Ketamine – biography of a space agent

Ketamine is both a powerful hallucinogenic drug and an effective anaesthetic that can create striking out-of-body experiences.

The history of ‘Taming the Ketamine Tiger’ is recounted by the doctor who has been most involved in researching and understanding the curious compound in an open-access article published in Anesthesiology.

The author is the wonderfully named Edward Domino who was one of the first people to study both the pain killing and mind bending effects of ketamine.

His article recounts the history of the compound from its discovery, to its use in surgery, to its deployment in the Vietnam war and its championing by the consciousness exploring counter-culture.

The paper is written for fellow pharmacologists and so has some fairly technical parts (the section ‘Ketamine Pharmacology’ is probably best skipped if you’re not into the gritty details of how it affects the body and brain) but also has some wonderful personal recollections and anecdotes from the drug’s history.

About 1978, the prominent physician, researcher, and mystic John C. Lilly, M.D. (1915–2001), self-administered ketamine to induce an altered state of consciousness. He summarized his many unique experiences as “a peeping Tom at the keyhole of eternity.” These included sensory deprivation while submerged in a water tank, communication with dolphins, and seduction by repeated ketamine use.

In 1978, Moore and Alltounian reported on their personal ketamine use. Marcia Moore was a celebrated yoga teacher, Howard Alltounian, M.D., a respected clinical anesthesiologist. They reportedly got high on ketamine together and after two ketamine “trips” fell in love and became engaged after 1 week. They felt they were “pioneering a new path to consciousness.” Ms. Moore was called the priestess of the Goddess Ketamine. She took the drug daily and apparently developed tolerance.

For her, ketamine was a seductress, not a goddess. Her husband warned her of its dangers. She slept only a few hours each night. She agreed that she was wrong about a lot of things and was “going to stay with it until it is tamed.” However, Moore was unable to tame the ketamine tiger and in January 1979 disappeared. The assumption was that she injected herself with ketamine and froze to death in a forest.

You can read the full article here although it’s not clear to me that the link is stable enough to be archived, in which case the DOI entry points here although you may need to do some clicking through to find the full text.

Anyway, a fascinating look back at a complex compound from the man at the centre of its science.
 

Link to ‘Taming the Ketamine Tiger’ in Anesthesiology.
Link to DOI entry for same.

The yin and yang of the LSD revolution

Neurotribes has a fantastic interview with the author of a new book on the relationship between Timothy Leary, Allen Ginsberg and their role in the LSD counter-culture that is still echoing through science and culture.

The interview is with Peter Conners, author of White Hand Society, a book that examines the relationship between the two men through their correspondence and looks at how it shaped each as individuals and the place of psychedelics in society.

Despite both men being major figures in the promotion of LSD, they ending up taking very different paths.

Leary, originally a Harvard professor who started out doing respected scientific research into mind altering drugs, ended up being thought of us a bit of a cartoon cut-out by both the establishment and by the counter-culture of the time.

Ginsberg took a less sensationalist route and used the experience as a springboard to spiritual exploration.

Despite the fact that neither ended up boosting serious research in psychedelics both had a massive influence on the scientific study of mind altering drugs.

Silberman: Do you think that if things had unfolded differently for Leary, psychedelics could have been successfully incorporated into mainstream medicine or psychology?

Conners: I actually think they are now more than they’ve ever been. My wife is a clinical psychologist. I recently read an article in The Monitor on tests they’re doing now with psilocybin and MDMA. One potential application is for post-traumatic stress disorder that all these soldiers are coming back with from the Middle East. Another is to help terminal patients prepare for death. The Monitor is a very mainstream venue — it’s the trade journal for psychologists. So after 40 years of a virtual blackout on psychedelic research, you can do it again now, thanks to the efforts of people like Rick Doblin at MAPS, the Multidisciplinary Association for Psychedelic Studies.

Silberman: I think Leary actually helped hasten the blackout, simply by going on and on with his inflammatory and hyperbolic claims about psychedelics. In a Playboy interview in 1966, he said in a properly conducted LSD session, a woman could expect to have hundreds of orgasms. He also insisted that LSD had “cured” Allen Ginsberg of homosexuality. Let’s just say that by the time I met Allen, when he was in his 50s, he must have been having a major relapse!

I have to say, the interview is a little hard on Leary, who, like Ginsberg, had a continuing cultural impact way after he abandoned the championing of LSD, but it is a fascinating look at the relationship between the two men.
 

Link to Neurotribes interview with Peter Connors.

Adler’s ashes rediscovered

The remains of Alfred Adler, the co-founder of psychoanalysis, have been found 70 years after they were lost in Edinburgh reports The Guardian.

