Saturday, September 1, 2012

A Neurologist Gets High

Well known neurologist and author Oliver Sacks has written an essay in the New Yorker about his drug experiences in the 1960s.  From about 1963-1967 Dr. Sacks ingested various compounds including cannabis, amphetamines, intravenous morphine, LSD, morning glory seeds, Artane (trihexyphenidyl hydrochloride) and massive doses of chloral hydrate with an accompanying withdrawal state.  He does an excellent job of describing various intoxication and delirium states.  As an example he describes his experience reading a text on migraines from 1873 while taking amphetamine:

"...In a sort of catatonic concentration that in 10 hours I scarcely moved a muscle or wet my lips, I read steadily through "Megrim"....At times I was unsure if I was reading the book or writing it...." p. 47

In my current professional iteration as an addiction psychiatrist these are familiar scenarios.  At some level Sacks realizes that he is lucky to have survived chloral hydrate withdrawal induced delirium tremens and amphetamine-induced tachycardia up to the 200 beats per minute range with an unknown blood pressure.  Vivid visual and auditory hallucinations and a distorted sense of time are described.  There is also the familiar interpersonal dimension that gets activated when a person's life is affected by drug use - concerned colleagues that implore him to seek help and take care of himself.

Dr. Sacks is an intellectual and this is presented in an intellectual context that may not have been very evident at the time of the experimentation.  He describes the sociocultural antecedents of a need for chemical transcendance that has been present throughout human history.  He proceeds to describe some of the relevant historical writings of physicians and other intellectuals.

The usual debate about whether or not there is any utility in taking life threatening amounts of drugs occurs in the text and on the podcast.  Not surprisingly, intellectuals derive insights from their experiences and taking drugs is no exception.  In  the article, the revolution in neurochemistry was one of the preludes to the period of experimentation.  The problems with psychotic symptoms and manic states are well described as well as what states might be the preferred ones.  We learn on the podcast that these experiences have provided insights into possible brain mechanisms and that this might be part of the basis for the author's new book Hallucinations that comes out in the fall.

Dr. Sacks describes himself as an observer and explorer of psychotic symptoms and how that seems to be protective when he is tripping.  What is missing here compared to the people I have talked with is a highly subjective response that increases the risk for drug use.  I typically hear about intense euphoria, high energy, and increased competence in physical, intellectual and social spheres.  Not having that response may be protective and may allow one to avoid the risks of ongoing chemical use.  In some cases there may just be a compulsion to recreate the drug induced state.  The essay may have been a lot more complicated or written by someone else if those descriptions were there.

George Dawson, MD, DFAPA

Oliver Sacks.  Altered States - Self experiments in chemistry.  The New Yorker, August 27, 2012: 40-47.

Oliver Sacks.  Podcast: The New Yorker Out Loud.

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