Happy Pills in America: From Miltown to Prozac.
Book Review by: Helen Lefkowitz Horowitz
For Citation: Business History Review 83 (Winter 2009): 858-860.
This brilliant study of tranquilizers and antidepressants in the era after World II is unusual, for it seeks, unlike most previous books on the subject, not to condemn or celebrate but to understand. For business historians, it brings evidence of the value of the cultural turn in business history. Its focus is not so much on corporate organization and strategy as on marketing and advertising, and it emphasizes connections to the wider culture. Specifically, Happy Pills examines the marketing and advertising of Miltown, Valium, and Prozac, looking not at their truth claims but, rather, at “how they came to be persuasive, to whom, and with what effects” (p. 11). David Herzberg sees the process not as an imposition on unwilling consumers, but as a free-flowing conversation in which consumers took an active role.
The book begins with the origins of modern psychotropic medications in the 1950s and 1960s, and it looks for the answer to a great mystery. How was it that, in the era of Freud’s ascendancy over American psychiatry, Miltown became the first blockbuster drug? Experts insisted that the physical brain and nervous system played no role in minor mental illness; only trauma and human interactions were behind it. What Herzberg demonstrates is that these Freudians got Americans to think about anxiety, assigning it the central place in neurotic distress. When Miltown and its pharmaceutical cousins were marketed as aids to the Freudian project, many physicians, including psychiatrists, accepted it in their armamentarium. In an era that allowed no direct advertisements, word of Miltown quickly spread through educational interviews, public-service announcements, celebrity interviews, Senate hearings, and news stories; it was even the subject of a painting by Salvador Dali, who was commissioned to produce it by Wallace Laboratories, the drug’s manufacturer. General physicians prescribed Miltown, celebrities touted it, and patients demanded it. Dispensed by pharmacies presented with physicians’ then indefinitely refillable prescriptions, believed to be safe and without side effects, Miltown assumed a generic identity, an aspirin for the soul.
All this occurred in a society that rhetorically condemned and criminally penalized drugs sold on the street. One of the most interesting elements of this book is its reminder of the distinction between the medicine cabinet and the street corner: middle-class patients gained relief from prescription medications, while the urban, impoverished, and often racially marginalized drug takers turned to street dealers. Herzberg effectively takes us back to the discussions of neurasthenia in the late nineteenth century that valued nervous illness as evidence of advanced American civilization. Drawing repeatedly on the neurasthenic discourse, he demonstrates how experts and advertisers contrasted the ways that the genteel and the rough differentially exhibited their symptoms of distress: whereas the former were considered peaceful and harmless, the latter were labeled violent and dangerous. So deeply has this divided discourse become embedded in the culture that even those committed to broader reform find themselves arguing in its language.
When research evidence revealed that the new tranquilizers were neither safe nor nonaddictive, a tug-of-war began between regulators seeking stricter controls and drug companies seeking wider markets. Over time, researchers established that it was the pharmacological property of the drug that was at issue, not the identity of the taker, and the federal government established a classification scheme that enabled tighter controls to be imposed on tranquilizers and antidepressants. Valium, the blockbuster successor to Miltown, was kept off this schedule for a decade by the arguments put forth and the pressure exerted by its maker. But in a society in which 20 percent of women tried the drug, feminists found Valium an appropriate target of attack. Applying consciousness-raising to the public stage, feminists used addiction to dramatize women’s difficulties in a sexist society and urged women to stop taking Valium and turn instead to activism.
Ironically, feminist opponents of Valium helped set the stage for Prozac. As attention turned from anxiety to depression, Prozac was marketed as an energizer especially suited to women in the workplace, who were coping with complex lives. Brain science moved to center stage, promising to realize the dream of pinpointing targets for the specific chemical imbalances believed to be the sources of mental disorders. Prozac, touted as a chemical remedy for depression, became the third blockbuster drug. Its growth was boosted in the 1990s by the decision of the Federal Drug Administration to allow drug advertising on television and in nonmedical publications. As the ubiquitous “Ask your doctor” was heard, physicians found themselves becoming middlemen, useful in many cases only as the required writers of prescriptions.
Happy Pills is a brilliant book. It should be paired with Andrea Tone’s fine The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers (2009), both standouts in a literature that typically takes sides for or against the contemporary pharmaceutical industry and its relation to medical practice. Both books make sense, rather than making judgments. In this case, Herzberg’s nimble mind and penetrating eye offer new insights in every chapter.
My reservations are few. Curiously missing is the “Sixties,” with its familiar story, perhaps exaggerated, of recreational drug use among hippies and college students—and the political backlash it inspired. More significantly, there are times, as in Herzberg’s discussions of the history of drug-enforcement policy, when one wishes for a firmer chronological structure to provide clarity. A tougher narrative structure might have produced a study that attended in a fuller way to political life and shifting political agendas. As Herzberg sometimes demonstrates, the control of the presidency and the makeup of Congress matter. He is aware that politics is a critical outlet for the expression of culture in American society. In my judgment, the ways that politics can shape the cultural conversation, or at least throw it off balance, should be more fully recognized.
These caveats aside, I find it hard not to praise this book too much, not to become a marketing tool urging its wider distribution and intellectual consumption. Happy Pills is a rich, mind-bending book. Written with verve, it offers myriad ways to understand the complexity and range of its subject. Not only does it illuminate American drug cultures; it also demonstrates the rich interplay of invention, marketing, advertising, expertise, regulation, medical practice, and consumption.