Saturday, December 15, 2018

Comments by Daniel Smith

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  • Lewis Mehl-Madrona’s work is very good on this. He is Cherokee-Lakota-European and an M.D., certified I think in psychiatry, gerontology, and family medicine. His book “Healing the Mind through the Power of Story” is especially good.

    There’s lots to say about his approach, but there are two things I’ve heard him say that I especially like. “In indigenous cultures, we assume that if a person has psychic distress it means something is wrong in the community and that person should be respected and listened to carefully.” (That’s a paraphrase) And (joking): “Psychiatry is the only profession in which the customer is always wrong.” Just a lovely man with a lot to offer.

  • Kindred, I think you are missing the importance of the different ways in which boys/men and girls/women are socialized. Just because traumatized women don’t usually become physically violent, and even just because most traumatized men don’t either, as Steve says, doesn’t at all mean that Gabor Mate is wrong here. Men are typically socialized to go outward with their feelings, and that anger is about the only intense feeling that is permissible to be displayed. Not all men, but an awful lot. And so some, even a small minority, end up doing awful, violent things. I’m not excusing it, and I don’t think Mate is, either, but I do think he’s absolutely right about the connection he’s describing.

  • Hey, sorry for being so strident there, I’m afraid I can get my dander up. I really did have many of the same reactions as you–to the interview I heard, anyway. But there were two things that bothered me in what you wrote.

    The first is phrases like: “Dear Lauren Slater: I learned, and I hope you learn, too, before it is too late,” and “Dear Lauren Slater, you need to find the answer within yourself. Plain and simple.” That seems pretty condescending to me and I just think we need to meet people where they are. The reason it pushes my buttons, of course, is that I as once told things were plain and simple by the people who got me hooked on antidepressants and it cost me dearly. I just don’t agree with you on the “everyone is different” thing. I know it’s a tricky phrase and can be used to legitimize really bad treatment, but I also think there’s truth in it–even if just in that some people are “different” in that they really aren’t able to get off the drugs. Or at least are convinced of such, and I won’t put myself in the position of judging them on that, as much as I might disagree, and tell them so. But I think it’s terribly important that the conversation always be respectful.

    The second things is regarding psychedelics. I spent five years of my life trying to get off of SSRIs and might never have been able to if I had not in the end done some careful, guided work with psychedelics. I have now been clean for six years and honestly feel I owe my life to those substances. And I know several other people who would say the same. I think we need to be careful not to counter psychiatry’s “drugs are always the answer” ideology with a reactionary “drugs are always bad” ideology. I think we need to listen and learn and consider individual people and individual treatments on their own merits.

    Thanks for your writing, and for the discussion–really.

  • I have not read Slater’s book, although I did hear interview with Terri Gross. Based on that, there are a great many things in this review that make sense to me, and also some things that don’t. More important, I am dismayed by the condescension towards a smart and thoughtful woman who doesn’t have all the answers but does have the courage to tell her story and offer her opinions, imperfections, uncertainties, and all. Why is it that so many people writing here can not see the way they mirror the arrogance of conventional psychiatry every time they dismiss the experience of real people and announce to us all that they know the truth and the way that everyone else must follow?

  • He also wrote a very nice book on ecological Marxism called: “The enemy of nature: The end of capitalism or the end of the world?” This is especially worth noting as we celebrate Marx’s 200th birthday. Although it gets into the weeds in places, the book is overall one of the best overall presentations of eco-Marxism, explains very nicely how capitalism so fundamentally feeds off the ruination of nature, just as it does off the exploitation of people, and considers deeply the question of whether “sustainable” capitalism is even at all possible, or whether the growth imperative will always outpace our piecemeal attempts at regulation. Needless to say, it ain’t lookin’ good. I did not know about his work on corporate medicine, though I’m not surprised–the bodies we live in being inseparable from the body we live on. Anyway, a very fine man, he will be missed even as he continues to be with us through his work.

  • As a victim of antidepressant poisoning (what else can you call it?) I am deeply disturbed, but not entirely surprised. What also comes to mind is that this is one of many symptoms of a profound social disease (or maybe something that should go in the next DSM?). I watched the other night a John Oliver piece (actually a quite good source of news) on nuclear waste and it showed barrels of it being duped off the coast of New Jersey in the 50s. (Some of them came back to the surface, so they strafed them with machine guns from a plane–really, what else was there to do?) So you know, develop a technology, pretend against all common sense that it’s safe, and wait for the shit to hit the fan. And now we have these marvelous smart (dumb) phones, that we already know are making people, especially teen-agers, miserable, but I don’t think we’ve even begun to see the full measure of what our life-of-screens is doing, not least making people even more complacent about all of the above. Let us be very, very angry, and then do something about it.

  • Indeed. What I realized after spending some time reading through those comments is that there is a range of views, but the top “readers picks” are all pro-drug. The one you quote was I think the highest on that list, got the most votes. What that says to me is that there are a TON of people who’ve swallowed the coolaid but perhaps on some level realize it and so get very defensive and “vote” those comments to the top of the list. Still, the article itself is what most people will see, and as Steve says it is progress.

  • Yes, it is progress, at least. I’m not sure how many people even read the print version any more, but letters to the editor might be worthwhile also. I did notice that among the “NYTimes Picks” in the comments every single one is pro-drug, so it looks like someone low on the totem pole (I always wonder who has to review the comments all day long) is taking a side, whereas I think letters to the ed may get more careful attention.

  • I just looked through the comments on this in the Times. It is unbelievable. There are so many people writing in, from first-hand experience, saying what wonderful, indispensable drugs they are. While I’m willing to bet a lot of that is because of placebo effect, I do think we need to take people’s personal stories, from both sides of this, seriously. But there is still the endless refrain on chemical imbalance and the diabetes metaphor. You read through it and just want to bang your head against the wall. Or maybe someone else’s! The endless circulation of long-dead pseudo-science propaganda. Well, thank God we live in the modern age of corporate media and miraculous electronic communication, where truth always rises to the top!

  • Thank you, Juliano, this is a very important perspective you offer, and one I agree with, including on the fear of psychedelics. I’m curious, though, why you say that about Jung–he has seemed to me not unalligned with your position, albeit too internally focused and so not attentive enough to the problem of social control.

    The only thing I’d add is that men are terribly harmed by patriarchy, also. The pressure to conform just happens earlier than for women (Carol Gilligan’s research suggests at about age 5, as opposed to early teens for girls), and so gets more thoroughly repressed. bell hooks says that “patriarchy has no gender,” which seems very true to me.

  • Thank you for this very helpful and thorough interview. The only thing I would question is the statement that it may not be possible to design research that would definitively answer the question of antidepressant efficacy. I think it’s very possible that long-term research, following people over the course of years and looking at both positive and negative effects, would show a clear long-term deleterious effect. It’s just so common to find people who benefitted greatly at first, and then reverse tolerance creeps up, and side effects creep up…my bet would be that if you extend the time scale to real-life scenarios, the results might just become pretty clear.

    I realize that isn’t too likely to happen, but strategically I think there’s a strong case to be made–a very plausible hypothesis to be put forth–that would strengthen the argument against the drugs. Well, not just strategically, as opening up the debate beyond the narrow confines of current research actually helps to expand people’s understanding. And who knows, maybe more discussion like that could actually open up the possibility of careful research?

  • Yes, exactly. And yet it passes peer review for publication in the Lancet. What more do we need to know?

    Johann Harri interviewed John Ioaniddes (sp?), who I think is about the most important figure in medical research in the last couple of decades for having shown clearly just how bad so much peer-reviewed research is. (2005, “Why Most Published Research Findings Are False” is the most downloaded article on PLOS medicine.) At the end of the interview in which Ioannides essentially says research on SSRIs is as bad as any body of research out there, Harri asks him how he feels about the whole thing. He says, well, it’s really terribly depressing…but not nearly depressing enough to make me want to ever take one of those drugs!”

  • Lawrence: Yes, absolutely. I think also it is true at the social level and not just individual–that it is definitely about subconscious desires, but also about systemic and institutional dynamics and structures, which help to perpetuate individual subconscious aggression. So, capitalism is very much about control and domination, baked in at the roots, the basic rules of organization. I am also remembering a very nice, succinct book by Jennifer Reid called “The Colonial Encounter:..something something”, about the English and Micmac encounter in the Atlantic provinces. She describes very nicely how ambiguity was easily accepted by the Micmac, whereas the English could not tolerate it, everything had to be clear, defined, black and white. So, for instance, the Micmac, like many indigenous peoples, could easily fold Christianity into their own relgion, whereas the English could only see anything outside of their own religion, anything introducing uncertainty or paradox, as just plain bad or downright evil, the work of the devil. (Not so different from the idea that there is clearly “sane” and “insane.”) This seems to me a sort of conceptual-emotional violence and makes me pull back a little on what I said before–I think the domination and oppression have also been there internally for a long time. I expect it is a result of both philosophy/culture and childhood trauma (consider European child-reaering practices…).

    These are fascinating questions and I thank you for once again spurring my thinking on such things!

  • Thank you, Lawrence; very thoughtful writing, as always.

    The only thing I would question is whether the U.S. was ever as free as we like to think. In certain respects, yes, but there has also been a strong inclination from the start to conquer and control (indigenous peoples, Africans, minorities and outliers of all sorts, and of course nature) and I think part of what’s happened is now that we no longer have such an open field for that, the old, blatant techniques become more subtle and we turn them inwards–within our own society and our own minds. Bruno Latour said that “the repressed returns, and with a vengeance.” I think we’ve repressed and hidden our profound aggression and violence for several hundred years (or a few millenia), the old targets are no longer available, and as the center no longer holds, it goes inward. There is, in the end, a fine and perhaps non-existent line between outward and inward aggression. Maybe? Thoughts?

  • rasselas, perhaps as people who have suffered terribly from having others control our minds to make us conform–well, perhaps we should not seek to control how others use words that are meaningful to them and how they think. Perhaps we should not do what was done to us, even if it is in more subtle form. Perhaps, like all who have suffered abuse, it is not our fault but nonetheless our responsibility to not perpetuate the cycle by seeking to dominate and control and ridicule others who are in pain. Maybe we should listen, instead?

    I see it all the time here, people who have been hurt and are in such pain becoming very angry and impatient with each other and painting us back into the black and white, polarized box of thinking we’re trying so hard to get out of.

    As for mental illness, I actually agree with you for the obvious reasons and avoid using the term myself. On the other hand, if I have a stomach virus, which of course indicates nothing inherently wrong with me but simply a hostile foreign invasion, I do feel ill and have a physical illness. While the context is different (which is why I don’t use the term), nonetheless, the painful rubbish our minds have been filled with from trauma and propaganda and drugs is not so different, so who am I to tell someone he does not have a mental illness? I might explain why I think it’s a problem , but in the end I will always be for cognitive liberation, not domination. Even more, first and foremost, I will be for compassion for others who have suffered.

