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Our forefathers did dissociatives

We talk about anesthetizing ourselves like it’s a bad thing. It doesn’t have to be. In October 1946, Dr. Henry Knowles Beecher, who held the enviable title of anesthetist-in-chief at Massachusetts General Hospital, gave an address called “The Emergence of Anesthesia’s Second Power.” He spoke from the Ether Dome, his hospital’s famous operating theater, where, exactly a century earlier, his predecessors had etherized a patient for the first time, a watershed moment in the history of painlessness. Now Beecher believed it was time for anesthetics to expand their remit: they could enliven the mind as they numbed the body. Though anesthesia was often perceived as a soul-smothering condition, a kind of temporary death, it allowed the “possibility of planned access to levels of consciousness not ordinarily attainable, except perhaps in dreams, in trances,” he said, “in the reveries of true mystics.” The right anesthetic agent could make a mystic out of anyone, enabling “the study of the life process itself.”

He had reason to be optimistic. Psychiatrists had been using sodium amytal (a barbiturate anesthetic sometimes known as “truth serum” for its dubious use by cops) to treat psychosis and depression in soldiers, a therapy they called narcosynthesis. But Beecher drew more inspiration from the nineteenth century, a time when anesthetic drugs were so new and novel that people were willing to try all kinds of crazy shit. He was especially enchanted by Benjamin Paul Blood, a fearsomely named, largely forgotten farmer from upstate New York who’d published, in 1874, an obscure pamphlet called “The Anaesthetic Revelation and the Gist of Philosophy.” After years of experimenting on himself with ether and nitrous oxide, Blood declared that anesthesia contained the germ of perfect, total knowledge, “the genius of being.” It whispered the secrets of the universe to you. In his speech, Beecher hailed Blood as a pioneer who’d developed “anesthetic tools to get at the memories in the subconscious.” Modern psychiatrists had only to pick up where he’d left off.

They didn’t. Over the next decades, anesthesiology and psychiatry parted ways; narcosynthesis fell out of fashion, Beecher died in 1976, and Blood’s pamphlet languished unread, save by the occasional surrealist poet. That’s a shame, because the jagged rise of ketamine—an anesthetic with a singular appeal to emergency-room nurses, gabber-loving Eurotrash, wellness influencers, and the suicidally depressed—suggests that Blood might’ve been onto something. Maybe the anesthetic revelation is an idea whose time has come.

Far Away Eyes

Ketamine’s full history is storied enough to repay scrutiny, but for now the bullet points will suffice. Patented in the 1960s by Parke-Davis, then the largest pharmaceutical firm in America, it was advertised as “a major advance in anesthesia” because of its wide safety margin and unusual “mechanisms of action”: unlike barbiturates, it didn’t slow down patients’ hearts or lower their blood pressure. Instead, it entranced them somewhere between consciousness and oblivion, catatonic but still capable of breathing normally. Ketamine received FDA approval in 1970. Some fringe figures in psychiatry realized its potential as an “abreactive agent”—a catharsis generator, essentially—but nothing came of their work until 2000, when a splashy Yale study linked ketamine to “significant decreases” in “items of depressed mood (paired t test, p = .0025), suicidality (p = .02), helplessness (p = .008), and worthlessness (p = .015).” Since then, ketamine has been increasingly prescribed to fight those “items.” It’s available in nasal sprays, quick-dissolve troches, intramuscular injections, and intravenous drips, and it is often infused under medical supervision at clinics. If this were all you knew about it, you might picture Beecher cheering from the grave. Here is vindication of anesthesia’s ability, as he put it, “to reveal, to control, and to relieve problems of the mind.”

In ketamine we have a drug that gets you epically fucked up, classified in a way that makes it sound like a personality disorder in a vial.

And yet, because it reveals perhaps too much about the problems of the mind, ketamine has been greeted with skepticism, even hostility. The FDA has refused to approve it for the treatment of psychiatric disorders. Doctors can still legally prescribe it, but there’s no consensus about the ideal dosage or means of administration. No standards, no regulation, almost no insurance coverage. The media loves to describe ketamine clinics as “the Wild West”—a phrase meant to summon lawlessness and snake oil, though it makes me think of cowboys swallowed up to their five-gallon hats by the k-hole.

