When Good Drugs Go Bad

We humans tend to like binaries. War and peace, good and evil, Leafs and Habs: they’re simple ways of seeing the world.

The problem of course is that life is rarely that simple. Wars are fought for peace; good people can do bad things; and other teams keep winning The Cup.

Nowhere is this quest for binaries and their fundamental inadequacy more obvious than when we talk about drugs. Heroin is bad; codeine is good. Cocaine is bad; Ritalin is good. Tobacco is bad; coffee is good. None of these binaries really works. Each substance has its place, depending on the social and political context, and can be simultaneously bad and good. Schroedinger’s cat had it easy.

Historians of drugs contemplate this binary problem often, while policy makers often stick with the “good or bad” dialectic. The two books under review here join a growing number of studies that explore the research and development of psychoactive pharmaceuticals and their relationship with psychology, society, culture and politics in the middle of the 20th century. The drugs followed similar trajectories, but with varying results. They are good, then they are bad, then they are, well, good and bad. In contrast, both books are quite good.

Andrea Tone’s The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers is a sweeping analysis of the emergence of the drug in the United States. Tone, Canada Research Chair in the Social History of Medicine at McGill University, argues that while many studies have been made of recently problematic drugs such as Prozac and Ritalin, no scholarly study has looked at the cultural shifts that facilitated the broad-based use of tranquilizers and the subsequent changes that resulted from the emergence of psychopharmacology. She takes her title from W.H. Auden’s Pulitzer Prize–winning poem that characterized the middle of the century as a fruitless search for meaning. As we will see, it is a fitting image.

She begins with a brief history, showing how the emergence of the idea of anxiety in western culture, from Thomas More’s first use of the term in the 16th century, through George Beard’s idea of neurasthenia, and on to Sigmund Freud’s description of the “worried well.” Anxiety became, increasingly, the stock-in-trade of the growing psychology profession.

Into this mix arrived Frank Berger, a German-Czech physician researcher who fled continental Europe during the 1930s and found work as a researcher in England. Working on ways to preserve penicillin, Berger found that one of his compounds, mephenesin, had muscle-relaxant properties. By the mid 1940s it was being used as an institutionally based intravenous treatment of conditions such as cerebral palsy and multiple sclerosis. In 1947, Berger accepted the position of president and director of research for Wallace Laboratories in New Jersey, a branch of Carter Products (the maker of Carter’s Liver Pills). An idealist who was interested in pharmacy’s potential to help people, Berger wanted to create a more user-friendly, pill-based and longer-acting muscle relaxant. In 1950, he and organic chemist Bernie Ludwig synthesized meprobamate, which they found had psychologically relaxing properties. The president of Carter Products was initially not enthusiastic; he did not see much of a market for tranquilizers. Berger and Ludwig sent samples to several physicians, whose initial enthusiasm helped to suggest the drug’s commercial viability.

The resulting pill, named Miltown after a local, bucolic village, entered the market quietly, but by the end of 1950 it had become a pharmaceutical sensation. The key was not clever marketing, but the endorsement by prominent celebrities, including Milton Berle, then the most popular TV host in the country.

Miltown shifted perceptions of the place of pharmaceuticals in American life. Psychiatry had been focused upon costly and time-consuming Freudian methods of “talk therapy.” Miltown was cheap (10¢/pill) and quick. Psychiatrists continued to debate the role of pharmaceuticals in their discipline, but usually general practitioners and the public did not. As Tone writes: 

This shift should not be viewed in isolation. The Red Scare ramped up panic; the fast-paced life of 1950s America increased business stress and social pressure. Far from an irrational solution to contemporary problems, Miltown and the “me too” tranquilizers that followed it (based upon the same chemical formulation tweaked slightly to avoid patent infringements) could be a reasonable alternative: “the question in many Americans’ minds in the 1950s may have been, Why not take a tranquilizer?” 

With the new-found demand for tranquilizers, other pharmaceutical companies soon joined the fray. In 1960, Hoffman-LaRoche (aka Roche) produced Librium. Not a “me too” drug, Librium was chemically different: benzodiazepine. It was followed by Valium three years later, cementing Roche’s dominance in the tranquilizer race.

