Author: Marc

Reader responses (here and on my new blog on the Psychology Today website) highlight both sides of the self as experienced with dissociative drugs (DXM and ketamine). There is a sense of being centred, perhaps while in free fall and watching the world go by, and there is a sense of freedom from constraints. You no longer care about the rules and regulations of that other world, the one you left behind, now that you are so very present in this one. On the other hand, you can’t seem to take this experience back home with you. So can it be of any real value? Without being moralistic about the fact that you got there with drugs, there’s also a real loss, a real sadness, about having to say goodbye to that magical place.

My own days of dissociating.

So what do I say to Charles? I used to drink bottles of DXM in my twenties (they hadn’t invented ketamine yet). I would sometimes drink a 250 ml bottle and then go to see a movie. Sitting there, melting in that cushy seat, I would feel that the movie had a special significance — that the people on the screen were really there for me, and I was a part of them. The people in the theater, breathing and whispering all around me, felt like an intimate tribe. (Then I’d try to leave the theater after everyone else, because I couldn’t walk without stumbling.) Or I’d sit on the Toronto subway brimming with exaltation. Every stop seemed a fantastic production, a special performance just for me. All that screeching of the brakes, the careening people, and finally….that glorious moment of stillness, punctuated by the dramatic whoosh of the opening doors — all at the same time! My emotions, my sense of astonishment, and the freedom of the moment were real. But it was a temporary reality. One that only crazy people can hold onto for good. In fact, ketamine is the drug that has been used most often to study the experience and the neurochemistry of schizophrenia. Hmmm….that doesn’t sound good.

A true self?

My diversions with dissociatives seem pretty juvenile compared to Charles’ existential struggles. Blockade your NMDA receptors for a few hours and you really will experience the world in a new way, you really will drop a lot of baggage, that baggage being all the rules, judgments, and mental habits you’ve been acquiring since infancy. Is there a true self left over when comprehension begins to disintegrate? For Charles it seems that way. He feels like he’s returned to his soul, or some reincarnated entity that came before birth or before the long road of knowledge acquisition, cognitive development, and increasing socialization that he’s followed ever since. But is this his true self?

Or is the true self rather the sum total of all that knowledge and comprehension, the tinker-toy configuration of familiarity that we build up over the years, as well as the peaceful, self-forgiving messages that blow through that complicated structure on good days? It seems to me that the true self actually includes the self-imposed constraints, rules of conduct, and uncomfortable habits that we’ve worked on for all these years. But also the energy and insight capable of changing them. If that’s so, then the true self might be something one wants to learn to accept, just as it is, with all its confusing habits. Rather than something one wants to relocate in a purified wonderland. Charles thinks he can find his soul by taking dissociatives. But I suspect that what he finds is a state of cognitive relaxation that can be very pleasant and that seems incredibly meaningful because it allows him to imagine himself at the centre of the universe.

Or maybe there’s a third answer. Maybe there is value in watching your values disintegrate, watching the rules melt away, just so you can finally get a glimpse of how those habits dominate you from day to day. If that’s the case, then Charles might be advised to see what’s left the next day: just loss, a headache, and some nausea….or is there some wisdom he can take with him?

In response to a recent post about Charles’ dilemma, readers brought up several issues that I’d like to address…before getting to Part 2. The issue of good vs. bad came up. Charles’ quest for his “true self” seemed to be based on an experience of goodness that could not be replicated without drugs (in his case, dissociatives like DXM and ketamine). But then he worried that what he was doing was not good…it wasn’t right or proper somehow. Readers also suggested that finding the “true self” is an achievement: it takes place over development — i.e, over time — and it requires hard work. Putting these ideas together, we’re stuck with a definitional matter that needs to be resolved before we can provide some advice for Charles.

Here goes:

Definition #1: the moral good.

Good means right, means socially acceptable, or valid, or productive, vs. bad, the opposite of those things. And this polarity further breaks down into detailed comparisons and ratings, like harm vs. help: if I’m not helping myself or others, then whatever I’m doing is not GOOD. Similarly, if I’m harming myself or others, that’s BAD. This already gets tricky: is harming the self necessarily morally bad? What about suicide in the case of terminal illness? What about slapping the side of your head to coach yourself against acting like an idiot? If you follow it to its logical conclusions, this kind of definition gets clunky and/or arbitrary and sometimes irrelevant; because it’s really just based on a simple formula: normativity. Following norms (either past or present, idealized or actual) gets to be the only reliable yardstick for being good. Sounds a bit boring. And perhaps irrelevant to things like…well, like taking drugs, which might harm the self a little, or a lot, in the short run, or the long run. But may also help, by opening doors that were previously closed. Yeah, boring but complicated (at least for a non-philosopher like me).

