Meditation on drugs

Recently a couple of friends admitted something to me.  They both asked me not to judge them, and then sheepishly told me they were taking antidepressants.  On both occasions I looked back at them and said, 'Me too'.

In fact, I've been taking them, off and on, for about a decade, ever since I began having chronic pain.  After trying a number of different drugs, I was prescribed amitriptyline.  It was easily the most helpful medication I'd been offered, and I've stuck with it.

Amitriptyline is an one of a family of older-generation drugs called tricyclic antidepressants.  It affects the levels of both serotonin and norepinephrine in the brain, unlike the newer SSRIs, which more precisely target the reuptake of serotonin.

Nowadays it's very commonly prescribed for chronic pain, usually at a lower dosage than is indicated for depression.  I started off taking 20mg a day in England, which helped me finish my first degree but left me in considerable pain. 

In my first three years in California (with the help of more liberal doctors) I was on 100mg a day.  I had periods when I was pain free, and though I did feel the side-effects (drowsiness and dry mouth) more strongly, I felt that the drug would never do me any harm.

That all changed one winter when I started taking 150mg a day because of some extra pain deriving from some dental surgery.  I began feeling very depressed, and noticed that I was twitching, itching, and sweating profusely all the time. 

I didn't know it, but those were the symptoms of 'serotonitis', an overdose of serotonin.  When I realized, I went cold-turkey, which immeditately made me feel better but which brought the same symptoms on in a more intense form.  I remember sitting in the Castro Theater one night in that period, sweating and itching and twitching, watching some noir classic in a strange euphoria of relief.

After that I was more cautious.  In the last few years I've gone off the drug completely a few times, only to go back on it again.  In some ways being off it isn't that different; I feel the pain much of the time in both states, but it feels more distant and manageable when I'm on the drug (and sometimes it's completely absent). 

Both of my friends who talked to me about antidepressants had spiritual or religious doubts about taking them, so I thought I might raise the issue here.  Are antidepressants antagonistic to a spiritual practice, or complementary? 

I can't answer the question definitively, partly because there are a lot of different drugs and practices out there.  But I have looked into this a bit online, and it might seem at first as if meditation and antidepressants are doing more or less the same thing, since they both raise levels of serotonin in the brain.

This is actually more complicated than it seems, though.  One recent Norwegian study (with only 27 subjects) suggested that regular meditators had higher levels of serotonin than non-meditators, but that meditation itself seemed to reduce the level of serotonin in their blood. 

An older Harvard study appeared to show that people who meditated produced the same amount of norepinephrine (a 'fight or flight' drug), but that it had ceased to trigger an emergency response in meditators. 

So the scientific evidence on this appears complex, and I'm not particularly well-qualified to assess it.  Looking at this from a traditional Buddhist angle also raises some hard questions, such as whether antidepressants should be discouraged as intoxicants, or encouraged as pain-reducing medicines.

I'm not sure that I have much to add from than angle, either.  But I can say a bit more about my own experiences of meditation and one kind of antidepressant, in the hope that it may be useful to other people who are in a similar situation.

I've practised meditation through the whole period I've been on amitriptyline, usually for twenty minutes a day, though occasionally less (and very occasionally more) than that.  Of course all I can do is tell you what it felt like to me (which may not be unimportant).

I think that meditation without the drug is more challenging.  My mind is more anxious and I'm distracted by pain more.  On the other hand, it's also more rewarding, since the difference between my state of mind before and after sitting is more dramatic.

When I'm on a lot of the drug, meditation is often very pleasant.  I breathe in, I breathe in, and it all flows along very pleasantly.  But in some way it feels more superficial.  I feel like things have gone more smoothly but that I have gained less insight about myself and my condition.

Ultimately, the plan is to go off the drugs.  The plan (often revised) usually involves doing more and more meditation as I slowly come off it.  Unfortunately, I've been too busy lately to commit to longer retreats of the kind I had in mind, so full implementation of the plan will have to wait a bit longer.

In the meantime, I try not to beat myself up about it.  Some people take insulin for diabetes.  Other take statins for high cholesterol.  I take amitriptyline for chronic pain.  I also meditate, which is cheaper and doesn't make my mouth dry.  In other ways they're just two different things that help. 

