Inspired: chemical cure, chemical cosh

Sometimes provocative and always interesting, this series of shorter stories can be inspired by pretty much anything in Wellcome Collection and offers a quick insight into some of the themes we explore. This one comes from Rock Webb.

‘Bedlam: the asylum and beyond‘ has recently closed. Our exhibition tracing the rise and fall of the asylum contained an array of inspirational objects: JJ Beegan’s toilet roll sketches from the Adamson Collection; a Hogarth engraving; original scrolls of mental health related acts of law; and a number of references to the unique family care system in Geel, Belgium.

Thorazine advert as shown in ‘Bedlam: the asylum and beyond’.

However, I was drawn to this 1950s advert of a patient both before (monotone photo of cuffed man on the left) and after medication (colour image, peacefully at home on the right). I’m intrigued by the claims and somewhat disturbed by the imagery; I want to find out more.

Chemicals have been used in the relief of mental illness since the early post-medieval period. The 1950s, though, was the breakthrough decade for psychiatric drugs, in particular chlorpromazine which was followed by a whole suite of pharmaceutical treatments, such as lithium, thioridazine and paraldehyde. Many of these drugs had been developed for other medical uses, but were found to have a powerful sedative effect. Subsequently, use in asylums and mental hospitals became widespread.

Prolonged use became common and many patients were required to have daily medication. This was usually in syrup form, but also by injection (especially when an immediate sedation effect, or ‘cosh’, was required). Systematically treating people with behaviour-altering drugs also affected their personalities to the point of malleable compliance. While patients were no longer physically shackled or cuffed, they were restrained nonetheless, albeit chemically.

Advertisements for anti-psychotic drugs also failed to mention side effects. Patients under a chemical cosh could develop a sluggish drag when they walked, or near-constant dribbling from the mouth. Others suffered from locked joints or blurred vision. Hypersensitivity to sunlight was another by-product of continual and repetitive use, so much so that some users found it rather problematic to go outside.

It would be wrong to suggest that the use of such medication is wholly negative. Doctors and patients report successful relief from some of the pain associated with mental illness. Drugs can help prevent physical harm to sufferers and carers, and sleep is now a distinct reality for many who had previously struggled with it. Perhaps the most powerful argument is that many people can be free from institutionalisation; medication makes living at home a possibility.

So, should these drugs be consigned to history along with other so-called modern innovations, such as insulin comas, ice baths, electroshock treatment and lobotomies? Or should they be hailed as a liberator? Chemical cure or just chemical cosh?

Rock is a Visitor Experience Assistant.

Drugs: a dangerous spectre in sports

Earlier this year, students from the Young Journalists’ Academy Summer School, supported by a Wellcome Trust People Award, visited our Superhuman exhibition. Benjamin Gibbons is a sixth-form student studying at Tiffin School, Kingston, and a graduate of the summer school. Here he reports on his visit.

A haunting image of a man, broken and dying, slumped over his bike remains etched in my mind. The image comes from a flickering, black-and-white film which is in an alcove in the Welcome Trust’s Superhuman exhibition. It plays endlessly on loop, the man always dying, but never dead, kept alive as a grainy spectre to the fascination of the audience.

The film portrays Tommy Simpson, the British Tour-de-France cyclist who ‘rode himself to death’ in 1967 when the combination of the slopes of Mt Ventoux, the intense heat and the use of amphetamines allowed him push himself beyond what his body was capable of, resulting in his death. His death serves as a tragic and macabre symbol for the danger of drugs in sport, a theme which is itself explored in the exhibition.

It raises the question, ‘Where is the line to be drawn between beneficial aid and artificial enhancement?’ A question like this seems to be needed when it comes to almost every aspect of technical innovation, but perhaps that is the brilliant challenge which technology offers.

There are clear parallels between drug taking and altitude training: both endow performance-enhancing physiological benefits to the athlete: altitude training for an increase in red blood cell count, and drugs in a multitude of ways, too many to document here. Then there are sports drinks and gels; but gels and drinks do not change your being, they only give you a boost of extra energy. To that extent, they are natural. Then there are genetic advantages which could be considered as something to be handicapped. In this instance, however, that could lead to a ludicrous system of blame, excuse and little personal responsibility. The difference lies entirely in the natural benefits of the legal methods against the artificial nature of the benefits that drug use promotes. And this is a very important difference.

