For centuries, psychiatrists searched for the cure to mental illness, frustrated that medical doctors seemed to be able to find the “magic bullet” medications to fight disease and infection. In the mid 20th century, though, a series of new major and minor tranquilizers revolutionized the world of psychiatry. Doctors doled out Miltown, Librium, and Valium to stressed businessmen and frazzled housewives, using ad men to market these psychiatric wonder drugs to just about every ailment imaginable. In the process, psychopharmaceuticals became intertwined with the women’s rights movement, enflamed mid-century gender politics, and changed the way Americans thought about mental illness.

Transcript for Mother’s Little Helper: Psychiatry, Gender, and the Rise of Psychopharmaceuticals

Sarah: In 1968, Wallace Pharmaceuticals ran an ad in the Journal of the American Medical Association for its extremely popular medication, Miltown. In the left panel, a shrunken woman in a dress and apron looks distressed, while her giant son looks ready to throw an alphabet building block at her. The block is part of a set that spell out “TENSION.”  On the right panel, the banner headline reads: “Syndromes of the Sixties: The Battered Parent Syndrome.”

Elizabeth: The text of the advertisement is like Betty Friedan’s The Feminine Mystique filtered through the brains of a Mad Men style ad team. You can practically smell the Lucky Strikes and the Scotch. The woman in question, pictured in the lower right, is “the paradox of our modern age.” The ad goes on to describe the middle-aged woman of the ‘60s: “Compared to her mother, she has more education, more usable income, and more labor saving devices. Yet she is physically and emotionally overworked, overwrought, and – by the time you see her – overwhelmed. What went wrong? Is parenthood something other than the rosy fulfillment pictured by the women’s magazines? Is anxiety and tension fast becoming the occupational disease of the homemaker? Some say it’s unrealistic to educate a woman and then expect her to be content with the Cub Scouts as an intellectual outlet.  Or to grant that she is socially, politically, and culturally equal while continuing to demand domestic and biological subservience. Or to expect her to shoulder the guilt burden of this child-centered age without unraveling around the edges. Or to compete with her husband’s job for his time and involvement. But whatever the cause, the consequences – anxiety, tension, insomnia, functional disorders – fill waiting rooms. Sometimes, it helps to add “Miltown” to her treatment – to help her relax her emotional and musculartension.”

Syndromes of the Sixties: The Battered Parent Syndrome | JAMA: The Journal of the American Medical Association, Vol. 203, No. 11, pp. 60-62

Sarah: Miltown, the minor tranquilizer first released in the early 1950s, was immediately hailed a wonder drug. It was prescribed for ‘tension’ – what we might now call anxiety – but also for allergies, asthma, and a whole host of other issues.[1] A quick scan of Miltown advertisements in 1950s and 60s medical journals will show it marketed to practitioners to ease the stresses of pregnancy, heart disease, parenting, working women, PMS, chronic disease, and even the incredibly vague “by-products of the new industrial revolution.” And it wasn’t just Miltown: major tranquilizer Thorazine, other minor tranquilizers Librium and Valium, ‘energizers’ Vivactil, Triavil, and Aventyl, sedative Butisol, and stimulant Ritalin, among many others, all hit the market in the 1950s and ‘60s.  No wonder Bruce Jackson wrote in the Atlantic in 1966 that Americans “think in terms of pills.” How did Americans come to “think in terms of pills?” Today, as part of our DRUGS series, we’re talking about the rise of psychopharmaceuticals.

