“And if ever, by some unlucky chance, anything unpleasant should somehow happen, why, there’s always soma to give you a holiday from the facts. And there’s always soma to calm your anger, to reconcile you to your enemies, to make you patient and long-suffering. In the past you could only accomplish these things by making a great effort and after years of hard moral training. Now, you swallow two or three half-gramme tablets, and there you are. Anybody can be virtous now. You can carry at least half your mortality about in a bottle.” -Aldous Huxley, Brave New World

In reply to Yet Another Harrowing Tale of White Collar Addiction, a friend and fellow journalist wrote me a letter detailing her personal history with psychiatric diagnosis and some of her thoughts on the process, which she has graciously allowed me to share here.  In my post, I suggested that the problems with psychiatric diagnosis are not specific to ADHD.  Camille’s case illustrates this well.

Camille – her middle name – is a beautiful, poised young woman, with a graduate degree in the sciences, a once-successful freelance writing career, and a history of depression.  Two years ago, Camille went to her local healthcare clinic complaining of general anxiety and sleep problems, hoping to be seen by a therapist.  Instead, within a month, her psychiatrist had prescribed her five drugs to help regulate her mood: Adderall (a stimulant), Ativan (an anti-anxiety medication), Celexa (an anti-depressant), Trazodone (a sleep aid and anti-depressant), and Yazmin (hormonal birth control).  Since she did not meet the criteria for a major psychiatric disorder, such as bipolar or schizophrenia, she has never seen a therapist.  Since that time, she has become addicted to Ativan, and has suffered severe withdrawal the few times she has tried to go off it.  Her weight has plummeted.  She has difficulty distinguishing waking life from dreams.  The problems she hoped to resolve in therapy remain largely unresolved.

Excerpts of her story follow below.

On immediately being prescribed Ativan

I didn’t know much about benzos [the class of drug Ativan belongs to] when I was prescribed.  That was actually the first thing I was prescribed, following my very first screening appointment. I expressed hesitation, since I had come to talk to a psychologist.  I sincerely wasn’t sure yet if I wanted medication. She (the nurse) said, “Don’t worry, it will just calm you down, make you feel better, it’s like valium. ” Anyway, I filled the prescription, came home and researched it a bunch, sat on it for a couple weeks and finally tried it because I was so sick of not being able to sleep. Turns out it’s more physiologically addictive than Adderall or coke or even speed.  The pharmaceutical company that manufactures it does not authorize it for use longer than three weeks. No doctor, nurse, or pharmacist ever mentioned that to me. At one point I told my psychiatrist that I had read about this and he prescribed me something else, another benzo, to calm my fears. But the withdrawal issue is the same with all benzos, so I just kept taking the Ativan.

On how she was prescribed Adderall, off-label, for depression

I did what so many have done to get an Adderall prescription. At the time, I thought it was a well-informed decision. I thought it would improve my psychological situation by making me more productive and focused, and thus less depressed about being unproductive. And despite what I’m about to tell you about my psychiatrist, I take responsibility in my head for having asked for Adderall.

If you were to ask me, I guess I’d say I’m a smart, perceptive person with a long history of use or contact with the effects of prescription and non-prescription drugs.  I walked into my psychiatrist’s office knowing what I was doing.  Ultimately though, it’s still the person with the medical degree’s responsibility to read people, to detect key aspects of the way they’re engaging the situation, and to properly diagnose and medicate a patient.

I think my guy [my psychiatrist] just recognized early on that I was smart and knew myself, so then released himself of doing any further investigation because he trusted me to accurately describe my needs.  The new guy they gave me after that guy retired was no different.  Once I said something to him about Adderall and he responded, “Well, sounds like you know more than I do about it, so I’ll take your word for it.”  I had actually wanted to have a conversation with him about some of the physiological effects of the drug, having read a lot about it, and it became clear that was not going to be possible. So it was just, “Ok, I guess I’ll just take that triplicate [prescription] and be on my way.” (I didn’t actually say that). He has since allowed me to pick up triplicates from the receptionist once every 3 months. I haven’t seen or talked to him since the summer. Again, I think he was just like, “OK she’s smart and isn’t a fiend, so I don’t have to worry about her as a liability.”

I can say I don’t regret being prescribed it.   I’m just not satisfied with the way it was handled.  At the time, I was like, “woohoo, that was easy!”  But looking back on the way my doctors have handled (and not handled) me, it was irresponsible.

On how the system works for ‘normal’ patients

I understand, perhaps more than most people who haven’t worked in a doctor’s office, that they have to keep on schedule and recognize which patients they’re going to need to spend more time with, so any easy person like me is great for them — wam-bam!  That’s how reasonably normal-presenting patients slip by.  The strange part is that ‘normal’-presenting patients seem to get prescribed more controlled substances than people diagnosed with mental disorders like bipolar or schizophrenia.  With my health plan, only a diagnosis of a severe mental disorder would grant me individual therapy, but depression and anxiety got me prescribed controlled substances in 20 minutes flat.

My original psychiatrist mostly worked in the psychiatric ER; I was one of his few outpatients. He was excellent at reading extreme behaviors and symptoms and knowing exactly what to put in their veins and what to write on their charts. He got frequent pages that he had to call back immediately during our meetings. That was his forte. Relatively normal people were his hobby. He mostly talked to me about movies and always told me I was pretty (in an absolutely not hitting-on way, but more of a “I’m a dad, I know about how the world works, and you’re smart and sweet and cute, and so it’ll all work out for you” way).

Keep in mind, I did not hide that much from him. I cried in his office more than once. I answered ‘Yes’ when he asked if I had ever thought about suicide. But comb my hair and look him in the eye and give a 3-minute speech about my sister’s success with Adderall and I’m at the pharmacy 15 minutes later. Thing is, you or I, not even being psychiatrists, would be able to flag people much more immediately and accurately than these doctors.

Camille’s account is troubling.  She was denied therapy to cut costs.  She was prescribed an anti-anxiety drug that is highly addictive in a casual, off-hand manner.  Indeed, her doctor wrote her prescriptions like he was doling out vitamins: one to treat anxiety, one to treat insomnia, one to treat depression, one to treat PMS, one to treat lethargy.  That Camille is smart and well-educated did not insulate her from such reckless malpractice; instead, it may have worked against her.  Her doctors ‘trusted her’, she says, and she liked that they trusted her.  But for all Camille’s research, she is not herself a trained psychiatrist, and as she would be the first to admit, she’s not sure she should have been the one in charge of her own treatment plan.

