Husserlian Self-Awareness and Selective Serotonin Reuptake

Inhibitors
Peter Hadreas
Philosophy, Psychiatry, & Psychology, Volume 17, Number 1,
March 2010, pp. 43-51 (Article)
Published by The Johns Hopkins University Press
DOI: 10.1353/ppp.0.0279

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Husserlian SelfAwareness and

Selective Serotonin
Reuptake Inhibitors
Peter Hadreas

Abstract: The goal of the paper is to offer a model of

self-awareness that fits the testimony of both good and
bad responders to selective serotonin reuptake inhibitors
(SSRIs), of which fluoxetine (Prozac; Lilly, Indianapolis,
IN) is probably the most well known. After a review of
troubling current uncertainties concerning how and for
whom SSRIs are therapeutic, it is argued that SSRIs, as
a rule, lessen the emotionality of SSRI subjects in favor
of an increased cognitive and volitional orientation.
Traditional empiricist and rationalist accounts selfawareness fail to provide models that adequately explain
how such a shift from an active emotional response to
an increased cognitive/volitional orientation is possible.
Instead, notions of self-awareness, as understood by
founding phenomenologist, Edmund Husserl, fit the
testimony of SSRI subjects.
Keywords: SSRI, Prozac, fluoxetine, Zoloft, sertraline,
Paxil, paroxetine, Husserl, phenomenology

his paper is concerned with a model of

self-awareness, which fits the testimony
of subjects reactions to selective serotonin
reuptake inhibitors (SSRIs), of which fluoxetine is
probably the best known.1 We consider the testimony of both SSRI good responders and poor
responders. SSRI good responders experience a
shift from dysthymia to confidence and hopefulness, often in as few as two to four weeks. The
2010 by The Johns Hopkins University Press

contrast in moods urges the adoption of an adequate model of self-awareness. The experiences
of those who respond poorly to SSRIs are also
relevant in that their own first-person descriptions of before and after SSRI use presume a
model of self-awareness. Inadequate are notions
of self-awareness proffered by psychologists and
philosophers of both of empiricist and rationalist
camps. They convey unsuitable and misleading
paradigms2 for explaining the experiences of both
those affected positively and negatively by SSRIs.
Instead, a suitable model of self-awareness is
offered by founding phenomenologist, Edmund
Husserl, particularly as developed in his middle
and late writings.
First, Ill present some preliminary remarks
regarding current uncertainties both as to how
SSRIs work and whom they help.
The U.S. Food and Drug Administration approved fluoxetine in 1987. During the salad days
of SSRIs usage, unbridled enthusiasm came from
various quarters as to the efficacy of SSRIs for
treating a broad variety of psychological ills. Peter
Kramer in 1993s Listening to Prozac was a bellwether of the times. Kramer announced that SSRIs
were successfully prescribed to treat not only clinically codifiable mental illnesses, but also personality traits such as shyness and diffidence. In patient

