Saturday, October 01, 2005

The Seduction of Valium

The creator of the drug Valium has died.

Leo Sternbach, 97, who created Valium, the nation's most-prescribed drug during the 1970s, until critics claimed it was overused and newer drugs replaced it, died Sept. 28 at his home in Chapel Hill, N.C.

Sternbach became a celebrated figure in research science for his creation of a group of chemicals that soothed anxious, irritated and agitated executives and housewives. Valium topped the list of most-common pharmaceuticals from 1969 to 1982, with nearly 2.3 billion pills passing into consumers' hands during its peak sales year of 1978.

Nicknamed "Mother's Little Helper" and "Executive Excedrin," Valium was a true cultural phenomenon. The Rolling Stones sang: "She goes running for the shelter of a mother's little helper, and it helps her on her way, gets her through her busy day." Novelist Jacqueline Susann called the pills "dolls" in her 1966 novel "Valley of the Dolls." In a 1979 memoir, "I'm Dancing as Fast as I Can," television producer-author Barbara Gordon said quitting Valium cold turkey landed her in an insane asylum.

Valium was the first in a class of drugs known as benzodiazepines. These days others in that class (like Klonipin, Ativan, Xanax) are more usually prescribed. They are popular because they instantaneously improve anxiety, but they are also incredibly addictive--both physiologically and psychologically. In psychiatry, we use the newer antidepressants like Zoloft, Prozac or Paxil to treat anxiety, but they aren't nearly as popular, since they don't provide immediate relief.

I won't go into all the problems of prescribing or taking this class of drugs--suffice it to say that in the short-term (several weeks max) they can be very helpful. It has been my experience as a prescriber that in the long-term, they cause quite a bit of trouble since larger and larger doses are often required to achieve the same "effect" and the addiction becomes front and center in the person's life. Patients become obsessed with getting the drug, often going from doctor to doctor; afraid of running out or not having enough. They can lie, cheat, steal and commit various crimes eventually to get it. In my own practice, people will willingly give up almost any drug; in fact, many patients hate their medications -- except for their benzodiazepine.

So, I rarely prescribe them; and when I do, I only do so for a short time and for very specific purposes. I had a personal experience with taking Valium that probably has something to do with my aversion to these drugs; and my appreciation of how seductive they are to those who take them.

When I was an intern at Harbor/UCLA Medical Center in California, my closest friend Sigrid (who was an intern in gynecology at a different hospital) committed suicide. I was devastated and could barely function; particularly since I had no idea that she had been so depressed. Internship--particularly in those days--was a severely stressful experience. Interns were overworked and paid a pittance. It was fairly typical to work 24 hours on and 24 off for days on end (which frequently ended up 36 on and 12 off). We were all sleep-deprived and depressed. I had no idea my best friend from medical school was having a bad time. But I blamed myself for not knowing.

One of the faculty helped me through this difficult time and the first night after Sigrid's death I was given a 5 milligram Valium to help me sleep. To this day, I can still remember the sensation I experienced within a few minutes of taking the pill. The whole world faded away and it felt as if I were safe and warm in someone's arms. Nothing seemed real except for that sensation of safety. I forgot about Sigrid; I forgot about being on call the next night. I remember smiling in perfect relaxation. Sigrid's death seemed relatively unimportant and something only on the fringes of my mind.

When I woke up the next morning, I was horrified that a drug could make me forget about my best friend's death. Until that moment, I had not realized how powerful this medication was, and how it could make you oblivious to reality; happy (when being sad was appropriate). Perhaps my own deepest need--something I've never been able to communicate and probably the reason I went into Medicine in the first place--was an intense desire to be taken care of; fused with the opposite desire to be in control all the time.

We refer to this psychological defense as a "reaction formation"--where one does the opposite of what is really wanted or desired. I wanted to be taken care of, so I went into a profession where I took care of others. When worked through and dealt with appropriately, "reaction formation" --a neurotic defense mechanism--can evolve into "sublimation" (see here for more discussion of psychological defenses).

I was rather amazed that all these needs had suddenly been awakened simply by taking one Valium. If I continued to take it, I could see that I would be able to completely avoid emotionally dealing with Sigrid's death for a long time. I could understand very clearly how seductive this idea was. Not to feel pain or remorse; not to care or be as involved in the reality that I desired escape from.

I flushed the rest of the pills down the toilet and commenced on a long, dark journey of mourning, that ultimately led me into my own therapy and then to psychoanalytic therapy. I slowly came to terms with Sigrid's death and my role in it. It took me much longer to deal with the need to be taken care of and the need to be in control that were so brightly highlighted by my one experience with Valium.

Every drug has a cost/benefit for the person who takes it. For me, the emotional cost of Valium turned out to be a price I was unwilling to pay.

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