10/13/17

Feuding Ideologies, Part 2

© Michal Bednarek | 123rf.com

In the first paragraph of “Dying To Be Free,” you are introduced to Patrick, a smiling 25 year-old who had just completed a 30-day drug treatment center. Among his possessions was “a talisman he’d been given by the treatment facility: a hardcover fourth edition of the Alcoholics Anonymous bible known as ‘The Big Book.” It pages were full of highlights and Post-It notes. He was said to be a “natural” 12-step convert. Four days later, his father found him dead of an overdose.

As you read about Patrick’s struggles with addiction, you get a picture of how he and his parents tried to help him establish sobriety. There is a reference to his residential treatment stay as a “30-day wonder,” where he received a crash course on the tenets of the 12-steps. “Staff at the center expected addicts to reach a sort of divine moment but gave them few days and few tools to get there.” In Part 1 of this article, I addressed concerns that an underlying ideology of addiction as a strictly biomedical disease contributed to a biased, distorted picture of addiction treatment in the U.S. by the author of “Dying To Be Free.” Here we will look at how he also misrepresents the recovery philosophy and history of A.A.

There is a preponderance of religious or magical rhetoric when describing 12 Step, abstinent-based change in “Dying To Be Free.” Already we’ve noted the main text of Alcoholics Anonymous, also called Alcoholics Anonymous, was referred to as a talisman and a “bible.” Patrick was a “natural 12-step convert.” Another reference described the AA Big Book as being the size of a hymnal, with an appeal to faith made in “the rat-a-tat cadence of a door-to-door salesman.” Addicts at a certain treatment center were supposed to “reach a sort of divine moment” in treatment or recovery. Entering the drug treatment system, which is dominated by the principles of abstinence embedded in the 12-Steps, was said to require a “leap of faith.”

In a description of the Grateful Life Treatment Center in northern Kentucky, it was noted that the wall above the desk of the center’s intake supervisor had a “Jesus bumper sticker.” Why add that detail unless you are trying to capture the scene in a particularly religious way? When describing treatment facilities modeling themselves on the 12 Steps, not only were recovering addicts said to be cheap labor, they were said to provide the “evangelism” to shape the curricula of the facilities. A resident of Grateful Life was noted to be “as close to a true believer as the program produces.”

At one point, the author of “Dying To Be Free,” Jason Cherkis, said AA came out “evangelical Christian movements.” More accurately, there is a clear historical connection between a nondenominational Christian movement popular during the 1920s and 1930s called the Oxford Group and Alcoholics Anonymous. The two cofounders of A.A., Bill W. and Dr. Bob met as a result of their personal association with the Oxford Group. A.A. approved books, such as Pass It On, Doctor Bob and the Good Oldtimers and AA Comes of Age freely acknowledge the connection and give further details about it. However, a crucial distinction made by A.A. within its 12 Steps is glossed over by Cherkis and others, namely the spiritual, not religious understanding of God and recovery embodied in the Twelve Steps.

Drawn from the thought of the American psychologist, William James, this distinction between religious and spiritual experience seems to underlie the widespread sense of generic spirituality in American culture today. The Varieties of Religious Experience  (VRE) by James had a fundamental influence on Bill W., the formulation of the Twelve Steps and the spirituality based upon them. In VRE James made a distinction between institutional and personal religion. Worship, sacrifice, ritual, theology, ceremony, and ecclesiastical organization were the essentials of what he referred to as institutional religion.

Personal religion/spirituality for his [James’] purposes was defined as “the feelings, acts, and experiences of [the] individual . . . in their solitude, so far as they apprehend themselves to stand in relation to whatever they may consider the divine.” In the broadest sense possible, this spirituality consisted of the belief that there was an unseen order to existence, and supreme good lay in harmoniously adjusting to that order.

Whether their disregard of the spiritual, not religious distinction is intentional or not, Cherkis and others give an incomplete and biased picture of Twelve Step recovery when they fail to note it. The very heart of Twelve Step spirituality is the permissibility of the individual to formulate a personal understanding of their “god.” So what unites members of Twelve Step groups like A.A. is the diversity of religious and spiritual belief permitted—even to accepting a lack of belief. I’ve written several other articles on the similarities and differences between the spirituality of the Twelve Steps and religious spirituality on this website. There are three particular articles that discuss the influences on the spiritual, not religious distinction of Twelve Step recovery: “What Does Religious Mean?”, “Spiritual Not Religious Experience” and “The God of the Preachers.”

