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1: Welcome
to the "Age of Anxiety"
Nobody likes
to feel anxious.
Whether you call
it tension, stress, or plain-old nerves, the jangled, tingling,
heart-pounding experience of inadequacy and dread that makes
up anxiety is just plain unpleasant. Period.
In fact, for
a while (about the time tranquilizers were first developed, in
fact) people even made a big deal out of it, deciding that the
late, great Twentieth Century was but the dawning of the "Age
of Anxiety," and rushed around trying to figure out What
It All Means and to explain How, exactly, We Got This Way.
No one's sure
if any one ever did figure out what it all really does mean (aside
from the obvious fact that a lot of people feel anxious a lot
of the time) or how, exactly, we did get this way (assuming,
of course, that it hasn't always been this way), but we are sure
that the "Age of Anxiety" turned into the "Age
of Tranquilizers" pretty darn quick -- at least as soon
as the pharmaceutical companies discovered the chemical keys
to turn the lock into the New Age.
And the biggest,
shiniest keys of all -- discovered in the 195O's and early-1960's
-- turned out to be an entirely new category of drugs, a group
of chemicals which eventually came to be known as the minor tranquilizers.*
[*Throughout this booklet, the minor tranquilizers
will be distinguished from the so-called "major tranquilizers,"
anti-psychotic mood modifiers such as Thorazine, Prolixin, and
others. The major tranquilizers do not produce effects generally
experienced as pleasurable, and are thus rarely abused.
In addition (and
for purposes of brevity and clarity), we will not discuss a number
of other drugs sometimes prescribed as tranquilizers. Drugs in
this category include products as diverse as reserpine-based
antihypertensives (e.g. Serpasil™, antidepressants with
tranquilizing properties (e.g. Sinequan™, Adapin™),
and sedating antihistamines (e.g. Atarax™, Vistaril™).]
What the minor
tranquilizers are, exactly, is a group of synthetic chemicals
that produce feelings of tranquility through their action on
the brain and central nervous system.
But for a group
of drugs that are supposed to produce calm, the minor tranquilizers
sure managed to produce more than their share of excitement when
they first burst onto the drug scene. They were thought to be
virtual "wonder drugs" at the time -- safe, effective,
and nearly side-effect-free.
Probably the
main reason for the chorus of hallelujahs that greeted the minor
tranquilizers was that they did look awfully good and awfully
safe, especially compared to the collection of chemicals that
had been in use for years as "tranquilizers" -- alcohol
and opiates and bromides and barbiturates.
Still, they weren't
perfect. It just took a while to find that out, that's all.
Meet Miltown,
The "Happy Pill"
The first "real"
minor tranquilizer marketed in the United States was meprobamate,
patented in 1952.
Meprobamate proved
successful, in fact, too successful, almost from the moment it
hit pharmacists' shelves. The drug, which was marketed under
the trade name Miltown (and later Equanil), was the immediate
darling of the then up-and-coming psychiatric profession and
became a popular recreational drug almost as quickly.
In fact, Miltown was one of the biggest drug abuse phenomena
of the 1950's, probably the first really middle-class drug abuse
phenomenon, and the drug quickly established itself as the "happy
pill" alternative for harried housewives and stressed-out
commuters. It was called a "dehydrated martini" by
some, and "Miltown parties" became respectable in more
than one suburb, at least until word began to leak out that there
were problems -- lots of them, in fact -- associated with use
of the drug.
For one thing,
in spite of the fact that meprobamate was thought to have little
potential for abuse, and no matter that early advertising for
the drug tirelessly pointed out its differences from the barbiturates
(which had emerged as the preeminent pre-tranquilizer "tranquilizer"),
Miltown quickly proved itself to be nearly the equal to the barbiturates
in just about every drug abuse category that's ever counted --
psychology, pharmacology, and all-around addictiveness.
They were found
to produce a barbiturate-like "buzz" when taken to
excess, along with a constellation of other barbiturate-like
problems, right down to the convulsive seizures of withdrawal
and the lethality of the respiratory depression of overdose.
All of which
happened to confound the drug industry "experts" who'd
predicted a long, leisurely product life (and a steady, stable
profit curve) for Miltown. But they'd already made piles of money
off meprobamate and began hedging their bets as soon as bad reports
about Miltown started hitting the evening news.
But by this time,
many who knew anything about the burgeoning new psychopharmaceutical
industry were already busy placing bets on a new category of
minor tranquilizer, hot off the pill presses of the tiny Swiss
pharmaceutical maker Hoffman-LaRoche, who happened to own the
patent on a fledgling group of tranquilizers that traveled under
the vaguely-ridiculous chemical family name of benzodiazepines.
Enter The
Benzodiazepines
What Hoffman-LaRoche
came up with in 1960 was a brand-new all-purpose minor tranquilizer
that went by the appealing name of Librium (which translates
from the Latin as the very-benign "to be free"). Librium,
known generically as the less-friendly-sounding chlordiazepoxide,
immediately picked up where Miltown left off, and then went its
older chemical cousin a thing or two better.
And Librium was
only the beginning.
