Protecting Mental Health in the Age of Anxiety: the Context of Valium's Development, Synthesis, and Discovery in the United States, to 1963 Catherine (Cai) E
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Iowa State University Capstones, Theses and Graduate Theses and Dissertations Dissertations 2009 Protecting mental health in the Age of Anxiety: The context of Valium's development, synthesis, and discovery in the United States, to 1963 Catherine (cai) E. Guise-richardson Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/etd Part of the History Commons Recommended Citation Guise-richardson, Catherine (cai) E., "Protecting mental health in the Age of Anxiety: The onc text of Valium's development, synthesis, and discovery in the United States, to 1963" (2009). Graduate Theses and Dissertations. 10574. https://lib.dr.iastate.edu/etd/10574 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. Protecting mental health in the Age of Anxiety: The context of Valium’s development, synthesis, and discovery in the United States, to 1963 by Catherine (Cai) Guise-Richardson A dissertation submitted to the graduate faculty in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Major: History of Technology and Science Program of Study Committee: Hamilton Cravens, Co-Major Professor Alan I Marcus, Co-Major Professor Amy Sue Bix Charles Dobbs David Wilson Iowa State University Ames, Iowa 2009 Copyright © Catherine (Cai) Guise-Richardson, 2009. All rights reserved. ii TABLE OF CONTENTS LIST OF TABLES iv ABSTRACT v CHAPTER 1. INTRODUCTION. THE VALIUM STORY 1 Terminology and Assumptions 8 Synthesis of 7-chloro-1,3-dihydro-1-methyl-5-phenyl 2H-1,4- benzodiazepin-2-one, also known as Valium 13 Overview 17 CHAPTER 2. ADAPTATION UNDER PRESSURE: EFFECTS OF WORLD WAR II ON DEVELOPING CONCEPTS OF NEUROSES 21 Preparing for War 23 Screening Recruits 27 Prevention and Salvage 37 Increased Roles for Neuropsychiatry 47 New Ideas, New Treatments, New Results 49 Conclusion 57 CHAPTER 3. THE AGE OF ANXIETY: NATIONAL BATTLES AGAINST MENTAL ILLNESS 63 National Efforts 64 National Defense- Federal Programs 69 National Institutes of Mental Health 70 The Joint Commission on Mental Illness and Health (JCMIH) 77 Mental Health Professionals 94 Final Report of JCMIH and Creation of Community Mental Health Facilities 98 Health Insurance and Access to Physicians 108 Mental Health and Health Insurance 112 Conclusion 117 CHAPTER 4. DEVELOPING NEUROSES: MENTAL HEALTH THEORY BEFORE VALIUM 120 Development of Mental Health Theories 122 Ivan Pavlov, 1849-1936: Neural/Behavioral Theories 123 Sigmund Freud, 1956-1939: Psyche-Based Theories 131 Mid-Century Modifications 135 B. F. Skinner, 1904-1990 136 Jules Masserman, 1905-1994 140 iii W. Horsley Gantt, 1892-1980 148 Links Between Neural and Psyche Theories 162 Conclusions 169 CHAPTER 5. FINDING TRANQUILLITY, DEVELOPING REASON: COMPETITOR COMPOUNDS AND STERNBACH’S SYNTHESIS OF DIAZEPAM 171 Naming Pharmaceuticals 172 Previous Tranquilizers, Sedatives and Hypnotics 174 Barbiturates 175 Valium as a Better Barbiturate 183 Relationship Between Valium and Alcohol 192 Drug Classification 196 Mephenesin and Meprobamate 208 Research and Development at Roche 215 CHAPTER 6. THE MOUSE THAT ROLLED: FROM DIAZEPAM TO VALIUM™: TESTING THEORIES AND FINDING USES 221 Pharmacologic Testing of Diazepam 226 Clinical Trials 253 Testing Valium: The Thalidomide Crisis and Reform of Drug Laws 255 From Diazepam to Valium™: Testing Theories and Finding Uses 266 Conclusion 280 CHAPTER 7. CONCLUSIONS. THE SOMATIC MASK: MARKETING VALIUM 285 Tranquilizer Advertising 286 Marketing Valium 297 Selling Scientific Medicine 305 Conclusion 309 BIBLIOGRAPHY 313 ACKNOWLEDGMENTS 376 iv LIST OF TABLES Figure 1. 1938 Baltimore Study 79 Figure 2. 1938 Williamson County Study 81 Figure 3. Types of Barbiturates and Duration of Action 180 v ABSTRACT This dissertation draws out various facets of the conditions preparing and situating Valium as a marketable substance and cultural entity. It offers one explanation for the widespread prescription and use of Valium in the 1960s. The post-World War II conceptualization of mental health and illness as a spectrum, with the majority of Americans falling between the poles and therefore either neurotic or at risk, heightened interest in mental health. Increased availability of health insurance brought more Americans to their physicians. National programs – establishment of the National Institutes of Mental Health, the Hill-Burton Act, and formation of a Joint Commission on Mental Illness and Health through the 1955 Mental Health Study Act – recognized widespread support for programs to increase the number of mental health