The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers (review)

Andrea Tone’s The Age of Anxiety fills an important gap in the history of American psychiatry, the rise and fall (and rise again) of tranquilizing medications. Tone describes the evolution of tranquilizers, beginning with Miltown and its success in the 1950s. She fleshes out the account of the medication’s discovery and marketing with the social and political context of the time, as well as the cultural phenomena created by the medication itself. As she reports, Miltown was a surprising national sensation, a blockbuster for an initially cautious pharmaceutical company. After the major success of Miltown, the new class of tranquilizers, benzodiazepines (marketed as Librium and Valium), also helped to expand the tranquilizer market. Although Librium and Valium were enormously successful in the 1960s and 1970s, their widespread consumption appeared more problematic by the middle of the 1970s and produced a backlash against tranquilizers over subsequent decades. Though tranquilizer use declined as a result of the emerging perception that they were drugs of abuse, Tone points out that new agents (such as Xanax), the introduction of aggressive marketing for anxiety disorders (by manufacturers of medications such as Paxil), and national anxieties after 9/11 have continued to keep tranquilizer markets alive.

Tone persuasively argues that it is essential to understand the context of medication introduction and use, and she draws on social, technological, cultural, and political trends to help explain the rise of an American tranquilizer culture. Tone is able to weave together sources such as newspaper accounts, popular media representations, and letters from consumers to give us images of Americans devouring tranquilizers at midcentury. As she outlines, these medications made sense in the context of American anxieties about the atomic bomb, and they appeared to address a myriad of personal, social, and business problems. Tone points out that men were avid consumers of tranquilizers in the decades after their introduction, despite the medications’ later questionable reputation as “mother’s little helpers.” Tone’s descriptions of tranquilizer presence in American society and culture are especially evocative. In addition, she incorporates oral history interviews with two pharmaceutical innovators, Frank Berger (who discovered Miltown) and Leo Sternbach (who discovered Librium and Valium). Tone is able to give both detailed accounts of the internal activities of the pharmaceutical industry, as well as a fascinating look at tranquilizers in popular culture. The book is written in a lively and engaging style, and Tone tells good stories about tranquilizers in all their complexities.

An accomplishment of the book is that it raises a number of important questions about tranquilizers in America, some of which Tone is unable to fully answer. One issue is the role of physicians, particularly internists and family physicians, in the tranquilizer story. Tone describes the professional shift within psychiatry as it moved from a psychoanalytic emphasis to a focus on biological interventions, and the ways in which medications fit into that shift. But as she points out, the majority of prescriptions for tranquilizers were written by general physicians rather than psychiatrists. Tone does not prominently feature physicians, and emphasizes more of consumers’ approach toward medications. Tone’s portrayal of the social and cultural forces that led to widespread tranquilizer use in the 1950s and 1960s suggests an underexplored aspect of physician-patient relationships in this time period. At a time when physician authority was well-respected, how was it possible for a consumer ethos to pervade the use of tranquilizers? What effect did tranquilizers have on general physicians’ professional issues? How did internists and family physicians conceptualize the blurry boundaries between tranquilizer use and abuse? And did cultural critics recognize the roles of the different medical specialties?

In addition, while Tone thoroughly explores the ways in which tranquilizing agents pervaded American society and culture, we are left with questions about the nature of anxiety itself. Although Tone makes reference to the shifting ideas about neuroses and the anxiety disorders as defined...