Concerns soon emerged about addiction. Faced with inquiries from worried users, the United States Food and Drug Administration and drug companies were evasive, often referring correspondents back to their physicians, who were best able to evaluate individual situations. Little research had been done in the area of habituation and, in any case, Berger argued, compared to barbiturates, tranquilizers were “relatively safe.” That relativism was not comforting.

So enthusiasm was followed by derision. Stories of iatrogenic addiction raised concern about the overuse of tranquilizers in “apple-pie suburbia,” while the 1960s counterculture, with leaders such as Timothy Leary flaunting mind-altering drugs as an alternative to mainstream conformity, fomented concern about recreational drug use in Middle America. Add to that the rise of the women’s health movement in the 1960s and several high-profile women and their tales of addiction in the 1970s and early ’80s, and it is clear how tranquilizer use was vilified.

The irony of this cultural backlash was that there was no discernable decline in tranquilizer use. No longer trendy, tranquilizers continued to be prescribed and consumed in remarkably high numbers. The psychopharmacological paradigm, where drugs were the first solution to mental disorders, had been established. So while the creation of selective serotonin reuptake inhibitors (SSRIs) helped to address addiction (while creating new dangers), they were simply following an established psychiatric conceit. Tone argues that in an anxious, post-9/11 world, antidepressants continue to make sense to many people.

Tone’s work is a dense examination of a complex topic that has been only touched upon by other researchers. The arguments are sound and the narrative is compelling. While an academic work, it will appeal quite easily to a broad readership. That is not to say the work is perfect. As a combination of cultural, political and social history, its broad scope leaves some questions unanswered. She is relatively light on examining changes within the FDA that allowed for a shifting focus of the drug companies. She mentions only in passing the growth of direct-to-consumer advertising. These, however, are not major omissions. This book is about cultural shifts, about the perception of anxiety in America and the rise of the pharmacological solution.

In Psychedelic Psychiatry: LSD from Clinic to Campus, Erika Dyck covers a less expansive topic. While Tone’s study plows somewhat familiar ground, Dyck digs deeply into an area of drug history that has for the most part been ignored. And the agriculture metaphor is appropriate since, although the topic was international in importance, Dyck’s focus is Saskatchewan.

Dyck’s book examines the rise and fall of experiments, which began in the 1950s, to use LSD to treat a variety of psychiatric conditions. A professor of history at the University of Saskatchewan, Dyck has uncovered what to many will be an unknown history of psychiatric experimentation in that province. While most histories of LSD have examined either Cold War–era CIA “truth serum” experiments or the use of “acid” among the 1960s counterculture, there was also a legitimate and far less subversive group of experimenters who saw in LSD a potentially important drug for psychiatric research.

In the 1940s, under the premiership of Tommy Douglas, Saskatchewan embarked upon a socialist experiment that included inviting prominent researchers to work in the province. Among these researchers was Humphry Osmond. A psychiatric researcher from England, Osmond and his colleague John Smythies studied the chemical properties of mescaline, which seemed to produce reactions that resembled the symptoms of schizophrenia. They theorized that schizophrenia was caused by a biochemical imbalance that created a substance with chemical properties like mescaline, and they wanted to develop experiments with mescaline and LSD. Finding that his colleagues in England were not all that interested in the project, Osmond responded to an ad by the government of Saskatchewan and, in 1951, moved to Weyburn, a small town southeast of Regina, to begin work at its provincial mental hospital.

This was a time of unbridled optimism in the province. Osmond began to work with Abram Hoffer, a Saskatchewan native who had been hired by the province to establish a research program in psychiatry. Hoffer and Osmond attracted other people to the dynamic research environment. The government seemed eager to fund innovative research, and Osmond explained in 1955 that the province was an optimal research environment, with generous government funding and professional liberty.

Osmond and Hoffer’s work sat in a sort of middle ground between the psychiatric emphasis upon the talk therapy (psychoanalysis) and somatic theories of mental illness that would become so popular as psychopharmacology took off later in the decade. Mescaline and LSD (the latter becoming the preferred drug because of its much higher potency) were dubbed “psychedelics” by Osmond in 1956; they were different from other psychiatric medicines. Rather than just treating symptoms, psychedelics, by mimicking madness, could provide insight into the subjective nature of schizophrenia and simultaneously give evidence about the function of the schizophrenic brain. This approach challenged both psychoanalysis and somatic psychiatry; it was a groundbreaking attempt to span two disparate arms of psychiatry.