practitioners and facilities focused on neuroses, personality disorders, and outpatients in general. Popular theories, including Walter Cannon’s homeostasis and Hans Selye’s General-Adaptation-Syndrome, promoted the idea that stress, and response to it, were among the most important aspects of health. The American public increased its demands for mental health services. Interplay between these conditions promoted use of psychopharmaceuticals. They were quick to prescribe and therefore allowed doctors to see more patients each day. They somaticized mental illness, bringing it within the boundaries of traditional medical insurance coverage. They did not cure an illness; they reduced symptoms and therefore either allowed the body to vi recover, or in an ongoing fashion prevented immature personalities from reaction to stresses in a manner leading to more serious medical problems. In the 1950s, it became possible to screen chemicals for a tranquilizer. The expense of creating and treating experimental neuroses in animals to screen chemical compounds was prohibitive. Yet these experiments informed pharmacologists; they could identify antineurotic or tranquilizing drugs through physical manifestations. With availability of antibiotics, pharmaceutical industries could keep fairly healthy populations of mice, rats, cats, and monkeys for testing. Chlorpromazine’s discovery and introduction into institutional psychiatry, around 1953, set out the basic features defining a tranquilizer. By 1958, pharmacologists had the ability and expectations required to inject a mouse with diazepam, check if it rolled off an inclined screen and, observing the tumbling rodent, recognize the ingested molecule was a potentially marketable tranquilizer. Valium’s development and discovery took place when tranquilizers were new and held out promise as mental health prophylactics, mild sedatives, and safe hypnotics. Mild mental illness needed rapid, effective, and fairly inexpensive treatment. Faced with patients undergoing severe or ongoing stress, doctors turned to anxiety-reducing drugs in order to prevent psychosomatic mechanisms resulting leading to any of a dozen physical illnesses. Compared with earlier alternatives – barbiturates, alcohol, major tranquilizers – Valium was safe, nonaddicting, and had few if any dangerous side effects. 1 CHAPTER 1. INTRODUCTION. THE VALIUM STORY Introduction Valium is a cultural icon, ripe with meanings, rife with contradictions.1 Viewed in hindsight, its place is remarkably like that of June Cleaver – mother in the iconic 1950s and 1960s television show ‘Leave it to Beaver’ – stuck forever in a perfect home, raising a perfect family, always perfectly calm. She is permanently associated with motherhood and subjugation of female independence to her own need and desire to nurture a family.2 And like June Cleaver, Valium is a creation of history; widely associated with memories of a world that never existed. In the United States, retrospect taints images of Valium. After the Women’s Movement, publicization of the gendered nature of psychiatry stuck to diazepam,3 the 1 Valium is the brand name for diazepam, a benzodiazepine tranquilizer the Swiss pharmaceutical company Hoffman-LaRoche began marketing in the United States in 1963. Diazepam is no longer produced or sold by the company. Throughout this dissertation I use the terms Roche and Hoffmann-La Roche interchangeably. Company literature similarly uses the terms. 2 The character June Cleaver is the mother in the 1950s television show ‘Leave it to Beaver.’ 3 For examples of books from 1970s and early 1980s see: Barbara Gordon, I’m Dancing as Fast as I Can (New York: Harper & Row, 1979); Eve Barbmann and Sidney M Wolfe, Stopping Valium, and Ativan, Centrax, Dalmane, Librium, Paxipam, Restoril, Serax, Tranxene, Xanax (New York: Warner Books, 1983); for a differently gendered book see Anton Holden, Prince Valium (New York: Chelsea House, 1992); the theme is less prevalent in books intended to keep youth off drugs, such as Gail 2 drug marketed as Valium. It became the Rolling Stones ‘Mother’s Little Helper,’ a crutch used by women to cope with minor stresses.4 Beginning in the mid-1970s, authors write about Valium as an addictive mental sedative or taming agent, given mainly to women (particularly mothers) for long-term use, often for social reasons.5 Winger, Valium: The Tranquil Trap (New York: Chelsea House, 1986); the traditional themes appear in the more recent book Joan E. Gadsby, Addiction by Prescription: One Woman’s Triumph and Fight for Change (Toronto: Key Porter Books, 2000). 4 The song “Mother’s Little Helper” appears on the 1966 record Aftermath, by the Rolling Stones.