There’s the crux of the issue: the k-hole. Ketamine gets you really, elaborately, bizarrely high. Doctors have never quite known how to describe this high or what to do about it. During the drug’s clinical trials in 1964, recovering patients reported that they’d been dead, suspended among the stars, or living in a movie. One researcher observed that ketamine “produced ‘zombies’ who were totally disconnected from their environment.” Investigators had to find the right word to broach these effects; hallucinations and zombies wouldn’t go over well with the FDA. An early contender, schizophrenomimetic (i.e., mimicking schizophrenia), was tossed out for obvious reasons. They settled on dissociative, which suggested a gossamer untethering of body and brain. A hot air balloon dissociates from the earth; the two halves of a Venn diagram are a dissociated circle. Confusingly, there was already a long history of dissociation in psychology, where the word describes someone too detached from reality to function. Dissociative anesthesia is technically unrelated, but people understandably conflate the two, especially now that ketamine is used in mental health contexts. Hence ketamine clinics speak of “the healing powers of dissociation”—seemingly the very thing of which you’d want to be healed.

In ketamine we have a drug that gets you epically fucked up, classified in a way that makes it sound like a personality disorder in a vial. In the early 1970s, as anesthesiologists became more adept in its deployment, its hallmark became “the Dissociated Look”: “that of an absent mind,” one doctor wrote, “detached from the present and fixed on infinity.” Marketing videos assured anesthesiologists that this look was entirely normal, no matter how creepy. Soon you could see “the look” not just in surgery but at nightclubs, warehouses, and loft parties. It turned out a lot of people enjoyed dissociating for its own sake. Ketamine’s profoundly disorienting fugues made them feel as if they’d discovered new textures beyond reality, or hidden aspects of themselves. “That twenty-two-minute journey to becoming the intelligence at the heart of the universe remains the most powerful and cosmic experience of my life,” one user said in 1997. At the very least, it made it more fun to dance.

As neuroscience advanced, pharmacology came to include a number of drugs in the dissociative family that antagonize the brain’s N-methyl-D-aspartate (NMDA) receptor, most of them beloved by recreational users, who call them “dissos.” Among the major players, there’s PCP (or angel dust), which makes you feel like you’re walking on the moon if you dose it right, though in the 1970s a few psychotic users ensured that it became better known for making people jump through windows and kill babies. There’s DXM, an active ingredient in Robitussin and other cough suppressants—it dissociates you just enough that you forget to cough. And there are ether and nitrous oxide, the favorite anesthetics of the nineteenth century. The latter remains a strong presence at dentists’ offices and parking lots outside of Phish shows, where intimidating men called the Nitrous Mafia—many of them from Philadelphia for some reason—will sell you three frosty, gassy balloons of pure euphoria for around twenty bucks. I once heard an editor of this magazine describe nitrous, accurately, as “a delay pedal for your brain.”

Ketamine therapists, fearful of being lumped in with fly-by-night thrill peddlers like the Nitrous Mafia, have distanced themselves from their drug’s “abuse” at the hands of the nightlife. I see the need to distinguish their practice from rank hedonism, but it’s an unfortunate stance; few people grasp ketamine’s therapeutic value more than the true believers who choose to take it. Castigating them suggests that the drug’s vaunted second power remains as misunderstood, or as uncontained, as it was in Henry Beecher’s day. Can two groups of people, taking the same drug, doing the same soul-searching, be arriving at different outcomes? One criminal and the other therapeutic? If that’s true, what does it even mean to dissociate? Who should be allowed to do it, and for what reasons?

In short, ketamine is so unwieldy, indescribable, and potent that it’s been hemmed in on all sides. Ravers resent shrinks for turning the k-hole into a glorified spa treatment. The depressed accuse Ibiza’s spring breakers of stigmatizing the only medication that helps them. And anesthesiologists can’t figure out why so much ink is spilled over a wonky drug they use to knock out kids with broken legs. Dissociation is a nebulous concept, and all parties have tailored it to their benefit; the least woo-woo clinics swear that the high is just a side effect, and infusions would work just as well without it. But since ketamine and its disso cousins produce a powerful, attractive condition, we’d do well to find a less impoverished way to talk about it. Which is where Benjamin Paul Blood, with his sweeping rhetoric about the anesthetized mind, comes in.

