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Book traces history of medicating anxiety away.


By Andrea Tone

Published by Basic Books, $26.95


How do we understand our anxiety and suffering? What is the role of medication in calming our frayed nerves? What are the benefits, risks and consequences of particular medications that are developed to do so? These are questions that individuals, the medical community, and society continue to grapple with in our modern age. Here, author Andrea Tone, a professor at McGill University in Quebec and scholar in the social history of medicine, convincingly argues that our cultural dialogue around these issues is profoundly shaped by social and political forces of the day. The Age of Anxiety represents a particularly valuable contribution to that conversation.

The book is a captivating account of the development and use of medications in the treatment of anxiety in the United States. My wife and I are both psychologists. In our training and practice over the past 12 years, we have watched what happens in the treatment of anxiety. Tone tells us what has happened historically. She presents a carefully researched and thoughtful narrative, beginning with a discussion of the nature of anxiety and how this dimension of human experience has been understood over time.

We're there when Frank Berger accidentally discovered the first modern "minor tranquilizer"--Miltown--while trying to synthesize a compound to address difficulties in penicillin, production. Tone makes a Compelling argument that the astounding success of Miltown as a tension reliever represented a revolution in at least two respects: first, in solidifying a shift toward biological psychiatry in the treatment of mental afflictions; and secondly, in marking the advent of "lifestyle drugs." As Tone writes, "the drug's appeal fomented a fundamental and lasting change in how Americans viewed and used prescription medicines: It was okay to see doctors for drugs to make them feel better about the vagaries of life, not just to treat diseases."

The book looks at how tranquilizers supported social stability in post-World War II America, an age marked by atomic anxiety, economic expansion, and family strain prompted by a baby boom and rapid suburbanization. Tone takes her title from W.H. Auden's famous characterization of this era as the "Age of Anxiety." Using historical records, Tone looks at how Hollywood culture and the popular press glamorized Miltown, "the fashionable pill." The book then follows the development of subsequent medications such as Valium and Librium, exploring issues such as gender differences in medication use, the marketing of these medications, shifting public attitudes toward tranquilizer use during the 1960s and '70s, and the public and political backlash against tranquilizers as their dangerous addictive potential became more widely recognized.

One interesting theme in the book describes the undercurrent of concern within scientific and popular circles about the potential for dependence and serious withdrawal effects from long-term use of tranquilizers. In The Age of Anxiety, Tone discusses research published as early as 1961 that documented the potentially serious withdrawal reactions that could occur with medications such as Librium and Valium. We learn of individual inquiries to the FDA that express similar concerns about addiction potential and withdrawal from these medications. What is most striking and alarming is that such concerns were largely minimized or unrecognized until nearly two decades later--the late 1970s. Then, public testimony and the budding consumer protection movement highlighted these dangers. The Age of Anxiety serves as a cautionary tale as to how social and political structures can overshadow scientific data in professional and public discourse about medical treatments.

It is easy to oversimplify the complex issues involved in the social, political and medical context surrounding the explosion in the use of tranquilizers. For example, other critiques have emphasized the role of corporate greed and slick marketing in the pharmaceutical industry in the promotion and growth in use of psychiatric medications. While the book certainly delves into this important aspect of the story, The Age of Anxiety also explores the wider web of influences, resulting in a much more nuanced account of how these medications became a mainstay in American culture, beginning in the 1950s. For example, Tone details the initial hesitation by industry executives, unsure if there would be a market for these medications. She also looks at the cultural enthusiasm that developed around tranquilizers, exploring what made American culture a fertile ground to make these medications some of the most profitable drugs in pharmaceutical industry history.

Perhaps one of Tone's greatest strengths is how she weaves a complex historical analysis of these issues into a readable and compelling narrative, She concludes by discussing the increase in the numbers of people seeking medical treatment for anxiety in the post 9/11 world (from 13.4 million in 2002 to 16.2 million in 2006). Moreover, she presents data that our enthusiasm for tranquilizers such as Xanax has not waned, even in the midst of the significant backlash against these medications.

One wonders if these numbers have continued to increase, particularly in light of anxieties prompted by the recent economic crisis. In another vein, a 2008 story in TIME magazine, titled "America's Medicated Army," explored the use of psychiatric medications among Army troops serving in Iraq and Afghanistan. Citing statistics that 13-17 percent of soldiers in these combat zones are currently taking psychiatric medications, the article describes how the Army is grappling with the unprecedented use of these drugs among soldiers at war.

In short, our current times are no less an "age of anxiety," marked by terrorism fears, a global economic crisis, and a generation of young Americans bearing the psychological wounds of two wars, than were Auden's following World War II.

[Aaron B. Murray-Swank is a clinical psychologist at the Denver VA Medical Center, and clinical assistant professor at the University of Colorado School of Medicine.]
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Title Annotation:The Age Anxiety: A History of America's Turbulent Affair with Tranquilizers
Author:Murray-Swank, Aaron B.
Publication:National Catholic Reporter
Article Type:Book review
Date:Nov 27, 2009
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