"If many remedies are prescribed for the same illness, you can be sure the illness has no cure."
I know a man in his mid-30s—creative, active, sociable and hardworking—who not long ago got out of an emotionally stressful, financially draining, crisis-filled relationship and moved to a country house. For the next two months he was alternately, and sometimes simultaneously, listless and tense. The remoteness of the country house made him feel isolated and displaced—feelings that worsened his abulia and melancholy—so he decided to move back closer to town, where he felt more at home.
At about that time, he had dinner with his mother. She told him that, rather than moving, he might be better served by antidepressants.
What would she have told her son 60 years ago, long before the class of psychoactive drugs known as SSRIs existed? Perhaps she'd have suggested a drug endorsed by the American Medical Association for producing "a sense of well-being ... [and] an increase in mental activity and efficiency." In 1946, according to one report, it was the first recommended treatment for 39 different ailments including depression, obesity, impotence and hyperactivity. The drug was available under many different brand names and was considered safe and free of side effects. At least one version was available over the counter: the Benzedrine inhaler.
The Benzedrine inhaler was intended as a decongestant, but it could do much more than unclog sinuses. You could break it open, remove the Benzedrine-laced paper strip inside and soak the strip in a cup of coffee. This preparation was called a "B-bomb," and it made you feel energetic, focused, alert, vivacious. A proponent of the B-bomb was the great saxophonist Charlie Parker; the young Beatles were also said to have taken B-bombs in order to stay awake through endless late-night gigs in their early days in Hamburg. B-bombs got so popular, and Benzedrine and its pharmaceutical relatives so widely misused, that the manufacturer, SKF, had to withdraw the inhaler in 1949, and the FDA stepped in to regulate the drug.
That's because Benzedrine is an amphetamine—or, if you prefer, speed, meth, ice, crystal. (A Thai variation, "yaba," is a tablet admixture of speed and caffeine; a modern, coffeeless B-bomb.) SKF, the company that popularized amphetamines, we now know as GSK—the Triangle's very own GlaxoSmithKline—or, if you prefer, as does Richard DeGrandpre, author of the new book The Cult of Pharmacology (Duke University Press, 294 pp.), a licit drug trafficker.
The subtitle of DeGrandpre's book is How America Became the World's Most Troubled Drug Culture. What's the trouble? According to DeGrandpre, it begins with our reliance on artificially derived pharmaceuticals like cocaine, rather than relying on natural substances, like coca leaves. The problem is compounded by our absolutist value system, in which a drug is labeled either an "angel" or a "demon," a judgment based exclusively on its pharmacological properties. When it's discovered that a presumed angel, like amphetamines, is not so angelic, it is reclassified, regulated, even banned as a demon. Some former angels now considered demons include opium, heroin, cocaine, tobacco, Quaaludes and barbiturates. A few former demons, like caffeine and alcohol, have been rescued from the pandemonium and, if not beatified, at least assimilated into daily life. Other drugs fidget uncomfortably in the middle: Desoxyn, a methamphetamine that has been around for more than 60 years, is still prescribed for obesity, and for ADHD—which was unknown, of course, in the Benzedrine days of the 1940s.
Much of DeGrandpre's case is made by demonizing some angels and angelizing a few demons, blurring the lines in order to loosen a rigid taxonomy. His first target is Ritalin. (DeGrandpre's first book, Ritalin Nation, portrayed the dangers of the drug and our flawed conceptions of ADHD.) Ritalin was once prescribed for chronic fatigue syndrome, and it's now a widely used ADHD treatment. But like amphetamines, it has also evolved into a recreational drug. That, according to DeGrandpre, is because Ritalin's psychoactive effect is much like cocaine's. (A high school fad is to get a buzz by grinding up Ritalin and snorting it.) "[P]opular and scientific beliefs concerning these two drugs in the twentieth century were nonsensical," DeGrandpre writes. "In fact, either cocaine is not the inherent demon it was made out to be, or Ritalin is incorrigibly evil and corrupting." Nonsensical perhaps, paradoxical certainly: Ritalin has been prescribed both to vivify the fatigued mind and to calm the jittery one. What are we to make of that?
DeGrandpre also takes on SSRIs, showing that drugs like Zoloft, Prozac and Paxil (which is made by GSK) can turn users psychotic, suicidal, even homicidal. He also points out that the first "S" in SSRI, which stands for "selective," is a lie. "The SSRIs are not selective in what they treat, or even in what they are claimed to treat (... everything from premenstrual syndrome to panic attacks to smoking to shyness). Nor are they selective in their biochemical actions on the brain."
So if the good drugs aren't so good and the bad drugs aren't so bad, what belongs in the pharmacopoeia? Put DeGrandpre in the camp of Dr. Andrew Weil, the integrative medicine guru who has a psychedelic mushroom named for him (that's Psilocybe weilii, if you're scoring at home): "There are no good or bad drugs," according to Weil, "there are only good or bad relationships with drugs." But in our absolutist pharmacological determinism, we neglect the potent concoction of social and cultural forces that shape drug use and abuse.
Those forces are not, DeGrandpre insists, conspiratorial, even though his own arguments insinuate a Brave New World nightmare: a nation kept hooked on soma (or SSRIs or Ritalin) by some fascist apparatus. "In suggesting that a cult of pharmacology came to reign supreme over America, I am not also suggesting a conspiracy theory," DeGrandpre disclaims. Instead, he concludes in his final chapter, the problem is "the simple play of the mechanisms of power oriented toward persuading and influencing others, perhaps even with the goal of doing good." But who is at the levers of those mechanisms, and how simple can such play really be, if so many powerful forces—big business, high-level government, billion-dollar research science—are playing? "Any battle against an American industry," DeGrandpre writes in his chapter on Big Tobacco, "even in the name of public health, [is] also a battle against those in Washington who protect that industry, regardless of the public health."