There’s one more important detail missing from this story.  Camille did not tell her psychiatrists that she is an alcoholic.  Camille did not reveal her addiction issues because, she says, “As soon as you’re labeled an addict, you’re an addict for life in the eyes of any health insurance company. They know they will either be paying to treat the damage you do to yourself or paying to prevent you from doing damage to yourself.”  Actually, there’s a question of whether she would have received treatment at all.  A close friend of mine, an alcoholic in the style of Winston Churchill, was denied access to an anxiety treatment program after opening up about his drinking.  The reason?  Liability issues.

On how she thinks the system should change

It’s not likely that psychiatrists are going to start spending more of their time with patients. So I think there should be a requirement that some number of close friends and/or family members verify what you’re saying about your symptoms.  With these kinds of drugs, you should have to bring in two people who are willing to provide identification and sign their statements about you.  That way, the doctor can get a fuller picture of  your situation, which would help in detecting inconsistencies and drug-seeking behavior.  Plus, your friends would be going on record alongside you.  Even if it were confidential, it would still present a risk, should you overdose or commit suicide, and that risk would incentivize them to be honest.

“Troubled people can’t navigate treatment alone,” she concludes, “and if doctors are not going to be the shepherds they signed on to be, perhaps their friends and family could be.”

While I agree with Camille that an ideal treatment program would incorporate the narratives of friends and family, I don’t see how it can ever be made a requirement.  Not everyone who suffers from mental illness has a reliable support network in place to advocate on their behalf, or to call into question their version of reality. (Some people’s families are more crazy than they are.) Would Camille have been better off if a family member had revealed her alcoholism in a sworn statement?  Perhaps — but only because it might have been better if she had never been subjected to that barbaric ‘treatment’ in the first place.  If there had been better treatment options in place, it’s not clear what rendering her both uninsurable and untreatable would have achieved.

What are we to make of Camille?  While it’s difficult to say how representative she is, I’ve spent years listening to stories like hers.  There’s the librarian who found herself suddenly depressed on a new birth control pill, and when she asked her doctor to switch brands, was instead recommended several options of anti-depressant.  Or the mechanic who was prescribed a heavy duty anti-psychotic ten minutes into his first appointment, after he admitted that a relative of his had recently been diagnosed with bipolar, and that he occasionally ‘drank a bit’.

He had gone in to discuss his issues with social anxiety, but found the conversation quickly derailed after he mentioned his relative.  He told me he didn’t know quite how to answer many of the questions, which seemed vaguely worded, and open to interpretation — like a horoscope, he thought.  Soon, he said, the psychiatrist was drawing a triangle in the air and explaining his fate to him: “It’s the unfortunate triad of genes, environment, and behavior…”  He never went back.

Perhaps the  most disturbing story I’ve heard comes from a friend who was interning in a medical clinic in El Paso, Texas that treated battered women, many of them immigrants from south of the border.  One might expect that these women would be referred to therapists or social services, but that was not the standard of care, not at that clinic.  Instead, they were prescribed Prozac, a practice that recalls that haunting rhyme from Brave New World which ends: Love’s as good as soma.

What troubles us about these stories is the way that the tangled skein of human lives are reduced down to symptoms, while cause and context are forgotten or outright ignored.  To give a physical analogy: I might feel a sharp pain in my lower calf because I have ‘flesh-eating’ necrotizing fasciitis.  Or it may be that I have badly strained a muscle after a particularly strenuous work-out.  In one case, intravenous antibiotics and surgery are called for; in the other, an ibuprofen and a massage would do the trick just fine.  Even a physician facing a motivated hypochondriac could tell the difference.  But listening to how psychotropic drugs are prescribed, one comes away with the uncomfortable feeling that when it comes to disorders of the mind, many doctors simply can’t tell the difference.  And they’re not being paid to.

Related Readings:

The Epidemic of Mental Illness: Why? in the New York Review of Books

The subjective nature of psychiatric diagnosis: Medicalising natural and normal responses to life experiences is a dangerous game in the New Statesman

Ill-Treated: The continuing history of psychiatric abuses in Reason

Ring the Alarm

The story of Richard Fee is a tragic one, and one that highlights both the dangers of prescribing ADHD drugs to neurotypical adults and some of the problems endemic in psychiatric diagnosis.  Regrettably, the reporter seems to believe that these problems are somehow specific to amphetamines, signaling “widespread failings in the system through which five million Americans take medication for ADHD”, and that Richard’s harrowing case, while undoubtedly rare, “underscores aspects of ADHD treatment that are mishandled every day with countless patients”.

Schwarz is a Pulitzer-prize nominated journalist, renowned for exposing the danger of concussive head injuries in football. More recently, he has cast that same critical eye on how attention-deficit disorder is diagnosed. The question is – to what end?  Presumably – in the case of this story – to tighten the restrictions on how amphetamines are prescribed to adults, and to ward against the kind of negligence and lack of oversight that characterized Richard’s case.  But there is a delicate balance to be struck here between serving the needs of the ADHD population, many of whom benefit tremendously from the regulated use of stimulants, and potential drug addicts, like Richard.  It is also far from clear, given the nature of psychiatric nosology, that there are any surefire ways of stopping con-artists and addicts from gaming the system.

Let me give an example. At the Big Ten school I attend in the Midwest, regulative policies are in full effect, and it is notoriously hard to obtain an attention-deficit diagnosis, regardless of diagnostic history.  To be seen for an intake interview with a psychiatrist, a student must first complete a half-hour standard battery that tests for a range of possible maladies.  If the results point towards some brand of attention-deficit, the student is then seen by a psychologist, who opens a case history.  If the psychologist also suspects ADD, the student must then requisition her grade school records from K-12, to be submitted alongside her current transcript, the results of previous psychiatric evaluations, and an extensive parent questionnaire.  All this to get penciled in for an initial psychiatric consult.  Given the limited number of available appointments, the process can take months. The joke is that the kids who have the wherewithal to make it through to a prescription couldn’t possibly have the problem to begin with.