44 PPP / Vol. 17, No. 1 / March 2010

after patient, Kramer wrote, Prozac seemed to

give social confidence to the habitually timid, to
make the sensitive brash, to lend the introvert the
social skills of the salesman (Kramer 1993, xv).
By the writing of his more recent book, Against
Depression (2005), Kramer revises his view of
SSRIs efficacy. Kramer states that fluoxetine and
paroxetine do especially well with social anxiety,
and they have improved the treatment of low-level
depression (Kramer 2005, 190). But, he rejoins
that early antidepressants, developed in the
1950s, are as effective [as fluoxetine and paroxetine] at ending depressive episodes (Kramer
2005, 190). Kramers restricted recommendation
matches the increased wariness of psychopharmacologists to treat clinical depression with SSRIs.
Further, there is, as yet, no accepted explanation
for the much publicized relative increased risk of
suicidality among SSRI-treated adolescents (Begley
2004, A1, A4).
After nearly two decades of SSRI usage, there is
a body of evidence suggesting that SSRIs are more
unpredictable than imagined when the drugs were
first licensed. During the 1980s through the mid1990s, it was widely assumed that SSRIs regulated
serotonin and that regulating serotonin was the
promising method for warding off and curing
depression. But, the neurotransmission model of
depression has recently been broadly questioned
(Barondes 2003, 161; Kramer 2005, 18998).
Further, even if the neurotransmission model were
retained, with suitable revisions, for explaining
depression, there is considerable evidence that
SSRIs set off the brain chemistry balance of normal subjects. It becomes increasingly difficult to
accept that SSRIs simply rectify abnormalities in
serotonin transmission.
David Healy, British psychiatrist and former
secretary of the British Association for Psychopharmacology, has brought to the publics attention
SSRI studies with so-called normals. In some
cases these studies have been available for decades
(Grunberger and Saletu 1980; Saletu et al. 1986;
Warrington et al. 1989; Healy 2000). Healy adds
the results of his own research.
In a study conducted with non-depressive
volunteers, that is, subjects with no history of
depression, two out of twenty of the healthy

volunteers became suicidal after two weeks on

sertraline (Zoloft, Pfizer, New York, NY). Healy
conjectures that the probability that such an effect
is due to chance is P = .0000005 (Healy 2004,
17682, 190). Such studies strongly imply that,
even if the regulation of serotonin were the sole or
perhaps even the primary effect of sertraline, the
drug does something else besides regulating the
neurotransmitter. At this point, we must reserve
judgment as to the neurochemical effects that SSRIs induce. Fortunately, for our purposes, we need
not rely on the, as yet, provisional understanding
of SSRI neurochemistry. We are concerned with
before and after first-person descriptions of
SSRI subjects. For practical reasons, we tend to
recount more good responder descriptions because
of their abundance in the literature and because
such subjects, so improved, have more cause to
describe in detail the differences in self-awareness
between their before and after. But for both
good responders and bad responders, the same
effects may be noted and well- or ill-fitting models
of self-awareness considered.

A Recurrent SSRI Effect:

Lessening of Affective
Response in Favor of
Increased Cognitive/
Volitional Orientation
Let us review an apparent effect of SSRIs,
which appears both with good and poor SSRI
responders.
The testimony of SSRI good responders describe not so much a shift in affective response as
a change from affective to cognitive and volitional
orientation. The statements of these patients are
further supported by recent empirical studies,
which show an increase in the cognitive functioning of human subjects on SSRIs compared with
those taking non-SSRIs antidepressives (Levkovitz
et al. 2002, 34550), as well as by studies that
show an increase in cognitive functioning in nondepressed, head-injured patients given fluoxetine
over a period of several months (Horsfield et al.
2002, 33744).
Kramer already notes as much in the good
responder patients he reports on in Listening to