Another example of how “Dying To Be Free” misrepresents the recovery philosophy of A.A. is the following. While introducing a discussion of Charles Dederich and the origins of Synanon, Cherkis said Dederich and others took a “hardline” message” from some of Bill W.’s written philosophy. Cherkis wrote: “Those who can’t stick with the program are ‘constitutionally incapable of being honest with themselves,’ reads the Big Book. ‘They seem to have been born that way.’” The two selective quotes were from the first paragraph of chapter five, “How It Works,” in Alcoholics Anonymous. Notice how the context of the complete paragraph changes your understanding of what Bill W. said in his “philosophy”:

Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average.

As Cherkis began to discuss the history of the expansion of drug treatment facilities in the 1960s, he quoted Nancy Campbell, a professor at Rensselaer Polytechnic Institute, as saying: “The history of 12-step came out of white, middle-class, Protestant people who want to be respectable.” She added that it offered community and belonging that was predicated on being normal, respectable and having a stake in mainstream society.  Campbell may be a historian, but she seems to have a distorted view of the early history of 12 Step recovery in A.A.

From the sociological perspective of labeling theory A.A. and other organizations based on their 12 Steps, like N.A. (Narcotics Anonymous), can at least partially be seen as social movements that seek to combat negative images associated with socially deviant drinking or drugging behavior, “in effect denying that their actions make them deviants.” This applies the idea of tertiary deviance, first described by John Kituse in: “Coming Out All Over: Deviants and the Politics of Social Problems.” Kituse noted that some people stigmatized as deviant (here as alcoholics) “rebel against their labels and attempt to reaffirm their self-worth and lost social status.” The above quote and reference to Kituse is found in a standard social science textbook by Clinard and Meier, Sociology of Deviant Behavior.  So part of Campbell’s assessment of 12 Step groups as social movements seeking to offer community and belonging, with a “stake in mainstream society” is accurate. However, the quote attributed to her glosses over the early history of A.A., which was the beginning of the 12 Step movement.

A.A. celebrates the anniversary of its founding on June 10, 1935. That was in the midst of the Depression. Bill W. and his wife Lois were living then in a house owned by her father on Clinton Street in New York City. In September of 1936, Lois’s father died and the house was taken over by the mortgage company, which allowed them to stay on for a small rental. In the midst of the Depression, they didn’t want the house to be empty. While struggling with “their acute poverty,” Bill was almost persuaded to accept a position as a paid alcoholism therapist at Towns Hospital, where he himself had been treated several times. He eventually declined the offer.

Almost two and a half years after the founding of A.A., Bill W. was jobless and Dr. Bob was in danger of losing his house. In 1938, through the charity of John D. Rockefeller Jr., $5,000 was approved for a fund that would pay off Dr. Bob’s mortgage and allow a weekly draw of $30 for each of them. Rockefeller told one of his associates afterwards: “But please don’t ever ask me for any more.” In 1939, as the Depression eased, the mortgage company was able to sell the Clinton Street house and Bill and Lois became homeless. They lived “as vagabonds,” as various places for two years. Bill W. and Lois eventually led a respectable, middle class lifestyle, but that wasn’t what it was like for them in the beginning of A.A.

This history is found in Pass It On, published by Alcoholics Anonymous World Services, Inc. In the early days of A.A., Bill W. repeatedly turned down offers to professionalize his work with A.A. This doesn’t entirely sound like a movement trying to gain white, middle class respectability. The Traditions of A.A., formally adopted in July of 1950, articulated this philosophy of non-professionalism and a focus on helping other alcoholics in the fifth, sixth and eighth Traditions.

Tradition Five Reads: “Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.” Tradition Six reads: “An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.” Tradition Eight reads: “Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.”

Alternative addiction treatment ideologies regularly attack A.A. as “religious,” ignoring or rejecting the spiritual-religious distinction A.A. made within the Twelve Steps from the very beginning. The abstinent-based recovery philosophy embedded in the Twelve Steps seems to be the primary target of these critiques. I see the same tendency in “Dying To Be Free.” The first part of this article addressed the biased portrayal of abstinent-based addiction treatment by Jason Cherkis in “Dying To Be Free.” The third and final part will address how it skimmed over the problems with MAT, specifically Suboxone.

