A Really Good Day

by Ayelet Waldman

  Although it’s long been known that 67 percent of women’s admissions to psychiatric facilities occur during the week immediately prior to menstruation, only recently have researchers begun to consider the effect of PMS on women with mood disorders. Premenstrual exacerbation, or PME, is when an underlying condition is worsened during a phase of a woman’s menstrual cycle. However, because I only ever experienced mood swings during two periods in my luteal phase (the days before ovulation and the week leading up to menstruation), my new psychiatrist concluded that I did not suffer from bipolar disorder at all, even bipolar disorder complicated by PME, but, rather, from mild PMDD, not so serious as to be disabling, but troubling nonetheless. Especially to my dry cleaner.

  This change in diagnosis immediately felt right to me. Though there’d been comfort in having the bipolar diagnosis to explain my shifting moods, the fact that I never experienced serious mania or profound depression had always given me pause. Many a morning I would feel fine and stable, stare at the handful of pills in the palm of my hand, and wonder whether it really made sense to swallow something that I knew would soon make me irritable and/or sap my sex drive. And yet I also knew what happened to people with bipolar disorder who said, “I feel fine!” and stopped taking their meds, so I was a good soldier and took whatever my psychopharmacologist prescribed. Now, finally, I was on the right track.

  Mood stabilizers don’t work on PMDD. Instead, low doses of hormones, including birth-control pills, are often prescribed, as are SSRIs, the latter given only in the week or ten days preceding menstruation. Research has also shown a positive effect from calcium supplements, light therapy, and cognitive therapy.

  Because evidence of the link between hormone replacement therapy and breast cancer made me skittish, I initially opted for the monthly short course of SSRIs. Though antidepressants normally take four to six weeks to become effective, in premenstrual women, as soon as SSRIs are absorbed, they inhibit the enzyme 3-ß-HSD from metabolizing progesterone. Because the drop in progesterone is the culprit in premenstrual blues, the change is immediate and profound. In my case, within twenty minutes of taking a pill, my mood lifted.*4

  Unfortunately, SSRIs don’t have the same magical effect prior to ovulation, when a woman’s hormones shift rapidly, estrogen levels peaking and LH (luteinizing hormone produced by the pituitary gland) surging. As Dr. Louann Brizendine, the founder of the UCSF Women’s Mood and Hormone Clinic, told me, “Abrupt changes in hormones are like the rug being pulled out from under the brain.” Because SSRIs don’t work during this period, I relied on techniques learned in cognitive behavioral therapy and, when I found myself flinging my children’s toys across the room or starting a social-media flame war, the occasional anti-anxiety pill. A chill pill, if you will.

  Once I understood the cyclical nature of my sleeplessness, I could wean myself off sleeping pills, and throw away most of my pharmacopeia. For a while, I was far better able to control my moods. I still cycled, but because I could anticipate my rages and my periods of sadness, I was able to plan for them and deal with them. I monitored my calendar the way a pilot monitors her cockpit controls, not only to determine when to start taking my medication, but also so that I could schedule important meetings and events to coincide with less volatile days of the month. Dr. Brizendine requires her patients’ partners to take the initiative during the premenstrual period, urging them to stop all arguments, jot down the subject on a piece of paper, and reintroduce it later in the month, when it can be dismissed without rancor. My husband kept track of my cycle and developed a bland and pleasant tone in which to ask the question “Do you think you might need an SSRI today?” I did my part by neither defenestrating nor decapitating him, but instead taking my pill.

  For five years, things were predictable and peaceful. Then the inevitable happened. I entered perimenopause, and my period became irregular. Some cycles lasted thirty days, others twenty. Sometimes I’d skip a period or two altogether. With my period behaving like an ambivalent Victorian suitor who drops his visiting card rarely and on no discernible schedule, I could not time my SSRIs. My doctor convinced me to overcome my trepidation and try a low-dose estradiol patch to combat my shifting moods. The patch, however, did not provide the instant and profound relief I was used to. More troublingly, the use of unopposed estrogen—estrogen taken alone—is associated with an increased risk of endometrial and uterine cancer. This risk can be eliminated by adding progestin, but that’s been associated with an increased risk of breast cancer. Furthermore, progestin has a marked negative effect on mood, especially in women with PMS or PMDD. Since the only reason I was wearing the patch was to ameliorate my low moods, I was not about to add a medication that would make me depressed and possibly give me cancer.

