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What can history offer 21st century psychiatry? Can practitioners and patients today benefit from a clearer understanding of psychiatry’s past? It can be challenging to bridge the disciplinary chasm separating history and psychiatry, despite the fact that historians and psychiatrists have much in common. Both are charged with the task of trying to understand struggles that affect their subjects’ minds, bodies, and souls. Both spend an inordinate amount of time studying people, tracking clues, and piecing together fragmentary evidence to make sense of a situation that might otherwise seem incomprehensible. 2 Disciplines, 2 PathsIn the last 50 years, however, history and psychiatry have followed divergent paths. Perhaps the greatest fault line resides in each discipline’s relation to ideas of science and progress. Until the 20th century, medical history was usually written by and for doctors. It documented the progress of medicine, honouring the discoveries, brilliant minds, and technological developments that made advances possible. This version of the past projected a hopeful future and a grandiose positivism—a belief that, in time, physicians would uncover natural laws that could explain definitively how humans worked, why they hurt, and how they could be healed. Valorizing medicine’s past, the Whig approach replicated in other histories of this time, gave physicians a stake in a heritage that celebrated who they were and what they did (1,2). The decline of the clinician-historian, the rise of professional historians in the early 20th century, and the development of social history in the 1960s and 1970s upended conventional approaches. Young scholars questioned how the conflation of history with progress accounted for war, poverty, and the many social movements that rippled through the Western world. Despite the passage of time and the achievements of “great men,” millions were suffering and millions more were angry. Scholars committed themselves to writing history that recognized the situational differences of a heterogeneous population; the history of doctors clearly told us little about patients and other health practitioners and almost nothing about race, power, gender, and class. In addition, as historians increasingly rejected the notion of progress as a useful or even unifying paradigm, they began to evaluate how medical attitudes and practices were historical contingencies, by-products of specific contexts. In this rendering, the present was neither inevitable nor immutable nor preferable; rather, it was a history whose making or “construction” needed to be critically assessed. The unleashing of social constructionism invited a reexamination of the development of psychiatry. The work of Michel Foucault, Thomas Szasz, and DL Rosenhan, among others, questioned the validity of psychiatric authority (3–5). In Women and Madness (6), feminist activist Phyllis Chesler suggested that the psychiatric establishment—its diagnoses, legal and moral stature, institutions, and treatments—had worked to contain and control women. At a professional meeting in 1970, Chesler demanded reparations on behalf of female patients
Not all of these reevaluations have been so tendentious. Last Resort (7), Jack Pressman’s acclaimed history of lobotomy, rejects the polarities of good and bad to explain why at least 20 000 lobotomies were performed in the US between 1936 and the mid-1950s. In a prechlorpromazine age, doctors, families, and many patients regarded lobotomy as good science. “Desperate circumstances,” insisted Pressman, “justified drastic acts” (7, p 2). Joel Braslow’s Mental Ills and Bodily Cures (8) looks at the treatment of ward patients in Stockton State Hospital in California in the first half of the 20th century. Sifting through patient records, he shows how contemporary understandings of science, economic imperatives, and cultural prejudices informed therapeutic decisions and propelled doctors toward somatic interventions (8). Elizabeth Lunbeck examines hospital records to chronicle the evolution of psychiatry’s cultural authority across 2 centuries. Her objective has been “to trace, not to condemn, the consolidation of a recognizably modern psychiatric point of view in early 20th-century institutional practice” (9, p 6). Other scholars, including Allan Young, Paul Lerner, and Mark Micale, have done important and careful work elucidating the social and intellectual construction of mental disorders in the 20th century (10,11). It is essential to situate the writings of scholars such as Foucault and Szasz in historical context, to understand them as a reaction, in part, to the rise of biological psychiatry. Until the mid-20th century, the discipline’s claims to science were tenuous. Psychiatry lacked the standardized nosology, scientific rhetoric, and heroic success stories of other medical specialties. It also lacked prestige. Canadian psychiatrist Heinz Lehmann, the first North American to publish