Without His Minding

I

On 19 January 1952, at ten in the morning, at the Val-de-Grâce military hospital in Paris, a twenty-four-year-old man was given fifty milligrams of a new thing intravenously.

In the file he appears as Jacques Lh. He was agitated, with a manic condition, and he had been inside for as long as people were inside then [as long as it took]. It was not given to him by the man who had insisted for months that it be given; it was given by the hospital's neuropsychiatry service [Hamon, Paraire and Velluz], who published the case that same year in a French journal.

Twenty days of repeated doses and he left the hospital. It is the first time in history that somebody goes into a psychiatric hospital agitated and comes out through a door because they have been given something, instead of through whatever would have happened before [restraint, induced sleep, electricity, time].

It has to be said carefully what that demonstrated, because it is almost always told as more than it was. Jacques Lh. did not receive the molecule alone. He received it accompanied by barbiturates, within a combination. What was seen at Val-de-Grâce was that the combination worked. That the compound alone was enough was demonstrated a few months later, at Sainte-Anne, by Delay and Deniker, with thirty-eight patients and nothing else on top; the clean proof arrived when the first time already had a date and a headline.

The first time and the proof are not the same date. It happens more often than it seems.

II

The molecule came from December 1950, from a laboratory on the outskirts of Paris, where a chemist had changed the tail of a chlorinated derivative and given it a number: 4560.

Its family is old and is not medical. The phenothiazines began as textile dyes, jumped from there to antihistamines and from antihistamines to this. What was injected that January morning was a distant relative of a dye.

The man who insisted was not a psychiatrist either. Henri Laborit was a naval surgeon and what kept him awake was something else —that the wounded died of shock on his table, from the body's reaction to the wound and not from the wound—. In June 1951 he asked the manufacturer for that compound because it was sold as an anaesthesia potentiator [a help towards spending less ether], and what he saw in his operating theatres was not what he was looking for.

The patients did not fall asleep. They stayed awake, answering what they were asked, oriented, and with no interest at all in what was about to happen to them. He called it “euphoric quietude”, and the phrase stuck to the compound for years. He was working then on something he called artificial hibernation, and he surrounded patients with ice to bring their temperature down; the whole body, wrapped, the way fish is transported.

A surgeon looking for a way of not having people die on him found, in passing, the first psychiatric medication in history. What he found was indifference.

It takes a moment to accept the order of events. First the effect appeared, in bodies that were there for something else; then somebody thought about what it might be good for; and only at the end was there a disease to apply it to. The drug arrived before its indication, which is the reverse of the order that is taught.

III

The first bodies that received this molecule are not the psychiatric ones. They are Laborit's surgical ones, in 1951, and none of them has a name.

Nor do they have one for the reason of the later trials. In 1951 there was no protocol, no committee, no compulsory anonymity. They were protected by nothing. They do not appear because it occurred to nobody that the indifference of a surgical patient was a finding worth noting, and because they were people being operated on for something else.

One absence from protection and another from lack of interest. They are nothing alike and both leave the same page blank.

IV

I was given something on a Tuesday at twenty to eight in the morning, and it was not this molecule or a relative of it. For this today a benzodiazepine is used, which is a whole other family and works by another route. The effect I bought, however, is Laborit's.

The operating theatre is prepared with a domestic efficiency that disarms you. A nurse says your full name and your date of birth, makes you repeat it, checks a wristband, and asks whether you have dentures in the same tone in which you are asked whether you want a bag. It is cold. Eleven or twelve degrees it seemed to me, and it was probably eighteen and the cold was mine.

The line goes into the back of the hand [a twenty-gauge needle, hypoallergenic tape] and the saline is at room temperature, which means it goes in cold and you feel it climbing up the forearm, a finger of cold advancing towards the elbow. Then somebody says something above my head, there is a movement in the line, and within a minute or two the other thing begins.

It is not sleep. It is not euphoria. What happens is that the thing that is going to happen in twenty minutes stops having weight, without ceasing to be there. I knew perfectly well where I was and what was coming next; I could say the time, the number of the door and the anaesthetist's name. I asked something, they answered, and I was not interested in the answer.

Of the following twenty minutes I remember three things: a ceiling light with a grey rubber gasket, the sound of a packet tearing, and the calm certainty that if it went wrong it would not be such a big deal either.

