On psychedelic drugs as medicine.

On psychedelic drugs as medicine.

We are creatures of habit.

learning_to_walk_by_pushing_wheeled_toyLife would be excruciating if we were not.  Can you imagine: consciously remembering to breathe every few seconds?  Concentrating with the intensity of a toddler each time you stand and walk across a room?  Carefully considering the rules of grammar and conjugation when you stop to ask someone for directions?

Our brains zip through so much unconsciously.  Most of us can drift into reverie while driving and still go through all the motions correctly, stopping at red lights, making the appropriate turns, our mind set on autopilot.

We live, and we learn, and our brains constantly change – neurons reach out to form synaptic connections to one another.  Other connections wilt away.  The resultant network determines who we are.  More precisely, the pattern of connections determines which thoughts we are good at having.  Thoughts we’ve thunk before come easily.

But our propensity for habit can hijack our lives.  In David Foster Wallace’s Infinite Jest, viewers of the highly-addictive titular film are unable to think of anything but watching it again.  One taste and you’re hooked!

otto_wegener_vers_1895_2Or, in an example closer to most humans’ experience, Marcel Proust writes of the way our shared experience with a lost love causes the brain to ache each time a similar experience must be forded alone.  Over and over we hurt: going to sleep alongside her was a habit.  Chatting in the evening was a habit.  Walking to the store hand in hand was a habit.  The brain is still wired such that it could effortlessly zip through these tasks, but… she is gone.

In an example that is – unfortunately! – increasingly relevant today, William Burroughs writes that powerful opiates do not hook users right away.  It takes many recurrent episodes to rewire the brain.  In his (overly cavelier) words:

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Painting by Christiaan Tonnis.

The question is frequently asked: Why does a man become a drug addict?

The answer is that he usually does not intend to become an addict.  You don’t wake up one morning and decide to be a drug addict.  It takes at least three months’ shooting twice a day to get any habit at all.  And you don’t really know that junk sickness is until you have had several habits.  It took me almost six months to get my first habit, and then the withdrawal symptoms were mild.  I think it no exaggeration to say it takes about a year and several hundred injections to make an addict.

. . .

You don’t decide to be an addict.  One morning you wake up sick and you’re an addict.

And then, depression.  To perceive the world a shade darker than it ought to be comes easily… to someone who is depressed.  A depressed person’s brain has been rewired through perhaps a lifetime of rumination and pain.  Suicidal ideation gets easier and easier and easier… unless it goes too far, and then it becomes impossible.  Dead matter doesn’t think.

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The Nightmare by John Henry Fuseli.

Cognitive behavioral therapy attempts to use the brain’s own habit-forming capabilities to battle depression.  Because today’s depressed thoughts enable tomorrow’s depression, a conscious effort to find joy and beauty today could ease tomorrow’s struggle.  Phrases like “virtuous cycle” are bandied about.

My wife, each evening, asks me to list four good things that happened during the day; if we forget the ritual through a harried week or two, it’s difficult to start again.  I lay in bed, pondering, “What was good about the day?”  Which should always be easy.  I have two loving children whom I am graced to spend time with.  I am not in jail.  I have a warm, safe place to sleep.  I have enough to eat.  I live near phenomenal libraries.

But the habit of depression digs the mind into a rut.

lsd-clinical-trial-bottleWhich has caused several researchers to wonder, “Would cognitive behavioral therapy work better if a patient could be jolted out of the rut first, then trained in a new virtuous cycle?”  We have access to several potent chemicals that wrest the brain out of its routines.  Psychedelic drugs like lysergic acid diethyl amide, dimethyl tryptamine, and psilocin are powerful beasts.

Which is not to say that, if you’re feeling sad, you should go find that raver dude you know and ask what he’s holding.  For one thing, most psychedelics are illegal in the United States.  This contributes to the dearth of high-quality clinical information about their uses – obtaining permission to run clinical trials with Schedule I compounds is difficult, and drugs can’t be downgraded from Schedule I status without reams of data from clinical trials.  Nonsensical bureaucracy at its best!

Plus, high-quality clinical trials must control for the placebo effect – neither patients nor doctors should know whether an individual is receiving the treatment or a control.  But I’m guessing most recipients recognize the difference between an injection of DMT or saline.  Did your visual field suddenly fragment into geometric patterns?  Did you feel an out-of-body sensation akin to alien abduction?  Did your memories begin to unfold like interlocking matryoshka-doll puzzle boxes?  Those are sensations I rarely experience from salt water.