08/9/16

The Wrong Doorway

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© captainvector | 123rf.com

Laughing gas or nitrous oxide (N20) has a surprising variety of uses or effects. The World Health Organization lists it as an essential medicine because of its anesthetic and analgesic effects. It’s used as an oxidizer in rockets and motor racing to increase the power output of engines. N20 is also a major greenhouse gas, with a per unit mass impact that is between 265 and 310 times that of carbon dioxide. And it is in the top ten most popular recreational drugs globally.

The English chemist Joseph Priestley discovered nitrous oxide gas in 1772. Priestley is also known for his discovery of oxygen. Humphrey Davy experimented with N20 on himself and others in 1799. He coined the term ‘laughing gas’ after observing its effects on people who inhaled it. Although he reported its analgesic effects in 1800, this property was not tested or used for another 45 years. During that time, it was primarily a ‘party’ or entertainment drug.

A British dentist in 1845 was the first person to demonstrate the anesthetic properties of nitrous oxide. However, it was not widely used in dentistry until 1863. Gardner Quincy Colton and his partners opened a series of dental institutes using laughing gas. Within five years, they had performed a reported 75,000 extractions. A history of reported nitrous oxide users includes: Allen Ginsberg, Samuel Taylor Coleridge, Ken Kesey, Winston Churchill and William James.

In 1882 James published an article titled: “The Subjective Effects of Nitrous Oxide,” in the journal Mind.  He said his use of N20 helped him develop a greater understanding of Hegel’s philosophy and he strongly urged his readers to repeat the experiment. “With me, as with every other person of whom I have heard, the keynote of the experience is the tremendously exciting sense of an intense metaphysical illumination.” Truth was almost blindingly obvious. “The mind sees all logical relations of being with an apparant subtlety and instantaniety to which its normal consciousness offers no parallel.”

But as he “sobered up,” the feeling faded. James was left with a few disjointed words and phrases—like staring at a black cinder left after the fire has gone out. James said he had sheet after sheet of phrases written during intoxication with N20 that to his sober mind seemed to be “meaningless drivel.” The most coherent and articulate sentence that came to him was the following: “There are no differences but differences of degree between different degrees of difference and no difference.”

In his later, seminal work, The Varieties of Religious Experience, James again reflected on the significance of intoxication by alcohol and anesthetics. He said the influence of alcohol over humanity was due to its power to stimulate the mystical faculties of human nature. Sobriety diminishes; drunkenness expands. “The drunken consciousness is one bit of the mystic consciousness and our total opinion of it must find its place in our opinion of that larger whole.”

Nitrous oxide, according to James, stimulated the mystical consciousness to an extraordinary degree. “Depth beyond depth of truth seems revealed to the inhaler.” But that truth fades as the individual sobered up. Nevertheless, a profound sense of meaning persisted. “I know more than one person who is persuaded that in the nitrous oxide trance we have a genuine metaphysical revelation.” He then went on to describe his own previous experiments with N20 described in his 1882 article.

In an article for The Atlantic, “The Nitrous Oxide Philosopher,” Dmitri Tymoczko noted how the experience James had with nitrous oxide remained with him throughout his life. He wrote a second article about it in 1898, “Consciousness Under Nitrous Oxide.” Then in his last essay, completed in 1910, he implied N20 had had an abiding influence on his thinking. Tymoczko thought N20 was a ‘passport’ for James to see religion from the believer’s perspective. “Drugs helped James to understand what religious belief was like from the inside.”

 James’s experiences with nitrous oxide helped to crystallize some of the major tenets of his philosophy. His writings emphasize, for instance, the notion of pluralism, according to which “to the very last, there are various ‘points of view’ which the philosopher must distinguish in discussing the world.” Nitrous oxide had revealed in the most dramatic way possible the existence of alternate points of view.

Tymoczko used William James’s experience with nitrous oxide to argue how drugs can contribute to human well being; sometimes fulfilling an authentic religious need. He reasoned that drugs could allow even the most skeptical people to experience temporary periods of “pleasing falsehood,” dividing their life into periods of sober rationality and “ecstatic religious intoxication”, like William James. “Indeed, this is the real religious significance of drug use, from the Jamesian point of view–that it lets us choose, if only vaguely and temporarily, what to believe.”