I’m Sarah

And I’m Elizabeth

And we are your historians for this episode of DIG

Elizabeth: First, let’s start with a bit of background about the history of psychiatry. We’ll need it to understand why ‘happy pills’ like Miltown were so important. For centuries, the study of the mind and mental illness wasn’t necessarily considered a distinct specialty within the medical profession. The ancient doctors like Hippocrates, Galen, Avicenna, Celsus, and others all wrote about mental illness alongside physical illness in their treatises. And the ancient theory of humoralism (which we’ve talked about many times, but in short is the theory that the body contains four ‘humors,’ or fluids, that balance with each other, and their balance or imbalance was what made you healthy or sick) was used to understand both psychological and physical health. Since everyone had a slightly different humoral make up, their personal ‘blend’ affected their personality. Someone with a balance that tipped toward the blood humor usually had a sanguine personality, meaning that they were talkative, happy, active and social. Someone who tipped more toward yellow bile was considered choleric, or ambitious, short-tempered extroverts. This theory of medicine and health – which continued to dominate the medical world well into the 19th century – saw the physical & mental as inextricably intertwined. If your humors were out of whack, it meant ailments for both body and mind. Even after the humoral theory started to fall out of favor, the connection between body and mind remained an absolute within the medical profession. In the 19th century, for instance, historian Nancy Tomes noted that both families and physicians described physical ills or imbalances in their descriptions of a patient’s mental illness –menopause, hemorrhoids,  a tooth extraction, rheumatism and the “morbid state of the bowels’ were all common causes of insanity.[2] In other words, the physical body’s health was the mind’s health.

Sarah: But while doctors continued to see a connection between body and mind, the idea that the mind was the domain of all doctors changed with the rise of the asylum. Institutions for the mentally ill have existed for hundreds of years, but for most of their history, they were more like almshouses, a catch-all social safety net. For instance, London’s infamous Bethlem hospital – better known as Bedlam – began its long life as a kind of public house, dedicated to the care of the needy, including the mentally ill but also the impoverished, sick, widowed, orphaned, and disabled. As was the case for most disabled people before the 18th century, mentally ill people typically lived at home, working alongside their family in the capacity they could or receiving in-home care. By the 18th century, however, institutions exclusively for the mentally ill began to appear. The industrial revolution in both Europe and the United States made it increasingly difficult for families to care for mentally ill family members, who might need constant supervision or intensive care. It might have been possible to provide this kind of support when the whole family more or less worked together at home (say, on a farm or in the blacksmith’s shop) but became impossible when most members of the family had to venture out during the day for factory work or labored at home doing piece work. Families needed someplace to take a mentally disabled relative, and in response, asylums that specialized in the housing and (ostensibly) treatment of the mentally ill began to proliferate.

Elizabeth: With the asylums came a new profession: psychiatry. Asylums hired physicians to serve as superintendents, overseeing the care and treatment of ‘inmates.’ While they didn’t really call themselves psychiatrists yet, doctors who worked in asylums started to understand themselves as distinct within the larger medical profession. In 1844, the superintendents of thirteen of the most influential asylums in the United States founded an organization for asylum superintendents and gave it the worst name in the history of acronyms: the Association of Medical Superintendents of American Institutions for the Insane (AMSAII). The organization, influenced by the work of founding member Thomas Story Kirkbride, established its own professional journal (The American Journal of Insanity, headquartered at the NYS Lunatic Asylum at Utica), encouraged research into mental illness and therapies, and drafted guidelines for the best practices for asylum architecture and building. They implemented Thomas Kirkbride’s own plan for the effective treatment of the mentally ill, called the moral treatment, which relied on the salutary effects of fresh air, exercise, sunny interiors, and a soothing environment. The AMSAII effectively marked the birth of the American psychiatric profession.

Thomas S. Kirkbride | Public Domain / Wikimedia Commons

Sarah: Problems for the profession began to arise toward the end of the nineteenth century, though. As the name suggestions, the AMSAII was almost synonymous with the asylum. Psychiatrists were almost entirely based out of asylums. While these positions might have been prestigious in the early 19th century, they started to lose their shine as the century wore on. Asylums – even those built to Kirkbride’s specifications for ideal therapeutic effect – were plagued with overcrowding. Despite their attempts to conduct research and develop effective treatments, superintendents were consistently plagued with what they called chronic cases, or patients whose condition did not improve enough to allow for their release from the institution. (I’m oversimplifying here for the sake of time; this was complex and was often the fault of the doctors themselves, who flexed their professional muscle by refusing to let patients leave even when they themselves reported feeling better.) To deal with the overcrowding, they petitioned state governments to build yet more asylums specifically for the chronically ill. (An example is Willard in upstate NY.) These institutions weren’t concerned with medical treatment as much as with economics – they often used patients for domestic and agricultural labor to keep the asylum solvent. (And yes, of course, they framed this as therapeutic in and of itself.[3]) The fact that so many patients were deemed ‘incurable’ – to the point where asylums literally could not hold them all – was bad for the profession: it only served to prove that psychiatrists weren’t effectively treating their patients.