Hadreas / Husserlian Self-Awareness and SSRIs 45

Prozac. He writes: Prozac alters an additional

aspect of dysthymia that has been the subject of
little research but that stands out prominently in
case after case . . . we have met a series of people
who, however else they responded to Prozac, became more mentally adept (Kramer 1993, 236).
Of a patient he refers to as Sally, Kramer writes:
The most important effect of the medication,
Sally felt, was that it cleared her headmade her
more awake and aware, more confident of her
perceptions (Kramer 1993, 147). Sally states
that, The medicine helps me clarify problems.
It takes me less time to find positive solutions
(Kramer 1993, 147). A second Kramer good
responder, whom Kramer calls Paul says he has
become more decisive and resolute after treatment
with fluoxetine. Paul says that, I just feel strong. I
feel resilient. I feel confident. I can get bombarded
and still feel in one piece. I no longer lack resolve
when it comes to the children. This is who I am
(Kramer 1993, 219). Of a third good responder,
named Sonia, Kramer says she became more
fluent, more articulate, and better focused. . . .
Sonia said she had never enjoyed such a clarity of
thought (Kramer 1993, 237).
Elizabeth Wurtzel in Prozac Nation, thanks to
her indefatigable sense of humor, tells an engaging, often entertaining, tale of her long-standing
depression. Her unyielding atypical depression
as a matter of fact was surely less amusing to
live with. Theres little question that shes a good
responder. Prozac saved my life, she declares
(Wurtzel 1995, 343). She also indicates that her
newly gained well-being relies on constraining
excessive emotionality. Fluoxetine doesnt make
you happy but does make you not sad (Wurtzel
1995, 340). She describes her well-being as an inbetween state that holds her emotional extremes
in check (Wurtzel 1995, 340).
David Healy observes that the reduction of
emotionality may serve people who are overly
conscientious. One subject cannot leave work at
5:00 pm without anxiety because she takes too
much to heart her bosss comments. Healy notes
that, Prozac had produced a certain beneficial
nonchalance in her case (Healy 2004, 175).
Even so, the cognitivevolitional shift is not
therapeutic for all. For some it amounts to emo-

tional blunting. In Better Than Prozac (2003),

Samuel H. Barondes, professor of psychiatry and
neurobiology at University of California, San
Francisco, describes his patient, Clara. Shes a
self-declared good responder who, nonetheless,
has regrets because shes less passionate and
argumentative on the drug (Barondes 2003, 16).
She complains of a dull-witted indifference since
taking the SSRI (Barondes 2003, 154).
David Healy directly asks the twenty normal
subjects in his study whether their new use of
sertraline is accompanied by emotional blunting.
They respond with split reactions. Half of the
group says it gives them a nothing bothers me
feeling; others report it makes them feel emotionally dead (Healy 2004, 182).
Those who commit suicide while taking SSRIs,
fortunately, are rare. But, for Healy, these worst
case SSRI scenarios also suggest an emotional
blunting. Healy describes an eccentricity of those
who commit suicide while on SSRIs:
People who kill themselves by hanging ordinarily dont
do it in the middle of the night in a bedroom next to
the rest of their family. Nor do they throw themselves
out of fourth floor windows to land on concrete where
their children will likely find them. The common theme
. . . [is] lack of concern for those left behind. (Healy
2004, 186)

Such tragic suicides suggest a unique lack of

affect, which make SSRI suicides unlike other
suicides. And it is again a deficiency of affect that
Lauren Slater warns against in Prozac Diary.
Slater worries whether SSRIs induce a blunting of
empathy which dulls a concern for social injustice
(Slater 1998). Aristotle already had observed that
feelings of shame and moral indignation are developmental for ethical behavior (Aristotle 1984,
a31b10). Not surprisingly, Salter is concerned
that the blunting such emotions forebodes grave
social consequences.

Unsuitable Models of SelfAwareness for SSRI Good and

Bad Responders
As suggested by even this short survey of cases,
a shift from a more affective orientation to a cognitivevolitional one, for some, induces well-being,

