Happy Pills in America: From Miltown to Prozac

Introduction. Medicine, Commerce, and Culture

1 introduction Medicine, Commerce, and Culture # in 2001 the GlaxoSmithKline Group of Companies announced good news for the ‘‘10 million people who live with excessive uncontrollable worry, anxiety, tension, irritability, restlessness and sleep disturbances’’: relief, in the form of Paxil, an antidepressant, was at hand. Advertising in Newsweek, the pharmaceutical giant advised ‘‘chronic anxiety’’ su√erers to ‘‘talk to your doctor about non-habit-forming Paxil today. So you can see someone you haven’t seen in a while . . . Yourself.’’ The main image showed a worried-looking woman striding purposefully down the street. The tag-line promised, ‘‘Your life is waiting.’’∞ Few Americans at the turn of the twenty-first century would have been surprised by this ad or its claims. The notion that pills could restore selfhood had become commonplace, pervading popular as well as medical culture. Advertisers were not the only ones spreading the gospel of neurochemistry, the idea that consciousness and selfhood were manifestations of biology, and therefore both knowable and controllable. According to this gospel, brains were like other parts of the body, capable of malfunctioning and leaving their owners painfully ‘‘not themselves.’’ Luckily, advances in medical science promised to fix the mechanical breakdowns (‘‘correct the chemical imbalance believed to cause the disorder ,’’ as the Paxil ad put it) and bring people back to health—to ‘‘themselves .’’ For people su√ering from depression and its very real miseries such promises meant a great deal, especially if (as was likely) they personally knew someone who had been helped by Paxil or one of its cousin drugs. The daily experiences of millions of Americans helped make possible the claim, once the province of LSD proselytizers like Timothy Leary, that taking a medicine—a drug—could lead to a more authentic self. Nor would early-twenty-first-century Americans have been shocked to see a powerful prescription medicine like Paxil advertised in a popular 2 happy pills in america Does the woman make the syndrome? Source: Paxil ad, Newsweek, September 17, 2001. magazine like Newsweek. For most of the twentieth century, ‘‘ethical’’ pharmaceutical companies had advertised only to physicians in medical journals and other professional forums. By 2001, however, ‘‘direct-toconsumer ’’ ads in magazines and on television had become familiar fare. These advertisements helped entrench the notion of patients as consumers who purchased pharmaceutical goods through their doctors. In combination with breathless reporting about drug sales, the expensive ads also served as continual reminders that antidepressants like Paxil were ‘‘blockbuster’’ drugs, earning enormous profits for their manufacturers . In this context, the claim to be able to deliver ‘‘yourself’’ took on the accents of the consumer culture, implying a lifestyle choice as well as a medical therapy. The most familiarly comforting part of the advertisement, however, making the other claims seem safe and unobjectionable, might have been the image. The woman is white and well-dressed; her neck and the uncovered portion of her arm look well-toned; she walks among blurry figures whose coats and ties are nevertheless visible. She therefore repre- Introduction 3 sented what Americans were likely to have already known or suspected about antidepressants: of the tens of millions who used them, far more were white than nonwhite, well-o√ than poor, and (by a two-to-one margin ) women than men. Public discussion of the drugs almost always appeared in white middle-class media, often women’s magazines, and almost universally related to the drugs’ meaning for white middle-class culture. The contrast with ‘‘narcotics,’’ associated with nonwhite and marginal groups, would have been obvious. It was, therefore, the woman in the ad who turned the constellation of otherwise fairly common symptoms—fatigue, sleep problems, worry, restlessness, muscle tension, anxiety, and irritability—into ‘‘Generalized Anxiety Disorder,’’ a legitimate medical problem calling for ‘‘non-habit-forming’’ mood-enhancing drugs. The Paxil ad might seem to be a recent phenomenon, but its roots stretch back to the origins of modern medicines in post–World War II America. The first blockbuster psychiatric medicine, the minor tranquilizer Miltown, was introduced in the 1950s, and use of the drugs reached a peak as early as 1973, when almost one hundred million prescriptions were written for Miltown’s successor, Valium, alone. Long before direct-to-consumer advertisements like Paxil’s, drug marketing campaigns supposedly limited to doctors’ eyes were designed to ‘‘escape’’ the medical world and spread into popular consciousness—informal campaigns that su√ered few if any...