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The Age of Anxiety: A History of America’s Turbulent Affair With Tranquilizers
Am J Psychiatry 2009;166:833-833. doi:10.1176/appi.ajp.2009.09010019
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by Andrea Tone. New York, Basic Books, 2009, 298 pp., $26.95.

Americans have had a very ambivalent relationship with minor tranquilizers. The course of this relationship resembles the usual one following the adoption of a new medication—after initial enthusiasm (frequently spurred by marketing) comes disappointment and condemnation (mostly due to unwanted, initially unreported effects), and finally a midlevel plateau of realistic appreciation is reached. America’s “turbulent” affair with minor tranquilizers has not yet settled into this plateau. Generally, some of us do view these very effective substances with realistic appreciation, while others are still in the age of disappointment and condemnation.

Andrea Tone, a Canadian historian of medicine, traces the story of minor tranquilizers in The Age of Anxiety (a book title originally used by W.H. Auden). She explores “anxiety before the tranquilizer revolution” from Sir Thomas More, who first used the term anxiety, through “irritable heart syndrome,” neurasthenia, and neurosis to the recent classification of anxiety disorders. She then turns to the discovery of meprobamate (brand names Miltown, Equanil), the first blockbuster psychopharmacological agent. Those doubting or unaware of its blockbuster status might be surprised to read how many Hollywood stars used it, that Milton Berle suggested changing his name to Miltown Berle, and that there once was a cocktail called a Miltini (dry martini with a Miltown instead of an olive). The discovery of meprobamate was partly serendipitous and partly a result of very focused research by Frank Berger, a refugee from Nazi-occupied Europe. The story of meprobamate is followed by that of chlordiazepoxide (Librium) and other benzodiazepines discovered by another refugee, Leo Sternbach. Both stories are not just stories of great discoveries but also of two extraordinary and very humble men.

The final part of the book deals with the fall of minor tranquilizers from fame and favor. The author traces their demise to various societal influences. One of them was the overuse of minor tranquilizers among the general public and suburbanite women (in contrast to psychopharmacological agents used for the seriously mentally ill). Another was the withdrawal syndrome and the possibility of abuse, which were not fully revealed originally, and yet another was women’s liberation.

The book is filled with fascinating facts and stories (such as Salvador Dali’s involvement in the marketing of Miltown). In view of the recent debate surrounding conflict of interest and relationship with pharmaceutical industry, one is amazed at how little Berger and Sternbach were paid for their discoveries (and they never complained about it), and how prescient and ethical Berger was in his ban of “detail men” (representatives) to be employed by the Miltown maker and his insistence on journal advertising and mailing to physicians only. Advertising was to be factual and educational.

The pendulum switched away from minor tranquilizers. Yet, these were the agents that truly started the psychopharmacological revolution and made the idea of affecting the psyche by prescribed medication palatable to the general public. Despite their fall from grace, they are effective, and hopefully we will recognize and appreciate their true value and learn from their history.

Last but not least, I liked this book and recommend it.

+The author reports no competing interests.

+Book review accepted for publication January 2009 (doi: 10.1176/appi.ajp.2009.09010019).




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