The couple, long time real estate agents who aligned with Keller Williams in 2007, seek to make the 365 agents affiliated with their brand successful.

Questions Regarding Meth (q/questionsregardingmeth)The Amphetamine Years

Excerpts from an outstanding dissertation.

© 2009 Nathan W. Moon, PhD Table of Contents and Summary reprinted with the express permission of Dr. Moon obtained by Travis P.Dungan on 4/21/2020. Full version available through PROQUEST Dissertations & Theses at most university libraries around the world and online.

THE AMPHETAMINE YEARS: A STUDY OF THE MEDICAL APPLICATIONS AND EXTRAMEDICAL CONSUMPTION OF PSYCHOSTIMULANT DRUGS IN THE POSTWAR UNITED STATES, 1945-1980

A Dissertation
Presented to
The Academic Faculty

By

Nathan William Moon

In Partial Fulfillment
Of the Requirements for the Degree
Doctor of Philosophy in
History and Sociology of Technology and Science

Georgia Institute of Technology

December 2009

© 2009 Nathan W. Moon, PhD Table of Contents and Summary reprinted with the express permission of Dr. Moon obtained by Travis P.Dungan on 4/21/2020. Full version available through PROQUEST Dissertations & Theses at most university libraries around the world and online.

THE AMPHETAMINE YEARS: A STUDY OF THE MEDICAL APPLICATIONS AND EXTRAMEDICAL CONSUMPTION OF PSYCHOSTIMULANT DRUGS IN THE POSTWAR UNITED STATES, 1945-1980

Approved by:

Dr. Andrea Tone, Advisor Social Studies of Medicine and Department of History McGill University

Dr. Douglas Flamming
School of History, Technology &
Society
Georgia Institute of Technology

Dr. Jonathan Metzl Women’s Studies Program and Department of Psychiatry University of Michigan

Dr. Steven Usselman
School of History, Technology &
Society
Georgia Institute of Technology

Dr. John Krige
School of History, Technology &
Society
Georgia Institute of Technology

Date Approved: November 2, 2009

ACKNOWLEDGEMENTS v

LIST OF TABLES xii

LIST OF FIGURES xiii

LIST OF ABBREVIATIONS xv

LIST OF PHARMACEUTICAL DRUGS xvii

SUMMARY xviii

CHAPTER 1 – INTRODUCTION 1

A Psychostimulant Primer 3

Historiographical Context 14

Establishing the Framework for Modern Pharmacotherapy
and Psychiatry 14

Situating the Psychostimulants 21

Key Themes and Arguments 24

Emphasizing the Clinician Perspective 25

“Therapeutic Versatility,” or the “Many Lives of Amphetamine”
Redux 26

Pharmaceutical Industry Responsiveness to Clinician Practices 27

Blurring Boundaries between Institutional and Outpatient
Psychiatry 29

Complicating the Transition from Psychodynamic to Biological
Psychiatry 31

Empiricism and Its Role in Psychiatric Pharmacotherapy 32

“Amphetamine Cultures” and Extramedical Consumption 34

Sources and Methods 36

Description of Chapters 37

CHAPTER 2 – “VIM, VIGOR, AND VITALITY”: PSYCHOSTIMULANT
DRUGS AND THEIR USE IN INSTITUTIONAL SETTINGS 40

Introduction 40

Institutional Psychiatry in the United States 42

Postwar Institutional Psychiatry and the Pharmacological Revolution 48

“Enter, Ritalin”: An Analeptic for Psychiatry 54

Ritalin as an Antidepressant 59

Ciba’s Own Drug Combination: Serpatilin 69

Uppers for “Oldsters”: Stimulant Use by Geriatric Populations 74

The Case of Ritonic 78

Considering Combination Drug Therapy 87

Industry Response to Clinician Practices 89

Conclusion 98

CHAPTER 3 – STRANGE COUCHFELLOWS: STIMULANTS, PSYCHOTHERAPY, AND DEPRESSION IN OUTPATIENT PSYCHIATRY
95

Introduction 95

The Rise of Psychoanalysis in the United States 99

Psychopharmacology Redux: Considering Outpatient Psychiatry 102

Adjuncts to Psychoanalysis 105

Abreaction in Practice 106

Psychiatrists’ Understandings of Drugs as Adjuncts 109

Patient Understanding of Drug-Mediated Psychotherapy 115

The Gendered Implications of Drugs and Psychotherapy 121

Conflicts over Drug-Aided Psychotherapy 125

Physician and Industry Receptiveness to Drug-Mediated Psychotherapy 131

Psychostimulants and LSD in Psychotherapy 136

“Environmental Depression” and the Decline of Drug-Mediated
Psychotherapy 139

Conclusion 152

CHAPTER 4 – BROTHER’S LITTLE HELPER: HYPERKINESIS AND
THE RISE OF PEDIATRIC STIMULANT THERAPY 154

Introduction 155

The Origins of Hyperkinesis: George Still and Alfred Tredgold 161

Charles Bradley and the Advent of Benzedrine Therapy 166

Psychoanalytic and Social Psychiatric Approaches to Children 173

Prelude to Pharmacotherapy 179

Reestablishing Stimulant Therapy and the Role of Empiricism 183

Etiology and Evidence-Based Treatment 188

Increasing Clinical Research and Federal Support
193

The Decade of Public Discourse 195

The Coming of Attention Deficit Disorder 205

Conclusion 208

CHAPTER 5 – THE SPEED YEARS: CHARTING THE EXTRAMEDICAL USES OF PSYCHOSTIMULANTS DURING THE POSTWAR ERA 210

The Many Cultures of Speed 212

“Speed Freaks” vs. “Acid Heads”: Amphetamine Youth Culture 212

The Diet Pill Culture 223

Truck Drivers and Amphetamines 241

Amphetamine Use in Athletics 245

Making Sense of the Amphetamine Cultures 248

Pondering Psychostimulant Addiction 251

Growing Concern by Medical Authorities 255

Physicians Debate among Themselves 263

Conclusion 269

CHAPTER 6 – REGULATION AND ENTRENCHMENT: CONTROLLING PSYCHOSTIMULANTS IN THE 1970s 270

Introduction 270

Prelude to Controls and Issues of Illicit Use 271

Firming the Controls on Psychostimulants 275

Considering Dissent to Controls 285

Putting Controls into Practice 295

Dealing with Diversion 301

The Intersection between Illicit Activities and Enforcement 304

“The Speed Years” Revisited 310

Conclusion 316

CHAPTER 7 – CONCLUSION 317

ADHD and the Resurgence of Ritalin 318

“Ritalin Culture” 321

Contemplating the “Fen-Phen” Debacle 326

Crystal Meth and Ecstasy 331

The Past and Its Relevance for the Present 333

Psychostimulants and the History of Psychiatry
334

Psychostimulants and Broader Trends in History
336

Methylphenidate versus Amphetamine: A History of Ritalin? 339

Future Directions 341

BIBLIOGRAPHY 344

Table 6.1

Table 6.2

Number of Prescriptions for Amphetamine and
Methamphetamine, 1968-1972 …………………………………………………….300

Dosage Units and Amount Prescribed, in Kilograms,
of Amphetamine and Methamphetamine, 1970-1972 ………………………..300

Figure 1.1 The basic molecular structure of phenethylamine and
Amphetamine 5

Figure 1.2 The molecular structure of methamphetamine and
MDMA 6

Figure 1.3 The molecular structure of dopamine and norepinephrine,
compared to that of amphetamine 7

Figure 1.4 Comparison of the molecular structure of methylphenidate and
amphetamine 10

Figure 1.5 The original Benzedrine inhaler, introduced by
SKF in 1933 11

Figure 1.6 1940s version of the Benzedrine inhaler 12

Figure 1.7 Dexedrine Spansule (10 mg.) 13

Figure 1.8 Tablet of Ritalin (10 mg.) 13

Figure 2.1 1957 advertisement for Ritalin for schizophrenia and depression 67

Figure 2.2 1956 advertisement for Ritalin for mild to moderate depression 68

Figure 2.3 1956 advertisement for Serpatilin 71

Figure 2.4 1957 advertisement for Ritalin, “When Reassurance Is
Not Enough…” 83

Figure 2.5 1966 advertisement for Ritalin, “Relieves Chronic Fatigue that
Depresses and Mild Depression that Fatigues” 83

Figure 2.6 1957 advertisement for Thorazine for elderly patients 85

Figure 2.7 Ciba advertisement for parenteral (intravenous) Ritalin for
recovery from anesthesia 91

Figure 2.8 SKF advertisement for Thorazine to prevent nausea during surgery 92

Figure 3.1 1952 advertisement by Burroughs-Wellcome for Methedrine 104

Figure 3.2 1958 advertisement for Ritalin for psychotherapeutic interviews 132

Figure 3.3 1959 advertisement for Ritalin in the use of psychotherapy
for alcoholism 133

Figure 3.4 1957 Ritalin advertisement, “mild stimulant…antidepressant” 142

Figure 3.5 1971 Ritalin advertisement for “environmental depression” 143

Figure 3.6 “Let’s go team! Spark Ritalin sales!”: 1967 Ciba promotional
photo of comedienne Alice Ghostley 149

Figure 3.7 1965 Ritalin advertisement for “tired housewife syndrome” 150

Figure 3.8 1970 Ritalin advertisement for “tired housewife syndrome” 150

Figure 4.1 1960s Ritalin advertisement for minimal brain dysfunction 158

Figure 5.1 Dr. David E. Smith of the Berkley Free Clinic with two
hippies in a San Francisco park in 1967 220

Figure 5.2 Dr. Smith in a scene from the 1969 amphetamine abuse film
Speedscene 221

Figure 5.3 1967 SKF advertisement for Dexamyl
for weight loss 237

Figure 5.4 1967 Wallace advertisement for Appetrol 238

Figure 5.5 1958 Geigy advertisement for Preludin
240

Figure 7.1 News articles mentioning “ritalin” or “Ritalin” between
January 1, 1960 and July 25, 2009 320

Figure 7.2 News articles mentioning “ritalin” or “Ritalin” between
January 1, 1980 and July 25, 2009 320

ACNP – American College of Neuropsychopharmacology
ADD – attention deficit disorder
ADHD – attention deficit/hyperactivity disorder
AIHP – American Institute for the History of Pharmacy
AMA – American Medical Association
AMLFC – Association des Medecins de Langue Francaise du Canada (Canadian
Association of French Speaking Physicians)
APA – American Psychiatric Association
BDAC – Bureau of Drug Abuse Control
BNDD – Bureau of Narcotics and Dangerous Drugs
CBT – cognitive behavioral therapy
CDC – Centers for Disease Control
CHADD – Children and Adults with ADD
CIBA, or Ciba – Chemische Industrie Basel (Chemical Industries Basel)
CNS – central nervous system
CMA – Canadian Medical Association
CMAJ – Canadian Medical Association Journal
CPT – continuous performance testing
DEA – Drug Enforcement Administration
DESI – Drug Efficacy Study and Implementation
DSM – Diagnostic and Statistical Manual of Mental Disorders
ECT – electroconvulsive therapy
EEG – electroencephalography (or electroencephalogram)
EES – Eugenics Education Society
FDA – Food and Drug Administration
JAMA – Journal of the American Medical Association
LSD – lysergic acid diethylamide
MBD – minimal brain dysfunction (or minimal brain damage)
MDA – methylene-dioxy-amphetamine
MDMA – methylene-dioxy-methamphetamine

