The Magic Bullet
A full-page advertisement in a 1960 medical journal shows a photograph of a woman visiting her physician. The woman—who is white and well-dressed, with high cheekbones, a Peter Pan collar, and a Mary Tyler Moore hairstyle—is there to discuss her emotional problems. As the ad explains, she has been “suffering from recurring states of anxiety which have no organic etiology.” In other words, it’s a mystery, these feelings of hers.
Fortunately, the woman’s doctor has just the thing: a tranquilizing pill that promises to dull the small anxieties of daily life. Armed with her new medication, the ad shows the woman going about her day. She takes a pill at breakfast so she can stay calm, “even under the pressure of busy, crowded supermarket shopping.” While in the grocery aisle, the woman peacefully examines the ingredients on a can of peas. She takes another pill at dinner so she is able to stay alert at her children’s school to “listen carefully to P.T.A. Proposals.” Finally, back home, tucked into bed, the woman drifts peacefully off to sleep.
By the time this advertisement appeared in the Journal of the American Medical Association, the advertised drug, meprobamate—known primarily by the brand name Miltown—was the most popular prescription drug in the United States. In 1956, after only a single year on the market, Miltown had been tried by nearly 1 in 20 Americans. Doctors used the pill to ease a host of ailments in men, women, and even children—including headaches, rashes, tension, insomnia, childhood bed-wetting, high blood pressure, juvenile delinquency, and epilepsy. Perfectly legal and easily available by prescription, Miltown was the first drug in a class that physicians started calling “minor tranquilizers” in the mid-1950s; instead of sedation, these pills offered peace of mind. For the first time in American history, everyday anxieties could seemingly be cured by a single trip to the doctor.
Like many advances in pharmacology, the discovery of chemical tranquility came about by accident. In 1946, Frank Berger, a Czechoslovak scientist and physician, was working in a laboratory in Yorkshire, England, researching a way to purify and extract the antibiotic penicillin, which was distilled from a temperamental mold that was easily contaminated. As Andrea Tone describes in her 2008 book The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers, Berger was a left-leaning humanist of Jewish heritage who had fled his Nazi-occupied homeland in 1939 with his wife, Bozena. The couple ended up in London without any money, sleeping on park benches and eating in soup kitchens, when his wife discovered she was pregnant. Their infant son died during an agonizing childbirth that also nearly killed Bozena.
After the war, Berger gave up his career as a physician—he said in his autobiography that he was “too deeply affected by the suffering of my patients to be a practicing doctor.” Like so many others of his generation, Berger had a deep, personal understanding of human suffering, and he would spend his career as a scientist trying to eradicate it for others.
Doctors used the pill to ease a host of ailments in men, women, and even children—including headaches, rashes, tension, insomnia, childhood bed-wetting, high blood pressure, juvenile delinquency, and epilepsy.
In the years after World War II, penicillin was in short supply because it was so difficult to make and store: doctors would collect urine from patients who took the antibiotic so that the drug could be captured and reused. While testing for a penicillin preservative, Berger noticed that a group of mice seemed to be especially calm following exposure to mephenisin, a chemically modified disinfectant. The mice were relaxed but still maintained a degree of alertness. He described the effect in a paper in the British Journal of Pharmacology in 1946: “Their eyes were open and they appeared to follow what was happening around them.” This was the first time a pharmacology journal had published a paper that focused solely on a drug’s ability to relax its subjects. Although tranquilization had been a side effect of other drugs, Berger offered up the calming effects of mephenisin as an end in itself.
At first, Berger believed that mephenisin might be useful as a form of sedative, which it was. By the late 1940s, it was being given intravenously in surgical wards to calm patients. It was also used by neurologists as a way to help people with multiple sclerosis and Parkinson’s disease relax their muscles. During this time, the most popular types of sedatives, for both clinical and recreational uses, were barbiturates like phenobarbital and Seconal. “Goofballs,” as these drugs were called on the street, were dangerous, strong, and habit-forming. Overdoses were common, and the effect of the drugs was usually too significant to allow the user to still go about the tasks of daily life—it wouldn’t have been easy to sit through a PTA meeting doped up on goofballs.
