An Ethereal Dilemma

Gosh, already just a day or so in and the fandom is atwitter with discussion regarding those last few minutes of the premiere episode. Which, you know, was likely the point; a television show’s goal is to get people talking. So let’s talk about Claire and her controversial ether use.

I feel compelled to address a certain narrative that has emerged since the episode and it is this: because Claire is a physician she would know how dangerous using such a drug would be and she could therefore never use it on herself.

This is patently false. Substance abuse and addiction exist among medical professionals and knowing the dangers of a drug is often not a deterrent. Overall, healthcare professionals are 10-15% more likely to develop substance abuse problems compared to the general population (source). Doctors, nurses, and other medical professionals suffer from extremely high rates of compassion fatigue, depression, career burn-out, exhaustion, and anxiety. Additionally, in the United States, an estimated 300-400 doctors die by suicide each year, which places this group at a risk rate of more than double the general population (source). And if you have a medical professional in your life, especially one that has been in the trenches these past two years, I encourage you to reach out and check in and let them know they’re appreciated and you love them. (Personal side note, the suicide rate is even higher among veterinarians, and I know several colleagues who have died by suicide. If you appreciate your veterinarian, let them know…kind words stay with us for a long time).

Healthcare professionals who work in anesthesiology, especially, are prone to substance addiction. According to a 2005 study, 80% of anesthesiology residency programs in the United States reported experience with substance use among its residents (source). And this actually shouldn’t be surprising— it’s an incredibly high-stress environment with relatively easy access to medications.

So knowing drug use is dangerous isn’t always a deterrent, even among healthcare professionals. The mechanisms of drug addiction are complex, and I am in no way an expert on the subject; I’ll let the specialists out there comment on addiction as a disease and I’ll only say there are tons of different factors (socioeconomic, environmental, medical, brain chemistry, etc) that contribute to substance use.

So knowing all that, the question still remains whether we think Claire would use ether as a form of self-treatment. Well, we should probably look at what other options might have been available to someone suffering from PTSD in the eighteenth century. But first, let’s discuss what ether actually is.

Ether, as we refer to it, is usually diethyl ether— a colorless, extremely flammable, sickly-sweet smelling liquid that was commonly used as an anesthetic induction agent up until the middle of the last century. We rarely use it anymore, as there are much better and safer agents that have been developed over the last seventy years. It still has the occasional place in medicine, however, especially in developing countries where it is not so cost prohibitive as other drugs. In the United States it was mostly phased out by the 1960s, but as a practicing surgeon in the 1950s and 1960s Claire would have been more than familiar with its use and properties.

Ether can be produced by mixing ethanol (that’s the alcohol we drink) with a strong acid, such as sulfuric acid. In Colonial America sulfuric acid was referred to as “oil of vitriol” and was derived from pyrite (iron disulfide, aka “fool’s gold.”)

So that’s ether. My personal experience with it as a veterinarian has only ever been to use it to remove tape that is stuck on surfaces…it works amazingly well to dissolve glue. It evaporates quickly, feels very cold, and its smell is extremely distinct. In fact, I once had lunch with my grandmother after using it and she caught the faintest odor of it on my clothes, stirring up all sorts of unpleasant memories from her childhood.

So what other drugs existed in the eighteenth century that might have helped someone manage their PTSD? There’s obviously alcohol, but Claire would likely avoid too much alcohol if she thought she might have to be in service as a doctor. Most cannabis in the colonies was cultivated for hemp production rather than for marijuana, so its use as a mood-altering drug would have been pretty limited (although book readers know people did find ways to get their hands on recreational cannabis). And then there’s laudanum and other opiates, which are highly addictive.

So back to Claire. A main argument I’ve seen coming out of the fandom since the premiere is that Claire’s ether use is wildly out of character; Claire in the novels does not do this, so this is a plot device created for the show.

And I agree- this is something that is wildly out of character for Claire. But that’s the whole point. She is desperate and she is human. Think of the times in our own lives when we’ve exhausted our normal coping mechanisms, only to still find ourselves in the same state of fear or despair or depression…we find ourselves willing to try anything, bargaining for a chance to just make things feel normal. The fact that Claire is doing something that is dangerous and out of step with what we know about her undermines just how serious her PTSD really is.

I can never presume to speak for the writers; I have no insider knowledge whatsoever. But I believe the writers are setting up Claire’s ether use as a tool to illustrate her character arc for the season. All the characters will be struggling with an internal conflict against the backdrop of a larger conflict, aka the Revolutionary War. And the first episode of this season did a pretty good job of laying down the beginnings of all those personal endeavors. And there is likely a bit of symbolism for a season based on a novel entitled “A Breath of Snow and Ashes;” we are perhaps examining the breaths characters take, full of ether or otherwise, as they move along their respective journeys.

So I’m going to be patient. Claire is a character worth rooting for, and so if this is part of her larger character arc this season I will cheer all the more for her success in overcoming this. But maybe watch those candles around the chemistry equipment, eh?

Slàinte

Editing to add- this is a good article with Diana Gabaldon’s thoughts on this: https://thedipp.com/outlander/diana-gabaldon-interview-season-6-premiere-claire-ether

Editing to add #2- a reader suggested a rereading of Chapters 94 and 95 of An Echo in the Bone; the book’s title and those chapters’ contents are applicable to this discussion.

Editing to add #3- SAHMSA is available for individuals and families seeking confidential treatment referral and information for mental +/- substance use disorders: https://www.samhsa.gov/find-help/national-helpline