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'Prozac Nation': 20 Years On

09/09/2014 17:32 BST | Updated 09/11/2014 10:59 GMT

In September 1994 Elizabeth Wurtzel's first book Prozac Nation was published and a new era of confessional-style memoir was born. Further than that, Elizabeth's frank and unsympathetic portrayal of her battles with depression was revolutionary in a way that now, even 20 years later, we're still getting used to.

Finally we are beginning to talk about depression and mental illness but back in 1994, this wasn't common so many did not know how to react to Elizabeth's frank, angry writing. So focused was the book on herself and her struggles that many ill-informed commentators accused Elizabeth of self-indulgence, even narcissism.

But this shows just how honest Elizabeth's writing was as for depressives, the dark cloud, the black dog consumes completely affecting their outlook to the detriment of everything else.

In style and in content, Prozac Nation was ahead of its time. I recently re-read the book both as preparation for this article but also to see how it has stood up over the years.

When I bought the book 20 years ago, I had just started University - much like Elizabeth in her book - and I remember finding the book heavy-going and intense. The subject matter was desperate and dark but it was also written in a relentlessly morbid way with no let up at all. The first line is "I hate myself and I want to die." It's a bold statement of intent for the rest of the book.

Of course, this was deliberate and it's interesting, reading it again after all this time, how you appreciate not just the clever way Elizabeth employs this relentless navel-gazing self-obsessed first-person approach but how she bravely stuck to it throughout the editing process.

Not only does this bring an interesting perspective to the main character - no character should be entirely sympathetic - but of course, this is what it's like with depression. Even Elizabeth refers to herself and other depressives in the book as "the walking dead."

So intense is the emotion in the writing that at times, you feel more for Elizabeth's mother than you do for Elizabeth. Her mother desperately doesn't know what to do for the best and propping up her daughter is taking over her life. As Elizabeth states "though she loves me very much, she no longer wants to be the one I run to."

Elizabeth's observations are sharp and downbeat. "Depression was the loneliest fucking thing on earth" she writes, and in the book it's clear how depression robs her of any and every opportunity to make friends let alone healthy, intimate relationships that last.

20 years on, Elizabeth's writing is so bold and contemporary that if you had never heard of the book you could be forgiven for thinking it had just been published for the first time.

I wouldn't go so far as to say it's common but we are certainly getting more used to reading and hearing of people in the public eye opening up about their battles with mental illness but I wouldn't say as a society we are in a place where we are open and kind in our discussions on the subject.

Yet what I found compelling in this book is not just Elizabeth's account of her battle with depression but also her battle with the medical system that's supposedly in place to help her. It's hard to argue that 20 years later, we're in a better place in understanding and supporting those in need.

Elizabeth runs through the roll-call of psychiatrists and counsellors wheeled out to help her, and you feel she is seen as an unfixable case just passed around a medical profession that is unsure how to treat mental illness. Indeed it's interesting how the one doctor Elizabeth ends up placing faith in, battles so hard to keep her out of a mental institution fearing it's the worst place for her to be.

"We live in a drug culture, both legal and otherwise" Elizabeth observes of her doctors' pleading with her to take medication. And it's hard to disagree that we've moved on that much since.

As a society we are (slowly) becoming more open about discussing mental illness and Prozac Nation remains a stark, unromantic reflection of depression as a crippling state of mind that robs you of any and all joy in life. But 20 years later, I am more aware (and just as impressed) by the book's technical style.

Prozac Nation is written in the first person throughout. And it's a memoir. These are two aspects that even today, new writers are advised to avoid. Yet Elizabeth ignored these rules and produced a classic.

Its influence in the popularity of the first-person memoir cannot be underestimated, nor can the fact that this book was written by a woman. Both of these aspects are critical in its classification as a modern classic.

And for this book, it is critical that it is in the first-person as the reader is forced into an intimacy with Elizabeth, and forced to see the world through her warped perspective.

Elizabeth was a writer of some repute even at this young age and this is reflected in some great passages on the impact of depression on her life that many have struggled to emulate since.

"Slowly, over the years, the data will accumulate in your heart and mind, a computer program for total negativity will build into your system, making life feel more and more unbearable.... Then one day you realizse that your entire life is just awful, not worth living, a horror and a black blot on the white terrain of human existence."

It was brave of Elizabeth not to court sympathy in her writing. She is open on how nasty depression could make her, referring to the silent competition with her peers at Harvard who were also suffering with depression with the acerbic "Still, no-one's desperation came close to matching mine."

The book has often drawn comparisons with Sylvia Plath though I can't help but feel that's a lazy comparison that does a disservice to both writers. Both women wrote about mental illness but Elizabeth writes with more gritty and ugly realism than the more tragic Plath.

For me, Prozac Nation has always been one of my favourite books. I've always admired its contemporary colloquial style, fearlessness and lack of apology. Elizabeth is incredibly exposed in this book and it is brave writing from someone so young (she was only 26 when she wrote this), that still today I can't help but admire its courage.

But also it remains today a terrific and terrifying testament to how a battle with mental illness often results in no victory. "That's the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it's impossible to see the end. The fog is like a cage without a key."