Dex and Dope

Highly intelligent people often display a huge gift: the ability to rapidly and distantly free associate, connecting ideas to areas that are so far away that most people can't see the connections unless they are patiently taught. There are other aspects to intelligence, of course, but the ability to free associate over vast mental distances is one of the most obvious to the sensitive onlooker.

At the same time, the decontamination of genius by neurosis is one of the most challenging tasks that can present itself to a psychoanalyst.

With respect to myself, I find that Marinol, the synthetic but legal (and generic) version of marijuana (actually, of the tetrahydrocannabinol component only), intensifies free association, rather like deliberate downshifting and revving up for performance driving. Free association remains a principle tool of psychoanalysis (and of psychiatry in general, if that secret would be admitted, at least until a pill is discovered that cures neurosis). I keep a journal of the torrent of my thoughts, especially noting the free associations. In fact, the purpose of keeping the journal while in an inebriated state is to deliberately provide a mechanism to provoke and record free associations, but my story of how to do that safely is not safe for you to use as a model, my readers, so I must leave it out. Tinkering with free association can be dangerous if there are preexisting, serious unresolved mental problems differing from the otherwise "normal" victims of myeloma who must take dexamethasone. Whoever they are. Get a shrink first, especially if you haven't taken Marinol or street pot enough to recognize and fend off a bad trip. Say "psych consult" to your oncologist, who might prescribe Marinol but who is not structured or perhaps even trained to handle a seriously-bad reaction to its combination with dexamethasone.

If  any of you have tried Marinol or the much-improved street versions thereof, or simply observed someone else high as the space shuttle, you'll note the moments when, in addition to promoting free association, the drug also plays havoc with short-term memory — namely, when you hear this: what the hell was I thinking before I had this thought? It seemed important and I don't want to lose it, but I just don't remember. Help?

Normally, the FDA would write that problem down as a negative amnesia-like side-effect of Marinol as a medicine. But in this special case, negatives are positive.

This is because many or most of us who have to suffer through high-dose dexamethasone also experience obsessive thinking or exhibit frankly compulsive behaviors. High-dose dexamethasone can act as a trigger for these protective mechanisms. Patients who have minimal obsessive-compulsive tendencies may reveal them. Those who are borderline can turn pro. Psychotic breaks are not uncommon. Dex can do whatever it wants. If you are a Borderline Personality Disorder, it probably will do something entirely different to you.

Nurse Ratched

Think of Marinol as a poor-man's electro-convulsive therapy (ECT). The FDA-assumed negative side-effect is what we want from it — a breaking up of the train of thought, and especially the location of the jumping-off place. It is difficult to obsess,  or, for that matter, to descend into fear or run madly around with elation when one finds oneself in an instant thinking of something else entirely, like how magnificent these cookies taste! I hope there's another box!

So I manage to maintain a more-or-less even keel on high-dose dex days by taking Marinol and dex at the same time as early in the morning as I can muster. I've been countering 20mg dex with 2.5mg Marinol, and 40mg dex with 5.0mg Marinol. Its use has made the days easier for me to bear and the nights easier to sleep through (I suspect that, for me, obsessing at night causes my sleeplessness with dex).

By the way, I find Seroquel to also be a poor-man's ECT if taken two-or-three hours before time of sleep. In the morning, I have trouble remembering what upset me the day before (incurable, universally-fatal cancer...was that it?). The problem is that Seroquel does a whole lot of other things, like leaving a hangover-like effect lasting into the next day, even though we myelomiacs generally take a very very small dose of a very very big drug.

Of course, I never drive on dex days, so the issue of driving while on dex/tetrahydrocannabinol never comes up.

Another thing to watch out for, and for which Marinol has a use, is the mind's natural ability to ignore or shut out physical pain. I'm no expert on evolution, but I suspect that the ability to ignore pain or simply not feel it when function is critical is a necessary component of survival in battle or in flight from battle. (There's a big difference between ignoring it and not feeling it in the first place. The first requires will power, the second is autonomic. I'm not sure I believe in the first.) The trouble is, it takes a lot of hormones and obsessive not-thinking (it's the same, just invert and call it repression) to protect us from the neuropathic and bone pains from which we myelomiacs generally and genuinely suffer.

Marinol's ECT-like effect may also make one aware of the physical pain from which one has been dissociating. In other words, you may suddenly realize that you are heavily in pain and exhausted from the effort of not feeling it, possibly becoming aware of it after a freely-associative jump. Dissociation is, to me, a kind of repression. Once connected with the pain, it is as if free-association led there, because, at a deep level, the system is in an unconscious emergency mode of operation. The tool for treating repressed thoughts (which is what free association is) produces results similar to the goal of treatment of dissociative reactions (such as not feeling physical pain) — by whatever means, one becomes aware of what is not being thought about or sensed. It must be emphasized that what is not being thought about or sensed is not small, but is generally overwhelming (as it must be to be able to initiate the protective mechanisms I've been discussing).

Marinol may help you get there, and getting there is important to do. It's important to turn off the flight-or-fight like response and feel the pain, regardless of type, in order to be kind to yourself, relax, and sleep. You may suddenly be overwhelmed with an awareness of how tired you are. Luxuriate in that tiredness. It is difficult to bring to consciousness either repressed thoughts (e.g., incurable cancer) or unsensed pain because both are primary survival mechanisms inappropriately — because of dex triggering and amplification — drawing away a huge amount of psychic and muscle power. Burning you out.

If you can feel the physical pain, then you know to take your Vicodin. If you think of what you were trying so hard not to think of, well, think of it now as hard as you possibly can. If it's scary, which is highly likely, surrender to the fear, at least for the time being — don't fight it off. Then try Xanax or Seroquel or whatever else your shrink prescribes for relief if the psychic pain doesn't lessen enough to let you sleep.

Freeing your mind (of psychic pain) or your body (of physical pain) by using medicines like Vicodin and Xanax is by far the healthier option for us, even at the price of a degree of conscious but temporary suffering. The suffering is temporary because the trigger of repression is really not all that good at making fine distinctions between concrete, immediate dangers and future possibilities as amplified by dex. Once what is feared is seen not to be immediate, the defense can switch off and the whole can recover.