One of the fundamental benefits of sport is the way in which it promotes the body. An athlete has to push the boundaries of what he thinks he is capable of in his mind to coax the best performance out of his body, and that for many is the simple reason why sports – in particular, endurance sports – are so enthralling. When the best athletes in the world push themselves to the limit, it should serve as an inspiring model to the rest of society, especially as pampered as we are in the modern age of health-and-safety regulations and sedentary lifestyles.

The use of performance-enhancing drugs destroys this common ground between all people of all abilities, changing the focus from the extraordinary mental discipline of the athlete to the unnatural physicality that they represent. An athlete becomes something you sacrifice yourself to become, rather than something you elevate yourself to achieve. The beauty of sport lies in the human body: what we are capable of, and what we can achieve in ourselves. Drugs will always remain unneeded and unwelcome substances in sport.

Superhuman runs until 16 October.

Should we pass on the clever pills?

Capsules. Anna Tanczos/Wellcome Images

If we can drink coffee to improve our concentration, why not take cleverer drugs to make us cleverer? At our discussion event about cognitive enhancement in February, Lydia Harriss was on hand to consider some thorny issues.

Would you take a pill to help you pass an exam?

“Definitely not!” I hear at least some of you say, bristling with indignation at the mere suggestion. That would be cheating, like an athlete taking performance-enhancing drugs before a competition. But are there occasions when using cognitive-enhancing drugs – which improve mental functions such as memory, attention and information processing – would be acceptable, or even desirable? A lively discussion at ‘The Clever Pill’, in February’s series of events on neuroethics at Wellcome Collection, made me think that there might.

What if cognitive-enhancing drugs (let’s call them CEDs) could be used to restore cognitive function in people who have lost some of their mental ability through injury or illness? Arguing against their use on purely ethical grounds, I think, would be difficult. Cries of ‘unfair advantage’ would seem churlish if a drug had the potential to improve a person’s quality of life, particularly if it were compensating for the loss of an ability that they’d originally had.

How about non-therapeutic situations? Are there some professionals who we should allow to use CEDs under certain, tightly regulated, conditions? Panellist Dr James Rowe, Clinical Neurologist and Wellcome Trust Senior Research Fellow, suggested that surgeons working on nightshifts could be good candidates. Perhaps they should have the option of taking CEDs to improve their attention and judgement for emergency night-time operations, when patients’ lives depend on accuracy and clear thinking but surgeons are likely to be more tired. That could be a win–win situation: the patient benefits from an operation that is performed as well as it can be, and the surgeon is elevated to a level of heightened skill.

But would it really be that simple? It would be difficult to claim that surgeons would have an ‘unfair advantage’ in this scenario, given that patients would be the main beneficiaries. However, there are other, more sinister, potential consequences… can you hear those slithering noises? They’re coming from a shiny can labelled ‘side-effects’. I’m afraid to lift the lid, as I suspect there are way more worms in there than I can deal with, but let’s be brave and take a tiny peek.

Side-effects are always a consideration where drugs are concerned. Researchers can do clinical trials to investigate the effects of a drug over a few years, but it becomes much harder to look at how humans respond to it over decades or a lifetime. So, realistically, there’s probably always some possibility, no matter how remote, of a person having an unintended reaction to a drug.

When drugs are taken as medical treatment, the potential benefits (which are often substantial) can be weighed against the possibility of adverse side-effects. But is it fair to allow our hard-working surgeons, who are running themselves ragged trying to save lives, to accept the risks associated with CEDs if there’s no personal benefit to their own health?

We could leave it up to individual surgeons to make a personal decision (assuming that the CEDs in question have passed the efficacy and safety tests required for new drugs). Surely professionals should have the freedom to decide whether CEDs are a useful tool that can help them in their work?

However, there’s another possible consequence rearing out of the increasingly murky waters of this debate – coercion. If more and more surgeons take CEDs, it seems likely that some individuals who would otherwise not want to take them could feel compelled to, under the weight of social expectation or the fear of falling behind in their careers.

When the debate swivels around to the idea of making CEDs freely available to everyone, the issues become even more complex. Perhaps CEDs could help us to more fully achieve our potential? They could enable us to be more productive, creative and clever.

Panellist and Senior Research Fellow at the Oxford Martin School’s Institute for Science and Ethics, Dr Bennet Foddy, pointed out that a huge number of cognitive enhancers are already in wide use throughout society. They include caffeine, carbohydrate-rich food, exercise and sleep. He suggested that there isn’t a moral distinction between taking a drug and using an alternative form of cognitive enhancement.