In 1963, a sister
drug, Valium (from the Latin "to be brave"), appeared
and the pair immediately shot to the top of medical drugland's
Most-Prescribed lists. And that was still only the beginning.
Because Valium
and Librium represented only the first arrivals of the brand-new
benzodiazepine family (BZD's for short). And as new BZD relatives
appeared throughout the next decade (new family "members"
showed up just as fast as drug-company researchers could tickle
the benzodiazepine formula into a new shape not already patented),
America's love affair with the new drugs just seemed to grow
and grow.
And the BZD's
did look to have everything going for them that meprobamate and
the earlier "tranquilizers" didn't. For one thing,
they were found to only mildly depress normal body functions,
which reduces the risk of extreme respiratory depression and
fatal overdose.
For another,
they seemed not to interfere with higher-level mental processes
to the same degree that barbiturates and meprobamate do, which
was seen as a definite advantage -- especially to the legions
of middle-class housewives, business people, and students who
constituted the main demographic target groups identified by
the manufacturers as likely candidates for the drugs.
And when the
manufacturers' marketing departments went for middle-class "Age
of Anxiety" converts (via medical journal ad campaigns aimed
at their physicians), they went after them in a big way.
Mother's (And
Brother's And Sister's) Little Helpers
Early ads for
the benzodiazepines portrayed them as the natural successors
to the old-fashioned nap in the shade as the ideal package for
up-to-date relaxation.
One 1969 ad for
Librium, headlined "A Whole New World... of Anxiety,"
pictured a mini-skirted college coed with the problems of the
age etched in the lines of her face.
The text of the
ad made it clear that the answer to her problems (which, it pointed
out, included insecurity over "today's changing morality"
and apprehension about "unstable national and world problems"
provoked by "her newly stimulated intellectual curiosity")
came in a pill and the pill was called Librium.
Valium's early
ads were no better.
One showed a
tense, unhappy-looking young man seated in front of an open book
in a library, notepad and pen at the ready, alongside the caption:
"Symbols in a life of psychic tension: M.A. (class of '66),
Ph.D. (thesis in progress), G.I. (series and complete examination
normal -- persistent indigestion)." The Rx? Why, Valium,
of course -- three, even four times a day.
And it wasn't
just Hoffman-LaRoche, Valium and Librium's manufacturer. A late-60's
(early-women's lib) ad for Wyeth Laboratories' Serax pictured
a distraught, finger-gnawing housewife imprisoned behind a wall
of broom and mop handles, captioned, "You can't set her
free. But you can help her feel less anxious."
And without even
bothering to read the rest of the copy, you know the help Wyeth
had in mind was the same "help" the Rolling Stones
talked about in their housewives-and-tranquilizers lament from
the same period, "Mother's Little Helper":
Doctor, please.
Some more of these.
Outside the door she took four more.
What a drag it is getting old.
But "Mother's
Little Helper" was only a hit for a few months.
The drug companies'
campaigns ran for years (decades, even). And what got remembered
and imprinted in the public mind during that entire time was
the Truth According to the Drug Companies -- that, and little
else.
Turning Fear
Into Gold
Thus emboldened
with the finest public relations that money could buy, the new
tranquilizer makers went after their middle-class target groups
with a passion. And the passion paid off.
By 1975, Valium
(or diazepam) had achieved such widespread acceptance that 61
million prescriptions were written in the United States alone,
and worldwide consumption totaled in the uncounted billions.
Diazepam's formula proved so popular, even, that chemists in
the Soviet Union and China pirated it -- presumably to calm revolutionary,
anti-imperialist anxiety.
Today, Valium
and the other BZD's are still mainstays in the chemical "war
on anxiety." And although their numbers have fallen in recent
years -- total annual prescription sales for diazepam slipped
to 10.7 million by 1999, accounting for a mere 15 percent of
the total U.S. tranquilizer market of 70 million prescriptions
-- BZD's as a group continue as one of the most widely-prescribed
class of psychoactive drugs in the world and look to stay that
way for a long time to come.
But they're not
as popular as they once were -- and for a few dozen very good
reasons.
For one thing
(and their early advertising to the contrary), they are addictive.
According to the U.S. Food and Drug Administration, the number
of current benzodiazepine addicts adds up to at least six figures,
and approximately 1.5 million current users have taken the drugs
longer than the maximum period of time (four months) for which
they're recommended.
Add in the fact
that some of these users have been using the drugs much longer
than the maximum recommended time -- some, in fact, don't know
how they'd live without their little yellow or blue or grey pill
three or four (or, in some cases, eight or ten or twenty) times
a day, and factor in the 60,000 or so hospital emergency room
visits the drugs figure into each year, and you begin to get
an idea of why doctors -- and a good many patients -- are much
more cautious about BZD's today than they once were.
But it's not
as though no one's taking BZD's any more. As we mentioned a moment
ago, the drugs are still among the most widely-prescribed psychoactive
drugs in the world, and look to continue to be for a long time.
But to understand why, exactly, we need to look more closely
at the pharmacological actions -- and the psychological effects
-- of these drugs, the benzodiazepines.
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