To encourage productive interaction among people who approach issues of mental health from diverse perspectives, and to facilitate the new openings which emerge from sharing of such perspectives.

MENTAL HEALTH

Center for Science in Society

Discussed 8 March 2001:

Name: Paul Grobstein
Username: pgrobste@brynmawr.edu
Subject: listening to ecstasy
Date: Fri Mar 2 10:07:32 EST 2001
Comments:
Having suggested the first forum article, I feel some need to try and explain why. What's certainly relevant is that I am a parent of adolescents, a neurobiologist, and ... yes, was myself an adolescent in the sixties (who did inhale). What's also relevant is that I have a longstanding and fairly deep skepticism about the value of psychoactive substances in general (to say nothing of our current understanding of how they act in the nervous system to produce the effects they produce), as well as about the search for "conversion experiences".

My skepticism notwithstanding, my feeling, as a parent, is that the national D.A.R.E program, with its associated "Just say no" message, is at best a waste of money and energy (as most kids themselves say). That's not, at this point, solely my own opinion. The D.A.R.E website for adults contains links to announcements of a revised D.A.R.E program, together with a very interesting New York Times article providing some of the reasons for a revision. In fact, my feeling is that the old approach was not only irrelevant but actually made worse the problems it was intended to address. What was and is needed by kids (and others) is not a blanket prohibition on a quite arbitrarily conceived category of "hazardous substances", but rather meaningful information and experiences which make it possible for kids (and others) to make wise and informed decisions with regard to each of a number of quite different materials which they (inevitably) will encounter. In lieu of this, it is not at all surprising that such encounters sometimes result in destructive behaviors.

In this context, Klam's article on ecstasy seems to be exactly the sort of thing which we have always needed more of, and both he and the New York Times are to be commended for publishing it. Yes, some kids (and others), who might otherwise not have done so, may be motivated by the article to explore ecstasy themselves. But this is not necessarily a bad thing, and is, in any case, part of the price one necessarily pays if one believes in the importance of individuals evaluating things and making wise choices for themselves.

This is not to say that I read Klam's article as endorsing the use of ecstasy. I don't, and it doesn't. In fact, what Klam does is to make it very clear that the experiences with, and results of, ecstasy use are, in important ways, quite different in different people. For some it is life-altering, for others not; for some it is positive, for others negative. This, I think, points to a general phenomenon of "psychoactive" substances (both licit and illicit) which is quite important both practically and theoretically (cf references on Individual Variation), and which has received too little attention, both in popular writing and in the professional literature. For the latter, it raises some very interesting issues about whether we really know as much as we sometimes assert about what psychoactive substances of any kind are doing in the nervous system, and even about whether we are actually asking the questions in the right way.

My other interest in Klam's article relates to Peter Kramer's book Listening to Prozac which fascinated me when it appeared a number of years ago, and which I still highly recommend to anyone interested in the issue of how best to approach an understanding of psychoactive substances and their actions on the nervous system/behavior. Kramer's book, unbeknownst to people who have read only reviews of it, is actually a very thoughtful and self-reflective effort on Kramer's part to make sense of observations of effects of Prozac that, given Kramer's professional training/background, surprised him. It was Kramer himself "listening" to his observations and trying to understand them. From it came the suggestion, largely ignored since, that Prozac was acting, relatively specifically, on a brain system concerned with "feelings of abandonment".

Kramer's is an intriguing hypothesis, of a kind unlikely to have emerged from people preoccupied with the details of neurotransmitters, receptor types, and animal models. It depends on having, as Kramer does, the kind of background and expertise in "talk therapies" which allows one to look fairly deeply into people's "souls", together with the ability/inclination to think seriously and critically about observations of this kind. The connection to Klam's article, in my mind, is both general and specific. Klam provides useful insights into what it "feels like" to use ecstasy, and this, along with issues of its relation to known neurotransmitters and receptor types, is relevant to any serious effort to understand it (as well as to evaluate its risks and benefits). In addition, there is an interesting resonance between Kramer's hypothesis and Klam's (and other people's) characterization of ecstasy as "empathy" enhancing. Perhaps there really are systems in the nervous system which play a major role in interpersonal/social relations? This is not part of "classical" neuroscience, but perhaps that's an accident of history and approach .... and maybe its time for a new "social neurobiology" to emerge?