Gas of Paradise

Blood was that kind of rogue do-it-yourselfer peculiar to nineteenth-century America—a homespun, spit-shined Renaissance man. He presented variously as a seeker, an idler, an autodidact, a contrarian, a bullshitter, a toiler in obscurity, a polymath, and a secular man of faith. One of an enormous brood—his paternal grandparents had nineteen children—he was born in 1832 in Amsterdam, New York, twenty-nine miles northwest of Albany, where he spent his whole life. His brick house on Eagle Street (still standing; I found it on Zillow) sat on the south bank of the Mohawk River, which was to him a site of scheming and dreaming, like Twain’s Mississippi or Whitman’s Delaware. A farmer and an internationally published poet, Blood patented a swathing reaper, a tension system for uniform machine-knitting, and a side saddle for ladies. He claimed to have coined the term playwright. (“I recall distinctly the psychological experience of inventing that word,” he wrote to the New York Times.) He liked gambling and figuring cube roots in his head. During the Civil War, he was ejected from the Union Army after having been kicked by a mule, but he was strong as a “fancy gymnast.” He once hoisted a 1,160-pound chain over his shoulder, and for sport he beat another man senseless over the course of forty minutes. Above all, he was a character, a talker who signed his notes “interminably yours.” The town papers called on him to fill column inches about grand jury indictments, water commissioners, or intemperance. “I have been a sort of pet of the city,” he once bragged. “In a large vote taken by one of the daily papers here . . . as to who were the 12 leading citizens, I was 6th.”

He first tasted the anesthetic revelation sometime around 1860, courtesy of his dentist, who’d etherized him before attending to his ghastly trade. Blood, as he recovered, felt the onset of a sensation outside of space and time. He “stood lost in the mystery,” he later recalled,

and then I said suddenly, “Well, by Christ!” And then I started to laugh “ha, ha” but the laugh did not come in, nor belong there, because—because I hadn’t got it, couldn’t hold it—there was no definite ground for the triumph of a laugh. This tendency to laugh, and then the finding of the laugh too late, “the escape” of the present into the consequent has ever been a feature of the revelation with me. There is a tendency to follow up as the cat after her tail—as if “I was the unanswered question.”

Blood was so flummoxed by his “unanswered question” that he spent the next fourteen years surfing it, riding a dissociative wave that crashed on the shores of the unknown. He never recorded the frequency of his experiments with ether and nitrous oxide, but they were indelible enough to persuade him that the drugs could render all of philosophy obsolete, so perfectly did they explain the raw facts of being. This explanation took the form of a riddle or koan, leaving us “put in mind of something we cannot think of.” By 1874, he’d honed his approach enough to write what would become his most notorious words:

By the Anaesthetic Revelation I mean a certain survived condition, (or uncondition,) in which is the satisfaction of philosophy by an appreciation of the genius of being, which appreciation cannot be brought out of that condition into the normal sanity of sense—cannot be formally remembered, but remains informal, forgotten until we return to it . . . because it cannot be remembered in the normal condition it is lost altogether through the infrequency of anaesthetic treatment in any individual’s case ordinarily, and buried, amid the hum of returning common sense, under that epitaph of all illumination: “this is a queer world” . . . all who enter the anaesthetic condition (and there are hundreds every secular day) will be taught to expect this revelation, and will date from its experience their initiation into the Secret of Life.

This was the heart of Blood’s pamphlet, published at his own expense: the notion that anesthesia conferred an arcane knowledge of nothing and everything, a gauzy hidden architecture that, once glimpsed, could never be conveyed in waking life. All that survived was the sense of having fallen into “this thick net of space containing all worlds.”

He mailed his pamphlet to the luminaries of his time—Ralph Waldo Emerson, Alfred, Lord Tennyson, William James—as well as the major newspapers. Their reviews cannot have gladdened him. One paper called his volume “a brilliant specimen of the asserted value of language—to conceal ideas.” Another wrote that “Mr. Blood’s most appreciative readers will be found in insane asylums.” It’s true that the bulk of the book comprises a ramble through the woods of Kantian, Fichtean, and Hegelian logic; Blood felt that he should demonstrate his mastery of such philosophers before discarding them.