He even referenced R. Gordon Wassson, who proposed that religion itself originated with drugs. According to Wasson, religion was a confused reaction to intense experiences provoked by the accidental ingestion of psychoactive plants. There have been examples where religious ritual has been entwined with the use of drugs. Some Native American cultures used psychedelic mushrooms in their rituals; and the Greek cult of Dionysus used wine to provoke visions. But Tymoczko went too far onto the magical mystery tour when he suggested that the use of wine by Christians could be a remnant of similar practices.

The Bible clearly puts the use of bread and wine within the context of a meal; not a mystical psychedelic religious rite. Tymoczko also failed to make a distinction made by James in The Varieties of Religious Experience that separated what James called institutional religion, like Christianity, from personal religion. James defined personal religion as “the feelings, acts, and experiences of [the] individual . . . in their solitude, so far as they apprehend themselves to stand in relation to whatever they may consider the divine.” James was looking at examples of personal religion, not institutional religion in The Varieties of Religious Experience. See “Spiritual, Not Religious Experience” for more on this distinction by James.

So now back to nitrous oxide. The significance of nitrous oxide to William James personally or to his philosophical and other writings has little to tell us about religious experience today. It may resonate with the increased interest in psychedelic drug rituals for therapeutic healing (See “Back to the Future with Psychedelics”). But before walking the path of Timothy Leary and Aldous Huxley, let’s take a look at what modern science tells us about N20—information that wasn’t available to James when he was doing his inhaling.

The Global Drug Survey, annually conducted by Adam Winstock and others, found that nitrous oxide was the seventh most popular drug in the world. More than 7% of the global survey respondents said they had used nitrous oxide in the past year. In the UK, it was used by 23.7% of respondents sometime over the past year. A recent article in the Journal of Psychopharmacology by Kaar et al., Winstock was a coauthor, indicated that the reported lifetime use of nitrous oxide for the UK and US was 38.6% and 29.4% respectively.

Most people using nitrous oxide recreationally do so infrequently without any serious side effects. But there is a subpopulation of heavy users. Quoted in an article for The Fix, Winstock said: “The majority of people who use it don’t use it very often, and only around 3% of heavy users say they have experienced negative health effects.” The Global Drug Survey found nitrous oxide use was associated with hallucinations (27.8%), confusion (23.9%), persistent numbness (4.3%) and accidental injury (1.2%). Accidental injury seems to be dose-dependent—injury is associated with higher numbers of ‘hits’ per session.

The pro-drug website, Erowid, has a ‘vault’ of information on nitrous oxide. Chronic exposure can effect reproduction in women. Immunological problems such as recurrent infections, decreased white blood cell counts and weakness have also been reported. There were also neurological issues with chronic N20 use.

A 1978 article in the British journal Lancet reported that a neurological disorder called myleneuropathy developed in 15 individuals with prolonged exposure to nitrous oxide. R.B. Layzer reported that: “The neurological picture is similar to that of subacute combined degeneration of the spinal cord, and it is possible that nitrous oxide interferes with the action of vitamin B12 in the nervous system.” A 1993 article by Flippo et al. in JAMA Surgery also described the dangers of neurologic degeneration from nitrous oxide. The abstract said:

Five cases (four from the literature and one new case) are presented in which patients unsuspected of having vitamin B12 deficiency developed subacute combined degeneration of the spinal cord following nitrous oxide anesthesia. Patients with vitamin B12 deficiency are exceedingly sensitive to neurologic deterioration following nitrous oxide anesthesia. If unrecognized, the neurologic deterioration becomes irreversible and may result in death.

Happily, some of these issues can be reversed. A 2003 article in the Wisconsin Medical Journal by Waclawik et al. described a case study of an individual who was a chronic nitrous oxide user whose neurological deficit was reversed after administering vitamin B12.

Sporadic use of N20 does not appear to be associated with serious health risks. But chronic exposure is another story. William James may have been influenced by experiences he had with nitrous oxide, just as Sigmund Freud’s use of cocaine shaped his psychoanalytic theories. N20 also fits with the current trend of looking for therapeutic healing or personal insight with psychedelics like LSD, ecstasy and even ayahuasca or ibogaine. But it is better suited as an anesthetic or analgesic in medical procedures; or an oxidizer in rocket engines than it is a doorway to religious experience.

02/18/16

American Polytheism

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© vectomart | 123rf.com

The Baylor Religion Survey looked “under the hood,” so to speak, of the commonly acknowledged fact of American religiosity. Consistent with other findings, it found that 85-90% of Americans said they believed in God, and 71.5% said they prayed at least once per week. Almost half (49.2%) said they attended church at least once per month. “In fact, under the surface American religion is startlingly complex and diverse. Americans may agree that God exists. They do not agree about what God is like, what God wants for the world, or how God feels about politics.” Let’s see what the Baylor researchers found out.

