The procedure can shatter silence almost magically.
Captain Jack Shale is a Navy psychiatrist who occasionally is called upon to administer truth serum. That’s the outdated lay term for Amytal, a central nervous system depressant derived from barbituric acid. Shale estimates that since 1975 he has done maybe 30 or 40 so-called “Amytal interviews,” enough for him to be considered a minor expert. The technique is required so rarely that not many people bother to learn it, he says. “It’s a fascinating little backwater of psychiatry.”
It is required, generally, on those rare occasions when an individual loses the will to speak. Not the ability, that’s aphasia, a condition that results when a stroke or a head injury or infection or some kind of lesion destroys tissue in the speech centers of the brain. “The aphasic person may very well want to communicate, and usually does,” Shale explains. Aphasia victims struggle for words that don’t come. They may or may not understand what is said to them. The damage done to them may be subtle, leaving intact most of the power of articulated speech but erasing certain words from vocabularies. “With aphasia, they can make noises,” the doctor says. In contrast, patients who are mute make no speech sounds whatsoever. “They have the physical capacity to speak. But generally for some psychological reason, they are choosing not to. Now, that’s a loaded phrase: ‘choosing not to speak.’ That suggests they’re rational.... But the choice may be irrational, based on some pathological process.”
Some mute patients respond to simple directives (“Raise your right hand”), but Shale says in many cases, the patients behave as if they’ve tuned out the world. “They may have their eyes open or closed. If their eyes are open, they tend to stare and not fix on an object passing before their eyes.” Confronted with such a person, how’s a psychiatrist to begin to know what the problem is?
That’s where the Amytal comes in. Shale says the basic principle underlying its use is as simple as the phrase in vino veritas. “It’s obvious to most people who drink alcohol or have ever been around people who drink alcohol that even taciturn people become rather loquacious after a couple of drinks. And talkative people become almost unbearable.” By the 1930s and ’40s, researchers began to realize that not just alcohol but some of the other central nervous system depressants have the same (or greater) tongue-loosening effects: the benzodiazepam family (which includes such drugs as Valium and Xanax), Pentothal (a slightly longer-acting version of Amytal).
A dissimilar group of drugs — the family of stimulants — also tends to make people talk more. “Anybody who’s seen someone who’s tweaked on crystal knows they can’t shut up,” Shale says. “Now, central nervous system depressants that make people more loquacious tend to put people to sleep. Stimulants tend to wake them up.” The ideal talk generator would seem to be some combination of the two, “And in fact that’s where you get the maximum effect.” Shale says when he did his first Amytal interview as a psychiatric resident at Harvard’s Massachusetts General Hospital, it was the common practice to combine the two. “We got wonderful results! You really had tremendous access to mute patients.”
Drug companies stopped manufacturing injectable amphetamines around then (“because it was so abusable,” Shale says), and now Shale combines the Amytal with a dose of Ritalin, another type of stimulant. The result “feels just like getting drunk,” Shale says. Most people experience a mild sense of euphoria, plus they also report an intense feeling of intimacy. “I mean intellectual or emotional intimacy, where they want to tell the other person about their deepest secrets.”
At its most effective, the procedure can shatter silence almost magically. Shale recalls one of his first cases, from his days as a resident 16 years ago. A priest, maybe 50 years old, didn’t show up for Mass one day and was discovered in his rectory, staring blankly. He seemed physically sound, so once transported to the hospital he was placed in the psychiatric ward. There he lay in bed, unresponsive to everything except for the appearance of female nurses. “Every time a female nurse came in the room, he would start masturbating. For male nurses, he didn’t do anything.” After a few days, the psychiatric staff decided that Amytal might open some doors. At first he resisted even the simple instruction to start counting. Within moments, however, there were physical signs that the drug had begun working, and the priest began answering simple, non-threatening questions. Shale gently led him to the subject of his problems, and the patient described sexual abuse he’d suffered as a child. Recently, he’d been experiencing agonizing depression and guilt. “He’d had homosexual leanings, but he’d never had any sexual contact because of all this guilt. He was depressed that he hadn’t lived up to his father’s expectations.”
Once alerted to the basic problem — depression — the hospital staff administered four or five treatments with electroconvulsive therapy (brief jolts of electricity administered to part of the brain). Within ten days, the priest was discharged from the hospital. He had forgotten everything he’d said in the interview. “He had just sealed the whole thing over,” says Shale. But “he did wonderfully.”