That last part is what I think I bought, and here I have to brake hard, because on checking it does not stand up.

What a benzodiazepine does is not to take the importance away from what happens. It gets into the lock of the brain's general brake and tightens it, and among the things that brake switches off is the place where what is happening gets recorded. It does not withdraw the importance: it withdraws the record.

So probably I was there, I minded the normal amount, and afterwards nothing was left written. The calm certainty I say I remember may never have existed; what I have is not the memory of being calm, it is the memory of remembering that I was, and there is no way of checking it from inside.

I came out at half past eleven with a dry mouth and an odd sensation that lasted all afternoon, that of having been present at something that did not happen to me. I ate at two, hungry. At night I remembered the number of the door and not the door.

V

Inside, the business is simpler than it seems and considerably stranger.

The molecule is flat, three rings stuck together, with a flexible tail hanging off one side. It is fatty, so it does not stay in the blood. It spreads through the whole body, enters the brain without asking permission and settles into the membranes like somebody sitting down on somebody else's sofa.

Where it does its work is at the door. In the brain there is a signal that does not report what is happening; it reports how much it matters. It is the one that turns up the volume of the relevant, the one that makes a noise in the corridor at four in the morning urgent and not a noise. That signal arrives at particular locks. Chlorpromazine sits on top and occupies them.

It does not switch off thought. It does not erase perception. It switches off importance.

That is why it worked in the operating theatre and that is why it worked on the ward. The agitated patient goes on hearing what they hear [none of that disappears], and what falls away is the urgency of responding. And that is why blood pressure also falls, which is what Laborit wanted against shock, and that is why temperature falls, which is what had him surrounding people with ice.

The body, meanwhile, does its own thing. If those locks have been occupied for weeks, the cell makes more. More locks means a more sensitive system waiting underneath the drug, and there begins the problem it took years to see —people who after a long time develop movements they cannot stop, in the mouth and in the hands, and that sometimes do not go away on withdrawing the treatment—.

VI

What was invented in 1952 was not a sedative. Sedatives existed and they were barbiturates, which lay you out [with their narrow margin and their dead]. Nor was it a sleeping draught, or an anaesthetic, or anything that suppresses consciousness.

It was the possibility of administering indifference: separating a fact from its importance and leaving the fact intact.

That is a new technology, and it is like nothing that existed before. A sedative takes you out of the world. This leaves you inside the world, working, answering questions, with your perception whole, and withdraws the part that turns what you see into something that has to be done.

That is what Jacques Lh. received, and it is not what I received.

He was administered indifference for twenty days. I was sold twenty minutes of something that resembles it from outside and works by another route: not a bad time that did not matter, but a bad time that is not remembered.

The detail that makes it serious is that from inside they cannot be told apart. The next day both leave the same gap and the same odd afternoon. They are two different technologies sold as the same twenty-minute service, and the customer has no way of knowing which they were given.

VII

After 1952 came medicated confinement on a large scale, and with fifty years' advantage a splendid denunciation can be written.

The problem is that it is historically feeble. This molecule filled wards and also emptied them: a good part of the closing of the asylums happened because, with it, many people could live outside. Both things are true at once and a denunciation forces you to keep one.

There is something worse for my position. I bought twenty minutes of that, knowingly, and I would buy it again. It was not administered to me. I asked for it, signed a paper and it came with its price.

VIII

Of Jacques Lh.'s file we know the hour, the dose, the route and the days. We do not know what he thought. The archive did not lose it: what was noted down was something else [whether he was agitated, whether he ate, whether he slept].

The only thing that can be affirmed of the two bodies in this text is the same, and it is little. Both were administered indifference. Him for twenty days, by other people's decision, so that he would stop being a problem on a ward. Me for twenty minutes, at my own request, so as not to have a bad time on a trolley, and not even that with certainty.

December 1950, synthesis of compound 4560.

19 January 1952, ten in the morning, fifty milligrams intravenously.

Twenty days of treatment, with barbiturates in between.

Thirty-eight patients, a few months later, with the drug alone.

A box of thirty twenty-five-milligram tablets, today, in a Spanish pharmacy: less than three euros.

My premedication, on the invoice, as a separate line.