NIH – National Institutes of Health
NIMH – National Institute of Mental Health
MAO – monoamine oxidase
MAOI – monoamine oxidase inhibitor
NCBDDD – National Center on Birth Defects and Developmental Disabilities
NPA – National Prescription Audit
NSF – National Science Foundation
OSRD – Office of Scientific Research and Development
PDR – Physicians’ Desk Reference
PRB – Pharmaceutical Research Branch
SKF – Smith, Kline & French
SSRI – selective serotonin reuptake inhibitors

Generic Name

dl-amphetamine dextroamphetamine methamphetamine methylphenidate phenmetrazine pemoline

chlorpromazine reserpine

meprobamate diazepam chlordiazepoxide

imipramine

fluoxetine paroxetine

Proprietary Name

Psychostimulants

Major Tranquilizers

Minor Tranquilizers (Anxiolytics)

Tricyclic Antidepressants

Selective Serotonin Reuptake
Inhibitors (SSRI)

Benzedrine Dexedrine Methedrine Ritalin Preludin Cylert

Thorazine Serpasil

Miltown Valium Librium

Tofranil

Prozac Paxil

The Amphetamine Years is a history of psychostimulant drugs and their clinical applications in post-World War II American medicine. Comprising such well-known substances as the amphetamines (Benzedrine, Dexedrine), methylphenidate (Ritalin), and phenmetrazine (Preludin), this class of pharmaceuticals has been among the most widely consumed in the past half-century. Their therapeutic uses for a variety of indications such as depression, obesity, and attention-deficit/hyperactivity disorder (ADHD) in children, not to mention their relevance for a number of different medical specialties, reveals that psychostimulants have occupied an important, if underappreciated role in the practice of modern medicine. In this dissertation, I illuminate the various ways in which physicians, particularly psychiatrists, put these drugs to work in clinical practice. In short, I contend that physicians exploited the wide range of physiological and psychological effects of psychostimulants and made a place for them in different therapeutic settings, even ones characterized by competing views and theories about the workings of the human body and mind.

My dissertation is distinguished by two prominent themes. First, I emphasize the clinician perspective as a vehicle for understanding the history of the psychostimulants, as well as related developments in psychiatry, pharmacotherapy, and the political economy of drugs, in the second half of the twentieth century. Scholars such Nicolas Rasmussen, David Courtwright, and Ilina Singh have elucidated the history of psychostimulants by emphasizing how pharmaceutical companies positioned their products in the medical marketplace. My dissertation takes a different, yet complimentary approach by studying clinicians, themselves, to further historical comprehension of the place of these pharmaceuticals within postwar medicine, society, and culture. Second, I advance the concept of “therapeutic versatility” to explain their historical trajectories. The complex set of psychological and physical effects these drugs produced made them ideal for a diverse range of therapeutic applications, which explains why they were embraced by many different medical specialties, why they were marketed by manufacturers for a variety of indications, and why they have enjoyed an enduring therapeutic lifespan, in spite of increasing efforts since the mid-1960s to regulate their availability and control their consumption. In addition to these two overarching themes, I advance five specific arguments in my dissertation. First, I contend that pharmaceutical markets were simultaneously created by the drug industry and clinicians. Pharmaceutical firms’ efforts to develop markets for their products have been well documented by historians, but in my dissertation, I underscore the role also played by clinicians in discerning drugs’ applications. Second, I argue that twentieth-century psychiatry’s conception of illness and therapeutics may not be served best by strictly dividing its history along lines of institutional and outpatient treatment. Third, I demonstrate how the use of psychostimulants by analytically oriented psychiatrists during the 1950s complicates historical notions of paradigm shift from a psychodynamic to biological orientation. Psychotherapy and psychopharmacology were not competing paradigms; in practice, doctors often employed both. Fourth, I assert that an appreciation of psychiatrists’ empirical and psychostimulants and their extramedical consumption, it is necessary to conceive of a plurality of distinct “amphetamine cultures,” each characterized by a unique set of relationships between physician-prescribers, patient-consumers, pharmaceutical firms, and political authorities.

Note: It would’ve taken even more than the day I spent working on this to properly separate the text from the many extended footnotes, so be aware: If you see out of place numbers and text, you’re probably reading a footnote. They are worth reading. I apologize for any glitches. Transferring this to a phone is tedious and I didn’t do a final edit

Chapter 1
Introduction

The Amphetamine Years is a history of psychostimulant drugs and their clinical applications in post-World War II American medicine. Comprising such well-known substances as the amphetamines (Benzedrine, Dexedrine), methylphenidate (Ritalin), and phenmetrazine (Preludin), this class of pharmaceuticals has been among the most widely consumed in the past half-century. Their therapeutic uses for a variety of indications, including depression, obesity, and attention-deficit/hyperactivity disorder (ADHD) in children, not to mention their relevance for a number of different medical specialties, reveals that psychostimulants have occupied an important, if underappreciated role in the practice of modern medicine. In this dissertation, I illuminate the myriad ways in which physicians, particularly psychiatrists, put these drugs to work in clinical practice. Clinicians exploited their wide array of effects and made a place for them in different therapeutic settings, even ones characterized by competing views and theories about the workings of the human body and mind.

At the same time, I examine medicine’s relationship with the extramedical consumption and regulation of these drugs. The psychostimulants’ concomitant identification as drugs of abuse, as well as their association with “speed freaks,” dieting housewives, and doping athletes, suggests the ways in which American society has contended balancing the therapeutic benefits of drugs and their potential for harm. Proving that medical authority often speaks with more than one voice, clinicians played significant roles in both abetting and contesting the extramedical use of these 4 pharmaceuticals. In doing so, they grappled with establishing the hazards of stimulant consumption. Medical leaders also demonstrated concern about the role of pharmaceutical firms that relentlessly sought to expand markets for their products, as well as the federal government’s growing interest in regulating both industry and physician practices. In addition to my overriding interest in understanding how clinicians employed psychostimulants as therapeutic options, I endeavor to illuminate, if only dimly, one of the most complex issues of the last fifty years: the evolving relationship between pharmaceutical companies that produce drugs, the physicians who prescribe them, the patients who consume them, and the policymakers charged with regulating these practices.

Writing about the history of pharmaceuticals demands that we consider manufacturers, prescribers, consumers, and regulators. Scholars such as Nicolas Rasmussen, David Courtwright, and Ilina Singh have advanced historical comprehension of stimulants by emphasizing how pharmaceutical companies positioned their products in the medical marketplace.1 My dissertation takes a different, yet complementary approach by studying the clinicians themselves. In particular, I utilize the lens of physician experience and what I term “therapeutic versatility” to explain psychostimulants’ contribution to postwar medicine, society, and culture. Put another way, the complex set of psychological and physiological effects these drugs produced in their users rendered them ideal for a diverse range of applications. Their versatility explains why they were

1 Nicolas Rasmussen, On Speed: The Many Lives of Amphetamine (New York: New York University Press, 2008); David Courtwright, of Amphetamine (New York: New York University Press, 2008); David Courtwright, Forces of Habit: Drugs and the Making of the Modern World (Cambridge, MA: Harvard University Press, 2001); Ilina Singh, “Bad Boys, Good Mothers, and the ‘Miracle’ of Ritalin,” Science in Context 15, no. 4 (December 2002): 577-603; and Ilina Singh, “Not Just Naughty: 50 Years of Stimulant Advertising,” in Medicating Modern America: Prescription Drugs in History, ed. Andrea Tone and Elizabeth Siegel Watkins (New York: New York University Press, 2007), 131-155.

embraced by many different medical specialties, why they were marketed by manufacturers for a variety of indications, and why they have enjoyed an enduring therapeutic lifespan, in spite of increasing efforts to regulate their availability and control their consumption.2 At the same time, I blur the boundaries that have characterized histories dealing with the therapeutic and illicit uses of these drugs. I do this by exploring the existence of distinct “amphetamine cultures” to provide a more nuanced understanding of the links between medical and extramedical consumption, as well as to explain the direction that efforts to deal with the latter took in the formulation of controls by policymakers during the 1970s.

A Psychostimulant Primer Psychostimulants are a class of synthetic drugs that increase the activity of the central nervous system (CNS) and produce a wide array of physiological effects, of which, increased wakefulness and energy are the best known. Caffeine is a wellrecognized CNS stimulant found naturally in coffee, tea, cocoa, kola nuts, and other plants. Its effectiveness in combating drowsiness and enhancing alertness makes it the world’s most widely consumed psychoactive substance, with up to 90 percent of adults ingesting it daily in North America.3 While psychostimulants have some effects in

2 For one discussion on the idea that pharmaceuticals have “lifespans,” see Sjaak van der Geest, Susan Reynolds Whyte, and Anita Hardon, “The Anthropology of Pharmaceuticals: A Biographical Approach,” Annual Review of Anthropology 25, no. 1 (October 1996): 153-178. The authors contend that pharmaceuticals have distinct phases, such as production, marketing, and prescription, which are comparable to the stages of life of organisms. Each phase, they contend, is characterized by different sets of agents, values, and ideas and should be also understood within its distinctive cultural and social context.

3 For historical considerations on caffeine as a drug, see Brian Cowan, The Social Life of Coffee: The Emergence of the British Coffeehouse (New Haven, CT: Yale University Press, 2005); Mark Pendergrast, Uncommon Grounds: The History of Coffee and How It Transformed Our World (New York: Basic Books, 1999); and Bennett Alan Weinberg and Bonnie K. Bealer, The World of Caffeine: The Science and Culture of the World’s Most Popular Drug (New York: Routledge, 2001).

common with caffeine, they are distinguished by greater potency, more complex effects on the body, and their synthetic rather than natural production.4

The best known psychostimulant is amphetamine, which refers to both a distinct compound and a class from which similar drugs have been derived. Amphetamines are chemically based on phenethylamine, a substance common in such foods as cheese, chocolate, and wine as a product of the microbial fermentation that results in their creation (see Figure 1.1). When consumed by eaters of these foods, the phenethylamine is usually passed through and removed from the body via the liver, where it and other dietary amines are degraded by the enzyme monoamine oxidase (MAO). Put simply, amphetamine is a synthetic derivative of phenethylamine whose only difference is a methyl group (-CH3) attached to the side chain.5 This single molecule makes a tremendous difference, however, because it prevents the MAO found in the liver from breaking down the phenethylamine. It is then able to enter the bloodstream and exert a variety of physiological effects upon the body and mind.6

4 The similarity of amphetamine to caffeine provides a convenient reference for American and European readers, but an even better point of comparison to amphetamine is the drug khat (or qat). This plant, which is native to East Africa and the Arabian Peninsula, contains the amphetamine-like compound cathinone. Chewing its leaves provides users with sensations of euphoria and excitement, as well as a loss of appetite, that more closely mirrors the amphetamine experience. For more on the history of khat, see Courtwright, Forces of Habit, 55; John G. Kennedy, James Teague, and Lynn Fairbanks, “Qat Use in North Yemen and the Problem of Addiction: A Study in Medical Anthropology,” Culture, Medicine, and Psychiatry 4, no. 4 (December 1980): 311-344; and Ezekiel Gebissa, Leaf of Allah: Khat and Agricultural Transformation in Harerge, Ethiopia, 1875-1991 (Athens: Ohio University Press, 2004).

