America's Long Love Affair with Anti-Anxiety Drugs

America's all-time favorite pill isn't for birth control, according to historian Andrea Tone. It's a potent little tranquilizer called Miltown, after Milltown, the New Jersey hamlet where it was manufactured in 1955. Despite virtually zero advertising, the release of the original "mother's little helper" set off a consumer stampede. By 1957, Americans had filled 36 million prescriptions for Miltown, more than a billion pills had been manufactured and these so-called "peace pills" accounted for one third of all prescriptions. The drug's popularity has fallen off a cliff since the 1960s, when studies found that it caused psychological dependence. But it nonetheless launched the age of psychiatric cure-alls. Dozens of "lifestyle drugs" (like Xanax and Paxil, which also treat anxiety) have followed in its wake, raising a perennial question: do we actually need these medications, or does Big Pharma push them on us?

Critics argue that the push is more like an aggressive shove. Drug companies spent more than $4 billion on syrupy and suggestive consumer ads last year, up from less than $1 billion in 1997. And more than three quarters of that cash went for television ads, which critics have blamed for trivializing the serious decision to take prescription drugs. Last year House Democrats tried (and failed) to pass a bill banning TV ads during a drug's first three years on the market. . But historian Tone differs with those who blame our pop-a-pill mentality on marketing hype and harried doctors too eager to write prescriptions. In "The Age of Anxiety" (Basic Books), her smart and crisp history of American tranquilizer use, the McGill University professor finds that demand for Miltown—the first lifestyle drug—was surprisingly patient driven. Tone spoke with NEWSWEEK's Tony Dokoupil. Excerpts:

NEWSWEEK: Why did Americans swoon for Miltown?
Andrea Tone: People weren't as cynical about new drugs as they are now ... In 1954, a year before Miltown's debut, Thorazine—which offered the first effective treatment for schizophrenia—had revolutionized the treatment of institutional psychiatry, and Miltown seemed to offer a pharmaceutical counterpart to the management of everyday nerves. Some people referred to it as "psychiatry's penicillin." Miltown's success also occurred during the Cold War, when America's political culture emphasized the virtues of staying calm in an atomic age. One civilian-defense film went so far as to urge patriotic citizens to stash a bottle of tranquilizers in their fallout shelter! It's also useful to remember that Miltown was cheap, fast, and it worked.

What does this say about Big Pharma's ability to foist drugs on the public with fancy ads?
The creation of pharmaceutical markets is not always a simple, top-down process. In the 1950s, people learned about tranquilizers not from the direct-to-consumer ads we have now—in fact, such ads were illegal for prescription drugs—but from friends, neighbors, relatives, doctors, television shows and Hollywood tabloids. Indeed, Miltown got heaps of free and unexpected publicity from Hollywood celebrities, who talked openly and enthusiastically about their casual use of the drug. Milton Berle, Mr. Television himself, took so much that he joked on his hit show that he was thinking about calling himself "Miltown" Berle.

Why has the market for anti-anxiety drugs like Miltown cooled since its peak in the 1970s?
Social conservatives effectively tied widespread tranquilizer use to the burgeoning war against recreational drugs, and critics charged that Miltown and Valium had left Americans emotionally numb and politically impotent. It didn't help that housewives had become the drug's most loyal users. In the hyperbole of the day, apple-pie suburbia had been chemically hijacked by "mother's little helpers." Interestingly, the [tranquilizer] backlash bypassed France, where a large swath of the population continues to use them with impunity. Are French people more likely to drive recklessly into trees? Have they lost their intellectual edge? No. It's important, always, to weigh a drug's benefits and costs on a case-by-case basis.

Miltown may not be in fashion now, but lots of other "lifestyle drugs" have taken its place. Should that worry us?
The concern is that we've pathologized and medicalized the normal vagaries of being human. We've set the human bar to an impossible height—only perfection, achieved with pills, will do. On the other hand, it's hard to generalize about where the line separating normal and pathological resides, and what counts as appropriate treatment. Each person is different. We can never really know what another person feels. A drug disparaged as a lifestyle drug might, for the person taking it, seem like a lifesaving intervention.

It's been argued that we should all use lifestyle drugs as performance enhancers. Do you agree?
It's complicated. By the way: coffee is a performance enhancer, but because it's not considered a pharmaceutical commodity, we don't stigmatize its use.

What would you like readers to take from your book?
I hope they will understand that in addition to being chemical compounds, drugs are social objects. How society determines their value and worth in any given age can tell us as much about that society as it does about the drugs themselves. In this sense, the trials and tribulations of tranquilizers mirror and track changes in American culture itself.

Between Obama's inauguration and the collapsing economy, we are at an interesting intersection of hope and fear. What does history suggest about our embrace of drugs in times like these?
Historically, tranquilizers have sold best during stressful times—December and January have long been their blockbuster months—but I confess I'm intrigued by the idea of Obama as an antidote to anxiety and fear. Here's hoping.