on the effects of chlorpromazine and imipramine, recalled how, in the 1930s his father chafed at his son’s choice of fields. Psychiatry in 1930 was “a rather derelict career. People only went there if they couldn’t do anything else—or were alcoholic” (12, p 16;13). Many psychiatrists have shared with me their impression that before the biological turn, psychiatry was regarded as a field lacking respect and intellectual rigour (14). The biological revolution that began after World War II transformed this view. In just a few decades, the psychoanalytic orientation prevalent in Canadian and US psychiatric hospitals and universities gave way to organic explanations of and treatments for mental illness. Suffering that had at times defied words was codified by psychiatrists into universal symptoms that connoted discrete biologically based entities. The publication in 1980 of the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders encapsulated the new approach. It abandoned the “presumed etiology” of the second edition for rigid diagnostic criteria based on descriptive psychopathology (15–17). At the same time, psychiatrists invoked the rhetoric and findings of neuroscience to explain psychiatric illness. The explanatory power of “blaming Mommy” was quashed by the more forgiving possibilities of the “broken brain.” The suggestion that psychiatric disorders had neurobiological origins served to destigmatize mental illness, for it defined them, in the words of Nancy Andreasen, as diseases “in the same sense that cancer or high blood pressure are diseases” (18, p 8). If malfunctioning brains rather than bad character or upbringing are to blame, it follows that those afflicted deserve dignity and medical attention, not societal opprobrium (18). Biochemical explanations encouraged pharmaceutical solutions. Chemical deficits could, in theory, be modified, even corrected. It was no accident that the rise of biological psychiatry as theory went hand in hand with the rise of psychopharmacology as practice (19). In recent years, the embracing of evidence-based medicine in psychiatry, marked in part by the appearance in 1998 of a psychiatry journal devoted to its practice, has shored up the discipline’s scientific credentials (20). Grounded in what is claimed to be objective data, psychiatrists’ recommendations eschew the ostensible pitfalls of clinician subjectivity. Evidence-based psychiatry relies on data collected from randomized controlled trials, whose findings remain the gold standard for determining the efficacy of particular therapies (21,22). At the dawn of the 21st century, the rhetoric of biological psychiatry remains wedded to the promises of neuroscience, standardization, and objectivity. Meanwhile, historians continue to question the legitimacy of medicine’s scientific claims by elucidating how disease categories, diagnostic technologies, medical knowledge, and therapies have been socially constructed. If there are bridges to be built, one must be constructed on the scaffolding of the obvious: psychiatrists are not a monolithic group, and their theories and therapies vary. Few psychiatrists would identify themselves as technicians rather than autonomous practitioners: almost by default, clinicians blend hands-on experience with evidence-based medicine; almost all concede the value of an individualized approach to patient treatment; a few openly admit that theory is secondary to finding treatment plans that work. Public debates on market-driven science, evidence-based medicine, and randomized controlled trials posit extremes as the appropriate parameters for debate, forgetting the nuances and subtleties that characterize the more populated middle ground. Within psychiatry, many have raised concerns about the field’s future that echo those of historians (20,22–24). In the dozens of interviews I’ve done with psychiatrists, men and women who entered the profession in the 1950s and 1960s are often Clio’s most diligent students, describing their work with a skepticism groomed by an appreciation of the fickleness of history. Have we become so attached to the brain that we have forgotten the human who houses it? What chance do older, off-patent therapies have in a profit-driven market? How will psychiatrists 50 years from now judge what we do? Luminaries in the field have raised these questions without prodding. Some, indeed, seem haunted by them. Perhaps the best lesson to be learned from this is that the rhetoric of scientific certainty does not translate seamlessly into the unpredictable rhythms of psychiatric practice. A vast gulf separates the universality of textbook psychiatry and the vicissitudes of clinical encounters. A new and important anthology edited by Jacalyn Duffin illustrates the myriad ways the turbulence of history can inform clinical practice (2). Many of the 23 clinicians whose stories she collected have found comfort in history—not the history of venerated and glorious accomplishments but a history that, intriguingly, connects