Life in the Fast Lane

Speed has sped back into American culture

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By NICOLAS RASMUSSEN

Gordon A. Alles was hoping to discover a profitable new allergy pill when, in 1929, he created and first tried amphetamine. The drug did not do much for his sniffles, but it did make the freelance chemist cheerful, talkative at dinner with friends, and inconveniently alert through the night. Uncertain about how to turn his curious invention into a marketable medicine, Alles decided to sell the rights to Smith Kline and French, a pharmaceutical firm. The drug, which would reap a fortune for Alles and make the company, now known as GlaxoSmithKline, a dominant force in the pharmaceutical market, has insinuated its way into American society, art, and culture in ways that Alles never could have predicted.

By 1969, Americans were annually consuming the equivalent of four billion hefty 10-milligram doses of pharmaceutical amphetamines by prescription, according to the Food and Drug Administration. Although speed consumption was significantly reduced in the 1970s by strong government action, Americans are once again consuming as many prescription stimulants as they did in the peak year of 1969. What accounts for the surprising return of amphetamines to mainstream medicine is that the two main drugs used to treat attention-deficit disorder are amphetamines.

Between 1990 and 2005, the medical use of methylphenidate (best known as Ritalin) and amphetamine itself (sold as Adderall) — prescribed for the treatment of attention-deficit disorder — increased more than 3,000 percent. On top of that, "speed freaks," people who compulsively take large doses of amphetamines to get high, have made a frightening comeback in recent years.

How did a dangerous drug, all but banned for very good reasons, become a pharmaceutical best seller once again? To get a handle on America's enduring attraction to speed, we must step back and explore how amphetamines became part of the fabric of American life.

In the late 1930s, Smith Kline and French conducted extensive clinical trials to test amphetamine as a treatment for a host of maladies, including bed-wetting, menstrual distress, and muscular dystrophy. But the company found that psychiatrists — not pediatricians, gynecologists, or neurologists — were the most receptive to the new drug. American psychiatry was passing through a period of bold experimentation as it struggled for recognition as a scientific medical specialty. Even psychiatrists committed to talk therapy were open to novel physical interventions, including electroshock therapy and lobotomy. One particularly innovative character was Abraham Myerson, an expert on depression with some idiosyncratic ideas about that condition. In a 1925 book titled When Life Loses Its Zest, the professor of neurology at Tufts University and professor of psychiatry at Harvard Medical School argued that commonplace depression was not best understood as nervous exhaustion or neurasthenia, as textbooks of the day maintained, but as an apathetic state in which rewards are not pursued and appetites thus remain unsatisfied. He called the condition "idiopathic anhedonia" — a neurosis defined by the failure to enjoy — and later speculated that it might be caused by insufficient levels of adrenaline in the brain.

When amphetamine became available in tablet form, in 1936, Myerson tested it immediately. In short order, he announced that the drug brought striking relief to his anhedonic patients, who returned to their previously unrewarding lives with renewed enthusiasm. It seemed to be a miracle cure, and Myerson became the first doctor to champion "antidepressant" medication. Although his theory of anhedonia would not catch on until after the Second World War, by 1940 the treatment of neurotic depression had become the main approved and advertised use of Benzedrine Sulfate tablets, the brand of amphetamine manufactured by Smith Kline and French.

The war bolstered the confluence of medical and commercial interests that made amphetamine the first antidepressant. The British and American forces adopted speed because it made soldiers more confident, despite authorities' knowing that by 1941 the German military had sharply curtailed its use of methamphetamine (a slight variant of the drug) because of its addictive qualities. The Allies administered the drug as a morale booster, notwithstanding a charade that the drug counteracted fatigue better than caffeine (two years of testing actually found amphetamine no more effective).

The drug helped win bloody, pivotal battles such as El Alamein and Tarawa. But the military's embrace of speed had serious side effects. An entire generation of young men had been turned on to the new pharmaceutical. There is evidence that the sanctioned use of amphetamines promoted drug abuse not only in the service but presumably after the war, too. That pattern repeated itself during the Vietnam War, when the military again distributed enormous quantities of amphetamine to American troops.

