I once dated someone who told me early on that they had been diagnosed with borderline personality disorder (BPD). I was instantly like, come on, you’re great. You don’t have BPD!  And anyhow, BPD is a made-up thing that’s not real.

After a month or two of dating, I found out what BPD is.

I jest, of course, but I feel I have a little leeway in talking about mental illness, in much the way you’re generally allowed to use the slur for your own marginalized group.  My brain is cooked and, after 40 years of therapy, meds, and meditation, appears unlikely to be uncooked.  I have always been drawn to media that attempt to portray psychiatric distress, whether the author’s own or what they (attempt to) observe in others: Who’s Afraid of Virginia Woolf, One Flew over the Cuckoo’s Nest, Crazy People, Girl Interrupted, The Royal Tenenbaums.  Does American Psycho count?  It seems like it should.

One thing that comes to mind, looking at this arbitrary and idiosyncratic selection, is that these stories tend to depict affluent white folks.  Perhaps it’s because the only people who can get treatment have money (and many plots hinge on getting medical help), or it’s just a reflection of the people who write and produce movies.  Certainly, this is true of two tales of struggle, based on confessional memoirs by young white women: 2001’s Prozac Nation and 2016’s Brain on Fire. While it might seem asymmetrical to pair these two – one was adapted from a book by the “voice of a generation,” and the other is a Netflix movie – I think they give a striking sense of how perceptions of psychiatric malady have evolved from the 1980s to the 2010s.

Elizabeth Wurtzel’s story is likely the more familiar one. Her 1994 memoir arrived at a propitious time: just seven years after the FDA approved fluoxetine for treatment of depression.  America became a very Prozac nation in rapid succession. (The medication saw a staggering 2.47 million prescriptions in its first year on the market, which ballooned to over 33 million by 2002.)  People oft attribute this transformation to the legalization of pharmaceutical ads, though the bonanza really did not get started until the FDA relaxed rules about how side effects ought to be explained in TV spots (which is to say, barely) in 1997.  Whatever one thinks of SSRIs or Big Pharma in general, Prozac was meeting a genuine and widely felt need when it popped into the public consciousness in the late 1980s.

In other words, Prozac Nation was a cri de coeur that truly met its moment.  It tells the story of Wurtzel, an aspiring writer with excellent taste in music (Patti Smith, Lou Reed, the Boss) and a resounding determination to alienate every single person who could possibly care about her.  Elizabeth’s controlling and self-pitying mother, played by the always great Jessica Lange, basically frog-marches her 18-year-old ass to Harvard against her will, in a naked attempt to load all of her own lost dreams and ambitions onto a fragile young woman. Harvard is everything; Harvard is it; Harvard is the pinnacle, the proof that I did not fuck up as a mom, or as a person in general.

The table is set once our hero meets her roommate Ruby (Michelle Williams), whose soft demeanor contrasts with Elizabeth’s never-ending glare of disdain.  (Christina Ricci could not possibly have been better cast.)  Elizabeth finds early success writing for the Harvard Crimson and even gets her foot in the door at Rolling Stone, so she immediately becomes an insufferable artiste, who loudly and frequently reminds her friends that she does not care about them.

The side characters look on Elizabeth with bewilderment.  Their faces say, “This is so weird, I’ve never seen anyone respond like this to anything; I like, or maybe even love this woman, but I just want to scream, ‘What is wrong with you?!’”  It cannot be stressed enough that these friends do not, in fact, blurt that out.  They try to help and put up with a lot of nasty shit.  (In a key moment, Elizabeth snarls at her boyfriend that he just “gets off” on taking care of his severely disabled sister.)

For a movie called Prozac Nation, there’s shockingly little fluoxetine up in here.  The med doesn’t even surface until late in the third act, and the filmmakers do a decent job of not making this look like a pharma ad in disguise.  All we see is that the medicated Elizabeth is calmer and more balanced, thankfully not flying off the handle at every perceived slight or insult. 

I hope Elizabeth Wurtzel enjoyed at least some respite from her demons, though her subsequent writings suggest otherwise.  What troubles me, though, is what her narrative says about depression.  Personally, I don’t think a near total lack of empathy and an unyielding demand to always be the center of attention – her two cardinal traits, if the film is any indication – are exactly symptoms of depression.  They could be, in some cases. Or maybe you’re just an asshole.

Flash forward to 2012, that halcyon year, when Susannah Cahalan published Brain on Fire: My Month of Madness.  She had been a bright-eyed cub reporter whose one dream was to work at the New York Post, of all places.  Susannah appears to have been faring decently enough, under the tutelage of editor Tyler Perry and officemate Jenny Slate.  But one day things go wobbly, fuzzy; the trouble is enough around the edges not to be obvious right away, to Susannah or the people in her life.  But her erratic behavior escalates, of course; one day you’re seeing bedbug bites on your arm that no one else can see, and the next you’re making “I’m a golden god” style speeches on the top of the desks at work.   

Chloe Grace Moretz does a great job at a difficult task; at no point does she let her portrayal of mental anguish turn into melodrama or camp.  I was most interested to see the moments where Susannah starts having seizures.  This is for selfish and parochial reasons.  Not long ago, I suddenly and unexplainedly started having such episodes.  The first occurred when I was about to start teaching a class, and it was one of the most frightening experiences of my life.  Why?  Because I don’t remember anything whatsoever.  I later had to ask my students what happened, what it looked like – what I looked like.

I have not read the book, but evidently the real-life Susannah watches videos of her bizarre behavior after she gets better.  No doubt I would be curious, but I don’t know if I would want to see it myself.

Setting aside the personality differences between Wurtzel and Cahalan, these stories still tell us a lot about how the culture of medicine and illness has changed.  Prozac Nation starts in 1985, back when everyone was still smoking everywhere.  Incredibly, the word “depression” only comes up twice in the screenplay.  The people around Elizabeth have no language to describe what she’s experiencing or what they’re seeing.  In contrast, the people in Susannah’s life have no trouble turning to a framework of mental health – addiction, anxiety, depression, bipolar – to account for her strange actions.  Her employer, friends, and family are prepared to see it in those terms. 

Ironically, a mental health diagnosis turns out not to be correct. Susannah suffered from a rare and poorly understood autoimmune condition that attacks the brain; perhaps we could categorize this under “mental illness,” but that doesn’t feel quite right.  If not for the intervention of a doctor (Souhel Najjar) willing to test a truly unorthodox hypothesis, Susannah might have languished in a catatonic state for the rest of her life, or even died.

Ultimately, Brain on Fire is a perfectly fine, bog-standard, movie-of-the-week style medical drama, albeit with a stacked cast (Moretz, Perry, Slate, Carrie-Anne Moss, Richard Armitage).  But it offers a disquieting reminder of how much of medicine – most importantly diagnosis – depends on guesswork, and without the right physician one can be consigned to a life with the wrong label and no hope for improvement.

It might be unfair to compare these two movies, seeing as they come from very different times and tell very different stories.  Notably, Susannah Cahalan’s horror appeared in an instant, out of nowhere; hence the book’s subtitle, My Month of Madness.  In fairness to Elizabeth Wurtzel, hers was no sudden Hell.  She likely had been enduring the pain of depression since she was in Garanimals.  Whatever their aesthetic qualities might be, these films give us snapshots of profoundly different moments in our understanding of mental illness, as experienced by real people and also as refracted through popular culture.  1985 feels like a far distant past when compared to 2009, when Cahalan’s problems first manifested.

But what do I know?  I’m no psychiatrist.  I’m just a bisexual woman with mental health problems.