Elizabeth: It also meant that increasingly, superintendents were not practicing medicine. By the end of the century, the superintendents running large state mental hospitals were no longer at the cutting edge of medicine like their AMSAII forebears were. Instead, they were essentially administrators with MDs. They supervised the business of the asylum (which often included active farms or other related businesses), managed hordes of attendants, nurses, cooks, janitors, and other staff, and shuffled piles of mail and paperwork. Overcrowding also meant that it was nearly impossible to actually provide treatment – there were simply too many patients. When investigative reporter Nellie Bly went undercover in the Blackwell’s Island asylum, she reported that each asylum building held at least 300 women, and each bedroom held up to 10. Most of the day-to-day ‘care’ of patients was left to nurses, who were themselves frustrated and overworked – resulting in cruelty and mistreatment. Desperate to maintain control, attendants often resorted to restraints like straightjackets, Utica cribs, or locked rooms to keep patients easy to manage. Thomas Kirkbride’s treatment plan was no longer possible, as those sunny rooms and large corridors full of fresh air were packed with patients.

Sarah: As the psychiatrist-superintendents were becoming less doctor and more administrator, they also started to suffer from competition. After the Civil War, the new medical specialty of neurology began to focus on the brain as the cause of much mental illness, and advocated for new ways of understanding and treating it. Doctors who had served in the US Army Medical Corps, like S. Weir Mitchell, began to criticize establishment psychiatry for its failures. These former army doctors had seen first-hand how traumatic injury resulted in nerve damage that could cause phenomena that mimicked mental illness – like phantom limb pain, which Mitchell studied extensively. In 1894, Mitchell excoriated the psychiatric profession in a speech, accusing them of being backward, anti-scientific monarchs who didn’t bother to do even the bare minimum to actually treat patients. Neurologists, on the other hand, were the real doctors, advancing the study of the brain and identifying the specific (and physical) underlying causes of mental illness.[4] Moreover, neurologists worked outside the asylum in private practices, which typically made them both famous and wealthy (like Mitchell himself, who was the father of the infamous ‘rest cure’ that he used to treat Charlotte Perkins Gilman for neurasthenia, resulting in the classic short story, “The Yellow Wallpaper”).

Elizabeth: All of this – seeing the failure of Kirkbride’s moral treatment as chronic cases piled up and frustrated with their stagnant roles as administrators – led to psychiatrists developing something of an inferiority complex. During the last half of the 19th century, medical science was advancing at what seemed like a startling pace: Joseph Lister innovated antisepsis, John Snow revolutionized public health, Louis Pasteur articulated germ theory, Robert Koch identified the tubercule bacillus – we could go on and on. Yet, psychiatry had changed very little from the beginning of the century. While treatments they offered might have changed a little, the reality was that the real therapy psychiatrists offered was still little more than institutionalization – and that was failing. In 1909, the work of doctor-scientist Paul Ehrlich resulted in the discovery of salvarsan, an antimicrobial agent that killed the spirochete that caused syphilis. The treatment, Ehrlich declared, was a magic bullet. And within a few decades, medicine became increasingly focused on the quest for “magic bullets,” that one treatment that could cure or eradicate some of the world’s most deadly diseases. In the 1930s, scientists at the Bayer pharmaceutical company created sulfonamide, another antimicrobial that effectively treated staphylococcus and streptococcal bacterial infections. And of course in 1928, Alexander Fleming famously left his petri dishes sitting out when he went on vacation and came back to discover penicillin on them – resulting in the early 1940s with the magic bullet of them all: antibiotics.