46 PPP / Vol. 17, No. 1 / March 2010

and for others a loss of passion and empathy. But

regardless whether the response is therapeutic
or not, SSRI subjects descriptions fit poorly
with traditional models of self-consciousness, as
drawn from both the empiricist and rationalist
traditions.
The classical empiricist model of self is commonsensical and likely the first view one comes
to in explaining self-consciousness. It assumes a
perception paradigm of knowledge. Just as we can
perceive things in the world, so we can turn our
attention inward and apprehend our own recollections, fantasies, thoughts, feelings, pleasures,
pains, and desires. Self-consciousness becomes the
product of introspection. Philosophers from Locke
and Hume to Russell presume such a model (Hume
1888, 261; Locke 1952, II.vi, 131; Russell 1959,
357). Hume famously takes the approach far
enough to arrive at the conclusion that the identity
of the self is an illusion (Hume 1888, 259).
However, this model of self-consciousness fits
poorly with the descriptions of the SSRI subjects
we have considered. If the empirical model of the
self were viable, we would expect a reinterpretation of self based on the new post-SSRI introspective data. But, in the case of the bona fide good
responders, there is not just a collection of new
post-fluoxetine introspections, which alter the
notion of self. SSRI good responders say that the
drugs do not change who they are, but rather enables them to be themselves with less impediments.
If anything, good responders say that SSRIs enable
them to be their true selves. Sally, for example
says, I am myself, but no longer shut out of everything. I am more comfortable in myselfnot
empty inside (Kramer 1993, 196).
Less than perfect good responders, such as
Elizabeth Wurtzel, do not see fluoxetine as uncovering her true self. She sees it as cutting deeply
into her sense of personal identity and her capacity
to cope. Wurtzels first and only suicide attempt
occurs soon after she takes fluoxetine. According
to Wurtzel, ironically, the attempt was motivated
by the prospect of giving up the belief that the
only way anything got attended to was if it had
reached a point of complete desperation (Wurtzel
1995, 326). It is as if fluoxetine tempts Wurtzel
with abandoning her former coping strategy. Long

enough on fluoxetine, Wurtzels sense of well-being

profoundly improves. But only on the drug for a
few weeks, she views the departure of earlier coping strategies as an abandonment of her fragile,
but familiar, capacity to manage her life.
The two normals about whom Healy reports
that become suicidal after two weeks on sertraline
are even more perplexing given the empiricist
model of the self. Presumably, in the two weeks
in which they become suicidal, they culled an unbearable collection of introspective data. Thanks
to Healys experiment with normals, we have
first-person accounts of their dangerous mood
shifts. The subject Healy calls Joanna develops
increasingly horrific ideation. First, Joanna has
vivid dreams of killing herself. By the second week
on sertraline, for three successive nights Joanna
dreams of slitting her throat open and bleeding
to death in the bed beside her partner (Healy
2004, 182-3). In her diary, she records that she
had become two selves, an adult and a child, and
the adult can only watch while the child responds
impulsively and emotionally (Healy 2004,183).
The second normal, named Max, who precariously veers toward suicide on sertraline, first
becomes recklessly aggressive, an uncharacteristic
behavior for her. Driving home after shopping with
her mother, Max confronts a group of teenage
boys who accost her with obscene gestures and
remarks. Max reacts by stopping the car in the
middle of traffic, confronting one of the teenagers,
and telling him if he continues shell deck him
(Healy 2004, 184). The empiricist model of self
tells us that this behavior would follow upon a
reassessment of self as formed out of a generalization based on new internal facts. But much more
happens than this. Maxs mother, who is with her
when Max confronts the teenagers, knows that,
ordinarily, her daughter would understand that
such assertiveness is reckless. The young hoodlums might readily retaliate with slashed tires or
a brick through the window. Nonetheless, Maxs
changed self erupts out of the circumstances. If
the empiricist model held, we would expect an
induction from introspective data, but what we
get is rather a confrontation with a new self, for
Joanna, an over-emotional child, and for Max,
an urban warrior.