Lacking a conspiracy, then, what drives our culture's relationship to drugs? Perhaps DeGrandpre has buried his lead. Halfway through The Cult of Pharmacology, he offhandedly notes that the long-abandoned tranquilizer Miltown "was popular for a simple reason: it made many of those who used it feel better." Right—people suffer and they want the suffering to stop. This most basic of life problems sets up the predictable rise-and-fall of almost every drug.
DeGrandpre sedulously narrates the identical use-to-abuse parabolas of copious drugs—cocaine, Valium, Quaaludes, et al.—and tracks decades of experiments on rats and macaques that support his thesis. But because he portrays the cult of pharmacology as essentially impenetrable and unbreakable, he seems to get frustrated by his own argument, which he's still restating near the end of the book. Angels and demons; pharmacological determinism: got it. Indeed, you may be frustrated, too. (A livelier, briefer, more empowering version of DeGrandpre's argument is Michael Pollan's recent New York Times article "Unhappy Meals," which applies precisely the same thesis to America's diet problem.) Just as with the bestselling Fast Food Nation, to which this book is a natural companion, The Cult of Pharmacology may leave you feeling numb and depressed, agitated and powerless. Surely GSK has an angel to heal you.
"It was like floodwaters roaring into the brain, spilling onto the synapses, short-circuiting electrical signals everywhere ... it rearranged the furniture, pushing the cerebrum to the corner, cramping the hypothalamus, reshuffling commonsense in the basal ganglia, jumbling all logic into madness."
That sounds like one of the many case studies in The Cult of Pharmacology, but it's actually part of Carlene Cross's new memoir, Fleeing Fundamentalism (Algonquin Books, 280 pp.). "It" is religion, and Cross likens it to a drug after iterating Karl Marx's famed axiom that "religion is the opiate of the masses." This is a common, if slight, misquotation, and it's usually taken out of context from Marx's Critique of Hegel's Philosophy of Right:
"Religious distress is at the same time the expression of real distress and the protest against real distress. Religion is the sigh of the oppressed creature, the heart of a heartless world, just as it is the spirit of a spiritless situation. It is the opium of the people. The abolition of religion as the illusory happiness of the people is required for their real happiness. The demand to give up the illusion about its condition is the demand to give up a condition which needs illusions."
Carlene Cross has found a lot of heartlessness in the world, both in and out of religion. As a bright-eyed freshman at a Montana Bible college, she fell in love with a charismatic classmate—"[l]ooking at David Brant made me wish that Jesus would postpone the rapture for a while" —married him, and began life as the wife of a fundamentalist minister. But she soon discovered that David was an alcoholic and a sexaholic; within a few years, she had left him and renounced the church.
Cross tells her story in broad, excitable strokes. Her prose occasionally gets a little overheated, but so does she; it's clear that Cross has a thriving libido. She also has a lifelong rebellious streak that led her to embrace erudition in a family of cattle hands and then to leap off the ranch and into school. So it fits that, despite the creature comforts of life as First Lady to a big congregation—a big house, plenty of merlot and Kenny G, and then (uh-oh) swinging, drunken, four-couple hot-tubbing—she flees with her three kids from David's spiral of sex, drugs and Pink Floyd.
Once free, Cross becomes an archetypal single American mom, working long hours and putting herself through graduate school—where after re-reading the Letters of the Apostle Paul ("a sexist"), and then digging into Nietzsche, whose pitiless abhorrence of Christianity makes Marx's rejection look almost sympathetic, she decides the problem goes deeper than good preachers gone bad: "It was time," she concludes, "to send Christianity to the morgue."
The mind drifts back to The Cult of Pharmacology here. Modern American fundamentalism—with its Swaggarts and Haggards, its invidious scriptural interpretation, its Promise Keepers sexism and its Christian Coalition political meddling—is a mass-market synthesization of Christianity (which is itself a synthesis), just as pharmaceuticals are derived from organic substances. Eventually, overuse leads to toxicity and addiction, especially for the David Brants of the world. As Cross grows more aware of the ovine role fundamentalism compels her to play, she starts to understand that her church offers no true salvation or faith but rather a sinister, addictive anesthetic—just as most drugs numb pain but fail to cure it—and she recalls that, as a child, "my attraction to fundamentalism was not out of quiet reflection but cold fear."
After reading DeGrandpre's book, every pleasure Cross finds seems merely a distraction from misery, every joy a narcotic, even the innocuous ones: post-shift gabbing with co-workers at the restaurant where she works, happy hour with her grad school classmates, tripping on Nietzsche. (Drugs! Drugs! Drugs!) Only near the end of Fleeing Fundamentalism, when after having sworn off all religion Cross tries and likes Buddhist meditation, does she find something that actually frees her spirit instead of merely doping it.
That Buddhist intent—to detach, relinquish and transcend the impedimenta of this world—leads back to a Marxist reading of the peculiarly economic nature of American soul-sickness. What's so curious about Cross's book, nominally about religion, is how much of it turns on fiscal concerns. Once Cross leaves David, she takes us through her long hours of exhausting labor, her battle with the arcane welfare system, her pursuit of a graduate degree (to increase her earning potential), and David's failure to pay alimony. God, happiness, love—whatever form of ataraxia you seek—all get bought out by the dollar, that undetectable drug, promising relief from pain—and also, of course, causing it.