Nonetheless, he had located the kernel of the dissociative experience. He was hardly the first to have his mind blown in the dentist’s chair. Dentistry is pure pain, and most people must submit to it at some point or another—which made it, back then, a perfect fit for ether and nitrous oxide. The adoption of these proto-dissos ensured that routine dental work carried a whiff of the sublime. Henry David Thoreau wrote, “If you have an inclination to travel, take the ether; you go beyond the furthest star.” He had taken the drug to have some dentures fitted.

Many Christians objected to anesthesia even as a part of surgery. God wanted birthing mothers to feel pain. God wanted toothache and thrashing limbs. What He certainly did not want was a shortcut to the mountaintop by way of a chemical-soaked rag.

The new anesthetics were so pleasurable, and so laden with celestial insight, that, as with ketamine, it was an open question where they belonged in society. Sir Humphry Davy, among the first to isolate nitrous oxide, once huffed so much of the gas that he declared, “Nothing exists but thoughts!” He and his colleagues had hoped it might alleviate consumption; failing to do that, it enjoyed a reputation as laughing gas, a bit of whipped cream for the upper crust. The party drug made its way into anesthesia almost by accident, when a dentist in Hartford attended a laughing gas exhibition and noticed that, after inhaling nitrous, people fell numb to the ground. Others hoped the “gas of paradise” might replace alcohol as an introspective tipple for the masses. A prominent scientist proposed an “etherial tavern,” where, in well-cushioned, gender-separated lounges, patrons could take “a fourpenny seraphic BREATH” from oiled-silk bags until “the toes, fingers, and ears are thrilling with all the feelings of musical vibration.” In parts of Ireland—and following the craze for “ether frolics” in the American South—Catholics drank ether because it was cheaper than whiskey. It was also more flammable, and they sometimes caught fire by belching near open flames during their “violent eructations.”

Those who were receptive to gas-sucking and ether-guzzling soon went in search of their own anesthetic revelations. Validating Blood’s discovery became trendy among the drug-friendly well-to-do. They never quite approximated his shorthand enlightenment, but their attempts are funny and velvety, a fool’s errand set to the music of the spheres. Oliver Wendell Holmes Sr.—father of the Supreme Court Justice, and the man who gave us the word anesthesia—wrote after ether that “the veil of eternity was lifted,” but all he could recall of “the all-embracing truth” was this: “A strong smell of turpentine prevails throughout.”

The nature of the quest gave it an esoteric cast. Many, including Blood himself, felt that they could bring the revelation back to Earth with them if they only tried hard enough. They organized themselves like disso freemasons. In Brooklyn, a group of physicians, lawyers, and one clergyman formed the Society for the Interpretation of the Anaesthetic Revelation, or SIAR. They gathered by night, “as secret as the sphynx,” and with the aid of an ether-soaked rag found themselves ushered into Blood’s promised land. When they tried to write down what they’d learned, they were “continually baffled.” The same fate befell Xenos Clark, a college boy from Amherst who referred to the revelation as Φ, as if the Roman alphabet were too debased to accommodate it. He became Blood’s disciple, intent on prying from ether “the formula by which the ‘now’ keeps exfoliating out of itself.” After his best efforts, he could say only, “I came from the ocean with some of the salt on me.”

The Password Primeval

By the end of the nineteenth century, the anesthetic revelation was living many lives at once. To most people it was a huge waste of time—this is all that getting high will ever be for much of the world. But it was also a subject of legitimate scientific inquiry among learned men in London, and a vital part of the burgeoning spiritualism movement, the stuff of theosophists and Ouija boards. Anesthesia could be mentioned in the same breath as Bishop Berkeley’s immaterialism, ghosts, and time travel. These threads were tangled up in the tumult of the day as people tried to figure out what was real and what was not, where God lived, and which paths could be reliably followed to the far side of the universe.