Adler, a core figure with Sigmund Freud in the group that founded the psychoanalytic movement before the pair split in 1911, collapsed after a suspected heart attack in May 1937 while he was in Aberdeen for a three-week-long series of lectures and seminars at the university…

Later this month, however, his ashes will be returned to Vienna for a civic ceremony following a remarkable discovery by the honorary Austrian consul to Scotland, John Clifford.

Asked to trace Adler’s remains by the institute he founded in Vienna, Clifford traced the casket to a crematorium only a few hundred metres behind the consulate in Edinburgh. They had been stored there in a quiet, wood-panelled gallery rarely visited by the public, alongside dozens of other caskets and urns.

Somewhat ironically for someone whose remains were forgotten almost immediately after his death, Adler’s most significant contribution to psychoanalysis was the concept of the inferioty complex.
 

Link to Guardian piece on finding Adler’s ashes (via @PsychNews).

Kids on speed and the birth of misbehaviour

Dr Charles Bradley first reported the effects of amphetamine on children with behavioural problems in 1937. An article in The Yale Journal of Biology and Medicine takes a look at how this early study opened the door to treating ADHD with Ritalin and how it tied in with changing ideas about child misbehaviour.

Bradley was a psychiatrist and director of the Emma Pendleton Bradley Home for children with behavioural problems. In the days where ad-hoc experimentation was not considered out-of-the-ordinary, he decided to try administering Benzedrine sulfate, a type of amphetamine, to his young patients.

After only a week, he observed that “The most striking change in behavior occurred in the school activities of many of these patients. There appeared a definite ‘drive’ to accomplish as much as possible. Fifteen of the 30 children responded to Benzedrine by becoming distinctly subdued in their emotional responses. Clinically in all cases, this was an improvement from the social viewpoint.”

The paper appeared in a top psychiatry journal and echoes the now common idea that amphetamine, which includes Ritalin (known generically as methylphenidate), has the seemingly paradoxical effect of calming over-active or out-of-control children.

It turns out that Bradley’s experiment was carried out as the social significance of childhood was changing, as was the concept of what was considered to be ‘child misbehaviour’:

During the 19th and 20th centuries, a new conceptualization of childhood and how children ought to behave emerged in both popular culture and the medical world. A model child embodied the ideals necessary for the new industrial economy: self-regulated behavior and orderly social relations.

Childhood became the critical period for learning restraint and developing a proper social identity in order to grow up to be a successful adult. This prevailing characterization of a good child generated its opposite: the troublesome child. A broad range of social problems fell into this category of misbehavior and could include difficulty in schoolwork, fighting, and failure to obey authority.

That’s not to say that there wasn’t a concept of a misbehaving child before, but just that a lack of social self-regulation and focus was not considered to be as important in defining ‘doing wrong’.

The article describes how Bradley’s work was forgotten for 25 years, owing to the fact that the drug company who made Benzedrine felt they couldn’t market the drug, because it would be difficult to ‘sell’ the seemingly contradictory effects of a stimulant having a calming effect.

However, it opened the door for the first studies of treating hyperactive kids with Ritalin in the mid-1950s which exploded in the 1980s when the diagnosis of ADHD first emerged.

The article is a fascinating look at how social changes, drug tests and scientific understanding interact to influence our modern-day understanding of psychiatric disorder and even childhood.
 

Link to article on Bradley’s Benzedrine studies.

From Both of Me to all 15 of You

While browsing through Flickr I just found this amazing signed photo that rocker Alice Cooper dedicated to his psychologist Eugene Landy.

If you click on the image for the full version you can see the photo in all its Cooper-esque glory. It’s dated 1976, which is apparently shortly before Cooper was hospitalised to treat his alcohol problems.

Even with an enlarged image the writing remains quite hard to read but according to this autograph auction page the text reads:

A b&w 8″ x 10″ photo inscribed “Eugene from Both of Me to all 15 of You” and signed “Alice Vincent Cooper” in black ink by the original shock rocker. the date “8-76” is printed above the inscription. “Eugene” refers to psychologist Eugene Landy, with whom Cooper was a patient in the 1970s. (Lundy also treated Brian Wilson of the Beach Boys.)

To say Lundy ‘treated’ Brian Wilson is a bit like saying Napolean ‘toured’ Europe as he eventually lost his license after it was found out that he had taken over Wilson’s business affairs while supposedly working with him as a responsible clinician.

The situation lasted several years and has become a notorious episode in Wilson’s life.
 

Link to photo on Flickr.

