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

This well-crafted book combines historical perspectives with the enduring issues of consumerism, patients' rights, ethical principles, and the role of pharmaceutical companies in marketing medicines. David Herzberg demonstrates how target marketing dominated after World War II, when the companies launched strong "direct-to-consumer" advertising campaigns in magazines rather than ads confined in the professional journals and forums. The mind-games played with the "wonder drugs" through public-relations ploys encouraged people to feel comfortable talking about their mental status, a taboo topic previously. The pharmaceutical companies' campaigns, writes Herzberg, "tended to conflate psychological illness with the familiar daily problems that populated the cultural landscape of consumerism" (p. 6).He presents as evidence advertisements for "miracle" pills from 1956 through 2001 and the long list of psychiatric drugs with the statistical representation of their use.

In the postwar era, there occurred a cultural shift that made room for self-dependence and patient autonomy. This, coupled with the effects of television and more recently the internet, brought about a drastic transformation. On one hand, there was the imperative of selling drugs, driven by commercial dynamics. On the other hand, the irreversible dependence on the "wonder drugs" became a daily routine, the perceived empowerment achieved in the name of tackling "the legal drug cultures of the affluent" (p. 189). Clinical trials sponsored by drug companies maintained a careful distinction between street drugs and these prescribed tranquilizers and antidepressants. The "smartly dressed junkie" turned into the health-conscious and empowered "normal" person who knew what decisions to make in order to maintain a fully functioning life. Currently, the powerful political connections maintained by the pharmaceutical industry have become an added factor in maintaining a profitable market.

Barron H. Lerner dealt with these issues in his famous 2006 book explaining the power of celebrity endorsement. But clever marketing has also tapped into possibilities for targeting the general public, an approach free of the conflict-of-interest issues raised by celebrity endorsement. What people would have otherwise considered as "narcotics" and "dope" got reclassified as "medicine."The cultural shift had an exponential effect because of the internet. Armed with poor or misleading information, people sought dangerous treatment options. Although there had been some resistance to the popularization of tranquilizers and antidepressants like Miltown, Valium, Paxil, and Prozac, Herzberg writes that "doctors embraced the drugs eagerly, prescribing them by the millions, while patients willingly accepted or even demanded them. Within a decade of the introduction of these drugs, prescribing a minor tranquilizer had become one of the most common therapeutic actions in American medicine" (p. 5). Herzberg adds that the careful classification of the psychiatric drugs and the distinction drawn "between types of drug dependence and types of addicts" fascinated cultural historians insofar as such distinctions "came to be persuasive" (pp. 121, 11).

Today, it has become virtually impossible to attain a balance between the technology-facilitated empowerment of the general public to make its own decisions and the ethical responsibilities of health-care professionals. The invasion of the "mind drug industry" into peoples' medicine cabinets is an accepted norm. It is true that, as a result of revolutionary cultural change, doctors and patients have many more options to choose from when it comes to accepting or rejecting medications. Still, people have become more dependent on medications to manage their mental sufferings and to control their ability to lead normal lives.