That may be true, but it seems to me that most of these other alternatives are widely available. I could choose to go for a run after work to boost my mental processes. If I decide that I’d rather spend the evening crashed out on the couch watching TV, then I’ve chosen to miss out. But if a wonder pill did exist that could significantly boost mental performance, it would probably cost money, and that brings with it the prospect of inequality. Would we find ourselves with an even more profoundly divided society, with intellectual disadvantage compounding existing economic privations? Without a crystal ball, it’s difficult to tell, but I wasn’t the only person in the audience who thought that it might.

I was intrigued to hear Professor Simon Wessely, Professor of Psychological Medicine at King’s College London, give his views on currently available CEDs. It felt like a sharp reality check. He said that the cognitive-enhancing effects provided by today’s drugs are very modest, and that even the longest-lasting effects wear off within about 12 weeks.

According to Dr Rowe, research suggests that CEDs tend to have the greatest effect on people with a below average IQ or those who have a temporary loss of cognitive ability – for example, through tiredness. This could mean that some of the people most tempted to take enhancers, such as high-performing students under pressure to succeed, may be less likely to benefit from them. Dr Rowe seemed to succinctly sum up the situation when he said that the benefits from a good night’s sleep, social networking and exercise will outstrip those from any of the drugs currently available.

Significant and lasting cognitive enhancement through drugs seems to be well beyond the reach of current research. After hearing the knotty issues surrounding CEDs, I’m rather relieved to hear that we don’t have the ability to lever open this particular Pandora’s Box just yet. However, it’s clear that there’s much to consider if one day we do.

Lydia Harriss is a graduate trainee at the Wellcome Trust.

Drugs in Victorian Britain

An Opium-den in the East End of London. Wellcome Images

My interest in Victorian medicine started at university and peaked with my dissertation on opiates’ metamorphosis from remedy to public enemy. There is something rich and romantic about the Victorians and their drugs. The works of Thomas de Quincey, Arthur Conan Doyle and Charles Dickens all owe more than a little to potent drugs that were freely available in their time. But the 19th century pharmacopoeia was actually much more mundane: most of the populace were taking these newly-illegal drugs for the common complaints of cold, cough and toothache.

February’s Wellcome Collection symposium, Drugs in Victorian Britain, saw a range of speakers exploring aspects of the many common remedies taken throughout the 19th century, as well as the more exotic experimental drugs. There was the drug as inspiration, the drug as medicine and the drug as a menace.

The symposium opened with an evening of performance by The Magic Lantern, a fantastical show that echoed the psychedelic phantasmagoria, a Victorian pre-cursor to cinema. The creativity and imagination of the show was matched with great technological prowess. It was particularly fitting for the symposium: Thomas De Quincey, in his work Confessions of An Opium Eater, states that a philosopher who takes opium will experience a phantasmagoria of dreams.

The following day, five speakers were introduced by Mike Jay. Jay is the author and cultural historian who co-curated Wellcome Collection’s ‘High Society‘. He expressed relief that we are now beginning to have a ‘grown-up’ conversation about current illegal drugs, and said that the day would be a chance to look at how some of these drugs came into society. The 19th century was a crucial period of drug-taking development both in terms of potency and plurality. The Victorians took not just alcohol and opium but cannabis, coca, mescal, and with the invention of the hypodermic needle in the 1840s, morphine and heroin. The 19th century was also the origin of drug control, and the medicalisation of addiction to these substances.

The first speaker was Dinah Birch. She offered a look at what these drugs meant in the context of Victorian society. Victorians are often mocked for the prudery and restraint, but they seem to have been venturesome and even wild in their pursuit of altered mind states. What can explain this? Birch supposed that Victorian austerity was part of an inclination to sensation seeking. The high from success and the high of narcotics are partners in pleasure. She quoted Edmund Burke, who said, “under the pressure of the cares and sorrows of our mortal condition men have at all times called in some physical aid to their moral consolations.” Victorians were not unique in their interests but drug-taking was important to their culture, and the promotion of drugs by industry, particularly the still legal tobacco, tea, coffee and alcohol cemented this status in Victorian Britain.

Birch also talked about the development of a serious scientific culture towards the middle of the 19th century that led to self-experimentation with drugs. This topic was picked up by historian Dr Michael Neve. His readings of three separate accounts of drug experimentation by S. Weir Mitchell, Henry Havelock Ellis and Mark William James demonstrated an eagerness to understand more about the mind, the body, and the connection between altered states of the mind and something more spiritual. Experimentation and exploration led to enlightened thinking.