ADHD: It’s (Probably) Not What You Think It Is

Which raises another point: Who are these kids left to slip through the cracks?  In grade school, ADHD is a catch-all for children who don’t behave in class and don’t play well with others.  You know, the ”kids who drop their pants in the schoolyard instead of playing hopscotch” (or so goes that persistent stereotype).  But the actual disorder, clinically, is probably not what you think it is.

I’ll save you the laundry-list of symptoms that get bandied about.  But for starters, there is no one way that the disorder manifests, no easy one-size-fits-all prototype. Given the complex interplay of neural development with personality and environment, the human category is a diverse one, counting charismatic entrepreneurs, famous artists, and a healthy number of criminals among its ranks.When ADD is understood as a problem of directing and controlling attention, rather than as a ‘deficit’ in attention, per se, the reason for this heterogeneity becomes clear: The ‘affliction’ produces a mind that is highly idiosyncratic in the way it attends to the world, unbound by social norms or parental pressures.  But how this ‘unbridled’ attention ultimately gets spent varies by individual.  Some teenagers with ADHD play video games for ten hours a day.  Others, like my high school boyfriend, expend that focus mastering dozens of languages, or obsessively annotating their music collections.  Brilliance and achievement do not preclude having ADHD, or vice versa.  A person that is ill-equipped to sit through classes, keep track of dates and appointments, and conform to staid social situations, may, nonetheless, be astonishingly creative and resourceful in other domains.  Or not – depending on the circumstances, and the outlets.

Whatever the stigma attached to ADHD, it is hard to deny its prevalence, which has been pegged at between 5-10% of the population in the US. Given what this implies for genetic selection – that the genes underpinning ADHD must have conferred some adaptive benefit over our recent evolutionary past - there is some thought that ADHD has only become a ‘disordered’ category of being in the context of modern life.

–Which is not to say that medication shouldn’t be prescribed to the individuals tasked with facing a world that was, perhaps, not designed with them in mind.

How can stimulants help with ADHD?

Maybe you have a friend, like I do, who took Adderall expecting to get work done and instead fell asleep.  Anecdotally, that’s classic ADD, kind of like recurrent ear infections when you’re five.  Many of the twenty-somethings I know who are prescribed stimulants complain that taking them actually diminishes their powers of single-minded concentration.  What it allows them to do is much more mundane: Make it to work on time. Run three different errands all in one day. Remember to pay the water bill before it gets shut off.  To borrow Jonah Lehrer’s metaphor, “The drugs haven’t suddenly turned on the spotlight of attention. The spotlight was always there. Instead, they have made it easier [to] point the spotlight in the right direction.”  Of course, this is the exact opposite of the popular perception of what these drugs are used for.  Unfortunately, the popular perception may be influencing the medical one.

A few weeks after Richard Fee received a prescription for Vyvanse from a nurse practioner, he returned to her reporting “excellent concentration: “reading books — read 10!” her notes indicate.”  Of all the red flags that Richard raised, this one was the Jolly Roger.  Drugs like Vyvanse are not designed to make ADHD kids super-human; they’re designed to help them approximate normal function.

There are a number of competing theories on how amphetamines interact with executive brain function, but the short story is that they work their magic by increasing circulating levels of  dopamine in the central nervous system. PET brain imaging of never-medicated ADHD patients has uncovered abnormalities in the dopamine reward pathway, marked by strikingly low levels of dopamine receptors in the midbrain and accumbens.  Dopaminergic drugs are prescribed to help restore the balance.  The difficulty, and the danger, is that these drugs are being unleashed on a fragile eco-system that can easily be tipped out of balance.

You can think of the problem by analogy to another delicate process: making a proper English toffee.  Take the batch off the heat too soon and you’ll get a candy with a sickly-sweet taste and a chalky consistency.  But leave it on too long, and the sugar burns, imparting a brittle, smoky character to the confection.  Hitting the sweet spot, which yields that rich, buttery flavor that you find in shops, takes practice and patience; with almond toffees, the difference can be a matter of seconds.  Dialing up to the right amphetamine dosage for a particular ADHD patient presents a similar tight walk.  At too low a dose, the therapeutic effects of the drug are attenuated.  But go too high, and your patient might as well be snorting lines off their prescription bottle.  The end goal is not to have them polishing off Finnegans Wake in an afternoon; it’s to get them up near a normal baseline.

Because patients can respond differently to the same dose, finding that target often takes some trial-and-error, and requires honest, forthright communication between doctor and patient.  Unfortunately, that reserve of trust is precisely what fakers and addicts exploit.

Drowning Innocents, Burning Witches

“[Richard] was smart and he was quick and he had A’s and B’s and wanted to go to medical school — and he had all the deportment of a guy that had the potential to do that,” Dr. Parker said. “He didn’t seem like he was a drug person at all, but rather a person that was misunderstood, really desirous of becoming a physician. He was very slick and smooth. He convinced me there was a benefit.”

Re-reading the story of Richard Fee, I am struck by how Schwarz plays the apologist for his subject – that tragic young man with his becoming prospects and his athletic build.  Again and again, Schwarz emphasizes that “[Richard] had it in his mind that because it came from a doctor, it was O.K.”  But this is nonsense: Richard was neither ingenuous nor uneducated. He was a pre-medical student who likely “faked or at least exaggerated his symptoms to get his diagnosis” and artfully scammed careless doctors and drugstores to support his growing addiction.  That we are supposed to accept these excuses at face value beggars belief.  White-collar addicts are not immune to self-delusion.

Schwarz whitewashes Richard’s narrative in part because he wants to fault the system.  But again, the question comes back to: What would tightening the reins on amphetamine actually do, in practice?  It might prevent a “worst-case scenario” like Richard Fee, but at the expense of many actual sufferers going unmedicated.While I agree with Schwarz that talk therapy is a critical component in any treatment program, for many adult ADHD patients, medication can be instrumental in helping them get their lives organized enough to actually attend therapy.  The system cannot be organized around rooting out false positives.