Sarah: What psychiatry needed was a magic bullet. But they had a bigger problem: they didn’t even know what the germ was for a magic bullet drug to kill. In other words, how could they develop a magic bullet for diseases that didn’t have a clear or identified origin? Psychiatrists desperate to find a somatic (or physical) origin and treatment for mental illness began to experiment with a wide variety of treatments sort of like throwing spaghetti at the wall – just to see what stuck. They tried high pressure showers and very long, hot baths. One physician in Scotland treated a patient with a diet of sheep thyroids. Psychiatrist and asylum superintendent Henry Cotton maniacally removed his patients’ teeth – and sometimes internal organs like colons and cervix – out of the belief that micro-infections in the mouth or body caused insanity. (Fun fact, Cotton actually worried he himself was going insane, and pulled out his own teeth to combat it.) By the 1930s and 1940s, they had shifted focus to the brain. One treatment to ‘reset’ the brain into rationality involved giving patients an overdose of insulin, which put them into hypoglycemic comas. Electroconvulsive therapy (often called electroshock) and lobotomy – in which the brain’s front lobe was destroyed with a literal ice pick forced through the eye socket – were also attempts to treat mental illness through the brain. These therapies were seen as having tremendous potential, but they soon fell out of favor or became the subject of harsh criticism. (Lobotomy and insulin therapy were soundly criticized and stopped being used widely in the early 1950s, and while ECT is still used, its reputation was permanently tarnished by its role in the book/movie One Flew Over the Cuckoo’s Nest.) What the profession needed was something that could provide the effect of these treatments – calmness, relaxation, and ultimately, controllability – without the treatments that seemed so obviously barbaric.

Elizabeth: In 1949, French naval doctor Henri Laborit discovered that certain antihistamines caused sailors under his care to enter a “euphoric quietude.” French scientists then experimented with the drug until they created chlorpromazine, which, unlike existing drugs like barbiturates and morphine, had the power to sedate while allowing the patient to remain conscious.[5] Their new drug became Thorazine, initially referred to as a major tranquilizer or neuroleptic, today considered an antipsychotic. Patients on the drug were conscious, but sedate. One study described the effect this way: “Seated or lying down, the patient is motionless on his bed, often pale and with lowered eyelids. He remains silent most of the time. If questioned, he responds after a delay, slowly, in an indifferent monotone, expressing himself with few words and quickly becoming mute. Without exception, the response is generally valid and pertinent, showing that the subject is capable of attention and of reflection. But he rarely takes the initiative of asking a question; he does not express his preoccupations, desires, or preference. He is usually conscious of the amelioration brought on by the treatment, but he does not express euphoria.”[6]

Thorazine Ad | Public Domain / Wikimedia Commons

Sarah: To be clear, Thorazine was not actually treating anything. In the words of one psychiatrist in the mid 1950s, “We have to remember that we are not treating diseases with this drug. We are using a neuropharmacologic agent to produce a specific effect.”[7] Effectively, Thorazine was actually what is now called a chemical restraint, a medication that is administered to “restrict a patient’s freedom of movement or for emergency control of behavior.” Because it was a pretty heavy tranquilizer, it was most useful inside asylums. In an overcrowded, understaffed institution, control was more important than therapy – and Thorazine made patients easy to control. Patients on the drug sat still, stared, and did not feel the need to talk, making it significantly easier for attendants to keep large numbers of patients under control. It also gave the appearance of treatment. Patients might go from screaming, crying, or acting out in mania to quiet and compliant. (Side note: this is also why antipsychotics are still very often used in nursing homes, not because the patients are mentally ill, but because the drugs to make it easier to deal with elderly people, especially those with dementia.)

Elizabeth: As powerful as Thorazine was, its usefulness was limited to institutional and hospital settings because it was such a heavy tranquilizer. The real revolution came with meprobamate, produced by Czech scientist Frank Berger, who found during research on various compounds came upon a drug called mephenesin that caused his laboratory mice to relax and lose their ‘fight’ reaction while remaining awake and responsive – in other words, a reaction similar to Thorazine but without its more profound effects. Berger used this drug as the jumping off point for what eventually became the minor tranquilizer – what we call an antianxiety today – Miltown. The company that funded the creation of Miltown, Carter Products, had a long history producing patent medicines, and thus was well versed not only in how to develop drugs, but almost more importantly, how to market them. Carter Products’s ad men marketed Miltown not as a sedative, but as a “minor tranquilizer” specifically because it linked it to Thorazine: this new drug could provide the tension-relief of the previous wonder drug to a broader population with its milder action.[8] Within about a year, Miltown and its sister drug, Equanil, made up almost 70% of the tranquilizer market.

