Our Brains on Drugs

Psychoactive drugs, or substances that alter the brain’s functioning, aren’t new. Humans have used them for thousands of years, and today millions of us rely on them—whether alcohol or Adderall, pot or Prozac—to relax, be more productive, or simply function. It’s therefore startling to read in three new books that no one fully understands how the drugs work or how to use them in a way that ensures the benefits will outweigh the costs. Although researchers and physicians can describe what psychoactive drugs do to us, they don’t know how and why they take effect. Whether we’re consuming the illegal (say, LSD), the legal (as I write this sentence, I’m sipping my third cup of coffee today), or the patented, regulated, and prescribed, we don’t always appreciate what we’re getting into. Pierre Kleinhouse Blue Dreams, by the psychologist Lauren Slater, explores the complicated history of psychiatric drugs. She suggests that it’s tempting—but wrong—to think of modern medicine as a system of elegant cures that have replaced the crude treatments of the past. In psychiatry, she says, the latest techniques aren’t necessarily better than the older ones. Take Thorazine, which Slater calls psychiatry’s “penicillin.” When created, in the early 1950s, it was hailed as a miracle drug. Doctors hadn’t yet begun to study neurochemistry, so they were clueless as to how Thorazine returned unstable patients to their normal selves. And yet the drug caught on—first slowly, in the hospitals of its native France, and then more quickly, in other parts of Europe and across the United States. As it spread, Thorazine transformed the lives of people around the world and drastically reduced the populations of state asylums. Then, after years of success, it was scrapped in favor of drugs said to be safer and more effective, though it wasn’t actually clear that they were. Each of these drugs has its own side effects, Slater says; often, choosing one is a matter of choosing the least of several evils. The cycle continues with various antipsychotics, antidepressants, and other pills. Lurking in the background, Slater notes, are the pharmaceutical companies, which invent, market, and sell new drugs to replace the old, whether or not the former are demonstrably better. The Genius Within, by David Adam, an editor at Nature, moves out of the medical world and into schools and workplaces, bringing us to the cutting edge of neuroenhancement—the growing trend of using “smart drugs” such as Modafinil to improve intelligence, memory, and assorted mental powers. People have long been fascinated by intelligence and how best to measure it, but defining intelligence can be surprisingly tricky. In Western societies it’s often thought to be the speed of one’s mental processes, whereas Eastern cultures think of it more as the ability to handle complexity. Whatever it is, Adam writes, intelligence plays a huge role in our daily lives, influencing how students are assigned to classes, which employees are hired and promoted, and whether two people on a first date agree to a second. The prospect of supercharging one’s brain with a pill, then, is understandably attractive. (Pop culture agrees: Movies including Limitless and the underrated Lucy revolve around protagonists who chemically unlock their brains’ full potential, with predictably outlandish results.) You might think these smart drugs have little in common with psychiatric ones, but the ethical considerations regarding them are similar. Adam takes us through the quandaries of the new intelligence boosters: To whom should they be available? Anyone? Only people whose IQ is below average? Should insurance pay for them? What if someone takes them without a prescription? And what if your classmates or colleagues start using them? Do you have to follow suit just to keep up? The two types of drugs have other things in common too. Smart drugs, like psychiatric ones, work on the brain in ways even scientists don’t understand, but that doesn’t stop people from consuming them. Nor, in some cases, does illegality. Ayelet Waldman’s A Really Good Day, out now in paperback, looks at psychoactive drugs from a personal perspective, helping us better understand the risks, rewards, and trade-offs. After struggling for years with a mood disorder, trying pill after pill in a fruitless effort to find a combination that would work, Waldman decided on a new approach. The book chronicles her monthlong experiment with microdosing, or consuming small amounts of a drug—in her case, LSD. Of course, LSD isn’t easy to come by, which is one reason scientists have a hard time studying it. But those who do are finding that although it and other psychedelics can be dangerous (think bad trips and brain damage), they can have profound positive effects as well, helping people feel calmer, happier, and even less afraid of death. What’s striking about Waldman’s account is that her microdosing results sound, well, normal: She had more control over her emotions; she got angry less often. If that seems a bit pedestrian, Waldman agrees. All she’s ever wanted, she writes, is to have one good day after another, “predictably, regularly, unexceptionally.” And perhaps that’s the sentiment that needs to stay at the center of discussions about the future of psychoactive drugs. When people need help, or an extra edge, they will get it where they can. So maybe we shouldn’t be limited by our lack of understanding about how these drugs work. Maybe a little ignorance shouldn’t stand in the way of valuable, viable treatments. Maybe “do no harm” can’t be allowed to mean “do nothing.”

Our Brains on Drugs

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