The Search for Tranquility through Tranquilizers

by Donald DeMarco, PhD

Anybody can be virtuous now. You can carry at least half your morality about in a bottle. Christianity without tears — that's what soma is. — Aldous Huxley, Brave New World

Tranquility — like peace, happiness, freedom, and all other qualities of the soul that man ardently seeks to attain — is ambiguous. It is calmness and nothing more, what Alfred North Whitehead calls "the negative conception of anaesthesia."¹ Or is it calmness combined with "a positive feeling which crowns the 'life and motion' of the soul."² In this sense Wordsworth saw the origin of poetry as "emotion recollected tranquility,"³ Edna St. Vincent Millay described human beauty as "the tranquil blossom on the tortured stem,"⁴ and St. Augustine viewed tranquility as the peace-conferring characteristic of man's life in moral order.⁵ Tranquility, then, describes both the enervated and the active, the quiescent and the creative. It is both incompatible and compatible with motion and emotion. Consequently, the search for tranquility leads either to anesthesia, or to a life that abounds in movement and meaning.

The popular predilection is to seek the kind of tranquility that is readily induced — anesthesia — and drug companies, being more than opportunistic, have mass produced tranquility in a pill. The relationship that has eventuated over the past few decades between the pill companies and the public has been — in terms of production-consumption standards — stupendously successful.

In the past generation tranquilizers, antidepressants and sedatives — most of which were unknown before the early fifties — have become the most powerful and extensive technology of mood and behavior control ever employed in a democratic nation. By 1971 the pharmaceutical industry was spending, according to the Social Security Administration, about $1 billion a year to promote these drugs, roughly $5,000 per practicing physician (at the same time American medical schools were spending a total of $977 million for all their educational activities). By 1975 American physicians were writing 240 million annual pharmacy prescriptions for psychotropic drugs for people who were not hospitalized, enough to sustain a $1.5-billion industry and to keep every American fully medicated for a month.⁶ In this same year tranquilizers were prescribed more than 100 million times to an estimated 30 million people: 61 million prescriptions were written for Valium alone, the nation's most popular tranquilizer with annual sales at about $500 million: 17 million for librium; and 25 million for other minor tranquilizers. In all, enough to provide some 15 million pills a day, and at a rate that is increasing by 5 or 6 million prescriptions a year.⁷

Why the dramatic increase?

In Canada, the situation is more temperate — 1,151,600 prescriptions for Valium in 1978, representing a commercial value of $5,539,000 — but still intemperate enough to prompt the Canadian Medical Association's late secretary-general J. D. Wallace to say: "It's a tranquilizer on demand syndrome. There's a feeling by the patient that he has a right to a prescription. And doctors with not the time to talk people out of the idea, give in. It's the fad of the century."⁸

Dependence on prescribed tranquilizers has risen by 290 per cent since 1962.⁹ For fifteen years, drug industry profits (as a percentage of sales and company net worth) have outperformed those of all other manufactured industries listed in the Stock Exchange. In all but two of the years between 1956 and 1971 the pharmaceutical industry was the most profitable industry in the United States.¹⁰ Valium and Librium have earned millions of dollars for their inventors, Swiss-based Hoffman-La Roche and have made it the largest drug company in the world, a single share currently selling for more than $35,000. In the United States drugs that affect the central nervous system represent the fastest growing sector of the pharmaceutical market, now making up about one-third of its total sales.¹¹

What has happened to man or culture in the past generation to account for this spectacular increase in medically prescribed psychotropic drugs? Is life more unbearable in the second half of the twentieth century than it was previously'? Has contemporary man lost sight of natural, non-medical ways of finding tranquility? Or is it that drug technologies are over-prescribed and over-consumed simply because they are available in virtually unlimited quantities?

One important change that is characteristic of contemporary man involves his fundamental attitudes toward life and pain. The Greeks viewed pain as the soul's experience of evolution. The soul-body unity that Aristotle postulated made the body's experience of pain as natural as the soul's experience of knowledge and joy. The Stoics fully acknowledged pain as an irremovable aspect of an irreparably impaired universe. Pain was natural, not evil, and reason mandated tranquil acceptance of the universe as it is. Cicero's teacher Posidonius epitomized the Stoic's acceptance of pain when he said: "Do your worst, pain, do your worst: you will never compel me to acknowledge that you are an evil."¹² Jews and Christians saw pain as purgative and purifying. Christians in particular saw life as a "way of the Cross" and the world as a "vale of tears." Pain was a natural part of life or it had personal meaning. Some pain could be removed, other pain could be alleviated, but some pain would always remain as a permanent feature of the human condition. The one attitude that is foreign, at least to the classical European tradition, is that pain would be — ideally always — destroyed by the intervention of a pharmacist or physician.

