A Really Good Day
Also by Ayelet Waldman
Fiction
Love and Treasure
Red Hook Road
Love and Other Impossible Pursuits
Daughter’s Keeper
Nonfiction
Bad Mother: A Chronicle of Maternal Crimes, Minor Calamities, and Occasional Moments of Grace
THIS IS A BORZOI BOOK PUBLISHED BY ALFRED A. KNOPF
Copyright © 2017 by Ayelet Waldman
All rights reserved. Published in the United States by Alfred A. Knopf, a division of Penguin Random House LLC, New York, and distributed in Canada by Random House of Canada, a division of Penguin Random House Limited, Toronto.
www.aaknopf.com
Knopf, Borzoi Books, and the colophon are registered trademarks of Penguin Random House LLC.
Portions of this work originally appeared in different form in T: The New York Times Style Magazine (www.nytimes.com/section/t-magazine) as “All the Rage” on February 15, 2012; in Finesse magazine (www.ThomasKeller.com/senses-issue) as “Sensory Deprivation: An Insomniac’s Lament” in September 2014; and on This American Life as “Ellis Island” (m.thisamericanlife.org) on November 21, 2014.
Library of Congress Cataloging in Publication Control Number: 2016023416
ISBN 978-0-451-49409-2 (hardcover)
ISBN 978-0-451-49410-8 (ebook)
ISBN 978-1-5247-1110-8 (open market)
Ebook ISBN 9780451494108
Author’s Note: This book relates the events surrounding the author’s experiment in self-medication with microdoses of the drug lysergic acid diethylamide, or, as it is more commonly known, LSD. It is a criminal offense in the United States and in many other countries, punishable by imprisonment and/or fines, to manufacture, possess, or supply LSD. You should therefore understand that this book is intended for entertainment and not intended to encourage you to break the law. Notwithstanding the legality or illegality of the treatment in question, no attempt at self-diagnosis or self-treatment for serious or long-term mental or physical problems should be made without first consulting a qualified medical practitioner. The author and the publisher expressly disclaim any liability, loss, or risk, personal or otherwise, that is incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this book.
Everything in these pages did happen, though I have changed some names and identifying details, and taken liberties with dates and chronology in order to protect myself and others.
Cover design by Greg Kulick
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Contents
Cover
Also by Ayelet Waldman
Title Page
Copyright
Dedication
Epigraph
Prologue
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
Day 11
Day 12
Day 13
Day 14
Day 15
Day 16
Day 17
Day 18
Day 19
Day 20
Day 21
Day 22
Day 23
Day 24
Day 25
Day 26
Day 27
Day 28
Day 29
Day 30
Afterword
Acknowledgments
Bibliography
A Note About the Author
To Sophie
If the words “life, liberty, and the pursuit of happiness” don’t include the right to experiment with your own consciousness, then the Declaration of Independence isn’t worth the hemp it was written on.
—Terence McKenna
Prologue
This morning I took LSD.
The table I’m sitting at right now is not breathing. My keyboard is not exploding in psychedelic fireworks, lightning bolts shooting from the letters “R” and “P.” I am not giddy and frantic, or zoned out with bliss. I feel no transcendent sense of oneness with the universe or with the divine. On the contrary. I feel normal.
Well, except for one thing: I’m content and relaxed. I’m busy, but not stressed. That might be normal for some people, but it isn’t for me.
I did not drop a tab of acid. What I took is known as a “microdose,” a subtherapeutic dose of a drug administered at a quantity low enough to elicit no adverse side effects yet high enough for a measurable cellular response. A microdose of a psychedelic drug is approximately one-tenth of a typical dose. A recreational user of LSD looking for a trip complete with visual hallucinations might ingest between one hundred and one hundred and fifty micrograms of the drug. I took ten micrograms.
Microdosing of psychedelics, so new and renegade a concept that I had to teach it to my computer’s spellcheck, was popularized by a psychologist and former psychedelic researcher named James Fadiman in a series of lectures and podcast interviews and in a book published in 2011 called The Psychedelic Explorer’s Guide: Safe, Therapeutic, and Sacred Journeys. Since 2010, Dr. Fadiman has been collecting reports from individuals who experimented with regular microdosing of LSD and psilocybin, a naturally occurring chemical found in a variety of different species of mushroom. Soon after his book’s publication, in a lecture at a conference on the potential therapeutic value of psychedelic drugs, Fadiman presented what he had learned from reading the dozens of reports mailed and e-mailed to him, some though by no means all of them anonymously. He said about microdosing, “What many people are reporting is, at the end of the day, they say, ‘That was a really good day.’ ”
A really good day. Predictably, regularly, unexceptionally. That is all I have ever wanted.
For as long as I can remember, I have been held hostage by the vagaries of mood. When my mood is good, I am cheerful, productive, and affectionate. I sparkle at parties, I write decent sentences, I have what the kids call swag. When my mood swings, however, I am beset by self-loathing and knotted with guilt and shame. I am overtaken by a pervasive sense of hopelessness, a grim pessimism about even the possibility of happiness. My symptoms have never been serious enough to require hospitalization, nor have they ever prevented me from functioning either personally or professionally, but they have made my life and the lives of the people whom I love much more difficult.
