Tag Archives: psychiatry

“For survival reasons, I must spread globally”

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Reading Trippy by Ernesto Londono for the Telegraph

Ernesto Londoño’s enviable reputation as a journalist was forged in the conflict zones of Iraq and Afghanistan. In 2017 he landed his dream job as the New York Times Brazil bureau chief, with a roving brief, talented and supportive colleagues, and a high-rise apartment in Rio de Janeiro.

When, not long after, he nearly-accidentally-on-purpose threw himself off his balcony, he knew he was in serious emotional trouble.

It was more than whimsy that led him to look for help at a psychedelic retreat in the Amazon hamlet of Mushu Inu, a place with no running water, where the shower facility consisted of a large tub guarded by a couple of tarantulas. He had seen what taking antidepressant medications had done for acquaintances in the US military (nothing good), and thought to write at first hand about what, in the the US, has become an increasingly popular alternative therapy: drinking ayahuasca tea.

Ayahuasca is prepared by boiling chunks of an Amazonian vine called Banisteriopsis caapi with the leaves of a shrubby plant called Psychotria viridis. The leaves contain a psychoactive compound, and the vines stop the drinker from metabolising it too quickly. The experience that follows is, well, trippy.

By disrupting routine patterns of thought and memory processing, psychedelic trips offer depressed and traumatised people a reprieve from their obsessive thought patterns. They offer them a chance to recalibrate and reinterpret past experiences. How they do this is up to them, however, and this is why psychedelics are anything but a harmless recreational drug. It’s as possible to step out of a bad trip screaming psychotically at the trees as it is to emerge, Buddha-like, from a carefully guided psychedelic experience. The Yawanawá people of the Amazon, who have effectively become global ambassadors for the brew (which, incidentally, they’ve only been making for a few hundred years) make no bones about its harmful potential. The predominantly western organisers of ayahuasca-fuelled tourist retreats are rather less forthcoming.

Psychedelics promise revolutionary treatments for PTSD. In the US, pharmaceutical researchers funded by government are attempting to subtract all the whacky, enjoyable and humane elements of the ayahuasca experience, and thereby distil a kind of aspirin for war trauma. It’s a singularly dystopian project, out to erase the affect of atrocities in the minds of those who might, thanks to that very treatment, be increasingly inclined to perpetrate them.

On one ayahausca webforum, meanwhile, the brew speaks to her counter-cultural acolytes. “If I don’t spread globally I will face extinction, similar to Humans,” a feminised ayahuasca cuppa proclaims. “For survival reasons, I must spread globally, while Humans must accept my sacred medicine to heal their afflicted soul.”

Londono has drunk the brew, if not the Kool-Aid, and says his ayahuasca experiences saved, if not his life, then at very least his capacity for happiness. He maintains a great affection for the romantics and idealists who he depicts in pursuit, according to their different lights, of the good and the healthful in psychedelic experience.

His own survey leads him from psychedelic “bootcamps” in the rainforest to upscale clinics in Costa Rica tending to the global one per cent, to US “churches”, who couch therapy as religious experience so that they can import ayahuasca and get around the strictures of the DEA. The most startling sections, for me, dealt with Santo Daime, a syncretic Brazilian faith that contrives to combine ayahuasca with a proximal Catholic liturgy.

Trippy is told, as much as possible, in the first person, through anecdote and memoir. Seeing the perils and the promise of psychedelic experience play out in Londono’s own mind, as he comes to terms over years with his own quite considerable personal traumas, is a privilege, though it brings with it moments of tedium, as though we were being expected to sit through someone’s gushing account of their cheese dreams. This — let’s call it the stupidity of seriousness — is a besetting tonal problem with the introspective method. William James fell foul of it in The Principles of Psychology of 1890, so it would be a bit rich of me to twit Londono about it in 2024.

Still, it’s fair to point out, I think, that Londono, an accomplished print journalist, is writing, day on day, for a readership of predominantly US liberals — surely the most purse-lipped and conservative readership on Earth. So maybe, with Trippy as our foundation, we should now seek out a looser, more gonzo treatment: one wild enough to handle the wholesale spiritual regearing promised by the psychedelics coming to a clinic, church, and holiday brochure near you.

 

An imaginary connection to the post office

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Reading Troubled By Faith by Owen Davies, 22 November 2023

Readers of this magazine may recall how, in early 2020, 5G mobile technology got caught up in a conspiracy theory that saw cellphone towers being set on fire across Europe. But how many of us knew just how dated this delusional belief really was?

A medical note from 1889 reports on the plight of one Henry Staples, 59, who ”fancies telegraph wires are over his head” and “that messages are being sent to people as to his character”. A year later, 56-year-old Janet Sneddon from Glasgow presented with an imaginary wire “connecting her to the post office”.

Owen Davies is an historian of magic. Troubled by Faith is his account of how early clinicians met with, understood, and dealt with irrational belief.