5 The name “amphetamine” is actually a shortened version of the drug’s full chemical name, alpha-methylphenylethylamine. The name refers to the fact that the methyl group is attached to the alpha carbon on phenethylamine’s side chain. Amphetamine is alternately known by the chemical name betaphenyl-isopropylamine.

6 My discussion of the chemical nature of the psychostimulants and their physiological effects is particularly indebted to Leslie Iversen, Speed, Ecstasy, Ritalin: The Science of Amphetamines (Oxford: Oxford University Press, 2006), 5-27.

Figure 1.1 – The basic molecular structure of phenethylamine and amphetamine,
suggesting the similarities between the two. Note the methyl group on side chain of
amphetamine. (Source: Author, redrawn from Iversen, Speed, Ecstasy, Ritalin, 6)

The methyl group crucial to the formation of amphetamine can be attached to the side chain in both a left- or right-handed manner, resulting in two mirror image forms of amphetamine, or stereoisomers. When the mixture of left-handed and right-handed molecules is equal, then the form of amphetamine is a racemic mixture. This particular version is known as dl-amphetamine, which was the first form of amphetamine to be synthesized by British chemist Gordon Alles in 1929.7 The drug was subsequently introduced as Benzedrine by Smith, Kline & French (SKF) in 1933. Following this discovery, other isomers of amphetamine were soon isolated. The most important of these was the right-handed form, or dextro-isomer, which was more potent than the left-handed variant, or levo-isomer. Several years after the launch of Benzedrine, dextroamphetamine (or d-amphetamine) was first marketed by SKF as Dexedrine in 1937. Many other variants of this basic form are also possible. The addition of a second methyl chain to the nitrogen of the side chain results in the formation of methamphetamine, which is even more potent biologically than either Benzedrine or Dexedrine. Like the basic mixture of

7 While Alles is given credit for initially discovering amphetamine’s effects on the body, as well as for patenting the drug, the Romanian chemist Lazăr Edeleanu synthesized it first in 1887. However, Edeleanu did not discern the medical applications of the drug, and it continues to be associated with Alles to this day. See Rasmussen, On Speed, 22.

amphetamine (dl-amphetamine), methamphetamine also can be separated into two isomers, of which, the dextro-isomer (d-methamphetamine) is more powerful pharmacologically. An alteration to the benzene ring creates yet another variant, methylene-dioxy-methamphetamine (MDMA), better known by its street name “ecstasy” (see Figure 1.2). Using the basic chemical “scaffold” provided by the original phenethylamine molecule, an almost unlimited number of different compounds can be made. American chemists Alexander and Ann Shulgin were notable for their discovery of 179 distinct phenethylamines that they synthesized and tested on themselves in order to document their psychotropic effects.

Figure 1.2 – The molecular structure of methamphetamine and MDMA. (Source: Author, redrawn from Iversen, Speed, Ecstasy, Ritalin, 6)

In addition to being a derivative of phenethylamine, amphetamine is chemically similar to a class of neurotransmitters known as catecholamines. These nervous system chemicals are synthesized primarily within the body from the amino acids phenylalanine (a molecular precursor of phenethylamine) and tyrosine. Amphetamine is closely related to two catecholamines in particular, dopamine and norepinephrine (see Figure 1.3). 8 Alexander Shulgin and Ann Shulgin, PiHKAL: A Chemical Love Story (Berkeley, CA:
Transform Press, 1991). The title is an acronym that stands for “Phenylethylamines i Have Known and
Loved.”

known for its role as the brain’s “reward transmitter,” dopamine is one of the most studied chemicals in the body. Among its diverse functions within the brain, it plays an important role in regulating a person’s emotions and behavior. On the other hand, norepinephrine serves as both a hormone and neurotransmitter. It is responsible for activating the body’s “fight-or-flight” responses, such as increasing the heart rate, raising the blood pressure, and releasing glucose from energy stores. As neurotransmitters, dopamine and norepinephrine work by stimulating cellular receptors, which, in turn, are responsible for producing the physiological effects in question.

known for its role as the brain’s “reward transmitter,” dopamine is one of the most studied chemicals in the body. Among its diverse functions within the brain, it plays an important role in regulating a person’s emotions and behavior. On the other hand, norepinephrine serves as both a hormone and neurotransmitter. It is responsible for activating the body’s “fight-or-flight” responses, such as increasing the heart rate, raising the blood pressure, and releasing glucose from energy stores. As neurotransmitters, dopamine and norepinephrine work by stimulating cellular receptors, which, in turn, are responsible for producing the physiological effects in question.

Figure 1.3 – The molecular structure of dopamine and norepinephrine, compared to that of amphetamine. (Source: Author, redrawn from Iversen, Speed, Ecstasy, Ritalin, 9)

Despite its similarity to dopamine, norepinephrine, and other neurotransmitters
such as serotonin, amphetamine is unable to activate cellular receptors directly. Instead,
the drug works by stimulating the release of natural neurotransmitters within the synaptic
cleft, the gap between neurons (nerve cells) or neurons and other cells. The synaptic cleft
functions as the space where chemical interactions take place as neurotransmitters pass commands between cells. Amphetamine works by boosting the amount of these chemicals within the synaptic cleft.9 For example, amphetamine’s increase of dopamine levels by inhibiting its reuptake partly explains the euphoria associated with the drug. Likewise, increased concentrations of dopamine caused by amphetamine have been linked to psychological dependency on the drug, due in part to dopamine’s association with the brain’s reinforcement of rewarding or pleasurable activities. Amphetamine’s increase of norepinephrine explains other physiological effects of the drug, such as increased pulse, faster breathing, and heightened energy.

While numerous studies have established the various brain mechanisms involved in amphetamine responses, the effects of the drug on human mood and performance are quite complex. Alles immediately recognized the ability of amphetamine to alleviate fatigue and create a sense of confidence and euphoria. In scientific studies carried out after his discovery to discern the drug’s subjective effects, one report identified “a sense of well being [sic] and a feeling of exhilaration” and “lessened fatigue in reaction to work.”10 A 1938 study established how the drug increased a desire for work, made users believe it was easier to start or accomplish tasks, and enhanced general well-being, good humor, talkativeness, enthusiasm, and excitement, all with few adverse effects.11 These

9 For an excellent visual depiction of amphetamine’s effect on boosting dopamine and
norepinephrine levels within the synaptic cleft, see “The Mechanism of Action of Amphetamine (High
Dose)” at [Lundbeck Institute Campus

item/Drug_amphet_high/default.aspx].

10 M. H. Nathanson, “The Central Action of Beta-aminopropylbenzene (Benzedrine): Clinical Observations,” Journal of the American Medical Association 108, no. 7 (February 13, 1937): 528-531. Among the phrases used by participants to describe the effects of amphetamine were “increased energy, felt as if I could not get to enough places fast enough”; “I have done things today I usually dislike but which I rather enjoyed doing today”; “the last hour and a half of work is usually an effort, today I felt fine”; “did not have my usual lethargic period after lunch”; “sense of well being, nothing seemed impossible of accomplishment”; “I wanted to stop and talk to everybody I met”; “I felt unusually friendly toward people”; “my spirits have been high all day, felt bubbling inside”; “I was able to organize my work quickly and efficiently”; “my mind felt clear all day.”

early reports discerned two key effects of amphetamine on users—a euphoric sensation and a concomitant ability to enhance work performance and increase cognitive ability.

While amphetamines are the best known of the psychostimulants, they are not the only ones. During the 1940s and 1950s, pharmaceutical companies discovered a variety of compounds with somewhat more complex chemical structures than the ones that comprised the early amphetamines. The best known of these was methylphenidate, synthesized in 1944 and introduced as Ritalin by Ciba in 1955.12 Like amphetamine, methylphenidate also exhibits several isometric forms, but it is the racemic version (again, an equal mixture of the dextro- and levo- forms) known as Ritalin.13

Ritalin was initially appreciated for its abilities to alleviate fatigue and stimulate mental and physical performance. Soon after its 1955 introduction, Ciba marketed the drug for chronic fatigue, lethargy, disturbed senile behavior, depression, and narcolepsy. As I discuss in this dissertation, many of these applications were eventually abandoned. Today, Ritalin is best known for its use in the management of ADHD in children and adolescents. It is still prescribed, though less commonly, as a treatment for narcolepsy.

Methylphenidate bears a structural resemblance to amphetamine, particularly
dextroamphetamine (see Figure 1.4). Like the amphetamines in general, it also functions
as a dopamine and norepinephrine reuptake inhibitor. However, the drug is ten times less

11 Poul Bahnsen, Erik Jacobsen, and Harriet Thesleff, “The Subjective Effects of BetaPhenylisopropylaminsulfate on Normal Adults,” Acta Medica Scandinavica 97 (1938), 89-131.

12 Ciba, alternately rendered in all capital letters as CIBA, is an acronym for Chemische Industrie Basel (Chemical Industries Basel). However, use of the name as an acronym slowly began to disappear during the years of my study. Throughout this dissertation, I will use the form Ciba, which appears to have been in common use for much of the postwar era. See Chapter 2, note 39, for more on the early history of Ciba.

13 As with amphetamine, the dextro-isomer of methylphenidate is the more potent of the two
stereoisomers. During the early 2000s, Novartis (formerly Ciba-Geigy) introduced dextromethylphenidate
to the market as Focalin for the treatment of ADHD.

potent than dextroamphetamine in terms of behavioral stimulation and its ability to promote catecholamine release in the brain. Nevertheless, this set of characteristics has given it therapeutic value for psychiatrists seeking a drug with qualities similar to amphetamine, but with somewhat less potency. As I note later, the positioning of methylphenidate’s effects between caffeine and amphetamine would serve as one of the drug’s major selling points.