Hadreas / Husserlian Self-Awareness and SSRIs 47

Although often presented as a polar opposite

to empiricism, the traditional rationalist does no
better than the empiricist in providing a model
for explaining the shift in self-understanding that
SSRIs induce. Whereas perceptual knowledge is
the paradigm for the empiricist, the paradigm for
the rationalist is mathematical knowledge. From
Descartes to Kant, rationalist thought finds in selfconsciousness the grounds for a priori knowledge.
First, classical rationalism maintains that it is the
essence of the human mind to entertain and form
thoughts, not perceptual experiences. Second,
thoughts are constituted out of ideas or concepts.
And third, the mind is transparent to itself. The
mind both constructs and maintains concepts.
Ultimately, self-consciousness amounts to the
self-reflexive construction of concepts. Leibniz
proposes a prototypical version of the rationalist
model of self-awareness in the Monadology, 30: It
is . . . through the knowledge of necessary truths
and through their abstraction from merely sensuous matters that we are raised to reflexive acts,
which enable us to think of what is called I and
to consider that this or that lies within ourselves
(Rescher 1991, 110-1).
The rationalist paradigm of self-consciousness
seems to come closer to the experiences of SSRI
subjects. The SSRI subjects do confront their
new selves as a given. But, it is hardly intuited as
a fait accompli. For good responders, is it rather
a newly found conviction that their self is a self
that is capable of coping. But their self is not a
transparent, self-contained identity. It is rather
given as a potentiality for handling circumstances,
even if, in the case of SSRI worst responders, the
management of circumstances prompts plans for
self-destruction.
Further, the intuited sense of self does not enter
into the SSRI subjects mental life immediately
upon self-reflection as Descartes cogito. It requires
some time to emerge, typically some two to four
weeks for good responders. Even the calamitous
self-reconception of Healys two suicidal normals,
Joanna and Max, takes more than a week to fully
emerge (Healy 2004, 1835).

Husserl on Self-Awareness
How does the Husserlian concept of selfawareness help in understanding the testimony
of SSRIs good and bad responders? First a note
as to the sources of Husserls reflection on selfawareness. As Husserl scholar Dan Zahavi rightly
notes, Husserls views on self-awareness are not
adequately contained in the writings published
in his lifetime but in the posthumously published
volumes of Husserliana as well as in manuscripts
still left unpublished (Zahavi 1999, 50). Even so
Husserls views on self-awareness have given rise
to intense debates and schools of interpretation.
How so? Zahavis response is worth quoting. He
states that, One answer is that self-awareness is
not simply a but rather the fundamental problem
of phenomenology (Zahavi 1999, 50).
In fact Husserl investigates and offers innovative explications regarding the notion of selfconsciousness as offered by both the empiricist and
rationalist camps. Husserl has plenty to say about
how the empirical Ego of the empiricists3 arises
as well as how the pure Ego of the rationalists is
intuited.4 Zahavis saying that self-awareness .
. . is the fundamental problem of phenomenology is warranted. We should also add that it is
fundamental inasmuch as Husserl offers innovative work on both the empiricist and rationalist
approach, as well as on a third approach, which
would ground the two traditional camps. Husserls most significant contribution to the topic of
self-awareness likely lies in his developing a prereflective self, which grounds, and is a necessary
condition for, both the empiricist and rationalist
notions of self.
Husserl, like William James, came to found consciousness on a subtle level of strivings, urges, and
endeavors. James understood these pre-conscious
tendencies as fringe promptings of furtherance
or forbearance (James 1890/1948, Feelings of
Tendency, 16187). Husserl instead describes
these pre-consciousness tendencies as striving
(Streben).
The ordinary experience of breathing provides
an example for observing pre-objective strivings.
The impulse to breathe is not so much a desire, as
a tendency, an urge, a prompting. It is not directed