I have sought many treatments for these moods and miseries. Though I managed to be one of the only neurotic Jewish children growing up in the seventies and eighties in the New York area to stay out of a shrink’s office, I did eventually dip my toe. Or, to be more accurate, I waded into therapy with the eagerness of a dehydrated camel sloshing into an oasis mud puddle. I wallowed in therapy of all kinds.
My first therapist was a psychiatric resident assigned to me by University Health Services when I was a third-year law student. I was looking for help dealing with a breakup that at the time felt tragic but that now seems like that moment when you look up from your phone just in time to avoid being plowed down by a city bus. I sat in my therapist’s office and sobbed. Once I stopped crying (two or three sessions in), we talked about my boyfriend and my ambivalence about the breakup. We talked about the guy (and the other guys, and the one or two girls) I cheated on him with. We talked about my mother’s anger and my father’s emotional reserve, and about how hard it was to grow up in a home where two people spent so much time fighting.
Since that first series of appointments, I have spent hundreds of hours in the offices of psychiatrists and psychologists, social workers and licensed family therapists, wearing my unique ass-print into so many leather couches. I’ve nattered on
to Freudians and diligently filled out the workbooks assigned by cognitive behavioral therapists. I enjoy these sessions; I’m analytical and an extrovert, so I enjoy picking apart my life and my feelings, especially with people I’m paying for the privilege. I was a good student in elementary school, and I find workbooks soothing.
Even though I am a cynic about all things countercultural (nothing makes me roll my eyes faster than a yogini pressing her lily-white palms together in a Namaste), I have on occasion even abandoned mainstream therapy for the decidedly alternative. In my eighth month of pregnancy with my second child, desperate to avoid another Caesarean section, I engaged in a series of sessions of hypnotherapy, during which I “rebirthed” my oldest child. This would, the hypnotist promised, guarantee a vaginal birth this time. I lay on her couch, my knees bent up around my ears, as she guided me in excruciating detail through the vaginal birth I did not have. Together we imagined every twisting contraction, the burn of crowning, the exertion of pushing. I panted, I moaned, I gritted my teeth and bore down. It turns out that the only thing one is guaranteed to produce by such efforts is a massive and propulsive fart.
One month, two doulas, a midwife, and forty-four hours of nonimaginary contractions later, my son was delivered by an obstetrician who waited with surprising patience for me to finish futilely visualizing my cervix opening before he performed the second of what went on to be four C-sections.
I’ve done mindfulness-based therapy, which required me to spend torturous minutes meditating, and many more torturous hours discussing with my therapist why I hate meditating so much. I responded to a crisis in a friend’s marriage by forcing my long-suffering husband into an infuriating kind of couples therapy that involved repeating back each other’s words, theoretically in a tone not dripping with passive-aggressive fury. (“I hear that it upsets you when I criticize how you load the dishwasher, but I feel sad when you insist on putting the glasses on the bottom rack, and I feel rage because, despite your vaunted intelligence, you can’t seem to learn that that’s how they get broken.” Oops.) We might still be frantically using “I” language with one another had my husband not pointed out that it was the therapy that was the most serious threat to our marriage. “I” had to agree.*1
Despite all of these hundreds of hours of talk therapy, I can’t say that I have ever experienced much in the way of a change of either outlook or behavior.
And then, one day, on my way home from giving a depressingly poorly attended reading in bucolic and beautiful Marin County,*2 I found myself considering the possibility of steering my wheel hard to the right and hurtling off the Richmond Bridge. The thought was more than idle, less than concrete, and though I managed to make it across safely, I was so shaken by the experience that I called a psychiatrist.
That psychiatrist diagnosed me with bipolar II disorder, a less serious variant of bipolar I, which was once known as manic depression. Though this diagnosis was a shock, it wasn’t a surprise. Bipolar disorder runs in families, and my father and other members of my family have it. I suppose in the back of my mind I always feared that my shifting moods might be an expression of the disease.
Bipolar disorder is characterized by changes in mood, energy, and activity levels. Most people experience these different emotional states, but in bipolar people they are intense, sometimes drastic and disturbing. Like “Maybe I’ll spontaneously drive my car off this bridge!” disturbing. They can have a profound impact on daily functioning and relationships. Up to one in five people with bipolar disorder will commit suicide, and rates may even, paradoxically, be higher for those suffering from bipolar II. Psychiatrists posit that individuals with bipolar I, though their suffering is more intense, are less able either to formulate a desire to commit suicide, or to carry it out. People with bipolar II possess the competence necessary to end their suffering.
