These studies were among the first to measure in any kind of systematic way the effects of a drug on the mental states of human beings. Today, when reports on randomized controlled trials of the efficacy of various psychotropic drugs are published by the score every month in newspapers and medical journals, this kind of study seems routine. But at midcentury the notion that psychiatric drugs could be widely and safely prescribed—let alone scientifically measured—was novel.
So novel, in fact, that Carter executives didn’t believe there was a market for such a drug. They retained a polling company to ask two hundred primary care physicians whether they would be willing to prescribe a pill that would help patients with the stresses of day-to-day life—and a large majority of them said they would not. Frustrated, Berger persisted on his own, sending meprobamate pills to two psychiatrists he knew, one in New Jersey and one in Florida, for testing. The New Jersey psychiatrist reported back that meprobamate had helped 78 percent of his patients suffering from what we would today call anxiety disorders—they became more sociable, slept better, and in some cases returned to work after being housebound. The psychiatrist in Florida gave the drug to 187 patients and found that 95 percent of those with “tension” improved or recovered on meprobamate.
“When I first came in here, I couldn’t even listen to the radio. I thought I was going crazy,” one of the Florida psychiatrist’s patients reported after a few months on meprobamate. “I now go to football games, shows, and even watch TV. My husband can’t get over how relaxed I am.”
Berger showed these results—which The Journal of the American Medical Association would publish in April 1955—to Henry Hoyt, the president of Carter Products, who finally allowed meprobamate to be submitted for FDA approval. The custom at Carter had been to name compounds after local towns, and so meprobamate had been internally dubbed Milltown, after a small hamlet about three miles from Berger’s lab that a guidebook called “tranquil little Milltown.” Since place-names cannot be trademarked, Hoyt dropped an l, and when the pill came to market in May 1955, meprobamate was called Miltown.
In 1955, barbiturates were still the most popular antianxiety medication; they were marketed as sedatives and had dominated the pharmacy shelves for several decades. Because they had a proven sales record, Berger wanted to market Miltown as a sedative, too. But one night over dinner in Manhattan, his friend Nathan Kline, the research director of Rockland State Hospital, advised against that. “You are out of your mind,” Kline said. “The world doesn’t need new sedatives. What the world really needs is a tranquilizer. The world needs tranquility. Why don’t you call this a tranquilizer? You will sell ten times more.” Out of such contingencies—an unexpected side effect of a penicillin preservative, a stray remark at dinner—is the history of psychopharmacology made.
Miltown was brought quietly to market on May 9, 1955. Carter Products sold only $7,500 worth of the drug in each of the first two months it was available. But sales of the compound—which was advertised as being effective for “anxiety, tension, and mental stress”—soon accelerated. In December, Americans bought $500,000 worth of Miltown—and before long they were spending tens of millions of dollars a year on Miltown prescriptions.
In 1956, the drug became a cultural phenomenon. Movie stars and other celebrities sang the praises of the new tranquilizer. “If there’s anything this movie business needs, it’s a little tranquility,” a Los Angeles newspaper columnist declared. “Once you’re big enough to be ‘somebody’ in filmtown you’ve just got to be knee-deep in tension and mental and emotional stress. The anxiety of trying to make it to the top is replaced by the anxiety of wondering if you’re going to stay there. So, big names and little alike have been loading their trusty pillboxes with this little wonder tablet.” Lucille Ball’s assistant kept a supply of Miltown on the set of I Love Lucy to help the actress calm down after spats with her husband, Desi Arnaz. Tennessee Williams told a magazine that he needed “Miltowns, liquor, [and] swimming” to get him through the stress of writing and producing The Night of the Iguana. The actress Tallulah Bankhead joked that she ought to have been paying taxes in New Jersey, home of Wallace Labs, because she was consuming so much Miltown. Jimmy Durante and Jerry Lewis publicly praised the drug on televised awards shows. The comedian Milton Berle took to beginning the monologues on his Tuesday night television show with “Hi, I’m Miltown Berle.”