Moreover, the problems that Schwarz notes with ADHD diagnosis are not, in fact, particular to it, but are rather endemic to the diagnosis of mental disorders more generally.  For instance, it is hardly surprising that standard batteries for ADHD cannot distinguish college students with the disorder from those instructed to fake the symptoms.  Given how the diagnostic process works, this should be true of any mental illness, save those with glaring physical manifestations, like anorexia.  After all, unlike in other branches of medicine, there are no certain tests; no X-rays or blood work-ups that can safely eliminate doubt.  In many cases of first diagnosis, the psychiatrist has two things to go on: what the patient tells them and how the patient behaves at intake.  This is the state of the art.  And it relies on, among other things, genuine self-report.  You don’t need to be good Will Hunting to defeat a system like that.

Psychiatry is still in its infancy.  So long as mental disorders are seen as illnesses that can be diagnosed in a quick check-up, and medications are doled out on the basis of checklists and questionnaires (absent better diagnostic tests), there will be serious potential not only for abuse, but for patient harm.  This is no less the case with drugs that target anxiety, depression, and psychosis, than it is for amphetamines.  All are powerful psychotropic drugs with unwanted side effects.  That not all of these drugs have addictive potential does not lessen their prospect for harm: just try pairing search terms for “suicide” and “SSRIs”,  ”benzo” and “withdrawal”, or “bipolar” and “diabetes”.   The problem is that there is, as yet, little alternative.  The science needs to improve before the medicine can.

I should note in closing that while I have said nothing here about the diagnostic practices for childhood ADHD, like Schwarz, I find the widespread practice of medicating children under eighteen for these disorders to be ethically fraught.  To my mind, the stories of children who are forced to medicate against their wishes – and of the doctors who willingly endorse this brand of Orwellian medicine – are far more compelling and worthy of being told than those of reckless adults exploiting loopholes.  Haven’t we heard enough of those stories already?

What’s the most surprising thing I’ve learned in class thus far?

When it comes to writing about stimulants, not a reader in the room thought Jonah Lehrer had a clue how to catch their attention, but they all fell hard for Ms. Molly Young.  Keep it personal, say the 19-year olds.  (Vintage Cakes also made mention that cupcakes are so named because they were originally baked in teacups. Mmm..!)

We were somewhere around Barstow on the edge of the desert when the drugs began to take hold. I remember saying something like “I feel a bit lightheaded; maybe you should drive….” And suddenly there was a terrible roar all around us and the sky was full of what looked like huge bats, all swooping and screeching and diving around the car, which was going about a hundred miles an hour with the top down to Las Vegas. And a voice was screaming: “Holy Jesus! What are these goddamn animals?”
-Hunter S. Thompson, Fear and Loathing in Las Vegas

The urgency of the moment always missed its mark. Words fluttered sideways and struck the object inches too low. Then one gave it up; then the idea sunk back again… For how could one express in words these emotions of the body?
-Virginia Woolf, To the Lighthouse

I want to know what we talk about when we talk about experiences for which we have little common language. People talk about the sublime feeling they have in face with a work of art, and they call it ineffable. They say, there are no words for what this has done to me, but I shall speak anyway (hence criticism, hence art bollocks). People talk about wine. They write on it, and they write somber, beautiful notes that conjure and evoke, and incite and compel, and so, naturally, we go and buy cases of it at the shop, we sit and mutter to ourselves, drinking, over the dinner table, words like ‘taut’ and ‘iridescent’ and ‘forthright’ and ‘burnished’, and wonder at what those words taste like (well, I do).

There is what we learn when we are small, and convention and culture are being stitched into us, and there is no resistance then, our minds like very capable sponges of the kind hawked on late-night television. That is one type of thing. Later, when we are large, and expert in being learned, we try to expand the borders of what we can say. But we did not learn to taste (wine) together, or to see (art) together, and so the words, even as we use them, feel less precise, less catching. We waver, drawing analogies in the sand. We wonder at our abilities to taste and see as others do. We hope we are talking about the same sort of thing.

Illicit drug use is like this. Perhaps more so. It is common, but not too common; there are communities of use, but not a community of use, as there is with the legal drugs of pleasure and habit – alcohol, coffee, tobacco, cannabis – for which our experience is structured by the expectations and attitudes of the culture in which we imbibe. The use of drugs beyond the pale – of acid and ketamine, vicodin and methamphetamine, pills, poppers, angel dust, tweak, molly, aunti, alice, susie-Q (and so on) – is stigmatized, marginalized, made to exist in backrooms and alleys, rather than coffeehouses and bars. It comprises a more mosaic set of experiences. There are the ravers, the coke fiends, the burners, the teenagers playing Russian roulette in the basement with the spoils of father’s medicine cabinet, the mothers who quaff their kids’ prescription adderall, the boys in the band, the inmates, the junkies – and these are but a few of the stereotypes, the categories we might draw circles around and make claim exist. That drug laws are variably enforced, as a function of race, class, and geography, only compounds the issue. There is no unified culture of use in America.

In the public discourse, drugs have long been associated with crime, with illness, danger, and addiction. Less is said about what it is like to use them, or what place they have in the lives of those who do. Perhaps it is offensive even to ask. Perhaps it seems indulgent. Drugs are certainly not hidden, of course. They play starring roles in popular films and television shows; provide narrative arc to celebrity gossip (“Lindsay Lohan train wreck reel”); we have even waged war against them, or so Richard Nixon liked to tell us. Lately too, prescription uppers have become a playground for intrepid young journalists, whose love affairs with stimulants are woven into dull cautionary tales about the inanity of hyper-efficiency. (“There’s a downside,” says Molly Young of adderall, in closing an essay extolling its many virtues, and wondering, seemingly, if she can admit there never was.) And so drugs are typecast as either villain or tempting mistress, and caricatured accordingly, their cartoon renderings a vehicle for our discomfort.

That drug use is taboo, even for being so readily on display, is reflected in our language. There are straight-edge folk who can use “high” or “drunk” in a sentence, like a blind child who knows the sky is blue, and it seems they have some idea what they’re saying (though likely all they know is a bit about language, and the way words go together). But what of drop, trip, toke, roll, jack, score, smack, sniff, pack, peak, split, blow? Everyday words, surely, but ones that, in the mouth of the drugstore cowboy, acquire meanings altogether different from their common use. It is a curious Christian Scientist who knows just how to wield them.