Pain exists on many levels

Modern man began to lose appreciation for pain's natural, cosmic, and personal meanings with the dawn of modern science in the seventeenth century. At that time Descartes, the father of modern philosophy, introduced a view of man in which man was divorced from the concrete world of matter. The more man saw himself as alienated from a world of matter, the more pain seemed unnatural to him. Cartesian dualism separated man as a thinking thing from the body as a mechanical thing. Pain, therefore, was an indication of a mechanical breakdown, a dysfunction correctable by technology.¹³ A new sensibility began to emerge which saw pain as a technologically eradicable evil and progress as the continuing reduction of the sum of human suffering.

Yet a conflict perdures between systems of meaning that are still connected with classical European tradition and systems of technique which are connected with modern science and its radical dualism. Patients commonly refer to their pain or disease as an "it," an intrusive object, rather than as a characteristic of self.¹⁴ They tend to see their problem as physiological, located within the body, and therefore assume that it can be easily eliminated through chemical therapy.¹⁵ By interpreting their problems in these narrow terms, however, patients can effectively foreclose other levels of intervention. A pain that is symptomatic of a problem that centers on the meaning of life will not be eliminated or resolved through chemical treatment.

Medical civilization tends to treat pain as a purely technical problem and in so doing deprives the patient of discerning the inherent meaning of personal suffering. The experience of pain evokes in the patient fundamental questions such as "Why must I suffer?" "Why is there pain?" or "Is my pain telling me something about my conduct or my life?" An attitude that is absolutely set against all pain smothers questions such as these, thereby leaving in oblivion important inquiries and potentially beneficial answers. This is not to imply that tranquilizers and other drugs that affect the central nervous system do not have any legitimate medical use. The point here is that man is not a solitary self enclosed in an alien body mechanism. Man is a unitary composite of soul and body, psyche and soma. Pain is not always reducible to a body breakdown or chemical imbalance. Pain may very well have its origin in the kind of personal crisis psychiatrist Viktor Frankl refers to as an "existential vacuum."¹⁶ For many patients the conflict between systems of techniques and systems of meaning is very real. Caught in this conflict, tranquility cannot be recovered through tranquilizers.

Ironically, as history shows, the more strongly people believe that pain is unnecessary and curable, the more they find it intolerable. For if pain has no meaning, there is no reason why it should be tolerated. As Nietzsche has said, what makes suffering so unendurable is not the pain so much as the senselessness of it. We have now reached the point in our society where contemporary man believes he not only has a right but an obligation not to feel pain, tension, anxiety, or stress.¹⁷ Commercial advertising continually reminds him of his right to a "carefree" life and his social obligation to overcome "problem perspiration," "static cling," "unsightly dandruff," "ring around the collar," and the "heartbreak of psoriasis." Viktor Frankl points out that "it is a well-known empirical fact that in times of war and crises the number of suicides decreases." In the context of a war or a personal crisis, pain and suffering are bearable because the goals that motivate people — victory, saving loved ones, and so on — are the objects of strong and healthy passions, passions more powerful than pain. In periods of peace and prosperity, on the other hand, the removal of pain may be a person's most important goal. Canada's suicide rate for the young has almost quadrupled since the 1950s; the United States rate tripled between 1955 and 1975; in West Germany the number of suicides among the young doubled between 1966 and 1976; and in Japan the rate for suicides of children under 19 has increased by 15% since 1977.¹⁸

Facing life means facing pain

A number of scientific studies have born out the fact that pain tolerance can be greater in times of unusually high stress. Of a group of soldiers severely wounded in various battles in the Second World War, only a third complained of enough pain to require morphine. After the war, of a group of civilians who suffered similar wounds that were surgically induced, 80% requested morphine.¹⁹ Virtually all researchers in the phenomenon of pain agree that a patient's attitude toward pain is highly influenced by his culture. Traditional Western culture has interpreted pain as a challenge that has its purpose in eliciting positive, soul-creating responses from individuals. In this sense Keats writes: "Do you not see how necessary a World of Pains and troubles is to school an Intelligence and make it a soul? A place where the heart must feel and suffer in a thousand diverse ways . . . As various as the Lives of Men are — so various become their souls, and thus does God make individual beings."²⁰ Today, however, people place extraordinary demands on their economy to have their pain removed promptly and expediently. Thus, the modern trend is for people not to integrate their pain into the general meaning of life for the sake of a fuller positivity, but to depend on the medical profession and the economy to provide them with a life of uninterrupted comfort.