Figure 1.4 – Comparison of the molecular structure of methylphenidate and
amphetamine. Note the similar chemical bonds (highlighted in bold) between the two
compounds. (Source: Author, redrawn from Iversen, Speed, Ecstasy, Ritalin, 56)

Because they possess an ideal combination of water and fat solubility, psychostimulant drugs may be administered in a variety of ways. Based on Alles’s research, SKF first introduced the Benzedrine inhaler in 1933, in line with the drug’s original indication as a nasal decongestant (see Figures 1.5 and 1.6). The Benzedrine inhaler was a capped tube that contained a paper insert with 325 milligrams of an oily amphetamine base.14 For the next 15 years after its introduction, Benzedrine would be

14 The Benzedrine inhalers originally contained 325 milligrams of the drug in the form of an oily, volatile base. The evaporative characteristic of the compound allowed the vapors to escape through an opening in the tube, which was originally made of metal. Eventually, the metal was replaced by plastic, marketed as an over-the-counter cold remedy. Unfortunately, users who were drawn to the drug’s stimulating effects soon found a way to crack open the inhalers and swallow the paper inserts. The potentiated active agent found in the inhalers was 20 to 30 times greater than the average clinical dose of Benzedrine, and it delivered recreational users a more immediate and concentrated high than oral versions of the drug. Reports of inhaler abuse forced the FDA to withdraw them from over-the-counter sales in 1949.15

Figure 1.5 – The original Benzedrine inhaler, introduced by SKF in 1933. (Source: Addiction Research Unit, SUNY-Buffalo)

making it even easier to “crack” the inhalers to access the contents inside. In the 1940s, SKF reduced the dosage contained within the inhaler to 250 milligrams.

15 On the early history of the Benzedrine inhaler, see Rasmussen, On Speed, chap. 2. For more on the inhaler’s abuse, see Courtwright, Forces of Habit, 78-80. Inhaler abuse was famously associated with the poets and novelists of the Beat Generation, particularly Jack Kerouac, William S. Burroughs, and Neal Cassady. These writers noted that their consumption of Benzedrine owed much to the creativity and productivity that the drug conferred. Kerouac wrote his most acclaimed novel On the Road in the span of three weeks while consuming massive quantities of Benzedrine. Likewise, Ginsberg penned “Howl” under the drug’s influence. However, “Bennie” soon revealed his dark side among the Beats. Burroughs’s wife Jean Vollmer wasted away as she consumed up to three Benzedrine inhalers a day. Later in life, Ginsberg would recant his use of stimulants when he became the voice of a new generation during the late 1960s. See Rasmussen, On Speed, chap. 4.

Figure 1.6 – A 1940s version of the Benzedrine inhaler. The plastic inhalers were commonly “cracked” by abusers who ingested the amphetamine-containing inserts. (Source: Addiction Research Unit, SUNY-Buffalo)

But the most common means of administering psychostimulants, particularly for medical applications, was and remains orally, through a measured dose dispensed in a tablet or capsule (see Figures 1.7 and 1.8). Alles patented the active salts of Benzedrine, and SKF introduced the first tablet form of the drug in 1936. Oral versions of other amphetamine drugs, such as Dexedrine and Dexamyl (a combination of dextroamphetamine and the barbiturate amobarbital) soon followed. Once swallowed, these drugs dissolve in the stomach and are absorbed into the body as they pass through the gut. The combination of water and fat solubility found in tablet and capsule forms of psychostimulants permit them to be easily absorbed into the body and to penetrate the blood-brain barrier. At the same time, oral administration allows the drug to be gradually released into the body and ensures a prolonged duration of action. For medications such as Ritalin, where a single dosage may be required to last an entire school day, Ciba (now Novartis) has released sustained release (SR) and long acting (LA) versions. These characteristics, not to mention the simplicity and convenience of a pill, have made oral versions of these drugs ideal for clinical use.

Figure 1.7 – Dexedrine Spansule (10 mg.), manufactured by GlaxoSmithKline, formerly SKF. The Spansule was an extended release capsule introduced by SKF during the 1950s for prolonged administration of the drug. (Source: U.S. Department of Justice)

Figure 1.8 – Tablet of Ritalin (10 mg.), manufactured by Novartis, formerly Ciba-Geigy. (Source: U.S. Department of Justice)

More potent forms of the amphetamines and methylphenidate have been available in parenteral, or injectable, forms. Such versions are delivered directly into the bloodstream and persist in the body longer than their oral counterparts. As a result of their potency, as well as their implication in illicit use by addicts, intravenous forms of amphetamines and methylphenidate historically have been more tightly regulated. In many cases, their medical application in such forms has been discontinued.16 Historiographical Context Establishing the Framework for Modern Pharmacotherapy and Psychiatry

As tools within the physician’s therapeutic armamentarium, drugs have been in
near-constant use for thousands of years.17 Yet their effectiveness in treating disease is a
more recent phenomenon.18 Prior to the twentieth century, drugs were valued more for
their ability to produce a set of physiological effects, such as purging, vomiting, and the

16 For example, Ciba-Geigy ceased production of injectable Ritalin in 1974.

17 There exists no universal agreement of what constitutes a “drug.” However, a 1969 definition put forth by the World Health Organization provides a concise and useful standard: “any substance that, when taken into the living organism, may modify one or more of its functions.” See World Health Organization, WHO Expert Committee on Drug Dependence: Sixteenth Report (Geneva: World Health Organization, 1969), 6. A somewhat more legal definition of “drug” is provided by the U.S. Food & Drug Administration (FDA). As codified in the Federal Food, Drug & Cosmetic Act, drugs are articles (other than food) intended to affect the structure or any function of the body of man or other animals” and “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease.” See Federal Food, Drug & Cosmetic Act, § 201(g)(1). This second definition suggests the medical orientation of many drugs. As Andrea Tone and Elizabeth Watkins have also noted: “Drugs are substances that alter the body in order to alleviate symptoms, help make a diagnosis, or promote health and well-being.” See Andrea Tone and Elizabeth Siegel Watkins, “Introduction,” in Medicating Modern America, 1. Even more specific are pharmaceutical drugs, which are generally distinguished by their industrialized processes of research and development, manufacture, distribution, and marketing.

18 In the Epidemics, the ancient Greek physician Hippocrates claimed that medicine “consists in three things—the disease, the patient, and the physician.” In a response to this quote, Charles Rosenberg observed that one seeking an understanding of medicine should begin with disease. Yet the notion of disease is a very complex one, as it is more than simply less than optimum health. For Rosenberg, disease is simultaneously a “biological event, generation-specific repertoire of verbal constructs, occasion of legitimation for public policy, aspect of social role and individual identity, sanction for cultural values, structuring element in doctor-patient relations.” See Charles E. Rosenberg, “Framing Disease: Illness, Society, and History,” in Framing Disease: Studies in Cultural History, ed. Charles E. Rosenberg and Janet Golden (New Brunswick, NJ: Rutgers University Press, 1992)

occasional alleviation of pain, than they were for the treatment of a particular disease.19 Indeed, opium, ipecac, and mercury were the American physician’s drugs of choice during the eighteenth and nineteenth centuries. Physicians and patients alike prized these substances for their visible and predictable physiological effects as part of the paradigm of practice described by historian Charles Rosenberg.20 At the beginning of the nineteenth century, physicians still interpreted disease as the product of bodily disharmony, such as an imbalance between the body’s humours. Physicians did not treat specific diseases. Rather, they relied upon “heroic therapies” to restore balance and good health. That the Tennessee physician John Gunn advocated the routine use of the emetic ipecac to promote frequent “puking” in order to clean a patient’s system, but eschewed the use of medicines for particular diseases, suggests the role that drugs played in heroic therapies.21 Accompanying this holistic approach to the treatment of illness was a worldview common to both physicians and patients about the effectiveness of heroic medicine. While such therapies may appear unscientific today, and though they actually may have done more harm than good, these practices were accepted by patients who

19 The idea of a single drug for a single disease, better known as a “magic bullet,” is a distinctively twentieth-century idea. Historically, it is associated with scientist Paul Erlich and his efforts to develop a cure for syphilis in which a drug would target the disease-causing bacterium without harming other organisms within the body. See Allan Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1880, expanded ed. (New York: Oxford University Press, 1987). By focusing on the social dimensions of sexually transmitted diseases, including AIDS, Brandt’s study complicates straightforward understandings regarding the attribution of disease to a single pathogen and its treatment to a selective therapy.

20 Charles E. Rosenberg, “The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth Century America,” in Explaining Epidemics and Other Studies in the History of Medicine (Cambridge: Cambridge University Press, 1992), 9-31. Rosenberg’s scholarship has been a pervasive influence on the history of medicine over the past several decades. For more on his strengths and weaknesses associated with his approach to the subject, see Naomi Rogers, “Explaining Everything? : The Power and Perils of Reading Rosenberg,” Journal of the History of Medicine and Allied Sciences 63, no. 4 (October 2008): 423-434; and Nancy Tomes and Jeremy A. Greene, “Is There a Rosenberg School? ” Journal of the History of Medicine and Allied Sciences 63, no. 4 (October 2008): 455-466.

21 Charles Rosenberg, “John Gunn: Everyman’s Physician,” in Explaining Epidemics, 57-73. appreciated their visible effects and shared physicians’ understandings of the body and disease.22

The advent of the germ theory of disease, associated with German bacteriologist Robert Koch, provided a major impetus for change in understandings of illness and treatment.23 Termed the “therapeutic revolution” by Rosenberg, physicians and scientists at the end of the nineteenth century began to acknowledge the specificity of diseases, each caused by a particular pathogen and with a specific remedy. One major shift in the practice of medicine came with the emergence of public health regimes in the United States during this time, accompanied by an attendant rise in secularism and scientific discourse, to address epidemics such as cholera and typhoid.24 In the face of new discoveries about the cause of disease, another key transition in medicine occurred during the early twentieth century with the establishment of institutions and methodologies that improved the healing practices of individual physicians.25 One bounty of this new

22 This is not to say that all drug-mediated therapies should be understood solely within the context of heroic medicine. For example, opium provided patients with appreciable relief from pain, and its use further contributed to the legitimacy of physicians during this time. For more on the transformation of therapeutics by physicians during the nineteenth century, see John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (1986; reprint, Princeton, NJ: Princeton University Press, 1997). Warner elaborates on the broad principle of a “therapeutic revolution” outlined by Rosenberg, but he does diverge at various points, especially in his emphasis that changes were more evolutionary rather than revolutionary. Regarding drugs, Warner argues that heroic therapy was not used as frequently as believed. In addition, the decline in heroic therapy in the late nineteenth century was accompanied by a rise in palliative drug therapy, as well as physicians’ belief in relieving pain as the first indication of patient care.

23 Much of the secondary literature on Koch’s life has been published in German. The leading
biography in English remains Thomas D. Brock, Robert Koch: A Life in Medicine and Bacteriology (1988;
reprint, Washington, DC: ASM Press, 1999).

Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866, 2nd ed. (Chicago: University of Chicago Press, 1987); Judith Walzer Leavitt, Typhoid Mary: Captive to the Public’s Health (Boston: Beacon Press, 1996); and Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998).

24

25 Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (New York: Cambridge University Press, 1997).

rational therapeutics” was the development of new pharmaceuticals for treating illness and realizing a host of therapeutic goals.