So what does the language of drug experience look like? What verbal behavior does use provoke? No doubt the psychonauts have words for their flights of fancy, as the botanists have for tiny, furling shrubs, as the Eskimos have for snow (though they say that’s a hoax). But every voyage is a solo feat. How can users fix the meanings of words which relate to internal distortions in perception and time, to ecstasies beyond reckoning?

Perhaps I should have looked to the poets for answers. Instead I turned to the dusty vaults of Erowid, combing through its records of ill repute with an open terminal window, a cup of Four Barrels’s finest, and all the wiles of a kid on the hunt for the mixed-up files of Mrs. Basil E. Frankweiler. What fruits were born of such adventures await below.

The Red Pill or the Blue Pill?

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Ayahuasca

Frequent Nouns: time, experience, life, body, night, friend, point, room, hour, vision, hand, people, part, head, thought, trip, mind, moment, ceremony, sense, shaman, pure, energy, music, water

Frequent Verbs: feel, have, be, seem, come, go, tell, say, think, become, start, ask, realize, find, take, want, know, get, decide, need, keep, give, try, do, talk

Collocates: abruptly twisting, accurate timepiece, across the river, am no longer, am still integrating, an explosion of, awe inspiring, back and forth, battery acid, be floating around, black hole, blew smoke, boiled down to, calm me down, caught up in, cheshire cat, childlike elements, choose pleasure, close attention, close my eyes, completely surrendering, could barely, crazy spiraling motion, drift away, dry heaves, during this phase, each other, ecstasy throughout, eternally connected, experienced traveler, eyes locked, feels like, forgiving path, found myself, friend of mine, galactic Bodhisattva brigade, give myself permission, got very hot, gradually silhouettes, greatest beauty, grinned approvingly, higher selves, horrible glittering, hyper dimensional, intricate colored, let go, lie back, mad hatter, majestic purple color, most intense, newspaper poorly crumpled, once again, open my eyes, other side, our minds, our souls, plant matter, please teach me, present moment, proved to be, retreat center, self-destructive behaviors, sense of tranquility, showed me, sinister caricatures, song that lasted, speckles shimmer, swirling colors, syrian rue, the divine presence, the greatest beauty, the only way, throwing up, too much, to take effect, total surrender, underwater creatures, visionary splendour, work of art, wrapped itself around

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Cannabis

Frequent Nouns: time, experience, eyes, mind, trip, friend, thoughts, people, world, head, body, night, room, life, smoking, point, house, effects, minutes, water, patterns, vision, sense, mouth, light

Frequent Verbs: be, have, feel, start, think, go, seem, look, decide, begin, make, know, come, get, smoke, realize, take, come, try, look, have, tell, see, want, walk

Collocates: quality bud, hysterical laughter, weird muscular sensations, frame rate, peripheral vision, high level, my inner artist, mother nature, lucid dreams, whirling noises, straight lines, make eye contact, crawl into bed, giant spiders, inner alien, computer screen, a girl named, paper doll, set in, watching TV, playing guitar, pair of headphones, internal monologue, under the influence, closed my eyes, in another dimension, cannot conceive, no idea where, lyrical language, profound nonsense, slow motion, can barely speak, mouth is dry, fade away, done something wrong, soon enough, kaleidoscope vision, hard to follow, field of vision, third dimension, makes sense, dry mouth, our minds, slowed down, stronger than, large amount, laced with anything, no idea where, the real world, far away, kept thinking, the most intense, profound insight, kept getting more, important thing, ever seen, worth it, spaced out, fucked up, freak out, over and over, smoked pot, smoked a lot, panic attack, calmed down, back to normal, seemed like forever

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Cocaine

Frequent Nouns: time, friend, line, night, drug, gram, minutes, nose, effects, experience, hours, people, hour, feeling, heart, point, days, times, powder, smoking, mouth, euphoria, room, years, body

Frequent Verbs: feel, have, be, go, take, want, do, start, take, decide, begin, stop, use, tell, make, think, keep, make, sleep, snort, smoke, gave, depress, walk, try

Collocates: Friday night, fast forward, handed me, for some reason, grams of pure, procure some, sniff coke, high quality, huge lines, too expensive, coked up, energy and euphoria, laid back, wind up, staring at, rubbing up against, danced for, coming down, hands are shaking, burning sensation, did another line, take a hit, do it again, I wanted more, a good time, a rush of euphoria, sex on drugs, love feels, feeling my pulse, heart was beating, heart pounding, a heart attack, still sweating, this time around, nowhere near, always wondered, addictive personality, social stigma, fucked up, group of friends, everyone else, rubbed it on, front teeth, on my gums, drinking water, attention deficit, wash over, wore off, left over, since then, right now, no idea, made me feel, light headed, wide awake, energy rush, super paranoid, bad feelings, dry heave, dry mouth, feeling of dehydration, side effects, ended up, stood up, thought it would, feel as if, think to myself, in my life, wanted to try, at once, all in all, a crazy experience, couldn’t stop

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Heroin

Frequent Nouns: friend, time, drug, minutes, needle, people, life, night, dealer, roommate, world, addiction, hours, house, line, coke, cigarette, blood, effects, block, room, foil, sense, junkie, mind

Frequent Verbs: feel, be, have, go, start, think, get, try, say, do, take, find, come, use, look, make, try, shoot, know, decide, sleep, begin, buy, ask, inject

Collocates: describe it, black tar heroin, the bitter taste, it went like, cigarette before, the tin foil, more powerful, a dark brown, months ago, fell into, my fears, didn’t want to, had no desire, I wasn’t going, buy some, will power, the next corner, make sure, his place, my friend, poster child, get addicted, almost instantly, went ahead, stared at, a good vein, shot up, that injecting, with needles, it felt like, better than, to smoke it, on the floor, continued to shoot, throughout the night, i could barely, on the couch, she sat, nodding off, stronger than, a little more, i ended up, i woke up, the first time, my first, in the past, i thought about, numbness of, my eyes, my heart, my stomach, my lungs, all over, it burned, could barely walk, across the street, too fucked up, right now, kind of hell, the entire world, wake up, sober up, an opiate, no longer, waking up, an addict, addict always

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Hydrocodone

Frequent Nouns: time, pills, drug, experience, bottle, pain, water, minutes, body, effects, hours, friend, feeling, hour, head, people, eyes, night, world, stomach, glass, room, warm, nausea, prescription

