- How I Joined the Secret SSRI Circles of 1985 - September 14, 2021
- A Nurse’s Call for Keeping the Human in Psychedelic-Assisted Therapy - October 29, 2020
I had heard about this stuff from a friend of a friend. “Ricky,” my buddy told me, “some big deal psychiatry researcher out at a university in Illinois has been studying this new drug, fluoxetine.”
I can’t even pronounce it, but I don’t really care. I’m just so sick of the meds that Dr. Woodchester keeps trying out on me for my moods, or what he keeps calling my “intrapsychic conflicts,” whatever those are…
But I guess he’s a doctor too, so he keeps trying out pills on me. Imipramine, desipramine, nortriptyline… none of them really work. They’re all awful in their own way.
I mean, we mostly spend the weekly meeting talking about how much more terrible I feel since the last time I saw him. He’s a psychiatrist, so I guess I’m supposed to tell him this stuff, even if it seems to have nothing to do with what’s on my mind right now. But I guess he’s a doctor too, so he keeps trying out pills on me. Imipramine, desipramine, nortriptyline… none of them really work. They’re all awful in their own way. They all seem to be really good at drying out my mouth. My dentist is pleased as punch about that. He says the dry mouth is why I’ve had so many cavities in the last couple of years.
The imipramine was a real joy… couldn’t shit for days. And let’s not get started on the clomipramine… I mean who really cares about orgasms, anyways? It’s not like I even want to fuck anymore, because that of course, would take energy. Good old dick, I mean Doc Woodpecker, suggested that I might try some old antidepressant that would mean I couldn’t drink red wine or eat cheese unless I wanted to risk a stroke. As tempting as it might be to take myself out with a ruptured blood vessel in my brain, I think I’d rather stick with the few pleasures I have of a good quattro formagio pizza and a glass of Chianti from that place down off West Broadway, even if ever since I started taking these stupid meds, everything I eat seems to stick to my belly.
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The depression got worse right after Reagan got reelected. I mean, I really didn’t think Mondale had a chance, but the idea of living with another four years of “Mourning in America” really makes me feel sick in my gut. I was starting to think about taking that flying leap in front of the uptown train at Canal Street when I heard about these secret circles.
This fluoxetine stuff isn’t even legal yet, but this guy who knows the guy in Illinois says that it will be in the next few years if the feds think the research is good enough.
This fluoxetine stuff isn’t even legal yet, but this guy who knows the guy in Illinois says that it will be in the next few years if the feds think the research is good enough. He says it works even better than the stuff they have now and, for some reason, it doesn’t make you all fat, constipated, and sleepy. A couple of guys in the circle even fired their analysts after they started to take it for a few weeks. They said they just didn’t see the point of going to talk about their problems to some Upper West Side shrink three days a week, and they now spend the money they save on coke and partying with the ladies. I mean, don’t get me wrong, I like Woodchester just fine, but I really don’t know why he’s so obsessed with my mother.
In order to get the address for the first circle, I had to wait until I got paged, then called the number and some lady told me to go to an address in Hell’s Kitchen. Hell’s Kitchen!? You don’t go to Hell’s Kitchen unless you’re looking to pick up either a bullet or a venereal disease, but I was desperate, so I took the cab as close he would take me.
In order to get the address for the first circle, I had to wait until I got paged, then called the number and some lady told me to go to an address in Hell’s Kitchen. Hell’s Kitchen!? You don’t go to Hell’s Kitchen unless you’re looking to pick up either a bullet or a venereal disease, but I was desperate, so I took the cab as close he would take me. He said he doesn’t go west of Seventh Ave., so I walked the last three blocks, looking over my shoulder to be sure I wasn’t being followed by muggers. Crime has been terrible in the city and just adds to the general sense of tension. I don’t think cops even come to this part of Manhattan anymore. While I don’t approve what Bernie Goetz did, I get it. I’m not even in any kind of shape to run away, let alone fight anyone off, given how shitty and sluggish I felt since the last med change. On this new drug, trazodone, I can hardly keep my eyes open.