Late twentieth-century medicine has been characterized partly by the emergence of a plethora of new medications to treat illness. The discovery and subsequent mass production of penicillin and other antibiotics during the 1940s and 1950s provided medicine with its first means to eradicate diseases with a bacterial origin, including tuberculosis and syphilis.26 The introduction of these new pharmaceuticals was complemented during the Cold War era by the appearance of federally funded medical research programs, large-scale pharmaceutical firms (collectively referred to as “Big Pharma”), and governmental bodies designed to regulate them.27 As just one sign of the pharmaceutical industry’s medical and commercial influence since this development, consider that Americans paid almost $200 billion for prescription drugs in 2005 alone.28 Consisting of institutions the historian of psychiatry David Healy has collectively termed

26 Robert Bud, Penicillin: Triumph and Tragedy (New York: Oxford University Press, 2007); and Albert A. Elder, ed. The History of Penicillin Production (New York: American Institute of Chemical Engineers, 1970). Antecedents to penicillin also deserve mention. Salvarsan, discovered by Paul Erlich in 1908, proved far superior to mercury compounds in the treatment of syphilis. Also, sulfonamides (sulfa drugs) were developed in the 1930s as forerunners to the antibiotics. See John E. Lesch, The First Miracle Drugs: How the Sulfa Drugs Transformed Medicine (New York: Oxford University Press, 2007).

27 The historical development of “Big Pharma” has been described by numerous scholars, including Jonathan Liebenau, Medical Science and Medical Industry: The Formation of the American Pharmaceutical Industry (Baltimore: Johns Hopkins University Press, 1987); Louis Galambos with Jane Eliot Sewell, Networks of Innovation: Vaccine Development at Merck, Sharp & Dohme, and Mulford, 1895-1995 (Cambridge: Cambridge University Press, 1995); Nicolas Rasmussen, “The Commercial Drug Trial in Interwar America: Three Types of Clinician Collaborator,” in Bulletin of the History of Medicine 75, no. 1 (Spring 2005): 50-80; Arthur A. Daemmrich, Pharmacopolitics: Drug Regulation in the United States and Germany (Chapel Hill: University of North Carolina Press, 2004); Alfred D. Chandler Jr., Shaping the Industrial Century: The Remarkable Story of the Evolution of the Modern Chemical and Pharmaceutical Industries (Cambridge, MA: Harvard University Press, 2005), chap. 7-10; and Marks, The Progress of Experiment. Andrea Tone and Elizabeth Siegal Watkins also provide a very useful synopsis of major themes in American pharmaceutical history during the twentieth century. See Tone and Watkins, “Introduction,” in Tone and Watkins, Medicating Modern America, 1-17.

28 Marcia Angell, The Truth about the Drug Companies: How They Deceive Us and What to Do About It (New York: Random House, 2004), 3; Greg Critser, Generation Rx: How Prescription Drugs Are Altering American Lives, Minds, and Bodies (New York: Houghton Mifflin, 2005), 2. the “medico-pharmaceutical complex,” the relationship between pharmaceutical firms that produce medications, medical practitioners who prescribe them, patients who consume them, and regulatory bodies charged with ensuring their safety and efficacy, has become an increasingly prominent feature of medicine since the end of World War II.29 The place of “Big Pharma” in American medicine, society, and culture is no less germane today, either.30

While many historians of medicine have been preoccupied with longstanding social issues such as race, class, and gender in the provision of health care or the relationship between physician and patient, historian Greg Higby has noted the development of a “new pharmaceutical history.” This emerging body of scholarship considers intersecting interests in the history of medicine, history of technology, business

29 David Healy, The Antidepressant Era (Cambridge, MA: Harvard University Press, 1997), 7-42. Healy’s observations limit themselves mainly to the institutional components of drug development, marketing, and regulation. However, one might go further to suggest that pharmaceuticals embody many of the features of what historian Thomas Hughes has termed a “technological system.” Though a consideration of drugs as technologies is somewhat beyond the scope of this study, it is possible to argue that pharmaceutical products (i.e. drugs) are technological artifacts within a larger system of invention, innovation, and development, as well as production, consumption, and regulation. See Thomas P. Hughes, “The Evolution of Large Technological Systems,” in The Social Construction of Technological Systems, ed. Wiebe E. Bijker, Thomas P. Hughes, and Trevor Pinch (Cambridge, MA: MIT Press, 1987), 51-82.

By and large, historians of medicine have generally not incorporated many of the concepts specific to the history of technology, yet medical historians can profit immensely from considering at least some of these ideas. Works that have attempted to integrate the two approaches include Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America (Baltimore: Johns Hopkins University Press, 1997); Joel D. Howell, Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century (Baltimore: Johns Hopkins University Press, 1995); and Bettyann Holtzmann Kevles, Naked to the Bone: Medical Imaging in the Twentieth Century (New Brunswick, NJ: Rutgers University Press, 1997).

30 For several excellent studies about the contemporary relationship between Big Pharma and the practice of medicine, see Merrill Goozner, The $800 Million Pill: The Truth Behind the Cost of New Drugs (Berkeley: University of California Press, 2004); Jerry Avorn, Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs, rev. ed. (New York: Vintage, 2005); James Taggart, The World Pharmaceutical Industry (London: Routledge, 1993); Stuart O. Schweitzer, Pharmaceutical Economics and Policy (New York: Oxford University Press, 1997); William C. Bogner with Howard Thomas, Drugs to Market: Creating Value and Advantage in the Pharmaceutical Industry (New York: Pergamon, 1996); Anita McGahan, Greg Keller, and John F. McGuire, “The Pharmaceutical Industry in the 1990s,” Harvard Business School, Case #9-796-058, 1995, revised 1996; and John Abraham and Tim Reed, “Progress, Innovation and Regulatory Science in Drug Development: The Politics of International Standard Setting,” Social Studies of Science 32, no. 3 (June 2002): 337-369.

history and political economy, and cultural studies, to comprehend the postwar pharmaceutical enterprise and its relationship with medicine.31

Developments in drug therapy during the postwar era included new medications for mental illness. Before the twentieth century, medical treatments for psychosis frequently met with limited success.32 In many cases, interventions at the societal level, such as institutionalization, predominated.33 By the twentieth century, however, psychiatry began to look toward bodily, or somatic, therapies for help. Despite the occasional success, such as the application of malarial fever therapy to treat neurosyphillis, most of these treatments had irresolute outcomes for physician and patient alike.34 In some cases, medical interventions such as psychosurgery incurred high human

31 Gregory J. Higby, review of Medicating Modern America, by Tone and Watkins, eds., in
Journal of American History 94, no. 4 (March 2008): 1323-1324. Further examples of leading historical
studies in this vein are discussed below.

32 Roy Porter, Madness: A Brief History (New York: Oxford University Press, 2003); Edward Shorter, A History of Psychiatry (New York: John Wiley & Sons, 1997); and David Healy, The Creation of Psychopharmacology (Cambridge, MA: Harvard University Press, 2002), 9-75. In a rejoinder to this view, Charles Rosenberg has observed that, despite its associations with twentieth century psychosomatic medicine, interest in the relationship between body and mind is considerably older. Moving away from specialized psychiatry and theological/metaphysical senses of mind and body, Rosenberg looked at everyday doctor-patient relationships to understand the nineteenth century construction of the neurosis concept as an outcome of the needs and circumstances of medical practice and the changing structure of etiological speculation between the mid-eighteenth and early twentieth centuries. See, Charles E. Rosenberg, “Body and Mind in the Nineteenth Century,” in Explaining Epidemics, 74-89.

33 Gerald N. Grob, Mental Institutions in America: Social Policy to 1875 (New York: Free Press, 1973); and Gerald N. Grob, Mental Illness and American Society, 1875-1940 (Princeton, NJ: Princeton University Press, 1983).

34 If somewhat myopic in their interpretations, Garfield Tourney, “A History of Therapeutic Fashions in Psychiatry, 1800-1966,” American Journal of Psychiatry 124, no. 6 (December 1967): 784796; and Elliot S. Valenstein, Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness (New York: Basic Books, 1986) are notable for their initial attempts to understand the history of bodily interventions for mental illness. In response to historical accounts that assess the somatic therapies of the early twentieth century as iterations on the path to modern biological psychiatry, critic Andrew Scull argued for the need to contextualize better these developments, observing that “historians have tended to pass over these innovations in embarrassed silence or to dismiss episodes of this sort as aberrations.” See, Andrew Scull, “Somatic Treatments and the Historiography of Psychiatry,” History of Psychiatry 5, no. 17 (March 1994), 9. Joel T. Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century (Berkeley: University of California Press, 1997), represented a remarkable attempt to locate and consider the “therapeutic rationales” of costs.35 Despite divergent interpretations of their efficacy and meaning for patients, somatic therapies in institutions in the first half of the twentieth century foreshadowed the future of psychiatry. In 1954, the major tranquilizer, or antipsychotic, chlorpromazine (Thorazine) was introduced in North America as the first effective drug in the treatment of schizophrenia. While chlorpromazine would eventually reveal its share of debilitating side effects in patients, the drug was a watershed in the treatment of psychosis and one that illustrated the intersecting developments in pharmacology and psychiatry.36

The minor tranquilizers, or anxiolytics, and antidepressants that followed the
initial major tranquilizers further revolutionized psychiatry’s back wards and private
practices. Their increased use by psychiatrists meant that pharmacotherapy during the
second half of the twentieth century superseded many of the bodily therapies used for the
treatment of psychosis.37 And as historians such as Andrea Tone, Jonathan Metzl, David
Herzberg, and David Healy have observed, the prescription of anxiolytics and
antidepressants beginning in the 1950s would eventually displace psychoanalytic therapy
in the treatment of neurosis, as well as engender a biological orientation for
understanding anxiety and minor depression.38 It would be no understatement to say that

physicians who undertook such therapies. Deborah Blythe Doroshow, “Performing a Cure for Schizophrenia: Insulin Coma Therapy on the Wards,” Journal of the History of Medicine and Allied Sciences 62, no. 2 (April 2007): 213-243, further considered the local world in which insulin coma therapies were undertaken. 35 Jack D. Pressman, Last Resort: Psychosurgery and the Limits of Medicine (New York: Cambridge University Press, 1998).

36 Judith P. Swazey, Chlorpromazine in Psychiatry: A Study of Therapeutic Innovation (Cambridge, MA: MIT Press, 1974); Shorter, History of Psychiatry; Healy, Antidepressant Era; and Healy, Creation of Psychopharmacology. Also of note is an early work on the subject, Anne E. Caldwell, Origins of Psychopharmacology: From CPZ to LSD (Springfield, IL: Thomas, 1970).

37 A major exception is electroconvulsive therapy (ECT), which remains an efficacious treatment for major depression.

psychiatry, as it is now practiced in the early twenty-first century, is beholden more than ever to the pharmacological revolution that began just over a half-century ago.