  • It can be terribly hard; took me the better part of five years until I finally found a way out, and even then it was very hard. Have you checked out the Inner Compass Initiative, which includes the Withdrawal Project? I think there is good support there and maybe ideas for how to make it work. I hope you find a way to get off, wishing very best of luck.

  • Thank you for this, Kelly. Your point that they are “throwing more of the same failed medicine at the very problem created by the failed medicine” is very much in line with similar dynamics in the realm of international development. About once a decade there is a new, “expert”-derived formulation to “develop” the poor of the world, and each time it is essentially an imposition of external force, as you say, and each time it fails, and each time a new and “better” formulation is cooked up. I’m sure there are other areas where this is true–well, industrial agriculture is another example, needing always more fertilizer and pesticides to “solve” the problems caused by their earlier application. This is a hallmark of late modernity. Let us keep our shoulders (lightly!) to the wheel not of force but of unfolding.

  • Thank you, James, and Johann, for this. It is a remarkably thoughtful and interesting interview and I think Johann’s work can do a great deal to get this perspective and information out to a wider audience. I also want to recommend very highly his earlier book on the war on drugs, “Chasing the Scream.” I always thought it just started with Nixon but, in fact, goes way back to the 20s and has profoundly racist and political roots.

    There are many wise people and wonderful writers here at MIA, but Johann is able to take this material to the next level, narratively-speaking, and produce real page-turners that are also deeply humane and wise. For that I am very grateful.

  • Tireless, it’s pretty clear already that you believe that. I thought one of the things most of us were against on this site was the presumption to know and judge the interior states of those we might deem less aware or enlightened than ourselves. Why not, instead, speak from your own experience and leave the judgemental presumptions to the psychiatrists? Why not be okay with the way others chose to work with their own consciousness? So what if they’re deluded and escapist? Why not just wish them well and hope they wake up to your superior view?

  • Jan,

    This is really helpful, thanks for taking the time and offering the detail. I know one cannot fully describe such things, but I think I get the gist.

    It actually sounds very much like what I was hoping for and led to expect with a group I worked with a few years ago. In my case, it went badly. I think I was somewhat desperate for community and got pulled in with the false-promise of that. It was also a group with very prominent and “respectable” people–doctors, lawyers, philanthropists, Ivy League professors, etc., and I’m chagrined to look back and realize I really suspended my own better judgement because of that, despite a longstanding proclivity to discount or even shy away from conventional markers and titles. (Of course, sometimes what we reject is exactly what we crave on a deeper level.)

    It was not until nearly a year in that someone who had a lot of careful experience working in other contexts pointed out to me that, in such a deep state, one could essentially be re-traumatized when interactions in that space come with impatience, disrespect, hostility, etc.–and given the gestalt of the whole thing, they tend to be relatively subtle, insidious…slippery. It took me the better part of a year to tease out the ways that had, indeed, happened to me. I have now heard of others who’ve left that community in a very troubled state, although I know many others who would describe in much the way you did your experience.

    This brings two thoughts to mind. First is that surely there is a continuum, from the very good and safe group you worked with, to the not-good one I was a part of. The second is that such groups can be very different for different members. I don’t assume it, but wonder if there may have been some in your group who did not have quite as good or safe an experience as you did. I know for my part that I did not give voice to the problems at the time. I was both very invested and trying to make it work, and also there was too much shame involved to even admit it to myself, much less others. What was wrong with me, I wondered, that I could not be a part of this wonderful, supportive, sharing experience that others seemed to be having?

    I should say that I am a very big believer in dispersed power–and not just on faith, but on the evidence, in many situations. But I’m still not convinced this is a situation where it’s best, or at least always so. I doubt these things can ever be regular or predictable enough to know for sure, and because it’s had to be kept so under wraps and quiet, I think we all have still a lot to learn.

  • Jan, your point about it being an event is very important; thank you for so nicely articulating that, and also that it is spiritual work.

    I didn’t mean to suggest the setting isn’t important (it is, absolutely), just that the therapeutic relationship isn’t necesSARilly a big problem in terms of power dynamics. I agree that it’s always something to be careful with, and in a sense always problematic. But I would be wary of putting too much confidence in group work. As with a therapist, it depends greatly on the nature of the group. But even in the most supportive of groups it can be a dicey business to rely for support on someone else who also is in a deep state of consciousness exploration. One of the lesser appreciated problems with this work, in the circles where it happens, is that there can be retraumatization when one is in that deep state. In a group that is not carefully set up and, ideally (in my view) supervised, you never quite know who might come along and drop their own shit on you. I think it’s really too much to expect someone in that state to be the primary support.

    That’s my take; I’d be interested in you have further thoughts on this.

    The way I think of it is that power dynamics will always be an issue and always bear the closest consideration in all relationships, whether a group or a dyad. But in a group it’s dispersed and a lot can be happening out of plain sight. Of course, that can also happen with a dyad! But personally, I would rather have the power relationship clear and up front with one trusted and experienced therapist or healer or even a really good friend (and yes, not a psychiatrist!) who’s sober than dispersed in a group, especially where people are doing their own deep work.

  • Here is a thought. Trauma begets trauma, abuse begets abuse, disprespect begets disrespect. It is my sense that the wilful ignorance and violence of psychiatric “care” has been internalized by some of those who have been most harmed by it, and further compounded by their suffering. How else to explain the disregard shown by many here for the views and experiences of others that fall outside their own framework of assumptions. How else to explain the unwillingness to even consider alternate views and experiences? Please note that I said “consider.” Not agree with or accept. Simply consider, and perhaps engage in dialogue.

    Fire away.

  • I just want to be sure you want to shackle, restrain, and imprison people who are assisting adults who have sought them out for assistance in exploring their own minds in a way that poses no threat at all to anyone else but that does diverge from your own ideas of what is an acceptable state of mind.

    If so, should we not also shackle and imprison the people choosing to have experiences of alternative consciousness? Note that in the early days psychedelics were sometimes referred to as “psychotomimetic” because they can induce temporary states that resemble “psychosis.”

    So if we’re going to shackle and imprison people who chose to do that, can you explain how that’s so different from psychiatry?

    Are you hoping for a diagnostic manual that can categorize these people? An army of specially trained doctors to “treat” them? Or are you looking more for old-school imprisonment where you just toss them in jail?

  • Hi Feelin, I want to ask a question that could seem argumentative but I’m honestly interested and curious and wondering if there could be unseen common ground. So the question is: If you’ve read this article, and perhaps also my comments in the thread, what accounts for your insistence that a drug is a drug is a drug? Do you assume the research is part of the pharma-industrial complex? Do you assume what I’ve written is untrue or that I’m deluded? Do you assume something else?

  • I was just looking over Scott’s article again–I came to it late last night after a long drive, and then mostly read the comments today–and am seeing anew the emphasis he put on the idea that this will “transform the face of mental health care.” (I do realize it’s in the title; mea culpa…and mea was pooped, too.) I think he’s right about the potential for paradigm change, but that you (Steve) are also right to emphasize the importance of power and question whether it will happen so easily as Scott suggests.

    I really do believe the paradigm is fundamentally different here (and that has been my personal experience), that it’s the difference between essentially anesthitizing people (oh, right: “fixing a chemical imbalance”) and trusting the psyche to reorganize and heal itself and facilitating that. Please stop and really consider that difference, and if it seems mysterious and whacked, look up some of the accounts from people who’ve done this work. IF the initial research results hold up, I do think it opens the possibility of major change, and I’m quite sure the substance itself is paradigmatically different from the drugs in use now.

    However! Notice the reliance in the article on Thomas Kuhn, who’s work on scientific revolutions (paradigm change) is, if memory serves, very much under-theorized in terms of power. (It’s been many years, but I think that’s right.) So that’s where I think the uncertainty is, and why the movement represented on this site, and the wider recognition that the modernist-imperialist-capitalist emperor is wearing pretty shabby clothes, is so important.

    I suggested before that people who have done work with MDMA and psychedelics can be some of our best allies. But it can work the other way, too. By pushing back against big pharma and psychiatry, we can help make sure there is room for alternative therapies and hopefully a new paradigm. What exactly the paradigm is, I’m not sure, but it’ll probably involve a lot more than MDMA and it’s gonna be an awful lot better that what we’ve got now, that’s for sure! Here’s hoping soon.

  • Hmm. I have to be tentative, because I really haven’t looked at the system in detail. I need to read Whitaker’s latest book on institutional corruption.

    I do hear you on the need for an uprising of sorts and for the confrontation of power. But I’m wary of my own adrenaline with such things and how it’s triggered by our heroic mythology around uprising and revolution. I think what you suggest could work and would be certainly the best thing, but if it doesn’t happen I also think smaller scale change, including the availability of alternative forms of care and healing–as you know, I think this is an important one–can be very important. Sometimes the time is right for revolution. Sometimes it’s right for incremental change. I think a large part of being attentive to power involves carefully gauging what is possible in a given historical moment–and also what might come after major upheaval, as we all know how traditional political revolutions have tended to go.

    I see a lot happening on both fronts but don’t know enough about specific leverage points and what it would take to bring the system down. So, personally, I’d start with (snore!) institutional and movement analysis. I realize that may be old hat for you and some others.

    But I also don’t think the two forms of action are mutually exclusive, so I would also focus on discerning which incremental changes will support the larger goals and focus on those.

    Richard Rockefeller, who was involved with trauma as a board member of Doctors Without Borders, gave a very nice talk on trauma and MDMA therapy at the Carnegie Council a few years ago. At the very end, he spoke to the larger social significance of healing trauma and asked something like “how in the world can we address our most pressing social problems when trauma is so widespread and so many people are suffering from it on a daily basis.” It’s a simple point but I think a very important one. Even beyond acute trauma (I think we’re swimming in more subtle or at least more accepted kinds of trauma that keep us shut up in little boxes of the mind) I think MDMA, and also true psychedelics, have the potential, if used with intention and respect, to help people open to the world and to become less conventional and more loving and more activist. The people I know who have done this work tend to have a very clear understanding of and strong feelings about what’s wrong with psychiatry and prescription psych drugs. I think they can be among your (our) strongest allies in building the movement.

  • Steve,

    Our particular concerns and expectations aside, this may be an interesting test case for the juggernaut you describe. Psych drugs always seem very similar to international development to me in their trajectory. Like “mental illness,” there never was such a thing as “development” until Truman put it on the map, a “solution” to a newly constructed “problem” of “underdevelopment.” Since then, about once a decade, there’s always been a new, shiny, better solution–either technological or institutional or both–and every time, the new solution fails, only to be replaced by another new one, and so on.