These days, Shale couldn’t get such speedy results, he complains. “Now everything’s bureaucratic. They say they want informed consent. Excuse me? How are you going to get informed consent from a guy who can’t even nod his head?” At the time of Shale’s residency, “We didn’t use informed consent. We’d do it the same way we would do a spinal tap. Or when someone comes in and they’re unresponsive. One of the things you do is start an intravenous fluid and give the patient 50 cc’s of glucose and water, in case he’s in a diabetic coma. You just do those things. Bam. And the guy responds or he doesn’t respond. And my attitude to this day is that’s the way it ought to be. But everyone’s so afraid of lawyers. With good reason.”
Shale says for virtually every Amytal interview he does, he’s now required to seek a special, one-time credential, a process that takes weeks. Besides working out of an office at the Miramar Naval Air Station and teaching classes at the UCSD Medical School, he spends some time at the County Mental Health facility. He cites the example of one man he saw there in 1990. Rousted out of the downtown bus station by police, this man wouldn’t respond to the officers’ questions, so they dumped him on the county facility, where “he was essentially mute,” the Navy psychiatrist says. It took 27 days for Shale to get the permission to do an Amytal interview. Under the influence of the medicines, the patient felt secure enough to confide his plight. “He was absolutely convinced he would be taken back and charged with molestation of his daughter back in New York State.” In the midst of a messy divorce, he’d been accused of the sexual abuse by his wife, an accusation that he claimed was totally untrue. He had escaped one step ahead of the sheriff and had been living hand to mouth for several months, winding up in San Diego. He felt terribly depressed by his inability to see his child. Shale says, “Once we had all this information, social service got involved and we got him out of the hospital. We got him into a crisis house and helped him deal with his legal problems back in New York.... Now the county spent, what, $300 or $400 a day to keep this guy in bed. And he was there 27 days before I got to do the interview. From the time I did the interview, he was out in 48 hours. Which is not atypical.”
Shale says this man’s diagnosis — severe depression — is a common cause of mutism. Alternatively, some patients are psychotic, like the fellow who, once talking, explained that he had been unable to say a word because he knew that if he did, someone would flip a light switch that would destroy the world. “He was crazy. Crazy as a fish in a tree,” says Shale. “He was protecting the whole world by virtue of his remaining mute. Very powerful guy.”
On rare occasions, Shale has used Amytal on patients who weren’t mute. He recalls one man in his late 30s who wound up in the urology service of one local hospital because he’d lost most of his penis to gangrenous infection. He’d shown up in the emergency room with a vague story about being bitten by a spider while out cutting the grass. But he seemed lackadaisical about what had befallen him. “The urologist figured most people would be pretty upset about it,” Shale recalls. The urologist called in Shale, who suggested that Amytal might help the man better recall the details of the injury. The man consented and under the influence of the drug revealed that he was a transvestite who had triggered an infection in his penis by putting a rubber band around it, a ritual he had engaged in routinely to help conceal his sexual identity.
Shale says this patient “was not being intentionally deceptive,” with his tale about the spider bite; that was simply his defense against the hideous reality of what had happened. “After we did the Amytal interview, we let the guy go to sleep, and we went back a few hours later and he claimed he couldn’t remember what he’d said. So we played him the tape. Then he started to cry and talk about it. We had broken through the denial.” Shale says psychotherapy later helped this man cope with his sexual ambivalence.
Shale says the Amytal has failed to work for maybe half a dozen of his patients. In the most recent case, the psychiatrist suspects that the patient was dissembling in order to secure a warm place to sleep. “He was what is today called a homeless person — what used to be called a vagrant or a bum. He was discharged soon after the interview, and I think he finally just got fed up. Or the weather got warm or something.”
In no cases can the medicine force someone to speak honestly when he doesn’t want to do so, Shale contends. “The business about truth serum is hogwash, basically. All you get [with Amytal] is no more and no less than a somewhat talkative patient. So just as when you become drunk, you’re less able to defend yourself either intellectually or physically, as you become intoxicated with amo-barbital, you’re less able to defend yourself intellectually and physically. Now if you’re a well-trained spy for the KGB or the CIA, and I give you some Amytal, you can continue to lie to me. No problem. Your lie may eventually get a little garbled because you’re intoxicated from the medicine, and you may talk a little too much. But you’re still able to lie.”