Situating the Psychostimulants The psychostimulants are somewhat older than the major tranquilizers, minor tranquilizers, and antidepressants that transformed psychiatry during the 1950s. Benzedrine’s discovery in 1929 coincided with a larger effort to capitalize on the demand for synthetic derivatives of naturally occurring hormones. Particularly prized were adrenal hormones, especially for their action in raising blood pressure. In 1894, a team of British physiologists first identified the hormone as adrenaline. After a race to isolate and purify the hormone, an endeavor that resulted in a number of competing products, Parke, Davis & Company introduced Adrenalin in 1901, and it soon became the leading version of adrenaline on the market. Physicians treating shock appreciated its qualities as a “pressor” that raised blood pressure. Adrenalin also was valued for its ability to constrict blood vessels and was soon added to local anesthetics to help prevent hemorrhaging. Termed a “sympathomimetic” drug for how it mimicked the sympathetic nervous system’s actions on the body’s organs and muscles, Adrenalin’s advent inspired an enthusiastic search for similar drugs.39 The next important sympathomimetic to be

38 Andrea Tone, The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers (New York: Basic Books, 2009); Jonathan Michel Metzl, Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs (Durham, NC: Duke University Press, 2003); David Herzberg, Happy Pills in America: From Miltown to Prozac (Baltimore: Johns Hopkins University Press, 2008); David Healy, Let Them Eat Prozac: The Unhealthy Relationship between the Pharmaceutical Industry and Depression (New York: New York University Press, 2004); and Healy, Antidepressant Era.

39 In outlining the features of adrenaline on specific bodily functions, I have suggested some of the characteristics associated with the sympathetic nervous system that stimulates the body’s organs and tissues during stressful situations. Its diverse effects include constriction of blood vessels supplying the skin, dilation of blood vessels supplying the heart and skeletal muscles, dilation of the bronchioles to facilitate increased ventilation, relaxation of the smooth muscle in the intestines, dilation of the pupils, and release of glucose from the liver. The sympathetic nervous system is complemented by a parasympathetic nervous system that rests and relaxes the body during less stressful periods.

discovered was ephedrine, a derivative of the Chinese herb ma huang, or ephedra. The drug firm Eli Lilly introduced ephedrine to the market in the 1920s, and it became a massive success. While ephedrine had many of the pressor qualities of adrenaline, it also relaxed the bronchial passages and could be taken orally, making it a pioneering treatment for asthma. Due to the limited availability and high prices of the plant sources from which ephedrine was synthesized, demand outstripped supply and inspired a hunt for synthetic alternatives. While searching for derivatives of the drug that could be used as a nasal decongestant and bronchodilator, Gordon Alles discovered amphetamine.40

The drug known today for its psychological properties began its therapeutic life very differently, yet the market for a nasal decongestant made the Benzedrine inhaler a bestseller. Alles was not oblivious to the broader potential of amphetamine. Nicolas Rasmussen has detailed how the threat of a patent dispute between Alles and SKF, whose products appeared to have been inspired by his findings, was transformed into a profitable alliance between the two parties. Alles subsequently isolated the active salts of amphetamine, which allowed the drug to be consumed orally. In 1937, the American Medical Association (AMA) approved the advertising of Benzedrine Sulfate for narcolepsy, postencephalitic Parkinsonism, and mild depression.41 The marketing of Benzedrine for depression coincides with Rasmussen’s broader observation about the significance of relationships between the pharmaceutical industry and academic clinical researchers during the interwar period. In the case of Benzedrine, SKF’s support of Harvard psychiatrist Abraham Meyerson played an important role in helping the

40

41

See Rasmussen, On Speed, chap. 1, for a fuller discussion of amphetamine’s discovery. See Rasmussen, On Speed, chap. 2.

company to market the drug for a form of mild depression termed “anhedonia.”42 The
indication of oral Benzedrine for depression propelled the drug to annual sales of
$500,000 by 1941, about four percent of SKF’s total sales.

The outbreak of World War II only furthered amphetamine’s ascendance. American and British forces supplied upward of 180 million tablets of Benzedrine to their personnel, particularly aviators, to keep them alert during combat. About 15 percent of Army Air Force pilots used amphetamines during the war, many of them determining their own patterns of use rather than following official guidelines for consumption. Likewise, the Germans and Japanese supplied their personnel with methamphetamine.43 Rasmussen has suggested that by war’s end, up to 16 million American servicemen had been exposed to the drug.44

Amphetamines exhibited no sign of decline after 1945, however. That same year,
SKF’s sales of the drugs had quadrupled to $2 million, including $650,000 from the
firm’s newest product, Dexedrine. The postwar era would see the drugs prescribed for an
increasing number of indications, and amphetamines’ popularity would continue to soar.
At the same time, their recreational consumption resulted in the emergence of what
historian David Courtwright has termed “amphetamine democracies.”45 Their
prominence in American society would become so entrenched by the 1970s that scholars

42 Nicolas Rasmussen, “Making the First Anti-Depressant: Amphetamine in American Medicine, 1929-1950,” Journal of the History of Medicine and Allied Sciences 61, no. 3 (July 2006): 288-323.

43 Historian David Courtwright has related how Japanese soldiers and pilots used methamphetamine to maintain their senryoku, “war energy” or “war strength.” Likewise, munitions and construction workers also consumed the drugs to maintain the frantic pace of wartime production. These experiences with the drug, coupled with their liberal sales as war surplus supplies following the war, contributed to a growing epidemic of methamphetamine abuse in postwar Japan. See Courtwight, Forces of Habit, 80-81.

44

45

See Rasmussen, On Speed, chap. 3.

See Courtwright, Forces of Habit, 76-84.

Lester Grinspoon and Peter Hedblom have called attention to the rise of the “speed culture.”46 My study focuses on this postwar era of clinical application and extramedical consumption.

Key Themes and Arguments

My dissertation is distinguished by two prominent themes. First, I emphasize the clinician perspective as a vehicle for understanding the history of psychostimulants, as well as related developments in psychiatry, pharmacotherapy, and the political economy of drugs in the second half of the twentieth century. Second, I advance the concept of “therapeutic versatility” to explain psychostimulants’ multiple applications and their enduring shelf life in American medicine. These two themes allow me to craft a narrative that complements other scholars’ approaches and further illuminates the complex history of a class of pharmaceuticals recognized as important to the history of medicine.

In addition to these two central themes, I advance five specific arguments in my dissertation. First, I contend that drug manufacturers reacted to the ways in which physicians utilized their products and introduced new ones to exploit these potential indications. This responsiveness accompanied pharmaceutical firms’ established role of creating markets that physicians followed. Second, I argue that twentieth-century psychiatry’s conception of illness and therapy may not be served best by bifurcating its history along lines of institutional and outpatient therapeutic realms. The application of pharmacotherapy within both settings suggests they had more in common than their divergent histories would readily suggest. Third, I demonstrate how the widespread use of psychostimulants by analytically oriented psychiatrists during the 1950s complicates

46 Lester Grinspoon and Peter Hedblom, The Speed Culture: Amphetamine Use and Abuse in America (Cambridge, MA: Harvard University Press, 1975).

historiographical notions of a paradigm shift from a psychodynamic to a biological orientation during the postwar era.47 Psychotherapy and psychopharmacology were not competing paradigms; in practice, doctors often employed both. Fourth, I assert that an appreciation of psychiatrists’ empirical and eclectic approaches to the use of drugs is necessary to comprehend the rise of pharmacotherapy in the postwar era. Finally, I contend that to understand the relationship between medical applications of psychostimulants and their extramedical consumption, it is necessary to conceive of a plurality of amphetamine cultures, each characterized by distinct relationships between physician-prescribers, patient-consumers, pharmaceutical firms, and political authorities. Emphasizing the Clinician Perspective The first theme of my dissertation involves my emphasis on the clinician perspective to illuminate the history of the psychostimulants. My approach parallels their study by Rasmussen in particular, who employed the pharmaceutical firm as his primary vehicle for understanding the history of amphetamines. While his history engaged myriad issues, it persuasively revealed how SKF responded to and even shaped the markets and indications for its amphetamine products. My inquiry is driven by a somewhat different concern. How did physicians interpret the medical applications of these drugs and make a place for them in their practices? By taking a “clinician-” rather than “industry-side” approach, my work provides a complementary perspective to his interpretation. Patients, pharmaceutical firms, regulators, and other key historical actors are important to my analysis. However, physician experiences provide a valuable lens for further clarifying

47 On the notion of “paradigm shifts” in the practice of science and, by extension, medicine, see
Thomas S. Kuhn, The Structure of Scientific Revolutions, 3rd ed. (Chicago: University of Chicago Press,
1996). In a few works on the history of psychiatry, the idea that psychiatry underwent a paradigm shift as it
was transformed from a psychodynamic to a biological orientation for explaining mental illness is explicit.
In many others, however, it is implicit.

the history of psychostimulants, specifically, as well as the history of medicine, regulation, and pharmaceuticals, generally.

“Therapeutic Versatility,” or the “Many Lives of Amphetamine” Redux

My dissertation is also informed by a second overarching theme. The historical trajectory of the psychostimulant drugs during the postwar era is best understood in the context of what I term therapeutic versatility. It was this characteristic that ultimately explains the variegated and enduring clinical applications of the psychostimulants. Rasmussen has also charted the “many lives of amphetamine.”48 Yet for all the narratives he uncovered, there are still others waiting to be illuminated. My dissertation exposes and analyzes a number of important, yet overlooked applications.

While the major tranquilizers have rightfully received much credit for revolutionizing institutional psychiatry during the 1950s, the role of other drugs such as Benzedrine, Dexedrine, and Ritalin as adjuncts to facilitate the use of novel antipsychotics has been obscured. As part of combination therapies to treat psychosis, the psychostimulants alleviated the untoward effects associated with the major tranquilizers, particularly lethargy, and enhanced their efficacy. In addition to their role in the treatment of psychoses such as schizophrenia, the drugs were deemed useful by psychiatrists in the management of major depression. Before the advent of the tricyclic antidepressants, stimulants such as Ritalin served to augment established somatic interventions such as electroconvulsive therapy (ECT). Documenting these ignored applications within the broader ambit of change in postwar American psychiatry, I advance understandings of stimulants’ therapeutic versatility.

48 The quote here refers to the subtitle of On Speed.

Even where the applications of these drugs are well understood, such as their indication for minor depression as early as the 1940s, there are still new facets to be revealed. Furthering the work done by Rasmussen in this area, I explore the use of pharmaceuticals by psychoanalytically oriented psychiatrists during the 1950s and 1960s. In particular, I demonstrate how these physicians turned to stimulants such as Ritalin, Dexedrine, and Methedrine to reduce patients’ inhibitions and intensify their emotional states in the process of administering a “talking cure.” Unlike in institutions, where the alleviation of visible symptoms and tangible results mattered most, psychiatrists in private practices often held different views of these drugs. Pharmaceuticals facilitated more open dialogues with patients, but they remained only adjuncts—the psychiatrist, not the drug, remained responsible for treatment. By taking a closer look at this and other applications that have passed unnoticed or have been discounted by historians, my dissertation contributes to our understanding of the “many lives” of psychostimulants. Pharmaceutical Industry Responsiveness to Clinician Practices

In addition to the themes that allow me to contribute to the scholarship regarding these drugs, I advance a set of arguments that engage, complicate, and contribute to the broader historical scholarship on psychiatry, pharmaceuticals, and the political economy of drug consumption in the postwar United States. First, I suggest how the pharmaceutical industry was responsive to the ways in which physicians utilized their medications. Scholarship by David Healy, Nicolas Rasmussen, and Jeremy Greene, among others, demonstrates the lead that pharmaceutical firms sometimes took in facilitating markets for their products by touting their therapeutic indications through advertising and detailing.49 I do not discount the arguments of historians who have emphasized the industry’s role in directing the hand of the market. But I do conclude that firms were simultaneously receptive to physicians’ uses of their drugs and responded with new products to capitalize on these applications.