After stepping around a couple of rats who were squabbling with each other on the sidewalk, I came to the door in the side of a warehouse near 10th and West 52nd Street. “What the hell am I doing here?” I thought to myself, as I looked at the graffiti-marked metal door. “Oh, yeah, I answered to myself, I’m interested in not loathing myself so much.”
I knocked on the door and, when the eye slit opened up, I said the code word “Donald Klein,” whoeveadafuck he was. The guy, now satisfied, opened the door and let me into a large room with a bunch of people who you would not expect to find in Hell’s Kitchen sitting around on folding chairs in a circle. It looked like some kind of AA meeting.
“Sit down,” the guy who opened the door, told me. “We’re ready to get started.” I caught a quick glimpse of the other people in the room. They seemed like people you’d see on an uptown A Train: a stockbroker type with his attaché case and three-piece suit; a lady who could have been a professor at Columbia, even a young guy who looked like he might have been studying in a Yeshiva.
A guy in a turtleneck and a corduroy blazer addressed the group. “OK, listen up. I’m glad you found us. The first thing you’re going to need to remember, is that you don’t know where this place is. Riiiiight???”
It took a couple seconds before we realized we were supposed to respond. I didn’t know about these other people, but my brain does not fire at its usual pace when it’s on all these medications. “Right,” we muttered asynchronously and without the prosody of the turtlenecked guy who had proposed the question.
“So, here’s how this is going to work. You’re going to need to come here every three days to pick up your pill. You will have to take it here. We can’t have this stuff floating around in the world. We don’t think it’s illegal, but it’s not legal, either. It’s kind of… a gray matter,” he said, smiling at his own joke. “The guy who makes it says it stays in the body for a long time so you don’t have to take it every day.”
The first thing is that you can’t tell your regular shrink that you’re seeing us. They don’t have access to this stuff, and if they heard about it, they might tell the feds, and they could trace it back to the lab. If that happened, then no one is getting any more of this stuff. I’m serious. Do you all understand?
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The dork in the turtleneck and glasses continued, “Now, we’re not looking for any money here. We feel called to the medicine and to help others, so you don’t have to pay us. But we do need you to do a few things for us. The first thing is that you can’t tell your regular shrink that you’re seeing us. They don’t have access to this stuff, and if they heard about it, they might tell the feds, and they could trace it back to the lab. If that happened, then no one is getting any more of this stuff. I’m serious. Do you all understand?” While he looked like someone my analyst might go out for a drink with at some psychoanalytic conference (what do shrinks drink, anyways? Martinis? Old Fashioneds? I wondered, snapping myself out of my distraction), there was a trace of Queens in his voice. Who was this guy, and why was he doing this?
“Now, do any of you have any questions?”
The Columbia lady sheepishly raised her hand. “I do,” she said, her voice barely above a whisper.
“Ok, go ahead,” said Bespeckled Turtleneck.
“What is this going to make me feel like? I’ve taken all the other medications out there—imipramine, clomipramine, doxepin—and all they do is make me feel slow, sleepy, and dumb. What will Fluoxetine make me feel?”
Turtleneck looked at the powerfully built man who had let us into the room. “Wanna tell ‘em, Rocco?”
“Better than well,” Rocco answered in a compact staccato. “I used to spend all day being what my psychiatrist called ‘neurotic,” he continued, “now, I just don’t give a damn.” He punctuated his words with a shrug of his broad shoulders and a sly smirk.
this stuff here?” he said, gripping the green-and-white capsule between his thumb and forefinger and holding it to the sky as if it were an offering to the gods, “corrects the imbalance.”
“That’s right,” said the Turtleneck Guy, “Better than well. The chemists think this is going to put psychoanalysis out of business. Greedy bastards, it would serve them right. Sitting on their duff all day, getting paid to listen to people kvetch. You see, the guys who sneak this stuff out of the lab in their lunchboxes say that the company that makes this stuff seems to think that depression is actually caused, not by your mother, but by a chemical imbalance. And this stuff here?” he said, gripping the green-and-white capsule between his thumb and forefinger and holding it to the sky as if it were an offering to the gods, “corrects the imbalance.”
I was not the only one who let out a little gasp at the sheer wonder of this possibility.
