Orkideh Behrouzan’s Prozāk Diaries is a formidable undertaking that elegantly recounts the generational shift in how young Iranians talk about and experience their post-revolutionary and postwar experiences. The author, trained as both an anthropologist and a physician, highlights the growing use of psychiatric medications, especially antidepressants, alongside a broader cultural shift that medicalizes the language of anomie and trauma as depression and anxiety, illnesses that can be treated biomedically, often denuding those experiences of the political conditions that gave rise to them.
Corresponding with the early stages of the formation of the post-revolutionary state and the 1980‒88 Iran‒Iraq War, Prozāk Diaries explores a decisive moment in the history of Iranian psychiatry. At the same time, it is an investigation into how clinical language became vernacularized and supplanted poetry as the primary means through which Iranians have come to make sense of their everyday psychic lives, experiences, and aspirations.
The book’s title invokes Lauren Slater’s Prozac Diary (Reference Slater1998). Although not a memoir, like the former, Behrouzan’s ethnographic narratives placed alongside scientific commentaries and historical reflections, offer a similar journey through the experiences of depression, anxiety, and attention deficit hyperactivity disorder (ADHD) and the rise of medications to treat these ailments. Behrouzan weaves the biomedical literature with engrossing interviews, participant-observation, and even medical textbooks to offer an accessible historiography of psychiatry for non-experts. Drawing from the scholarship in medical anthropology and Iranian studies, Behrouzan attempts to make sense of this momentous cultural shift. She builds on Byron Good, Mary-Jo DelVecchio Good and Robert Moradi’s groundbreaking scholarship on depression in Iran (1986) to engage the cultural and linguistic contexts that shape experiences of illness. Then, following Michael Fischer (Reference Fischer1980), she unpacks cultural and linguistic cues that reveal the specificity of emotional expression. At the same time, the work is not overwrought with heavy theoretical or medical jargon. Rather, Behrouzan allows her scholarly contributions to theory and methods to emerge from her ethnography, within her narrators’ accounts. Applying Michael Taussig’s “storied implicitness,” Behrouzan lets her account render its own theoretical meanings and significance (p. 11).
The book is written in fluid prose and possesses a clear narrative arc. One of the strengths of this book is Behrouzan’s literary sensibility, through which she interlaces ethnographic descriptions with analyses of aesthetic works, literature, poetry, and music. The aim is not simply to render a well-written monograph about psychiatry. Instead, Behrouzan’s goal is more nuanced, and, at the same time, a central query of ethnographic methods: translation. Behrouzan asks whether it is possible “to narrate in English affective states that were so deeply imbued with the Persian language and its semantic and emotional sensibilities” (p. 15). Thus, the book’s intense engagement with aesthetics is deployed as a methodological tool to convey the larger affective realm that this cultural and generational shift entails.
Behrouzan recounts this shift and its effects (and affects) through seven substantive chapters, plus an introduction and conclusion. Just before each chapter, a narrative interlude situates the key points of inquiry to come. In chapter 1, Behrouzan lays the groundwork for the broader argument, mapping the cultural shift and examining the exigencies of the historical period that created the conditions for the rise of a psychiatric discourse of depression as a vernacular language of everyday life. That chapter’s interlude offers a sense of the rich and complex associations that the book makes throughout. It opens with a satirical image taken from a special section of a popular youth weekly: a masked joker-thinker dwelling on the apparent tragicomic performativity of depression. Accompanied by stories about depression, the cover of the weekly’s special issue offers faint homage to much-loved Iranian poet Sohrab Sepehri, while exchanging his poetic prose “solitary” and “strong,” for the clinical term “depress.” For Behrouzan, the image and accompanying headline underscore the nature of this historical, cultural, and generational shift. But that is not all. The authors of the weekly not only invoked the Persian term for depression, afsordegi, they also employed the anglicized term, depress. As Behrouzan notes in the opening words of the chapter, medicine, in a different language, finds new life; in a changed temporality, it also makes new cultural forms. Accordingly, she invites the reader to ask, in Iran, “what does it mean to be ‘depress?’”
In chapter 2, Behrouzan takes us through a pedagogical history of mental health and psychiatry in Iran. To do so, she traces the storied past of Iran’s Ruzbeh hospital, where academic psychiatry first emerged. Through analyses of a fascinating set of data, including textbooks and memoirs written by some of the hospital’s founders, Behrouzan charts key themes in the Iranian medical establishment of the early twentieth century: “the spirit of modernity and the role of physicians as mediators between popular culture and scientific expertise; the legacy of Galenic and Avicennian medical distinctions between diseases of the nerves and diseases of the soul; and the creation of the mental health institutions” (p. 42). She also highlights how psychiatric medicine spoke to broader social and political concerns of the times, how psychiatrists who trained abroad, often in France, returned to employ their scientific mindset to advance reform-minded policies, even as they located their foreign medical education in their own “pre-Islamic and ‘authentic’ history” (p. 47). The chapter also serves to offer a mini-primer on the history of psychiatry in the twentieth century as Behrouzan describes the nature of the historical medical distinction between mental and nervous diseases in the pedagogy of Iranian psychiatry, the introduction of psychoanalysis and psychotherapy.