Frequent Verbs: feel, have, be, go, take, decide, take, seem, make, notice, come, think, get, begin, talk, start, make, try, know, find, become, turn, walk, say, want

Collocates: instantly got, pharmaceutical opiates, Vicodin pills, prescribed me some, read the label, skipped breakfast, an empty stomach, diet coke, pill bottle, decided to take, cold water extraction, watching TV, chatting on AIM, jack off, stay awake, my wisdom teeth pulled, jaw pain, didn’t expect, tingling sensation, cloudy headed, state of mind, breathing deeply, complete relaxation, sensation throughout, world around me, finding myself smiling, once again, close my eyes, i fell asleep, they make me, my legs were, like jelly, my head was, my hands on, becoming less, rolled around, body feels, experimenting with, felt as if, the first time, my mouth, got tired, got comfortable, coming down, get addicted, help me

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Ketamine

Frequent Nouns: time, body, experience, eyes, mind, room, brain, drug, trip, consciousness, reality, life, minutes, sense, words, effects, head, space, state, friend, place, point, thoughts, existence, control

Frequent Verbs: feel, be, have, start, seem, take, begin, think, say, make, take, go, come, know, tell, try, remember, decide, leave, move, keep, want, do, look, need

Collocates: read the screen, suddenly I realized, wide open, dissociative effects, time and space, sensory input, neurological impact, anesthetic effect, under the influence, the most intense, panic attack, Timothy Leary, it felt beautiful, to control myself, sitting upright, arms and legs, red and green, nothing more than, into infinity, flying through, levels of existence, other realities, vast plains, what the hell, what to expect, opened my eyes, I remember seeing, gravitational forces started, geometric patterns, different dimensions, stretched out, green blotches, ego loss, infinite number, melted onto, possible universes, electric current, beckoning to, prepare myself, hard to explain, there is no, in my head, my physical body, detached from, began to feel, most powerful thing, know her name, provoked new, wide open, in fact, was it because, totally paralyzed, starting to come, onto the floor, small dose, accompanied by, turned off, were no longer, drip down, other beings, snarfed up, being sick, flying through, stretched out, mental effects, pretty good, very well, detached from, escape from, turn off, figure out, cut myself, last infection, take place, body feels, reminded me, communicate with, make sense, what happened, down the hall, off the lights, leaving me completely, feel some sadness, funny thing is, needs to be

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MDMA

Frequent Nouns: time, people, experience, friend, night, hours, music, life, house, minutes, body, everyone, dose, trip, brother, years, drug, pill, hour, mind, love, home, thoughts, room, effect

Frequent Verbs: feel, be, have, go, take, tell, decide, say, seem, think, want, know, begin, walk, come, start, get, turn, ask, look, become, make, find, realize, keep

Collocates: accurate representation, amplified considerably, became aware of, best friend, bolt upright, breeze caressed, car accident, cartoonish nature, chewing gum, conscious decision, crown chakra, cruise ship, dance floor, drawing near, each other, engulfing euphoria, experience with MDMA, explore reluctantly, feelings are, focus on, fractal images, friend of mine, fuckin’ unreal, gag reflex, gauging yourself, geometric patterns, hit me, hypnotic whispers, i could see, i ended up, illusion created, infinite paradise, in love with, in my head, intimately connected, kaleidoscopic daydreams, lazy bastards, life-sucking, looked forward to, low dose, lowered serotonin levels, my ability to, my perception of, oral sex, pure MDMA, so we decided, stage area, starting to come, starting to feel, still very much, than normal, unfortunately narrow reality, very positive, with my girlfriend

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Mescaline

Frequent Nouns: trip, time, hours, body, effects, experience, girlfriend, eyes, hour, mind, colors, minutes, time, visuals, dose, head, home, level, life, room, substance, world, amount, feelings, capsules

Frequent Verbs: be, feel, have, think, go, start, seem, trip, decide, take, keep, look, become, come, get, do, make, leave, begin, give, close, want, happen, think, move

Collocates: accoutrements strewn, afternoon wore on, amber-like color, am right here, animals live encaged, anxiety disorder, art conceived, automaton machinery, basically broken, battling depression, becoming hyper sensitized, begins telling, benevolent feeling, bodily calmness, breathtaking variety, chemical aroma, chronically overdosing, closely resembled, color brightening, comfortable crossing, crystalline solid, curious detachment, data indicating, deepest depths, deep spiritual, dramatic increase, ego loss, electric shock, emotionally opened, encompassing reverberations, euphoric lightness, everything is, figures forming, fine poision, finished dressing, flash clarity, general satisfaction, gradually wearing, greatly excited, gruesome deaths, highly soluble, hot ethanol, hysterical happiness, ice bath, illegible sentences rambling, I could feel, I thought I, important books, induced vomitting, leopard print, limbs ripped, lone animal, lung opening expansion, mannequin parts, mescaline trip, mucous membranes, my body, my eyes, my face, my head, my mind, my room, natural rhythm, negative emotions, not remembering, ongoing process, panic attacks, passionate thought loops, perceived depth, perception unchanged, psychologist created, pungent chemical aroma, rapidly changing, rarely bring emotion, reality ego, repeat mantras, sense of, serious buddah, smoothly flowing, society deplores, strange considering, tell ourselves, temporary obsession, tentacles emerged, that night, the mirror, the nitro styrene, there was no, time dilation, to finish, to speak, unidentifiable shapes, unremarkable appearance, upon shooting headfirst, veteran trippers, vigilance comes

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Methamphetamine

Frequent Nouns: time, people, drug, night, hours, experience, friend, speed, body, drugs, mind, reality, rush, head, home, line, house, world, point, crystal, everyone, shit, life, sleep, days

Frequent Verbs: be, feel, have, go, start, do, take, try, think, say, talk, know, come, want, get, smoke, become, find, look, end, make, decide, stop, tell, notice