48 PPP / Vol. 17, No. 1 / March 2010

toward a conscious object or goal. Yet it has an

lan, what James calls a furtherance. An uneasiness prompts inhalation, resulting in a passing satisfaction. But, again, there is ordinarily no distinct
reflection on taking pleasure in the inhalation. It
is a pre-reflective striving in Husserls language.
Exhalation similarly begins as a hiatus, a momentary pause, which turns into an urge to inhale.
All this takes place pre-objectively inasmuch as it
involves no intentional or conscious desideratum.
If we have difficulty breathing, we shift into the
fully unfurled subjectobject relation. We seek an
object. Catching a breath is a profoundly sought
after goal. And, in our desperation to breathe,
we emerge as an intensely self-consciousness ego
seeking some object as a remedy. Struggling for
breath, one single-pointedly tries to throw off the
smothering pillow or to swim to the lakes surface
to gasp for air.
Pre-reflective life does not involve self-consciousness either in the empiricist sense of a selfconception, which draws on mental facts, nor
in the rationalist sense of a cogito intuited from
reflecting on mental acts. However, pre-reflective
life does convey a manner of self-awareness. We
encounter this in experiences when habitual behavior, such as breathing, goes awry. It does not
require an act of reflection for awareness. Prereflective life does not need an act of reflection for
self-awareness because it is, from the beginning, a
feel of experience. Striving presumes minutiae of
satisfactions, frustrations, and fulfillments, which
add up to an immediate self-affectivity. Husserl
writes in a late manuscript:
I recover an I, that had not yet carried out reflection,
nor yet carried out an act of self-consciousness, but
rather a background self-consciousness, as sensed from
a primal affectivity [Uraffektion] and a primal sensory
given [Urhyle], etc. (my trans., Husserl 1973c, 78).

In his later investigations, Husserl refers to

life (Leben) itself, in general, as a confluence of
subjective strivings in face of worldly resistances
or accommodations. Striving in its manifold
modalities determines the life of the I, as Husserl
writes (Husserl 1973b, 172).5
An awareness of this pre-reflective confluence
of strivings and resistances makes up what Husserl
calls sometimes the subjectivity of a life. And,

the empiricists notion self-awareness as well as

the rationalists notion of a pure Ego, in different
ways depend on it. He writes in Ideas II:
But even abstracting from the associative nexuses, the
Ego constituted in reflection refers back to another one.
Properly spoken, I am originally not a unity composed
of associative and active experience (if experience means
the same as it does in the case of the thing). I am the
subject of my life, and the subject develops by living.
(Husserl 1952/1989, 264)

Returning to the topic, then, the behavior of

SSRIs good and bad fluoxetine responders implies this pre-reflective self-awareness. The good
respondersSally, Paul, and Sonianot surprisingly, evaluated empirically who they were before
they took fluoxetine. They had already culled a
so-called empirical self. Sally says: I am very, very
anxious, I am afraid of everything, even centipedes
and roaches. In Pauls case, his empirical self
included a self-attribution of lack of self-respect
and self-confidence. For Sonia, her own sense was
that she was disorganized and tongue tied. After
taking SSRIs, over time, Paul, Sally, and Sonia
came to revise their empirical selves. But these
revisions were based in subtle shifts in their prereflective strivings, hindrances, accommodations,
and resistances. In other words, their revisions
were based in what Husserl calls, the subject of
my life.
The same good responders to SSRIs say that
the drugs do not change who they are, but rather
enable them to be themselves with fewer impediments. We would expect, as these good responders
state, that they do not change their sense of who
they are, but rather they have a sense of being
more themselves, especially as relates to their cognitive and volitional activity. The administration
of SSRIs does not lead to a sense of change of self,
but a sense of a self more successfully realized.
It also should not be surprising then that delayed
good responders, such as Elizabeth Wurtzel, do not
see fluoxetine as uncovering her true self. As noted,
Wurtzels first and only suicide attempt occurs soon
after she takes fluoxetine. Once on fluoxetine,
Wurtzel notices a difference in her behavior that
she conceptualizes as presaging the abandonment
of those who love her. She says, the only way
anything got attended to was if it had reached a