A long view of the nervous system

BBC Radio 4’s In Our Time has a wonderful programme on the history of our knowledge about the nervous system which you can listen to streamed from the webpage or download as an mp3.

It’s a satisfyingly in-depth discussion that tracks first beliefs about the nervous system from ancient times through the renaissance into the modern age.

Scholars first described the nerves of the human body over two thousand years ago. For 1400 years it was believed that they were animated by ‘animal spirits’, mysterious powers which caused sensation and movement. In the eighteenth century scientists discovered that nerve fibres transmitted electrical impulses; it was not until the twentieth century that chemical agents – neurotransmitters – were first identified.

 
Link to episode page with streaming.
mp3 of programme.

The early years of the frontal lobotomy

Neurosurgical Focus has an excellent open-access article that takes a critical look at the work of the Portuguese neurologist Egas Moniz – who controversially won the 1949 Nobel prize for inventing the frontal lobotomy.

Although the over-enthusiasm for cutting patients’ frontal lobes to try and ‘cure’ them of mental illness is now looked upon as rather an embarrassing phase in the history of medicine, the article makes clear that criticism of the technique – including Moniz’s sloppy research – has been around for as long as the operation itself.

The article is a comprehensive look at the early history of frontal lobotomy and psychosurgery in general and is a wonderful guide to the long-standing controversies surrounding the procedure.
 

Link to Neurosurgical Focus on the early history of psychosurgery.

Clouding over the moon

The mythical connection between phases of the moon, madness and epilepsy are discussed in an engrossing but sadly locked article from the Journal of the History of the Neurosciences.

However, it does have this wonderful section where some of the more whimsical portrayals of ‘lunacy’ are discussed:

In the epic poem by Ludovico Ariosto, “Orlando Furioso” (1532/1992), when the paladin Orlando learns that his lover Angelica is married, he becomes mad and goes through Europe and Africa destroying everything in his path. The English knight Astolfo flies up to moon where all human intellects lost on Earth are collected and finds Orlando’s in a bottle, thus restoring him to sanity (Ariosto, 1532/1992).

In the seventeenth century, the term “lunatic,” especially in its more specific acceptation of “insane” as a result of some mental obsession, began to be substituted by the term “moonstruck.” Reflecting the popular association between the moon and the irrational, primitive, and dark side of the human mind, the adjective “moonstruck” makes its first appearance in John Milton’s Paradise Lost.

 

Link to summary and DOI entry for ‘lunacy’ article.

The battleground of remembering

I’ve just discovered a engrossing two-part BBC World Service documentary on ‘oral history’ and how the process of getting everyday folk to relay their memories of important event often challenges the authorised memories of official history.

The programme makes an interesting distinction between public memory, the authorised version of events; individual memory, that we each hold inside us; and collective memory, the process by which we collectively negotiate what we believed happened.

Oral history gets individuals to recount their memories of events, but focuses much more on lived experiences and opinions than names and dates, although can be unsettling to official histories when they contradict politically convenient narratives.
 

Link to two-part Memory Wars documentary.

Treating the madness of the hippies

In 1972, Colombian psychiatrist Miguel Echeverry published a book arguing that hippies were not a youth subculture but the expression of a distinct mental illness that should be treated aggressively lest it spread through the population like a contagion.

I found the book, called Psicopatologia y Existencia del Hippie (Psychopathology and Existence of the Hippy), in my local library and it turns out to be one of the most surprising psychiatry books I have ever read.

At some point, I suspect the good Dr Echeverry must have been driven to breaking point by a bunch of long-haired youths strumming poorly tuned guitars outside his window, because he is clearly furious.

This is his definition of a hippy, translated from p83, where he is so angry he forgets to use a full stop.

The true hippy is an individual with a frank disposition to hereditary psychopathology, who has abandoned himself, has totally neglected his hygiene and self-presentation, has let his hair and beard grow, is dressed bizarrely, eccentrically and ridiculously, wears a multitude of rings, necklaces, beads and other extravagances, is opposed to all defined and purposeful social and family structures now and in the future, rejects productive and redeeming work, irresponsibly and cynically promotes the cult of free love, aggressively promotes contempt for moral, social and religious conventions, preaches paradoxically about the abolition of private property, harmfully drugs them self with marijuana, LSD, amphetamines, hypnotics, mescaline, psylocybin, sedatives and heroin etc to rebelliously and insanely avoid the sad realities of life.

The author notes with disdain that the ‘hippy threat’ seems to be a particular problem in Bogotá, probably reflecting more than a little regional distrust of the free-wheeling capital.