Collocates: 21st century, acrid odor, alternate reality, another bump, an overwhelming, arouse suspicion, be careful, beer bottles, being awake, big city, black film, bloody lovely, bullet proof, chamber clouded, color-coded map, come down, concrete alley, conspiracy theories, control over, convenience stores, crave affection, crawl by, crushed epsom salts, cultural phenomenon, damn good, demons chasing, disappearing rapidly, doorknob turning, double-edged sword, downright frightening, eerie waking dream, elite university, exceptionally un-addictive, experiences fuel, extra nasal secretion, fiending for more, focusing abilities, forced myself to, found myself, fucked up, fueled pilgramage, gay male hustlers, grand finale, hang out, headless chickens, head rush, hit me, huge explosions, ill-advised sexual encounters, immense caution, inanimate objects, inherent tension, interpreted as, intoxicated or, lesser extent, like crazy, made me feel, minded revolutionaries, moderate dysphonia, more comfortable, muscle spasm, my jaw, mysteriously disappeared, notorious counter-culture, offending object, perfectly lucid, performed rituals, periodic table, pinball machine, pink champagne, planetary consciousness, play chess, potent cocktail, pruned indefinitely, pupil constriction, purely platonic, realistic hallucination, remarkably easily, replied confusedly, revolutionary rewrites, sacrifice efficiency, screaming tortured souls, seething mass, severely damaged, shady ass motels, sheeps’ clothing, sickly looking, sleep deprivation, smooth talker, spun out, sticky bile, successfully heightened, sweated profusely, taking speed, teeming colony, telepathic link, tell them, the dark forest, the human body, thousand snakes, throw up, tolerance builds, trapped souls, truck drivers, true nature, unconscious mind, unit bomb, was coming down, white devil

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Psilocybin

Frequent Nouns: trip, time, experience, room, life, people, mind, friends, water, world, body, sense, eyes, thoughts, minutes, place, house, words, state, home, fact, night, someone, love, reality

Frequent Verbs: be, feel, have, say, begin, go, look, start, seem, want, know, think, make, come, realize, take, decide, look, keep, want, get, ask, tell, trip, try

Collocates: amazed how, blinders on, altered reality, those moments, every color, deeper and deeper, traveled somewhere new, towards infinity, whatever I imagine, flowing through my head, every passing moment, crazy grin, death rebirth, bad trip, complete self-loathing, pure evil, crystal clear, mental clarity, existence non-existence, learned to accept, the ultimate truth, more or less, found it humorous, pale ghost, touch with reality, more intense than, drowned myself in, pulled the number, points of view, press into your, tripping so hard, kick in, group unity, fellow campers, kill a rabbit, travel along, experiencing so many, psychedelic substances, voice sounded, same page, full moon, fetal position, psychological stuff, exact same, harder than, positive energy, getting younger, ever seen, earth existence, someone else, round room, original plan, no boundaries, conscious thought, totally different, completely insane, have fun, caught tripping, stoned feeling, being alive, kept telling, strange sort, grams of dried mushrooms, make sense, spinning around, wandered around, getting stronger, surrounded by, press into, would reset, drown myself, curled up, pass out, slipped into, total silence, beyond words, beyond amazing, what would happen

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Detailed Gallery

The most frequent nouns, verbs, and adjectives, by drug class.

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How many words is a trip worth?

Whereas the physiological effects of uppers and downers are of a piece with sensations known from everyday life, psychedelics represent a radical break with normal perception. Predictably, then, psychedelic experiences prompt the longest outpourings; depressants the shortest; stimulants fall roughly in the middle. As one user put it, psychonauts must “reach out for more and more words to capture how extraordinary the experience is”.”

Curiously, while the vocabulary of psychedelia is richer than that for uppers and downers, it is also more redundant, scoring lower on measures of lexical diversity. What does that mean exactly? Measures of lexical diversity assess how many different word types writers use, relative to the number of words they use overall. For example, the sentence “the the the the the” is composed of five words, but has only one word type (“the”), making it lexically impoverished compared to the sentence, “the girl drew a map”, which runs through five distinct word types. Controlling for length, psychonauts use only about three-quarters as many word types as dopers.

This finding is somewhat misleading, however. When we look at the collocates that appear for ayahuasca (“galactic Bodhisattva brigade”) versus heroin (“in the past”), it becomes clear that psychonauts make use of a broader array of less common, more distinctive words and phrases to describe their experiences. It is often the case that when we communicate about something ununusal or simply unexpected, we ease our audience into it by adding in redundancies, either in the way we introduce the idea, or in how we explain it after. This can be seen at the word level in the phrases “a nice cold beer” or “a cute little puppy“, where the information added by the adjectives is largely redundant, but helps make the nouns more predictable in context. Similarly, unusual concepts or ideas are often implicitly or explicitly redefined by the surrounding context, as in the following:

“The ability of stereotyped students appears to be latent, underestimated by their level of prior performance.”

Drug users of all types make use of various parts of speech in similar ways. Across Erowid reports, nouns make up a little over a quarter of all word tokens, verbs a little under a fifth, and adverbs and adjectives an eighth. (Psychedelic use does seem to invite slightly more adjectives than usual, at the expense of adverbs.) All reports are littered with temporal markers, indexing stop, start, when and for how long, with transitions registered in seconds, minutes, hours, days, weeks, months, years, and so on.

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What’s under the hood?

What makes these visualizations possible? The usage data was gleaned from a manually-created corpus of single-drug experiences, which comprises the top twenty-five public postings on Erowid for each of the selected drugs. Erowid is a popular drug library that hosts open forums in which users share their experiences, along with detailed information about the amount and preparation of what they ingest, imbibe, inject, and so on.

To analyze the composite texts, the entries were first manually standardized for spelling, which comes in a variety of forms, both standard (British vs. American English) and non-standard (slang). Drug texts were then run through a simple script that created a dictionary entry for each word type, along with its corresponding part of speech tag (verb, noun, adjective, or adverb) and its frequency (how many times it occurred in the text). Once a lemma frequency dictionary was in place for each drug, this information was fed into Wordle to generate the detailed visualizations for each part of speech. Visualizations across all words were created directly from unfiltered corpus texts with Tagxedo, which sacrifices some advanced functionality, for striking, graphic designs. IBM’s free data visualization service, Many Eyes, was used to visually inspect the size of the various drug corpora.

Notably, the script used to analyze the texts relied on modified versions of four of the Natural Language Toolkit’s prepackaged modules: the word tokenizer, part of speech tagger, WordNetLemmatizer, and collocation finder. While NLTK’s modules are not the current state of the art, they are freely available, well documented, and readily accessible. Demos are available here.