Hadreas / Husserlian Self-Awareness and SSRIs 49

point of complete desperation (Wurtzel 1995,

326). It is not that fluoxetine had failed to work
yet. Rather, it worked first on the pre-reflective
self that we are calling after Husserl the subject
of my life. Wurtzel first conceptualized this new
self-awareness as antagonistic to her own interests,
because it threatened the loss of the care givers on
whom she has relied. Only later does she realize
that this new sense of self is actually in keeping
with her interests. She says, It took a long time
for me to get used to my contentedness. It was hard
for me to formulate a way of being and thinking
in which the starting point was not depression
(Wurtzel 1995, 329). In fact, Wurtzel was adjusting
to a new way of conceptualizing her self, that is,
a new empirical self. It was first met with distrust
and then with acceptance. But the first dubious
then acceptable new self-conception was grounded
in the same fluoxetine induced pre-reflective selfawareness that, in its everyday strivings, urges, and
endeavors, was, in truth, less impeded.
The so-called paradoxical cases, the two
normals who became suicidal after two weeks
on sertraline, also require a pre-reflective background self to make sense of their behavior. As
mentioned, the subject Healy calls Joanna develops
increasingly horrific ideation. Like breathing, the
pre-reflective self continues to strive, encountering
furtherances and forebearances. For some subjects
such as Sally, Paul, and Sonia, there is a release
from hindrances. But for others, such as Joanna,
there is ideation of violence and self-mutilation.
We need not speculate as to the neurochemistry
that foments such ideation. What is key is that it
is immediate. For all the talk of the weeks required
for SSRIs to work, the effects of the drugs on the
pre-reflective self would seem to be quicker. In fact,
Joanna records in her diary that she had become
two selves, an adult and a child (Healy 2004, 183).
This is the result of reflection upon a week and a
half of nightmarish ideation. Were it not for her
pre-SSRI empirical sense of self, she, like those
teenagers, who have not yet had enough experience to construct a strong empirical self, would be
left with an uncritical intuition of the subject of
my life with, perhaps, disastrous results.
Husserls pre-reflective self is suggested especially in the case of Healys second normal, Max.

Recall that Max on sertraline became dangerously

aggressive, an uncharacteristic behavior for her.
Max confronted teenage boys who accosted her
with obscene gestures and remarks. She stopped
her car, telling one of the teenagers if he continued
she would deck him (Healy 2004, 184). This
behavior was a new and compelling way for Max
to deal with hindrances and hardly the result of
a deliberation of Maxs to conduct her life more
confrontationally. Moment by moment, she found
she might confront obstacles differently. She experienced an emboldening in her striving, especially
when those foes were understood to be morally
blameworthy. Later, this pre-reflective audaciousness leads Max to an empirical generalization.
She knew she had gone past mere assertiveness
(Healy 2004, 184). But this empirical generalization occurs after-the-fact vis--vis Maxs new style
of striving. A new, empirical self-conception follows a change in pre-reflective endeavoring, whose
immediate awareness might be better understood
not as self-conception but as self-affectivity.
This leads us to take seriously the advice that
Elizabeth Wurtzel offers at the end of Prozac
Nation. Wurtzel admonishes that fluoxetine is
suitable only after experiencing depression, trying
exhaustively to end it, and finding that nothing else
really works. Her point is not that SSRIs should
be a last resort. Rather, we should learn who we
are first so as to assess how we have changed on
fluoxetine (Wurtzel 1995, 360). In terms used here,
SSRI subjects are better off having lived enough of
life to have formed, for better or worse, an abiding
empirical ego. If the empirical ego is mature, SSRI
subjects will meet the new subject of their life,
even as a subject who is better than well with
some critical distance. As such, they will be able
to enjoy the SSRI cures as well as acknowledge
the SSRI poor responses.

Notes
1. Other SSRIs currently prescribed in the United
States besides fluoxetine hydrochloride (Prozac) are
sertraline (Zoloft), paroxetine (Paxil), fluvoxamine
maleate (Luvox), and citalopram (Celexa). We follow
the current tendency to lump SSRIs into the same class
designation. However, it should be noted that it has been
demonstrated that these drugs, although all curtailing
serotonin reuptake, differ in their effects upon other