Blood, as a philosopher, was loath to see anesthesia co-opted by sideshow acts and hocus-pocus. “It would be so easy for the revelation to get spoilt by being classed once or twice with the spiritualism business,” Clark warned him. When a medium came to town, offering to connect people with their deceased relatives “on the other side,” Blood studied the man’s equipment and showed the crowd how the hoax had been perpetrated. “Those of you who believe with Mr. Blood that the whole affair has been humbug,” proclaimed the spiritualist’s manager, “will at least admit that you have had a good twenty-five cents worth of humbug.”

“The Anaesthetic Revelation” may have gone down in history as twenty-five cents of humbug were it not for William James, who had warmed to the pamphlet in the years since it arrived unsolicited in his mailbox. James included Blood in The Varieties of Religious Experience, anointing him as the ur-purveyor of “the artificial mystic state of mind.” James meant no disrespect. Having been thrust by nitrous oxide into “a perfect delirium of theoretic rapture,” he knew the revelation could smack a man plumb in the face no matter what he thought he believed. The gas had taught him that “our normal waking consciousness, rational consciousness as we call it, is but one special type of consciousness, whilst all about it, parted from it by the filmiest of screens, there lie potential forms of consciousness entirely different.” This Harvard man hyped Blood as a genuine thinker whose “trumpet-blast of oracular mysticism” merited consideration alongside meditating yogis and gibbering saints. Anesthetics had democratized the trance.

This was a hard sell even in James’s enlightened cohort, and Christian America had long since written it off as apostasy. The average churchgoer was not about to breathe nitrous oxide and taste its sacred fruits. Many Christians objected to anesthesia even as a part of surgery. God wanted birthing mothers to feel pain. God wanted toothache and thrashing limbs. What He certainly did not want was a shortcut to the mountaintop by way of a chemical-soaked rag. “Opium, ether and chloroform are no keys to the kingdom of heaven,” wrote one critic. Mesmerists and hypnotists also objected to anesthetics. You didn’t need drugs when you had animal magnetism.

Can two groups of people, taking the same drug, doing the same soul-searching, be arriving at different outcomes? One criminal and the other therapeutic?

Fortunately for Blood, James thought he’d seized on something original, and the two made a friendly project of plumbing the depths of the revelation—not, as one would hope, by inhaling nitrous together through the same bromantic mask, but through a rarefied exchange of ideas about the composition of the universe. Their letters got kind of flirty at times, with Blood, maybe fishing for compliments, writing “This is a horse” below an enclosed portrait of himself, and James urging him, “Do, like a good boy, sit down and have a crack at the anesthetic revelation again. Squeeze it tight!” In their intimacy it can seem like they were the only people alive who cared if nitrous oxide was received as a Delphic instrument rather than a parlor trick.

The revelation was perfectly circular, but Blood kept trying to square it: Was it telling him that the universe had an at-oneness, or that it was various and sundry? Beguiled by the mystery, he hammered out his metaphysics in a second book, Pluriverse, whose construction busied him until his death in 1919. It’s strange to realize that its many hundreds of pages issued from one life-changing encounter with a dentist nearly sixty years earlier. “The universe is wild—game flavored as a hawk’s wing,” he once wrote. “There are no fortunes to be told, and there is no advice to be given.” James agreed. He dedicated the final essay of his life to Blood’s pluralism, which signaled “no all-pervasive unity, but everywhere some residual resistance . . . that says ‘hands off,’ and claims its privacy, and means to be left to its own life.”

And yet Blood wouldn’t leave it alone. He was never sure he’d gotten the anesthetic revelation right, and he kept rearticulating it, hoping to decrypt “the password primeval.” The right words for his ineffable experience, the punchline to the cosmic joke, would stop philosophy in its tracks and destroy superstition. Clearly this didn’t end to his satisfaction, but the effort galvanized him. He died aged eighty-six, “and his last breath,” read a local obituary, “was drawn as easily as any during his long life.” His dotage was marked by an accident that adds a final irony. While he was cleaning his shotgun one day, it discharged, claiming two of his fingers. During the operation that followed, Blood declined to take an anesthetic. The great poet of anesthesia’s second power had refused to avail himself of its first.