Definition #2: feeling good.

The other definition is that good = feeling good. Nothing moral or normative about it. Feeling good is easy to determine. It’s the most basic perception one can possibly have. Ask any two-year old. Without the complexity of “norms” to follow or defy, two-year olds just go with the straightforward definition: Good = happy. Bad = unhappy. And that perception of the world comes straight from their orbitofrontal cortex (OFC). This relatively primitive part of the prefrontal cortex is called “paralimbic” for good reason. It’s intimately connected to limbic structures like the amygdala and striatum. But it also serves as a sort of limbic structure itself. Cells in the OFC fire more rapidly when you eat something sweet. That’s a natural reinforcer (reward), built into our biology. But other cells in the OFC respond to “secondary reinforcers” like a sexy smile from someone you find attractive, or the steam rising from your foil-wrapped burger, or a green light. You can’t argue with your OFC’s perception of good. The OFC has been around for at least 100 million years, and it knows its job.

The developmental angle.

Little kids perceive good via definition #2. They just feel it. And besides, norm-following, i.e., the capacity for moral behaviour, does not come on line until about the age of 3 1/2 to 4 years, when children acquire what’s known as Theory of Mind, an important watershed in cognitive and social development. Before the onset of Theory of Mind, you can’t imagine what others might be thinking or feeling. You just think that everyone sees things the way you do. So kids younger than 3 1/2 can’t possibly be good in a moral way that requires seeing the impact of their actions on others. All they can do is follow rules to avoid punishment.

What’s so bad about feeling good?

Charles says he feels good according to definition #2. But that’s a child’s definition. Isn’t it distasteful because it’s indulgent and immature? Or is it spontaneous, and thus precious? Charles tells me that the “goodness” of getting high on dissociatives (e.g., ketamine and DXM) involves feeling wholeness, excitement, and spontaneity. Good on the inside. Plus — and here’s the special bonus, available now for the next 8 hours, so hurry before the offer expires! — pot and/or DXM and/or ketamine allow you to disengage from definition #1, to shuck off those normative demands. Because the obligation to follow, or at least to be concerned with, social norms breaks down when you’re on these drugs. And that’s because norms and standards make up a large part of the sense that’s held together by networks of cortical neurons, communicating through NMDA receptors. Recall that dissociatives are NMDA antagonists, which break up the orderliness of the cortex. So they break up your model of what’s moral. Pot can do the same through a different mechanism. Now put together that fundamental child’s feeling of goodness, e.g., via wholeness and spontaneity, with freedom from norms and societal constraints, and Charles gets to his “true self” — at least that’s how he sees it.

I think definition #2 is crucial for thinking about GOOD vs. BAD when it comes to drug/alcohol use. Yet we (most of us, including, no especially, ex-addicts) tend to slip into definition #1 instead. We get moral, and we tend to dismiss the very plain fact that drugs, booze, and other things to which we get addicted, feel good. At least for a while. Intrinsically good. Or else we wouldn’t keep going back to them again and again.

Feeling good is the guiding force behind children’s spontaneous behaviour, including their love, their eagerness, and their creativity (all mediated by the OFC, which develops a few years ahead of the dorsal prefrontal circuits — e.g, the dACC — which support norm-following). Feeling good is our principal, fundamental aim in approaching and understanding the world, before we learn morality. It’s bodily good, sensory good. It’s the good that comes from activating orbitofrontal circuits that evolved to keep us tuned into what’s valuable in life. Rather than take the high road of morality, I write quite a bit about the “goodness” of drugs in my book — even as I emphasize their dark side.

So, back to Charles’ dilemma: if you can knock out the blind pursuit of being good (morally, slavishly, obsessively) for those few hours, at the same time as just feeling good…well, that sounds pretty damn attractive.

Please add your own thoughts and impressions, and stay tuned for Part 2.

I’ve been talking to a young man about his drug issues, and he feels he’s got a serious dilemma to unravel. Lately he’s been taking dissociatives — dextromethorphan (DXM) and ketamine — and they take him somewhere he can’t seem to get without them.

