Panic Diaries: A Genealogy of Panic Disorder (review)

We have only begun to map out the history of psychopharmaceuticals. The basic details of who discovered what, and when, remain in many instances to be established, and many myths remain to be punctured. But if the field is to thrive and ultimately to come of age, it will need a great deal more than just the establishment of facts and the puncturing of myths: it will require much more detail about the lived experience of people taking drugs, and their experiences at the interface between the drugs they have taken and the cultural air they have been breathing. And while the 1950s were a miracle decade for the discovery of new drugs, pharmaceutical companies are arguably now far more adept at manufacturing cultures than they are at making breakthrough medical remedies.

Panic Diaries is just the kind of book the "doctor" might have ordered to complement the spadework going into establishing aspects of the internal histories of the better-known psychotropic drugs. The book sheds an important light on what it has been like to be a subject in a clinical trial out of whom commercial knowledge has been generated. Jackie Orr bluffed her way into the role of a research subject in one of the key trials of the era, one of the Upjohn panic-disorder trials of Xanax (alprazolam) versus imipramine versus placebo. Her descriptions of the trial process ring very true—confabulated or not. She catches the research clinicians unerringly in her descriptions, and contrasts the new form of clinical interviewing and probing for blood samples with the kinds of probing a subject might have expected only a few years previously. In the process, the author juxtaposes the intimately personal and the scientifically impersonal: I cannot imagine there will be many readers who will ever have had the detailed processes of a clinical trial interleaved with fantasies about sex—it was certainly a first for me. But far from being off-putting, the juxtaposition works.

This is more ethnography than social history—but it is ethnography with attitude, amounting at times (in the author's own admission) to a confabulating reenactment of history. Risky stuff for a doctor of history to buy or recommend. If you are a historian, faced with colleagues in the natural sciences who think history is bunk, and want to establish facts, this may not be the book for you.

There are other pitfalls for potential readers who might baulk when they scan the index and see frequent references to Foucault, to psychopower, and to traumatizing technoscience. However, something interesting happened in the 1990s when "Foucault" met psychopharmacology that is best exemplified in the work of Nikolas Rose and colleagues (cited in Orr's book) and Kal Applbaum and others. Both Rose and Applbaum have introduced new ideas about the interface between markets and new psychotechnologies that have become very influential in social-scientific and anthropological considerations of genetics and neuroimaging, but especially in the domain of psychopharmacology. And Panic Diaries illustrates many aspects of the way psychopharmacology is moving.

This is a book that was overtaken in the writing by history itself. It almost certainly seemed like a reasonable project, covering the dynamics of crowd hysteria and the mass anxieties of the early nuclear age and mapping these onto the lived experience and clinical management of panic, a new form of—or at least a new name for—anxiety born in the 1960s. The project was manageable because the age of anxiety had ceded the stage to an age of depression and had become a relatively clearly defined object of study. But all of sudden we have landed back in an age of terror, and we face open and regular discussions of the manipulation of fear for political purposes. The story has looped back on itself far faster than anyone could have expected, and this makes the book very immediate. This sense of immediacy is heightened by Jackie Orr's...