50 PPP / Vol. 17, No. 1 / March 2010

neurotransmitters. Sertraline, unlike the others listed,

inhibits dopamine reuptake more than norepinephrine.
It also, more than the rest, inhibits histamine reuptake.
Paroxetine, unlike the rest, likely has anticholingeric effects. See Tollefson and Rosenbaum (2001, pp. 289).
2. In setting aside the empiricist and rationalist paradigms in favor of a different model of self-consciousness,
I am not proposing a novel contrast in models of consciousness. The inadequacies of empiricist and rationalist concepts of self-consciousness were noted early
in the history of psychology. Although William James
(1912, 41ff) finally characterized his own epistemological orientation as radical empiricism, he specifically
contrasts it with classical rationalism and traditional
empiricism. Among phenomenologists, Merleau-Ponty
in Phenomenology of Perception presents the empiricist
and rational points of view as antinomies that lead to
the misinterpretation of first-person reports as well as
to misunderstandings of behavioral and neurological
data (Merleau-Ponty 1989). Nonetheless, the opposition between empiricism and rationalism remains
instructive, especially as applied to self-awareness for
several reasons.
First, traditional empiricist and rationalist perspectives in modern philosophy and philosophical psychology are far from dead. Consider Chomsky (1975),
Cottingham (1984), Carruthers (1992), and Bonjour
(1998). Second, the antinomy of empiricism and rationalism does, and likely will, continue to beleaguer
researchers models of consciousness because of confusions prompted by ordinary language. As Wittgenstein
showed the alleged logically privileged status of firstperson experience builds upon false analogies between
various ordinary language usages (e.g., see Wittgenstein
1965, 489). Third, as will be discussed, the empiricist
and rationalist positions are not so much false as derivative upon a pre-reflective self, which Husserl sometimes
calls the subject of my life.
3. Husserl develops the empiricists approach to
self-awareness in a discussion of how we constitute
ourselves as persons. He pointedly contrasts this type
of self-awareness with the intuited self-awareness of a
pure Ego. Husserl writes for example in Ideas II:
In order to know what a human being is or what I myself
am as a human personality, I have to enter into an infinity
of experience in which I come to know myself under ever
new aspects, according to ever new properties, and in an
ever more perfect way. Only this experience can exhibit (or
perhaps repudiate) what I am and even that I am. . . . On
the other hand, in order to know that the pure Ego is and
what it is, no ever so great accumulation of self-experience
can profit me more than the single experience of one sole
and simple cogito. (Husserl 1989/1952, 111)

4. The origins of Husserls many different senses

of a pure ego are indicated in the Fourth Meditation
of Cartesian Meditations. In 30, Husserl describes
a transcendental Ego that, like Kants transcendental
Ego, a priori must be presumed by experience given
the unity of the sense of self (Husserl 1973a/1950, 65).
In the following section, 31, subtitled The Ego as
Identical Pole of the Subjective Processes, we find a
sense of self-awareness, that, like Descartes cogito, is
continuously constituting himself as existing (Husserl
1973a/1950, 66).
5. German text: Streben in seinem mannigfachen
Modalitten macht das Leben des Ich aus; Consider
also Ms. A VI 26, p. 42a: All life is continuous striving, all satisfaction transitory. German text: Alles
Leben ist unaufhrliches Streben, alle Befriedigung ist
Durchgangsbefriedigung. Ms. A VI 26, p. 42b: Life is
striving in the manifold forms and contents of intention
and fulfillment; in the broadest sense, [it is] pleasure in
fulfillment; in the lack of fulfillment, [life is] a tending
toward pleasure as a pure striving that desires or as a
striving that slackens off in the realization that fulfills
it and that accomplishes its purposes in the process
of the realization of the life-form of pleasure with its
release of tension. German text: Leben ist Streben in
mannigfaltigen Formen und Gehalten der Intention und
Erfllung; in der Erfllung im weitesten Sinne Lust, in
der Unerflltheit Hintendieren auf Lust als rein begehrendes Streben oder als sich im erfllended Realisieren
entspannendes Streben und sich erzielend im Proze der
Realisierung der in sich entspannten Lebensform der
Lust. For the manuscript citation and translation I am
indebted to Mensch 1998, notes 5 and 6, 2312.

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