*15 Brook L. Henry, Arpi Minassian, and William Perry, “Effect of Methamphetamine Dependence on Everyday Functional Ability.”
*16 Carl L. Hart et al., “Is Cognitive Functioning Impaired in Methamphetamine Users? A Critical Review.”
*17 Carl L. Hart, Joanne Csete, and Don Habibi, “Methamphetamine: Fact vs. Fiction and Lessons from the Crack Hysteria.”
*18 Hart, Csete, and Habibi, “Methamphetamine: Fact vs. Fiction.”
*19 Ibid.
*20 T. Linnemann and T. Wall, “ ‘This Is Your Face on Meth’: The Punitive Spectacle of ‘White Trash’ in the Rural War on Drugs.”
*21 “Given the weak evidentiary basis for epidemic and diagnosis, I offer a preliminary interpretation that the meth epidemic is constructed as symptom and cause of White status decline, with dental decay the vehicle for anxieties about descent into ‘White trash’ status” (Naomi Murakawa, “Toothless”).
*22 Megan S. O’Brien and James C. Anthony, “Extra-Medical Stimulant Dependence Among Recent Initiates.”
*23 Dr. Hart believes even that figure is exaggerated. In a report prepared for the Open Society Institute, he writes, “Less than 15 percent of those who have ever used the drug will become addicted.” (Hart, Csete, and Habibi, “Methamphetamine: Fact vs. Fiction.”)
*24 K. L. Medina et al., “Neuropsychological Functioning in Adolescent Marijuana Users: Subtle Deficits Detectable After a Month of Abstinence.” For a thorough review of research on marijuana and youth, see Seth Ammerman, Sheryl Ryan, and William P. Adelman, “The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update.”
*25 L. M. Squeglia, J. Jacobus, and S. F. Tapers, Ph.D., “The Influence of Substance Use on Adolescent Brain Development.”
*26 At http://www.drugpolicy.org/sites/default/files/DPA_SafetyFirst_2014_0.pdf.
Day 11
Transition Day
Physical Sensations: None.
Mood: Nice.
Sleep: Woke up way too early.
Work: Trouble focusing at first, but eventually got down to it.
Pain: Is it the microdose, or is my shoulder just finally starting to unfreeze?
I woke this morning at dawn after having fallen asleep too late. I tried to force myself to go back to sleep. I snuggled up to my husband, laid my head on his chest, and felt his heart beat against my cheek. Antoine de Saint-Exupéry once wrote, “Love does not consist of gazing at each other, but in looking outward together in the same direction.” Bullshit. When I gaze at my husband, when I feel his body along the length of mine, I feel a deep, contented joy, a warmth that begins in my belly, spreads out to my limbs and through the top of my skull. If that’s not love, what is?
I kissed him softly so that I didn’t wake him, and slipped out of the darkness of our bedroom, through the quiet hall, downstairs to the kitchen. Though the cacophony of a house full of children is one of the delights of parenthood, I am coming to love the early hours of the morning, when I wake to a silent house. So used to being a grump in the mornings, so used to clutching mightily to every last shred of sleep, I find it a pleasure to sit silently at my kitchen table, drinking a cup of tea, with the dog resting her chin on my lap as I scratch her ears while I read the paper or check my e-mail.
Still, despite the delight I’m taking in this early morning solitude, I am worried about how little I’m sleeping. Though the protocol warns that some people require a sleep aid, I am loath to get back into a habit I worked so hard to kick.
Some of my earliest memories are of lying beneath my scratchy polyester quilt, my head balanced on a pillow at once lumpy and hard, staring at the blades of yellow street light slicing between the slats of the mini-blinds that inadequately covered my window. I fought hard to keep from looking at the glow of my flip clock, but the numbers would drop with an audible flop, reducing one by one the possibility of getting enough accumulated minutes of sleep before the radio buzzed static and KISS-FM.
