classic is the research undertaken by John Darley and Bibb Latané in the wake of the 1964 murder of Kitty Genovese, a young Queens woman who was brutally attacked while 38 people, in different apartments, saw or heard what was happening, but did nothing to aid her. People are more likely to come to the aid of others, Daley and Latané found, when they are alone than in a group. Also included is Leon Festinger's research into ''cognitive dissonance,'' or how we deal with apparently irreconcilable facts and ideas -- research that led Festinger to infiltrate a cult that had set a date when the world would end.

 

Some of Slater's selections seem influenced by her own experiences. (The author of ''Prozac Diary,'' ''Lying: A Metaphorical Memoir'' and ''Welcome to My Country,'' Slater is herself both a psychologist and someone with first-person experience of mental illness.) That may have led her to include David Rosenhan's 1970's experiment on how easy it is to get admitted to a psychiatric institution, and how hard it is to get out again. In the book's final chapter Slater gives a largely sympathetic account of psychosurgery.

Though Slater is well aware of the ethical questions posed by the application of experimental techniques to patients, she wants us to see the issue as gray, rather than black-and-white. She reminds us that we tend to criticize yesterday's treatment too harshly, and to accept too easily our current practices. We readily assume that taking antidepressants is safer than psychosurgery, because cutting into the brain is irreversible. But Slater points out that we really don't know the long-term effects of taking drugs like Prozac. Psychosurgery today is far more precise than it was in the crude days of the lobotomies that gave it a bad reputation, and it does not turn people into zombies.

Ethical issues run through the book. Milgram's experiments on obedience have made us more aware of the dangers of uncritically accepting authority, but they would be unlikely to get through one of today's institutional ethics committees. Milgram certainly misled his subjects about the nature of the experiment in which they were participating. Most of them were forced to confront the fact that they were capable of giving severe shocks to innocent people. But does the deception, or the discovery, make his research wrong?

Slater interviews one of Milgram's obedient subjects and finds him crediting his involvement with Milgram's research with helping him to become a better person, by confronting his moral weakness. And Milgram apparently received many letters from other subjects saying the same thing. So Slater raises the question whether today's ethics committees have tilted too far in the direction of protecting human subjects.

In another chapter, Slater describes the work of Elizabeth Loftus, a psychologist who has sought to disprove the idea of ''repressed memory.'' Juries that trust the reliability of a recovered memory of sexual abuse or incest that supposedly occurred decades ago can put people living utterly respectable lives into prison for many years. Loftus has found it hard to carry out research into the reliability of such memory because, she asserts, ''you can't get ANYTHING'' past a human ethics committee anymore. Nevertheless, in the end Loftus did, with some ingenuity, manage to set up an experiment that didn't violate ethical guidelines but still demonstrated how easy it is to get people to ''remember'' an entirely fictitious occurrence.

Slater's most ethically troubling chapter, however, is about research not on humans but on animals. Slater describes how Harry Harlow deprived infant monkeys of their mothers to study the effects of maternal deprivation. Then, because he wanted to know what the effect of an ''evil mother'' might be, he designed a mechanical surrogate mother that he called the Iron Maiden. When the infant monkeys tried to cling to it, this mechanical monster would, on command, shoot out sharp spikes or blast the babies with cold air that threw them back against the bars of their cages. In his later years Harlow -- who at this time was, in the words of one of his research assistants, ''a terrible drunk'' and ''always, always intoxicated'' -- devised new ways of tormenting monkeys. Since the maternally deprived female infants grew up into neurotic adults who would not allow a male to mate with them, he constructed a ''rape rack'' -- his term -- so that he could tie them down while males mated with them. Then, Slater tells us, he constructed an isolation chamber ''in which an animal was hung upside down for up to two years, unable to move or see the world, fed through a grid at the bottom of the V-shaped device.'' This he called ''the well of despair.'' Roger Fouts, who has done research with chimpanzees, feels strongly, Slater reports, that what Harlow learned from these experiments was ''not only obvious but derivative.''

 

At this Slater, to her credit, draws a clear moral line. She thinks what Harlow did, and all the monkey research he spawned, is wrong. When she tells her husband this, he predictably responds by asking her if she'd choose a monkey's life over that of their child. Her response is that as she is 99 percent monkey herself, she would of course choose her child. But that is just animal instinct, or mammalian love. The other 1 percent, which may be her reason, tells her that it is ''rarely defensible to cause suffering to sentient beings.''

 

Slater makes some errors that made me wonder about her accuracy in areas with which I am not familiar. Some of these are minor slips, like placing Roger Fouts in Oregon, not Washington, and misspelling the names of his chimpanzee friend, Washoe, and of the animal rights activist Alex Pacheco. Others are more troubling. When Linda Santo tells her that the Roman Catholic Church is formally investigating her daughter Audrey for possible sainthood, Slater tells her readers that ''the last time the Catholic Church considered naming someone a saint was in 1983.'' She obviously hasn't been paying attention to Pope John Paul II's canonization binge -- he has named more than 400 saints since that year. To link Milgram's research with Nazism, Slater writes of ''Hannah Arendt's thesis on the banality of evil, the bureaucratic Eichmann blindly taking orders, propelled by forces external to him.'' This misdescribes Arendt's thesis. In ''Eichmann in Jerusalem'' she emphasizes his statement that his obedience was justified by Kant's definition of duty, and that he was able to give a broadly correct account of Kant's categorical imperative. In Arendt's view it was Eichmann's considered decision that he ought to obey orders. He was not ''propelled'' to do so by anything external to him.

 

Though careful readers may want to check some of Slater's assertions, ''Opening Skinner's Box'' is a very readable, if highly personal, account of what we know, and don't know, about human nature, and of the ethical issues raised by our efforts to find out more.

OPENING SKINNER'S BOX, W. W. Norton, 2005

Reviewed by Peter Singer in the New York Times

"Adventures of the White Coat People"  

 

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BLUE BEYOND BLUE, W. W. Norton, 2005

 
 

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THE $60,000 DOG, Beacon Press, 2012

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PLAYING HOUSE, Beacon Press, 2013

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