Sarah: These tranquilizers (along with benzodiazepines Librium and Valium, which came along soon after) were immediately described as psychiatric ‘magic bullets.’ In 1954, Time magazine lauded Thorazine and called it as important as “the germ killing sulfas discovered in the 1930s.”[9] The New York Times called it a “miracle.” Miltown, according to Consumer Reports, “relaxes the muscles, calms the mind, and gives people a renewed ability to enjoy life.”[10] Miltown in particular became a commercial phenomenon, partly because Carter Products hired the Ted Bates and Company ad agency, which was famous for doing campaigns for “Wonder bread, M&Ms, Colgate, Anacin, and presidential candidate Dwight Eisenhower.”[11] But the reason that the Bates agency was able to market Miltown so effectively requires another little sidestep into the history of psychiatry – this time to the guy who has almost become the doctor associated with psychiatry, Sigmund Freud.

Elizabeth: We would need an entire additional episode to really talk about Freud and the history of his theory of psychoanalysis, so we’re sort skipping over all the details – if you want an episode on that, of course, let us know. But essentially, what you need to know here is that in the mid 20th century, almost all psychiatrists in private practice used Freudian theories and methods. These doctors – also called “analytic and psychological” or “A-P” doctors – were the ones who spent hours in talk therapy with their patients, attempting to ‘gain insight’ using methods like dream analysis and free association. On the other hand, most of the doctors who worked in the state hospitals (as asylums had come to be called in the mid 20th century) were “directive and organic” or D-O doctors, who were focused much more on changing behaviors through quick, usually group therapy sessions and organic means like electroshock or major tranquilizers.[12] The World Wars had given the Freudians an interesting position and perspective: thousands of soldiers returned with what had been dubbed “shell shock,” which was certainly disabling but typically did not require hospitalization except in particularly severe cases. This boosted the position of those in private practice and shifted the profession toward Freudian analysis. It also meant an increased emphasis on Freudian ways of interpreting symptoms. Psychiatrists increasingly talked about anxiety as the underlying cause for all “neuroses,” which was a term that referred to basically all disorders that didn’t involve psychosis. And in 1951, the Freudians had a powerful hold over the committee that wrote and published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), meaning that the resulting diagnoses (used by AP and DO psychiatrists alike) were strongly influenced by Freudian theories.[13]

Freud’s psychoanalytic couch | The Freud Museum London

Sarah: Freudian theory was based on the idea of psychodynamics – or the idea that your behaviors or neuroses today are based on underlying causes. This is where we get the classic image of the psychiatrist sitting in a chair asking a patient, usually reclining on a couch, about their mother. And one theory within psychodynamics is psychosomatic theory, which states that underlying emotions or stresses actually manifest in physical symptoms, ranging from muscle soreness to heart palpitations to ulcers. This was another development in the long belief that the psychological and physical were intertwined. By the 1960s, the concept of anxiety, and its connection to an endless variety of bodily symptoms, were mainstream – which meant that everyone and anyone was in need of psychiatric intervention. This meant that the potential market for Miltown was enormous. In his book Happy Pills in America, David Herzberg details numerous studies that appeared in the 1950s and 1960s that declared that nearly everyone needed psychological help: one study of office visits found that tens of millions of people had gone to their doctors with psychiatric complaints; a study done at Mount Sinai Hospital in New York City found that an overwhelming majority of patients who presented with difficult to diagnose ailments actually had “psychological factors as the basis for their complains and illness.” Herzberg even writes that “by the mid 1960s, conventional wisdom held that up to half of all patients seen in general practice were free of organic illness, their suffering entirely psychological.”[14] 

Elizabeth: So when those minor tranquilizers like Miltown and Equanil hit the market, the ad teams tapped in to the idea that nearly everyone in American society needed these drugs for either, or both, psychological and physical reasons. Miltown could help with “mental stress” and “tension” that accompanied other ailments. People with heart disease or allergies needed drugs to help with their underlying stress, which would in turn help them recover physically. The new minor tranquilizer Atarax was advertised in the Journal of American Medical Association for pediatric use including tantrums and bed-wetting. Equanil ads asserted that “anxiety is part of every illness,” and included the tagline: “in every patient – in every illness.”[15]