In a book that never lets the big ideas get in the way of the always entertaining fine detail, he builds a cast-iron defence of the movement that saw asylums springing up across western Europe in the 1830s. There were certainly abuses — there still are — but asylums were also places of compassion and sensitivity. Nor, by the way, were you ever just dumped there. Half of all “incarcerated” patients left after less than a year, and most within two years.

19th-century asylum records have serious limitations — the patients’ own words are rarely recorded directly — but Davies’s examination reveals what he calls “an extraordinary cultural space where under one roof prophets, messiahs, the bewitched, and the haunted, wrestled with angels, devils, imps, and witches.”

Troubled by Faith is a complex, sometimes tragic and ultimately uplifting story of how intelligence, sympathy and good-will triumphed over clinical ignorance. Growing up imbued with the values of the Enlightenment, doctors like the pioneering French neurologist Jean-Martin Charcot and his pupil Sigmund Freud believed that magic was “a diseased survival of a benighted mediaeval past”, and that “madness” was therefore largely determined by history. Ignorance had spread superstition; superstition had fertilised irrational beliefs; and irrational beliefs were driving people into manias and insanias of one sort or another. If you could educate people into thinking rationally, mental wellbeing was bound to follow.

But irrational beliefs were not irreconcilable with modernity after all, Owens explains. Magical thinking, which ruins lives, is just a species of rule-of-thumb thinking, without which day-to-day life is impossible.

These have been humbling lessons for a discipline that, when it started, imagined the problems and mysteries it confronted could be cleared up in a generation.

Troubled by Faith is hardly the first book to be written about the very early years of psychology. But while most of these tend to plash about in the shallows of developing theory, Owens does everyone a tremendous favour by rolling up his sleeves and diving into the lived experiences of distressed and delusional people.

Owens explains how insanity diagnoses spread from behaviour to belief — in witches or fairies or ghosts, in divine or infernal visitations, or in new technologies operating in supernatural ways — and he explains how, by listening to and caring for patients, this diagnostic overreach was eventually corrected.

Many a contemporary observer found such a muddle infuriating, of course. In a long section about the legal culture around insanity, we meet the judge Baron George Bramwell who, we are told, “became something of a bogey figure in the psychiatric community as he routinely critiqued and dismissed medical expert witnesses and scoffed at the notion of moral insanity.”

With hindsight, and thanks to works as insightful as this one, we can afford to be more admiring of the effort to understand the mind, that enjoys reason, but does not need reason to be right.

A balloon bursts

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Watching The Directors: five short films by Marcus Coates, for New Scientist, 31 August 2022

In a flat on the fifth floor of Chaucer House, a post-war social housing block in London’s Pimlico, artist Marcus Coates is being variously nudged, bullied and shocked out of his sense of what is real.

Controlling the process is Lucy, a teenager in recovery from psychosis. Through Coates’s earpiece, she prompt Coates in how to behave, when to sit and when to stand, what to touch, and what to avoid, what to look at, what to think about, what to feel. Sometimes Coates asks for guidance, but more often than not Lucy’s reply is drowned out by a second voice, chilling, over-loud, warning the artist not to ask so many questions.

A cardboard cut-out figure appears at the foot of Coates’s bed — a clown girl with bleeding feet. It’s a life-size blow-up of a sketch Coates himself was instructed to draw a moment before. Through his earpiece a balloon bursts, shockingly loud, nearly knocking him to the ground.

Commissioned and produced by the arts development company Artangel, The Directors is a series of five short films, each directed by someone in recovery from psychosis. In each film, the director guides Coates as he recreates, as best he can, specific aspects and recollections of their experience. These are not rehearsed performances; Coates receives instructions in real-time through an ear-piece. (That this evokes, with some precision the auditory hallucinations of psychosis, is a coincidence lost on no one.)

So: some questions. In the course of each tricky, disorientating and sometimes very frightening film, does Marcus Coates at any point experience psychosis? And does it matter?

Attempts to imagine our way into the experiences of other beings, human or non-human, have for a long while fallen under the shadow of an essay written in 1974 by American philosopher Thomas Nagel. “What Is It Like to Be a Bat?” wasn’t about bats so much as about the continuity of consciousness. I can imagine what it would be like for me to be a bat. But, says Nagel, that’s not the same as knowing what’s it’s like for a bat to be a bat.

Nagel’s lesson in gloomy solipsism is all very well in philosophy. Applied to natural history, though — where even a vague notion of what a bat feels like might help a naturalist towards a moment of insight — it merely sticks the perfect in the way of the good.

Coates’s work consistently champions the vexed, imperfect, utterly necessary business of imagining our way into other heads, human and non-human. 2013’s Dawn Chorus revealed common ground between human and bird vocalisation. He slowed recordings of bird song down twenty-fold, had people learn these slowed-down songs, filmed them in performance, then sped these films up twenty times. The result is a charming but very startling glimpse of what humans might look and sound like brought up to “bird speed”.