With so many prominent champions, Miltown’s popularity spread nationally. Magazines wrote about “happy pills” and “peace of mind drugs” and “happiness by prescription.” Gala Dalí, the wife of the surrealist painter Salvador Dalí, was such a devotee of Miltown that she convinced Carter Products to commission a $100,000 Miltown art installation from her husband.a Aldous Huxley—whom, based on the drug-addled dystopia he painted in Brave New World, you might have expected to be a stern Cassandra about such things—proselytized that the synthesis of meprobamate was “more important, more genuinely revolutionary, than the recent discoveries in the field of nuclear physics.”
Within eighteen months of its introduction, Miltown had become the most prescribed and—with the possible exception of aspirin—the most consumed drug in the history of the world. At least 5 percent of Americans were taking it. “For the first time in history,” the neurologist Richard Restak would later observe, “the mass treatment of anxiety in the general community seemed possible.”
Miltown contributed to a wholesale transformation of the way we think about anxiety. Before 1955, there was no such thing as a tranquilizer—no medication that was designed to treat anxiety per se. (The first use of the word “tranquilizer” in English was by Benjamin Rush, a physician and signatory of the Declaration of Independence, who used the term to describe a chair he had invented to restrain psychotic patients.) But within a few years, American pharmacies were full of dozens of different tranquilizers, and companies were spending hundreds of millions of dollars to develop more.
The confidence of psychiatrists in the new drugs could be overweening. Testifying before Congress in 1957, Frank Berger’s friend Nathan Kline enthused that the advent of psychiatric drugs may “be of markedly greater import in the history of mankind than the atom bomb since if these drugs provide the long-awaited key which will unlock the mysteries of the relationship of man’s chemical constitution to his psychological behavior and provide effective means of correcting pathological needs there may no longer be any necessity for turning thermonuclear energy to destructive purposes.” Kline told a journalist from BusinessWeek that meprobamate was good for both economic productivity (because it restored “full efficiency to business executives”) and artistic creativity (because it helped writers and artists break free of their neuroses and overcome “mental blocks”). This utopian vision of better living through chemistry may have been overblown, but it was broadly shared. By 1960, some 75 percent of all doctors in America were prescribing Miltown. The treatment of anxiety had begun to migrate from the psychoanalyst’s couch to the family doctor’s office. Soon attempts to resolve conflicts between the id and the superego were being displaced by efforts to better calibrate the neurochemistry of the brain.
The deficiencies in our description [of the mind] would probably vanish if we were already in a position to replace the psychological terms by physiological or chemical ones.
—SIGMUND FREUD, Beyond the Pleasure Principle (1920)
The insulin of the nervous.
—FRENCH PSYCHIATRIST JEAN SIGWALD’S CHARACTERIZATION OF THE NEWLY DISCOVERED DRUG CHLORPROMAZINE (THORAZINE), 1953
Meanwhile, a series of unexpected pharmacological discoveries in France were to have medical and cultural consequences that were perhaps even further reaching than Miltown’s.
In 1952, Henri Laborit, a surgeon in Paris, decided to experiment on some of his patients with a compound called chlorpromazine. Chlorpromazine, like so many drugs that would find their way into the modern psychotropic arsenal, had its origins in the rapid growth of the German textile
industry in the late nineteenth century—specifically in the industrial dyes developed by chemical companies starting in the 1880s.b Chlorpromazine came into being in 1950, when French researchers synthesized the new compound from phenothiazine, intending to create a more powerful antihistamine. But chlorpromazine failed to improve on existing antihistamines, so they quickly put it aside. When Laborit asked the chemical company Rhône-Poulenc for some chlorpromazine, he was hoping he would find that its purported qualities as an antihistamine would help mitigate surgical shock by reducing inflammation and suppressing the body’s autoimmune response to the trauma of surgery. It did—but to Laborit’s surprise, the drug also sedated his patients, relaxing some of them to the point where they were, as he put it, “indifferent” toward the major surgical procedures they were about to undergo.
