Blue Dreams

by Lauren Slater

  Once the 1950s were over, though, the discoveries dried up, with the bright exception of clozapine, a drug to treat schizophrenia, and the SSRIs, which Peter Kramer came to call cosmetic medicine, a drug that could dull the jagged edges of an irritable person, a drug not for the person but for the personality, a designer drug that could help people be bolder, more charming, more patient, nicer. Of course that’s not all the SSRIs did. Although they were and perhaps still are used abundantly for all sorts of minor ills, they also gave people like me a shot at a regular life, a life lived outside of institutions. But as we’ve seen, when compared with the tricyclics, the SSRIs were found to be no more effective in treating anxiety and depression, and they could also cause suicidal ideation. Meanwhile, they continue to be used in relative ignorance, as no one seems to know what their long-term side effects are. In other words, the Holy Grail has not been found.

  It could be, however, that psychedelics, long used as sacred drugs in more shamanic cultures, will bring us closer to what we are always seeking: peace of mind. These drugs are so powerful that they can actually cause love, as is the case with MDMA, which also appears to help autistic people—those locked in the box of their brains—enter into dialogue with the neurotypical world. Ayahuasca and psilocybin both have proven to be very effective at treating addictions, as these psychedelics allow substance abusers to powerfully experience just what their behavior is doing to them and those within their circle. There is more than a little irony in the fact that psychedelics, considered evil and dangerous drugs by the DEA, can help addicts relinquish highly addictive chemicals such as opium-based concoctions like heroin and fentanyl, the very boogeymen at the center of our ill-conceived War on Drugs.

  Our next golden era of psychopharmacology, I predict, will be with psychedelics, drugs not discovered but rediscovered, drugs so pure and powerful that they crack the thin veneer we call reality and show us a show the likes of which we do not forget. Psychedelics may be more potent in treating many psychiatric disorders than anything we have right now, and in some strange way they reunite us with the father of psychoanalysis, Sigmund Freud, who believed that awareness was the vehicle by which we could be cured of our ills. At once brand-new and ancient, psychedelics allow us a radical awareness of our place and purpose in the universe; they actually seem to set us straight, these tie-dye drugs of long-gone hippiedom.

  Thus it may be that we need to get high in order to finally act right. I hope, however, that we do not go so far as to forget the men and women who found the first cures, even if they have turned out to be radically less than perfect. The drugs presented in this book all have their flaws, for sure. But they all, in one manner or another, have helped numerous people to live a life, and that’s no small thing. Even if the price has been steep, and the side effects sometimes severe, nevertheless the first golden era gave people back their minds and their days, long hours of light and water, serenity in the gaps where there used to be screeches, with the possibilities pure and seemingly endless, at least for a little while.

  Acknowledgments

  Thanks go to my editor at Little, Brown, Ben George, for seeing me the whole way through, for pulling this book up by its bootstraps, and, to mix my metaphors here, hand-planing its many rough edges, doing the long hard work of an editor with a vision, and a belief, so much so that I feel the product comes not from me but from a joint effort, although any mistakes, soft spots, brown spots, or rust ridges are mine and mine alone.

  I could not have even conceived of this book were it not for my extraordinary agent, Dorian Karchmar, who heard, one day, five years ago, the delicate thrum of an idea and from that thrum pulled out a whole soft skein that came to be called “the proposal.” I have written eight other books and seven of them were born on the backs of proposals, but no one has ever guided me from the first stray glitters of an unformed notion to a whole exposition of ideas and structure and done it so patiently and insistently, so calmly and forcefully, and for this I am deeply indebted.

  Anna Jaffe read early drafts of this book and gave me the confidence to go on when I felt I could not. Alberta Nassi provided similar support. My children, while involved in no explicit way, nevertheless gave me motivation, because they were living proof that I was capable of producing at least two beautiful beings, and thus I felt my manuscript stood a slim chance. A book, of course, is not a human, but still, if it is any good, it has a heart, and legs too; a book should skip and beat, and if it’s really doing its job it should exert some force upon your heart, the reader’s heart, and thus I have, as well, to thank you, the reader, for putting these pages in your palm, or on your tablet, or wherever they may be. It is a great honor to be held in such a fashion. I hope I can return the favor.

  Notes

  1. Thorazine: Awake!

  Sea change in policy regarding mental health treatment: Taylor, “Caught in the Continuum,” 218–30.

  History of treatments preceding Thorazine: Valenstein, Great and Desperate Cures, 15–20.