  And then things took a turn for the worse. I found myself in a state of seemingly perpetual irritability. I seethed, I turned that fury on the people around me, and then I collapsed in shame at my outbursts. These alternating states of anger and despair came far more frequently than before, and made me feel hopeless. I couldn’t seem to find pleasure in my life, or even contentment. I saw the world through a sad and dingy scrim. I knew there was light and love on the other side, but I couldn’t manage to lift the grimy curtain of my unhappiness.

  My husband, who had been dealing with my vicissitudes of mood for years, seemed finally to be exhausted by them. We fought, and we seemed to take far longer to recover from our altercations. Or perhaps that’s more of my despondency talking. Perhaps he was no less patient than before, but my depression made me newly terrified that he would once and for all pack his bags and leave me alone with my ugly self.

  It was in this state of mind that I stumbled across James Fadiman’s book.

  Before becoming a writer, I was a federal public defender and law professor with a particular interest in criminal justice reform. For many years, I taught a seminar called The Legal and Social Implications of the War on Drugs at the UC Berkeley School of Law, and was a consultant to the Drug Policy Alliance, an organization dedicated to the reform of U.S. drug laws. However, though I have experience and expertise with drug-policy reform issues, I knew very little about psychedelic drugs. I had never taken LSD, and my experience with other hallucinogens began and ended in my freshman year of college, with a pleasurable but somewhat disconcerting few hours spent languidly spinning on a tire swing after consuming a very small quantity of psilocybin in the form of “magic mushrooms.”*5 I have always been too afraid of enduring a terrifying bad trip or suffering lasting psychiatric harm to experiment further. But microdosing seemed different, less frightening. The doses Fadiman discussed were sub-perceptual, so small that there was no possibility of any kind of hallucination, positive or negative. Not so much going on an acid trip as going on an acid errand.

  The individuals whose reports Fadiman presented in his book experienced “joy and gratitude,” increased focus, better mood. I wanted that. They reported rarely losing their tempers, becoming more fun to be with. I really wanted that. They experienced that most seductive and elusive thing: a really good day. I needed that! None reported any negative experiences, but, then, the book was hardly a thorough research study. It provided, however, a glimmer of hope. With reservations, of course.

  There has never been an officially sanctioned study of microdosing. The closest thing to research is Fadiman’s anecdotal data collection, assembling reports from individuals who reach out to him. There is, however, a tremendous amount of data on LSD. Before the drug was criminalized, it was thoroughly studied. Thousands of doses were administered in therapeutic and research settings, with very few negative effects. LSD has a very low toxicity level and a large safety range.*6 This means that even massive doses are not physically dangerous. Microdoses have no discernible biological effects at all.

  I contacted James Fadiman and received a memo entitled “To a Potential Self-Study Psychedelic Researcher.” The document makes clear that it is not meant as an encouragement to engage in illegal
activity but is, rather, a set of cautions and procedures designed to minimize harm, should you engage in illegal activity without the encouragement of James Fadiman.

  The protocol is simple. To participate in the international self-study group on the effects of sub-perceptual doses of LSD on normal daily functioning, a “self-study psychedelic researcher” is to take microdoses of LSD on repeating three-day cycles. The suggested dose is ten micrograms, one-tenth or less of what a person would have to take in order to experience an altered state of consciousness. The idea is to take a dose so small that you don’t actually feel anything unusual. Or at least nothing immediately tangible. On Day 1 of every cycle, participants are to take ten micrograms of LSD. They are to keep to their normal schedules of work, leisure, meals, coffee, naps, exercise, and social life. They are instructed to monitor mood, physical strength, symptoms, productivity, and the ease with which they do their work, and to “write a few notes about how [the] day went.” On Days 2 and 3, participants are to take no LSD, but merely to continue monitoring and noting.

