Happy Pills in America: From Miltown to Prozac (review)

Amid the current flurry of interest in the history of pharmaceuticals, minor tranquilizers hold a special fascination, possibly due to the present resonance of controversies surrounding them a generation ago. In Happy Pills in America: From Miltown to Prozac, David Herzberg sets out to describe, through a focus on the rise and fall of tranquilizers from the late 1950s to the late 1970s, the advent of mass-consumption psychiatric drugs. That is, the book describes the commodification of “happiness” as a medical product. Focusing on popular and political discourse, Herzberg takes a cultural history approach, and throughout the book, his main sources are mass media and medical journal advertisements. These are supplemented in places by congressional records, memoirs, and some medical journal articles. The narrative begins with the introduction of Miltown (meprobamate) as a tranquilizer in the mid-1950s—it is cast not only as the first widely prescribed mental health pharmaceutical but “the first blockbuster drug”—and ends with the return of “happy pills” in the 1990s in the form of Prozac (fluoxetine).

While this simple “psychotropic revolution” framing has long been a staple in the history of psychiatry, Herzberg departs refreshingly from the standard narrative by treating the marketing of the tranquilizers to physicians and the popular reception of the drugs as a single phenomenon. Drug companies in the 1950s, he points out, worked hard to violate the spirit of ethical advertising rules even as they honored the letter, for example hiring public relations firms to place pharmaceutical stories in mass media and providing free copies of popular magazines in a “special physician edition” that contained prescription drug ads (ideal for the waiting room). Thus popular late-1950s controversies about the problem of overcivilization-induced anxiety, conformable with Freudian psychiatry and potentially treatable by tranquilizers, and the clashing Cold War discourse of a crisis in masculinity that was implicitly hostile at least to men’s use of tranquilizers, not only affected pharmaceutical marketing (as Jonathan Metzl has pointed out in his 2003 Prozac on the Couch) but also must be regarded as a battlefield in which drug companies actively and directly influenced popular perceptions. According to Herzberg, in perhaps the book’s nicest insight, the outcome of this 1950s struggle over masculinity, anxiety, and drugs was not only new tranquilizer advertising to physicians that cast potential male patients as hypermasculine cave men, but the now-infamous female bias in tranquilizer prescribing.

Herzberg goes on to recount two major political controversies of the late 1960s and 1970s in which minor tranquilizers were embroiled: the middle-class feminist attack on Valium as a symbol of patriarchial oppression, which eventually brought down the drugs, and the charged debates surrounding drug addiction policy. The second of these discussions suffers from an overly narrow focus on tranquilizers and heroin, with major aspects of 1960s cultural conflict, like Vietnam, winning scarcely a mention and, still more surprisingly, youthful “hippies” with their distinctive marijuana, psychedelic, and amphetamine usage pattern winning no mention at all. The treatment of the feminist movement is more compelling, and here Herzberg makes another important observation that, in political contexts like congressional hearings, middle-class feminists actually undermined drug policy reformers aiming at what is now called “harm reduction” by emphasizing the role of middle-class women as innocent victims of tranquilizer makers and prescribers, thus hardening the contrast between medicines and “street drugs” wilfully taken for pleasure by deviants.

The book admirably achieves its main aim: describing the reception of tranquilizers in the popular imagination of postwar America. It also draws attention to the important issue of happiness as an increasingly medicalized commodity in that context, although the tranquilizer story hardly exhausts that topic. It does not delve into the role of psychiatric medicine in actually redefining “happiness” in theory and, with drugs, materially shaping the consciousness of the postwar subject as consumer. Nor does the book feature any systematic...