  Manfred Sakel coma therapy: Healy, The Creation of Psychopharmacology, 52–53.

  Depth of hypoglycemic comas: Lehmann and Ban, “The History of the Psychopharmacology of Schizophrenia,” 152.

  Meduna experiments: Ibid.

  Lucio Bini’s use of electroconvulsive therapy: Endler, “The Origins of Electroconvulsive Therapy (ECT),” 5–23.

  Lehmann’s use of fever in treatment: Muldoon, “From Psychiatrist-Researcher to Psychiatrist and Researcher,” 222.

  Moniz, the invention of psychosurgery: Healy, The Creation of Psychopharmacology, 40–41. See also Raz, The Lobotomy Letters, 5–7.

  The physician turned pilot and the virtuoso violinist: El-Hai, The Lobotomist, 196, 277.

  Use of an ice pick in the first lobotomy: Johnson, American Lobotomy, 24.

  Chemical makeup of chlorpromazine: Healy, The Creation of Psychopharmacology, 80–81.

  Methylene blue protects against Alzheimer’s: Atamna and Kumar, “Protective Role of Methylene Blue in Alzheimer’s Disease via Mitochondria and Cytochrome C Oxidase,” 439–52.

  Methylene blue staining nerve cells of frogs: Healy, The Creation of Psychopharmacology, 44.

  Treating neuralgia with methylene blue: Ibid.

  Pietro Bodoni treating manic patients with methylene blue: Ibid.

  Methylene blue transformed into chlorpromazine: Ibid., 39.

  “no drug company would market an old drug even if it worked”: Ibid., 45.

  “competing therapies or interest groups”: Ibid., 44–45.

  Phenothiazine nucleus having antihistamine effects: Swazey, Chlorpromazine in Psychiatry, 58.

  Promethazine synthesized in 1947: Ibid., 77.

  Promethazine precursor to Thorazine: Ibid., 78.

  The sinking of the Sirocco: Laborit, L’esprit du grenier, 103–53.

  Laborit’s use of promethazine: Alemanno and Auricchio, “Sedation in Regional Anesthesia,” 233.

  Artificial hibernation and Laborit’s use of promethazine: Swazey, Chlorpromazine in Psychiatry, 62.

  “euphoric quietude”: Laborit in La Press Medicale (1950), cited ibid., 79.

  “tense and anxious Mediterranean types”: Ibid.

  Description of surgical shock: Ibid., 62.

  Courvoisier and Charpentier test discoveries: Healy, The Creation of Psychopharmacology, 82.

  “a completely different molecule”: Ibid., 81.

  Pierre Koetschet on the usefulness of Thorazine: Swazey, Chlorpromazine in Psychiatry, 96.

  “The idea of an antipsychotic”: Healy, The Creation of Psychopharmacology, 84.

  Laborit’s “lytic cocktail”: Ibid., 79.

  Thorazine included in soldiers’ battlefield kits: Ibid., 82.

  “possible use of the product in psychiatry”: Swazey, Chlorpromazine in Psychiatry, 106.

  Quarti’s account of Thorazine’s effects: Ibid., 117–18.

  Treatment of Jacques Lh.: Ibid., 119–20.

  Jean Delay’s reputa
tion: Healy, The Psychopharmacologists, 1:2.

  Patients given rectal enemas: Thullier, Ten Years That Changed the Face of Mental Illness, 5.

  Woman getting second-degree burns in the bathtub at Sainte-Anne: Ibid.

  Sigwald and Bouttier: Swazey, Chlorpromazine in Psychiatry, 126.

  Madame Gob: Owens, A Guide to the Extrapyramidal Side Effects of Antipsychotic Drugs, 7.

  Hamon’s results: Ibid., 112.

  Delay and Deniker first learned of Thorazine: Ibid., 7.

  The case of Phillippe Burg: Healy, The Creation of Psychopharmacology, 91.

  Responses to Thorazine of catatonic patients: Valenstein, Blaming the Brain, 25.

  The barber’s reaction to Thorazine treatment: Healy, The Creation of Psychopharmacology, 91.

  The barber shaves the psychiatrist: Ibid., 93.

  Account of the juggler’s reaction to Thorazine treatment: Ibid., 91.

  Jean Thullier to the fishmonger: Healy, The Psychopharmacologists, 3:551.

  Glaziers’ work reduced: Healy, The Antidepressant Era, 63.

  Laborit suggests Largactil as name: Swazey, Chlorpromazine in Psychiatry, 141.