    There always comes a point, however, when a regime or paradigm falls. Can I ask what you think it would take in this case? Can you imagine any positive role that non-patentable substances can play in that? (I realize you’ve already answered that second question, but pushing a little harder to see if you think there’s any circumstance in which it could happen.) That’s not meant to be argumentative, I’m honestly curious.

  • Shoot, I thought weak bones was original!

    I’m always uncomfortable with absolute certainty in dynamic situations. This seems dynamic to me. I don’t think they can patent it, and I’m much more hopeful than you that people are starting to see through the emperor’s clothes on this and other fronts. And that’s coming from someone who’s academic work was both Marxist and Foucaultian; I totally hear you on power. Keep in mind that this is also related to the true psychedelics (MDMS is a sort-of psychedelic). Those come with their own pros and cons, but I think there is something important afoot outside the realm of patents that has the potential to help break the power relationships you’re concerned about. (Help, I said…only help.)

    I don’t assume it! I once heard a prominent physician with ties to big-philanthropy (and who, in my opinion, is stuck in a psychedelic quasi-cult) suggest the hashtag “psychedelics, the cure for poverty!” She was serious. I think she meant that they can help people self-actualize, and I suppose become the go-getters capitalism wants. (Needless to say, capitalism actually needs them to stay poor; gotta have that reserve army of labor.) So it was utter bulllshit. As some Indian guru apparently once said “A fool going in, a fool going out.”

    Still, I think it’s dynamic, the world is coming apart at the seams, things are not as predictable as they once were. And people who are suffering need help.

  • Thank you, Steve, for this helpful clarification. I share your concern about what will happen when this comes to be seen as the new silver bullet. Absolutely. I’m less convinced that this can be used to keep trauma out of the picture. MDMA therapy is all about working with trauma and, for many, making it clear that there is no underlying biochemical problem. Talk to anyone who’s worked with it, read any of the accounts now circulating from the MAPS research, and trauma, along with it’s social causes, is almost always front and center. Can you explain how you see this getting sidelined? What am I missing?

  • Steve, to my ear, this is not at all about looking away from root causes, but rather is about recognizing them and asking how injury to a once-healthy system can be healed. That doesn’t at all preclude working also on changing the social context and root causes embedded in it. If a child is being hit and having his bones broken, should we not both address the family and social context AND set those bones so they can heal? That seems to me very different from saying (to perhaps strain the metaphor), oh, my, that child has weak bones! He is diseased. Give him a daily dose of bone strengthener…that has not actually been shown to strengthen bones and has a host of nasty side effects. Just to be extra clear for anyone skimming, I’m not suggesting MDMA works as simply and clearly as setting bones! 😉

    Perhaps it has also to do with how this is theorized and described. No doubt big pharma could spin it the way you suggest, but I’m not sure they have enough interest, since it’s not patented or making money for them. No? But either way, I think it’s up to us to make sure it doesn’t get hijacked that way.

  • Jan, thank you for this thoughtful post. You are moving into a realm of helpful discussion and healthy, constructive skepticism. I have a few thoughts.

    As someone who was deeply traumatized by prescription psych drugs, I’m not sure that there is always the problem with power relationship that you describe; I certainly have not felt that way myself, as I’ve found a range of relationships and power dynamics in different psychotherapy contexts, and suspect others have, also. (I do realize there are always questions of power at play, I just haven’t found it to always be a problem.) I also think it has more to do with the actual therapist and the personal relationship than with the decor of the office; there are good, careful people doing this work, and not good, not careful people, and it can make all the difference.

    I also do not see nearly as clear a differentiation between power-laden individual relationships and supportive group work as you do. Group work with psychedelics can be really very problematic and needs to be done with just as much care and attention to power dynamics as individual work.

    I also think you’re right about the problem of people shutting down, or at least snapping back to base-line, after the experience. It’s just not a silver bullet, doesn’t work for everyone or at any time, and I think there’s a real danger of people not realizing this. One thing that I think is very helpful about the MAPS protocol is the way they embed the experience in traditional therapy. That really helps establish trust and help people go deeper and integrate the experience, and minimize the problem you describe, and I think their research is helping us to understand how best to use the substance.

    Thanks again,

    Daniel

  • It’s very late and I’m beat but I feel I really must take a minute and come to the defense of both Scott and the research and emerging field of practice he describes. I have done this work myself, so speak from both that experience, and my prior, truly awful, experience with prescription antidepressants (I lost a decade of my life to those goddamed things, so don’t think I’m not as skeptical as anyone else), and as an enthusiastic reader and supporter of this website. The suggestion others have offered that MDMA marks a continuation or simple reconfiguration of chemically-based psychiatry is, frankly, nuts. I don’t think you guys are actually reading what he wrote, and I know for sure you have not had any direct experience with this work. The suggestion that this is simply a matter of “taking ecstasy” to avoid the hard work of healing is also far off the mark–frankly, it strikes-me as fear-based, reactionary, and unthinking. If you have serious trauma to heal, work with MDMA is anything but easy. It can be, however, life affirming and insight inducing and overall profoundly healing. It doesn’t work for everyone and it is not a silver bullet for anyone, but it can be an enormously helpful way of facilitating the inherent self-healing nature of the psyche. I’m really sorry so many people have been hurt by dependence-inducing and harmful psychiatric drugs (and I am one of them, and remain, five years out, mad as hell about it), but I really, really, REALLY, think we need, unlike the corrupt field of psychiatry, to keep our minds open long enough to discern what actually works to help alleviate suffering, rather than rest on our comfortable knee-jerk reactions. As much as I respect this community and the members that make it up, I see an awful lot of that last here and hope it will change.

  • I am so terribly sorry about what happened to your daughter, and to you. It seems to me that the old treatment of using leeches to draw out poisons was actually quite humane by comparison. Simply awful, and all because of our pervasive fear of emotional pain. Any poison, apparently, is okay so long as it maintains the illusion that pain and death can be eradicated. My greatest sympathies, and appreciation for writing this.

  • Yes, I can totally see how it would play out as you describe. And it goes that way in so many fields.

    So, in academia, for instance, it’s often the people who focus on grant-writing and commercial applications who do well and stick with it, whereas many who really care about teaching publish less, and do less flashy or commodifiable research, end up as low-paid adjuncts, and eventually give up.

    Or, to take another example more germane to this discussion, and very personal for me, my father was the VP of marketing for Smith, Kline, and French (before it was SmithKline Glaxo) and was forced to retire, i.e. fired. Many years later he told me he “wasn’t up to it,” but I at least like to think he actually was too decent a man to get fired up about selling drugs. He might otherwise have ended up the guy in charge of marketing Paxil. Maybe he’d have seen how rotten things were, but more likely, I suspect, he would have been too enmeshed in the whole thing to see it clearly. So, thankfully (!), he was fired.

    Anyway, I think this sort of thing happens in many fields. It would be interesting to do interviews with psychiatrists who took different paths with this and try to tease out what caused some to maintain critical thinking and others to hop on board with the drugs.

    Thanks again, Lawrence, please keep writing!

  • Thank you, Lawrence, for another in your series of thoughtful and important articles. I won’t recount the great many things that seem to me right about what you’ve written but rather, in a constructive spirit, point to a few things that might warrant further thought and refinement.

    The first is perhaps somewhat rhetorical, but I think at this historical juncture important, namely that there are other state-sponsored religions, in addition to the rather awful one you describe. Capitalism, for instance–and of course that is intimately connected with what you describe here via the pharma-medical-industrial complex. There must be profits…

    The other relates to what in social-science jargon is called functionalism. Some years ago, in defending my dissertation, I was rightly challenged for saying that certain things “must happen” within the context of a certain social system, in the sense that there appears to be a certain systemic logic (or “functional requirement” of the system) that almost magically leads consistently to certain outcomes, outcomes that seem to satisfy what the system demands. (This problem was not new to me. I should have known better! But I fell into a functionalist trap, which is a very easy thing to do when you work with a narrative or a system that has great power.)

    So, as one example in your case, the DSM “had to be” invented to keep psychiatrists employed. I think there are risks with stating it this way. One is that something appears inevitable when perhaps it was not. Was the DSM the only option, or were there others that were discarded?

    The other is that it takes our attention away from specific people, interests, decisions, and uses of power. Was it “necessary” because ALL psychiatrists are manipulative creeps and colluded to make it happen? Or because they are indoctrinated into a system of belief and so are not aware, or not fully aware, of other options or the effects of what they do or simply of their own responsibility? In which case causation is at a higher level, but then it begs the question of whether someone made the decisions to set things up this way (i.e., in our medical-education system) or whether it’s truly at a “system level” and no one actually made a conscious decision to make all this happen. All of this, of course, matters both in terms of who’s responsible for this god-awful mess, and also in terms of what we need to do to get out of it.

    So basically, I think it could help to disaggregate, to look more closely at WHY it seemed inevitable and at specifically who did what, when, and why. Otherwise we risk assuming that either all psychiatrists are inherently selfish jerks intentionally harming their patients or that “the system” simply required things to happen this way, and the psychiatrists are just doing what they were trained to do. I think most often it’s somewhere in between those two, such that the system does tend to indoctrinate people and require certain sorts of outcomes, but also that certain people are in positions to make decisions, and to abuse power–and that last, of course, is a key point of leverage if we want to change things.

    Another reason I think this is worth considering is that, while I find your account compelling and know others here do also, it has a bit of a ring of conspiracy theory, and that may raise credibility issues for the wider audience you so rightly suggest we are hoping to reach through MIA. I think the more specific we can be, and the more careful about assigning responsibility and blame, the higher the credibility with people outside our circle here.

    I hope it doesn’t seem like I’m taking shots at your work, which I really do find important and inspiring–and especially so coming from a physician. Like you and so many others, I am angry as hell about this business and am fully in support of greatly appreciate your work.

  • Thank you, Lawrence. This seems profoundly and sadly right to me. I think it is part of the larger trend of Focualtian “disciplining” of individuals and society, as opposed to more physical and explicit–and thus resistable–forms of control. I would add also to what you write the effect of “smart” (really dumbing) phones; in addition to what is obvious all around us, I believe there is no solid research showing sharp increases in childhood depression and anxiety within a few years of their introduction. We are, indeed, in truly awful shape, as a society, for dealing with what is coming down the pike.

  • I’m sure this is true about Norman Kline, but for an indication of just how early the drug companies were pushing substances that would “tranquilize us into oblivion,” as Kline says, see these ads from the 50s from Smith, Kline, and French for Thorazine. Good for, let’s see: arthritis, menopause, “senile agitation,” “hyperactive” children, cancer, bursitis, alcoholism, pain (wouldn’t want any pain…), and, of course psychosis and scizophrenia. My mother was given the stuff for several years as an alternative to being committed. It “became necessary” shortly after her parents told her they would not support her in any way if she left a bad marriage. So, you know, bad marriage + thorazine or mental institution, take your choice. Anyway, I would imagine Kline had things like this in mind when he said that about tranqulizing ourselves into oblivion.

