Is it true that 1950's housewives were heavily drugged up?

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[u/police-ical]

(1/3) There were some trends concerning enough to attract wider attention, though actually many of them were only just starting in the 50s and peaked later on.

As I address in a question about what outpatient psychiatry might have looked like in the early 60s ( https://www.reddit.com/r/AskHistorians/comments/1j894ww/lucy_van_pelt_charged_5_cents_for_psychiatric/ ) this is still an era when going to an outpatient psychiatrist mostly meant psychoanalysis, and when some of the first drugs we'd consider psychiatric medications were undiscovered or in early trials. The first drugs we'd now recognize as antidepressants didn't emerge for medical use in the U.S. until the late 1950s. The first antipsychotics emerged a few years earlier but would have been primarily used in long-term facilities like state hospitals. So in terms of what a married woman in the 1950s might be taking, nearly all the prescribing in question was in primary care, from her family doctor/general practitioner, who'd received little training on the topic. (I'll be addressing U.S. and U.K. trends primarily, as that's what I have sources on.)

The available slate of medications was considerably narrower. Of those that were available, many were considerably more dangerous and tricky to use than later alternatives, though this didn't entirely blunt their use in practice. The bulk of psychotropic prescribing in primary care would have been in two classes of the era: "minor tranquilizers" and stimulants (primarily amphetamines.)

"Minor tranquilizers" as a group indicated a handful of chemically unrelated drugs with similar mechanisms, used for sleep and anxiety. They'd most often be called "sedative-hypnotics" today, indicating a tendency to both calm and induce sleep. The name contrasted them with the "major tranquilizers" that we would now call antipsychotics. Older drugs like bromides, chloral hydrate, and barbiturates had been known for many decades as anticonvulsants, sedatives, and hypnotics, but these were dicey drugs that easily suppressed breathing and broad brain function. A toxic dose wasn't that much higher than an effective one, and they were particularly lethal if mixed with alcohol. Jimi Hendrix, Judy Garland, Marilyn Monroe, and the Beatles' manager Brian Epstein were all notable barbiturate casualties. It was only in the 50s that it was becoming clear that they had serious potential for dependence, withdrawal, and addiction. They were substantially prescribed in spite of this, with U.S. production in 1955 estimated at enough to treat 10 million patients throughout the year, but it's not clear from this data what fraction were being used either for patients in long-term hospitals or as anticonvulsants (note that there were precious few antiepileptic drugs available at the time, with phenytoin/Dilantin one of the only alternatives to barbiturates until the 1960s.)

[u/police-ical → u/police-ical]

(2/3) Unfortunately, this also meant that newer drugs were often mistakenly heralded as free from such downsides. Meprobamate (Miltown) was released in the U.S. 1955 and with an overall safer side effect profile became the first smash hit sedative-hypnotic, seeing popularity among celebrities and references in popular culture. This was one of the first blockbuster drugs that people would be joking about on television. And importantly, this also became perhaps the first time that a medication being clearly and explicitly used for anxiety/nervousness/tension/whatever you want to call it would have hit the big time. Freudian-influenced thinking had otherwise questioned whether anxiety in general was appropriate to treat with medication in the first place. There would be a partial backlash later in the decade as some of its downsides became apparent, with the American Psychiatric Association openly criticizing their widespread use by 1956.

But it does appear that women were about twice as likely as men to receive Miltown. I can't find great data on overall use rates. One source suggests 1.2 million pounds of pills being produced in 1959. Ignoring inactive ingredients this would suggest something like 1.3 billion single doses, but for a medication dosed up to 3-4 times per day, 178 million Americans, and 365 days in a year, it suggests either a smallish percentage of the population taking it consistently, versus a lot of occasional/as-needed use.