Three years before in 2010 The Trip, a collaboration with St. John’s Hospice in London, Coates enacted the unfulfilled dream of an anthropologist, Alex H. Journeying to the Amazon, he followed very precise instructions so that the dying man could conduct, by a sort of remote control, his unrealised last field trip.

The Directors is a work in that spirit. Inspired by a 2017 residency at the Maudsley psychiatric hospital in London, Coates effort to embody and express the breadth and complexity of psychotic experience is in part a learning experience. The project’s extensive advisory group includes Isabel Valli, a neuroscientist at King’s College London with a particular expertise in psychosis.

In the end, though, Coates is thrown back on his own resources, having to imagine his way into a condition which, in Lucy’s experience, robbed her of any certainty in the perceived world, leaving her emotions free to spiral into mistrust, fear and horror.

Lucy’s film is being screened in the tiny bedroom where her film was shot. The other films are screened in different nearby locations, including one in the Churchill Gardens Estate’s thirty-seater cinema. This film, arguably the most claustrophobic and frightening of the lot, finds Coates drenched in ice-water and toasted by electric bar heaters in an attempt to simulate the overwhelming tactile hallucinations that psychosis can trigger.

Asked by the producers at ArtAngel whether he had found the exercise in any way exploitative the director of this film, Marcus Gordon, replied: “Well, there’s no doubt I’ve exploited the artist.”

Now and again they kill people

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Reading Andrew Scull’s Desperate Remedies for the Telegraph, 3 April 2022

Are mental illnesses real?

Well, says, Andrew Scull, they hurt; they blight lives; now and again they kill people. So there’s that.

But are they illnesses in any recognisable sense? They can’t be cured. Some people, after years of suffering, experience complete remission for no reason. The search for reliable genetic markers for schizophrenia and major depression has proved a snark-hunt. And so on: Desperate Remedies is the story of what happens when the world stubbornly refuses to reward our efforts at rational understanding.

There are two traditions in psychiatry. The first, greatly shaped by our experience with syphilis, assumes that mental illness is an organic failing, perhaps the result of an infection. Henry Cotton is the unlovely poster child of this tendency, a man whose fin de siecle war on “focal infection” involved the surgical removal, of teeth and tonsils first of all, then colons and cervixes, and then just about anything his knife could reach — and killed very nearly half his clientele.

The other tradition, mindful especially of those traumatised by war, assumes mental illness is grounded in individual experience. At its psychoanalytic height, in the twenty years following the second world war, it could blame just about everything on the parents. The Hungarian-American psychoanalyst Franz Alexander believed that “the asthmatic wheeze was the ‘suppressed cry’ of a patient suffocated by an over-attentive mother.” The current crop of trauma therapies — springing from the roots of 1960s-era PTSD like mushrooms after a spring rain — is the latest lurid flowering of this tradition.

Meanwhile psychiatrists — the poor bloody footsoldiers in this intellectual conflict — have been treating ordinary people in oversubscribed, underfunded institutions (or in the absence of those institutions, where “care in the community” holds sway). It’s their “desperate remedies” — from shock therapies to lobotomies — that form the core of this book.

Andrew Scull’s erudite, precise, blisteringly critical history of 200 years of psychiatry spends many pages explaining what happens when overambitious clinicians meet clients deprived of their rights. (Not everyone in the profession is a Nurse Ratched, but it’s worth remembering that One Flew Over the Cuckoo’s Nest was drawn from personal experience.)

In spite of everything, Scull still holds out the narrow possibility that psychiatry has a future, if it would only calm down and own up to its limitations. In the psychopharmological present, for instance, much that we’re told works, doesn’t work. Or doesn’t work for very long. Or is accompanied by so many side effects that many feel they would be better off if it didn’t work. What actually works doesn’t work nearly as well as the press says it works. And — the cherry on the cake — we don’t know why it works. (Any piece of folk wisdom you may have picked up about “dopamine imbalances” or “serotonin levels” is almost certainly wrong.)

The opioid crisis in the United States is a public health scandal that’s been waiting to happen since the early 1940s, when Arthur Sackler, among others, worked out how to couch drug advertisements as clinical information. In its wake, the efficacy of countless drugs is being reassessed. Old trials are being picked over, old claims re-examined. The result? “GlaxoSmithKline has all but closed its psychiatric laboratories,” Scull remarks, surveying the ruins left by this latest “paradigm shift” in psychiatry; “AstraZeneca has essentially dropped internal research on psychopharmacology, and Pfizer has dramatically reduced its spending in the psychiatric arena.”

Were all their efforts quackery? Of course not. It is easy (and cheap) to cherry-pick horror stories from Scull’s impassioned history. But his far more worrying point is that plenty of the effort expended over the last 200 years was intelligent, sincere, and honestly conducted — and that, too, has brought only marginal and temporary relief to the suffering mind.