  • Yes, I am (despite my post below on the iceberg of trauma, which I think? you may be referring to here) also wary of that inflation. It sometimes seems like trauma is becoming the mot du jour, and overused, and so watered down, and also something a little too convenient to hang our neurotic hats on and evade our responsibility to act and change. Still..

    In my own head (from which of course all this springs), you are prompting me to realize I sometimes mean different things with the same word–hence that wariness, but also the post below expanding the definition. So, for instance, when I read the much-lauded book “The Trauma of Everyday Life,” which is basically buddhist psychology about all sorts of everyday suffering that humans are always faced with, it seems to water the meaning of trauma down. Still, I think the subtler things I refer to are also a SORT of trauma, and while more subtle, perhaps even do overwhelm one’s sense of safety and ability to cope on a more subtle, sensitive or even spiritual (?) level that is essential to our well-being? Perhaps we cannot be “fully human” even in that more subtle realm because it inhibits our full sensitivity and creativity and vulnerability? And that, in turn, I am convinced, is making it more possible for us to tolerate and contribute to a system of (bell hooks) white-supremacist-capitalist-patriarchy that really is generating all sorts of capital-T trauma? I’m not sure, but that’s what’s coming to mind. A continuum of trauma, or trauma and Trauma. But perhaps it’s just stretching the word too far? I would love a lively dialogue on this and perhaps it is deserving of it’s own post. Thanks, Wayne, for your thoughts.

  • Yup. This sounds a lot like what Gabor Mate says about drug addicts. You spend a little time with them and…duh! It becomes very clear that trauma lies at the heart of it. I’m sure there are genetic problems, birth defects, brain injuries, etc. that cause “mental illness” but they have got to be rare. There is just no way nature or God designed us so that huge portions of people would have inherent defects of this sort. On the other hand, we live in a hugely traumatized society. I refer to it as the iceberg of trauma. There’s the obvious, spoken, explicit trauma; then there’s the repressed major trauma (those two of themselves are huge); but then also consider, on a subtler level, what we’re all embedded in. We live in isolated sterile lifeless little boxes. Maybe a house plant or two, maybe a dog or a cat. If we’re lucky, a loved one or two, with whom we probably have lots of tension because we’re unnaturally isolated in those boxes, which become familial pressure-cookers. Then we go to work and sit these beautiful bodies down in stupid chairs and stare at electronic screens. In order to connect with anyone or get to work we have to hurtle down to road in two-thousand pound steel boxes, squashing frogs and squirrels and mice, more beautiful miraculous bodies, spewing poisons out our tailpipe that literally kill people and are killing the planetary home we live in, and that originate from fossil fuels from half-way around the world secured by the most violent military machine the world has ever seen or gouging through fragile arctic tundra or rainforest and running through pipelines alone which peaceful native inhabitants are beaten and tear gassed for saying, hey, this is not right. So, you know, that would do a number on a person’s psyche. Then of course we’re also told that religion, which Jung referred to as the world’s great psychological healing systems (yes, I know they have their problems; I mean religion very broadly) are simply wrong or delusional by people who are so crude as to have no concept of how metaphor or symbolism work or just how the human heart works and insist that “rational science” and capitalism combined, which, in the way they’ve been combined, are flushing us all down the toilet, are in fact going to make everything just fine. So long as we keep buying stuff and voting in meaningless elections. Yup, that would do it.

  • Wayne (and others), I thought of this recent thread and especially this question of under-reported trauma while reading an article this morning about Michael Phelps and another olympic swimmer going public about “mental health” troubles that emerged after their competitive years. I dated a woman who had been a world-class tennis player because she had been driven rather brutally into it from the age of 5 by her father. (In this case, there were also military drills at 5 a.m., so it may be an extreme case.) It gave me a real window on how some, perhaps most, hyper-achievers are essentially driven by trauma and develop an incredibly effective sheen of calm control that hides it from view, often including from themselves. Of course they have enormous focus and discipline, and this can, in some cases, come from love of the sport (or other pursuits, including intellectual, business, etc.), but my sense is that it often, maybe usually, also becomes a form of addiction and a way to constantly keep the pain of trauma at bay. In line with our discussion of underreported trauma, I often have the sense that an awful lot of public personalities, and even people we think we know well, are operating at a high level in a way that is in part trauma driven. I’d be interested in anyone’s thoughts on this.

  • Congratulations, Yet, on getting off what I call the FPs, or Fucking Pills. I was on fifteen years and it took me a solid five to get off, multiple hellish attempts before I finally pulled it off. How long since you’ve been off? I ask just because it can take a while for the system to equilibrate. Certainly it was six months for me, probably more, and some say it can take years. I hope you feel much better soon!

  • Yup, I think you’re right. And meanwhile, while I know this will be controversial here, other non-pharma substances that can really help will not be part of the picture. A friend of mine who is a palliative care nurse has, on the side, helped several people transition off of opioids with cannabis, but of course the doctors she works with won’t touch it. Meanwhile, one or a few sessions with psychedelics, coupled with ongoing therapy, can be extremely effective with all sorts of addictions. Someone above mentioned Gabor Mate, who I think is probably our best and most eloquent, and compassionate, person working on addiction. Until recently he led ayahuasca retreats in Mexico and has had remarkable success working with addicts in this way. See also the work of Dmitri Mugianis, a former heroin addict in New York who has helped many, many people with Ibogaine, and now has a clinic in, I think, Costa Rica. But those most effective treatments are on the fringes–precisely because they are not part of the pharma-industrial complex.

  • This certainly makes sense to me, Lawrence. Putting these pieces together, it brings to mind the way combat veterans tend not to experience PTSD in a severe form until they are home and out of their combat units, which is to say, when they have left the tight social group in which many or most are experiencing the same sort of trauma and where the strength of social bonds holds things together and, you might say, keeps people afloat and sometimes even quite well adjusted under the circumstances. Perhaps trauma has not increased compared to fifty or a hundred (or twenty) years ago but we are now just so isolated, society so fragmented, that we have no social container with which to hold or share our experience. That is not to suggest trauma is just fine and dandy at any point, but you remind me that we do seem be in a particularly vulnerable time. There was a recent piece in the Atlantic by a woman who researches trends in child and adolescent health and it was quite alarming; apparently within a few years of the introduction of smart phones (really dumbing phones) teenage isolation (except for constant texting, etc.) goes way up and so does depression, anxiety, suicide. So the trends are very disturbing.

  • Thank you for this very good article. I have a more general question about ACEs and wonder if anyone here may be interested. Whenever I read about that research, it always seems to me that it must seriously underestimate the problem because of the prevalence of repressed trauma, especially from very early in life. For my part, I had no idea that I had early life trauma until I had done a lot of careful work with a therapist, trying to understand why I had always had periodic and unexplained turmoil in my head, and until a family member finally told me our great secret, that my mother had had a psychotic break when I was a small child. I also think of Carol Gilligan’s work, which shows so elegantly that, while girls start feeling intense social pressure to conform to narrow gender roles in their early teens, boys get hit with this at about the age of four, and that it is especially about “being a man,” even a little one, and being strong and tough and competitive and not showing emotion, which sure sounds like a recipe for repressed trauma to me, if sometimes (often?) diffuse trauma. That is a rather brutal thing for most boys to encounter at a very tender age. I do not mean to give short shrift to girls at all; plenty there, also. Mostly, it seems to me that the ACE work must substantially underestimate the experiences that lead to later distress (and to addiction as an attempt to alleviate it) and wonder if there are any researchers looking at this, or just clinicians or others writing about it. Any thoughts?

  • Frank,

    I hear you on the problematic nature of labels and also on the risk of overusing “trauma” and becoming stuck in it rather than moving beyond it. I am concerned about this myself and while I often consider “trauma” explicitly, I often also question it and sometimes cringe at it’s overuse. But are you suggesting we should not use labels at all and that we should not look for ways to heal or simply work with whatever things are causing distress (things we tend to put…labels on)? If we do not use labels, then how can we have “anti-psychiatry”? (And what are the perils of collapsing such a wide range of views under that label?) For that matter, how can we communicate, since all words are signifiers and so, in a sense, labels? And what is this “human nature” you speak of, if not another–and I would say, seriously misleading–label?

    What if the trick is to careful consider and reflect on our terms, in community (as here), rather than claim that others’ are bad and our own are good? What if what you consider “blaming” is, for someone else, seeing clearly and coming to terms with? You refer to blaming ACEs; to be very frank, I think I hear an undercurrent of blaming in your own comment–blaming of people doing their own work in a way you disapprove of.

  • This is such an important topic, and I love Larry David as the poster child of healthy acceptance of negative emotion. It also makes me think of Barbara Ehrenrich’s “Bright-sided,” which I haven’t actually read but like the theme of–her experience with breast cancer and resisting the uber-optimistic, feel-good mantras. But it does always seem to me like the trick is twofold, both accepting the “negative” emotions (if they even are negative, perhaps just difficult but crucial guides or information signals) and also looking for the points where things can be shifted, how that information or guidance can be made best use of. This piece seems to leave out that second half, although I suppose it is sometimes true that if you accept, then the “positive,” or the solution, can emerge naturally. Sometimes…sometimes not.

  • MJMS,

    Thank you for your thoughtful comments and for sharing your story. You sound like someone who has gone through and learned a lot. I’d like, though, to suggest something different on addiction and addicts. My feeling, and my read of others’ stories, and m read of some of the emerging scientific work on this, tells me that there’s a lot more than personal choice at play, and especially that addiction stems in large part from isolation and trauma, which of course are very much related–early life (and later) trauma tending to lead people to be isolated.

    Two things I would recommend are the writings of Gabor Mate (and also his talks; a particularly good interview from Democracy Now is: https://www.youtube.com/watch?v=9nddzq8nTZg) and also accounts of the “Rat Park” experiments. (https://www.madinamerica.com/2013/09/morphine-size-cage-rat-park-experiment-upturns-conventional-wisdom-addiction/, https://www.madinamerica.com/2017/05/alcoholism-is-it-a-disease/).

    The rat park experiments are elegant and very telling. If you put a rat in a cage alone he will gobble up heroin and become addicted. If you put him in a larger cage, with an exercise wheel and other rats to play with and snuggle with, he has no interest in heroin. In my experience, this is roughly the same as with people, especially if you consider how alone and isolated people can feel even if they are physically with others.

    To put it differently, addicts will sometimes say that they are routinely in intense physical pain, and heroin is like a big warm hug that takes the pain away. If humans (and rats!) do not get consistent warmth and love as young children, and a certain amount throughout life, addictive tendencies arise as a desperate attempt to not feel empty and in pain. And when it’s intense enough, people lose a lot of their ability to choose. Or so I believe.

