Reading the morning newspaper a month ago at Gimme Coffee, where I customarily take my morning cup, there was a feature article on some promising new research on a new way to combat opioid addiction. (Ithaca Journal March, 2018) The smiling researcher was pictured in her lab. What she was pursuing with all of her intelligence and drive and education was exactly what the great saviors of medicine toiled tirelessly and at great personal risk for: Louis Pasteur with smallpox, James Carroll and Walter Reed for yellow fever, and many others whose names we know such as Salk, who protected me as a kindergartener from polio. Now the great danger is a plague of drugs. The scourge of addiction is everywhere. Young people are dropping dead as if it were indeed the plague, or the polio of my early childhood. Meth labs blow up regularly in the countryside.
The research that this scientist was pursuing was about how to block the “pleasure” squirt of dopamine when the user shoots up. The “rush,” it is called, which yields to a pleasureable, warm sense in which one feels, at least for a while, a bit like a fortunate infant in arms. This comparison is not psychological: it’s physiological. So the reasoning goes, since the big dopamine charge is what causes use, why not just cut off the pleasure response?
The problem with this, as a moment’s reflection can tell us, is that if you cut off the dopamine response, you cut off all pleasure. All pleasure: the pleasure of work, the pleasure of seeing your family’s relief that you are sober, the pleasure of the Ithaca festival parade, the pleasure of sex. But as long as you take a daily medication to block dopamine, you are no longer an addict.
My first job out of college was at Willard State Hospital, a historic and since, abandoned asylum on Seneca Lake. I got to know many people there who had been given lobotomies. It was only twenty years then since they were routinely performed, so patients who had been lobotimized in their more violent twenties were in their forties when I knew them. I got to know a few of such people fairly well. In my fresh-eyed shock at all that I was seeing, one thing stood out to me: the people who had been given lobotomies were the “characters” among the manageable patients. They still, to my eye, had some kind of force of spirit that made them stand out. It’s just that it had no weight to it.
Otis was 300 pounds of muscle and a lot like the old TV character “Mr.T.” He had one eye, and would pick up the front of an employee’s car for a quarter.But being a big strong angry African-American guy back then was not appreciated. He had once shoveled coal out of the institution steamship, the Nautilus, into the coal cars on the railway. I heard old employees say that attendants were scared of him, back before he had the lobotomy. They were scared for a reason. That’s why he was in a state hospital.
I wonder if trying to chemically stop all pleasure has a certain similarity to lobotomies. Although the technology is light-years apart (Many lobotomies then were done with an ice-pick) both reason that if the situation is desperate enough (maybe someone hallucinated and full of rage, before drugs) it merited a major intrusion into the operation of the brain. There are various ways of doing this: drugs, surgery, electricity. The most public victim of this was Rosemary Kennedy.
When we say that somebody “looks like they’ve been lobotomized” after experiencing something, I think back on those hordes of lobotomized people on those wards, who were no longer excited about anything.
In the fifties, research revealed that lobotomies were a complete failure as treatment. The noted psychiatrist Dr. Peter Breggin, now here in Ithaca, helped put a stop to it. Now his focus is on harm caused by psychotropic drugs.
If we go back to the case of dopamine-blocking for opium, I noted that this would take the pleasure out of life. But the most progressive research on addiction in such books as Jeffrey Foote’s et. al.’s Beyond Addiction: How Science and Kindness Help People Change points out that when a person is not getting any dopamine from their experience, the depletion makes a huge “rush” attractive. An important part of treatment is supporting the person to be able to live a life in which the daily things that they do give them pleasure - produce dopamine - on a regular basis. There is no longer a deficit to drive a charge: the big charge of opiates, or other such drugs.
Such treatment implies that if people cannot live reasonably rewarding lives, dopamine-producing lives, they will become sitting ducks for anything that will lift them from their depressed uselessness. As the greed of a few has “hollowed out” communities in the United States, people in my rural home county who used to maintain farms and shops, or work like their fathers at Shepherd Niles crane manufacturer, or Watkins Salt, had no honorable work to do. The outlook for their kids is even grimmer. They (and I) had every damn reason in the world to get mad. But mostly people who have nothing meaningful to do just start feeling despair. Opium relieves despair. It only took a couple of opportunistic physician-businessmen to throw gasoline, in the form of a particularly addictive opiate, on to the fire, accompanied by an energetic campaign to persuade doctors that it was not addicting.
They were lying, as it turns out.
It was a tinder-dry forest waiting for a match.
That there are dedicated people, including researchers, trying to help people with addictions is a wonderful thing. Thank (insert Higher Power here) for rehabilitation and treatment. The opening of Dr. Justine Waldman’s Reach non-profit harm-reduction medical practice for people with addictions, downstairs from my office, is a great humanitarian effort. They don’t try to block pleasure - they block the specific response to opiates while offering their patients personal medical care.
But resistance to the opium-hunger of despair only comes from the daily pleasure of living reasonably rewarding lives. Whether people can live such lives depends upon social and economic conditions. Do they produce despair? Or do they produce some pleasure? Maybe there is not a technical/medical solution to every human problem. Maybe that researcher could look into MS, which has reduced my once gloriously-Amazonian friend and sometime lover Kate into a puddle. That’s not a social/economic problem.
Wendell Berry once wrote a book called “What are People For?” As he explains in his book, this is the question. It’s all about knowing that there is a reason for us to be alive. It’s not a brain problem. Stopping pleasure in the brain seems a high price to pay. So were lobotomies.