Problems equal illness?

The present over-consumption of tranquilizers, then, occurs not because people need them so much as cultural assumptions lead people into thinking they do. This being the case, people unwittingly allow the medical profession to compromise its ethics as a helping profession to accommodate a new function as a managerial one. What is at stake — more fundamentally than the integrity of the medical profession — is the autonomy of the individual. Peter Schrag warns that slowly and subtly, "science" is repealing the Constitution and that in the long run individuals "will no longer know, or care, whether they are being served or controlled.²¹ Ivan Illich laments the "medicalization of life," and the medical profession's expropriation of man's coping abilities.²²

Advertisements for tranquilizing drugs that appear in medical and psychiatric journals offer remedies not only for well established categories of mental illnesses, but for a long list of problems which, until recently, have never been regarded as illnesses. A popular theme in these ads is the housewife who is plagued by nothing more than the usual round of domestic chores. She is often depicted standing in front of stacks of dirty dishes or behind mops and brooms. "Women are impossible," states one ad, "You can't set her free but you can help her feel less anxious." Another ad reads, "Restless and irritable, she growls at her husband. How can this shrew be tamed?"²³ Serentil, a major tranquilizer, is suggested for "the woman who can't get along with her new daughter-in-law." Librium is suggested for the anxious coed for whom "exposure to new friends and other influences may force her to reevaluate herself and her goals."

Roughly two-thirds of the minor tranquilizers are consumed by women, among whom the heaviest users are unemployed domestic housewives, a fact that has aroused the indignation of a number of women's groups. One study reveals that some physicians are more inclined to prescribe drugs to the housewife because they believe she can sleep and does not have to be mentally alert. And if the housewife can resist the negative depictions toward her that appear in the medical profession's ads and attitudes, she still has the subtle pressure of the media to contend with. The Rolling Stones laud the benefits of minor tranquilizers in their song "Mother's Little Helper":

Doctor please get me some of these —
And it gets her on her way
Gets her through her busy day.

Contemporary man's lack of autonomy and his unhealthy and unnecessary dependence on the medical profession is summed up by public health physician Herbert Ratner in the following passage he included in a lecture he prepared for a state medical school:

Modern man ends up a vitamin taking, antacid-consuming, barbiturate-sedated, aspirin-alleviated, benzedrine-stimulated, psychosomatically despoiled animal; nature's highest product turned out to be a fatigued, peptic-ulcerated, tense, headachy, over-stimulated, neurotic, tonsilless creature.

On previewing these words, a former medical school dean advised Dr. Ratner not to use them, "It will antagonize the drug houses, and we are trying to build up research funds."²⁴

Man's passive attitude toward drugs is a reflection of his passive attitude toward life. The net result is a profound insensitiveness to both himself and his surrounding world.

With rising levels of induced insensitivity to pain, the capacity to experience the simple joys and pleasures of life has equally declined. Increasingly stronger stimuli are needed to provide people in an anesthetic society with any sense of being alive. Drugs, violence, and horror turn into increasingly powerful stimuli that can still elicit an experience of self. Widespread anesthesia increases the demand for excitation by noise, speed, violence — no matter how destructive.²⁵

Anesthesia and violence go hand in hand. The search for tranquility — in the negative sense of anesthesia — terminates in the discovery of death. This is not a cruel joke played by a deceitful God, but the logical and inevitable working out of a natural law. If man's primary concern in life is to eliminate pain, his preoccupation with the negative leads to more negatives until there is no more life. Pain is an ineradicable part of the human condition. One may eliminate a particular pain, but another pain is always there to take its place. Particular pains may be removed but not pain itself. Peter Schrag remarks that "beyond the Valium is the breakdown, and beyond the breakdown the Thorazine, the hospital, and the shock treatments."²⁶ If one wants to face life, one must learn to live with pain. Contemporary man, however, has chosen to flee pain rather than face it and in so doing has forfeited the feeling of being intensely alive.

Tranquility, in the positive sense, is not something one finds by employing a specific technique or by following a particular strategy. It is a quality of the whole person which one experiences as deeply as his life is lived wholly. If one is to find tranquility, he should forget about it and try to live as a whole person. Only then will he find it. Frankl believes that "the present increasing tendency to become addicted to tranquilizing drugs is a sign that contemporary man has been more and more seduced to a belief in the illusion that he can strive for happiness, or for peace of mind."²⁷ Tranquility, like happiness, is something that happens (the words "happiness" and "happy" are derived from the word "happen"). Tranquility does not result from a motive but arises as a consequence; it must always remain a side effect and is spoiled to the degree it is made a goal in itself.