    Certainly there is choice in involved. (Well…maybe. There are strong neuroscientific and philosophical arguments that suggest everything we do comes from some combination of genes and conditioning and context. But still, I think it’s true that we all, ultimately, believe and behave as if we have choice.). But, for my part, I have a lot of sympathy for addicts.

    On a more personal note, I have, as things go, fairly modest addictive tendencies. (Which is of itself pretty striking, since my mother had a psychotic break when I was very young, so life was not exactly warm and loving. But I had a babysitter who loved me to death, so I really lucked out.). But in recent years I have had three short episodes, a week or two each, when I was in great pain and started to drink. First a bourbon. Then a couple. Then three or four. I could feel the pull of it strongly, but felt very fortunate, each time, to to get to a point where I saw it for what it is and to know where it might lead and was able to empty the bottle down the drain and stop drinking. (I also feel very fortunate to have had this experience and so to have some understanding of how all this works.)

    During the last episode, two nights in a row, I got as far as the liquor store in my car. It was like a tractor beam. Each time, at the last minute, I did a U-turn and went home. Both times, it was about seeing or feeling connection. Once, I saw that I could actually express the enormous, debilitating anger I was experiencing at being really quite abused, emotionally, by my partner–it was a relationship that, I eventually came to realize, was a playing out of my earliest years, so the triggers were very strong and for several years I could not find a way to leave it. (I veered away from her driveway also; it would have been too much in that moment, and just being in touch with it internally was enough–a form of connection.). The other time, I realized I could call my sister. That was it; there was an opening to connection, and the addictive drive was gone. I also saw, that night, that the relationship was much the same as the alcohol; a great promise of something good and happy, and always a false promise that, after the initial high, leads in exactly the opposite direction.)

    So of course, I made “choices” there, but I also feel I was terribly lucky to have whatever it was that made it possible for me to see those openings at the last second. Maybe it was love I got as a child, that made the addictive drive not fully overwhelming. Maybe it was a nimble brain that allowed me to process the whole thing and see those openings in the midst of great pain. Maybe it was years of therapy and learning about the importance of connection and communication. Maybe it was just something inherent and superior in me, some “will power” that allowed me to choose, but my bet is that was not it. I think I was really really lucky. I wish everyone were so lucky, and I have a lot of sympathy for those who are not so lucky–even though they can be really hard to be around and can push my buttons in any given moment and sometimes make me angry or just want to run away!

    So that’s my take and my experience, for what it’s worth. It’s a wonderful thing to have a place like this to learn and exchange stories.

    Best,

    Dan

  • There was an article recently in the Atlantic by a woman who does research on adolescent trends who sees this and a host of other major changes among teenagers as related to phones. Within a couple of years of when the iPhone comes out, kids stop doing things together and start staying at home communicating by phone and text, they get less adventurous and engaged with the world, rates of anxiety and depression go up, etc. It sounded pretty convincing to me.

  • Apropos of this, MDMA research last week received fast-track status from the FDA because Phase II trials are finding about a 2/3 rate of essentially “cure” for severe, treatment-resistant PTSD. (Participant have, I believe, all already tried at least two treatment modes with no results.). From my own experience and also looking into that work, it appears to be very signifiant, but not because it works in any way the same as current prescription drugs from the drug companies. MDMA certainly can be abused, and if so can be harmful, but it tends strongly to be anti-addictive rather than addictive, in the sense that it helps markedly to heal trauma and so reduce or remove addictive impulses (where are essentially an attempt to mask or heal trauma, to fill that gaping and painful hole at the center of one’s being). I agree that it’s unfortunate that psychedelics (and MDMA is a…sort of…psychedelic) are being, or have to be, treated this way, as a formally researched and prescribed drug, but there is also the “nose camel’s nose under the tent” theory, i.e., this may be the best or even only path to destigmatizing these substances and eventually decriminalizing them.

  • Yes, absolutely. I also share that tension between talk and action and completely hear you on the importance of the latter. One thing that has helped me over the years with that came early in my graduate work, looking at belief systems, linguistics, and discourse, and someone–Oh, it was Kai Erickson, who’s father was Eric–suggested that talk is in fact a form of action and the distinction not as great as we often think. That’s not at all to argue with the importance of “action” but I find it loosens it up a bit for me, helps me remember that talk actually “does” things in the world. I also hear you on reflexivity, thank you for that reminder.

    Looking forward to more…here…but now I’ve managed to snag three whole days of summer vacation and am off. Be well, all, and really thank you so much for the community and the forum.

  • Bueno, no lambasting here–it’s okay–but still…come on. Who’s heated here? Didn’t I explain how this discussion has been personally helpful to me? Don’t movements always need to put some effort into language? What makes a handful of comments puzzling this out pointless? And I do notice that you offer your own catchy phrase at the end. Cooly, of course. 😉

    I think you’re right about it being part of humanities’ downfall. Part. I saw Al Gore’s new movie recently and, as much as I appreciate what he’s done over the years, it was so striking, and disillusioning, to see yet another plodding repetition of data-worship and techno-evangelism. I think it’s a great deal of what gave us Herr Drumpf. And very much related to the idea that we just need to tweak the chemicals in a brain to make it “right.” All of a piece.

  • Lawrence,

    I hope I was not unduly pessimistic about “illify”! Always hard to know what will fly, semantically. It doesn’t quite have a ring for me that has legs on it, but we certainly need to work all this and see what sticks and what works. On doctor motives, I’m pretty sure the psychologist who recommended SSRIs for me was well intentioned and did not profit from it, but rather was carried away by the idea of technical wizardry and a fix for troubles he did not know how to work with otherwise. But perhaps I’m being naive? It would be really interesting to see a careful study of such people and how they come to recommend the drugs. Lastly, on the Development Dictionary, that’s one title in a large literature on the topic. Having done a lot of work in that field (environment and development) I’ve been really struck by the similarities to. psychiatry. If you or anyone else is interested I could suggest more, and have wondered for some time if some collaborative writing on this might be helpful and interesting. Thanks again for your excellent and thought provoking piece!

  • This is so interesting. I had not thought about most iatrogenic illness being more accidental. Though I’d think the pharma-industrial complex’s marketing machine is behind a fair amount of that also. No? And I do think there have been a lot of doctors with good intent but lousy insight or high gullibility who’ve pushed SSRIs. I’m not sure illification would fly; it doesn’t have the best ring to it, to my ear. I was illified? (Of course, then it would get confused with abillify!) What about iatrogenic (also awkward, but of course it sounds like SCIENCE, which people love…), which I think is strictly correct, but then more simply: “I was made sick.” Coupling the formal with the vernacular repeatedly might make the meaning of iatrogenic clear…to some. Of course, there’s still “poisoned,” but it’s a little over-dramatic and wouldn’t fly. I think toxic is a good word to get in there when possible. As in, “I was made sick by toxic drugs pushed by negligent physicians and greedy pharmaceutical corporations.” Mostly, I think this is really quite important.

    You know, there’s a wonderful book called “The Development Dictionary,” a series of short essays by many authors, from a critical theory perspective, that parses all the bullshit obfuscatory words in the international development discourse. It’s worth a look. The two projects, int’l development and psychiatry are very similar. You “find,” or better yet, create a “problem,” (always with the best of intentions) cook up solutions that end up benefitting the “helper” and not the “helped” (or target), turn it all into a big government and corporate juggernaut, and then when the solutions fail (i.e., the targets don’t improve the way they’re supposed to), you cook up more solutions, and quickly forget the failures and so miss the systemic reasons for repeated failure, and repeat…and repeat, so the whole machine can keep on going, always with some new magical solutions to fix the natives/backward/broken/etc. so they can get with the picture and become nice little compliant capitalist tools. It would be very interesting to look at the language of the two discourses.

  • Thank you Richard, I actually had iatrogenic illness in mind but did not say it, I think now because I had in the back of my mind that I’ve used that term a couple of times and encountered silence, which I’ve taken as either confusion or skepticism. Because THAT one goes directly against the “helpful doctor” narrative. But I think you’re right, it is the most accurate term and probably the best to use. I didn’t HAVE an addiction or BECOME an addict. I was made sick. Which is to say, poisoned.

  • Thank you for pointing this out. After a rather awful experience with SSRIs I have tended to want to use “addicted” because it suggests a seriousness and depth of difficulty people understand. As an addiction counselor friend said to me once, “everyone I my business knows that stuff is harder to get off of the heroin, and it’s even worse because there’s no socially acceptable narrative to draw on.” It’s not until I saw your comment here (five years later) that I saw, aha, right!…”addict” comes with a whole other layer of stigma. But then there’s also the new (and I think right) view of addiction as mostly a response to trauma, so not a “weakness” so much as a normal response. So anyway, it’s complicated! But for me, overall, I’d prefer to go with addiction over dependency, just because it suggests a certain magnitude.

  • Perhaps so regarding speed, but this is not at all right about acid, which is profoundly anti-addictive. Bill Wilson, the founder of AA, wanted to make LSD a part of their recovery program but his board, probably rightly, felt it was a bad idea politically. Recent research in Scandinavia has found lifetime use of psychedelics negatively correlated with mental health issues. And so on…

  • This is good to see. I haven’t read it, but think Barbara Ehrenreich’s “Brightsided” is probably very good on this also–she is always smart and insightful.

    But this also makes me think we should be cautious about a simplistic view of this as though either gratitude ingratitude (really, I think it’s more grieving here no?) is the “right” thing. Isn’t it more a sort of dance? Letting in the things that have been harmful, being honest about how they are and how they feel, and yes, getting in touch with the anger and grief without any happiness bullshit. But then also finding gratitude for what is left, whether it’s little things we take for granted or the great blessings we are able to find. Doesn’t it take both? To avoid the temptation of being angry and bitter and also of being a smiley-faced Pollyanna? And of course we may need to have phases dominated by one or the other.

  • Lawrence,

    I appreciate much of the content of your post, but, like Richard, I also am concerned about your dismissal of the actual chemical and biophysical effects of these drugs. I cannot claim to know Kirsch’s work terribly well, but I’m pretty sure it is not right to say that he proved SSRIs only have placebo effects. I believe he showed that, at the level of a population (on average, you might say, or statistically speaking) that the improvement in depression is largely about placebo effect. That’s not at all the same as saying they don’t have real effects at the individual level. Robert Whittaker describes them as likely not rebalancing an unbalanced system, but rather as a more random perturbation–essentially, shaking things up–which to my mind would help explain why they can have such variable effects in the short run, ranging from major improvement in mood (and yes, of course, placebo is probably big there) to abrupt shifts into suicidality and probably homicidality. (On a personal note, coming off the drugs, I felt the emergence of an unprecedented inner rage for a day or two that I really don’t think could have been about placebo. I know I am not alone in experiencing that sort of major mood swing). See also Whittakers discussion a few years ago in these pages on reverse tolerance, which I think is a pretty good theory regarding the very real chemical withdrawal effects. Finally, leaving the realm of mood, I believe sexual side effects (the most common side effect) run around 65 – 70% (yes?), which I think exceeds by a good margin the realm of placebo effects Kirsch describes, and it would also be rather odd to find such a strong “placebo” effect in an area that is not at all part of the rationale or hope associated with the drugs. Then of course there are other side effects, and an awful lot of personal accounts of rather awful physical withdrawal symptoms that lie well outside the realm of worsening mood tied into a collapsing placebo effect.