That lasted my entire life, until I discovered Ambien. That’s when everything changed. I would climb into bed and pop a pill, and the lights would go out with a snap. Sometimes the metaphorical lights went out even before the actual ones. My husband, coming in from work at 3:00 or 4:00 a.m., would find me, lights blazing, glasses on, book in hand, snoring away.
I loved that drug so much, even if some of the side effects were, well, disconcerting. Jet lag rendered me impervious to the effects of a single Ambien pill, so when I was traveling I would often allow myself a second one, and sometimes, my judgment impaired, even a third. It turns out there’s a reason the correct dosage is five to ten milligrams. The following text stream, reproduced verbatim, illustrates what happens when you take thirty milligrams:
You love m me right?
YES
Our kids are goog. We did ik
Okay, Ambien typing
If I die too ire il be ins rigyra
Put screen away
Sex in nit sir. Very sky adequate
Stop. Turn off phone and you will be asleep in 5
You talk me. Before you I was imonible. Now in on accordion monorail
HONEY TURN OFF YOUR PHONE NOW
Income home tomorrow
Please, darling. I am begging you. If you love me, turn off your devices, pick up your book, and read. Screens activate
Hiccups
Bad enough sending such gobbledygook to my husband, but once I took two Ambien on a red-eye to London and decided that a very beautiful and accomplished actress friend would make the ideal wife for my husband and stepmother for my kids in the event that the plane plummeted into the Atlantic. I texted her a long set of unfortunately too-coherent instructions on how she should go about taking my place.
Worse than making me a late-night idiot, Ambien made me depressed, though I did not recognize this correlation until I finally stopped taking the drug. Only in retrospect did I appreciate how much gloomier I was the day after I’d taken an Ambien. It also played havoc with my memory. This, too, took a while to realize, masked as it was by the fact that since having children I have experienced an overall decline in memory. For years I blamed my failure to remember simple events—whereas once I’d effortlessly memorized long mnemonics for things like the Rules of Evidence—on pregnancy brain, or lactation fuzzies, or on the myriad distractions of a large family, but now I realize that Ambien was at least partially at fault. Short-term memory loss is a recognized side effect of the drug. Even worse, studies show that, though Ambien might actually help in the consolidation of long-term memories, that effect is true only for bad experiences.*1 Ambien, which makes you forget everything else, actually sharpens your recall of unpleasant emotions and events. Like I needed any help with that.
The six years I relied on Ambien were the first six years of my youngest child’s life, and I have heartbreakingly few memories of that time. Worse, those I do have are all too often unhappy. What if that period of my life was characterized not only by the unhappiness and mood swings that I recall, but also by periods of contentment, even joy, that I have lost like digital photos on a crashed computer? What if Ambien has warped my perception of the extent of my unhappiness, causing me to forget happiness and remember only misery? Wouldn’t that almost be sadder than never having been happy at all?
Kicking the Ambien habit was hell. I lay in bed night after night, rolling from side to side, flinging the covers off, pulling them back up, longing for a pill, my Nightly Roll Call of Anxieties studded with entries like “You’ll never sleep again” and “You’re a pathetic drug addict.” I felt like I was trying to break free from an addiction, though my doctor had promised me that Ambien was not habit-forming. Even now, when I search for research on the topic, I am reassured that he was correct—when, that is, the drug is used correctly. But how non-habit-forming can a non-habit-forming drug be if the non-habit-forming drug has you forming a habit where you’re taking enough to form a habit?
Indeed, m
y experience with Ambien doesn’t rise to the level of the accepted definition of drug dependence. I did not experience a “preoccupation with a desire to obtain and take the drug, and persistent drug-seeking behavior.”*2 But, then, I always had a prescription bottle in my medicine cabinet, refilled automatically through the mail every three months. I ran out of toilet paper more often than I ran out of Ambien. On the rare occasions when my pharmacy failed me, I experienced a pang of concern, but that was immediately remedied by a call to my doctor. A heroin addict with a bucket full of dope on her nightstand wouldn’t need to engage in “persistent drug-seeking behavior,” either.
