We're Out of Miltown

Back in 2006 ABC’s All in the Mind program presented what they called “in the spirit of Sigmund Freud and his One hundred fiftieth birthday” an interview with Jonathan Metzl. In a sense, the presenter offered “we are psychoanalysing psychiatry itself.” The timing for this was of course also related to Metzl just having published Prozac on the Couch: Prescribing Gender in the Era of Wonder.

The premise of the book is that the biochemical revolution in psychiatry, which displaced Freudianism from its central role in treating mental illness in the United States. The ABC program opens with the vey fitting jingle, Mother's Little Helper, and introduction along the lines “You may remember this 1967 Rolling Stones hit "Mother's Little Helper", a tongue in cheek tribute to a housewife coping with whinging kids and a demanding husband with a little help from the minor tranquiliser Valium.”

Jonathan Metzl sees himself as someone who on one hand is a practitioner of psychiatry and on the other hand someone who studies the kind of cultural history of the ways that depression came to be seen and thought of in present day American society but also internationally. His book examines, for example, how pharmaceutical advertisements, representations of depression in film and media and medical writings are framed.

The book gives a historic account of psychiatric medications in medicine and popular culture starting in the 1950s, a time when Miltown (Meprobamate) became really the first of the modern psychiatric wonder drugs. Prior to the 1950s these kind of drugs weren't an established phenomenon. Metzl tells the story of initial scepticism among psychiatrists and drug companies because, interestingly, they would ask who would use medication when there is talk therapy. However, within two months the demand for Miltown in the United States was so great that there were like these famous signs in the windows of pharmacies saying 'We're out of Miltown.

So whilst the biological basis for depression was perhaps beginning to be addressed through medication Metzl suggests that the rhetoric by which these drugs came into being, again in popular representation, took a lot from Freud even if there was an implication that Freudianism was being overthrown. In the first chapter aptly called The Freud of Prozac, Metzl argues that the ways that these drugs were understood in the popular realm, biology owes a lot to Freud with regard to gender.

Metzl looks at these medications through the lens of what are the implications for gender He says even though we think of Valium as being the 'mother's little helper' for the popularity of the Rolling Stones’ song and in part because of the fact that according to some studies up to 70% of prescriptions for Valium in the United States were written to white middle class women. He goes on, Miltown set the stage for Valium by creating a set of connections between the anxieties of motherhood, or more aptly the anxieties that people who were creating a certain kind of public rhetoric had about the role of mothers in society, and treatment with psychiatric drugs.

Metzl discusses the cultural history of the ways that depression came to be seen and thought of. We saw that for women, overwhelmingly, depression came to be described in popular articles in relation to the women's roles as mothers, or being married, or menstruation.. For men, there was almost nothing about men getting depressed and it impacting their roles as fathers, or as boyfriends, or as anything that might imply emotions or inner-lives. Depression related to aggression, athletics, sports and, to a little bit lesser extent, work. And so we would see articles about famous athletes who got depressed and couldn't win races, or hit the ball, or something and then they would take Prozac and they would start winning again.

However, Metzl never gives an alternative to the Freudian father/superego, mother/unconscious, and his interpretations of women are filtered through this distorting lens. Hence, his sometimes absorbing and adroit presentation of examples is hamstrung by an interpretive paradigm that is no broader than that which he seeks to question.