them to generations of doctors who rose each morning to face fear, uncertainty, and clinical doubt. One of history’s virtues, Duffin writes, is that it “provides a strong antidote to the arrogance that tracks medical life like an occupational hazard” (2, p 10). Whether or not this arrogance is intrinsic to all medical fields, it has left its mark on psychiatry. Psychiatrists take stock of their discipline’s achievements by distancing themselves from and, at times, denouncing their past. Things are better because they are not what they were (9). Exploring the history of meprobamate and the benzodiazepines through archival evidence, oral histories, media and periodical reports, and political investigations, I want to suggest that history continues to have import for psychiatrists. History can illuminate the complex and often troubling ways ideas about psychiatric therapies—what is unacceptable, risky, or safe—become normalized in different constituencies. The creation of new therapeutic paradigms often depends on forces as much outside as within psychiatry. Thorazine “worked” because it helped seriously ill people but also because it was regarded as more humane than lobotomies and permitted the deinstitutionalization of patients previously cared for at taxpayers’ expense (25). By the same token, the stigmatization of a drug as dangerous—as happened to LSD in the 1960s and the benzodiazepines by the late 1970s—may tell us more about the politics of the society that passed judgment on it than about the drug’s chemical ability to alter mood and behaviour. In the age of biological psychiatry, social, political, and economic circumstances continue to be as important as biochemical responses in deciding a drug’s fate. Anxiety in HistoryTransport yourself back to the state of Virginia in 1862. You are young. You are male. Your misfortune is to be a Union soldier at a point during the Civil War when, by all accounts, the Confederacy is winning. Your regiment is preparing to fight again, this time at Fredericksburg. You survive, but, in another decisive Confederate victory, the Union you are fighting for suffers 12 000 casualties. Before you go to Fredericksburg, you get diarrhea. After the battle, you remember the sounds of screams fading into silence, the sight of shattered limbs, the smell of urine and blood. This was the experience of WWH, whose symptoms were recorded by his attending physician, Jacob Mendez Da Costa. After Fredericksburg, WWH was seized with lancinating pains in the cardiac region, so intense that he was obliged to throw himself down upon the ground, and with palpitation. The symptoms frequently returned while on the march, were attended with dimness of vision and giddiness, and obliged him often to fall out of his company and ride in the ambulance (26). Detecting no sign of physiological disease, Da Costa focused on the patient’s cardiac symptoms and concluded that it was “most likely that the heart has become irritable, from its overactivation and frequent excitement and that disordered innervation keeps it so” (26). Da Costa called this “irritable heart syndrome,” a condition he encountered in some 300 soldiers referred to his care but which he believed also existed in the civilian population. Primary symptoms were shortness of breath, palpitations, respiratory problems, and nervous and digestive disorders. Da Costa treated the syndrome with drugs at his disposal: digitalis, belladonna, opium, strichnine, and acetate of lead, among others (26–29). Today, WWH would be diagnosed as suffering from anxiety, but when Da Costa’s article on irritable heart syndrome was published in 1871 (making it one of the first studies of war-related illness and nervous conditions), the nosology of modern psychiatry had not been written. That doesn’t mean that what WWH complained of is unrecognizable or irrelevant. Rather, Da Costa’s observations and WWH’s predicament underscore both the timelessness of anxiety and the unique circumstances that locate psychiatric disorders in history. Men and women have complained of anxiety since the dawn of time. Fears of pain, solitude, ridicule, grief, and death have shaped the prose of great poets, have coloured artists’ visions, and have haunted the words of the dying. Anxiety has followed soldiers onto battlefields and clouded the minds of parents wondering why their child is late from school, from work, or from a date. For most of us, merely being born human destines us to confront anxiety as part of what it means to be alive. However, anxiety also has a history, for how it has been described, interpreted, and treated has changed dramatically. Before the arrival of blockbuster tranquilizers in the 1950s, people relied on several strategies to tame tension. Some eschewed chemical interventions, seeking solace in the comforts of the mind, spirit, and flesh. By the late 19th century, when Boston physician George Miller Beard first coined the term “neurasthenia” to describe “weakness of the nerves,” unregulated