On 12 August 2017, P.E Moskowitz almost died in a terrorist attack – and not for the first time. A writer and journalist, Moskowitz was in Charlottesville, North Carolina, to report on “Unite the Right”, a rally which saw white nationalists from across the US marching with torches and chanting racist and antisemitic slogans. To begin with, as Moskowitz joined a crowd of thousands of counter-protesters, the atmosphere was thrilling. “Yes, scary too. But mostly it felt exhilarating because, for most of the day, it seemed like we were kicking the Nazis out of town,” they write in their compelling new book, Breaking Awake: My Search For a New Life Through Drugs.

The exhilaration wasn’t to last. Later that day, a white supremacist drove a car through the crowd, killing activist Heather Heyer, injuring dozens of others, and forcing Moskowitz and their friends to run for their lives. A month later, they woke up in a hotel room to find themself hyperventilating and shaking uncontrollably, feeling as though they existed in a new and intolerable reality. “That state of life-ruining craziness, of PTSD, of nervous system deregulation, of dissociation, of breakdown – whatever you want to call it – lasted for years,” they write. This breakdown was compounded, they later realised, by the earlier trauma of surviving 9/11, fleeing their school in downtown Manhattan as the towers fell, and a growing ambivalence about their gender identity. 

While complicating the idea of linear recovery, Breaking Awake is partly a memoir about Moskowitz’s efforts to piece themselves back together, a journey which involves psychoanalysis, various forms of therapy and drugs both legal and illicit: think Eat Pray Love but with ketamine instead of pasta. It is also a work of political polemic, rigorous social history and cross-country reportage, which takes in New York’s queer rave scene; a non-profit handing out free heroin on the streets of Vancouver, and a slick corporate conference dedicated to psychedelic research (where, incredibly, one of the exhibitors is named “Woke Pharmaceuticals”.) 

As well as writing for publications like New York Magazine, GQ and The Nation, Moskowitz publishes a Substack – Mental Hellth – which focuses on mental health, the pharmaceutical industry, therapy culture and our emotional lives under capitalism. They return to these themes in Breaking Awake, offering an incisive critique of various popular assumptions about the origins of distress and how it should be treated. I spoke with Moskowitz over Zoom about why they have found diagnosis unhelpful, the problem with the idea that depression is caused by chemical imbalance, whether we should be able to buy whatever we want at the “literal drug store”, and more. 

In Breaking Awake, you’re interrogating the binary between prescribed medications on one hand and illegal drugs on the other. Why is that distinction misleading?

P.E Moskowitz: There’s two answers to that question, one based on my personal thoughts and one based on history. My personal opinion, based on my own reporting and experiences, is that we all take drugs for the same reason: when I had a near-death experience and a mental breakdown and needed to make my brain feel less bad, drugs like SSRIs, Adderall and mood stabilisers helped to do that. I used a bunch of illegal drugs and they also helped. And whether I was interviewing people in the streets of Vancouver or Philadelphia or people on SSRIs in the suburbs, they all said the same thing – that they were trying to ameliorate the pain of daily existence. 

As for the historical answer, like so much else it comes down to racism. When there was an influx of immigrants to the US in the early 1900s and late 1800s, there was a big media scare about Chinese men luring white women into opium dens and getting them addicted. But at the same time, white people were being given so many opiates through doctors and this was considered a medicine, even though it was essentially the same drug. So it’s always worked like that: ‘medication’ is for the good, rich or least middle class white people, and drugs are for the bad, other people.

Self-medicating using drugs is generally considered to be harmful, but you make the case that it can be an effective or legitimate way of coping with life. Why is that?

P.E Moskowitz: I think if we accept that some drugs are good for us, we have to accept that they can all serve a purpose. If you’re going to tell someone not to use weed or LSD then you should also tell them not to use SSRIs or ADHD medication, which is just a low and regulated dose of what is essentially street speed. Drugs are effective modifiers of our brains and our psyches, and allow us to fit into a society which is incongruous with living a good life. If we’re forced to sit in front of a computer for eight to ten hours a day, if we’re isolated from the community and feel despondent about the state of the world, it turns out that speed helps us feel better. I take Adderall almost every day because of that and it works.

I think we should give the same sympathy we give to people who ‘need’ to take things like Adderall to people who use illicit drugs, because they’re trying to modify their brains in the same way, to fit into this system or to ameliorate the pain that the system causes. Does that mean that doing fentanyl is the same thing as taking an SSRI? No, it’s much more risky, but the goal is often the same.

You argue that some of the problems caused by addiction can be attributed to a lack of regulation, and could be ameliorated by harm reduction measures such as providing reliable access to tested drugs. But do you think there are any drugs that are just inherently harmful, and would be impossible to take safely even in a better world?

P.E Moskowitz: There are drugs I think are bad, but they exist for specific reasons which aren’t just because people want to take them. Fentanyl is bad, for example, and almost no one really wants to be doing it. They want to be doing heroin, which is like 100 times less powerful and, from what I understand, feels much better. But fentanyl exists because heroin is more expensive to produce and, thanks to prohibition, much harder to smuggle across the border these days, so fentanyl becomes the de facto drug for people who are addicted to opiates.