Sarah: While this was a gift to pharmaceutical companies like Carter, it held a potential threat for the Freudians psychiatrists. Drugs, they believed, were the domain of the D-O doctors, who used them largely as chemical restraints in psychotic, residential patients. Freudians didn’t want to think of themselves as doling out tranquillizers like doctors in those overcrowded, underfunded, and frankly horrific state hospitals. They also worried that drugs like Miltown would hurt their bottom line if patients could just pop a pill and not do the hard, and they thought necessary, work of psychoanalysis. They also worried that patients would go directly to their primary care doctors to get prescriptions, rather than to psychiatrists.

Elizabeth: Advertisers responded by resassuring Freudian psychiatrists that drugs were just one tool that they could use to help their patients, and that they would help to make particularly challenging cases more receptive to treatment. Psychiatrist & sociologist Jonathan Metzl found that drug ads began to use words like augment and adjunct. One Miltown ad had a banner that read “Miltown: An Effective Adjunct to Psychotherapy,” followed by the assurance that “Miltown moderates tension and anxiety, affording better accessibility and rapport in psychotherapy.”[16] Historian Janet Walker analyzed dozens of these ads in her book Couching Resistance and found that these ads weren’t just designed to reassure Freudians that their business wouldn’t be stolen by pharmaceutical companies, but also to assuage their bruised male egos. Ads centered the psychiatrist’s perspective and point of view, almost never depicting the medication visually at all. An ad for methedrine (a methamphetamine) assured doctors that the drug would help with male patients “who will neither ‘fit in’ with his surroundings nor cooperate to treatment,” sympathizing with psychiatrists that such frustrating patients “present an increasingly wide-spread problem in these anxiety-ridden times.” Several ads are explicitly from the point of view of the doctor, such as one looking at the patient reflected in a doctor’s eyeglasses or another with the camera positioned behind him. That ad, for the tranquilizer Sandril, promised doctors that the drug would “facilitate psychiatric treatment,” making “raging, combative, unsociable patients … become more cooperative, friendlier, quieter, and much more amenable to psychotherapy and rehabilitation measures.” Drugs, they promised, would make psychiatrists better at their jobs.[17]

miltown ad 1967
Miltown advertisement, 1967 | JAMA: the Journal of the American Medical Association, Vol. 202, No. 12, pp. 58-60.

Sarah: While Equanil advertisers declared that the minor tranquilizers were for “every patient – in every illness,” they didn’t really mean it. Ads emphasized complaints like “tension,” “stress,” “worry” and “nervousness,” all by words for the classic disease of the ‘civilized’ classes of the Gilded Age: neuresthenia. We’ve talked about neuresthenia before (in our conservation episode, I think?) but we’ll give a quick recap: it was a diagnoses often given to people of the middle and upper classes who had symptoms that we today would probably associate with anxiety. (They didn’t use that word.) Neuresthenia was a disease of civilization and modernity. The upper and middle classes were refined and used their brains for work instead of their brawn, which resulted in debilitating stress. While the diagnosis became old fashioned, the crisis of anxiety in the post World War II years in many ways became the new neuresthenia: a disease of the upper and middle class. Miltown was ideal for “brainworkers,” went one psychiatrist, who suffered from the tensions of “a group of individuals who are by reason of their inherent qualities and training, the finest product of our culture.”[18] Like the clerks and professionals of the Gilded Age, middle class Americans suffered from the anxiety that came with their social status. People of color and the poor simply weren’t sophisticated enough to suffer from anxiety. That logic also applied to the prescription of Miltown and other minor tranquilizers. Those with the delicate sensibilities of the civilized could be soothed with those gentle pills – the poor and marginalized would better be institutionalized and sedated.