sedatives such as bromide salts, ethyl alcohol, and opiates were common remedies for relief (30). By the early 20th century, barbiturates available in dozens of formulae and brands on European and American markets had been added to the arsenals of the anxious. No one doubted that barbiturates had a calming effect, but their side effects—sedation, a potential for dependence, and life-threatening toxicity with overdose—deservedly marked them as risky drugs that jeopardized the health and functionality of users (31). A 1951 article in The New York Times declared barbiturates to be more dangerous than heroin or cocaine (32). The debut of Miltown (meprobamate) in 1955 was a turning point in the history of psychopharmacology. Its success was largely due to the long-standing desire of men and women to attenuate anxiety, but it was also made possible because of changing social values, rising consumer expectations, and the burgeoning authority of pharmaceutical science. Indeed, to confine the history of pscyhopharmacology to medical theory, the laboratory, and physicians is to disconnect it from the very world that gave it meaning. In much of North America and Europe, the decade of the 1950s was an era of unprecedented prosperity but also of uncertainty: suburban bombshelters, duck-and-cover drills, and dog tags for children coexisted with postwar economic expansion, a baby boom, and a consumer bonanza that promised citizens a range of new material and social comforts. Buoying American optimism were significant advances in science and medicine. The thalidomide disaster had yet to occur, and Americans understandably seized on pharmaceutical innovations as a symbol of the practical possibilities of scientific progress and research. Antibiotics, cortisone, the Salk vaccine—these and other laboratory triumphs helped offset the gloom-and-doom prophecies of nuclear disaster. An expectant public waited hopefully for the next pharmaceutical breakthrough. In this context—a time when international tensions were rising, psychoanalysis ruled the psychiatric establishment, and the realization that millions took dangerous and addictive barbiturates was headline news, but also a time when consumers were less cynical about pharmaceutical creations than they are now—Miltown, created by Frank Berger, was born. It was a complicated delivery. Berger’s employer, Wallace Laboratories (a New Jersey subsidiary of Carter Products, whose chief claim to fame was Carter’s Little Liver Pills), was reluctant to give Berger financial support to bring the drug to market. When Berger created Miltown in 1950, there was no preexisting market for prescription-only tranquilizers, and newly adopted US Food and Drug Administration guidelines meant that meprobamate would be available only by prescription (33–35). This was new territory for drug companies, and Carter executives were worried. Who needed a pill to get by? This suspicion was compounded by the company’s own data. Wallace had conducted an advance poll of physicians, most of whom had expressed unwillingness to prescribe a drug for anxiety. Executives wondered whether a pharmaceutical market for anxiety was commercially tenable. Unsure, Carter Products shelved the drug (31). Berger persevered. In 1955, executives at Wyeth learned about meprobamate at a professional meeting in San Francisco. There, Berger unveiled a film showing Rhesus monkeys in 3 distinct chemical states: naturally vicious, unconscious on barbiturates, and calm but awake on Miltown. What worked for monkeys presumably worked for humans. With Wyeth paying a hefty sum to license meprobamate as Equanil, Carter Products brought out Miltown, 5 years after Berger and Carter chemist Bernie Ludwig had initially concocted their chemical compound. The hiatus between the drug’s creation and its launch challenges sweeping claims that minor tranquilizers were hatched by men chiefly to pacify women—a less invasive, but no less insidious, measure of control than earlier “heroic” somatic treatments such as electroconvulsive therapy or lobotomy. The gendered parameters of the tranquilizer market were clear by the late 1960s, but they were never preordained, and they were far from obvious to pharmaceutical executives in the 1950s. Indeed, pharmaceutical firms had no financial incentive to confine tranquilizers to a “woman’s market”: the surest path to profits was to position tranquilizers as a drug suitable for all anxious Americans—as a versatile drug that a wide swath of the medical profession, not just psychiatrists, would prescribe. Never conceived simply as a tool to tame women, tranquilizers were a medical technology that became feminized in a complicated process that included a wide range of historical actors. Miltown became an overnight sensation, the first psychotropic wonder drug in medical history. In the US, more than 35 million prescriptions were sold in 1957 alone, the equivalent of one prescription per second. In Japan, where direct-to-consumer advertising was legal, billboards