In 1947, Berger and his wife moved to the United States, and in 1949 he joined Carter-Wallace Laboratories, in Cranbury, New Jersey, as the president and director of research. Berger went to work creating a pill form of mephenisin, something that would be easy for the average person to take and would last for several hours in a patient’s system: a replacement for barbiturates that would keep people calm but alert. His original drug was an injectable liquid, and the effect lasted only a few hours. Berger thought that if the drug was going to work for ordinary people, he would need to find a way for it to exist as a long-lasting oral tablet. Berger worked on synthesizing his drug for almost ten years before he finally landed on a compound that worked: meprobamate. Carter-Wallace named variations of its testing compounds after nearby cities in New Jersey; Miltown—which takes its name from Milltown, a small, unremarkable township in Middlesex County—happened to be the one that worked best.
The Age of Anxiety, the title of W. H. Auden’s book-length poem published in 1947, coined a phrase that fit the ethos of the postwar nuclear age. Most heath-care providers during this time believed that anxiety should be treated with therapy or psychoanalysis. Therapists needed to root out the underlying causes with time, talk, and patience—a pill couldn’t possibly cure anxiety, they reasoned. Before bringing Miltown to market, Carter-Wallace conducted a survey among doctors about whether they would prescribe such a drug to their patients and got a resounding “no.” Miltown was the first drug of its kind, and doctors weren’t sure it made sense to treat anxiety symptomatically.
There were also critics who weren’t so sure it was such a good idea to cure anxiety at all. “Our civilization has been built on the divine discontent of tense men,” wrote one physician in the American Journal of the Medical Sciences in 1959. “Perhaps Columbus could have discovered the New World while taking tranquilizers, and Beethoven might have been able to compose his symphonies, but I submit that if they had been full of [Miltown] they wouldn’t have bothered.” In the pages of the Journal of the American Medical Association and Time magazine, doctors and journalists expressed their anxiety of a fearless society. “What happens to people accustomed to avoid all anxiety, who know no fear, who need not think or love or hate?” wrote David Cowen in The Nation in 1960. Anxiety was good because it was motivating, the very emotional impulse fueling American success and ingenuity. In a country built on the Protestant work ethic, what would it mean to manage anxiety with a pill instead of effort?
Berger, however, was committed to his drug. He believed that by curing the symptoms of anxiety, psychoanalysts could better treat the underlying causes of that anxiety. (He was also suspicious of any theory that suggested people needed to suffer in order to find relief.) In 1955, Berger made a short film to screen at scientific conferences in order to demonstrate what Miltown could do. The film showed an unmedicated rhesus monkey acting violently, as monkeys do in nature. (The lab worker in the film had to wear thick gloves and a welding mask so the animal wouldn’t claw his face to shreds.) The next scene depicted the monkey high on barbiturates, stoned and unconscious. Lastly, audiences were given a glimpse of the monkey on Miltown. It was calm but awake, docile and seemingly happy; a monkey you wouldn’t mind having around.
In order to sell Miltown, Carter-Wallace hired the advertising firm Ted Bates & Company, the agency that had sold Wonder Bread and M&M’s to the American public. The firm placed ads in medical journals to appeal to doctors, who at first took limited interest, and also encouraged gossip columnists to write about the drug in Hollywood. Despite these efforts, Miltown didn’t sell well at first. In May 1955, the first month that Miltown was on the market, sales of the drug brought in less than $7,500, approximately $74,000 in today’s terms. But by September, sales had risen to $218,000, and by the end of the year had skyrocketed to $2 million (nearly $19 million today). Miltown owed its initial success not to its catching on with the doctors who had been skeptical, but rather because the gossip machine had worked: Miltown had become the drug du jour for Hollywood celebrities.
Uppers and downers had fueled the production of Hollywood’s studio successes in the 1930s and ’40s. Benzedrine, a brand-name amphetamine, powered all-night shoots on 1939’s Gone With the Wind, while a teenage Judy Garland was rumored to have become addicted to amphetamines on the set of The Wizard of Oz after she was given uppers to lose weight. Actors took uppers to stay awake and peppy on set, and when they were ready to calm down, they needed barbiturates, downers, to counteract the effect of the speed.