Meaning preserves tranquility

Social psychologist Gordon Allport finds that "As the focus of striving shifts from the conflict to selfless goals, the life as a whole becomes sounder."²⁸ This statement is in accord with Frankl's general theory of logotherapy which holds that man finds the will to live and endure even extraordinary hardships when his life has meaning, an attitude that is reflected in Nietzsche's dictum, "He who has a why to live can bear with almost any how."²⁹

Frankl discusses the case of a woman who came to his clinic after an attempt at suicide. The woman had just suffered the loss of her eleven-year-old son; her remaining boy was crippled by infantile paralysis and could be moved around only in a wheel chair. She could not overcome the loss of her son and tried to end her life, but it was her crippled son who prevented her. For him life had remained meaningful, but for his mother it had not. When Dr. Frankl asked the woman to imagine herself looking back on her life from her deathbed at age eighty, she suddenly saw meaning in her life, especially in helping her crippled son and sparing him life in an institution. She could now accept her suffering because the life meaning she now found included her suffering.³⁰

One must find meaning in his life in order to preserve his tranquility. And he must find meaning in spite of what Frankl calls "the tragic triad of human existence; namely, pain, death, and guilt."³¹ This triad brings man face to face with the reality of his human condition. Pain and suffering are inevitable because man has a body and a soul. Death and guilt are also inevitable since man is mortal and fallible. There is no way except through illusion and anesthesia that man can avoid consciousness of these implications of his being.

Edith Hamilton remarks that "it is by our power to suffer, above all, that we are of more value than sparrows."³² Human excellence is not achieved through avoiding the inevitable. Man is not free to exempt himself from the human condition; he is free only in how he chooses to stand in the face of the inevitable. Because man can suffer and comprehend the meaning of his suffering, he is of greater value than sparrows. Because he can find meaning in his situation, he can transcend it. Only in this stance can he possess the "peace that passeth understanding."

The contemporary hegemony of the medical profession has narrowed the concept of health to mean medical health. Yet health has an incomparably richer meaning. It is infinitely more than the body's physiological balance. Animal health has little in common with human health. Lobotomized patients still perceive pain but they have lost their capacity to suffer from it; they "adjust," as psychiatrist Thomas Szasz says, "at the level of domestic invalids or household pets."³³ Can we say that they are healthy in the fullest sense of the term? Etymologically, the world "health" is derived from "whole." Health, in its fullest sense, includes man's capacity to deal positively and creatively with the tragic implications of his being. A healthy man is able to accept discomfort, disease, and death insofar as they are unavoidable aspects of human existence. Man's ability to be responsible and human in the face of hardships — something he will not learn from the medical profession — is an essential part of his health. There is a skill to the art of suffering. Ivan Illich writes: "Man's consciously lived fragility, individuality, and relatedness make the experience of pain, sickness, and of death an integral part of his life. The ability to cope with this trio autonomously is fundamental to his health."³⁴

Recover by forgetting self

The search for tranquility through tranquilizers carries one into the very heart of the anesthetic society. There, one not only tries to feel no pain, but also tries to numb his consciousness to fundamental realities such as self, others, and the basic meaning of his life. A Toronto general practitioner writes: "These are tough economic times, and the reality is you have to work and make money. If giving a guy some pills will help him do it, I will."³⁵ This kind of advice typifies the anesthetic society's need to reduce reality to a manageable economic machine, a need that is uncomfortably reminiscent of the anti-utopian vision of Aldous Huxley which he expressed in 1932 in Brave New World: "But industrial civilization is only possible when there's no self-denial . . . Otherwise the wheels stop turning . . . You can't have a lasting civilization without plenty of pleasant vices."³⁶

The tranquility that is worth having cannot be the object of a search. It is a quality of man's wholeness and is possessed to the degree man is whole. This wholeness is also a sign of man's health, a health that reflects his ability to cope with the unavoidable aspects of human existence that are represented by discomfort, disease, and death. Only through self-less and self-forgetful dedication to his authentic vocation and mission in life does man recover himself, his wholeness, his health, and his tranquility.