Elizabeth: But unlike neuresthenia, anxiety could be treated with a little pill. Advertisers made it clear that anxiety was central to life as a middle class American, and that it was an individual problem that could be alleviated through the purchase of medicine – keying into the consumerist culture of the postwar. And having “mental stress” became a marker of being middle class – keying into the conformist culture of the postwar. And while politicians (like Teddy Roosevelt, for instance) used neuresthenia as an indication that America needed systemic change (remember, TR claimed that America’s overcivilized weakness could be alleviated through war and imperialism), anxiety made no such claim. It could be cured by popping a pill.

Sarah: Neuresthenia was also an intensely gendered disorder: therapies were designed to make women more womanly and men more manly. Thus, S. Weir Mitchell’s rest cure, which required that women lie in bed without any stimulation at all – no reading, writing, drawing, parenting, just complete rest. It forced women into an extreme, and extremely distressing, form of domesticity. After all, the experience traumatized Charlotte Perkins Gilman so significantly that she channeled her experience into the disturbing short story, “The Yellow Wallpaper.” Men, on the other hand, were encouraged to be more active and pushed toward manly pursuits like camping, hunting, fishing, and boxing. But the tranquilizers faced a gender dilemma: a pill is a pill. Both men and women can take it – so they needed to somehow make it appeal to both men and women. Initially, there was concern that tranquilizers would be harmful for men, who needed to be vigorous to be successful. One doctor wrote in a medical journal that “our civilization has been built on the divine discontent of tense men,” and speculated that Columbus might not have ever bothered to sail the ocean blue in 1492 if he had been tranquilized by Miltown.

Elizabeth: Advertisers needed to find a new way to sell the drug to men that made it clear that it was still manly to be tranquilized. They hit on a truly amazing narrative: men were actually so manly, so vigorous, and so full of drive that they needed help managing their instincts for a fight. One ad for Librium depicts two panels with what looks like a heart rate in front of it: on the left, a loin-cloth wearing cave man’s heart rate spikes when he sees a tiger; on the right, a suit-wearing business man’s heart rate spikes over and over because of the constant “threats” of modern life. Men had evolved to react to these acute threats – but now smaller-scale threats came constantly, leaving men trapped in a high anxiety fight response. Tranquilizers would help to “calm the restless animal within,” as David Herzberg describes it.

Sarah: Women’s use of tranquilizers, on the other hand, did not cause any gender anxieties. Just like in the age of neuresthenia, women neeed to find a way to be happier and more content with their traditional role of mother and wife. I mentioned at the beginning of this episode an ad for Miltown that sold the tranquilizer to overwrought housewives using language that mimicked Betty Friedan’s The Feminine Mystique. Friedan used the language of neuresthenia to describe the “problem that has no name,” the mental distress of women who felt trapped by oppressive femininity. Friedan wrote with worry about the role that tranquilizers like Miltown were having on such women. One woman she interviewed for the book wrote about her experience with psychiatric drugs: “You wake up in the morning,and you feel as if there’s no point in going on another day like this. So you take a tranquilizer because it makes you not care so much that it’s pointless.”[19] Tranquilizers – like Mitchell’s rest cure – were specifically marketed to help make women better adhere to the expectations of femininity. An ad for Vivactil declared that it “first gets the patient moving, then gets her mood improving” over an image of a woman carrying a laundry basket down the stairs. A Dexamyl ad showed a woman hanging new floral curtains next to a headline that stated “REGAINED: an interest in her surroundings, a feeling of well-being.”A Butisol ad shows a mother in the kitchen smiling as a little girl ties her legs together as part of some kind of make-believe game and states “now, she can cope.” By the end of the 60s, drug ads were purposely tapping into Friedan’s argument to sell the very drugs that she worried would further trap women. One astonishing Serax ad from 1969 depicts a woman surrounded by cleaning supplies. A broom and mop create the illusion that she’s behind bars. The ad copy reads: “You can’t set her free. But you can make her feel less anxious.”