One of the intriguing aspects of the Baylor Religion Survey was how it assessed religious affiliation. Most surveys simply ask the person to select their affiliation or denomination from a list. But this has become increasingly problematic as more and more Americans lose a strong denominational identity through the rise of nondenominational congregations as well as congregations that minimize their denominational ties. I watched with interest as a large local church completed its building program and shed the “Assembly of God” part of its name to simply become “Church.” Rick Warren’s Saddleback megachurch is similar. How many people realize it is part of the Southern Baptist denomination? I didn’t.

What the Baylor researchers did was look beyond mere denominational affiliation. In addition to the typical checklist of denominations, they asked respondents to give the name and address of their places of worship. This enabled them to more accurately sort persons into broader religious traditions. By their calculations, Evangelical Protestants comprised 33.6% of their survey; Mainline Protestants were 22.1%; Catholics were 21.2%; the Unaffiliated were 10.8%; Other was 4.9%; Black Protestant were 5.0%; and Jewish were 4.9%. See the Survey for further information on these religious traditions.

The so-called “nones,” individuals not affiliated with any religious tradition, have been getting a lot of attention in the reporting on religious surveys lately. The Baylor Religion Survey found that 62.9% of American nones believed in God or some higher power. Most of these individuals (44.5% of the 62.9%) reported a belief in a higher power. There were 37.1% of nones who said they didn’t believe in a God or higher power, while 11.6% believed without any doubts and 6.9% sometimes believed in God or believed with doubts. Almost one third of the unaffiliated (31.6%) reported praying at least occasionally; 10.1% of those prayed daily. What comes to mind is the spiritual, not religious language and distinction made within Twelve Step groups.

Another intriguing aspect of the Baylor Religion Survey was how it used 29 questions about God’s character and behavior to get a sense of what people meant when they said they believed in God. They discovered there were two distinct dimensions of belief in God. The first dimension was God’s level of engagement or activity. This captured the extent to which the individual believed God is directly involved in worldly and personal affairs. The second dimension was God’s level of anger. This described the extent to which the person believed God is angered by human sins and tended towards punishing, severe, and wrathful characteristics.

From these two dimensions, the researchers separated their sample into four types of believers: Type A was the Authoritarian God; Type B was the Benevolent God; Type C was the Distant God; Type C was the Critical God. Type A believers scored above the mean on both the activity and anger dimensions. Type B believers scored above the mean on activity, but below the mean on anger. Type C believers scored above the mean on anger, but below the mean on engagement. Type D believers scored below the mean on both the dimensions. See the following figure taken from the Baylor study:

Baylor

What struck me about this way of assessing belief in God was that it captured more of a sense of how the respondents viewed God, closer to the sense of “God as you understand Him” in Twelve Step recovery. These types don’t neatly fit within a denominational category. You could potentially find all four types within one denomination.

Those who believe in an Authoritarian God represent 32% of the population. They think God is very involved in their lives and world affairs. He is responsible for global events like tsunamis and economic upturns. They also tend to feel God is angry and capable of meting out punishment to those who are unfaithful or ungodly.

Those who believe in a Benevolent God make up 23% of the population. They also see God as very active in their daily lives. But they are less likely to believe God is angry and that He acts in wrathful ways. Instead, they see God as a force of positive influence in the world who is less willing to condemn or punish individuals.

Believers in a Critical God comprise 16% of the population. They feel God does not really interact with the world. However, God still observes the world and views the current stat of affairs unfavorably. His displeasure will be felt in another life and divine justice may not occur in this world

Believers in a Distant God include 24% of the population. They think God is not active in the world; neither is He especially angry. These individuals tend towards thinking about God as a cosmic force, which set the laws of nature in motion, similar to deism. As such, God does not “do” things in the world; nor doe He hold clear opinions about human activities or world events.

When these views of God are used to sort through selected aspects of religiosity, there were some interesting results. Believers who saw God as active in personal and world affairs, (Type A and Type B), were significantly more likely to attend church services weekly, pray several times a day, believe that Jesus was the Son of God, and be biblical literalists.  See the following table derived from Table 8 in the Baylor Religion Survey.