at busy Tokyo intersections directed stalled motorists and running-scared pedestrians to take Miltown to combat the stresses of urban life. In the largest of cities and smallest of towns, script-toting patients hungry for made-to-order tranquility emptied drugstores of their supplies and forced startled pharmacists to post signs reading “out of Miltown” and “more Miltown tomorrow” (36–39). Everyone—businessmen, housewives, doctors, even celebrities—praised their “tranks.” In New York, the drug’s fanatical following among the white-collar weary earned it the nickname “Executive Excedrin.” In Hollywood, “Miltown” Berle, a daily devotee, assured millions of televison viewers that they were addicted only if they were taking more than their doctors. Journalists and doctors insisted that the drug was not habit-forming. For patients who complained that Miltown left them groggy, there was more good news. The drug firm CIBA announced that its new drug, Ritalin (methylphenidate), kept tranquilized patients alert. By all accounts, meprobamate fulfilled the promise of better living through chemistry. Once again, it seemed that pharmaceutical science was paving the way for a better future (40). A 1955 article in the Journal of the American Medical Association (41) found that Miltown reduced tension, anxiety, depression, menstrual stress, psychosomatic symptoms, and insomnia. It augmented rather than undermined psychotherapy: “all patients become more responsive to suggestion, to hypnosis, and to free association (conversational or discursive therapy)” (41, p 1595). Equating consumer demand with genuine medical need, Newsweek suggested that the drug’s market success proved how many patients had previously suffered (36). Writing for Cosmopolitan (42) (at the time a more mainstream periodical than it is today), Donald Cooley captured contemporaries’ excitement. Cooley touted the new pills as “just the thing” for “tension-ridden, nervous patients: perfectly normal people who need temporary help” (42, p 70). The “peace pills,” “happiness pills,” and “emotional aspirin” as meprobamate was nicknamed, would promote health and productivity. Might tranquilizers be psychiatry’s penicillin? Eager to cash in on Miltown mania, other pharmaceutical firms hopped aboard the tranquilizer bandwagon. Many were still struggling to create a solid financial foundation and were searching for reliable “round-the-clockers,” that is, drugs patients would take for habitual disorders such as hypertension, arthritis, and hypothyroidism. Miltown’s success suggested that anxiety, too, could become part of this coveted list. Executives commanded their top scientists to invent compounds similar to Miltown but faster-acting, stronger, safer, and less sedating. The company that best met the challenge was Hoffman La-Roche. At the Swiss corporation’s campus in Nutley, New Jersey, Leo Sternbach was cleaning up his laboratory when an assistant stumbled across a compound Sternbach had experimented with years earlier. On a whim, Sternbach sent it for screening to Lowell Randall, the head of pharmacology. Randall’s news was encouraging. More potent but less sedating than meprobamate, the compound was tested on mice, wild cats, outpatient “neurotics,” and male prisoners in Texas before being brought to market in 1960 as Librium (chlordiazepoxide), from the word “equilibrium.” It was the first of the benzodiazepines (43). As historian Edward Shorter has noted, the commercial context of the discovery of benzodiazepines sets them apart from other drugs of this era, whose development was often supported by university researchers and hefty government grants, then the emblems of impartial science (31). Psychiatrist Irvin Cohen, who ran clinical trials on Librium, perspicaciously observed that the benzodiazepines were “a model of how a therapeutic agent is conceived and brought forth by an enterprising pharmaceutical manufacturer who simply seeks to find a drug superior to others already in the marketplace” (44). Years later, the commercial origins of benzodiazepines would inflate critics’ charges that tranquilizers were created to compound corporate profits rather than to eradicate human suffering. Sternbach’s Librium was marketed amid a wave of positive fanfare. After LIFE Magazine trumpeted the pill’s ability to calm a European lynx, it would forever be known as the drug that “tamed wildcats” (45). A few years later, Sternbach tweaked the chemical structure of Librium and produced Valium (diazepam). Approved by the US Food and Drug Administration in 1963, the drug with the telltale “V” was the most widely prescribed drug of any kind in the Western world between 1968 and 1987. In 1978 alone, Hoffman La-Roche sold nearly 2.3 billion tablets, enough to medicate one-half the global population (46). Marketed as suicide-proof, Valium was considered safe, even when used in excess. This claim was tested in very public ways. When Ronald Reagan’s national security adviser, Robert McFarlane, tried to kill himself