Stars initially discovered Miltown in the gossip columns that the advertising firm had seeded, and the drug quickly became a part of the culture of Los Angeles. Miltown offered a smoother experience than Seconal and phenobarbital, barbiturates that had been popular in the 1940s. Schwab’s, on Sunset Boulevard, the most famous pharmacy in Hollywood, sold 25,000 pills of Miltown in the winter of 1955 and 1956. Stores posted peppy signs on their windows when new shipments arrived: “Yes, we have Miltown!” At parties, celebrities served “Mil-tinis”—martinis garnished with a Miltown instead of an olive. (It was dangerous to mix the pill with alcohol, but few knew it then.) Lucille Ball, Lauren Bacall, and Tennessee Williams were all known users. In 1955, Milton Berle —one of the first stars of television—openly joked on his variety show that he should be called “Miltown Berle.”
But pop culture’s embrace of the pill concerned Berger. In his autobiography, he expressed worry that the media and celebrities had made Miltown fashionable, and had turned the gravity of anxiety into a “stupid joke.” Cosmopolitan magazine called the pills “emotional aspirins” in an article in 1956, which spoke both to the casual way people were using Miltown and to the effect the drug had. But Berger believed that his Miltown was an important breakthrough, a cure for a kind of pain that had never really been taken seriously before. Berger wanted doctors to see his pill as a medical treatment, not a frivolous fad.
Yet by discussing the drug on television, talking about it in magazine articles, and dishing about it to gossip columnists, Hollywood had taken the message of Miltown mainstream for the medical community, and the doctors who had once shunned the pill now proscribed it with gusto.
Actors took uppers to stay awake and peppy on set, and when they were ready to calm down, they needed barbiturates, downers, to counteract the effect of the speed.
Who, exactly, were the people taking Miltown, and what was making them so anxious? In the eyes of many psychiatrists, the kind of anxiety that Miltown treated was, by definition, a condition of the white middle and upper classes.
According to historian David Herzberg, author of the 2009 book Happy Pills in America: From Miltown to Prozac, “anxiety” had been long divided along class and race lines. People of color and those living in poverty had little access to psychiatric treatment, and the modes of self-medication they often used—heroin and other opioids—were criminalized. Psychiatrists, physicians, and drug companies felt that poor people weren’t smart enough to get anxious in the same way as those of the middle class. As Herzberg put it, “Some kinds of suffering were seen as deserving, and others as undeserving.”
Two physicians put it plainly in the 1957 Annals of the New York Academy of Sciences: anxiety was “so common as to be statistically ‘normal’ among professional persons, but rare among Southern Negroes and reservation Indians.” It was the “brainworkers” who needed drugs like Miltown, as some medical journals called white-collar workers. And, increasingly, the wives of the brainworkers.
By 1960, women were twice as likely as as men to be taking tranquilizers like Miltown. Advertisements, popular culture, and physicians had begun to push women toward the calming effects of Miltown, especially as they related to the needs of their husbands. In a 1956 article in Cosmopolitan, one doctor reported that after taking the drug, “frigid women who abhorred marital relations reported they responded more readily to their husbands’ advances.”
The popularity of Miltown eventually split the diagnosis of anxiety along gender lines. At first, Miltown had been marketed to both men and women; pharmaceutical companies wanted all the customers they could get. Male business executives took a Miltown before negotiating a raise; women popped one to deal with a toddler’s temper tantrum.
But by 1960, psychiatrists and commentators in magazines like Look and Business Week were expressing concern about the emasculating effects of the drugs. “I don’t look with any favor on a society where everybody just floats around in his own tub of butter,” a psychiatrist said in 1956 in Life. “A certain amount of tension and alertness is essential to keep things straight in life.”
Women, on the other hand, did need to calm down, at least according to advertisements and magazine articles in Cosmopolitan, the Journal of the American Medical Association, and Good Housekeeping. One ad for Miltown from 1968 showed a photograph of a miniature woman about to be pummeled with toy blocks by a giant toddler. “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—probably overwhelmed. What went wrong?” The ad posits some potential answers (housework, child-rearing) but also makes clear that the cure for feeling overwhelmed is simple: Miltown.
Male business executives took a Miltown before negotiating a raise; women popped one to deal with a toddler’s temper tantrum.
As Herzberg writes, as men returned to jobs that women had taken over during the Second World War, there was a purposeful effort by unions, corporations, banks, and the federal government to assert control over gender; women needed to go back to being women, and men need to go back to being men. Any deviance from traditional gender roles was seen as pathological.