Chapter 3 employs five distinct frames to illustrate the discursive shift in the psychiatric language of mental health that serve to destigmatize, popularize, and normalize the clinical terms, assessments, and outcomes. Each context shows how the speakers mix English with Persian, scientific with poetic language, and educate Iranian publics about mental health issues with direct reference to psychiatric discourse, while also attuned to a cultural politics of performativity. Here, Behrouzan draws from a psychiatric lecture on anxiety, public awareness media campaigns, the public circulation of epidemiological evidence and statistics, suicide and mental illness destigmatization programs, and an examination of rates of medical prescriptions.
If the first three chapters explore the rise of the vernacularization of mental health language, problems, and psychiatric care or treatment, the next four chapters move into an analysis of the cultural possibilities that this shift in mental health conceptions have produced.
Chapter 4 begins with an exploration of how the psychiatric vernacular, thus language, shapes not just experience, but also representation (Das, Reference Das1996). In this chapter, Behrouzan explores how individuals who self-identify with the terms depreshen, another phoneticized English word, articulate a “particularly performative and generative” (p. 94) mode of depression. Behrouzan examines how psychiatric terminologies move and take on vernacular qualities and how talk of Prozāk, an apparent catch-all for different types of psychiatric drugs, becomes a mode of psychic expression. Biomedical treatment, in the form of a pill, Behrouzan shows, is “both transitional and transformative object,” helping individuals fashion new identities, move beyond challenges, and chemically repair their inner selves while signaling modern sensibilities about mental health (p. 116). In this context, in Iran’s thriving art scene, Behrouzan highlights a photo exhibit entitled, Deep Depression, and follows bloggers’ encounters with depression in a clinical key, as she explores experiences of Iranians who left and others who stayed. The depreshen talk, as Behrouzan refers to it, underscores a certain kind of anxiety and abiding concern for a generational sense of loss, a specific mode and affective encounter with the Iran‒Iraq war, which produced the nasl-e sukhteh or the “burnt generation.”
It is in chapter 5 that Behrouzan takes up what she refers to as “the psychological afterlife” of the Iran‒Iraq war as she steps into the lifeworld of the postwar generation and examines the relationship between the trauma of war and memory. The aim here is to gain a better understanding of how individuals have “internalized, reconstructed, and interpreted” their childhood experiences of the war (p. 126). In this context, as well, Behrouzan explores the Persian blogosphere, as it served for many of this generation as a space in which they could tell their stories and engage in social performativity and cultural production that was otherwise missing from their non-virtual lives. Blogging allowed for a new kind of dialogical encounter for those who had experienced a shared form of trauma and opened new affective capacity for reworking emotions, both across generations and in a virtual world, which then goes offline (and vice versa) (p. 141). In this chapter, Behrouzan also explores the visual form of cultural production about depreshen.
In chapter 6, Behrouzan moves away from adult depreshen to childhood ADHD, highlighting the medicalization of hyperactivity and the corresponding increase in the use of Ritalin, a move that coincided with the designation of child psychiatry as a sub-specialty in 1997. Behrouzan highlights some of the tensions in the medical science and diagnosis of ADHD, both in Iran and in western medical scholarship. The aim in this chapter, however, is to explore generational attunement to psychopharmacological care—from parent to children. Behrouzan examines how Iranian parents negotiate ADHD, both medically and socially, and what is at stake for them in seeking medical treatment in the form of Ritalin for their children. As the author shows, the answer lies in the all-too-common concerns parents have for their children’s future—parental anxiety fraught with doing all one can to create the best possible conditions for a child’s success. What is at stake, thus, is the parent’s sense of their own successful parenting, as a modern subject amenable to biomedical self-care tools, hoping to ensure both greater health and flourishing futures.
In the last substantive chapter, Behrouzan returns to Ruzbeh psychiatric hospital and takes a step back from the fine-grained analysis to examine psychiatry as a discipline, reflecting more broadly on whether it can serve as a lens for cultural critique. Behrouzan relates the debates in psychiatry, both inside Iran and outside, that examine the tensions between psychodynamically and biomedically oriented approaches to mental health. Behrouzan outlines the approaches to both, while laying out the criticisms that biomedical psychiatrists have of their more therapeutically oriented brethren—in a word, unscientific. The Iranian approaches to mental health, however (and seemingly despite the country’s international isolation), are driven by the global pharmaceutical market and the effects of neoliberal biopolitics that emphasize individual self-care and a Foucauldian notion of “responsibilization” (p. 208).
In the end, Prozāk Diaries concludes with a return to the art of storytelling. Behrouzan highlights the work that stories about psychiatric selves do when exposed to anthropological analysis. They reveal personal experiences with historical, cultural, and generational processes. Stories about psychiatry also move us away from scientized, biomedical renderings of life to an appreciation of the generative qualities of the psychiatric vernacular that yields new cultural forms and ways of being. Indeed, as Behrouzan shows through her many animated interlocutors, anthropological forays into psychiatry can also highlight and explore the agency of psychiatrically medicalized individuals.
Prozāk Diaries should have a broad and varied readership. As a scholarly book, it will be attractive not only to students of Iranian studies, but also anthropology, medical and sociocultural, as well as those working in Medicine, especially Psychiatry, and Science and Technology. Prozāk Diaries should also be read widely by non-academics interested in depression, postwar trauma, medical histories, and, of course, contemporary Iran.