For those who are unfamiliar with these techniques: Tokenization takes a text and carves it at the joints, selecting out individual words, while ignoring spaces and punctuation. Collocation finders extract multi-word sequences that occur together more often than would be expected by chance. Lemmatization collapses across various forms of the same word. So, for example, the WordNetLemmatizer treats ‘run’ and ‘runs’ as one verb, rather than two separate ones, and similarly collapses ‘go’ and ‘went’. Part of speech taggers identify which grammatical category a word belongs to, depending on how it is being used in context. Many words, like ‘run’, can be used as a noun in one context (“She went on a run”) and a verb in another (“She likes to run”). The tagger is designed to resolve ambiguities like this, while also handling more straightforward cases.

Many thanks are due to Jordan Dye, a pharmacology consultant on this project, and to Ya Yang, for assisting with corpus creation.

“The influence, upon our thinking, of a comprehensive scientific theory, or of some other general point of view, goes much deeper than is admitted by those who would regard it as a convenient scheme for the ordering of facts only. …scientific theories are ways of looking at the world; and their adoption affects our general beliefs and expectations, and thereby also our experiences and our conceptions of reality. We may even say that what is regarded as “nature” at a particular time is our own product in the sense that all the features ascribed to it have first been invented by us and then used for bringing order into our surroundings.” -P.K. Feyerabend, Explanation, Reduction & Empiricism

Cargo Cult Contrarian is a new incarnation of The Psychotronic Girl, a would-be blog that never was.  It is named for Richard Feynman’s classic speech, Cargo Cult Science, which warns against the dangers of pseudoscience, and of letting the attractions of theory overrun careful experimentation.  In an age when science is increasingly being called upon to furnish explanations it is ill fit to provide, Feynman’s message seems more pressing than ever.

I will have more to say about Feynman on another occasion.  For now, by way of introduction, let me say a little about my interests:

One of the great attractions of studying the mind is the promise that we might one day unravel how the reality we each experience is manufactured, what it captures, and how it errs.  In this pursuit, the questions one might pursue are boundless.  For my part, I am fascinated by narrative; by how we lend meaning and coherence to our existence and our practices through language.

Words, as a tool for sense-making, can be dangerous, slippery things.  With them, one might weave false memories; derail moral judgment; guide what is seen, or noticed, or understood; carve up the world. Because our narratives help structure our expectations about how the world works, they can also deeply influence and profoundly distort our perceptions of it.

Yet there is little escaping such influence.  As humans, we must decide what to attend to and what to take meaning from, against a backdrop in which we cannot possibly attend to everything.  Cultures establish norms for how we should do this, and languages, in part, encode them.  Still there is nothing positively concrete or static to these conventions within or across cultures; nothing definitive.  Rather, there are loose edges, clusters, and distributions.  There are ways of seeing.

It is only in madness, where what we observe is a disruption in perception, a sharp break with culturally-wrought modes of understanding, that we gain some purchase on the space of what we call normal.  We see these breaks in the paranoia of the schizophrenic, in the depths of anxiety and depression, and the heights of mania.  The mind is no longer mining the world as it has done; as we think it should do.  It finds patterns where there are none, it fails to finds the ones that matter most keenly.  A screw has come loose, we say.  Something has gone deeply awry with the mind’s interpretive efforts.

In short: Disorder interests me.  Genius interests me.  The bewitchments of language interest me – how we wield words against each other, how we use them to deceive ourselves, how we communicate and negotiate power, how we construct and alter memory.  I am curious too about the extent to which we share our lenses in on reality, both within our culture and without.

This is some of what I will be writing on.

“Electricité, électronique, cybernétique‥et ensuite?‥Proposons Psychotronique, utilisation de la pensée et de la volonté.” (Toute La Radio, N° 192 du 12 janvier 1955.)

Welcome to The Psychotronic Girl, a freshly-minted blog on the science and politics of language.

What does it all mean? In English, psychotronic is a word that has its origin in 1980′s B-film fandom and is a term of affection for those quirky campy counterculture offerings that somehow slip under the radar – the spaghetti westerns, survival horror and exploitation flicks of the lost years.  It’s an apt metaphor for what’s on offer here: a stew of the high-brow and the surreal.

Why the psychotronic girl? Mostly because it calls to mind Barbarella, Queen of the Galaxy. “Who can save the universe?” the billing screams. Evidently, Jane Fonda can. Evidently so can this blog.

What am I about? Autobiographical narratives invariably invite self-deception and self-flattery, so I offer instead a list of easily verifiable facts:

I measure in at the ninety-fifth percentile for height.  I register in the top tenth of a percent on tests of facial recognition.  At fairs, I always beat the carnies at balance games.  In races, I regularly beat the boys.  Only the Irish and the Russians can best me in my tolerance for stiff drink.  I have an inordinately high threshold for pain.  My look is chameleon and my features distinctly immemorable.

In short, the fact that the CIA has yet to recruit me can only be seen as a grave failing of national security.  Were I a spy, I would be world-class – grade-A -the real deal.

But alas. Here I am.

If you’re interested in my day job, you can befriend me on the poor man’s Facebook – academia.edu – in which I can be found advertising a chocolate fondue fountain and wishing for a more ecstatic truth.

Why did I start writing? To begin to chip away at the Chomskian hegemony over public discourse on language.

…What? Kidding. Though strangely, I’m not even the first person to use the term (and only apparent oxymoron) “Chomskian hegemony.”  Go ahead. Google it.

What’s next? That, dear reader, is to be determined. In the pregnant pause – between now and some as-yet-unspecified next posting date – you can further research my credentials with the following fool-proof guide:

Articles for Scientific American here.  Scientific publications here.  Representative blog post here.  Comic book action hero here.  I do warn you: subsequent googling may return embarrassing videos and/or stunning failures in investigative reporting, such as this piece on neighborhood parking enforcement.

How do I feel about the anonymous comment box? Miserable, in the main.  It’s a bit like a comic who gets some belly-laughs, a few helpful guffaws and a blitzkrieg of plump, overripe tomatoes to the nose.  Ouch.  That said, commenting – both signed and anonymous – is duly enabled for future postings.  Civil debate, corrigendums, addendums and plea bargains encouraged.  I exercise the right to editorial control over rotten tomatoes only when lobbed anonymously (and ingloriously).