during the Iran-Contra scandal, he downed dozens of Valiums. The attempt was futile. He woke up days later, embarrassed but very much alive. Valium rapidly became a staple in medicine cabinets, as common as toothpaste, brushes, and razors (47). In what the poet WH Auden called the “age of anxiety,” Westerners had found their favourite chill pill. As Miltown had before it, Valium shaped popular culture. Celebrities gushed over it; the Rolling Stones sang about it; even father Mike on the Brady Bunch, a television show projecting the reassuring message that wholesome family values were possible in modern “mixed families,” popped one to offset prewedding jitters. When one didn’t work, he took another (48). The audience laughed—and why not? Taking tranquilizers had become enjoyably routine. By the late 1960s, however, not everyone found the globe’s prescription habit laughable or laudable. Once embraced as drugs no part of the civilized world should be without, tranquilizers began to be criticized for their adverse effects. Because the chemical properties of benzodiazepines remained unchanged, this shift can be explained only by understanding these drugs as historical artifacts whose political viability tells us much about the world that determines their worth. In the late 1960s, the US was engulfed by worries that the cultural and therapeutic popularity of anxiolytics such as Valium made worse. The diethylstilbestrol (synthetic estrogen) scandal, the thalidomide tragedy, and nagging doubts about the safety of oral contraceptives had burst the bubble of confidence in pharmaceutical panaceas. There were also the illicit drugs, such as marijuana and LSD, that were being widely used by a rebellious youth who, conservatives insisted, had no right to be discontented. “The carefully nurtured offspring of solid middle-class and upper-middle-class families are using drugs—for kicks, for escape,” a 1967 New York Times story warned (49, p 63). That tranquilizer users got their drugs from doctors rather than on the streets made the drugs no less dangerous, for it meant that mind-altering agents had penetrated the “safe” inner sanctum of middle-class suburbia. By the early 1970s, the media had seized on this image of chemical contamination to promote the idea of widespread but secret middle-class addiction. Journals that had once praised the drugs changed their tune: “The Toxified Society,” “Danger Ahead!—Valium—The Pill You Love Can Turn on You,” and “Businessmen Hooked on Valium” were but a few of the foreboding headlines (40). Grafted onto the tranquilizer scare were other unsettling problems: the Vietnam War, student protests, the counterculture, the civil rights movement, and Watergate. Some pundits thought such serious issues could be resolved only by a citizenry whose intellectual acumen hadn’t been chemically dulled. As early as 1967, Stanley Yolles, then director of the National Institute of Mental Health, wondered to what extent would “Western culture be altered by widespread use of tranquilizers?” Might “Yankee initiative” disappear (50)? By the mid-1970s, patients from all walks of life were sharing tales of tranquilizer addiction to the press and to congressional committees. Yesterday’s therapeutic success stories had become today’s addiction nightmares. A 1978 CBS exposé of the hazards of Valium profiled Cyndie Maginnis, aged 32 years, a stay-at-home wife and mother of 3. When Maginnis told her gynecologist about problems she was having with her family, he prescribed Valium. When her problems worsened, he prescribed more. “These were ordinary problems,” Maginnis told the CBS reporter; however, “because of medication she took for these ordinary problems,” the broadcast concluded, “she became a prescription drug addict” (51). Media reports erased the nuances of a complicated history of drug development and use. They presented instead a 3-minute antidrug diatribe that marshalled interest in and incited outrage over one dimension of the tranquilizer story. In 1979, television producer Barbara Gordon’s best-selling I’m Dancing as Fast as I Can recounted how her private struggle to withdraw from Valium by going cold turkey landed her in a New York insane asylum. The same year, Edward Kennedy convened a Senate investigation to investigate the “Use and Misuse of Benzodiazepines.” He opened the first session with the somber news that “excluding alcohol, diazepam is the number one drug problem in the US today” (52; cited in 40, p 338). In Canada and the UK, public officials and investigators busily catalogued their own drug woes. Under the auspices of Health Canada, Dr Ruth Cooperstock and her colleagues published a report documenting the overprescription of benzodiazepines to women and the dangers the drugs imposed on society (53). Although evidence from the time suggested that consumption rates across Canada were lower than they were in the US, the government held parliamentary debates that led to the placement of benzodiazepines on Canada’s list of