Elizabeth: These ads pointed to a real conundrum in the American construction of femininity. Women, these ads declared, would be happier if they could just be better in their role as housewife. But they also marketed Miltown and other tranquilizers specifically on the point that for a lot of women, that role wasn’t really possible without chemical tranquilization. Through the 1960s and into the 70s, minor tranquilizers Librium and Valium were prescribed almost exclusively to women, and the drug companies stopped bothering trying to market them to men. No wonder the Rolling Stones wrote a hit song about psychiatric drugs called “Mother’s Little Helper.” The song is a little misogynistic – it criticizes women for popping pills when they’re not really sick and have things easier than women have in the past (the woman in the song bakes instant cakes and burns frozen steaks). In the 70s, however, came the growing, uneasy realization that the minor tranquilizers were addictive – and causing people to abuse their prescriptions. Famously, President Gerald Ford’s wife Betty made a series of public appearances in the late 1970s where she appeared obviously drunk or high, slurring her words and stumbling. In 1978, she announced that she had been “overmedicating” and checked herself into a hospital – later, she founded the Betty Ford Center, a treatment facility for those struggling with substance addiction.

Sarah: Once considered ‘minor’ and perfect for the busy moms and business men, now Valium and other minor tranquilizers were seen as potentially dangerous. Feminists in particular took on the over prescription of the drug, which seemed to be prescribed to women for just about every possible reason, including skin problems and vaginal pain. When tv producer Barbara Gordon kicked a Valium addiction in the late 1970s, she went on the offensive, calling attention to sexist male doctors pushing drugs on women who they believed needed to be put back in their place, while not warning them about the potential side effects. Women, she wrote, needed to stop being “docile patients” and take control over their own health. (It’s not a coincidence that this fight over Valium was happening at the same time as the women’s health movement, which I talked about in my witchcraft episode!) Eventually, Valium began to market itself as specifically not for everyday stresses, but instead for acute duress. But the market didn’t let a vacuum develop where the minor tranquilizers had been: enter the anti-depressant, Prozac. In fact, one psychiatrist went so far as to describe Prozac as a kind of feminist wonder drug: it would help women succeed in a man’s world.[20] Prozac also empowered women in a sense by advertising directly to them, telling them to “ask their doctor” and putting the decision to seek out the drug in their hands. Instead of dulling women to their plight, Prozac, it was argued, opened them up to new possibilities. In the 70s and 80s, depression overtook anxiety as the psychic ailment of the masses, and Prozac the new wonder-drug.


[1] David Herzberg, Happy Pills in America: From Miltown to Prozac (Baltimore: Johns Hopkins University Press, 2009), 34.

[2] Nancy Tomes, The Art of Asylum Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry (Philadelphia: University of Pennsylvania Press, 1994), 96.

[3] Sarah F. Rose, No Right to be Idle: The Invention of Disability, 1840s-1930s (Chapel Hill: University of North Carolina, 2017).

[4] S. Weir Mitchell, “Address Before the Fiftieth Annual Meeting of the American Medico-Psychological Association,” Proceedings of the American Medico-Psychological Association 50 (1894): 101-121.

[5] Robert Whitaker, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (New York: Crown Publishers, 2010), 48.

[6] Whitaker, Anatomy of an Epidemic, 50.

[7] Whitaker, Anatomy of an Epidemic, 51.

[8] Herzberg, Happy Pills, 24.

[9] Whitaker, Anatomy of an Epidemic, 58.

[10] Whitaker, Anatomy of an Epidemic, 59.

[11] Herzberg, Happy Pills, 29.

[12] Jonathan Metzl, Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs (Durham: Duke University Press, 2003), 38.

[13] Metzl, Prozac on the Couch, 38-39.

[14] Herzberg, Happy Pills, 33.

[15] Herzberg, Happy Pills, 35.

[16] Metzl, Prozac on the Couch, 42.

[17] Janet Walker, Couching Resistance: Women, Film, and Psychoanalytic Psychiatry (Minneapolis: University of Minnesota Press, 1993), 33-36.

[18] Herzberg, Happy Pills, 57.

[19] Herzberg, Happy Pills, 79.

[20] Herzberg, Happy Pills, 146.

Bibliography & Further Reading

David Herzberg, Happy Pills in America: From Miltown to Prozac. Baltimore: Johns Hopkins University Press, 2009.

Robert Whitaker, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and teh Astonishing Rise of Mental Illness in America. New York: Crown Publishers, 2010.

David Healy, The Creation of Psychopharmacology. Cambridge: Harvard University Press, 2002.

Jonathan Metzl, Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs. Durham: Duke University Press, 2003.


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