The spectacular increase in the use of psychiatric drugs over the past 50 years involved what a University at Buffalo historian calls "a massive break with what we consider 'normal' mental health," one linked to myriad social and cultural changes in America.
"Happy Pills in America: From Miltown to Prozac" (November 2008, Johns Hopkins University Press), a new book by David Herzberg, Ph.D., UB assistant professor of history, considers a wide range of psychiatric medications hailed in pharmaceutical marketing as "wonder drugs" and the social changes they provoked. Notably, he examines how we came to see "normalcy" in light of their mood-altering capabilities, and how we continue to respond to the barrage of drug advertising aimed directly at consumers.
"Patients have always demanded sedatives and stimulants from their doctors, who generally obliged them," Herzberg says, "but after World War II, something new happened. A vast and powerful system of commercial medicine anchored by pharmaceutical companies brought the values and practices of the consumer culture to psychotropic medications."
He says these values and practices were used to market scores of prescriptions for the pharmacological treatment of depression, mania, anxiety and a host of other thought, mood and attention disorders, many of which were, at that time, unfamiliar to the general public as common illnesses.
"This system drastically changed the way we viewed normal mental health by dramatizing emotional problems to promote pharmaceutical solutions. As a result the products sold well, made the drugs themselves household names and the conditions they treated part of the public conversation about health," he says.
"The the real transformation brought about by the cultural celebrity of these drugs, however, is in the political dimension of happiness."
First, he says, medications helped make "happiness" (defined in relatively narrow terms by commercial medicine) an obligation of middle-class citizenship. If, as the marketing assured us, we could be "happy" with pharmaceutical assistance, then the implication is that we should be "happy," a process has been bemoaned by those who say that we no longer appreciate a broad range of subtle moods.
"Second," Herzberg says, "the availability of these medications opened up new arenas for contesting, challenging and, ultimately, remaking what that 'happiness' could entail, often in directly political terms."
Herzberg points to the fact that in the 1950s it was popularly argued by pharmaceutical marketers that women, having strayed from their "natural" domestic roles, had become anxious and needed tranquilization.
"By the 1970s, however," he says, "many came to be persuaded that a sexist medical system was funneling tranquilizers to housewives to keep them in happy servitude."
Betty Friedan wrote, for instance, that in the 1950s a condition referred to medically as "housewife's fatigue" came into common parlance. Some physicians decided that women with this condition were not taxed enough by their domestic chores and were bored, so needed to get out more. Other docs, however, prescribed the newly popular tranquilizers.
Herzberg notes that, in fact, "Some second-wave feminists used the cultural celebrity of Valium to argue against the enforced domesticity of females, arguing that, surely, any situation that required so many tranquilizers could not be a happy one for American women. The sensationalist, but real, risk of Valium addiction helped circulate their argument to wider audiences than they might ordinarily have anticipated.
"There are many explanations for why women were prescribed and used so-called 'happy pills' at twice the rate of men, for instance," he says, "but contrary to what many believe, it was not because pharmaceutical advertising of drugs like Valium and Miltown targeted women.
"Men were depicted in at least half the ads for these medications. The arguments from many quarters for medicating women were more effective in American culture than the ones for medicating men."
Herzberg's work addresses aspects of the process of medicalization by which health or behavioral conditions came to be defined and treated as medical issues. The process itself usually involves changes in social or political attitudes and typically accompanies or is driven by the availability of treatments.
"No one denies that drugs from Miltown to Valium to Prozac, Celexa, Paxil, Wellbutrin and many others have saved lives and made life easier for many people with emotional problems," he says.
"What we are unaware of in general, however, is that the meaning ascribed to tranquilizers and antidepressants, and to normalcy itself, has been molded and re-molded along the way and the result owes as much to commerce and culture as it does to science."
The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.