While amphetamine abuse was brewing on the social margins in the 1940s, as Beat literature and jazz memoirs attest, mainstream medical use of the drug began to explode. One reason was the sharply elevated profile of psychiatry in postwar America. Family doctors were encouraged — not least by innovative drug-marketing campaigns — to recognize commonplace depression as the root cause both of psychosomatic illness (that is, complaints for which doctors could find no cause other than patients' need for attention) and of that new disease of civilization: obesity, itself thought to be symptomatic of a mood disorder. Physicians were encouraged to give distressed and overweight patients amphetamine, and writing a prescription took a lot less time than listening to a life story.

In the postwar era, Myerson's interpretation of depression as the failure to seek pleas-ure and advancement took hold as a mass phenomenon. Amphetamines were advertised as psychological-adjustment aids for successful businessmen beset by worry and doubt, for single women and older men overly invested in their careers, and, especially, for middle-aged women disenchanted with being housewives. The pills also put the new feminine ideal of slimness within easy reach. Prescribed amphetamine thus promoted mental health for the new consumer, maintaining gender roles, economic order, and docility in the fortified suburban paradise. As one family doctor put it, speed was the only thing that kept vast numbers of her patients capable of facing, and sometimes even enjoying, their daily duties.

By the end of the 1950s, enough pharmaceutical amphetamines were being produced to supply every man, woman, and child in the United States with 40 hits of speed yearly. Of course, it was only a minority who actually took the drugs, but it was a large minority. Surveys in the late 1960s found that 5 percent of American adults used prescribed amphetamines a year. But only about half of the pharmaceutical amphetamines being manufactured were dispensed as medicine; the rest made their way from the drug companies to the streets without benefit of prescription. Counting everyone who took amphetamines, prescribed or otherwise, there were some 10 million speed users in the United States. And while it was fashionable in the 1960s to inject methamphetamine made in amateur "laboratories" (read: residential bathrooms and kitchens), the vast majority of the nation's speed users were supplied entirely by the pharmaceutical industry. Public outrage mounted, and in 1971 federal narcotics and medical regulators overcame the lobbying efforts of the drug industry and instituted strict production quotas and oversight. Within a few years, America's speed epidemic was brought under control.

Forty years later, speed use has returned in force. At least three million Americans use the drugs medically each year, mainly juveniles being medicated for attention-deficit disorder. Three million more use amphetamines nonmedically, over 300,000 of whom are dependent to some degree. Furthermore, half of those recreational amphetamine users take strictly pharmaceutical amphetamines — attention-deficit drugs, not methamphetamine manufactured illicitly.

We do not know how many of the three million Americans using amphetamines by prescription each year are dependent, because surveys do not ask. But we do know enough to conclude that the distinction between medical and nonmedical use is as fuzzy today as it was in the 1950s. Many users of methamphetamine and nonprescribed attention-deficit drugs are taking them for essentially the same purposes as those with prescriptions: heightened concentration, elevated mood, and weight control.

So the amphetamine-assisted, physician-abetted social adjustment of yore is back as a mass phenomenon. But it does not, at first glance, represent as severe a problem proportionally. There are fewer than 10 million medical and nonmedical amphetamine users today, whereas the population has increased from 200 million to 300 million since 1969. Amphetamine use is therefore less than two-thirds as prevalent as it was in 1969. But we might expand our purview beyond simple statistics to ask a broader sociological question: Has the medical demand that amphetamines once filled abated? Apparently not. Counting all the medicines used now for conditions that amphetamine once treated — depression, obesity, and "fatigue," or inadequate working attention — we can estimate that, proportional to population, each year roughly twice as many Americans now take a drug that would, in 1969, have very likely been an amphetamine.

That calculus suggests that if the amphetamine epidemic of the 1960s was symptomatic of a deep-rooted social disease — drug use to meet unwholesome expectations of incessant cheeriness, unnatural productivity, and extreme slimness, and to boost the postwar consumerist ethos that the sociologist David Riesman once called the "fun morality" — then America is now twice as sick. When Allen Ginsberg helped open the counterculture's own anti-amphetamine campaign in 1965 under the slogan "speed kills," he wasn't referring just to the drug that so many Americans relied on to keep up. He was also thinking of the demand that amphetamine satisfies. It might be time to think again about heeding his call.

Nicolas Rasmussen, an associate professor in the history and philosophy of science at the University of New South Wales, in Australia, is author, most recently, of On Speed: The Many Lives of Amphetamine (New York University Press, 2008).