Pain killers

A small friendly man with glasses slipped two white pills into my hands.  I closed them over the pills and bowed to him.  This was Day 2 of my second sesshin - meditation intensive - at the San Francisco Zen Center, and the small friendly man in glasses was Roger, who'd been my work-partner earlier in the day when we'd been assigned to sweeping the steps outside the temple.  He'd said that he'd noticed I was struggling in the meditation hall, and indeed I was.  I'd been sitting cross-legged left foot over right, then right foot over left, then kneeling with a cushion, then kneeling with a bench.  I'd had pain in my legs and lower back as well as in my head and neck, which is where I usually have it.  As we were sweeping the few leaves that had blown up the entrance steps onto Page Street, Roger offered to get me some Ibuprofen from his room upstairs.  'It really helps', he beamed.

And indeed it did.  That was the first sesshin I've made it through from beginning to end, probably because it was unusually only three days long.  I'd stayed up at retreats for longer periods - five days in the case of one Pacific Zen Center sesshin - but I'd always missed either the opening or the closing ceremony.  In the closing ceremony of this Spring sesshin, we all sat kneeling in rows with the two teachers - Wendy Lewis and Rosalie Curtis - sitting on chairs in front of us.  We passed trays with nuts and dried fruit on them to each other along the row, bowing every now and then to say thanks.  The people I'd just spent three days in silence with began to open up, producing accents I'd never expected to have to match with those particular faces.  The Senior Dharma Teacher said, 'There's always a first sesshin, and only one'.  I nervously offered my several failed attempts as counter-examples and said I was feeling pretty proud of myself just for still being there.

The last time I'd spent three days at SFZC had been during a seven-day intensive.  I'd signed up for five days and made it through three, dropping out because the pain in my legs and back had started to keep me awake at night.  This time everything felt less strange and less painful.  The constant bowing I took in my stride, which bothered me in some way because I hadn't changed my intellectual objection to it; only my attitude had somehow shifted nonetheless.   I genuinely enjoyed the ritualized oryoki eating, and this time not only the part when people in robes run down the meditation hall sliding a wet cloth along the wooden beams which separate the meditation mats from the floor.  I was even able to see the fun in the 'random reading' of the Diamond Sutra: everyone was handed a translation and asked to read from whatever point of the text they wanted.  Holy hubbub ensued.  And I made it through the three days with pain, but without feeling that the pain was taking over me.

Why did I go back after the first retreat, when I'd decided that SFZC's stern style didn't appeal to me?  I was about to move out of my room in the Lower Haight after nine months there, and I sensed I'd never again live within a stone's throw from a Buddhist temple.  I wasn't feeling rich (not that I ever am), and I knew that I'd be able to cut costs by sleeping at my place and making the five-minute walk to the temple for the early-morning starts.  And I'd been reassured by Victoria Austin's comments about SFZC's commitment to oversight and transparency during my interview with her.  This time around, the atmosphere was pretty much the same, and all the things I took a dislike to - the excessive and pervasive formality, the arid dogmatism, the grim-facedness of it all - were, unsurprisingly, still there.  Rosalie Curtis used her dharma talk partly to insist that things which beginners found rebarbative they would eventually uncritically accept.  I agree, but is that really a good thing?

Wendy Lewis' talk was better.  It was at least clear, well-prepared, and gamely delivered.  She is also knowledgeable, with an MA in Religious Studies from SF State, and her sermon certainly had something of the academy about it.  (She described Buddhism at one point as 'a non-theistic soteriological tradition'.)  The sesshin was also kept ticking along with military precision by David Haye, who would make a fine army officer if he ever wanted to trade compassion in for shooting people.  I ended my second intensive at SFZC again feeling pretty sure that this particularly faithful rendering of Japanese Zen wasn't for me, but all the same recognizing that the temple is a unique place in the West and one that I've been lucky to be involved with.  I don't know if I'll be back.  As for Roger, he sold his highly successful café on Potrero Hill and has moved in as a monk full-time; he's traded in lattes for Ibuprofen, and I wish him and his co-residents as pain-free an existence as there can be.

Brave yellow hay

Old-time (13th century) Zen master Dogen said that studying the way is about studying the self, so here's more about me (not the real me; the pseudonymous one I'm more sure about).  Seeing that he's a fictional character, it's not all that surprising that there's no good picture of Mr. Propter out there on the internet, so I had to make do with one of Aldous Huxley for my blogger's profile instead.  When I introduced Mr. Propter a few weeks ago, the introduction amounted to a summary of some of the central ideas in After Many a Summer Dies the Swan (to give the longer title of the US editions of the book).  There Huxley comes across as rather straightforwardly as a proponent of a certain kind of social and political detachment, and more centrally of a particularly uninstitutionalized form of religious experience.  He is, to put it more simply, a mystic, or at least an admirer of mystics.  But if you read some of Huxley's other novels you come away with a quite different impression.