“Come look at this,” Laborit reportedly said to one of the army psychiatrists on the staff of the Val-de-Grâce military hospital, pointing out that the “tense, anxious, Mediterranean-type patients” had become completely calm, even in the face of major threats to their health.
Word got around the hospital, and one of Laborit’s surgical colleagues would soon tell his brother-in-law, the psychiatrist Pierre Deniker, about the effects of this new compound. Intrigued, Deniker administered the drug to some of his most psychotic patients on the back wards of a Parisian mental hospital. The results were astounding: violently agitated patients calmed down; the crazy became sane. When one of Deniker’s colleagues gave it to a patient who had been nonresponsive for years, the man emerged from his stupor and wanted to leave the hospital and return to his work as a barber. The doctor asked him for a shave, which the patient carefully gave him, and so the doctor discharged him. Not every case was as dramatic, but the calming effects of the drug were powerful. Neighbors reported that the noise emanating from the asylum had dropped significantly. Other small-scale experiments with the drug showed similarly potent results. In 1953, Jean Sigwald, a psychiatrist in Paris, gave chlorpromazine to eight patients suffering from “melancholia with anxiety,” and five of them got better. Chlorpromazine was, Sigwald declared, “the insulin of the nervous.”
Chlorpromazine came to North America when, one Sunday evening in the spring of 1953, Heinz Edgar Lehmann, a psychiatrist at McGill University in Montreal, read an article while luxuriating in his bath. The article, which had been left in his office by a drug company sales representative, reported on chlorpromazine’s effect on French psychotics. (“This stuff is so good that the literature alone will convince him,” the salesman had told Lehmann’s secretary.) When Lehmann got out of the bath, he ordered a shipment of the compound, and he used it to launch the first North American trial of chlorpromazine, administering it to seventy mentally ill patients at nearby Verdun Protestant Hospital, where he served as clinical director. The results amazed him: within weeks, patients who had been suffering from schizophrenia, major depression, and what we would today call bipolar disorder, among other psychiatric ailments, seemed effectively cured. Many found themselves completely symptom-free; some of those who doctors had thought would be confined to asylums for life left the hospital. It was, Lehmann would later say, “the most dramatic breakthrough in pharmacology since the advent of anesthesia more than a century before.”
Smith, Kline & French Laboratories, an American drug company, licensed chlorpromazine and in 1954 brought it to market with the trade name Thorazine. Its arrival transformed mental health care. In 1955, for the first time in a generation, the number of hospitalized mentally ill in the United States declined.c
Together, Thorazine and Miltown reinforced a culturally ascendant new idea—that mental illness was caused not by bad parenting or unresolved Oedipus complexes but by biological imbalances, organic disturbances in the brain that could be corrected with chemical interventions.
For me, the watches of that long night passed in ghastly wakefulness; strained by dread: such dread as children only can feel.
—CHARLOTTE BRONTË, Jane Eyre (1847)
As it happens, my own decades-long experience with chemical interventions would begin, some twenty-five years later, with Thorazine.
As I approached the end of elementary school, my proliferating array of tics and phobias drove my parents to take me to the psychiatric hospital for the evaluation where it was determined I needed intensive psychotherapy. In seventh grade, I started at a new school. One Monday morning in October, I refused to go. The prospect of separation from my parents, and of exposure to germs, felt too terrifying to endure. But my parents, after calling Dr. L. (the psychiatrist who had conducted the Rorschach test during my evaluation at McLean Hospital and whom I was now seeing for weekly psychotherapy sessions) and Mrs. P. (the social worker who was supposed to be counseling my mother and father about how to be less anxiety-inducing parents), refused to let me refuse. Which led to a melodramatic standoff that would replay itself most mornings for the rest of that school year.