Charles (I’ll call him) is in his early twenties, bright, energetic, and a bit lost. He’s tried a number of jobs and hobbies, a little time at university, and lately quite a few drugs. He seems to have a healthy fear concerning really nasty drugs like meth, crack, and heroin. But dissociatives are freely available among his friends and at the local drugstore, they don’t come with a heavy price tag, either in terms of money or raised eyebrows, and they don’t seem very dangerous to him. In fact I’m not aware that there is a toxic dose for these drugs, though you can sure make yourself sick. And brain damage does not seem likely, but it wouldn’t be that hard to kill yourself if you stumbled around in traffic or fell down the stairs.

What dissociatives do to your mind and brain.

Dissociatives do exactly what their name suggests. They break down associations between current experience and all the reference points, memories, and meanings that normally make experience make sense. Experience that pulls away from sense is a liquid sea of emotions, impressions, and shifting boundaries between the real and the imagined. Take enough and those boundaries disappear for hours at a time. Take more and you can’t walk or talk very well, if at all. Dissociatives work by blockading NMDA receptors all over the cortex. These are principal channels (entry ports into neurons) for communication among cortical regions. But NMDA channels have a special function: they receive information that allows cortical activation to cohere rapidly and sensibly. In other words, they might not be much good for interpreting abstract art, but they tell you what you’re doing, where you’re doing it, when you started doing it, and why it makes sense to be doing just that. This is all pretty important for day-to-day living. But it gets seriously messed up with DXM or ketamine (or PCP or angel dust). Now you can experience things the way they seem to be or the way you want them to be. With your cortex in disarray, meaning might get formed by more primitive (e.g., limbic) parts of your brain, without the usual “reality testing” that goes on every moment. Sounds interesting.

Charles was not surprised when I shared this information with him. But his dilemma remains. There are times when he’s on these drugs that he feels completely free of the constraints, values, and habits he’s been enslaved by (so it seems to him) for most of his life. The rules by which he conducts himself, his constant efforts at impression management, and his sometimes suffocating need to be “good” dissolve into a mist of spontaneity and adventure. He can let himself be himself, his real self — the true self that, as he puts it, has been out of reach for his whole life. So his question is this: I know I get there through drugs, I know it’s a short-cut, and I know it won’t last, but isn’t there something productive, even wonderful, at finding my true self, even for a few hours?

I’d like to know your thoughts about this. I’ll tell you what I think in Part 2, coming in a couple of days.

A new act to control the prescription of narcotics (we assume they mean opioids) just went into law in Ontario on November 1. (Similar acts are not unlikely in the rest of Canada.) This act will presumably make it harder for people to forge prescriptions, use alternate names, borrow prescriptions, and so forth. One of the hallmarks of the act seems to be better enforcement of the recording of information never previously required, including the registration number for the prescriber (doctor) and an identification number for the drug itself. It’s hard to get specific, based on the wording of the act, but the upshot is that pharmaceutical opiates will be more difficult to obtain. What does that mean for those of you who treat or study addiction? What does it mean for those of you who use opiates?

Let’s start with the last question first. If users use less, if the problem really diminishes, then those who treat users will have less work to do. But if users get more desperate, or more clever, if they have to pay more, steal more, lie more, etc, then those who treat users may have more work to do. So all we need to do is figure out the consequences for users.

But it’s complicated. Like the age-0ld competition between cops and robbers, or rulers and rebels, there has been an ever-escalating stalemate between attempts to banish drugs and attempts to procure them. The dopamine-pumped addict, like the starved animal he resembles neurobiologically, has one goal and one goal only. All that dopamine crashing around in the nervous system…. When it doesn’t lead you directly to the goal, it supports the most effective, efficient, creative thinking on how to get around the obstacles and get you there regardless. Dopamine is good for thinking, planning, strategizing, and conniving. People with ADHD, and who can’t keep enough dopamine in their synapses, suffer from the dissolution of focused attention. They can’t keep their goals in mind. Dopamine-stoked addicts have the opposite problem. The goal is all they have in mind.

Also, dopamine makes you desperate, just like the starving animal. Contrary to the out-of-date view that dopamine is part of a pleasure circuit, dopamine is about doing when the goal is available and craving or striving when the goal is out of reach. That has pretty stark consequences for the law of supply and demand. When the supply of opiates is diminished (but not eradicated), the demand goes up. Way up. That’s why addicts of various stripes resort to poor quality drugs, hugely expensive drugs, and drugs mixed with all kinds of nonsense. It’s also why alcoholics on a low budget traditionally drink after-shave, cooking wine, or even rubbing alcohol (which is poison).