At first sight, Huxley's novelistic career presents a rather unusual development, progressing from the light-hearted yet mordant satires of the 1920s, to the spiritual and psychedelic utopianism of his final novel Island.  The strangeness of writer's artistic trajectory is mirrored by what seems an unusual course through life for Huxley the man.  Scion of a distinguished intellectual family - Matthew Arnold the poet and critic was his grandfather, and Thomas Henry Huxley ('Darwin's pit-bull') his great uncle - Huxley received the conventional education of an English gentleman, attending Eton College and Balliol College, Oxford.  By the end of his life, Huxley had relocated to California and transformed himself into a disciple of the neo-Hindu mystic Prabhavananda and an enthusiastic advocate of New Age causes.  The Doors of Perception, his report on his experiments with mescaline, published in 1954, went on to become one of the literary touchstones of the counter-culture of the 1960s.

Once you scratch the surface, though, and read through a few of Huxley's novels, this bewildering career begins to take the form of an understandable enough progression.  It is true that the early novels are taken up almost entirely with the witty but ultimately meaningless chatter of the English upper-classes, and that the rather perfunctory episodes that punctuate their dialogue are chiefly calculated to expose the hypocrisy and moral emptiness of that particular slice of social life.  In a characteristically inconsequential tale-within-a-tale embedded in Huxley's début, Crome Yellow, published in 1921 and set in an aristocratic country-house, a naive young suitor makes the acquaintance of three ethereally spiritual sisters, who declare their distate for the 'coarse' activity of eating.  Later, he unintentionally comes across them feasting surreptiously in a hidden chamber, their hands clutching chicken-drumsticks to their mouths.

And yet it is possible to discern something else beneath the impeccably witty surface of these early books.  What that something else is precisely is difficult to tell, but it's unmistakably present.  Mr. Gumbril, the hapless anti-hero of Huxley's 1923 follow-up Antic Hay, in a rare break from galivating around fashionable London, reflects that there's 'a quiet...in spite of everythng, at the back of everything.  Lying awake at night, sometimes - not restlessly, but serenely, waiting for sleep - the quiet re-establishes itself, piece by piece...The quiet grows and grows.  Beautifully and unbearably.  And at last you are conscious of something approaching; it is almost a faint sound of footsteps.  Something inexpressibly lovely and wonderful advances...Nearer, nearer come the steps; but one can't face the advancing thing.  One daren't.  It's too terrifying, it's too painful to die.  Quickly, before it is too late, start the factory wheels, bang the drum, blow up the saxophone.  Think of the women you'd like to sleep with, the schemes for making money, the gossip about your friends...'

There are similar moments in Brave New World, Huxley's 1932 vision of a scientific future which has rather surprisingly proven to be by far his most enduring work.  The world of the novel is both utopian and dystopian.  All sources of pain and discomfort have been removed by scientific progress and the systematic application of reason; and if anything does go wrong, citizens can have recourse to soma, a kind of souped-up valium that acts as a panacaea for mental anguish.  But precisely because of this, life has lost all meaning.  A hint of where that meaning might still be looked for comes when Mustapha Mond, the Contoller, decides to suppress a new book because its ideas might lead people to 'lose their faith in happiness as the Sovereign Good and take to believing, instead, that the goal was somewhere beyond, somewhere outside the present human sphere; that the purpose of life was not the maintenance of well-being, but some intensification and refining of consciousness'.  And as the Controller concluded, this was quite possibly true, 'but not, in the present circumstance, admissable.' 

Huxley's denigration of chemically assisted happiness in Brave New World sits rather uneasily with his later eager adoption of drugs as shortcuts to spiritual experience.  And for those inspired by Mr. Propter's advocacy of an autonomy grounded in meditative practice, Huxley's later championing of the psychedelic cause can seem something of a disappointment.  As late as 1952, in his non-fiction work The Devils of Loudun, Huxley explained that there were two paths for those seeking to transcend the dissatisfactions of the ordinary self:  downward transcendence, sought for in alcohol, which provided some refuge, but at the cost of the obliteration of all consciousness; and upward transcendence, which offered an escape from the mundane while preserving, and even enhancing, clarity of thought.  Huxley died in 1963, too early to witness the discrediting of psychotorpic drugs as a toll-free highway to higher consciousness.  But the quiet lurking below the chatter of his earlier novels can still remind us to listen out, every once in a while, for footsteps.