Though these statistics scared me, having a diagnosis was also in many ways a profound relief. It explained so much! Like my tendency to overshare at dinner parties and on the Internet. Or the day I stood, trembling with rage, as the dry cleaner shrugged his shoulders at the ruin he’d made of my expensive new shirt. The purchase itself was made in a period of overspending typical of bipolar disorder, and my reaction to the dry cleaner’s perfunctory apology was a symptom of what’s known as “irritability.” Irritability, or “irritable mood,” is a clinical term, a piece of jargon, defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as “a mood state in which apparently minimal stimulus or irritant produces excessive reaction, usually characterized by anger, aggressiveness or belligerence.” It seems kind of an anodyne way to describe shrieking at one’s local dry cleaner.
My diagnosis gave me the language to understand the more positive aspects of what was happening to me as well. It shed light on experiences like the time I wrote three novels in six months, with a clarity of focus and attention to detail that I had never before experienced. This type of sublime creative energy is characteristic of the elevated and productive mood state known as hypomania. So exhilarating and fruitful were these periods that I sometimes thought they were sufficient compensation for the other, dark side of the disease.
After my diagnosis, I embarked on seven years of psychotropic medications, suspended only for a brief period in the early stages of one of my pregnancies. The list of meds I’ve tried and rejected is so long that my friends use me as a kind of walking Physicians’ Desk Reference, able to recite symptoms and side effects for anything their shrinks might prescribe, like the soothing voice-over at the end of a drug commercial: “Abilify is not for everyone. Call your doctor if you have high fever, stiff muscles, or confusion.” Off the top of my head, I have over the long course of this journey in mental illness and mood alteration been prescribed the following medications: selective serotonin reuptake inhibitors (SSRIs) including: citalopram (Celexa), its nongeneric and thus more costly fraternal twin sister escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft); the serotonin-norepinephrine reuptake inhibitors duloxetine (Cymbalta), venlafaxine (Effexor), and venlafaxine XR (Effexor XR); the atypical antidepressant bupropion (Wellbutrin); the mood stabilizers lamotrigine (Lamictal) and topiramate (Topamax); amphetamine (Adderall, Adderall XR), methylphenidate (Ritalin and Concerta), and atomoxetine (Strattera); the benzodiazepines alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan); the atypical antipsychotic quetiapine (Seroquel) (a particularly bizarre prescription since I have never been remotely psychotic); the sleep aids zolpidem (Ambien) and eszopiclone (Lunesta). I’m sure I’m forgetting some. That can happen when you take a shit-ton of drugs.
Some of these medications worked for a little while—sometimes a few days, sometimes a few months. But with every new pill there were new side effects. Since SSRIs made me gain weight and deadened my libido, standard practice dictated that we add new meds to combat the weight gain and to pump up my sex drive. Those drugs made me irritable, so the doctor prescribed something else to calm me down; round and round in a seemingly futile cycle.
Unfortunately, this kind of trial-and-error experience is quite prevalent in mental health treatment. These drugs act on people in different and unexpected ways, and it is often difficult to concoct the precise cocktail to address an individual’s array of issues. Furthermore, practitioners, even the best ones, still lack a complete understanding of the complexity and nuance both of the many psychological and mood disorders and of the many pharmaceuticals available to treat them. Were mental health research more adequately funded, perhaps there might be more clarity. Certainly, misdiagnosis might be less common.
Years after my initial diagnosis, while tumbling down an Internet rabbit hole the genesis of which I can’t remember, I stumbled across an abstract of a clinical study on PMS that made me question whether my diagnosis of bipolar disorder was correct. My bipolar disorder did not comply with the requirements written in the DSM-5. My hypomania rarely lasted the requisite four days, and never toppled into mania
, and, though I regularly fell into black moods, I had never had a major depressive episode. My moods were not as extreme as my father’s, nor had I ever suffered any real professional or personal damage as a result of them.*3 Was I really bipolar?
When I got out the mood charts I’d been keeping since my diagnosis and compared them to my menstrual cycle, it became strikingly clear. My mood, my sleep patterns, my energy levels, all fluctuated in direct correspondence with my menstrual cycle. During the week before my period, my mood dropped. I became depressed, more prone to anger; my sleep was out of whack. I also noticed another dip in mood in the middle of my cycle, this one lasting only for a day or so. This dip happened immediately before ovulation, and was characterized not so much by depression as by fury. It was during these pre-period periods that I traumatized that poor dry cleaner and picked fights with my stoical husband over issues of global importance like the proper loading of the dishwasher.
I consulted a psychiatrist recommended by the Women’s Mood and Hormone Clinic at the medical center of the University of California, San Francisco, a psychiatric clinic that treats women with mood disorders that can be attributed, in part, to hormonal influences on the brain. My new doctor immediately evaluated me for PMS.
PMS—defined as mood fluctuations and physical symptoms in the days preceding menstruation—is experienced in some form by as many as 80 percent of all ovulating women. Nineteen percent suffer symptoms serious enough to interfere with work, school, or relationships, and between 3 and 8 percent suffer from PMDD, or premenstrual dysphoric disorder, symptoms so severe that those who suffer from them can be, at times, effectively disabled.