Ancient Peace

I sometimes wonder about the parts of the anesthetic revelation that Blood deemed unworthy of mention. It makes sense that he and James, in their nitrous reveries, were swept up on a heady zephyr of Hegelian dialectics and monism; these were some of the preeminent concerns of their day, and they were right that dissociative anesthesia primes the mind to face life’s complexity with an eerie forthrightness. But dissociatives also send you to less cerebral places. Ketamine gets me thinking about my friends, my marriage, my petty embarrassments and prides, “Magic Carpet Ride,” The Legend of Zelda, and the beauty of my ceiling fan in motion. I’ve become convinced that everyone’s eyes would look better upside down and that I must write a legal thriller called Billable Hours. There’s little of this noise in Blood’s account, and none of the fun. It’s all metaphysics, all the time. Henry Beecher was taking some creative license when he credited Blood in 1946 with getting at “memories hidden in the subconscious.” If there’s any personal material in his revelation, it may be buried here:

the naked life is realized only outside of sanity altogether; and it is the instant contrast of this “tasteless water of souls” with formal thought as we “come to” that leaves in the patient an astonishment that the awful mystery of Life is at last but a homely and a common thing, and that aside from mere formality the majestic and the absurd are of equal dignity . . . To minds of sanguine imagination there will be a sadness in the tenor of the mystery, as if the key-note of the universe were low,—for no poetry, no emotion known to the normal sanity of man can furnish a hint of its primeval prestige, and its all-but appalling solemnity; but for such as have felt sadly the instability of temporal things there is a comfort of serenity and ancient peace.

This serenity serves as a bridge between Blood and those of us anesthetizing ourselves today. We speak a language of trauma, ego death, and emotional breakthrough that would have been foreign to him, but we could, without too much effort, widen our approach to ketamine to include his impossibly vast sense of “ancient peace,” which is acute precisely because it’s so obtuse. The anesthetic revelation refuses containment by the clichés of psychedelia and withers under modern medicine’s desiccating gaze. If anesthesia’s second power is coming into its own, we should recognize that it has roots deeper and more knotted than the current conversation allows. Today’s psychiatric researchers sometimes ask their subjects to quantify ketamine’s “mystical-type effects” with Hood’s Mysticism Scale, which uses a range of +2 to -2 to rate such sentiments as “I have had an experience in which ultimate reality was revealed to me” and “I have had an experience that is impossible to communicate.” On Instagram, Reset Ketamine, a clinic in Palm Springs, posted a meme with Star Trek’s Jean-Luc Picard burying his head in his hands. The caption read “When you get an epiphany during a ketamine infusion but you can’t remember it afterwards.” It got fifty-one likes.

I want desperately to believe in some organizing principle. Blood’s disso odyssey, however ridiculous, has helped me glimpse one, fleetingly, on ketamine and nitrous. I’m certain for a few seconds that I know exactly what he’s talking about. Yes, friends, I subscribe to the revelation. Like Henry Beecher, I think that ketamine therapy, whether you practice it with a doctor or on a dance floor at 5 a.m., is an extension of Blood’s “mumbling and mouthing mystery of the cosmos.” His style describes dissociatives more richly than anyone else because it feels like chemical dissociation on the page: it takes that much excess, and that much punctuation, to capture its creamy, noetic messages, its powerful indifference, its dizzying gusts of cerebration—and its tendency to wrest back whatever wisdom chemicals impart, leaving only a few fine hairs from the godhead. Maybe I’m not alone in feeling that he’s pinpointed how it feels to have your NMDA receptor antagonized. Two recent books, Mike Jay’s Psychonauts and John Kaag’s American Bloods, discuss Blood in detail, and psychiatrists are testing nitrous oxide against depression. The moment could be ripe for Blood’s return.

This is not to say that we should endorse the would-be prophet from outside of Albany’s every exhausting word. (He made intoxication the fundament of an entire philosophy. Even people who love getting high don’t do that.) But dissociative drugs, in their vexed current form, call for a dash of exalted absurdity. Like the spiritualists in Blood’s day, New Agers and the self-help set are trying to rebrand ketamine—a Big Pharma chemical that they lump in with plant medicine and “holding space”—for their own narrow purposes. It can be so much more than that. And, just as important, so much less.