Klam, by his own description, is far from a "flower child" (and, for the sake of the record, neither was I). But there was certainly a wish in the 60's to change things in such a way that people became more understanding of one another, and there seems to be more than a little of that same aspiration expressed in Klam's account of his own, and other peoples', explorations of ecstasy. No, for all the reasons expressed above, I don't think that ecstacy is the wonder drug that will suddenly make the world a better place. But, perhaps, "listening to ecstasy" might, in the long run, contribute to some improved understandings of the nervous system and behavior which could move us all in a saner direction?

While I respect the authors right to comment on his experiences with ecstasy, he takes a sample of 3 (hardly significant) and, based on this sample, makes some assumptions about an illegal substance (albeit not illegal initially). He fails to mention, however, the many other people who use and do become addicted, have bad "trips", or suffer additional subsequent consequences. In addition, research has not yet been able to explore the effects of ecstasy, which may or may not be very detrimental.

I admit, not everyone who uses drugs/alcohol becomes "addicted". However, views such as the one espoused in this article that advocate for use of these substances, have all been made by well-educated and admittedly fairly well-functioning young adults. This view fails to account for teens who have a less solid psychic base from which to start when taking substances and far fewer emotional/psychological resources from which to draw when dealing with the aftermath. Admittedly, these people's experiences were positive, the reason most people use substances - it feels good. However, my concern really lies with the existence of too little research on the potential harm they may cause. If research results deomstrate ecstasy has no more determental side effecs than other psychotropic mediations on the market, I would support it. Before this time I maintain a conservative stance on advocating its use.

A good kickoff for our series, I though. With, hopefuly, some more contributions in the forum here in the future. Thanks to Daniel and Elizabeth for getting the series rolling. Looking forward to future conversations. Let me, Daniel, Elizabeth know if you have suggestions for topics/readings and/or any other thoughts about projects/activities we and/or the Center for Science in Society might do together. .

These observations of course treat drug abuse as a social problem -- and more specifically, a social organization problem. We talked, though, about other ways to treat drug abuse. We seemed to agree in general that drug abuse should be viewed as a medical problem -- that it should be treated with medical care, not incarceration. But should it be viewed as a medical problem before it happens? This gets to the question of whether there is, in fact, an innate predisposition to drug (ab)use, and raises a number of moral issues surrounding genetic screening, but also has immediate policy implications. Jail time is in part used as a deterrent to discourage first-time use, but if that use is physiologically determined, jail time is irrelevant.

A lot of other good issues were raised, including some specific to Ecstasy. As I said at the beginning of our discussion, Ecstasy seems like a great starting point for a mental health discussion because it touches both on drug use and on therapeutic use of psychoactives. Because it creates feelings of empathy and insight, its actions are related to antidepressants. Two good questions come from this vein of thinking: first, what is the benefit of drugs in creating insights? Are they artificial insights, or is it important to have a pharmacological aid to psychotherapy, which can be stigmatizing, difficult, and discouraging? Second, as we talked about with everything from Ecstasy to nicotine, a great deal of individual variation is seen in people's responses to drugs. An ability to predict how people will respond could be of great clinical use: it may allow a more targeted treatment of drug abuse, and a greater efficiency in using medications to treat other mental illnesses. It was rightly pointed out at our meeting, though, that this, too, raises questions of morality related to genetic screening.

In short, a wonderful discussion, and I hope the next is as fruitful!

Lots of people reach out for help with their anxieties, not just teens. Some times the self and other stuff gets a bit heavy. Is the problem anything more than this? If one existed all by one's self--it doesn't sound better, but then the call for community is rooted deep within.

Perhaps if this self and other issue is a big problem for us, perhaps evolution will step in and ease the anxiety.

Also what about illegal drugs that can help a person's health such as marajuana and as I mentioned at the discussion Ecstasy? Along this wave length of thought the New York Times reported recently that doctors are looking into the theraputic uses of hallucinogenic drugs such as LSD. It is an interesting article I encourage people to read.

http://www.nytimes.com/2001/03/13/health/13DRUG.html

On a different note, I was really pleased with how the discussion turned out and am eager to find a new topic to discuss again. Any suggestions?

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