  I read Fadiman’s memo, I reread his book, I researched, and I considered. The idea of becoming a “self-study psychedelic researcher” felt ridiculous. I am the mother of four children. I am, to use my children’s gibe, “totally basic.” I wear yoga pants all day, I post photos of particularly indulgent desserts on Instagram. I am the mom surreptitiously checking her phone at Back to School Night, the woman standing behind you in Starbucks ordering the skinny vanilla latte, the one getting a mammogram in the room next to yours, the one digging through her too-full purse looking for her keys while you wait impatiently for her parking spot. I am a former attorney and law professor, a law-abiding citizen. A nerd. If a cashier hands me incorrect change, I return the excess. I don’t cheat on my taxes, don’t jump the turnstile in the subway, don’t park in handicapped spots. I write and lecture on the criminal justice system; I don’t regularly commit crimes.

  But I was suffering. Worse, I was making the people around me suffer. I was in pain, and I was desperate, and it suddenly seemed like I had nothing to lose. I decided to try a one-month experiment. I would follow James Fadiman’s protocol, taking a microdose of LSD every three days. I would carefully track the results, keeping notes of the effects. Because I am a writer, I would write these notes up in a form that might be useful not just to myself or to Fadiman, but to others curious about the potential therapeutic uses of microdosing. I would also use this month to learn more about psychedelic drugs and to think deeply about what brought me to try something so unusual, so desperate. A single month out of fifty years. What harm—or what help—could there be in that?

  * * *

  *1  Lately, we’ve started going to a more traditional kind of couples therapy, in which we each try to recruit the therapist to take our side against the other. She’s annoyingly neutral—Switzerland in sensible shoes.

  *2  The single audience member, a malodorous gentleman slumped in a rear seat, woke up halfway through the reading, gazed at me with pity, and trundled his shopping cart heaped with beer bottles out the door.

  *3  Other than the time I was fired for cursing out a sexist boss. But I’d waited until my last week of work before taking on the guy. He was such a complete and utter shitheel that I consider that experience an example of forbearance rather than (or perhaps in addition to) loss of control.

  *4  Incidentally, alcohol seems to act on the same receptors, so a glass of wine can have the same effect. As appealing as was the idea of spending a week of every month in a mild state of inebriation, I opted for the pills.

  *5  Or maybe the mushrooms weren’t magic at all. I didn’t hallucinate, and who wouldn’t become dizzy spinning on a tire swing? It’s possible that all I ate was a handful of dried shiitakes dipped in cow manure.

  *6  The safety range is the span of difference between a therapeutic dose and a toxic one. If the safety range is narrow, then someone can easily overdose.

  Day 1

  Microdose Day

  Physical Sensations: Heightened awareness.

  Mood: Excited. Nervous. Delighted.

  Conflict: Who, me? Even the idea seems absurd.

  Sleep: Hard time falling asleep. Woke up early.

  Work: Astonishingly productive, lost track of time.

  Pain: My shoulder—frozen for the past year and a half—is killing me.

  Today I took my first microdose. My senses are ever-so-slightly heightened, a feeling all but unappreciable, so perhaps it’s psychosomatic, though that word carries little meaning when anything that might be happening to me right now has inevitably to do with the interaction of mind and body. I feel a tiny bit more aware, as if my consciousness is hovering at a slight remove, watching me tap the keys on my keyboard, rub my ankles together, sip a mouthful of tea and swallow it. The trees look prettier than usual; the jasmine smells more fragrant.

  It suddenly occurs to me that I feel mindful, a feeling I have tried to achieve through meditation, though I always come up with zip. I am finding it a little bit easier to notice both my thoughts and my body moving through space. Though, even as I write this, I fear the sensation has passed.

  Even more thrillingly, for the first time in so long, I feel happy. Not giddy or out of control, just at ease with myself and the world. When I think about my husband and my children, I feel a gentle sense of love and security. I am not anxious for them or annoyed with them. When I think of my work, I feel optimistic, brimming with ideas, yet not spilling over. There’s nothing hypomanic about this mood. My mind is not racing. I feel calm and content. Surely, the results cannot be evident so quickly? This is, in all likelihood, nothing more than the placebo effect. But even if it is all in my mind, even if the mood passes, I am grateful for this respite.