Next, Stuart Anderson, Associate Dean at the London School of Hygiene and Tropical Medicine, took us on a tour of the Victorian pharmacy. Most Victorians were poor and life was hard: drugs and medicines were vital. Chemists were available for free whereas doctors were not, and most Victorians got their drugs over the counter, without a prescription. The wide range of these drugs was intriguing. The Victorian chemist stocked not only patent and proprietary medicines, ready made, but nostrums made by himself and raw ingredients for home remedies. There was laudanum for dysentery, chlorodyne for coughs and cold, camphorated tincture of opium for asthma. Opium pills were coated in varnish for the working class, silver for the rich, and gold for the very rich. Angelic children frolicked on the bottles of Ayers Cherry Pectoral, a mixture of alcohol and opium that would now be deemed a poison. Coca leaf, from which cocaine is now obtained, was advertised as a nerve and muscle tonic, to “appease hunger and thirst” and to relieve sickness.

Anderson’s presentation was the most entertaining of the day. Delight rippled through the audience when he showed a slide of a small chemist’s shop in Nottingham with the name “J Boot”. Another laugh was raised when he announced that Pope Leo the 13th had awarded the cocaine-laced Mariani Wine a Vatican gold medal.

English lecturer Julian North was next and gave an overview overview of the influence of drugs on Victorian literature. She ranged from the obvious: Princess Puffer in Charles Dickens’s Edwin Drood and Arthur Conan Doyle’s Sherlock Holmes shooting up cocaine, to the more subtle. Although Charlotte Bronte never experimented with drugs, there are apparent influences of her brother’s opium addiction in her writing.

North highlighted an aspect of Victorian society that was touched on by Dinah Birch: division. On the outside, the Victorian is socially respectable, underneath they are bubbling away. This reverberates in their literature. It is most notable in the transformation of Robert Louis Stevenson’s Dr Jekyll into Mr Hyde. (Allegedly, Stevenson wrote the novel during a six day cocaine binge.) Bronte’s character Lucy Snow is outwardly mousey; inwardly passionate and imaginative. Jasper John from Edwin Drood is a choirmaster who visits opium dens. The unageing Dorian Grey is angelic and beautiful but locked away is his horrifying portrait. Thrill-seeking Sherlock Holmes says, “I abhor the dull routine of existence, I crave metal stimulation.”

It is no accident that drugs in Victorian culture are entwined with the emergence of detective literature. Opium and cocaine, like detection, held the power to trace back and uncover our darkest motives. Sometimes these drugs are portrayed as crimes, accomplices to murder. But they are also portrayed as a liberation, a fight against the boredom of respectability. Victorian writing anticipates our thoughts about what drugs can do to us.

Michael Neve’s exploration of personal drug narratives on mescal, peyote, nitrous oxide produce some wonderful quotes. “It is the most democratic of the plants which lead men to an artificial paradise” wrote Henry Havelock Ellis of mescal. A phrase like this is a far cry from the mundane use of laudanum for toothache. He wrote that under the influence of mescal, the world becomes sublime. And from the sublime to the ridiculous, Neve suggested that Havelock Ellis’s description of eating a biscuit during his experimentation led to the naming of satirical band Half Man Half Biscuit nearly 100 years later.

Historian Louise Foxcroft was the final speaker of the day. She asked, what is addiction? It has been recognized as a medical problem since the middle of the 19th century. But is it a sin, a crime, a vice or a disease?

The medicalisation of addiction came with the growth of the scientific profession and the medial market place. There was a growth of specialism and new terminology. First there was the inebriate, then the addict, later the morphinomaniac, who took his place between the neurotic and the melancholic. Christian evangelists regarded addiction as a sin linked to the story of Adam and Eve. George Beard, an American doctor, argued that addiction was an eminently treatable, heritable disease related to the quality of brain nerve tissue. Addicts were often treated brutally, with scalding baths, mustard plasters, and physical force, all applied with contempt. The addict himself was seen as the source of the problem and treated without looking at his environment.

Foxcroft noted that not a lot has changed on this topic. There is still question of what an addict is. And how do we treat them? Victorian morphine addicts were weaned off their “demon” with heroin. Now the substitute is methadone. Do we need to get away from the Victorian method of looking at the individual, and rather look at society?

The symposium ended with a round table discussion chaired by writer and critic Brian Dillon. Mephedrone reared its head. Michael Neve remarked that we saw a bit of the 19th century in the press treatment of “miaow miaow”, with the focus on individual stories of drug taking and little subjective analysis. We are at least moving away from the Victorian medicine cabinet to manufactured drugs, synthesized specifically for the needs and desires of our current lives.