I would wake up crying and clutching my covers, saying I was too scared to go to school. After failing to reason me out of bed, my parents would tear the covers off, and the wrestling match would begin: my father would hold me down while my mother forced me into my clothes as I struggled to escape. Then they’d frog-march me out to the car while I tried to wriggle free. During the seven-minute drive to school, I would sob and beg my parents not to make me go.
As we’d pull into the school parking lot, my moment of reckoning would arrive: Would my parents have to physically remove me from the car, humiliating me in front of merciless schoolmates? School was terrifying—but so was the threat of humiliation. Wiping my tears, I’d get out of the car and begin the gangplank walk to my homeroom. My anxiety was not rational; I had nothing, really, to fear. Yet anyone who has suffered the torments of acute pathological anxiety knows that I am not exaggerating when I say I do not think I would have felt much worse had I been walking to my own beheading.
Stunned by despair, blinking back tears, struggling to control my roiling bowels, I’d sit mutely at my desk, trying not to embarrass myself by bursting into sobs.d
By January, my phobias and separation anxieties had become so consuming that I had begun to drop my friends, and they to drop me; I scarcely socialized with my peers anymore. Engaging in the give-and-take of schoolboy banter had become too stressful, so at lunchtime I preferred to sit quietly beside a teacher. This put me in a position, on the first day back after holiday break that year, to overhear the Spanish teacher tell the French teacher a graphic tale of spending the holidays with friends in Manhattan, where she and her companions had been stricken by a stomach virus that had included prolific amounts of vomiting.e
This was more than I could bear on the first day back after vacation; I left school, went home, and pretty much lost my mind.
Here are the snapshots I can remember from that evening: me throwing things around the house, smashing everything I can get my hands on, while my father tries to grapple me into submission; me lying on the floor, pounding it with my fist, screaming so hard that drool froths from my mouth, yelling that I am so scared and can’t take it anymore and want to die; my father, on the phone with Dr. L., talking about whether I should be committed (there is mention of straitjackets and ambulances); my father going to Corbett’s, the local drugstore, and coming back with emergency doses of Valium (a minor tranquilizer of the benzodiazepine class, about which more shortly) and liquid Thorazine (which was then known as a major tranquilizer and is now classified as an antipsychotic).
The Thorazine tasted awful. But I was desperate for relief, so I drank it in some orange juice. For the next eighteen months, I was on Thorazine around the clock. And starting later that week, I began also taking imipramine, the tricyclic medication that was the antidepressant of choice prior to the arrival of Prozac in the late 1980s.f
Every day for the next two years, my mother would place one large orange Thorazine pill and an assortment of smaller green and blue imipramine pills on the edge of my plate a
t breakfast and at dinner. The medication reduced my anxiety enough to keep me out of the hospital. But at a cost: on Thorazine, I became foggy and dehydrated, shuffling along with a dry mouth and hollowed-out emotions and twitching fingers, the result of a common Thorazine side effect known as tardive dyskinesia. A year earlier, prior to going on Thorazine and imipramine, I had been selected for an elite soccer team. When I showed up the following autumn in a Thorazine stupor, the coaches were baffled. What had happened to the short kid who had embarrassed older players by dribbling circles around them? They now had a kid, still short, who moved slowly, tired easily, and became rapidly dehydrated, a gluey white mucus encrusted around his lips.
Even after I was heavily medicated, my anxiety persisted. I’d make it to school but then get overwhelmed by fear, leave class, and end up in the infirmary with the school nurse, begging her to let me go home. When the confines of the infirmary came to feel too claustrophobic to contain my antic pacing, she would kindly walk around school with me while I tried to calm down.g
Seeing me wandering the campus with the nurse when I should have been in class, my peers naturally wondered what was wrong with me. The mother of an erstwhile friend ran into my mother and asked if I was ill. My mother, prevaricating, said I was fine.
But I was not fine; I was miserable. In photographs from that time, I look hunched and hangdog and sickly, like I am shrinking into myself. I was on antipsychotics and antidepressants and tranquilizers, and I was taking daily walks with the school nurse instead of attending class.
My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind Page 20