The book contains not a single reference to any scientific or clinical study, although is happy to wax lyrical about the subgroups of the hippy mental illness. Apparently, there are five: hippies with defective personal relationships and autistic-like problems, aggressive hippies, hippies with defective behaviour and poor family adjustment, emotionally impaired hippies, and those with abnormal, perverted or inverted instincts.

For those worried that he may be getting a little too psychoanalytic, Dr Echeverry makes it clear that there is both a strong environmental and genetic component to hippy psychopathology. Yes, apparently, you can inherit hippidom.

The image on the right is from one of the adverts in the book, all of which advertise the drug Lucidril as a ‘treatment’ for hippies, and it’s no surprise that the book was sponsored by the makers of the medication.

Considering the tone of the book, and the fact that the author concludes that being a hippy as akin to having schizophrenia, it’s interesting that Lucidril is not an antipsychotic, but the trade name for a little known compound called meclofenoxate.

There is weak evidence that the drug boosts memory and is notable largely for its enthusiastic uptake by some sections of the ‘nootropics’ brain hacking crowd.

I suspect the enthusiastic adverts for this oddball drug are largely because the book happened to be sponsored by pharmaceutical company Instituto Bio-Quimico Ltd who were clearly trying to sell the drug as a ‘mental detoxification’ compound for the great unwashed.

But not every bearded girl or guy is a real hippy, says Dr Echeverry, who notes that there are also cases of pseudo-hippies, who are really just weak-minded youths who get swept along with the genuine ‘clinical cases’.

How can you tell the difference you ask? Well, pseudo-hippies are the ones who revert to normality once a psychiatrist pumps them full of approved medication. Simple.

A visit to San Lázaro

History of Psychology has just published a brief article I wrote about my trip to Hospital San Lázaro in Quito, Ecuador, one of the oldest psychiatric hospitals in Latin America and still a working mental health facility.

In the strong morning light, the whitewashed walls of the Hospital Psiquiátrico San Lázaro come alive with lucid sunshine. The beautiful but commanding building looks out over Quito’s old town, set back from the historic centre, where it retains its ambivalent mixture of the modern and medieval. It’s not a welcoming structure and, externally, seems more castle than care facility. Visitors need to enter large metal gates, before climbing an external ramp, and then must announce themselves to reception in the imposing stone gatehouse. I had come, I explained, to visit the hospital, but so far had no luck getting in touch with anyone to organise an appointment.

I had heard of ‘El Hospicio de Quito’ from colleagues in Colombia who had informed me that it was one of the oldest psychiatric hospitals in Latin America, but yet it merits barely a mention in the English language literature and surprisingly little in the Spanish. Determined to discover more, I visited the hospital and, after arranging to return with a letter officially requesting my visit, I was shown round by one of the staff psychologists.

You can see virtually nothing of the hospital from the gatehouse, but after stepping through the iron doors you find yourself in a courtyard of surprisingly gentle beauty, filled with trees and fountains, and surrounded on all sides by the building’s open internal arches. Although built at the dawn of the Renaissance, the hospital feels more like a medieval fantasy and is made up of a collection of multi-level walkways and clinical areas in cobbled courtyards that seem to have been ‘added on’ rather than designed.

The consulting rooms are sparse with high ceilings, while the patient wards, both male and female, consist of large dormitories and both indoor and outdoor communal areas around which patients meander until therapy, mealtime or visits take priority. But despite the antique façade there was determined modernisation programme in progress, with both the historic chapel being restored and the clinical facilities being renovated.

As I discovered at the time, the hospital itself is not the best place to go to research its history and I have learnt in retrospect that there are much better sources for the serious investigator – albeit ones which necessitate a visit to the city. Nevertheless, I managed to find some background in Luciano Andrade Marín’s (2003) La Lagartija que Abrió la Calle Mejía; Historietas de Quito thanks to the assistance of the staff at the Biblioteca Municipal. The hospital lies on the site of a Jesuit seminary originally founded in 1587 as a place of training and spiritual retreat.

Although damaged in the volcano eruption of 1698 and the earthquake of 1755, the building retains many of its Jesuit features including an impressive baroque entrance arch. The building lay empty for some years after the expulsion of the Jesuits in 1767 although by 1785 the Royal Order of Spain (a plaque in the hospital names them the Mercedarians) had converted the seminary into a hospice for the poor, disabled, mad and leprous. By the time of Ecuador’s independence, the hospice was notorious for the brutal treatment handed out to its mentally disturbed residents.