    So, that’s my concern and I’d be interested to hear your thoughts. More generally, I really do appreciate the larger point you are making, so please keep working on this!

  • Yes, bc, I think that’s exactly right. They are catalysts for experience. In that sense, vis. addiction, they often function in much the same way as finding a “higher power.” Religion, AA, psychedelics are all ways of seeing something bigger than ourselves and taking the enormous pressure off of wounded egos and connecting to something bigger in the world, and to love.

  • Thank you for adding this about social context, Richard. I would add that psychedelics have a potential role in this, in that unlike prescription psych drugs, they can help people to think more freely and break out of the sort of constraints and conceptual (and material) oppression you’re referring to. They certainly tend to shift people from power to love. But that freer thinking is not always the case, or doesn’t always lead in anti-oppressive directions. They can also simply reassure the privileged by introducing superficial “free thinking” without any real critique of social oppression. I also have pondered how the power of psychedelic experience may play into our addiction to spectacle and so keep people on that treadmill–it’s always got to be bigger, more spectacular, more mind-blowing, whether it’s a car chase in a movie or another psychedelic experience. So, as you and others have said here, it’s complicated and variable and I think these things require not only medical and psychological carefulness, but elucidation of social context and oppression and how we deal with that. All the more reason for these discussions. Thanks again for your thoughtful post.

  • Robert,

    I’ve appreciated so much of your writing on this site, and agree that the current resurgence of interest in psychedelics warrants scrutiny. But I find some things here troubling.

    Your suggestion that psychedelics have been put forth as a cure for supposed chemical imbalance is completely at odds with both their pharmacology and how proponents (and even opponents) describe their mode of action and effects. This suggestion is not even in the ballpark and, at least for me, raises questions about other aspects of your account and the sort of bias you may be bringing to the discussion.

    As for their usefulness and safety, I think it’s safe to say that there is great variability. Personally, I’ve had considerable experience and found them very helpful at certain junctures and also encountered some serious problems when they’ve not been used carefully. Let me offer a few examples.

    I spent four years working with a careful, and chemically very conservative, therapist trying in vein to get off of SSRIs, which I never had any great need for but was told they would just make everything better (cf Peter Kramer; I was supposed to be “better than well.”). But after ten years on them, I could not get off. Or more precisely, every time I DID get off them, within a month I would enter a dark depression far, far worse than anything I had experienced before the drugs and it would go on for months until finally I had to start up the drugs again. But they were slowly killing me, emotionally and physically. The last thing I had to try was guided work with MDMA. I did just one session and it worked, not by shifting any “chemical imbalance” but by re-opening a window on authentic emotion that I had lost years before and so giving me hope and soul susteneance. Staying off SSRIs was still very hard for months, but that work got me over the hump. I doubt I would have been able to do this without pschedelics; my therapist, who I am still working with, agrees. I shudder to think what I would be like without it. Well, I know: I would be fat, asexual, and emotionally numb.

    I did, however, make the mistake after that of getting involved with a “therapeutic” and “shamanic” community that was not at all good or careful in it’s use of psychedelics. The work was very free-form. Unlike the careful and controlled work being done in some quarters, you had many people in various states of experience with various substances roaming around or huddled up together. I think some people were helped. Others had some really interesting times. It was not good for me, and I’m sure for some others. Finally, after a year, as I was sliding downhill, someone pointed out to me that in such settings psychedelics can be re-traumatizing. As she said to me, “you never know who’s going to come by and drop their shit on you when you’re in a deep and vulnerable place.” I learned that the hard way and it took me a year to work through it all after getting out of that community. One of the reasons I got involved and couldn’t see the problems for almost a year is that this group included many highly reputable and esteemed professionals. Doctors, lawyers, philanthropists, therapists. And a couple of very talented, even brilliant, neo-shamans who were, in my view (retrospectively) quite reckless. But my normal avoidance of flakeyness and carelessness was overridden by all that prestige and by the very powerful experiences involved. I mention this and offer those details in support of your suggestion that this sort of work begs critical scrutiny. There is, indeed, dangerous and damaging stuff happening in the psychedelic resurgence. I did not however, encounter anything even close to the sort of psychedelically-induced scizophrenia you suggest is so common. In fact, now after five years of substantial familiarity with this sort of work, including attending conferences and consulting with many researchers and practitioners, I have yet to even hear of a case like that. I’m sure it has happened but I think it’s pretty darned rare, and about unheard of when the work is done carefully.

    Lastly, I will say that since then, I have participated in a few ayahuasca ceremonies with a very careful and skilled practitioner who has trained extensively with native Peruvians. To give one positive example of what is possible, after several years (since I got off the SSRIs and started to become aware of and to work on underlying trauma) of waking almost every night in a sort of tense, wrestling panic, during one experience I was able to go back and see my earliest trauma, which was very intense and had a feel very similar to those wakings in the night, and to bring my own adult kindness and love to my very young self. That was almost a year ago and I have not woken up in that way since. At that point, I had been for seven years in the sort of careful and caring therapy that you and I both believe strongly in and that has helped me immensely. Would another seven years, or ten years, of therapy have eventually healed those very early wounds? Maybe. I don’t know. But I do know that psychedelics helped.

    My point is simply that, despite limitations and problems, these substances have legitimate uses and help many people. I hope the best minds and souls in psychiatry and psychology, like your own (and I really mean that), can at least stay open to these possibilities, even while bringing much needed scrutiny to this realm.

  • In addition to the above, notice that there is also the assumption, later in the article, that there still IS a genetic component to depression, even if not the particular (serotonin) gene they looked at. I can certainly see how there may be a genetic component but I have my doubts about whether it’s as clear as suggested here. Does anyone have a read on that?

  • Her description fits my experience pretty well, except it was in a way even worse because I had an initial period (a year or two, maybe even less) when life really did feel better, and then all the bad things crept up on me and I couldn’t get off the stuff. It took me five years of trying, maybe 6 or 7 attempts, until as a last ditch effort I tried MDMA therapy, which opened enough of an emotional window (e.g., I could actually feel sadness at my father’s death a few years prior) to give me enough hope to get over the hump. Interestingly, Julie Holland is a medical supervisor for research on MDMA therapy for trauma–so in my view, she is getting everything right! (Except maybe the description of serotonin theory, which from what I’m reading here maybe simplistic.)

  • Thank you, James. This is such an important theme, and very nicely laid out here, and really inspiring.

    It also converges with some of my own recent thoughts and I thought I’d toss out a bit of writing I did just a couple of days ago–perhaps these musing on emotional pain will be interesting along with yours on physical. Here is what I wrote, with the main point starting in the second paragraph. The only thing I’d add is that antidepressants kept me from realizing all this for many years by tamping down pain that needed to be felt.
    – – –
    Sitting in silent meditation at Quaker meeting, what arises in my mind, up through a peaceful stillness, is a thought exercise I use to help my students in environmental studies see the importance of alternate perspectives, even on issues that might seem clearcut. The exercise goes like this. Climate change is the one issue that all of us should be able to agree must be a top priority— right? There are, of course, “climate denier” close to home, often with ulterior motives, but consider also, I say to my students, that you are a young child in a poor country and you spend your days, long boiling hot days, scavenging through the steaming stinking piles of a giant garbage dump, a landfill that holds the worthless refuse of millions. You do this to stay alive, perhaps among orphans, a small society of small people, or perhaps to help your family in the only way you can. There are many real children who live such lives, I tell them. Consider what you might say, if you were such a child, about a looming climate catastrophe that can not be seen or felt but only imagined according to the warnings of scholarly experts with great computers in faraway places, projected out in decades that exceed what is likely to be your own short life. That child inhabits a personal universe that is a small subset of the Earth, which in turn is a small part of a much bigger universe. So: what matters? It all depends. We are not as right as we like to think. I use this exercise not to argue against the importance of climate change, but simply to suggest that we should always consider, and try to imagine, the experience and feelings of others, especially those who have, through sheer bad luck of the draw, not ended up in positions of privilege and power, as we have.

    I am surprised to find that what comes next to mind is something very personal and even more uncomfortable: that we must become aware of our own pain and that I must, in some fashion, speak of my own pain, out of my own little universe, even knowing that there are far worse things happening elsewhere to others. There is no particular reasoning behind this thought, just an intuitive clarity. And suddenly a voice that is both my own and not my own, that comes from inside and from outside all at once, says, deep, driving, powerful, echoing—I can feel it vibrate through my body—“How dare you?” How dare you suggest such a comparison, how dare you elevate your own suffering in this way? And another voice, this one entirely my own, pushes back against that thunderous mountain of prohibition and says, with a much quiter force, “No, we must do exactly that; I must do exactly that.” It is the still, small voice from the bible that my mother used to speak of and that I have heard mentioned at this meeting.

    In the moment, that is as far as it goes; it is simply an assertion, contrary to my own patriarchal conditioning, that all suffering matters and must find a voice—not necessarily loud or public, but some meaningful voice. Later, what comes to me, in relation to my own work with environment and social justice, is a quote from Lilla Watson, the Australian aborigine artist and activist. She says, “If you have come here to save me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together.” If we are not in touch with our own suffering, we will always be coming at those children from above and it is no good. Related but more fundamental is the emergence of our own otherwise burried humanity that comes with the ability to feel and express pain. Pain is the dark night to the bright daylight of joy, and without that contrast neither one would exist in our experience. Pain is what tells us something is wrong and needs to be changed, or what needs are not being met, and so it is something to listen carefully to. Pain also, when unrecognized and unheard, tends to burrow down into the Jungian shadows and to morph into malignancies, aggressions that must go either inward, into self-destructive depression and neuroses, or outward into the world. As Bruno Latour has written, “The repressed returns, and with a vengeance.”

  • This is the same Governor Shumlin who penned a New York Times Op Ed arguing against FDA approval of Oxycontin for children, right? My sense from the kerfuffle that editorial sparked was that it’s…arguable…since there are some cases where it can actually be very helpful for children in intense pain. Really, I don’t know enough about it, but there’s something pretty interesting here about a physician-governor who wants to prohibit a drug that may be helpful in some circumstances while promoting the forceful administration of another drug against people’s wills. Is this what happens when you merge physician-authoritarianism with political power?