Type A Authoritarian

Type B Benevolent

Type C Critical

Type D Distant

Attends church weekly

50.9%

31.5%

9.8%

7.8%

Never Attends

13.5%

8.2%

16.7%

41.5%

Prays several times daily

54.8%

31.7%

6.5%

7.0%

Never Prays

1.8%

2.5%

18.4%

38.7%

Biblical Literalist

60.8%

26.5%

10.2%

2.5%

Jesus is the Son of God

41.3%

27.8%

14.4%

16.0%

Denominational affiliation is not the whole story on American spiritual and religious practices and beliefs. While the Baylor Religion Survey and other research, such as that by the Pew Research Center, suggest that “nones” are becoming increasingly secular, there clear evidence that many still believe in some kind of a transcendent or higher power and pray at least monthly. The Baylor survey found that around 10% prayed daily. The Types of God used to categorize views of God in the Baylor Religion Survey illuminated an understanding of God that cuts across denominations and has some correspondence with the sense of “God as you understand Him” within the Twelve Steps.

This reflects a growing movement in American religiosity towards what William James described as personal religion in his seminal work, The Varieties of Religious Experience. Institutionally-grounded religious belief and practice is waning, while personal expression of a belief in God and spiritual practices such as prayer continues, even among those who see themselves as not religious. The distinction between institutional and personal religion first articulated by William James in The Varieties of Religious Experience seems to resonate with the modern spiritual, not religious distinction within many Twelve Step groups.

07/22/15

No Laughing Matter

© Ievgen Soloviov | Dreamstime.com

© Ievgen Soloviov | Dreamstime.com

In his famous work, The Varieties of Religious Experience, William James discussed what he said was the ability of nitrous oxide (laughing gas) to produce “mystical consciousness” to an extraordinary degree. “Depth beyond depth of truth seems to be reveled to the inhaler.” But the revelation fades as the gas wears off. What is left seems like nonsense to the awakened mind. But the sense of “a profound meaning” persists. James said he knew more than one person who was persuaded that a genuine metaphysical revelation could come in a nitrous oxide trance. Now, laughing gas is being researched as a treat for depression.

James said he had personally tried nitrous oxide, and even wrote of his experience in print. He said one impression from these experiments stayed with him—that our waking consciousness was but one of several other potential form of consciousness. “No account of the universe in its totality can be final which leave these other forms of consciousness quite disregarded.”  Looking back on his own experiences, he saw them converge towards a kind of insight that he felt had metaphysical significance.

His essay was “Subjective Effects of Nitrous Oxide,” and it appeared in the 1882 volume 7 issue of Mind. It can be found in a few places online. I’ve linked it on the website Erowid, which will also have other references we’ll examine. In his essay, James said that the keynote of nitrous-oxide intoxication was an intense sense of metaphysical illumination that occurred as the altered state of consciousness was wearing off.

The mind sees all logical relations of being with an apparant subtlety and instantaniety to which its normal consciousness offers no parallel; only as sobriety returns, the feeling of insight fades, and one is left staring vacantly at a few disjointed words and phrases, as one stares at a cadaverous-looking snow peak from which sunset glow has just fled, or at a black cinder left by an extinguished brand.

What James saw as the most coherent and articulate of his bursts of insight was this: “There are no differences but differences of degree between different degrees of difference and no difference.” James said there was an initial rapture of emotion in “beholding a process that was infinite” that turned to horror as the individual realized they were caught in an inevitable fate, “with whose magnitude every finite effort is incommensurable and in the light of which whatever happens is indifferent.”

As James himself said in the essay, just as every person’s encounter will vary, the individual’s personal experience with nitrous oxide will vary from time to time. However, he still thought that there still was a common thread running through all those who were intoxicated with nitrous oxide, namely an “intense metaphysical experience.”

A group of researchers, Nagel et al., reported on a pilot study done to assess the potential of nitrous oxide as a rapidly acting treatment for treatment resistant depression (TRD). The theory was based upon the influence of nitrous oxide on the NMDA receptor, which has been “implicated” in the neurobiology of depression. Other NMDA receptor antagonists, such as ketamine, have been shown “to provide a rapid and sustained antidepressant effect” when used at low doses. Given the similar mechanisms of action, the researchers hypothesized that nitrous oxide may also have rapid antidepressant effects on treatment resistant depression. So they designed a study to assess the immediate (2 hours) and sustained (24 hours) antidepressant effects of nitrous oxide in TRD patients.

