“Pill Line, Pill Line!” The PA system blared the summons twice a day throughout my two-plus decades in federal prison. In response, inmates did the “thorazine shuffle,” making their way to the pharmacy for a fresh dose of meds. It's been several years now since I was released, but that routine remains emblazoned in my mind. Early on, fellow inmates often struck me as zonked out on meds in some kind of sweet escape from the drudgery of life inside. Growing up in 70s and 80s suburban sprawl, I had become vaguely familiar with many of the drugs fellow inmates took for various ailments. But I never tried any—I thought of myself as more of a weed guy—and didn’t have a real sense of what depression felt like to whose who grappled with it.
The world I re-joined in 2014 has required me to play catch-up in a big way. More people than I imagined possible—one in six, according to a major study—were taking prescription medicines for depression, anxiety, and other mental illnesses. And right now, there's fresh hope out there—Jeff Sessions notwithstanding—that drug prohibition is in its last throes, and that after weed legalization could come the acceptance of psychedelic drugs as promising treatments for people who need help.
In her forthcoming book, Blue Dreams: The Science and the Story of the Drugs That Changed Our Minds, Lauren Slater—who previously wrote Prozac Diaries about her own experience with depression—explores the strange history of psychopharmacology in America. From the explosion of modern psychotropic drugs like lithium in the 1950s to the rise of antidepressants like Prozac to the ongoing (re)discovery of psychedelics’ medical potential to drugs that can literally erase your memory, her account is a comprehensive one. I called her up to find out how doctrine has changed from the era of insane asylums of the 19th and 20th centuries, how Prozac turned depression into a sort of superstar syndrome, and why drugs like MDMA and LSD may be closer to legal use than you think.
Here’s what she had to say.
VICE: You've been taking these drugs or dealing with related conditions for 35 years now. What stands out from all that experience that non-users wouldn't know?
Lauren Slater: Well, it's taught me, first of all, that you can't really rely on them [because] they are time-limited. I started off taking Prozac at ten milligrams, and then I had to raise my dose to 20 milligrams, which is the standard dose. But then I had to go up to 40, and then 60, and then 80, and then 100, and then 120, which is way over what you're supposed to take. I was building up a tolerance to it. I had to go off that drug, and onto another drug. It's not only that the drug wears off. The other way of looking at it is that the symptoms that you're taking the drug for break through.
A psychotropic drug, even if it works, is no guarantee that you're not going to have episodes of whatever is it you're taking the drug for. It's a tool to use, but it's not a cure. It's definitely not a cure. With real mental illness, it tends to get worse as you get older. Each time you have an episode, it's oftentimes worse than the one before. In some respects, you learn how to deal with it. I think what you learn is that it's going to go away. It's not forever, even though it may feel that way at the time. But I wouldn't say that it gets easier to deal with. A breakdown is never really easy to deal with.
It's perhaps common in our culture to critique young people or recent generations as being overly inclined toward medicating. But the reverse was also true—we treated people terribly when they had mental heath problems in decades past, right?
In the old insane asylums, before there were medications, or the kinds of medications we have today, we used physical restraint. We used isolation rooms. We used electric convulsive therapy- shock therapy without any kind of benzodiazepine—the person was conscious and it was terrifying for them. We had all kinds of [so-called] cures that were horrible for people. We used to shoot people up with insulin until they fell into a coma and then hope that when they woke up from the coma, they would be more cognizant. We used to use something called deep sleep therapy, where we would essentially put a person in a coma for weeks at a time and hope when they woke up, they’d be better.
We used to tie people to beds. We used to plunge them in ice-cold baths. We did unbelievable things in the name of pursuing a cure. We used to do lobotomies, cutting out a piece of people's brains. All of that is pretty much gone. We still do a form of lobotomy, called the cingulotomy, but it's very rare. Very few people have that. The treatment [today] is much more humane. As we learn more about the brain and how it goes awry, our treatments get more refined. [But] we still have a really long way to go, in terms of understanding the causes of mental illness, and discovering treatments that really work.
You have a long and well-known history with Prozac. Can you talk a bit about your conception of the drug as having molded depression its own special kind of illness?
It used to be that people understood their distress in terms of nerves. That was the word that was used in the 60s and 70s. People were anxious. They would complain about anxiety. They wouldn't complain about depression. You’d say you had a bad case of nerves and you’d be treated with one of the benzodiazepines, Valium or Klonopin. Then Prozac came along, and it got featured on the cover of Newsweek and on the cover of TIME. And Peter Kramer wrote his runaway bestseller, Listening to Prozac.
All of a sudden, everybody knew about Prozac, and it was written about in these glowing terms as a drug that could not just help with your depression, but could change your whole character. Take irritability and turn it into sweetness. Take low feelings and turn them into high feelings. It could take shy people and make them confident and outgoing. It could enhance your attractiveness at cocktail parties and dances or whatever. Suddenly everybody wanted to take it. But you couldn't take Prozac if you had nerves. Prozac wasn't for nerves; it was for depression. So people started saying that they have depression. It’s not that there's any more distress than there was 50 years ago; we [just] went [conceptually] from nerves to depression.
I took a lot of LSD, and always felt that it kind of opened my mind and made me more creative, or just made me see things in different ways. Mushrooms just kind of made me laugh, and ecstasy was a whole different realm. But that was all recreational. Do you really have optimism about those drugs as medical treatments for people suffering?
I think MDMA or ecstasy will get approved for the treatment of severe trauma, probably by 2021. It will be approved as a prescription medicine for people with severe trauma, because it's worked so well in trials. It's not going to be approved for people with just run of the mill trauma, if there is such a thing as that, anyway. But it will be approved for people whose trauma has devastated them, has made it so that they can't function.
There may come a time when hallucinogens or psychedelics like LSD and psilocybin are approved for the treatment of pain, for anxiety relating to terminal illness. But that's further away. I don't think we're going to see the psychedelics approved for just humdrum problems. Or for enhancement, or as aids to spiritual growth, or something like that. Even though they really can do that. But I don't think that the DEA and the FDA and the government are going to ever really approve those drugs for that kind of use.
How close are we to Men in Black–esque memory wipes or drugs that are capable of completely erasing a frightening or traumatic event?
There is that drug called ZIP, which can erase memories in rodents. I don't think we're anywhere near getting that approved as a treatment, though. The ethical conundrums that accompany a drug like ZIP are just so snarled and complicated.
People who’ve been raped or who’ve been to war and seen horrible things—they would benefit from having those memories erased. But on the other hand, those experiences, as horrifying as they were, have a role to play in their lives and in their understanding of the world. And I don't know that trauma survivors would [necessarily] want them erased. Especially when you have something like MDMA, which can deal so effectively with trauma, without erasing it. That seems like much more sensible approach.
If the 50s and 60s were the golden age of the psychopharmacology—when treating the mental suffering of the human brain was kind of coming into vogue—how do you see the present moment, when old-school prohibition is less credible than ever?
Some psychiatrists are discovering that psychedelics have a powerful ability to remake the human mind. And slowly, the stigma surrounding the psychedelics from the 60s as, like, hippie drugs and just drugs to use if you wanted to tune in and drop out or whatever it was [Timothy] Leary said—slowly that stigma is going away.
The more studies that are done that show that psychedelics can really change a person and open a person to new ways of being, the closer we get to a real revival of these drugs. I mean, it's not just psilocybin and MDMA. There's ayahuasca, and there's LSD, and there's a whole bunch of psychedelics that are potentially useful for a whole range of human problems. I predict that that will be our next golden era.
Learn more about Slater's book, out February 20, here.
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