If we want to address the harm of drugs, we have to address the reasons they’re used. If you really cared about people not doing the bad drugs like fentanyl, then I think you would not only do harm reduction, where you get people onto safer, regulated versions, but you would also change the circumstances which lead people to use those drugs in the first place. 

We feel sad and anxious because our lives suck, but we’ve been sold the idea that it’s all our in brains

If we dont change those circumstances, do you think legalising drugs would make things better? Or do we need to have the kind of social transformation you're advocating for first? 

P.E Moskowitz: A system where every drug is legalised and regulated would be better than what we have now, which is just people buying them illegally, not knowing what they’re getting and overdosing because they don’t know the strength. But it wouldn’t solve the root cause of the problem, which is that we’re using these individual salves for our discomfort, pain and despondency, and there is no individual solution to the crisis of capitalism. Until we address that massive amount of pain, until we provide everyone with housing and jobs, people will continue to use too many drugs. 

What is the problem with thinking about mental illness in terms of chemical imbalance?

P.E Moskowitz: First of all, that theory has been around for over 30 years and it’s still never been proven. Researchers did a study where they asked a few hundred people what they thought caused depression: most of them said chemical imbalance, and the number one source for that information was prescription drug advertisements. So this idea is 1) advertising and 2) attractive to people because it allows them to ignore everything that’s making them depressed or anxious. It’s much easier to think that you can control your brain through a chemical than it is to look around and think, ‘maybe I hate my job, maybe I hate my husband, maybe there’s no way for me to be happy in this suburban existence where I have few friends and can’t even walk down the street.’

You also write about how diagnosis has been unhelpful for you. Why is that?

P.E Moskowitz: As with the chemical imbalance theory, it mislocates the problem. If you believe that all of your symptoms are because you have ADHD or something called clinical depression, that disincentivizes you from actually looking at your life, understanding that, essentially, capitalism is to blame for your mental health and realising that many other people are in the same boat. If I have ADHD, but you have BPD, or if I have depression but you have generalised anxiety disorder, we believe that we’re dealing with these hyper-individualist problems, as opposed to realising that we’re all having slightly different reactions to same thing.

In a different society, we probably wouldn't need to be taking these drugs in order to function

Do you think there can be benefits to diagnosis as well? 

P.E Moskowitz: We have to be able to hold two things in our head at once. Cars are bad and we should probably just have public transportation, but if you live in bumfuck Iowa and there is no public transportation, I’m not faulting you for needing a car to get to work. It’s similar for diagnosis and medication. I ‘have’ ADHD – put that in quote marks, if you would. I’ve been diagnosed with it, I take Adderall and it helps me to get my proverbial car down the road to work. But that doesn’t mean that any of this is a good thing, right? In a different society, one in which the natural divergence in our brains, ways of being and personalities was respected rather than punished, we probably wouldn’t need to be taking these drugs in order to function.

So would it be better if we did away with diagnosis and people could just access medications they wanted to, without the need to go through a doctor?

P.E Moskowitz: The only good thing about medical gatekeeping is that it puts you under the care of a system. If you have a doctor monitoring your intake and figuring out which combination works best for you, that’s better than doing it all on your own. But we do a lot of work to justify what should be very obvious, which is that giving people amphetamines makes them feel better. The symptoms of ADHD are constantly changing, and I’m sure you’ve seen all these viral tweets and TikToks where it’s like, ‘did you know one symptom of ADHD is forgetting people when they’re not in the room with you’. That’s not true. None of this shit online is true, none of it is really studied, but we’ve decided that we need to call it something in order to justify the fact that taking a drug makes us feel better. I think it would be great if we could just admit that. 

What do you think are the limitations of drugs as a tool of liberation? I dont think youre doing this in the book but there is a slightly annoying version of this argument thats like, going to raves is a form of resistance!

P.E Moskowitz: The last section of the book is my reporting on the rave scene in New York, and drugs are obviously a big part of that. I think if there is any radical potential in drugs, it’s that they can help enable us to see a better life, a better future and a better collective vision of the world. You want to chase the feeling of togetherness. But the problem is that there’s no context through which people can have these realisations and then run with them in some other way. Drugs can glimpse a new future, but they can't build it for you. I’m very cynical when I hear people talk about the rave as a community and whatever – that’s not really true, because to build a community requires something beyond drugs. It involves providing for people, fighting for people and doing actual material things outside of your own head. 

In some ways the book rejects or at least complicates the idea of recovery, but would you say that you feel happier now, having been on this journey?

P.E Moskowitz: I feel much more alive, and that comes with feeling happier at times and also sadder and worse and less productive. I feel better and freer, and I also feel like my life is harder than it used to be, and to be corny about it, I wouldn't have it any other way.

The TLDR of it all is that we have to get weird with it, throw shit at the wall and see what sticks. There's no hero’s journey to follow, there’s no A to B to C. You have to think of your life less like a five paragraph essay or a fairytale about a prince slaying a dragon, and more like a Picasso painting. Just allow yourself to explode.

Breaking Awake is available now.

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