Patients received either an admixture of up to a maximum of 50% nitrous oxide and 50% oxygen (as the active ingredient) or 50% nitrogen/50% oxygen (as the placebo) for one hour. Outcomes were assessed for each participant at baseline, 2 hours after treatment and 24 hours after treatment. The results indicated a significant improvement in depressive symptoms at 2 and 24 hours. There was also a sustained improvement with some participants for 1 week. Yet there were several limitations noted by the researchers of this study.

The full 60-minute nitrous oxide treatment was only completed by 15 of the 20 patients. The placebo treatment was completed by 20 individuals. The side effects for the treatment group were noted to be mild or moderate (nausea, anxiety, vomiting) and immediately reversible. This suggested an acceptable risk/benefit ratio of nitrous oxide for TRD to the researchers.

Their discussion suggested several limitations of the study. The small sample size meant that the results should be interpreted with caution until the results were replicated in larger populations. They also noted that the euphoric effects of nitrous oxide are hard to mask, so the blinding attempted in the study may not have been adequate. Despite knowing this, the researchers did not try to assess whether or not the participants were aware of their group assignment, “and this limits our conclusions.”

They also pointed out that there could have been a masking effect of depressive symptoms, meaning that: “the depressive symptoms were not really altered, but rather ‘covered up’ by other effects.” They noted where symptom masking has been evident with rapidly acting psychostimulants like cocaine and methylphenidate, “which promote a transient alteration in mood but not a true antidepressant effect.” Their preliminary study concluded there was evidence that nitrous oxide may have rapid and marked antidepressant effects in patients with TRD. They called for further studies that would attempt to determine optimal antidepressant dosing strategies and the risk/benefit of nitrous oxide in a larger and more diverse population of individuals with TRD.

Psychiatrist Sandra Steingard expressed reservations with the promotion of nitrous oxide as a rapid acting treatment for depression. She commented that while she never personally tried nitrous oxide herself, she knew others who did and expected that her mood would undoubtedly have been elevated as theirs was. Her suggestion was the observed “treatment’ effects of nitrous oxide were actually drug effects that would occur with any individual who used it. She proceeded to voice several questions on the use of nitrous oxide, ketamine or stimulants to treat depression. She thought there was a huge potential for harm; possibly greater than the drugs psychiatrist currently prescribed for depression.

What are the long term side effects? How hard is it to stop them?  How do we deal with the corrupting influence of the profit driven forces so powerful in medicine?  Most of these drugs are still studied over weeks and then prescribed for years. With drugs like stimulants, ketamine and nitrous oxide, I have a particular worry because these drugs are known to cause psychosis. Colleagues of mine have told me that they do not see people who become psychotic on stimulants. If they don’t, they are not looking. I am not comfortable assuming when an 18 year old develops psychotic symptoms after several years of treatment with an antidepressant that these two things are not related or that the psychosis was inevitable because the person had a diathesis to Bipolar Disorder. Stimulants are used to create animal models of psychosis because we have known for decades that stimulants can cause a person to become psychotic.

Erowid is the website for an organization that seeks to “provide accurate, specific, and responsible information about how psychoactives are used in the United States and around the world.” So you will find pro and con information on the use and effects of psychoactive substances there. Here are a few of the catalogued articles on problems from nitrous oxide use and abuse: “Asphyxia deaths from the recreational use of nitrous oxide;” “Suicide by nitrous oxide poisoning;” B 12-related medical problems from nitrous oxide: “Nitrous oxide myleopathy in an abuser of whipped cream bulbs [whippets] (nitrous oxide is used in whipped cream cans), “Myleneuropathy after prolonged exposure to nitrous oxide,” and this case report from outside of Erowid of a woman who developed myleopathy.

Below is a quote from a 1991 article on “Health hazards and nitrous oxide” in medical settings. Here is a link to a case report of an individual who suffered paranoid delusions after abusing whippets.

Although N2O was for many years believed to have no toxicity other than that associated with its anesthetic action, bone marrow depression in patients administered N2O for extended periods of time and neurological abnormalities in health care workers who inhaled N2O recreationally have disproved this notion.

Simply put, regardless of the short-term reversals of a depressed mood state, it does not seem that there will be any long-term benefits from the therapeutic use of nitrous oxide (N2O). And there seems to be plenty of concerns with its use. Treating depression with laughing gas is no laughing matter.