So picture the addict, with all that dopamine and no place to go, frothing wavelets rising higher and higher in the tank of the self. That dopamine has got to be good for something, and that something is success, regardless of the obstacles. Natural selection didn’t preserve dopamine because it helps you spit out watermelon seeds. Dopamine means business. Dopamine circuitry evolved to help achieve goals, difficult goals, despite the barriers of competition, scarcity, and natural enemies. Well, I suppose drug enforcement policy is a natural enemy for drug users.

Now if opiate drugs could be made completely unavailable, that would certainly diminish the problem of opiate addiction. But is that possible? If not, we’ll see what new tactics users adopt, with this latest plugged leak in the dopamine bucket.

In the last 24 hours, a video clip of a Texas judge beating his teenage daughter (for the crime of downloading music) has gone viral on the internet and news media. It’s a horrendous video, involving not only brutal violence but also vicious humiliation of a child by a parent. What makes the story more provocative still is that the daughter, 16 years old at the time, has cerebral palsy, the father is a judge who presides over child welfare issues, and, oh yeah, he was apparently addicted to opiates.

There’s little doubt that, as the story spins out in various directions, the issue of opiate addiction will hit the spotlight. While thousands clamour for the judge’s dismissal or worse, even his daughter, the victim of the abuse, says he needs rehabilitation instead. Could opiate addiction possibly explain this kind of behaviour? Could it excuse it?

There are drug families that change the personality in fundamental ways, as a direct result of brain damage. But it’s pretty clear what those drugs are: methamphetamine and crack are the most infamous culprits, and inhalants such as gasoline and various solvents also destroy cells up and down the nervous system. But opiates don’t damage the brain, in and of themselves, unless you OD, in which case you can lose a little, a lot, or all of your brain.

Yet some of the byproducts of opiate addiction can lead to behaviour problems so severe that the question of brain damage becomes a matter of definition. The first byproduct is craving itself. In a recent post, I compared the addict’s craving brain to that of an animal in a state of starvation. That’s not an analogy. The parallels are concrete. Drug craving laces the brain with dopamine, replacing the role of other neuromodulators. Thanks to massive gouts of dopamine in the ventral striatum, there is only one goal to pursue, and all the animal’s attention and behaviour is focused on that goal. But that doesn’t sound like the judge’s problem. Craving takes attention away from other people. The good judge was overly attentive to his daughter.

Withdrawal is another byproduct of opiate addiction. As junkies and drug counsellors know all too well, the physical discomfort of withdrawal symptoms produces a high level of irritability. Neurochemicals that have an arousing impact on brain and body (e.g., corticotropin-releasing factor, an ingredient of the stress response) are suppressed by opiates. When the opiates begin to leave the system, these neurochemicals rebound with a vengeance, yielding a state of agitation and hyperarousal. And with many common painkillers, that can happen within 6-24 hours following the last dose. So, was the judge going through withdrawal at the time of the beating? Probably not. The video clip, posted on Youtube (not fun to watch!) shows anger and methodical aggression, but there is no sign of the twitchy irritability that characterizes withdrawal.

I think the judge suffered from a more common ailment caused, not only by addiction, but by almost any kind of personal failure; and that’s shame. Shame is a powerful emotion, and it’s one of the few emotions that literally hurts. That cringing, crumpling feeling deep inside, the wish to fall through the cracks in the floor, to disappear from the world, because one’s own self is just so despicable — that hurts! Addiction to anything is shameful. It feels like, and perhaps is, a personal failure. But abusing a helpless child, over whom one holds both power and responsibility, is at least as shameful, and maybe a whole lot more. Being an addict and an abuser…well you see where I’m going. So the judge, like many violent people, was probably responding to and at the same time inducing intense feelings of shame. In himself.

Does that excuse his behaviour? Not at all. Shame doesn’t make you harm others. Shame is painful, and it elicits all kinds of defences. Violence is one of those defences, but to roll up your sleeves and indulge in it, to watch yourself doing it and not stop, is unjustifiable — especially for a justice of the peace. It’s one thing to abuse yourself: not nice, not logical, but you’re the one who suffers. It’s quite another thing to abuse someone else as a way to make yourself feel better.