As Dyck explains, “psychedelic psychiatry promised a consciousness-raising, identity-changing therapy within a medically sanctioned and scientifically rigorous environment.” Researchers conducted self-studies, taking LSD and describing their experiences in a controlled environment. Osmond, Hoffer and their Saskatchewan-based colleagues were joined by a broad network of psychedelic researchers. While schizophrenia was the initial focus, they soon came to examine the value of the psychedelic experience in the treatment of other conditions, notably alcoholism.

Other medical researchers were not as enthusiastic. The LSD experiments were being conducted at a time when the double-blind placebo-controlled trial was gaining cachet as the gold standard for drug research. The problem with LSD research under this paradigm was twofold. First, double-blind placebo-controlled trials assumed objectivity in research that undermined the subjectivity that was required of psychedelic research. Second, using a placebo was impossible. Since the LSD experience was so vivid, a subject would know immediately if he or she had taken LSD. The Weyburn results seemed irreproducible.

As substances that create significant perceptual changes, psychedelics also inspired explorations of a more spiritual side of the experience. Hoffer and Osmond were invited to a peyote ceremony with the Native American Church of North America. Researchers and research subjects described profound spiritual experiences after taking LSD. Still others, researchers and soon-to-be prophets of the counterculture, such as Alan Ginsberg and Timothy Leary, saw the use of LSD as having the potential to alter the individual’s relationship with society and foment profound social change.

This is where the promise of LSD research began to break down. The inability of the LSD experiments to conform to accepted scientific methodology and the growing counterculture that saw LSD as a tool for social transformation created a perception in scientific and political circles that LSD was either ineffective or downright socially dangerous. Moreover, enthusiasm for recreational acid led to the emergence of street versions of the drugs that had radically divergent and risky effects. News articles about the scientific potential of LSD were replaced by sensationalized stories of the dangers of acid to social stability. Meanwhile, attempts of LSD researchers to assert their authority in evaluating the size of this “acid panic” were fruitless.

By the late 1960s, political and legal pressure against LSD was unbearable. The United Nations and World Health Organization recommended that the countries place LCD and hallucinogens on narcotics control schedules; the United States placed LSD under the Narcotic Control Act of 1968, making all LSD use illegal; in 1969, Canada’s Royal Commission on the Non-Medical Use of Drugs rejected the entreaties of experts such as Hoffer and condemned LSD as dangerous. Under the pressure of the law, the rejection by funding bodies and the intense scrutiny of the media, many researchers abandoned LSD studies. Osmond “lamented that North Americans had chosen to reestablish a comfortable sense of order rather than invest in a potentially extraordinary medical technology.” Much of the Saskatchewan research ended soon afterward. The book concludes with some words about the ongoing legacy of LSD research and the renewed interest in the value of psychedelics in psychiatry.

The two books offer valuable and surprisingly corresponding narratives about the cultural and political place of psychotropic drugs in society. Tone’s work describes how pharmaceuticals infiltrated society through various channels of popular culture, pharmaceutical advertising and medical paradigm shifts. Dyck’s book provides the other side of the story: how the very popularization of drugs that had seemed valuable in scientific research undermined the view of their therapeutic potential. Beyond this intersection are several factual convergences: the era of the 1950s shifts to the rise of the counterculture in the 1960s, the issue of the gap between psychotherapy and somatic psychiatry or psychopharmacology, and even author Aldous Huxley’s role in endorsing psychotropic drugs.

For anyone who has studied drug history, the social panic surrounding the perceived dangers of drugs is a very familiar one. Social panic and political expediency trump scientific pragmatism, and all often ignore the informative power of cultural history. As a quick scan of drug history will show you, and what these books reinforce, history is repeating itself when society panics over “dangerous drugs.” Much of it has been said before, and we would like to believe that someday the bureaucrats and people in power will listen. It is not about binaries, about good and bad, but about a range of options, uses and implementations. These books add to the growing evidence of the need for reason in the face of panic, and they say their piece in a fascinatingly readable way.