The Degradation Drug
CARL ELLIOTT teaches philosophy and bioethics at the University of Minnesota. He is the author of several books, including Lonesome Whistle, about whistleblowers, which will be published next year.
It started with selfies. Hannah had never taken a selfie before, or even given the idea much thought. She was a tenured 39-year-old psychology professor at a New England college. But eight days after she started on pramipexole, a drug prescribed off-label by her psychiatrist for depression and anxiety, Hannah began taking photos of herself obsessively. She couldn’t explain the desire. At the time, it didn’t even seem especially strange.
Neither did the hats. She just felt like wearing them—or, really, any item that would cover her head. A gray wig. A red fedora. A spider-webbed fascinator. A vintage, canary-yellow beehive cap. Ordinarily Hannah was a modest dresser. But within weeks, she began ordering exotic clothing online, including flamboyant suits made for adolescent boys. “I had green velvet, red velvet, black velvet,” Hannah told me when we discussed her case. “I had my tuxedo. I had my plaids.” (To protect Hannah’s privacy, I have changed her name and some of the identifying details of her story.) Many of these outfits were impulse purchases. “Sometimes I could drop a grand in less than 30 minutes, waking up in the middle of the night to shop,” she said. One selfie from this period shows her wearing headphones, a short strapless dress, and a Batman mask. Men began to pay her a lot of attention. “I didn’t think to stop and analyze too much what was happening,” she said. “It was a constant rock ’n’ roll party in my head, and I was the star.”
Pramipexole, or Mirapex, was developed to treat Parkinson’s disease. As a dopamine agonist drug, pramipexole is believed to work by stimulating dopamine receptors in the brain that have degenerated. Hannah did not have Parkinson’s. She had struggled with depression and anxiety since she was 16. Along with Mirapex, which Hannah started taking in December 2014, her psychiatrist had prescribed a cocktail of psychoactive drugs that included lithium, Lamictal (lamotrigine), Xanax (alprazolam), and Provigil (modafinil). And the drugs worked. Hannah felt terrific. But patients on dopamine agonist drugs such as pramipexole can have trouble controlling their impulses—the impulse to gamble, to shop, to eat, to have sex. Hannah was never told of these potential side effects. She didn’t realize that her new personality might be chemically induced.
In July 2015, Hannah took a trip to Rome with her mother. Standing before Michelangelo’s in St. Peter’s Basilica, she had a profound religious experience that left her weeping. It felt as if a passage to a supernatural realm had opened up in her mind. Afterward, she began to paint nonstop, sending her bewildered mother out for art supplies. “One night in the hotel she caught me in the bathroom at three a.m., painting,” Hannah recalled. “I hadn’t gone to bed yet.” Within several months of her return to the United States, Hannah had rented a 650-squarefoot commercial studio and was painting more than 18 hours a day, mainly large abstract expressionist murals. Critics and gallery owners began to take notice. “My mind was on fire,” she said. “It was pure compulsion. It had to be done.” She would pace around the studio