  Smith, Kline & French’s response to Rhône-Poulenc’s inquiry: Valenstein, Blaming the Brain, 160.

  Smith, Kline & French’s marketing: Ibid., 141.

  Difficult to get Thorazine into North American treatment programs: Swazey, Chlorpromazine in Psychiatry, 196.

  Henry Brill on resistance to Thorazine: Ibid.

  “No one in his right mind was working with drugs”: Ibid., 196–97.

  Patients would have taken the two years of restored life: Healy, The Creation of Psychopharmacology, 97.

  “One of them would even rip radiators right off the wall”: Heinrichs, In Search of Madness, 151.

  A clean somatic approach: Swazey, Chlorpromazine in Psychiatry, 217.

  “That was perhaps the most spectacular demonstration”: Ibid., 201.

  “Lest everything be evaluated in terms of decibels”: Ibid.

  Mortgaging his house to buy shares in SK&F: Healy, The Creation of Psychopharmacology, 98.

  Within a year Thorazine had been prescribed: Starks and Braslow, “The Making of Contemporary American Psychiatry,” 181.

  The patient populations in asylums: Swazey, Chlorpromazine in Psychiatry, 222.

  Ayd’s patient dismissed as “hysterical”: Healy, The Creation of Psychopharmacology, 110.

  Parkinson’s seen as repressed anger: Ibid., 112–13.

  Naming and history of the double-bind theory: Bateson et al., “Toward a Theory of Schizophrenia,” 251–64.

  Acetylcholine given to schizophrenic patients: Shorter, A History of Psychiatry, 247.

  Chemical versus electrical signaling: Valenstein, The War of the Soups and the Sparks, 3.

  An alkaloid from the rauwolfia plant: Healy, The Creation of Psychopharmacology, 102.

  Bowman invented a machine called the spectrophotofluorometer: Harden and Lefant, “The AMINCO-Bowman Spectrophotofluorometer.”

  Brodie used the new machine: Healy, The Creation of Psychopharmacology, 106.

  Rabbits became lethargic, apathetic: Stossel, My Age of Anxiety, 174.

  Arvid Carlsson discovering that dopamine: Yeragani, “Arvid Carlsson, and the Story of Dopamine,” 87–88.

  The “dopamine hypothesis of schizophrenia”: Brisch, “The Role of Dopamine in Schizophrenia from a Neurobiological and Evolutionary Perspective,” 47.

  Schizophrenics experiencing obstetrical trauma at birth: Geddes, “Schizophrenia and Complications of Pregnancy and Labor,” 413–23.

  Schizophrenia caused by an error: Shorter, A History of Psychiatry, 270.

  Neurons were jumbled: Ibid., 268.

  PET scan and fMRI technology: Ibid., 269.

  In 2011, atypical antipsychotics were prescribed: Friedman, “A Call for Caution on Antipsychotic Drugs.”

  “their psyches manipulated by therapists”: Healy, The Creation of Psychopharmacology, 148.

  The drug has been relegated: Estrada, “Clinical Uses of Chlorpromazine in Veterinary Medicine,” 292–94.

  “When it comes to antipsychotics”: Personal interview with Alexander Vuckovic, February 19, 2015.

  Tossing out Hiroshi Utena: Agar, Science in the 20th Century and Beyond, 243.

  Students in France storming Sainte-Anne asylum: Ibid.

  The ransacking of Jean Delay’s office: Healy, The Creation of Psychopharmacology, 176–77.

  Spiders under the influence of hallucinogens: Siegel, The Search for Unusual Substances, 73.

  2. Lithium: A Salted Stone

  Lithium found in space: Pidwirny, Understanding Physical Geography, 3.

  The element atomizes on contact with air: Lowe, “I Don’t Believe in God.”

  José Bonifácio de Andrada e Silva: Enghag, Encyclopedia of the Elements, 291.

  Lithium found on Utö: Johnson, The History of Lithium Therapy, 3.

  How lithium came to be called lithion: Ibid.

  Lithium’s ability to alkalize excessively acidic urine: Ibid., 8.

  Physicians’ beliefs about excess uric acid: Healy, Mania, 90.

  Lithium levels in tap water: Sugawar, “Lithium in Tap Water and Suicide Mortality in Japan,” 6044–48.

  Japanese research on tap water: Ohgami et al., “Lithium Levels in Drinking Water and Risk of Suicide,” 464–65.

  “I was born in 1917”: Johnson, The History of Lithium Therapy, 18.