LauretaAnd the sheer power of psychedelic drugs also makes them dangerous.  Dr. Lauretta Bender, whose least harmful contribution to science was the idea that emotional disturbances could be diagnosed by asking a child to reproduce pictures of geometric shapes, assumed that LSD would cure autism.  If she’d been right, this sort of baseless cognitive leap would’ve been heralded as brilliance.  She injected large doses into the muscles of children as young as five.  Daily.  When that “cure” proved insufficient, she combined it with electroconvulsive therapy: high currents to overwhelm their little brains.

Enforced acid trips in nightmarish environs of total control can ruin lives.

Especially since Dr. Bender was diagnosing autism in routinely-abused orphans based on symptoms like “avoids eye contacts” and “difficulty forming trusting relationships.”

5009548522_6701801dcb_oAcid trips can end lives, too.  At least one involuntary research subject ensnared in the CIA’s efforts to use LSD as mind-control reagent committed suicide.  And there are innumerable horror stories of murders committed by people mired in psychedelic trips.  Then again, most murders are committed by people who haven’t taken psychedelics.  In Ronald Siegel’s Intoxication he writes that:

Many bad trips are a function of personality; not everybody is a good subject for a mind-altering experience.  And even experienced users can have a bad day.  … Harold, a veteran of one thousand LSD trips, wanted to volunteer to be a psychonaut but he had a history of violence, both on and off the drug.  “Ever since I was small,” confessed Harold, “I go ape when I’m bothered.”

.. [a grim description of Harold murdering two hikers outside Santa Barbara in 1984 follows.  Yes, Harold had “drank some beer, smoked a little marijuana, and swallowed a few amphetamine tablets along with a full dose of LSD.”  But he’d also “been bothered by financial problems.  He was passing bad checks and had failed to make child-support payments to his ex-wife.”  So I’m not sure the drugs were at the root of his malaise.]

Cases like Harold’s tend to confuse the issue of intoxication and violence.  Violent people are often intoxicated but the violence is usually rooted in the personality, not the drug.  . . . What seems difficult for us to understand is that despite overt behaviors, the subjective experience can still be fun.  In other words, one’s inner feelings and sensations can be under the influence but such influence may not extend to outside acts in the real world that remain chillingly sober.  This is most difficult to accept if users are obviously intoxicated when they commit criminal acts.  The subjective intoxication can remain an enjoyable experience, despite our desire to blame the fires inside for the destruction outside.

Used incorrectly, psychedelic drugs are awful.  They disrupt habits, seeming to dissolve the mental filters that allow humans to function despite constant bombardment by thoughts and memories and myriad sensations from the world.  This newfound wonderment & reset can help, of course, but for someone in a bad place, it can be horrible.

mdma1Then again, for someone with post-traumatic stress disorder, the world might be horrible already – even if the chance that psychedelics could help were low, they’d be worth investigating.  Thankfully, the FDA finally granted permission for a trial to be run on the use of methylene dioxy methamphetamine (ecstasy – when I was a TA for undergraduate organic chemistry at Stanford, I wrote most of the quizes.  After they learned about acetal protection of ketones, all 200 or so pre-meds wrote out a partial synthesis for MDMA.  The reactants and products were unnamed, so I don’t think the students or the other TAs noticed) to treat PTSD .

In other experiments, LSD and psilocin seem to help terminal cancer patients overcome depression.  Ayahuasca is also being tested as a treatment for depression and those seeking to quit substance abuse (peyote has long been used for the latter), although these studies are far from the FDA clinical ideal.

Many people, as they live, drift into routine and no longer consider the implications of their actions.  I’m well aware that drugs can wreck lives, but sometimes we need a jolt.  I wish people weren’t shunted to jail for drug addiction – and obviously the dudes in there wish they were almost anywhere else – but a surprising number are grateful that something interrupted their habits.  Junkies don’t want to look back on a wasted life, either.

pills-750x400I’m not super keen on the rich & entitled using psychedelics for fun & games, and psychedelics certainly should not be used often.  But these molecules, treated respectfully, can heal damaged lives.

Even in the ostensibly healthy, psychedelics can do good.  Does the way you choose to spend your time benefit the world?

On pain.

On pain.

Recently I heard a man read a beautiful poem.  The first half of his poem was a slangy narration of an evening out.  Then the piece turned, brutally, into a crystal clear description of his lover’s death by overdose.  Though he was not a user, he’d taken some of her shot, worried she might overdo it.  His fraction was enough to put him under, but not enough to save her.  He woke beside her body, cold.

When he finished reading, everyone in the room was still.  He was asked to read his poem again – it’s difficult for me to follow a poem aloud the first time I hear it, and I assume this is hard for other people, too – at which point he opened his mouth to speak.  Several seconds passed.  No sound came out.  Tears rolled down his face.  He shook his head.