Throughout this dissertation, I highlight the case of Ciba, the pharmaceutical firm that manufactured Ritalin. The company introduced the drug in 1955 with a set of initial indications and some basic supporting research. However, clinicians followed their own paths—driven by their experiences, needs, and therapeutic agendas—to discern how the drug would be used. Capitalizing on the findings of numerous psychiatrists during the mid-1950s, Ciba launched Serpatilin (a combination of methylphenidate and the antipsychotic drug reserpine) to harness what appeared to be a receptive market for combination therapies for schizophrenia and major depression. Likewise, when Ciba introduced Ritonic in 1959, the firm appears to have been responding to the reported experiences of physicians who tried combinations of amphetamines, vitamins, and hormones to increase the energy and quell the agitation of elderly patients who did not suffer from a specific disease. Eventually the company would take a more active role in directing the prescription of its products in the 1960s by indicating and advertising the drug for depression. But my research suggests that physician practices played a role in directing the early marketing trajectories that drugs such as Ritalin followed.

49 Healy, Antidepressant Era; Healy, Let Them Eat Prozac; Rasmussen, On Speed; Rasmussen, “Making the First Anti-Depressant”; and Jeremy A. Greene, Prescribing by Numbers: Drugs and the Definition of Disease (Baltimore: Johns Hopkins University Press, 2008).

In my discussion of the therapeutic versatility of psychostimulants, I alluded to their different applications in institutional and outpatient settings. Conventional interpretations have underscored the differences between these two modes of treatment as a defining characteristic of psychiatry for much of the twentieth century.50 This view has a certain basis in fact: patients suffering from the worst mental illnesses were frequently committed to mental hospitals where medical interventions commonly focused on the body. Collectively known as somatic therapies, these treatments included hydrotherapy, insulin coma therapy, malarial fever therapy, ECT, and psychosurgery.51 By contrast, outpatient psychiatry was concerned mainly with lesser mental ills collectively termed neurosis. For much of the century, psychiatrists approached “nerves” most visibly through the application of psychotherapy, a set of methods employed to elicit interpersonal rapport and establish a therapeutic relationship between clinician and patient. Perhaps the best-known form of psychotherapy in the 1950s was Freudian psychoanalysis, characterized by techniques such as free association and transference therapy to recover the repressed memories believed responsible for neurosis. The emergence of the minor tranquilizers and antidepressants during the 1950s and 1960s would have an important effect on outpatient psychiatry. Their increasing prescription, accompanied by biological models of mental illness and publications such as the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) that

50 See Shorter, History of Psychiatry, for one prominent synthesis in this vein. 51

For studies focusing on the various aspects of institutional psychiatry, see Gerald N. Grob, The Mad Among Us: A History of the Care of America’s Mentally Ill (New York: Free Press, 1994); Braslow, Mental Ills and Bodily Cures; Pressman, Last Resort; and Doroshow, “Performing a Cure for Schizophrenia.” A more detailed historiographical discussion is provided in Chapter 2 of this dissertation.

privileged their use, would eventually overshadow psychodynamic approaches in private practice care.52

Yet such compartmentalization overlooks the fluidity that existed between the two modes of practice. Following examples set by historians Jonathan Sadowsky and Mical Raz, I contend that the application of psychostimulants as “adjuncts” that augmented existing psychiatric practices in both realms complicates the notion that these two therapeutic domains were separated by immutable boundaries.53 A case in point is the use of psychostimulants for depression. I explore how medications such as Ritalin were used as antidepressants in both institutional and outpatient settings, as well as how Ciba tailored its marketing efforts to capitalize on each. I also compare how clinicians experimented with Ritalin to discern efficacious pharmacotherapies for patients with psychosis at the same time that outpatient psychiatrists employed the drug to aid psychoanalysis. I concede that there were fundamental differences between the two

52 Studies focusing on the psychodynamic approach to outpatient psychiatry include Nathan G. Hale Jr., The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917-1985, Freud in America, vol. 2 (Oxford: Oxford University Press, 1995); John Burnham, “The Influence of Psychoanalysis upon American Culture,” in American Psychoanalysis: Origins and Development, ed. Jacques M. Quen and Eric T. Carlson (New York: Brunner/Mazel, 1978); and Donald K. Freedheim, ed., History of Psychotherapy: A Century of Change (Washington, DC: American Psychological Association, 1992). Studies that consider pharmacologically oriented outpatient psychiatry

during the postwar era include Metzl, Prozac on the Couch; Herzberg, Happy Pills in America; and Tone, Age of Anxiety. See Chapter 3 of this dissertation for a fuller historiographical discussion of postwar outpatient psychiatry.

The DSM has exerted a profound influence on the practice of psychiatry since its introduction in 1952. To date, there have been four editions published (with the fifth expected around 2012), and each version has coincided with prevailing trends within psychiatric practice. For example, the DSM-II, published in 1968, has been interpreted as the most psychoanalytically influenced version of the manual. By contrast, the DSM-III, published in 1980, reflected a shift toward biological explanation of mental disorder, as well as their treatment with drug therapy. For more on the historical development of the DSM, see Gerald N. Grob, “Origins of the DSM-I: A Study in Appearance and Reality,” American Journal of Psychiatry 148, no. 4 (April 1991): 421-431; Theodore Millon and Gerald L. Klerman, eds. Contemporary Directions in Psychopathology: Toward the DSM-IV (New York: Guilford Press, 1986); and Shorter, History of Psychiatry, 298-308.

53 Jonathan Sadowsky, “Beyond the Metaphor of the Pendulum: Electroconvulsive Therapy,
Psychoanalysis, and the Styles of American Psychiatry,” Journal of the History of Medicine and Allied
Sciences 61, no. 1 (January 2006): 1-25; and Mical Raz, “Between the Ego and the Icepick: Psychosurgery,
Psychoanalysis, and Psychiatric Discourse,” Bulletin of the History of Medicine 82, no. 2 (Summer 2008): 387-420.

modes of practice. But by demonstrating the use of psychostimulants as adjuncts, I discern at least one commonality shared by institutional and outpatient psychiatry during the immediate postwar period.

Complicating the Transition from Psychodynamic to Biological Psychiatry

My dissertation also complicates historians’ understanding of the paradigm shift from a psychoanalytical orientation in outpatient psychiatry toward one that was biological and pharmacological in character. Historians such as Jonathan Metzl and Andrea Tone have alluded to the manner in which psychiatric medications for anxiety and depression were marketed to analytically oriented psychiatrists during the 1950s. However, little attention has been paid to psychiatrists who turned to stimulants to reduce patients’ inhibitions and intensify their emotional states for psychoanalysis. My study of this practice compounds historical accounts that have typically assumed that psychodynamic and pharmacological approaches were largely incompatible with one another, and it forces historians to reconsider the process of historical change within psychiatry during the postwar era.

My dissertation problematizes the notion of a psychiatric paradigm shift in a second way. As the diagnostic category of depression broadened in the 1960s and 1970s to include a wider spectrum of symptoms alleged to affect the general population, psychostimulant drugs were often marketed for and prescribed to patients under the care of general practitioners rather than psychiatrists. Drugs such as Ritalin, like the antidepressants and anxiolytics, helped shift the practice of psychiatry from specialists to nonspecialists. Hence, their study tells historians much much about professional dynamics and the vicissitudes of clinical practice. It also augments our understanding of what counted.

as psychiatric expertise. During the 1960s, physicians with no advanced training in psychiatry were targeted by drug companies as a new prescriber base for the treatment of depression.54 In doing so, pharmaceutical firms served as arbiters of expertise for psychostimulant drugs. New indications for psychostimulants were promoted in medical journal advertisements aimed at general practitioners, as well as industry-based publications such as the Physician’s Desk Reference (PDR). Such practices illustrate the role of pharmaceutical marketing in facilitating professional shifts and expanding the base of potential consumers for a drug.55 I look at the professional dynamics behind this “mainstreaming,” examining how psychiatrists reacted to the efforts of manufacturers such as Ciba to widen the prescriber and consumer base for its drugs during the 1960s and early 1970s.

Empiricism and Its Role in Psychiatric Pharmacotherapy Throughout my dissertation, I emphasize the pragmatic and eclectic approaches taken by clinicians who prescribed psychostimulants. No example better illustrates my focus on empiricism than the way these drugs were applied within pediatric psychiatry. By the early 1960s, stimulants were established as a treatment for hyperkinetic disorder in children, later reclassified as ADHD. Scholars such as Ilina Singh, Rick Mayes, Adam Rafalovich, Andrew Lakoff, and Matthew Smith have charted the development of ADHD

54 For such an example involving anxiety and the tranquilizer meprobamate (Miltown), see Andrea Tone, “Listening to the Past: History, Psychiatry, and Anxiety,” Canadian Journal of Psychiatry 50, no. 7 (June 2005): 373-380; and Andrea Tone, “Letter to the Editor,” Canadian Journal of Psychiatry 51, no. 1 (January 2006): 60.

55 For more on drug marketing, see Nancy Tomes, “The Great American Medicine Show Revisited,” Bulletin of the History of Medicine 79, no. 4 (Winter 2005): 627-663; and Greene, Prescribing by Numbers. A useful visual resource for tracing the importance of race, class, and gender to the consumption of drugs includes the “Medicine and Madison Avenue” project, available online at [Medicine and Madison Avenue / Digital Collections / Duke Digital Repository].

as a diagnostic category, as well as the accompanying rise of a biological model for the disorder and its management with pharmacotherapy.56 However, much of the scholarship has explained this development as the result of competition between psychodynamic and biological orientations in psychiatry, in which the latter prevailed over the former. An alternate body of scholarship, most notably the work of Peter Conrad, has contended that the treatment of children with stimulants represented the medicalization of socially unacceptable behavior.57 Yet, neither of these interpretations necessarily matches the experiences of the physicians most responsible for the establishment of pediatric stimulant therapy.

By contrast, my dissertation follows the clinical and pharmacological research
that established pharmacotherapy as the preferred means for treating hyperkinesis. Rather

56 Singh, “Bad Boys, Good Mothers”; Singh, “Not Just Naughty”; Rick Mayes and Adam Rafalovich, “Suffer the Restless Children: The Evolution of ADHD and Paediatric Stimulant Use, 190080,” History of Psychiatry 18, no. 4 (December 2007): 435-457; Andrew Lakoff, “Adaptive Will: The Evolution of Attention Deficit Disorder,” Journal of the History of the Behavioral Sciences 36, no. 2 (Spring 2000): 149-169; and Matthew Smith, “Psychiatry Limited: Hyperactivity and the Evolution of American Psychiatry, 1957-1980,” Social History of Medicine 21, no. 3 (December 2008): 541-559.