The problem is that the “correct” way to use Ambien isn’t how most of us use it. Supposedly, Ambien is intended for occasional insomnia. A night here or there, once in a rare while. But when I was taking the drug, it was my every-night companion. My regular midnight snack. I only rarely took more than the recommended dose, but I was less apt to skip a pill than I ever was when I was taking birth control. Though my evidence is only anecdotal, most Ambien devotees I know are like I was, using Ambien regularly, not occasionally, because their insomnia is regular, not occasional.
My campaign to kick the drug was two-pronged. First I substituted medical marijuana as a nighttime medication (though only briefly); then I turned my bedroom into as close an approximation of a sensory deprivation tank as I could achieve without passing my nights in a soundproof pod full of salt water.
I took the concept of “sleep hygiene” to a level of neurosis that only others who spend their nights frantically calculating the mounting hours of their sleep deficits can appreciate. I turned off the heat in our bedroom, chose a fan for its cooling and white-noise properties, and eliminated all sources of light. Tiny squares of black vinyl electrical tape cover every single LED light. All of this has left our bedroom darker and quieter than a womb, and a hell of a lot colder.
In that black, freezing, white-noise-filled room, I generally sleep almost as soon as my head touches my (three) pillows. But what about on the all-too-many nights when I’m out on the road? This is not a neurosis that travels easily. I do my best, turning the heat down and the air conditioning up. I travel with a pack of black Post-its that I stick over all LED and other indicator lights, including the insanely bright strobes that are a feature of hotel smoke detectors. I put a rolled-up towel in front of the door to block the light from the hallway. I wear earplugs. Actually, now that I’m taking stock, everything I do to try to get some sleep in a hotel is also an exact recipe for how to die successfully and obliviously in my room should the hotel I’m staying in catch fire. That’s a thought to help me drift off next time I hit the hay in a Radisson.
I know that the precautions that I have taken against insomnia have only served to acclimate me to an absurd ideal. I’ve made myself soft. If I really wanted to cure my sleeplessness, I would take away all these crutches and teach myself to fall asleep in a hot room, on a hard, lumpy mattress covered in prickly sheets, beneath an unshaded skylight—the exact state, in fact, of my childhood bedroom. Surely, the fact that I’m no longer a discontented preadolescent wearing a padded bra and a huge chip on her shoulder would militate against the discomfort. But, honestly, who really wants to find out?
Moreover, even before I began the microdose protocol, though I would generally fall asleep with little difficulty, I often popped awake at 4:00 a.m. Sometimes I think I should make regular 4:00 a.m. plans with my other perimenopausal friends. We could do something productive with our wakefulness, like play mah-jongg or renovate derelict apartments for homeless families, instead of tossing and turning on our sweat-soaked sheets, Googling the side effects of hormone patches and bio-identical hormone creams, and “accidentally” kicking our blissfully sleeping spouses.
Still, though I am staying up late and waking up early, I’m not feeling the effects of the resulting sleep deprivation as much as I would have expected. But even this concerns me. Needing less sleep can be a warning of the onset of hypomania. I should be tired, and if I’m not, that might itself be a problem. The prospect of the protocol’s causing either hypomania or a return to insomnia is really starting to worry me. And, of course, that worry is keeping me up at night.
* * *
*1 Erik J. Kaestner, John T. Wixted, and Sara C. Mednick, “Pharmacologically Increasing Sleep Spindles Enhances Recognition for Negative and High-Arousal Memories.”
*2 From World Health Organization Expert Committee on Drug Dependence (Twenty-eighth Report, 1993) definition of drug addiction. WHO Technical Report Series 836.
Day 12
Normal Day
Physical Sensations: None.
Mood: Fine.
Conflict: None.
Sleep: Perfectly fine.
Work: Productive.
Pain: Minor.
Today I decided to risk repetitive stress injury and work at a café. The café had free Wi-Fi, but I was halfway through my morning before I realized that I had not once bothered to go online. How strange. Who am I?