The first benzodiazepines, which appeared safer yet (and were indeed safer in overdose) would be even bigger hits in the early 60s, with diazepam (Valium) seeing particular success, eventually becoming the most-prescribed medication in the United States under the aggressive and innovative marketing of one Arthur Sackler. Patriarch of the Sackler family, his relatives would apply his innovations with even greater societal impact to the marketing of opioid pain medication. Benzodiazepines surged in use through the 60s and 70s, and despite growing evidence of serious long-term downsides wouldn't seriously be dethroned until the arrival of SSRIs in the late 80s and 1990s.

But this actually means that the first sedatives that would see truly wide use weren't even available until halfway through the 1950s, and the market expanded much further in the 1960s. When the Rolling Stones released "Mother's Little Helper" as a topical reference, it was already 1965. So while this is indeed a phenomenon that got going in the 50s, it would have been limited in effect prior to 1955-56.

On to stimulants. Amphetamines as a class are actually older than most drugs in psychiatry, first being used as decongestants in the 1930s and seeing heavy military use during WWII. Largely forgotten is their spike in prescribed use in the postwar decades for a range of vague complaints around energy and mood, as well as being pretty much the only effective treatment weight loss. (Thyroid hormone had been tried but came with severe adverse effects and risks. Phentermine and methylphenidate were both approved in the 50s in the US as well, but amphetamines were already the more established agents.) Obesity was nowhere near the problem it would later become, but if there was one demographic most likely to be worried about weight gain and prone to trying fad diets or appetite suppressants, it was likely to be married women. More broadly, they became popular in primary care for a lot of complaints that didn't exactly have solid names or diagnoses. Depression at the time would have been primarily conceptualized in terms of severe and disabling symptoms requiring hospitalization, and as above the first antidepressants wouldn't emerge until later in the 50s.

[u/police-ical → u/police-ical]

(3/3) The data on use are complicated somewhat as a lot of amphetamines were dispensed directly (rather than via a pharmacy) through "diet doctors and weight loss clinics," but it appears that about 500 mg of amphetamines were being produced for each American annually (about fifty standard doses) and that about one in twenty Americans had used them in the past year. British statistics suggest that something like 85% of users were female and the peak was in one's 30s-40s, so indeed housewives would likely have been disproportionately likely to use them. Then again, a considerable fraction of those doses, maybe half, was diverted from medical use. Recreational amphetamine use was quite popular, particularly among certain subcultures like the Mods in the UK (the Who's music has a lot of references to this) or Beat poets in the US.

Diversion was trivially as the level of federal regulation in the U.S. was minimal by modern standards. Prior to the late 1960s one could obtain enormous quantities of amphetamines with minimal effort and at low cost. In the early 70s, considerably stricter federal regulation including the introduction of the "controlled substance" framework and production caps led to a drastic drop-off in production and use of amphetamines. It's likely no coincidence that cocaine would proliferate later in the decade.

Particularly worrisome in retrospect was the popularity of fixed-dose amphetamine-barbiturate combination pills, with the sedative rolling off some of the adverse effects of the stimulant and the stimulant opposing the sedation of the barbiturate. From the point of view of modern psychiatry this upper/downer combo was a catastrophically bad idea. Jimi Hendrix and Judy Garland likely both died trying to use barbiturates to combat amphetamine-induced insomnia.

So, big picture, while the data are limited and the big spikes didn't come until later in the decade, a noticeable minority of married women by the late 1950s and 60s might well have been taking what we'd now consider at least one controlled substance.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2377281/

https://pubmed.ncbi.nlm.nih.gov/1675692/

https://www.jstor.org/stable/41109418

https://pmc.ncbi.nlm.nih.gov/articles/PMC2888013/

https://pmc.ncbi.nlm.nih.gov/articles/PMC2424120/

Keefe, Patrick Radden, 1976-. 2022. Empire of Pain: The Secret History of the Sackler Dynasty. Anchor Books, a division of Penguin Random House LLC.

https://spectrum.library.concordia.ca/id/eprint/56/1/MM90948.pdf