Prozac, enhancement, and self-creation.

Marina's history is notable for significant childhood neglect. After her parents split up when she was four, her father became distant and mostly uninvolved and her mother suffered from depression and a borderline case of alcoholism. Although involved in Marina's day-to-day life, she was inconsistently available on an emotional level. Because Marina was the oldest child and apparently "had her shit together," she was often called on to help out with her younger sister and two brothers, who had a variety of problems ranging from depression to juvenile delinquency to significant obsessive-compulsiveness. Due to the distraction of other family members' more dramatic struggles, many of Marina's own needs were never met. However nurturing this "parentified" child was, she never felt nurtured. Although by her own account she had a troubled adolescence--doing less well than she wanted in school, flirting with drug use and reckless sexual encounters--she managed to get accepted to a good university. Settling down considerably, she excelled in college and got into a top business school, where she continued her academic success. Throughout this period, her primary source of emotional sustenance came from several close friendships. Although these relationships were generally strong, Marina sometimes bristled from perceived putdowns and betrayals by those she held dear. Her family's demands for advice and assistance persisted, but coming to understand how her overreaching family oppressed her, she established some reasonable boundaries with her mother and siblings, an achievement made easier by living in a different city. Her romantic life she considered a failure. Her intense work ethic afforded little time for dating, and the men she wound up with tended to be distant, rejecting, and sometimes emotionally abusive. Marina has also always been somewhat obsessional. She has been disturbed by thoughts about death since adolescence and overly concerned with the possibility of tragedy befalling her or her family, although these thoughts occur fleetingly and do not disrupt her functioning. For many years, her recurring sexual fantasies have featured powerful older men. She is troubled and disgusted with herself when these fantasies drive her to consume late-night hours pursuing the half-hearted titillation of sex-oriented internet chat rooms. As she approaches age thirty, Marina is rather successful in nearly everyone's estimation: She is a well-paid manager for a large computer company, she has close friends, and she has several pastimes that she genuinely enjoys (especially bicycling and guitar). Yet Marina finds herself brooding and pensive, wondering about her life and its direction. She seeks out a psychiatric consultation, which takes place over four sessions, and accepts the psychiatrist's conclusion that she has no diagnosable disorder. When he suggests that psychotherapy might nevertheless be of help to her, she is inhibited by the prospect of paying for many sessions out of pocket (since her HMO will not cover them). Still, she wants changes. At work, she feels overly tentative, unsure, too prone to worry about possible errors. In her social life, she hates how she endlessly interprets the latest transactions with friends and the way she is attracted to men who are bad for her. She feels alienated by her obsessional thoughts, considering them ridiculous and bothersome even if not very harmful. After extended periods of introspection, fueled by her impending birthday and the discussions that took place in the psychiatric consultation, Marina decides that she wants to become more outgoing, confident, and decisive professionally; less prone to feelings of being socially excluded, slighted, or unworthy of a good partner; and less obsessional generally. She calls the psychiatrist who provided the consultation, whom she likes, and explains that she has heard that Prozac sometimes produces transformations like the ones she seeks--and more quickly and less expensively than could be expected from therapy. …