“A woman who was married with no job, if she was unhappy with that, it was considered mental illness,” Herzberg explains in a phone interview. “If you [weren’t] happy doing that which biologically is supposed to make you happy, you [were] ill.” For the social critics and psychiatrists who were advocating a female return to domestic life, Miltown was a medical way to enforce the idealized woman.
By the late 1950s, pharmaceutical companies were working hard to develop the next great tranquilizer. In 1960, Hoffmann–La Roche was in the final stages of testing for its drug Librium, a benzodiazepine. That same year, the US Senate questioned Frank Berger and Carter-Wallace about the addictive properties of Miltown; several patients had written to the FDA with concerns about their difficulty quitting the drug. Miltown had replaced barbiturates because it was significantly less toxic—it caused fewer overdose deaths. When Librium came on the market, it promised the same tranquil alertness as Miltown, but with even lower toxicity. Three months after it was brought to market, Librium had replaced Miltown as the most commonly prescribed tranquilizer.
In 1963, a benzodiazepine that offered the same calming effects as Librium, but without the unpleasant aftertaste that many patients disliked, came on the market. It was called Valium. By 1968, Valium had eclipsed Librium to become the best-selling drug in America—and by 1981 it was the most highly prescribed drug in the Western world.
By the time Valium was introduced, the reputation of prescription tranquilizers as easy, safe fixes to the problems of daily anxiety had curdled. More and more people were concerned about the habit-forming properties of the minor tranquilizers. In the 1960s and ’70s, tranquilizer addiction was the subject of three congressional hearings, and representations in the media of people taking tranquilizers had changed dramatically.
No longer was Milton Berle making jokes about his love for Miltown. Instead, the image of the tranquilized housewife, doped up on a new kind of goofball as she pruned her rosebushes like a zombie, permeated popular culture. In 1963, Betty Friedan used the image of the tranquilized housewife as part of the impetus for her era-defining book The Feminine Mystique. The Rolling Stones’ 1966 song “Mother’s Little Helper” described a woman addicted to pills; filmmaker Barbara Gordon’s memoir about Valium addiction I’m Dancing As Fast as I Can was a best seller in 1979.
In 1978, the FDA Consumer, a magazine published by the government agency, described a new kind of addict: “The smartly dressed woman driving a sleek, late model car could be the envy of her neighbors. She has a loving husband, bright children, a beautiful home in the suburbs, and apparently no care in the world. Except one. This woman is a junkie.” The dark side of minor tranquilizers had fully emerged (although it hardly harmed sales). The simplicity of Miltown, which was once seen as an easy antidote to the daily trials of Cold War life, had disappeared.
Frank Berger’s goal of eradicating anxiety was one born of his own traumatic past. For him, no good could come of it; fear is both a symptom and a disease. The people who came into their doctors’ offices with insomnia, headaches, and rashes were unhappy in their lives and looking for relief. Miltown offered them treatment for their symptoms—and for many, that may have been exactly what was required. But for others, Miltown only took the edge off a problem that was much deeper; it offered tranquility, but for how long and at what cost?
In 1996, the then 81-year-old sat down for an interview with his friend Leo Hollister, a professor of psychiatry and pharmacology, to reflect on his life and accomplishments. By the late ’90s, the Valium panic of the ’70s had dissipated; the new psychiatric drugs of choice were Prozac and other SSRIs. Although these drugs were designed to treat depression, in many ways they owed their existence to Miltown. While some people took Prozac for severe mental illness, many also took it for low-grade depression; like Miltown, Prozac was a pill that offered relief for basic human suffering.
Just as the interview comes to a close, Berger, in his thick Eastern European accent, says to his friend, “I thought you were going to ask me what it was that I hoped to achieve,” alluding to his famous pill.
“I can tell you only what I think,” Berger continues. “There are so many psychiatrists now who say too much anxiety isn’t good, but a little anxiety is necessary. I don’t think that is so. People who perform best are people who aren’t scared.”
A Cure for Fear
A Cure for Fear
Dr. Merel Kindt is a clinical psychologist with a new way to treat, or even eliminate, phobias and the effects of emotional trauma: first you confront the thing you’re scared of—then you take a pill, a beta-blocker called propranalol. Amazingly, it seems to work. In this four-part documentary series, we follow the doctor as she cares for patients terrified of everything from butterflies to needles, and begins to question just how fundamental fear really is to human nature.