Blue Dreams – Lauren Slater

I will be reviewing a number of memoirs by psychotherapists and people who have experienced psychotherapy as clients or patients. For a book that I originally conceived as “The Culture of Psychotherapy” one of my chapters is devoted to what I refer to as the “Insiders” – those on both sides of the couch, so to speak. I will share some comments and interpretations of various memoirs in future posts, but I want to begin with reviewing a recent book by my favorite insider memoirist, Lauren Slater. “Blue Dreams: The Science and Story of the Drugs that Changed Our Minds” (2018) is only part memoir. It is primarily about mind drugs and mental illness. Lauren Slater knows both better than most, as she has been both a long time patient both on and off various drugs, as well as a psychotherapist, helping others navigate their challenges with mental illness. Later I will comment on a few of Slater’s previous memoirs, particularly “Welcome to My Country” (1997)    and “Prozac Diary” (1998).

“Blue Dreams” is an engaging and  thorough tracing of the history of using various psychiatric drugs to deal with various mental illnesses. Slater has experienced numerous medications to treat bipolar and obsessive-compulsive disorders. She draws on both her own experiences and the research on the efficacy in trials and with ongoing patients in psychiatric care. Her conclusions are decidedly mixed about long term efficacy of any drugs, to include the once considered “miracle drug” – Prozac. The book’s chapters follow a general chronological path from Thorazine and Lithium through SSRIs to MDMA (Ecstasy) and Deep Brain Stimulation. Slater wants psychiatry to move toward discovering answers to “why” and not just “how”. She says: “I’d rather see psychiatry come up with a few theories that finally pan out, theories that illuminate the pathophysiology or etiology of depression, the structure of schizophrenia, the reason for the retreat that autism so often is.” “What, for instance, causes schizophrenia? How durable is the dopamine hypothesis, and what does it mean that when it comes to schizophrenics, drugs which dampen dopamine seem to diminish hallucinations and drugs that increase dopamine appear to make schizophrenic symptoms worse, even though, when researchers compare dopamine levels in so-called normal subjects with those in schizophrenic subjects, they find no correlation between high dopamine levels and psychiatric problems in the general population? Perhaps more compellingly, the low-serotonin story suffers the same fate. We have been told that depression and OCD are the results of too little serotonin in the brain, and that this is the reason why serotonin boosting drugs such as Prozac work. But some depressed people have a lot of serotonin while some well-adjusted people have less.”

Slater sums up her view of the possible future of psychiatry in her chapter ” Where We’re Headed”: “I think the future of psychiatry is, strangely enough, right here, in tiny tabs of acid and chalices of psychedelics such as ayahuasca, psilocybin, and MDMA. ” She also reviews the newest psychedelic that psychiatry has turned to – ketamine, a drug typically used by anesthesiologists during surgeries, but now being used (ketamine infusion therapy) only for those patients who are treatment resistant.

In a favorite passage of hers which looks back and points forward in psychiatry, Slater says, “Our next golden era of psychopharmacology, I predict, will be with psychedelics, drugs not discovered, but rediscovered. And in some strange way they reunite us with the father of psychoanalysis, Sigmund Freud, who believed that awareness was the vehicle by which we could be cured of our ills. At once brand-new and ancient, psychedelics allow us a radical awareness of our place and purpose in the universe; they actually seem to set us straight, these tie-dye drugs of the long-gone hippiedom.” Whether Slater is right about this or not we may be opening back up to psychedelics and we may approach them quite differently from our hippie past. We may also discover the “why” of some mental illnesses in the process?