Alpha Blocker
Like many people, I have a recurring dream where I’m somewhere completely ordinary but inherently humiliating. Not for everyone, but for me. One moment I’m in my bed metabolizing antihistamines, the next I’m trying to operate that most complex of machines: the combination padlock on a middle school gym locker.
Before long, from somewhere in my limbic system a semipredictable parade of emotions streams out in costume, each hiding among the throngs of other students to present unique challenges throughout the dream. For the next several hours I plod and scrape my way through some mundane setting that only I can see is a screaming hellscape. My voice comes out wrong. I drop things constantly, my thumbs don’t work right. Every third person I meet is actually three life-lessons in a trenchcoat come to drag me through a sidescrolling haunted house of childhood trauma.
I wake up in a sweaty mess of anachronicity and confusion that lays like a thick fog atop the rest of my day.
Combination locks are a perfect metaphor for anxious childhood. Comprised of a series of interconnected parts which need to be massaged into precisely the right order, they’re an executive functioning nightmare. The more pressingly you need to get into your locker the harder it is to steady your hands, the harder it is to land on that perfect line between two wrong numbers. Since it’s a sequence, your mistakes aren’t always obvious. A person could spend an hour trying to figure out the last number in the series before realizing it was the first that was jamming up the lock. Generally speaking it offers no clue, no resistance, no hint as to exactly when you made a crucial mistake, but until you address it you simply can’t move forward. All around you kids are spinning the dials and pulling out gym shoes, bored. Laughing, but not necessarily at you. Who could possibly be hamstrung by a gym locker?
Yet gym locker rooms are the apex of so much societal anxiety. Before anyone knew who they were supposed to hate, gyms were already hostile environments for the overwhelming majority of us. Pungent, constantly wet, covered in body spray and sweat, they comprise the most base-level form of political theater when we’re young. They're constant social auditions where everyone pretends they're completely fine with their clothes off. Beginning in middle school, they became places where our social, emotional and sexual anxieties cranked up until the knob fell off the dial. All of us left in some terrifying state of undress even after our clothes were back on. A permanent rendition of Lord of the Flies where everyone is Piggy.
So it's not surprising really, that all of these dreams have at least one scene like this with some state of communal vulnerability— a place where our anxieties metastasize, where al| of us learned to become wholly ashamed of yet another part of who we are as people. A place of unspeakability.
We talk about our brains as if they're precision instruments like search engines or card catalogues. We imagine ourselves scanning through keywords to pluck out specific thoughts and ideas, leaving the rest of the shelf undisturbed. We retrieve information and use that information, and most of the time we give little thought to where it goes next. But like a generative search engine, the way we retrieve information actually shapes the information itself, imposing a slightly new order through new associations.
Some mnemonic research suggests that even the emotional approach to how we solve the problem of retrieving hard-to-reach information may itself run the risk of overwriting it. Scientists on a study I can’t currently remember the name of showed that there was a threshold after which trying to recall a word you can’t remember begins to decrease your future odds of successful retrieval in the future. This led the authors to suggest that you try to remember for no more than a few minutes, trying to find that ideal time before the memory you’ve forgotten is overwritten by the memory of forgetting.
This may be useful for the waking and the living, but when we sleep our brains are giant fishing trawlers dragging up a small ocean of memory networks every time they pull up a familiar face. Sweetness first smelled next to a car crash can make any bakery throughout your life smell suddenly and inexplicably like sadness. When that same sadness later co-occurs during a period of heightened anxiety, the smell of sugar can make your heart race and break a little at the same time. It took me three therapists to figure out that this is why the smell of sand makes me nauseous.
Forty years ago, neuroscientists started to experiment with the use of alpha modulating medications (specifically alpha-2 agonists and alpha-1 adrenergic receptor antagonists) for post-traumatic stress disorder. Wildly oversimplified, the hypothesis was that by regulating sympathetic nervous system functions the way we might treat ordinary hypertension, we might be able to cut off the cascade of events which come together to form a post-traumatic night terror.
So when sleeping Jess finds herself in the middle of her elementary school cafeteria, her blood pressure starts to go up. Her muscles constrict and her breathing becomes more labored. The association between this newly hyperaroused state and danger is made, giving the cafeteria a terrifying makeover. Suddenly sounds and light and fear all merge into a single agonizing sensation until daybreak. Alpha blockers don’t make the cafeteria a better place— they don’t transmute the meaning of the cafeteria and its relevance to sleeping Jess’ life, but they prevent the process of hyperarousal that leaves her in a pool of sweat and stress hormones when she wakes up.
The first time I took prazosin, I walked through the landscape of my dream feeling an aching sense of loss and longing. The people were there, the emotions were mostly there but the volume was turned way down.
Think about how different the most frightening jump scares are with the sound off. Sure, that paroxysm of fear centers around the pivotal moment where the killer is suddenly in the mirror, but for many people it’s the sound which accompanies the visual that makes it so terrifying. This is why videogame manufacturers put laborious breathing into fight scenes: the sound stimulates our sympathetic nervous systems. To a certain extent, we actually synchronize our breathing to that of the game. We mistake the avatar being out of breath for our own lack of oxygen and we hyperventilate.
The same nightmare landscape with no sound and slow, methodical breathing isn’t pleasant, but it never reaches a climax. Sometimes this means you see more. For me, I saw the ways in which the basic organization of society makes all of our individual pain so much worse. How children are pushed into an annual year-long play where everyone pretends to know how to be an adult, before a short intermission in the summer forces us to endure it all over again. I found myself being able to see sleepy Jess in her nightmare landscape in situations she never should have found herself. We haven’t yet developed the drug or the psychological mechanism that would allow me to pull her out, but I can sit with her so that some small part of her knows that when she wakes up we’ll be here.
That the morning will be hard, but it will be at least a little better.
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