About fifteen years ago, I acted for a time as what might be called the vulgarity correspondent of a British newspaper of enormous circulation, whose own attitude towards vulgarity could best be described as ambivalent. In theory, it was against vulgarity; but in practice, it did much to advance vulgarity’s cause.
The newspaper would send me wherever adolescents and young adults were gathering in large numbers and behaving badly, so there was no shortage of material. Once it sent me to the Balearic island of Ibiza, where there were nightly drunken saturnalias on the beaches and in the streets. The motto of the thousands of young British holidaymakers was an adaptation of a famous Churchill speech made during the war: ‘We shall vomit on the beaches, in the fields and in the streets; we shall never be sober.’ And they were proud of their disgusting behaviour, exhibitionistic of it.
What most struck me on the island, however, were the names of the two main nightclubs, Amnesia and Manumission: forgetting and release from slavery. They were giant institutions, not like the nightclubs at the time of my childhood: great hangars of noise, drunkenness, drug-taking and casual sex.
Forgetting and release from slavery! As desiderata, what a picture of the life of the clients that the names of the night-clubs implied! I was already familiar with the notion of drinking to oblivion as the highest pleasure that social life could afford; often I had listened to young people talking to one another on buses and trains, saying that they had had a wonderful night the night before because they could remember nothing of it. Because, not despite, their amnesia.
But what was the slavery from which they wanted release? More than one possibility comes to mind. Perhaps it was the slavery of having to earn a living, often in a capacity below that which their education had led them to expect or hope for. Perhaps it was the slavery of social convention from which they sought release (though, acting in crowds, they were deeply conventional people). Perhaps, again, it was the slavery of consciousness, the sheer inescapability of thought. Many a patient has asked me for tablets to help him to stop thinking: not any particular thoughts, but thoughts in general. If I were opening a new night-club in Ibiza in competition with Amnesia and Manumission, I would call it Anaesthesia.
An article in a recent edition of the New England Journal of Medicine draws attention to a sudden increase in the number of calls from American doctors to Poison Information Centers about their patients’ reactions to synthetic cannabinoids taken for recreation. According to the Center for Disease Control, such calls in the first five months of 2015 were 339 per cent more numerous than in the same months last year; and of 2961 calls whose medical outcomes were known, 335 were deemed life threatening or permanently damaging, with fifteen deaths possibly (though not certainly) attributable to the consumption of such drugs.
These figures do not mean an awful lot by themselves, but a colleague in the hospital in England in which I used to work tells me that in the last five years several cases of intoxication a week have been admitted, such that the staff have a word of their own for the drugs: noids. The hospital is now able to screen agitated, confused or somnolent patients for noids within two hours.
The noids are produced in informal chemical factories, and no sooner does the government ban one noid than the chemists in the factories develop another. Since the banning always lags behind the development, there are shops and internet sites that sell new noids in perfect legality, though hypocritically claiming that their products are not to be consumed, but used only as incense. Some of the internet sites promise same-day delivery, as if the matter were urgent.
The names of the products are intriguing and perhaps emblematic. Some are merely antinomian: Voodoo Gold or Damnation, names to attract suburban Satanists. Others, such as Pandora’s Box, suggest the release of one’s inner demons, or perhaps of one’s talents and abilities (though the mythological precedent is not an altogether happy one). Space Cadet suggests either the exploration of that vast vacuum known as one’s inner space, or being spaced out.
But the names that most caught my attention were Exodus and Annihilation. From what captivity were the consumers of Exodus seeking escape? Who was their Moses (or their Charlton Heston)? To what Promised Land were they going to be led by this noid?
Perhaps the answer is to the land of Annihilation. If I say that I think this is sad, no doubt someone will reply that ’twas ever thus, Man has always sought chemical oblivion. Maybe so: but what then of the immense progress that we think that we have made?
 N Engl J Med 2015; 373:103-107July 9, 2015DOI: 10.1056/NEJMp1505328