  • Thank you for this response, Robert. Your account certainly resonates with me, and in fact I have my own experience of SSRI-withdrawal very similar to what you describe. I’m afraid, however, that the thrust of my question seems not to have quite come through. I am especially interested, as someone with only a cursory understanding of the science involved, in how certain we can be of the dynamic neuro-chemical aspects of the model you present. My understanding has been that we simply do not understand with any great clarity how serotonin operates in the brain with regard to mood and emotion. I believe you are suggesting otherwise, that, in fact, it is very clear how it operates. Is this right?

    This seems a very important question to me. If it really is this clear, it would help to know how and why, to know something of the scientific basis of your account. If it is not that clear, I would think we should maintain more flexibility and openness and still consider other accounts, as compelling as yours is.

    Best,

    Daniel

  • Robert,

    What you say seems intuitively right to me, and I appreciate the artful attention you give to your writing. Could you comment on the degree of confidence you have in your description of the neurochemistry involved? I read in these pages and elsewhere that there is virtually no evidence for the idea that a serotonin deficiency or imbalance causes depression. Is there clearer evidence for the more nuanced processes you describe?

    To my ear, the psychological dynamics you outline sound very much right, but I’m not sure if the details you offer are simply known and correct or if they are more speculative, and I wonder what the implications of that question may be for people for whom extensive therapy has not alleviated severe depression. Personally, I think that most people in that situation have not had very good or the right sort of or enough therapy, but I also think (as much as I hate to agree on anything with the remarkably rude and clearly very angry Dr. Hassman above) that we need to pay close attention to cases where therapy has not worked. I am especially concerned about people who had intense early trauma that inscribed especially deeply those warring synaptic pathways you describe and affected brain development in other ways–what some have considered a form of brain injury. This raises, I think, questions regarding the potential limits of talk therapy; the role of faith and religion (which I think can help some people transcend these questions but opening up higher realms of consciousness); and whether we should be completely closed to the possibility of chemical or neurological approaches.

    Thank you for your response and for your writing,

    Daniel

  • Thank you, David, this is very helpful and important. The flip side, of course, is that we live in a world of constant alienation and low-level trauma. Consider the typical isolation of American households, and the fact that to connect most of us must get into two-thousand pound chunks of steal that indirectly kill people across the globe and directly flatten creatures along the road. We need connected, loving, respectful alternatives at all levels.

    You remind me of a beautiful piece of writing by Barry Lopez that I will share here. It’s a story called “Traveling with Bo Ling,” about a Viet Nam vet and the Viet Namese woman he married and who was disfigured in the war. Here is the end of the story.

    “The wages of trauma, as I have written it out in my life, is anger. The resolution of that anger, say the therapists, breaks the grip of the traumatic event. But to resolve the anger–and this I got onmy own–it’s necessary to love. It’s not enough just to arrive at a place where no one, not even yourself, is to blame.

    You have to go further.

    For several years now Bo Long, from her own perspective, has also been telling me this. To wash out the anger, she ways, fall in love. Be in love with peach, she says, its summer juice running down your bare chest. Be in love with the sound of your brother’s truck as it pulls up to the curb on a summer night with supper just ready on the table. Be in love with me, she says, when my fingers move slowly across her small belly.

    Reengage your innocence here, in the Dresden of my face, she says.”

  • Yes, I see that you are questioning the mechanism. I suppose we could both continue repeating “it’s all placebo” and “it’s not placebo,” but that feels to me disturblingly similar to “it’s all chemical imbalance.” There are a host of empirical “objective” studies anyone can find, just look them up or go to the citations of the meta-analysis referenced above and others listed in the book that Steve1930 mentions; I’ve looked them over and believe (as someone highly skeptical of drug approaches) that I see an effect strong enough to suggest something more than placebo. I understand that you disagree, but I’m not seeing a response to the specific points I’ve made, rather just a continued assertion of your belief.

    But also, I think demanding “objective” results in the forms of quantitative analysis is not the answer. “Statistical significance” is important, of course, at the population level (if the research any good), but that’s all about averages. Suffering happens to individuals, not populations, and treatments have variable results, especially so in this realm. So I think it’s important to also look at clinical experience and individual variation that controlled trials generally do not account for–I think we need to look at both, and to consider SUBjective evidence, as well as supposedly objective evidence (it can only ever be “relatively” objective, there is no such thing as purely objective). It’s all imperfect, there is no evidenciary silver bullet in this realm, or at least that’s my view, and it’s why I feel it quite important to stay open to possibilities, even as we can (I hope) agree that the big-pharma juggernaut has done enormous harm–please know that I am with you on that. Differences aside, I think we’re all mostly after the same thing here and so the more dialogue, and disagreement, even (!), the better, which is why I’ve tried to be specific and give others something to respond to.

  • Spatler, I agree this is important and perhaps I’m not giving enough attention. But is it not possible to write off just about everything this way (hey, maybe setting a broken bone is just placebo–I mean, where’s the double blind trial?) and is it not worth a little closer consideration than simply assuming any effect people find is placebo? My take is based on what I believe are pretty consistently strong positive effects with both infusions and low-dose, oral and adminstration, including a few trials with hospice patients using very low-dose oral for both pain and depression, a situation that would hardly indicate major placebo effect. Overall, the effect certainly seems much stronger than, for instance, SSRIs, which, even if you exclude negative results (as drug companies have done), are barely better than placebo–I think we could agree on that.

    But there is also perhaps something to look inductively vis. the experience of individuals. The accounts are pretty persuasive on a human level–do you feel they should simply be ignored? I mean, what WOULD you say to someone who has suffered for years, tried everything else, is pretty much crippled, and finds ketamine really helpful? Is that simply invalid in your eyes? Why not consider possibilities outside our own personal experience?

  • I would like to offer a few points of clarification and a minority opinion–I hope that ketamineclincics and steve1930, especially, might read and respond. For starters, I am deeply suspicious of psychiatric drugs (and have been massively harmed by them myself) but feel it is important not to throw the baby out with the bathwater and believe ketamine has real value.

    I think the most important point that is often missed in these discussions is that, while the chemical imbalance theory is a terrible fallacy that has caused great harm, there are still biophysical issues at play. Intense abuse or neglect in childhood causes what can be considered a brain injury. For some people, psychological difficulties and historical trauma do not heal and progress the way they do for others–these are the people who seem to suffer endlessly despite trying different approaches, drug and non-drug. That doesn’t mean assisted brain-plasticity (which I believe is essentially what ketamine does) is necessary for everyone, or always necessary for anyone, but I think it is a serious mistake to simply kick this substance out with a jerk of the knee, given the fact that there really are people who’ve been suffering terribly and cannot find relief elsewhere. (And also that ketamine has been used at low doses for chronic pain for years and so far appears to be pretty safe.) Personally, I feel it can also be very helpful for people not in that category, especially because it does not inhibit psychological healing and growth the way most other psych drugs do, but can actually make it more possible, and thus does not necessarily need to be used long term. (There’s a recent issue of the journal of transpersonal psychology that speaks to this.)

    As for the article cited here, aside from conflicts of interest mentioned above (of course drug companies want to diss ketamine, it’s off patent and not a money-maker), it doesn’t really offer much, to my mind. I don’t think anyone working with ketamine these days would suggest that a single infusion can be a cure–that’s what the article seems to be evaluating, and it’s beside the point. From everything I can see, and I’ve looked at this carefully as it has evolved, ketclinics, above, is right that multiple infusions can give more lasting relief and periodic later infusions can sustain this for many people, as can more regular use of low doses–which really don’t have the addictive potential alluded to above (we’re talking tiny, tiny amounts compared to addictive street use).

    I also think Steve1930 (who is maybe Steven Hyde?), above, is right that low-dose ketamine is a very important alternative to the expensive medical procedures done at clinics. The book he cites discusses alternative (minority) research using very low doses, and also several doctors and researchers who’ve been working in this mode with considerable success. So why is this approach not even on the radar screen for most people in the states? I suspect it is some combination of war-on-drugs paranoia, the clinics being profitable, and perhaps some a priori assumption among researchers that high doses are necessary because ketamine’s primary use as an anaesthetic uses even much, much higher doses. And perhaps drug company influence–cf. the article at issue here.

    The book, “Ketamine for Depression” is self-published, so that does raise some concerns, but it appears to be an attempt to get the information out quickly and gives a thoughtful account of previous work that to my eye hangs together pretty well.

    So them’s my thoughts. I realize this could turn out to be a dead end, or worse, harmful, but I honestly don’t see much evidence of that, especially given how effective ketamine appears to be–it’s dramatic enough that I can’t see it as placebo at all. Mostly, I think it’s awfully important not to dismiss alternatives out of hand when people are suffering.

  • The first few times I tried getting off Zoloft I did the standard, relatively fast taper and each time I would have a couple of days of really intense anger. Every time I hear about one of these shootings I remember that and can very easily imagine how someone more troubled and less regulated than me, and less supported, might move into a violent state.

  • Corinna, I love this. Very clear and helpful. The only thing I wonder about is the centrality of changing brain chemistry and how that may, for some, tie into the “chemical imbalance” myth. Are there maybe other sorts of changes to include? I hope that does not seem critical–I really like it very much!

  • I’m going to chime in here, although more briefly than regarding a similar post last week–if anyone wants to see more of my thoughts (including the basics of how ketamine actually works) they should be easy to find there. Basically (don’t shoot!), my take is that ketamine has the potential to be very helpful to some people and I want to be careful not to throw the baby out with the bathwater on this one.

    I do not trust the pharmaceutical industry one iota. I firmly believe that most psychiatric drugs are harmful to many and perhaps most of the people who take them. I certainly have experienced that harm myself, and am angry as hell about it. I also am very wary of where the ketamine thing may go once a derivative is patented (please note that ketamine itself is not, and not a money-maker for big-pharma)–as someone last week pointed out, that may well open the floodgates wider to the “it’s all chemical” crap.

    However. There are people suffering horribly from intense, crippling depression, which of course can be fatal. Many people in that category who have tried ketamine say they have found remarkable relief, and with a substance that is only used periodically for very short intervals, not continuously like current psych drugs, and that, at least in the short run, does not have the nasty side-effects of other drugs. Maybe it really is a bad thing, and if there is specific information pointing in that direction I very much want to know about it. But my feeling is that we should stay open to the possibility that this may not be the same as what we have seen before, and especially to things–anything–that might be helpful to people in great pain.

  • Suzanne, either way, I really do thank you for finding that and helping me to see how there could be some unfortunate outcomes with this down the road.

    By the way my earlier comment should have said “discourage non-drug approaches and ENcourage happy-happy social conformism.”