The hospice was taken over by The Sisters of Charity in 1870 who dedicated the institution to the mentally ill and began altering the building to better accommodate its more singular purpose. Patient care was not so forward thinking, however, and a doctor who visited the hospital in 1903, quoted in Andrade Marín (2003), minced no words in describing the conditions: the patients “were treated like animals… writhing in unclean yards, enclosed in dirt and gloomy dungeons, fed like wild beasts… naked and maltreated”.

Sadly, I found out little about the 20th Century history of the institution, but now considerably more humane and caring, the institution is one of the most important psychiatric hospital in Ecuador. Those wishing to investigate further may want to obtain Mariana Landázuri Camacho’s (2008) book Salir del encierro. Medio siglo del Hospital Psiquiátrico San Lázaro, which apparently contains a more complete history, although seems only available from select shops in Quito. The city libraries I visited could only provided limited help but apparently archives relating to the hospital are held in Quito’s Museo Nacional de Medicina.

The building is not open to the public, but the staff were friendly and welcoming, and, at the very least, the exterior is worth a visit for its architectural beauty and evocative location. There are no histories of this important institution in the English academic literature, and Landázuri Camacho’s book is apparently the only serious attempt at historical scholarship anywhere. Clearly, there is still much to be investigated about the history of this important institution.
 

Link to article entry at History of Psychology.

I can smell burnt toast

Pioneering neurosurgeon Wilder Penfield was the subject of one of Canadian television’s ‘Heritage Minutes’ in a melodramatic classic that celebrates his stimulating brain research.

It really does just last one minute and looks like a cross between Hammer Horror and Gone With The Wind with the dramatic stares and hammy acting to match.

Penfield is portrayed as a brilliant neurosurgeon (and “the greatest Canadian alive”!) who operates on women in full make-up to cure them of their epilepsy.

If you ask me, any piece of television that hits a high on a cry of “I can smell burnt toast” has got to be a timeless masterpiece.
 

Link to Wilder Penfield ‘Heritage Minute’ on YouTube.

Wading through the killing fields of the mind

BBC Radio 4’s From Our Own Correspondent has a gripping report on a meeting with a Cambodian psychologist who works in a country still trying to come to terms with the collective brutality initiated by the Khmer Rouge regime in the 1970s.

The text of the report is online and makes for powerful reading but I really recommend listening to it, either streamed from page linked above or by downloading the podcast available as an mp3.

The Khmer Rouge are considered to be perhaps the bloodiest regime in history, with over 7 million estimated killed. They began a form of genocide where average citizens were recruited into killing people considered to be subversive from their own community.

Needless to say, many are still living with those who committed the atrocities, or, with the memories of having atrocities committed against them.

The piece is reported an understated but powerfully insightful manner, the psychologist himself reflecting the ambivalence the society still feels towards its past.
 

Link to text of report and streaming audio link.
mp3 of podcast.

Terminal self-diddling

The fantastic Morbid Anatomy blog found this picture from an 1845 medical book depicting ‘the Last Stage of Mental & Bodily Exhaustion from Onanism or Self-pollution’ from the days when self-diddling was widely assumed to be a cause of madness.


 

Of course, you wouldn’t find anything quite so ridiculous as a mental illness described as ‘the last stage of Onanism or Self-pollution’ in the DSM-5, because stages have been rejected in favour of dimensions.
 

Link to post at Morbid Anatomy.

A history of friends in high places

I recently indulged in the outrageous luxury of placing an international order for the book High Society: Mind-Altering Drugs in History and Culture by Mike Jay and I’m very glad I did.

If you want to get a feel for the sort of thing it tackles, the author has a fantastic video where he discusses the history of opium use and how the British in the 1800s were doing exactly the same as the modern day cocaine cartels do now.

It is an incisive and eye-opening history of society and its highs, as well as being wonderfully illustrated on almost every page.

In fact, it’s so beautiful it could almost be one of those expensive coffee table books but it also has the advantage of being shot through with a compelling narrative about how drug use developed in the world’s diverse cultures.

And it really is breathtakingly diverse in its scope – tackling everything from Native Americans and their use of the hallucinogenic cactus peyote, to the black sweet tea enjoyed in the Arabian peninsula, to loved-up urban clubbers popping ecstasy, to the enthusiasm for betel nut in the Far East, to.. well, you get the idea.

The book has been published in conjunction with an exhibition of the same name, currently showing at London’s Wellcome Collection, but it more than holds its own.

It’s a compulsive, colourful journey through one of the world’s favourite pass-times and definitely worth checking out if you’ve ever had an interest in how we tweak and have tweaked the brain’s reality settings.
 

Link to book details on publisher’s website.
Link to excellent 10 minute video on the history of opium.