  When I woke up this morning, I crept out of my house to the place where I hid the little cobalt blue dropper bottle that contains my microdose of diluted LSD. Careful not to hold it up to the light (LSD degrades when exposed to ultraviolet light—ironic, considering all the black-light posters users have stared at while feeding their heads), I shook the bottle a few times, filled the dropper, and carefully deposited two drops under my tongue.

  This was certainly not the first time I had tried an illegal drug, though I have never been what you would call a regular drug user. I smoked marijuana a few times in high school, a dozen or so times in college, once or twice as an adult, and then not again until I was prescribed medical marijuana (I live in California), first to end my dependence on the sleeping pill Ambien and then to ease the pain of a frozen shoulder. I have used MDMA six or seven times.*1 In college, I tried cocaine twice, and those mushrooms that purported to be magic once. All together? More than some people my age, less than Presidents Obama and Bush.

  Nor am I an avid user of legal recreational drugs. I don’t like the taste of alcohol, and am too readily susceptible to its effects, so even when I’m not taking psychiatric drugs I rarely drink. Though I’ve certainly been mildly intoxicated, I remember being inebriated only twice: once in high school, when I threw red wine up on the shoes of a boy I liked (he drove me home, helped me up the stairs to my bedroom, muttered an awkward excuse to my mother, and disappeared from my life), and once in college, when I was convinced to try a beer funnel (I threw that up, too). Tea is my stimulant of choice, and on a workday I can go through a pot or two before noon, when I stop in order not to spend the night wide awake.

  I have never purchased drugs from a drug dealer. Whatever illegal substances I’ve ingested have been passed to me at a party or given to me by friends. When I decided to try the protocol, despite living in Berkeley, a place I’d always assumed to be the psychedelic capital of the world, I had no idea how one would go about buying the drug. Should I wander down to People’s Park and hit up one of the dealers who ply their trade among the homeless teens? How would that go?

  “Hey, lady, smoke, shake?”

  “Why, yes! Do you happen to have lysergic acid diethylamide? And do yo
u take Visa?”

  Having dismissed the possibility of a street hand-to-hand, I found myself in yoga class one morning, staring at the grubby-footed young woman on the mat next to mine. Her sweat-stained Interstate 420 T-shirt was a good sign, but then I noticed the Tibetan mandala tattoo on her ankle. How can you trust someone who inscribes permanently on her body something specifically designed to symbolize the transitory nature of the material world? I couldn’t buy drugs from an idiot, especially a dirty one.

  It then occurred to me that, like all middle-aged women in the Bay Area, I have a healthy supply of gay male friends, most (though by no means all) of whom are childless. Surely, they still knew how to party! Or at least maybe knew someone who knew someone who knew how to party. I started calling.

  Unfortunately, it turns out that the gay men of my acquaintance no longer jet around from one circuit party to the next, but, instead, spend their weekends in the same domestic torpor as I do. Binge-watching episodes of Orange Is the New Black is the closest they get to criminality. My former-stoner friends were similarly useless. The guy who used to grow hydroponic weed in his dorm room closet? He’s the third-grade room parent, his only remaining allegiance to the counterculture the Darwin fish bumper sticker on his Prius.

  I was at a loss, so though Fadiman stresses the importance of discretion, I began tentatively bringing up the subject of microdosing in conversation. If the response was familiarity or even curiosity (or really anything other than befuddlement or disgust), I’d mention that I was looking for a reputable (or at least not entirely disreputable) source. After some time, an acquaintance told me that he had heard a story about an elderly professor who had been microdosing with LSD for years. He didn’t know the professor’s name or anything about him, but he’d pass a message along to the person who had told him about the professor. Maybe that person would reach out to the professor on my behalf. The entire tale had the ring of the apocryphal, and I had little faith that anything would result from this attenuated game of telephone with someone who I wasn’t sure even existed.