Tuesday, October 16, 2018

Lauren Slater’s Blue Dreams: The Science and the Story of the Drugs that Changed Our Minds

By: Moran Cerf, Ph.D.

Editor’s Note: In 1988, Lauren Slater became one of the first patients in the US to take Prozac. She also emerged as one of its most poetic chroniclers when she detailed her heady, complex love affair with the drug in “Prozac Diary” (1998). Thirty years since that first book, Slater explores the discovery, invention, science, and people behind today's drugs that define mind, emotion, and behavior, from the earliest, Thorazine and Lithium, to Ecstasy, "magic mushrooms," and through today's most cutting-edge memory drugs and neural implants.

Every time I give a talk about my work in neuroscience—regardless of the topic—I get the same three questions at the end. 1). Are the brains of men and women different? (a question that, based on my experience, always comes from a woman). 2). What are the ethical concerns in contemporary neuroscience? (a legitimate question that deserves its own article). 3). What are the effects of drugs on our brain? (“asking for a friend”).

Having read Lauren Slater’s Blue Dreams. The Science and the Story of the Drugs That Changed Our Minds (Little Brown & Company), I feel more equipped to answer this third question. In her book, Slater takes us on a journey that captures the beauty, fear, mystery, dangers, and opportunities inherent in drug use.

In an era that has seen a massive epidemic in opioid usage—as well as an increase in the diagnosis and prevalence of mental disorders, and changes in drug policies that have rendered some formerly outlawed drugs mainstream—a book like Slater’s is a necessary guide to the world of psychoactive compounds and the way we should think about them.

The book describes the power and awe doctors felt when a miraculous element (i.e., lithium) seemed to have cured individuals with bipolar disease who were deemed untreatable, bringing them back to the fold of society. At other times, Slater reminds us that we still have no convincing theory of why many drugs work.   

An analogy of pouring oil over a car’s engine hoping that some drops will land in the oil compartment and make the engine work is a reminder of how scarce our knowledge of most drugs currently is. We pour chemicals into the brain, something good happens, and we move on—even though the mechanism of action is not fully understood. But we often lack a deeper understanding of the mechanisms by which those drugs work.

The book is structured as an encyclopedic walk among specific drugs, mainly in the context of psychiatric disorders. Chapters begin with the story of the drug’s discovery, leading the reader through the people and experiences that led to it. The author follows this with a discussion of the drug’s potential opportunities and pitfalls, and typically ends with how it is currently used.

Slater does not shy away from criticizing and head-butting some of the big players in the drug industry, suggesting that they are ineffective or cause side effects that cause further psychiatric problems. Eli Lilly and Company’s aggressive push for the use of its drugs, despite a clear lack of understanding around some of their adverse effects, gets the limelight multiple times. So, do other big institutions that aren’t often criticized. In a brave and unapologetic take on a field that the author has explored in previous books, Slater voices skepticism about the researchers who are driving the academic work, holding them accountable for failing to act as checks and balances in an industry where revenues take precedence over benefits. In the same vein, Slater calls out psychiatrists who, in their desire to give their profession a veneer of science by using medical solutions that seem more rigorous than talk therapy, have endorsed drugs with clinical testing outcomes that they know are complicated due to the variability of the disease being treated.

Much of the credibility of Slater’s assessment comes from her comprehensive research. But equally important is the fact that, as we learn quickly in the very first pages of her book, she is not a mere observer of the field but has used many of the drugs she mentions. In a vulnerable, open, and gentle way, she describes her personal struggle with mental disorders and the unintended consequences of some of the drugs she had taken to stabilize herself (one helped with depression but induced diabetes, another helped with eating disorders but created mental challenges, and the list goes on). Slater enumerates the grocery list of drugs she is currently taking, adding that she would have taken additional ones—e.g., MDMA (Ecstasy/Molly)—were it not for the fact that the effects of some might have countered the effects of others.

The book offers a perfect balance between thorough reviews of the drugs’ discoveries and effects, detailed explanations of what is  known and missing in the scientific study of drugs, and illustrative personal stories of patients (e.g., a violinist with depression who became a virtuoso again after treatment; a patient no one knew was a juggler until he was treated; a barber who, similarly, no one believed was a barber until he shaved his doctor’s beard upon his astonishing recovery, thanks to drug treatment).

The book seems to target individuals who are seeking information about drugs for therapeutic purposes (according to US statistics: about a third of the population use these drugs) or in finding a cure for addiction, side effects, or disease. Less focus is given to the recreational usage of marijuana, making the book less appealing to readers who are merely curious about such drugs as a lifestyle choice. This is unfortunate if one considers that some states are about to or already have legalized marijuana and that the change in public perception around drug usage would benefit from such a discussion (this shift becomes obvious when comparing two US presidents: In the early 90s, presidential candidate Bill Clinton, when asked if he ever smoked weed, answered “Yes, but I did not inhale,” while candidate Obama not only said he inhaled, but added, "Isn’t that the point?’).

Slater’s book is, therefore, ideal for readers who are interested in the story and history of important drugs, the sociology of the pharmaceutical world, and the visceral experience of patients. It might be less appealing to those hoping for deeper insights into drug policy or the neuroscience of drugs, which receives less attention.

In an era where so many seek a deeper understanding of themselves and their minds, a book about drugs and their ability to help us discover our psyche and alter our thinking is a perfect companion, and Blue Dreams is a wonderful and exhilarating gateway to the subject.

About Cerebrum

Bill Glovin, Editor in Chief
Carolyn Asbury, Ph.D., consultant

Scientific Advisory Board

• Joe Coyle, the Eben S. Draper Chair of Psychiatry and Neuroscience at Harvard Medical School; director of the Laboratory for Psychiatric and Molecular Neuroscience; former editor of JAMA Psychiatry

• Martha Farah, Annenberg Professor in Natural Sciences, professor of psychology, and director of the Center for Neuroscience & Society at the University of Pennsylvania

• Pierre Magistretti, professor in the Brain Mind Institute, EPFL, Center for Psychiatric Neuroscience, Department of Psychiatry - CHUV/UNIL, Switzerland

• Helen Mayberg, director of Center for Advanced Circuit Therapeutics for the Icahn School of Medicine at Mount Sinai

• Bruce McEwen, Alfred E. Mirsky Professor; head of the Harold and Margaret Milliken Hatch, Laboratory of Neuroendocrinology at the Rockefeller University

• John H. Morrison, director of the California National Primate Research Center and professor in the Department of Neurology, School of Medicine, UC Davis

• Harald Sontheimer, I. D. Wilson Chair and professor and executive director, Virginia Tech School of Neuroscience, Commonwealth Eminent Scholar in Cancer Research, and director of the Center for Glial Biology in Health, Disease & Cancer, Virginia Tech Carilion Research Institute

• Stephen Waxman, founding director of Yale University’s Neuroscience & Regeneration Research Center and the Flaherty Professor of Neurology, Neurobiology, and Pharmacology

• Chuck Zorumski, Samuel B. Guze Professor of Psychiatry and Professor of Neurobiology, department head, psychiatry director of the Taylor Family Institute for Innovative Psychiatric Research and Cynthia S. Smith, M.B.A., executive director of the Department of Psychiatry, Washington University School of Medicine

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