  Discovery and development of lithium’s medicinal uses: Ibid., 5–22.

  On the popularization of lithium spas: Ibid., 18–19.

  “For a person to obtain a therapeutic dose”: Valenstein, Blaming the Brain, 41.

  Lange first to use lithium prophylactically: Shorter, “The History of Lithium Therapy,” 4–9.

  John Aulde’s treatment: Johnson, The History of Lithium Therapy, 12.

  Cocoanut Grove fire: Kowalski, Attack of the Superbugs. See also Levy, The Antibiotic Paradox, 1–4.

  By the 1940s you couldn’t get your hands on a lithium tablet: Johnson, The History of Lithium Therapy, 31. See also Healy, Mania, 96.

  Cade held as a prisoner of war: Johnson, The History of Lithium Therapy, 32–34. See also de Moore and Ann Westmore, Finding Sanity, and Cade, “John Frederick Joseph Cade,” 615–16. For conditions at the camp, see Roland Perry, The Changi Brownlow.

  How and when Cade developed his ideas: Healy, Mania, 100; Johnson, The History of Lithium Therapy, 32–34.

  “mourning the wasted years”: Johnson, The History of Lithium Therapy, 34.

  Cade’s powers of observation: David Healy, The Psychopharmacologists, 2:262.

  “Because I did not know”: Johnson, The History of Lithium Therapy, 35.

  Cade storing urine samples in family refrigerator: Ibid., 36.

  Urine “from the manic patients”: Valenstein, Blaming the Brain, 44.

  “all that had been demonstrated so far”: Gershon, Lithium, 9.

  Cade injected large doses: Johnson, The History of Lithium Therapy, 36.

  “the animals, although fully conscious”: Ibid., 36.

  Cade trying lithium on himself: Cade, “John Frederick Joseph Cade.”

  Cade believed that “spontaneous remission is far less likely to occur”: Cade, “Lithium Salts in the Treatment of Psychotic Excitement,” 518–20.

  “How to proceed?”: Johnson, The History of Lithium Therapy, 108.

  “Our kitchen refrigerator”: Ibid., 37.

  In total Cade treated nineteen patients: Mitchell, “On the 50th Anniversary of John Cade’s Discovery,” 624.

  “in a state of typical manic excitement”: Cade, “Lithium Salts in the Treatment of Psychotic Excitement,” 350.

  “enjoyed preeminent nuisance value”: Valenstein, Blaming the Brain, 44.

  Cade’s “expectant imagination”: Ibid., 46.

  “he found normal surroundings and liberty of movement strange at first”: Healy, Mania, 102.

/>   “I readmitted him to the hospital”: Johnson, The History of Lithium Therapy, 39.

  “very first scientific evidence”: Blackwell, Bits and Pieces of a Psychiatrist’s Life, 218.

  “E.A., a male, aged forty-six years”: Cade, “Lithium Salts in the Treatment of Psychotic Excitement,” 2.

  Patients lithium did and did not help: Johnson, The History of Lithium Therapy, 38.

  Cade’s hypothesis on the effects of lithium deficiency: Cade, “Lithium Salts in the Treatment of Psychotic Excitement,” 3.

  Young found that lithium salts: Johnson, The History of Lithium Therapy, 59.

  W.B. was “back to his old form again”: Cade, “Lithium Salts in the Treatment of Psychotic Excitement,” 349–52.

  Cade reported that W.B.’s skin: Johnson, The History of Lithium Therapy, 40.

  The paper stirred little interest: Healy, Mania, 105.

  Young “found a supply of effervescent lithium”: Johnson, The History of Lithium Therapy, 58–59.

  Schou recalled how his father: Healy, The Psychopharmacologists, 2:259.

  Schou clearly remembered: Ibid.

  Schou on Cade’s paper: Ibid., 263.

  Schou’s study was the first: Ibid.

  Schou published findings consistent with Cade’s: Shorter, “The History of Lithium Therapy.” See also Johnson, The History of Lithium Therapy, 68.

  Danish researchers learning to use the flame spectrophotometer: Johnson, The History of Lithium Therapy, 61.

  Two reports of thirty-five patients: Ibid., 69.

  A common substrate for mania and depression: Ibid., 70.

  Baastrup on patients who chose to continue lithium: Ibid., 71. See also Healy, Mania, 113.

  Baastrup’s findings: Healy, Mania, 114.

  Geoffrey P. Hartigan gave lithium to twenty of his patients: Ibid.