controlled substances. In the UK, the popular BBC television program That’s Life! highlighted the plight of 3 ordinary people addicted to benzodiazepines. When thousands of viewers wrote back, the BBC teamed up with Mind, the leading mental health charity in England and Wales, to survey the extent of tranquilizer addiction (54). Media coverage, published patient narratives, and political hearings augured sweeping legislative and policy reforms designed to curb tranquilizer use (55). By the early 1990s, the epidemic had presumably been curtailed—or at least contained. As tranquilizers were discredited and users stigmatized, sales of Librium and Valium declined. Some psychiatrists wondered whether the medial trials of tranquilizers had caused more harm than good. Among them was Heinz Lehmann. Testifying in 1960 before a US Senate subcommittee, he warned that the popularization of minor tranquilizers such as Miltown and Equanil (meprobamate) had led to “tremendous” abuse: Doctors were prescribing outside normal ranges and patients were having a hard time discontinuing their medicine (56). Decades later, Lehmann worried that the pendulum of political opinion had swung too far in the opposite direction. In the 1980s Lehmann made national news in Canada, telling reporters that patients had been hoodwinked by “sensational, horror stories that equate tranquilizers with addiction” (12, p 17). Irresponsible media treatment had caused thousands of Canadians to forego medication and to suffer needlessly. In a 1998 interview with David Healy, the eminent American psychopharmacologist Karl Rickels blamed puritan political attitudes for encouraging Americans to “throw the [benzodiazepine] baby out with the bathwater when we don’t have anything better” (57, p 8). He noted that in France, where there was no benzodiazepine backlash and consumption rates remained high, society continued to function perfectly well. “I don’t see that people [are] dying more on the road in car accidents. I don’t see that in any way [French] society is more affected” (57, p 8). ConclusionCurrent thinking about anxiety and its treatment remains conflicted. Many social scientists, activists, and journalists argue that patients suffering from anxiety are overmedicated and that tranquilizer use fosters addiction. Conversely, the National Institute of Mental Health reports that anxiety is the most common mental health problem in the US today, affecting at least 19 million people, many of whom are undertreated (58). A spate of new books and studies suggests the same. Psychiatrists and patients using benzodiazepines continue to operate under a cloud of suspicion, despite studies showing that only a small percentage of benzodiazepine users abuse these drugs and that these patients tend to “abuse a variety of other compounds as well” (59, p S396). One woman found that the answers to her worries required both a sympathetic physician and the suspension of prevalent attitudes about benzodiazepines that deter others from getting help. “I meet people looking haggard and they say they have been so worried and can’t sleep,” the woman, aged 59 years, told a London reporter in 2003. “I think, you stupid wallies—take a Valium and it’ll all look different in the morning” (60). How have history’s politics and prejudices affected the mental health of patients? The trials and tribulations of tranquilizers suggest that pharmaceutical drugs continue to be objects pregnant with social and political meaning. Understanding how drug therapies are conceived, popularized, and marginalized requires that we listen carefully to the tones and cadences of the past and appreciate the myriad issues that have shaped and will continue to shape the development of psychopharmacology. Recognizing the inseparability of psychiatry and history may seem, at first glance, to counter the claims of biological psychiatry—upending the reassuring but misguided notion that medicine has progressed along a linear timeline. As with mental illness, however, history is rarely clear-cut. Progress occurs in fits and starts—assuming people can agree on what progress is. For historians trying to piece together medicine’s past and for psychiatrists treating those who struggle in the present, the particular contexts in which psychiatry has been made and remade deserve a closer look. 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Available: http://static.highbeam.com/t/theindependentsundaylondonengland/november232003/visforvaliumthewonderdrugoftheseventiesbecameoneof/index.html. Accessed 26 April 2005. Author(s)Manuscript received and accepted April 2005. 1. Professor of History and Canada Research Chair in the Social History of Medicine, Department of Social Studies of Medicine and History, McGill University, Montreal, Quebec. Address for correspondence: Dr A Tone, Department of Social Studies of Medicine, McGill University, 3647 Peel Street, Montreal, QC H3A 1X1 e-mail: andrea.tone@mcgill.ca
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