Benzodiazepines also got a boost from the Prozac era. Though new research has raised questions about their efficacy, SSRIs revolutionized the way people sought and received treatment for minor mental illnesses. Before Prozac, a person with low-grade depression or anxiety would turn to talk therapy, which was expensive, time consuming, and not necessarily effective; another treatment was a family of drugs called tricyclics, which could have nasty side effects. After Prozac, that same person could take a much safer pill, and that pill could be procured with a simple visit to the family doctor. So even though doctors and drugmakers continue to recommend drug therapy together with talk therapy, people with minor mental illness have over the past ten years increasingly sought help from drugs alone. A study published in the journal Psychiatry in 2008 showed that 55 percent of all prescriptions for benzodiazepines were written by general practitioners, and according to the National Institutes of Mental Health, people in treatment for psychological problems now spend half their budgeted dollars on drugs and less than a third on therapy. In 1997, those ratios were reversed.
It may be that this moment in history justifies an increased use of benzos. Ronald Kessler, an epidemiologist at Harvard University, does sweeping, long-term studies for the National Institutes of Health. He has found that a quarter of Americans will have a diagnosed episode of anxiety—generalized anxiety disorder, panic, phobias, post-traumatic stress disorder, obsessive compulsive disorder—in their lifetimes. That number, he says, hasn’t changed in decades. But Kessler’s research doesn’t account for the blips he calls “situational anxiety,” which come with tough times: an underwater mortgage, a diminished retirement account, or a child deployed in a foreign war. A benzodiazepine, says Kessler, could be a reasonable answer to “a terrible situation.” Just as the exhausted new mother of a colicky 3-month-old might drink two cups of coffee in the morning instead of one, so might a banker facing the wrong end of a “strategic restructuring” pop a Xanax before an encounter with the boss. “This goes beyond the science,” says Kessler, “but it could be that a pharmacological solution is the smart thing to do.”
The question, then, is one of degree. The crises people face in these early months of 2012 are individual and circumstantial, yes, but they’re global and abstract as well, stemming largely from the haunting awareness (it’s certainly haunting me) that the fates of everyone in the world are intertwined and the job of protecting civilization from assorted inevitable disasters seems to have fallen to no one. “Situational anxiety” today stems from threats that are both everywhere and nowhere at once. How will the debtor nations in the eurozone ever manage to pay back what they owe? How can Israel disarm Iran’s nuclear program without inciting the messiest international conflict since World War II? How can you be absolutely, 100 percent sure the cantaloupe you had for lunch wasn’t contaminated with listeria that will make you or your kids or one of your guests deathly sick?
To the point: Do modern realities merit an increased dependence on Xanax? Steven Hayes, a clinical psychologist at the University of Nevada, believes that benzos stop a gap that evolution has yet to fill. As humans try to control an exponentially growing number of inputs with which they are confronted, “our attention becomes less flexible, our minds become more chattering, and the next thing we know, we’re frantic.” Humans are ill-equipped to process or accommodate all these new signals. “Our task now is to create modern minds for the modern world, and that modern mind has to be psychologically flexible.” In the absence of that flexibility, Hayes says, people need a bridge—a pill—between what life doles out and what people can realistically handle.
In 1972, a psychiatrist named Gerald Klerman coined the phrase “pharmacological Calvinism” to describe Americans’ tortured love affair with psychopharmaceutical drugs. Klerman was writing at the height of the Valium era, when its huge popularity lived alongside the perception, fed and perpetuated by the nascent feminist movement, that the pills were creating a generation of robot wives—numb, unfulfilled suburbanites forced into domestic servitude by the men who ran things, including the pharmaceutical companies. “You wake up in the morning,” wrote Betty Friedan in The Feminine Mystique, “and you feel as if there’s no point in going on another day like this. So you take a tranquilizer because it makes you not care so much that it’s pointless.” As fashionable as it was to take the pills, it was also fashionable to blame them.
On the one hand, Americans love convenience and scientific progress and thus herald drugs like Miltown and Xanax as miracle cures (like the washing machine or canned spaghetti) for the travails of modern life. On the other, Americans value self-reliance and authentic experience and regard dependency on chemicals as weak. Especially in this era, when entire sectors of the population have devoted themselves to eating organic and giving birth without painkillers, when otherwise sane parents decline to vaccinate their children against fatal diseases, chemical purity is held up as a sacred shield against future environmental cataclysm and failures of personal health.