Friday, April 24, 2009

How I (almost) became Superman

This week's big piece in The New Yorker is headlined "Brain Gain" and carries the subhead "The underground world of 'neuroenhancing' drugs." Glancing through it reminds me of an incident early in my cancer career. More on that soon, after a little context.

The piece sets up underground neuroenhancement roughly as follows:
Adderall, a stimulant composed of mixed amphetamine salts, is commonly prescribed for children and adults who have been given a diagnosis of attention-deficit hyperactivity disorder. But in recent years Adderall and Ritalin, another stimulant, have been adopted as cognitive enhancers: drugs that high-functioning, overcommitted people take to become higher-functioning and more overcommitted.
You've probably seen a headline or two along these lines ("Valedictorian admits to prescription drug abuse") or seen a reference or three in movies. The use and abuse of drugs like Ritalin and Adderall among people without ADHD has generated more frequent news stories over the past few years. Less well known, though, is that some psychiatrists use the drugs to treat cancer-related fatigue and other problems. My former psychiatrist, a gnomish man with heavy-framed glasses and a taste for fine dining, is one of them.

Was I tired? Well, yes.
Did I have any drug or alcohol problems? No.
Blood pressure OK? Sure.

After a battery of questions lasting a few minutes, I left the office with a script for dextroamphetamine (an agent highly similar to the active ingredient in Adderall, with very little practical resemblance to methamphetamine) and a paean to the drug ringing in his ears. His patients loved it. Almost all of them said it helped them. They felt sharper, more energetic. Getting through the day was much easier. Addiction wasn't a problem -- you just tapered off. Likewise, as you developed a tolerance, you took more drug to achieve similar effects.

Before I took the drug, I looked it up. That's when I started to get really excited, or as excited as I could get in those woozy, muffled, cotton-candy days of chemotherapy-by-vein.

I read, and as I did, I imagined myself happier, livelier, more social, better in conversation, sharper, smarter, more focused; I imagined myself becoming a sort of a Me 2.0, a bug-checked improved iteration supercharged by some harmless little pills. Before I filled the prescription, I began referring to the drug fondly as "dex," as the gnomish psychiatrist did. I found paragraphs on the Internet elaborating on my future cognitive greatness and social prowess and read them to L., jokingly hinting that she might have to step it up. I was mostly playing it for laughs, of course, but the idea of being smarter and more focused held almost elemental attraction for me, an attraction more compelling even than solving the immediate problem of loosening the crushing weight of fatigue that made routine daily tasks seem almost impossible.

Needless to say, I filled the prescription posthaste, and here the story gets anticlimactic. I took my pills faithfully at the low initial dose the doctor suggested and felt nothing. As he recommended, I titrated the dosage upward slightly. For a while, still nothing. Then my heart rate began steadily increasing. A new sort of shrillness entered my mind and body, an unpleasant sense of acceleration that felt like a cousin to panic. The shrillness made me feel edgy, the edginess made me more conscious of my ever-rising heartbeat, and soon I felt like I had a huge, resonant bongo thumping away under my ribs.

Genius, however, remained elusive. I was still distractible. I was still tired (though now I struggled to sleep over the din of my new side effects). I received no reports of being more amusing or incisive. So I quit.

The funny thing is, though, is that every time I read or see a story like The New Yorker's, the idea of short-cutting myself to a better brain and more accomplishments still appeals to me, even though my experience with cognitive enhancement was miserable. So, yeah. As the piece says somewhere, it looks like "cosmetic neurology is here to stay."

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