The bottom line was that there is a very radical drive within human nature to find ways of transcending the mundane. Our current situation with illegal drugs here might seem the result of a very modern society, but our relationship with narcotic substances goes back a long way, to Victoria and beyond.

Louise Crane is a Picture Researcher at the Wellcome Library.

Lunch on drugs

Joint, by Marcos Fernandez, on Flickr

Packed Lunch returns soon with more tales of research from local scientists. To get you in the mood, we’re catching up with some of last year’s, via the Packed Lunch podcast. In December, Benjamin Thompson went along to hear from a scientist who comes round to your place when you’re getting high…

Subscribe via iTunes | Download mp3 | Podcast feed URL

This month’s Packed Lunch at the Wellcome Collection concentrated on the study of illegal drugs. The room was full to bursting, leaving many of the guests sitting on the floor. Whether they were there because the Collection’s excellent High Society exhibition had raised their intrigue in the illicit, or because they were active users of non-prescription medications, the talk raised a huge amount of questions and stimulated a high level of debate.

This month’s interviewee was Dr Celia Morgan, a research fellow in clinical psychopharmacology from UCL. Dr Morgan’s area of research focuses on both cannabis and ketamine.

With her recent cannabis studies, Morgan described an interesting approach to gathering data, very different to what I perceived most drug studies to be like. Rather than exclusively observing the effects of the narcotic in a lab based environment, she goes round to people’s houses to test them at home.

Volunteers are all students from UCL, who have been checked to ensure they have no family or personal history of psychosis, nor any serious head injuries in the past. Dr Morgan and colleagues visit the volunteers twice; on the first visit the team take a hair and urine sample, then ask the volunteer to skin up, get high, and undertake some cognitive tests. A sample of weed is also taken for analysis.

A week later the same volunteer is visited and the tests are repeated, except this time the subject is ‘straight’. Saliva samples are taken to ensure no drugs have been taken in the past few hours.

Why are the hair samples taken? It turns out that hair acts like the rings of a tree, keeping a record of all the drugs you’ve taken in the past. On average a person’s hair grows about 1 cm per month, so by taking a 3 cm length a record of all drugs ingested over the past 3 months is available. This can be more useful than asking the volunteers themselves to remember what they’ve taken, especially as the substances used can impair memory!

What about the weed samples? Why are they taken? Dr Morgan explained that these are tested to assess the levels of two active compounds: tetrahydrocannabinol, or THC, is the most well known and produces the ‘high’ associated with cannabis, but also assessed is the level of cannabidiol, or CBD, which appears to reduce anxiety at high doses and may act as an antipsychotic, counteracting the effects of THC.

Levels of CBD in cannabis are dropping, not due to consumer demand for more potent strains with higher levels of THC, but due to modern growing conditions – indoors, frequently under constant lighting in UK factories – which appear to be lowering the plants’ natural levels of CBD.

Too little CBD may lead to acute memory loss over time and an increase in levels of proneness to psychosis.

Dr Morgan’s other research is on ketamine, a substance developed as an anaesthetic in the 1960s. Ketamine is still used today, mainly due to its safety, as it doesn’t interfere with a patient’s breathing. However, the drug has several unpleasant/pleasant side effects, depending on how you look at it. Patients described vivid hallucinations after surgery, and because of this the drug became popular for recreational use.

Ketamine began being used in the UK during the rave scene in the 1990s, when it was frequently cut with ecstasy. At low doses the drug is a stimulant, whilst a mid-strength dose may cause the user to experience bodily distortions, with limbs feeling much longer or shorter than they really are. A high dose can result in the user becoming catatonic, known colloquially as a ‘k-hole’. There is no comedown associated with ketamine as there frequently is with other drugs.

So far this sounds interesting. Sadly, however, there are a number of dangerous downsides associated with the use of this drug. Ketamine is addictive, and Dr Morgan suggests that this may be due to its short action time. Heavy users may experience both mental and physical issues, including severe memory problems and the charmingly named ‘ketamine-associated ulcerative cystitis’. This irreversible condition is caused by the drug physically binding to the bladder, which can ultimately result in bladder removal.

Dr Morgan is interested in the drug as its use is becoming more popular in the UK, but little research has been undertaken on its mode of action and long term effects. She hopes the work on this drug, and that on cannabis, will help inform the public and hopefully drive future government drugs policy in an evidence based, rather than media frenzied, direction.

Benjamin Thompson is a writer at the Wellcome Trust.