  • Well that is alarming. I do think they’re wording is more tentative and nuanced than you suggest. Still, they’re tapping into this myth in a way that does make me worry, down the road, once J&J or whoever develops a derivative without the dissociative effects for at-home use (I believe that’s where they’re headed), which of course they will then patent and market like crazy (ketamine itself is not patented, or it has expired, so there’s no big-pharma there) that this will then put it into the mass-use pipeline. Even if it proves to be significantly safer and more effective than SSRIs (which seems pretty likely to me, that will then perpetuate (“prove”!) that “chemical imbalance” is the root of all troubles and discourage non-drug approaches, happy-happy social conformism, etc.

    Thank you for digging that up.

  • Prisoners,

    What you point to seems very important, and, from my angle, certainly argues that such substances are not for everyone, or for anyone all the time, and should be used with care. I have not seen what you describe, though I’ve assumed it is out there, but I have seen something perhaps related, where people seem to feel their experiences, because of the great intensity, have given them a direct pipeline to divine truth and can get rather screwy in their thinking. I think it’s important to make sure people know about such risks in the midst of the current resurgence in psychedelics and the tendency of many users to assume that, because they are safer than other drugs, they are therefore totally safe.

    It still seems to me, however, that you have a very particular, and in important ways limited, window on this. Going back to the question of anecdotes and qualitative accounts, it seems a safe bet that we should not extrapolate from an addiction clinic to the larger population, since the latter is a far, far more varied and diverse set. Then there is the question of your own personal interpretation of what you have seen, and especially what to do with the accounts of other addiction specialists that diverge from your own. That would include Bill Wilson, founder of AA, who was in favor of making psychedelic work part of the protocol there (his board, rightly, felt it would be too controvercial); Gabor Mate, who has spent years in the trenches working with addicts and finds ayahuasca to be very helpful in treating addictions and psychic healing more generally; Dmitri Mugianis, who broke a decades-long addiction to heroin with the help of ibogaine and has gone on to work with many addicts in this vein in New York and elsewhere; and Jaques Mabit, a French M.D. and addiction specialists who runs a clinic in Peru that has high efficacy working with ayahuasca. Then there is the work of Teri Krebs, in Norway, that shows in the general population a small positive relationship between both recent and lifetime psychedelic use and mental health status. Also recent work from Rowland Griffith’s lab at Johns Hopkins finding about an 80% success rate using psilocybin in a smoking-cessation program.

    So, what to do with all that? Ketamine, of course, is not the same, but I believe there are similarities in the way the debate plays out.

  • Dear PD, I think your experience may be with a limited set of drugs and drug users. I can say from my own experience that, to take the example I’m most familiar with, psychedelics can help to facilitate profound healing, and I know many others who have had the same experience, and therapists who have worked with the substances to the same effect, and we can now add to that careful, nomothetic (non-“anecdotal”) research in the past ten years by scientists who’s work runs entirely counter to the interests of big pharma and mainstream psychiatry. All this can, of course, be dismissed, as anything can be, out of hand, but my feeling is that it is better to actually look at the evidence that does not fit what you have outlined above. (It may not, in the end, mean what I think it does, but we can only establish that if we actually consider it with an open mind.) I also disagree that “anecdotal” equates with being not realistic, as you suggest. There is a fine line between anecdotes and inductive research or more broadly inductively-produced knowledge. The problem lies only in confusing the two–which would happen, for instance, if you took the experience I mention above and try, mistakenly, to come to a quantitative/statistical conclusion about overall effects across a population. To take one example, I doubt Darwin ever did a double-blind trial or statistical analysis. His work was primarily inductive, it used careful “anecdotal” observations to examine and make sense of patterns and processes. He learned some pretty interesting things that have held up to scrutiny over time. To dismiss this dimension of the larger research process, or simply of human understanding, seems mistaken to me.

  • Sure. The standard treatment, and what most research has used, is a 40-minute IV drip in order to get steady and controlled release into the bloodstream. This seems to be at least somewhat important to causing a sustained and effective elevation of BDNF. (I believe it’s more complicated, that’s my shorthand and I think the essence of it.) Some people get lasting or even permanent relief with one treatment, but that’s rare–probably extremely rare for “permanent”. More commonly people will get relief (when it works, about 70% of the time) for a few days to a few weeks. Typically, people will have several treatments over a few weeks to get cumulative effect, and then maintenance treatments everywhere form a few weeks apart to six months or a year. The more people develop healthy, fulfilling lives, at this point, the less frequent maintenance needs to be and the higher chances of full recovery with no maintenance. (Personally, I see it as ideally a spingboard to being able to deal with depression without drugs.) A crucial point, of course, is that ketamine is in your system for a very brief time. I do not at all assume there may not be potential long-term side effects, but it does seem to be a much safer and more benign thing than traditional psych meds.

    There has also been a bit of research suggesting that intranasal delivery (nasal spray) can be effective, and some patients report it so, but it’s trickier because a) bioavailability is variable so dosing harder to determine, and b) there is then, with a use-at-home prescription, potential for overuse. Pills are also possible, but bioavailability is even lower (though more consistent than nasal) and potential for abuse seems much reduced because effects are milder. There’s been some research using oral for hospice patients, to relieve end-of-life anxiety and depression, and it suggests pretty good results for this. (I’d emphasize it does not dope people up the way benzos, often used in this context, do. It seems to maintain normal emotional status and awarness. My partner is a hospice nurse and strongly anti-drug but feels ketamine seems like a helpful tool in these situations.

    Then it can also be used intramuscularly (injection) and there are a few papers from India, very preliminary, showing good results with that for acutely suicidal patients. (And we really are talking here about people who could be dead soon, who are actively looking to kill themselves and try this as a last resort.) Of course, with these other methods, there is real overlap with recreational use and potential for abuse. I think that’s part of why most places limit treatment to supervised IV. Problem is that’s very expensive and not now covered by insurance.

    So that’s the lay of the land as I see it.

  • p.s. I know ketamine is used “recreationally” as a street drug, but just to add that if you read the accounts of people who’ve had therapeutic treatments you don’t get this impression at all. Some people find the experience neutral, some refer to “side-effects” as a negative, some find it pleasurable, some find it opens up a space where they get fruitful insights into their own consciousness. Most of them are focused on the after-treatment (after-high) effects and seek to have the treatments as infrequently as possible because of the time and money required.

  • Thank you, Ted, I appreciate this very much. And also know that sometimes my skin gets a little thin, in a way–partly because I yearn so much for connection and dialogue on these things–and in fact I often do find it here, earlier protestations aside.

    My own distrust of and antipathy to drug companies is considerable. Largely because I was hooked on Zoloft for fifteen years and spent another five agonizing years getting off it and am still digging myself out from that hole. But also, my mother was “psychotic” (?) and was given Thorazine when I was a child. (The alternative she was given was hospitalization.) My father then ran marketing at Smith Kline and French (now SKGlaxo), which makes Thorazine. (To see some truly alarming ads for Thorazine, which fortunately I think mostly pre-date my father, see: http://www.whale.to/a/chlorpromazine_ads.html) My father was later fired from SKF. He considered it the central failure of his life, whereas I now believe he was actually too decent a man to make it in competition with sociopaths.

    So. No big-pharma-love, or trust, here! Still, I disagree with your assessment. Ketamine has anaesthetic, dissociative, and I believe some psychedelic qualities. It certainly can have very intense effects when used in high doses (depression treatment does not; the dose is tiny compared to anaesthetic use) and can be abused and result in addiction, no question. In a sense it gets one high, but not at all in the way heroin does or even, I submit, in the way most people think of as getting high. If we broaden our definition of high, lots of things get us there: cannabis, alcohol, various plants and funguses (which both animals and people have been intentionally ingesting forever), and also things like (this may evoke ridicule from some, but I will say it anyway) lots of exercise, being in love, sex, breathwork (pranayama, holotropic) and being a child. (Andrew Weil argues cogently that children live in an essentially “high” world, where conscious and unconscious have not yet separated…and that many drugs mimic this effect.)

    The main thing ketamine seems to do therapeutically is to increase BDNF (brain…derived?…neuotrophic factor), which stimulates the growth of brain cells and synapses and increases brain connectivity. This effect is very similar to what happens with exercise, learning, occasional fasting, and social engagement. The effect is simply stronger with ketamine, and this appears to have a profoundly positive effect, not in dulling feeling, but in shifting it away from intense depressive and anxious states that typically come with having had intense physical or psychological abuse as a child–which, I think it is clear, result in major changes to brain structure, what is effectively a form of brain injury and connectivity deficit. (There is a Dr. Brooks in New York who works with ketamine and has found that the vast majority of his patients have this sort of background.) People describe being ABLE to feel for the first time in ages.

    Of course, this may all turn out to be untrue. (I have yet to observe a synapse growing, so as with all things like this, full certainty is elusive!) But I do believe there is a lot more solid evidence on this than there ever was on, say, the chemical imbalance shibboleth–which I think you and I would agree has done immeasurable damage. And I think ketamine is significantly different from the other drugs you mention. I may be wrong, but that is my best judgement so far and I want to learn more.

    Lastly, I think this is about more than people being unhappy, that the sort of distress we are talking about here is much, much more than that, and that we can’t assess ketamine without keeping that in the forefront. For people who are “unhappy” I agree this is not at all the answer, and in fact may be seriously counterproductive.

    Oh, and really lastly (!), I considered ketamine last winter and decided to try a combination of the activities I mentioned above as an alterative approach to what I’ll call the BDNF factor. It’s been great, and I’ve lost ten pounds, too! I think the biggest thing has been intermittent fasting–not hard really, just going for at least 16 hours (including overnight) a couple of times a week. It seems to mimic the conditions we mostly evolved under and to be one of these paradoxical things where a little low-level stress does wonders, in this case by stimulating various body systems to go into repair and rejeuvenation mode.

    Okay, that’s the end of that tome, thanks for listening!

  • Needless to say, the wool question was rhetorical. What I would posit is that the level of uninformed certainty in comments like this, above, is remarkable similar to the smugness we all have heard coming from psychiatrists and drug companies. For my part, I will go with another approach altogether, one that actually leaves ideological baggage at the door.

  • Seriously? No, I would not force ketamine, or any substance, (or anthing) on a patient. Nor would I keep it from any patient who wanted it for legitimate purposes. I am a strong believer in personal choice, and in cognitive freedom of all sorts.

  • I really have to protest. In this community, do we want to be known for hurling around insults, presumptions, stereotypes (including racially-based, above?) Or do we want to have thoughtful discussions?

    More specifically, I have read accounts from and spoken with seriously depressed people who’ve used ketamine therapeutically. I know people who use it occasionally recreationally. They do not bare the slightest resemblance to the fear-based stereotypes above and that I’ve seen previously on this issue here. I know it can, like any consciousness altering substance, become a problem for some people, and I think that requires thoughtful attention, as does the possibility that ketaminee, like other psych drugs, will draw attention away from non-drug alternatives, which I agree should be the principal focus of treatment.

    But I also would like to have an intelligent discussion on this and hope someone will join me.