“But waidaseccond,” Three-Piece-Suit suddenly interrupted. “If this stuff is so powerful, is there any risk that it could make you, you know, psychotic?”
“Good question,” replied the guy in the turtleneck. “You know how, in places like Bellevue, they use antipsychotics like Thorazine? Well, they think that this stuff is gonna be referred to as an antineurotic! Now, we’ll just have to see if it fixes Woody Allen!”
There was the soft murmur of laughter that emerges from a group of depressed people, but everyone kept looking at the ground.
“Now,” said the therapist guy, “let’s all take our pills and leave here one at a time. Don’t loiter, don’t talk to each other when you leave here, don’t talk to anyone else, and I’ll see you back here on Wednesday. Capeesh?” With a nod of our head, Rocco passed each of us a little paper cup containing a single pill, dull-green and white, like an uncut emerald. With the other hand, he gave us a cup of water. We swallowed the pill, dropped the cups in a rusty tin wastebasket, and left, one at a time, as we had been instructed.
And that is how I joined the secret SSRI circle of New York City in 1986.
~~~~~~~~~~~~~~~~~~~~~~~~~
The story is, of course, fictional. I don’t think there were clandestine gatherings of antidepressant medicine circles in the 80s or fluoxetine being snuck out of the Eli Lilly laboratories. But, if SSRIs were as hyped as psychedelics are now, perhaps there would have been. I can’t remember a time when a treatment was so anticipated as psychedelics are at this moment. What fascinates me is that this never-before-seen excitement is for drugs in clinical trials that are still at least 2–5 years away from legal availability.
Setting aside their longstanding use in Indigenous culture, arguably, the medicalization of psychedelics is not a new phenomenon, but rather a return to a practice that was present (recall that LSD was made by a pharmaceutical company, Sandoz, and explored as a treatment for substance use disorders and “neuroticism”) before their sequestration to schedule 1 of the Controlled Substance Act in 1970. In addition, the constant media buzz (what some have called “The Pollan Effect”) has added to the clamor for these medicines before they have completed the ongoing clinical trials to become FDA-approved medicines. People are not waiting for the FDA; they are going overseas where these compounds are legal, or they are going underground where practitioners who risk their own liberty provide treatment with these currently illegal substances.
In writing this piece of fiction, I read Peter Kramer’s landmark text, “Listening to Prozac.” Written in 1993, just five years after the approval of Prozac (fluoxetine), Kramer reflects on the SSRI revolution in psychopharmacology; its relative safety (compared to the lethal toxicity of a tricyclic antidepressant overdose) and tolerability (it was devoid of the anticholinergic side effects of its predecessors, complained about by the characters in this story), made it ubiquitous. When it became widely prescribed, it became a well-known cultural trope, a kind of Huxleyan Soma. But what really made Prozac a phenomenon was not its safety or lack of side effects; it was the promise of relief and change that it brought about. Kramer overestimated the power of Prozac to change our unwanted character traits and irritating neuroses (something he disparaged as “cosmetic psychopharmacology”), but I see some of the same claims for widespread relief being made for psychedelics now, leading some to not wait until these drugs become legally available, instead seeking out treatment from the underground.
Of interest, Kramer later withdrew some of his critiques of Prozac in his later book, “Against Depression” (2005), in which he acknowledged something that is well known to its sufferers: depression is real, and should be treated to alleviate suffering. In it, he acknowledges that SSRIs, like most treatments in psychiatry, do not live up to their initial hype when they become more widely available. Why is this? Perhaps, once in practice, the treatments are given to more complex, sicker people than in clinical trials, people that have multiple comorbidities that prevent the drugs from working as well as they did for cherry picked subjects in a clinical trial. Perhaps the difficulty in accessing a treatment before it is widely available amplifies the hope embedded in every treatment (what we sometimes call part of the “placebo effect”). Perhaps it is only human to imagine that the next thing will work better than what we have now. But regardless, once the treatment is available, early hopes tend to fade, and the once shiny new bauble in the medicine kit becomes just another tool to use in the slow, steady slog against mental illness. Will the same be true for psychedelics? Only time will tell.
Art by Trey Brasher.
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