57 Peter Conrad, “The Discovery of Hyperkinesis: Notes on the Medicalization of Deviant Behavior,” Social Problems 23, no. 1 (1975):

12-21. For further elaboration of Conrad’s thesis, see Peter Conrad and Joseph Schneider, Deviance and Medicalization: From Badness to Sickness, expanded ed. (Philadelphia: Temple University Press, 1992); and Peter Conrad, The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders (Baltimore: Johns Hopkins University Press, 2007).

Medicalization, first advanced as a sociological concept, is generally understood as the process in which nonmedical conditions are transformed into medical problems, usually in terms of illnesses or disorders. Scholar Irving Zola is generally credited for coining the term. See Irving K. Zola, “Medicine as an Institution of Social Control,” Sociological Review 20, no. 4 (November 1972): 487-504. While the concept has also been closely associated with social theorist Michel Foucault, he did not explicitly use the term “medicalization” to describe what he viewed as increasing authority of medical knowledge, institutions, and practitioners in modern society, and its concomitant exertion of power on social structures. See Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason (1969; reprint, New York: Vintage Books, 1988); Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception (1973; reprint, New York: Vintage Books, 1994); and Michel Foucault, The History of Sexuality, Vol. 1: An Introduction (1978; reprint, New York: Vintage Books, 1990). However, Deborah Lupton has noted how Foucault presented a “consonant vision that shows the impact of medical discourses on peoples’ lives.” See Deborah Lupton, The Imperative of Health: Public Health and the Regulated Body (London: Sage Publications, 1995), 1-15. At the same time, however, sociologists have tended to view medicalization more as a form of social construction than the exertion of Foucauldian “biopower.” Perhaps no scholar has done more to advance the sociological concept of medicalization than Conrad.

than parsing the rhetoric behind the causes and treatment of the disorder, or assuming that psychopharmacology triumphed in a clash of competing approaches toward children’s problems, I focus on how clinical researchers and practicing pediatric psychiatrists themselves approached the issue. It is worth noting that many clinicians who came to embrace stimulant therapies were initially uncertain about their potential efficacy. Yet, in the words of two psychiatrists, they were willing to attempt their use because of a “chief need…to improve a situation” in children’s behavioral problems.58 Emphasizing the therapeutic pragmatism of pediatric psychiatrists who established the efficacy of stimulant therapy for hyperkinesis, I examine the roles of such leading figures as Leon Eisenberg, C. Keith Conners, Gabrielle Weiss, and Donald and Rachel Klein in creating a space for pharmacotherapy among children.

“Amphetamine Cultures” and Extramedical Consumption Published in 1975, Grinspoon and Hedblom’s The Speed Culture was the first major work to consider the history of amphetamines in a comprehensive manner. Their book had two major concerns: the medical application of amphetamines and the culture surrounding the extramedical and illicit use of the drugs. Written at a time when concern over amphetamine abuse in the United States was reaching a fevered pitch, Grinspoon and Hedblom’s greatest contribution was an attempt to address the tension between amphetamines’ potential as an efficacious addition to the therapeutic armamentarium of physicians and the drugs’ capability for great harm when when misused. In the end, the authors were unable to legitimate the precarious balance and concluded that, socially and medically, amphetamines’ drawbacks outweighed their therapeutic benefits. In their final

58 Herbert Freed and Charles A. Peifer, “Treatment of Hyperkinetic Emotionally Disturbed
Children with Prolonged Administration of Chlorpromazine,” American Journal of Psychiatry 113, no. 1
(July 1956): 22.

summation on the consumption of amphetamines, Grinspoon and Hedblom observed, “To put it quite simply: our culture influences, encourages, and sometimes causes people to use amphetamines; and their behavior under the influence of these drugs often constitutes a caricature of the very society that produced it.”59

Over three decades later, Rasmussen sought to explain how the amphetamines fit into the broader history of pharmaceuticals in the United States. Of particular interest was the common narrative in which many “miracle” drugs of the twentieth century, ranging from corticosteroids to benzodiazepines, were enthusiastically prescribed for illness, only to be found wanting later.60 Rasmussen highlighted the initial excitement surrounding the therapeutic possibilities of the amphetamines as antidepressants, performance enhancers, and diet aids. But he also documented how the therapeutic capabilities of Benzedrine, Dexedrine, and Dexamyl gave way to the horrors of speed junkies and crystal meth addicts.

I accept these assertions about the downsides of amphetamine consumption. But there is a need to transcend, or at least complicate, the dichotomy that views the history of drugs solely in terms of a therapeutic “boom and bust.” I examine the extramedical consumption of amphetamines during the 1960s and 1970s by focusing on what I term amphetamine cultures, each with their own constituents, modes of use, and relationships with the medical establishment, regulatory authorities, and cultural brokers. For example, women who used Dexedrine to lose weight had a common set of experiences, expectations, and understandings indicative of a specific milieu in time.

59 Grinspoon and Hedblom, Speed Culture, 291.

60 See Tone, Age of Anxiety, chaps. 7-9, for a discussion of what she terms the “benzodiazepine backlash.” See also, David Herzberg, “‘The Pill You Love Can Turn on You’: Feminism, Tranquilizers, and the Valium Panic of the 1970s,” American Quarterly 58, no. 1 (March 2006): 79-103.

historical specificity of such cultures resulted in unique relationships with other key actors of drug consumption, manufacturing, marketing, and regulation in the United States, as well as shaped the historical trajectories each of these modes of use would take as controls on the extramedical use of these drugs were tightened through the 1970s. Sources and Methods To excavate physician experiences, I consulted hundreds of relevant articles on the clinical use of psychostimulants during the timeframe of my study. Like many historical studies into the history of pharmacotherapy, the medical literature comprises the foundation for my study. I also made use of the archival collections of the American College of Neuropsychopharmacology (ACNP) at Vanderbilt University (recently relocated to the University of California, Los Angeles) and the American Institute for the History of Pharmacy (AIHP) at the University of Wisconsin. Among the collections of the ACNP, the papers of Dr. Heinz Lehmann proved particularly valuable, especially in comprehending Lehmann’s own response to controls on amphetamines during the 1970s. The AIHP’s archives provided me with access to materials on Ciba-Geigy that helped me understand its marketing of Ritalin during the 1950s and 1960s. Other collections, such as McGill University’s Osler Library Archives, further enriched this study. In addition, I made use of oral histories, especially for Chapters Three and Four of this dissertation. Several of these are published in the three volume series The Psychopharmacologists, edited by David Healy. These interviews provide a wealth of personal insights for historians of psychopharmacology. Many of the oral histories relevant to my topic, however, are unpublished and were made available to me as part of the ACNP archival holdings.61 Finally, government documents, particularly Congressional hearings on the subject of drug regulation, controls on stimulant drugs, and concern over amphetamine consumption, are also integral to my analysis. Chapters Five and Six, in particular, profit from my use of these sources.

Description of Chapters

Chapter Two considers the place of psychostimulant drugs within the pharmacological revolution that took place in institutional psychiatry beginning in the mid-1950s. As analeptics that complemented the newly introduced major tranquilizers, psychostimulant drugs played an underappreciated role in this shift. Even if a minority approach, combination drug therapy conferred increased effectiveness on the major tranquilizers responsible for the treatment of psychosis and contributed further toward deinstitutionalization in the postwar era. As antidepressants or, to use the vernacular of the day, psychic mood energizers, psychostimulants likewise provided institutional psychiatrists with useful alternatives to involved somatic therapies such as ECT.

Chapter Three reveals the role of psychostimulant drugs in outpatient psychiatry from the late 1940s to the late 1960s. It investigates the application of drugs by psychoanalytically oriented psychiatrists in the 1950s and 1960s. In particular, I examine how these physicians utilized Methedrine, Dexedrine, and Ritalin to improve psychoanalytic therapy. In addition, I discuss how pharmaceutical firms began marketing stimulants for conditions they termed “environmental depression” during the 1960s, mainly as a means to court general practitioners as a new set of prescribers for these drugs, as well as cultivate a wider base of consumer-patients.

61 These oral histories were done by other historians of medicine and have been made available to researchers as part of the ACNP’s archives, either as audiocassette or videotape recordings. In some cases, written transcriptions of these oral history interviews have also been produced.

Chapter Four assesses the application of psychostimulant drugs in the management of hyperkinetic disorder during the postwar era. My primary concern is the discovery and establishment of pharmacotherapy with stimulants as a primary therapy for the disorder. I emphasize the empirical, even atheoretical, orientation of physicians who sought any means possible to improve children’s behavioral problems. Also important to the rise of pharmacotherapy for children during the 1960s were methods of qualitative and quantitative assessment that confirmed psychiatrists’ initial observations.

In Chapter Five, I examine amphetamine cultures during the 1960s, a decade in which the extramedical uses of the drug soared. Looking at four cultures in particular“speed freaks” associated with the Haight-Ashbury district of San Francisco between 1967 and 1969, diet pill users, truck drivers, and athletes—I conclude how the specificity of each of these cultures resulted in unique relationships with other players in drug consumption, manufacturing, marketing, and regulation in the United States, as well as shaped how authorities responded to extramedical consumption. Why, for example, would authorities be more likely to penalize the recreational use of the drug by teenagers living in Haight-Ashbury than they were to arrest an Indiana housewife who may have turned to diet drugs to give her more “pep”? The key to that assessment, I contend, involved how medical and political authorities defined and responded to sanctioned or legitimate uses. At the same time, I discuss how physicians became increasingly concerned during the 1960s about the potential dangers of amphetamine consumption. Part of the problem involved a definition of addiction rooted in a paradigm of physical dependency and associated with narcotics. Psychostimulants, by contrast, were characterized more by their potential for psychological, rather than physical, dependency.

Hence, they were identified initially as drugs of “habituation” rather than addiction. Debates by medical leaders during the early 1960s set the stage for a reappraisal of the safety, if not the efficacy, of amphetamines during the second half of the decade.

Chapter Six considers how lawmakers, using the newly passed Controlled Substances Act as a platform, moved to tighten controls on amphetamines and other psychostimulant drugs during the early 1970s. Debates over the proper level of controls for psychostimulant drugs during the early 1970s focused on whether they should be controlled according to their legitimate medical applications, a position held by the FDA, or according to their potential for addiction and danger of being illegally diverted for illicit use, the preference of the Bureau of Narcotics and Dangerous Drugs (BNDD, to become the Drug Enforcement Administration, or DEA, in 1973). In contrast to those medical experts who supported the imposition of more stringent controls, I also consider how some leading physicians expressed opposition.

My dissertation concludes with a brief look at clinical psychostimulant use since
1980, particularly the staggering rise of these drugs to treat ADHD. But also notable have
been failed attempts to revive their prescription for other indications, as the “Fen-Phen”
debacle of the 1990s suggests. I end the dissertation by assessing the contributions this
study has made to historical scholarship, as well as identifying future research directions.

© 2009 Nathan W. Moon, PhD Table of Contents and Summary reprinted with the express permission of Dr. Moon obtained by Travis P.Dungan on 4/21/2020. Full version available through PROQUEST Dissertations & Theses at most university libraries around the world and online.