I am usually so addicted to the Internet that I can’t be productive unless I turn off my laptop’s Wi-Fi, and even then I keep my phone at the ready just in case of emergency. If, for example, the barista swirls the face of Jesus into the foam of my cappuccino, I need to able to get the photo up on Instagram right away, so pilgrims can attend before the bubbles dissolve.
But today hours passed before I even remembered that I had close at hand a means of escaping the responsibilities of work. Can this be the microdose? If so, it’s an unanticipated outcome. I experienced a similar phenomenon when my psychopharmacologist prescribed Ritalin, but that class of drugs made me anxious and irritable. (By “irritable” I mean that they made me scream obscenities at my husband, blare my horn at cars that I felt were lingering at stop signs, and fling various objects across the room.) But though today I was focused, I was not at all irritable. I felt calm and composed. Almost unnervingly so.
My highest hope for this experiment is that it will result in my experiencing more days like this. I have always been excitable, impulsive, and easily agitated. There is no quality I admire so much and possess so little as equanimity.
Is equanimity a characteristic of intelligence, or does it seem so because we associate rationality with intellect? Certainly, that isn’t true of brilliance. The genius of fantasy is often mercurial and tumultuous. “We of the craft are all crazy,” Lord Byron said. “Some are affected by gaiety, others by melancholy, but all are more or less touched.”
I came upon that quote years ago, when I was diagnosed with bipolar disorder. I read it in a book by Kay Redfield Jamison, a professor of psychiatry and an expert on manic-depressive illness, who is a fellow traveler. Her memoir An Unquiet Mind provided me with the comfort of shared experience, but it was her book Touched with Fire: Manic-Depressive Illness and the Artistic Temperament that I loved. In that book I learned that my diagnosis didn’t doom me to a life of somnambulant, drug-induced torpor alternating with ill-tempered irritability. Or at least not necessarily. All I needed to do was figure out how to harness my “heightened imaginative powers, intensified emotional responses, and increased energy” and I might, like Jamison herself, join the ranks of genius. Like the poets Robert Lowell and Anne Sexton, like Emile Zola and Virginia Woolf, like Georgia O’Keeffe and Jackson Pollock, I might be “touched with fire.”
Except that all too often Jamison’s geniuses were consumed by the fires they set. Moreover, my work, though more “serious” now than it was when I was writing books with titles like A Playdate with Death, is no Café Terrace on the Place du Forum or “She Walks in Beauty.” My talent, such as it is, does not merit the emotional price paid either by me or by the people I love. I can’t simply dismiss my lack of equanimity as a necessary evil, the flip side of creativity. I must try instead to find it.
About an hour northwest of where I live, nestled in a little glen in the hills of Marin, is the Green Gulch Farm Zen Center. I’ve driven by it
dozens of times on my way to the coast. Every Sunday, the Zen Center hosts a public meditation and dharma talk, a lesson in Buddhism, followed by lunch. Their mission is “to awaken in ourselves and the many people who come here the bodhisattva spirit, the spirit of kindness and realistic helpfulness.” Equanimity is one of the four core practices of Buddhism, along with Loving-Kindness, Compassion, and Sympathetic Joy. Buddhism teaches that you can intentionally create equanimity in your body by relaxing and letting sensations wash through you. You can create equanimity in your mind by letting go of negative judgments and treating yourself and others with loving acceptance. You learn how to do all this through meditation. My favorite.
My first experience with meditation occurred when I was pregnant with my second child and frazzled from caring for his older sister. I was lured to that class (and have been lured since to yoga classes, meditation circles, TM mantras, and mindfulness iPhone apps) by the promise of increased happiness, decreased pain, improved memory and cognitive function, and a longer, more satisfying life. I sat in a middle-school classroom that smelled of pencils and feet and, at the behest of the instructor, practiced imagining a lotus blooming above my head, dropping its petals one by one. This was in the early era of the Internet, when it was not so easy to search out photographs of things we’d never seen before, and it was years before I realized that my “lotus” was actually a chrysanthemum. Lotuses have eight petals, chrysanthemums 1,327. This might explain why I got so bored.
A Really Good Day Page 10