The Wholesale Sedation of America's Youth

By Andrew M. Weiss, Skeptical Inquirer. Posted May 5, 2009.

With the modern science of chemistry in the nineteenth century, new synthetic substances were developed that shared many of the same desirable qualities as the more traditional sedatives and stimulants. The first modern drugs were barbiturates -- a class of 2,500 sedative/hypnotics that were first synthesized in 1864. Barbiturates became very popular in the U.S. for depression and insomnia, especially after the temperance movement resulted in draconian anti-drug legislation (most notoriously Prohibition) just after World War I. But variety was limited and fears of death by convulsion and the Winthrop drug-scare kept barbiturates from more general distribution.

Stimulants, typically caffeine and nicotine, were already ubiquitous in the first half of the twentieth century, but more potent varieties would have to wait until amphetamines came into widespread use in the 1930s. Amphetamines were not widely known until the 1920s and 1930s when they were first used to treat asthma, hay fever, and the common cold. In 1932, the Benzedrine Inhaler was introduced to the market and was a huge over-the-counter success. With the introduction of Dexedrine in the form of small, cheap pills, amphetamines were prescribed for depression, Parkinson's disease, epilepsy, motion sickness, night-blindness, obesity, narcolepsy, impotence, apathy, and, of course, hyperactivity in children.

Amphetamines came into still wider use during World War II, when they were given out freely to GIs for fatigue. When the GIs returned home, they brought their appetite for stimulants to their family physicians. By 1962, Americans were ingesting the equivalent of forty-three ten-milligram doses of amphetamine per person annually (according to FDA manufacturer surveys).

Still, in the 1950s, the family physician's involvement in furnishing psychoactive medications for the treatment of primarily psychological complaints was largely sub rosa. It became far more widespread and notorious in the 1960s. There were two reasons for this. First, a new, safer class of sedative hypnotics, the benzodiazepines, including Librium and Valium, were an instant sensation, especially among housewives who called them "mothers' helpers." Second, amphetamines had finally been approved for use with children (their use up to that point had been "off-label," meaning that they were prescribed despite the lack of FDA authorization).

Pharmaceutical companies, coincidentally, became more aggressive in marketing their products with the tremendous success of amphetamines. Valium was marketed directly to physicians and indirectly through a public relations campaign that implied that benzodiazepines offered sedative/hypnotic benefits without the risk of addiction or death from drug interactions or suicide. Within fifteen years of its introduction, 2.3 billion Valium pills were being sold annually in the U.S. (Sample 2005).

So, family physicians became society's instruments: the suppliers of choice for legal mood-altering drugs. But medical practitioners required scientific authority to protect their reputations, and the public required a justification for its drug-seeking behavior. The pharmaceutical companies were quick to offer a pseudoscientific conjecture that satisfied both. They argued that neurochemical transmitters, only recently identified, were in fact the long sought after mediators of mood and activity. Psychological complaints, consequently, were a function of an imbalance of these neural chemicals that could be corrected with stimulants and sedatives (and later antidepressants and antipsychotics). While the assertion was pure fantasy without a shred of evidence, so little was known about the brain's true actions that the artifice was tamely accepted. This would later prove devastating when children became the targets of pharmaceutical expansion.

With Ritalin's FDA approval for the treatment of hyperactivity in children, the same marketing techniques that had been so successful with other drugs were applied to the new amphetamine. Pharmaceutical companies had a vested interest in the increase in sales; they spared no expense in convincing physicians to prescribe them. Cash payments, stock options, paid junkets, no-work consultancies, and other inducements encouraged physicians to relax their natural caution about medicating children. Parents also were targeted. For example, CIBA, the maker of Ritalin, made large direct payments to parents' support groups like CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder) (The Merrow Report 1995). To increase the acceptance of stimulants, drug companies paid researchers to publish favorable articles on the effectiveness of stimulant treatments. They also endowed chairs and paid for the establishment of clinics in influential medical schools, particularly ones associated with universities of international reputation. By the mid 1970s, more than half a million children had already been medicated primarily for hyperactivity.

The brand of psychiatry that became increasingly popular in the 1980s and 1990s did not have its roots in notions of normal behavior or personality theory; it grew out of the concrete, atheoretical treatment style used in clinics and institutions for the profoundly disturbed. German psychiatrist Emil Kraepelin, not Freud, was the God of mental hospitals, and pharmaceuticals were the panacea. So the whole underlying notion of psychiatric treatment, diagnosis, and disease changed. Psychiatry, which had straddled psychology and medicine for a hundred years, abruptly abandoned psychology for a comfortable sinecure within its traditional parent discipline. The change was profound.

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