End Notes

1. Alfred North Whitehead, Adventures of Ideas (New York: The Free Press, 1967). p. 285.
2. Whitehead, p. 285.
3. William Wordsworth, "Preface to the Second Edition (1800) of 'Lyrical Ballads,'" College Book of English Literature, ed. J. E. Tobin, V. M. Hamm, and W. H. Hines (New York: American Book Co., 1949), p. 690.
4. Edna St. Vincent Millay, "On Hearing a Symphony of Beethoven," Modern American Poetry, ed. Louis Untermeyer (New York: Harcourt, Brace & World, 1958), p. 448.
5. St. Augustine, City of God, XIX. 13: tran. Dods. "Peace between man and man is well-ordered concord . . . The peace of all things is the tranquility of order."
6. Peter Schrag, Mind Control (New York: Pantheon, 1978), pp. 34-5. See the National Prescription Audit, for 1975 (Ambler, Pa.: IMS America, Ltd., 1976).
7. Schrag, p. 136.
8. Sheila Gormely. "Tranquilizers: The New, Approved Opiate of the People," Maclean's, March 22, 1976, p. 58.
9. Ivan Illich, Limits to Medicine (Toronto: McClelland & Stewart Ltd., 1976). pp. 70-1.
10. Neville Doherty, "Excess Profits in the Drug Industry and their Effect on Consumer Expenditures," Inquiry X, Sept. 1973, pp. 19-30.
11. Illich, p. 69.
12. Quoted by Herschel Baker, The Image of Man (New York: Harper & Row, 1961), p. 77.
13. Illich, pp. 147-151.
14. Eric Cassell, "Disease as an 'It': Concepts of Disease Revealed by Patient's Presentation of Symptoms," Social Science and Medicine, 10: 143-6.
15. Michael Radelet, Medical Hegemony as Social Control: The Use of Tranquilizers, Working Paper # 135, Institute for the Study of Social Change, Purdue University, May 1977, p. 3.
16. Viktor Frankl, Psychotherapy and Existentialism: Selected Papers on Logotherapy (New York: Simon & Schuster, 1967), p. 17.
17. Schrag, p. 137.
18. Frankl, p. 116. Psychiatrist Dr. Harvey Golembek recently stated that in the present peaceful, affluent times about 60,000 high school students in Metropolitan Toronto consider committing suicide each year. See Jane O'Hara, "Young Suicides," Maclean's, July 30, 1979, p. 20.
19. H. K. Beecher, Measurement of Subjective Responses: Quantitative Effects of Drugs (New York: Oxford University Press, 1959).
20. John Keats, Letters, ed. M. B. Forman (New York: Oxford University Press, 1935), pp. 335-6.
21. Schrag, p. 255. Peter Manning with Martine Zucker, The Sociology of Mental Health and Illness (Indianapolis: Bobbs-Merrill, 1976), p. 8. "In Western societies, the growth of medicine has enabled it to obtain a powerful hegemony of control over the meanings of 'deviant behavior' and deviance has been seen increasingly as a medical problem." See also Radelet, p. 7. "Because of the lack of power of potentially competing systems of meaning, this hegemony remains fundamentally unchallenged."
22. Illich, pp. 271-275. "Medicalization constitutes a prolific bureaucratic program based on the denial of each man's need to deal with pain, sickness, and death." p. 131.
23. Robert Seidenberg, "Drug Advertising and Perception of Mental Illness," Mental Hygiene 55, no. 1, Jan. 1971, pp. 21-31.
24. Herbert Ratner, "Medicine: An Interview by Donald McDonald," Child & Family, Vol. 11, No. 4, p. 366.
25. Illich, p. 152. "Pain has become a political issue which gives rise to a snowballing demand on the part of anesthesia consumers for artificially induced insensibility, unawareness, and even unconsciousness" p. 135. See also Rollo May, Love and Will (New York: Norton, 1969), p. 30. "Violence is the ultimate destructive substitute which surges to fill the vacuum where there is no relatedness."
26. Schrag, p. 146.
27. Frankl, p. 41.
28. Gordon, Allport, The Individual and His Religion (New York: The Macmillan Co., 1956), p. 95.
29. Viktor Frankl, Man's Search ,for Meaning (New York: Washington Square Press, 1966), p. xiii.
30. Frankl, 1967, pp. 26-7.
31. Frankl, 1967, p. 15.
32. Edith Hamilton, The Greek Way to Western Civilization (New York: Mentor Books, 1948), p. 168.
33. See Thomas Szasz, "The Psychology of Persistent Pain: A Portrait of l'Homme Doulereux," ed. A. Soulairac, J. Cahn, and J. Charpentier, Pain, Proceedings of the International Symposium Organized by the Laboratory of Psychophysiology, Faculty of Sciences, Paris, April 11-13, 1967 (New York: Academic Press, 1968).
34. Illich, p. 275.
35. Gormely, p. 58.
36. Aldous Huxley, Brave New World (New York: Time Inc. Book Division, 1963), p. 207.

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