No, he could not read the poem again.  He handed it to me and I read it aloud a second time for our class.

It was difficult for me to read.  My voice is squeaky and might well crack at the best of times.  And I’ve lost an uncle to overdose; nearly my namesake, too.  But I’ve lost less than the men in jail.

When I finished, several more were crying.

Habitual drug use ruins lives.  But the War on Drugs ends them.

Our culture rarely celebrates the endurance of pain.  There are exceptions, of course – professional sports dominates our media, with traffic in many cities tangling for hours on game days, and no one can argue that athletes do not suffer – but for the masses we promote convenience and ease.  Such are the advertisements that flicker seductively on our ubiquitous gargantuan TVs.

There’s fast food for whenever you feel hungry.  Programmers work round the clock to develop new ways for any interstitial time – stint in a waiting room, stop at a red light, lull in dinnertime conversation – to be filled with pleasurable distraction.  Nurses trained near the turn of the century were taught to eliminate pain amongst their wards, since the newest opiates were presumed to be much less addictive than their precursors.

Oops.

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In a culture that celebrates immediate gratification & constant ease – and, moreover, does not teach people how to gracefully suffer – painkiller use can easily spiral out of control.  Opiates ameliorate both physical and psychological pain; for many who’ve felt perpetually beleaguered by the world, a script after surgery might bring the first flush of mental relief in years.

I am not saying, after all, that Americans do not suffer.  Poverty hurts.  Through a cascade of cortisol, stress causes physical harm.  But our pain & forbearance is rarely celebrated.

Instead, we turn on the TV and see another ad for the latest pharmaceutical.

symptoms-muscle-painBut there’s a hook.  Painkillers do not remove pain, certainly not when the pain is psychological, stemming from structural disconnects between our desires and the world.  Painkillers simply act to make pain temporarily bearable.  Over time, painkillers aggravate pain.

This was demonstrated with a recent experiment asking opiate users to put their hands in cold water.  Pain is necessary – some people are born with unusually high pain tolerance, and these people are exceptionally prone to injury because they fail to extricate themselves from circumstances that ought to hurt.  Luckily, most people’s brains are looking out for them.  When people take painkillers, their bodies will produce fewer endogenous opiates and the signals reporting pain will scream louder, attempting to be heard over the muffling cloak of chemical numbing.

If a person uses painkillers too long then tries to quit, the body’s efforts to re-sensitize to pain will make every moment agony.  Dip a hand into chilly water and it’ll feel unbearable.  Our skin is a huge surface, and nerve endings grope throughout our body: when quitting, all scream hurt!

According to William Burroughs, “No one will stand still for junk sickness unless he is in jail or otherwise cut off from junk.  The reason it is practically impossible to stop using and cure yourself is that the sickness lasts five to eight days.  Twelve hours of it would be easy, twenty-four possible, but five to eight days is too long.”

The sickness can drag on interminably.  The agony.  Worse, the mind knows all the while that there is a way to make it stop.  Another pill.  Or, if you can’t afford a pill, then…

409px-bayer_heroin_bottlePainkillers are known entities, with precisely calibrated dosage, but they are expensive.  Even for those with money, they require a prescription.  Many switch to heroin, which might be ten-fold cheaper, but the War on Drugs ensures that heroin users face mystery dosage.  The product is gravely unstandardized.  Here in the Midwest, where the cartels sometimes experiment with new blends, new compounds to cut their product with, no one can anticipate the effects.

Hearts slow, lips turn blue.  By forcing everything underground – unregulated, uncontrolled – the War on Drugs prevents users from learning their limits.  A safe dose from one batch might kill you from another.  Users are well away from medical care.

But there are intimations that, as more and more wealthy, “respectable” people get hooked, the world might change.  In Vancouver, Canada, users are provided with a space safe to inject, and one consequence has been a drop in the rate of addiction.  It’s easier to quit when you’re not cut off from the world by the stigma of being considered a criminal.  And decriminalization would allow addicts to choose safer alternatives – my namesake, who didn’t die, was able to obtain standardized pills.

speaker_at_the_2010_annual_rally_against_the_war_on_drugs_at_u-c-_berkeleyIf it were legal, marijuana could supplant some opiate use.  Pot isn’t harmless, but one of the worse side-effects is that it makes people insufferably boring.  This seems preferable to making them dead.

Within the depths of addiction, the world looks awful.  Many users want to quit.  But quitting means suffering through the spell when the body screams, and the mind feels nary better … and we’ve criminalized help.