Psychedelic Psychotherapy in the 21st century
“Anything goes” –Paul Feyerabend
Paul Feyerabends “Against Method” (1975) was an awakening to the philosophy of science. It stood in scientifically anarchistic opposition to the opinions of consensus science and methodology. This is not a trivial matter; as has been evidenced, many revolutions and paradigm shifts in scientific thought have not come about from studiously adhering to what is already known, but on the contrary, have come into existence precisely because those with an innate curiosity have sought answers by challenging what is already known. With this in mind, the prospect of utilising psychedelic compounds such as N,N di-methyl-tryptamine (DMT) and psilocybin for purposes of therapy should not be met with scourge, or ridicule; there is very good reason to address this within the psychological community. Dr. Richard Strassman’s (1995) studies into the properties of DMT and its effects on human consciousness brought a renewed interest into the psychological study of psychedelics. The Multi -Disciplinary Association of Psychedelic Studies (MAPS) has, since 1986, stood at the front line of contemporary research into the use of psychoactives and psychedelics for therapeutic purposes. Krebs & Johansen’s (2013) review on the relationship between psychedelics and mental well-being yielded results that were contrary to consensus opinion. Their 2012 paper revealed how the use of LSD (paired with therapeutic intervention) had a lasting effect on relapse into alcohol misuse (Krebs and Johansen, 2012). Though a divisive subject matter for government and public, it should be informed decision that leads to informed policy making; not unfounded bias. To be clear, this paper does not suggest, nor condone the legalisation of these substances; this paper is written to defend the right of science to investigate these substances.
A brief history of human interaction with psychedelics:
Conservative estimates conclude that human interaction with these compounds dates back as far as 10,000 years ago (Merlin, 2003; Schultes & Hofmann, 1979; McKenna ,1992), though there is no agreed definitive date. Human foraging is thought to have explained how these substances came into our species food chain, with repeated use leading to recreational or spiritual use. Although speculative, this repeated interaction may have contributed to religious /metaphysical/ divinatory concepts within the human mind (McKenna, 1992; Merlin, 2003; Schultes & Hofmann, 1979). Cross culturally from the Old world; cave paintings of mushrooms from late Neolithic Hungary and shamanistic rock art from Tassili-n-Ajjier, as well as Soma, the god plant, from ancient Vedic ceremony (thought to be the amanita muscaria mushroom (McKenna, 1992) are some of the earliest documented evidences of human use of psycho-integrative plants.
In the Amazon basin, tribal use of ayahuasca a powerful psychedelic brew (DMT) that combines the bark and root of two plants has been documented in tribal practice for millennia (McKenna, 1992) .One aspect of ayahuasca is the fact that neither of the plants can produce the effects by themselves, they are only active through symbiosis; that DMT in one plant becomes orally active with MAOI, an enzyme inhibitor, contained in the other (McKenna, 1984). R. Gordon Wassons (1957) article “Seeking the Magic Mushrooms” was one of the earliest papers to bring to the awareness of modern society the impact of psychedelic compounds and human consciousness (McKenna, 1992). Albert Hofmann, who first synthesised LSD in 1938, used Wasson’s samples to identify the active compounds of psilocybin. Scientific research into LSD and psychedelic substances was granted a brief window during the 1960’s, however the political climate, recreational abuse and lack of regulation brought a halt to scientific interaction with these substances. They were then scheduled as class A drugs (a position they still hold in Ireland today, 2014). Psilocybin has been placed in the most restrictive schedule of drugs in the Misuse of Drugs Act (Schedule 1 / Class A), defined as having no medical use and having high abuse liability. It wasn’t until American psychiatrist, Dr. Richard Strassman conducted his 1995 study on the endogenous molecule N, N di-methyl-tryptamine (DMT) that a renewed interest was born. In Strassman’s book “DMT : The Spirit Molecule” (2001), he notes that he spent five years seeking approval from various governmental departments, including the FDA, in order to conduct his research.
Psychedelics act on the same pathways as neuromodulators Serotonin and Dopamine, and also, by interrupting sensory binding pathways (Kent, 2010). This is due to the structural similarity of the molecules and the neurotransmitters themselves. Monoamines (containing one nitrogen group) are not able to pass through the blood brain barrier, however psychedelic molecules have a neutral charge; they are assimilated through and bind with dopamine and serotonin receptor sites (McKenna, 1992). Serotonin is a variant of tryptamine, and is believed to be responsible for a number of functions including: mood, depression, contentment, sleep and appetite. In conjunction, Dopamine is considered to be responsible for food, risk behaviour and the reward system. Different types of psychedelic effects are produced by how closely the molecules resemble serotonin / dopamine. Monoamines do not increase the firing rate of neurons, they tune the spiking rate; meaning they make neural assemblies more or less responsive to stimulus (Kent, 2010).
DMT binds to the same receptor sites as serotonin, and though an increase in serotonin generally causes relaxing sensations, DMT is different; though not acting antagonistically. DMT is considered to be a partial and /or full agonist at all serotonin (5-HT) receptor sites, affecting the release and efficacy of the neurotransmitter(Kent, 2010). The other psychedelics operate in a similar function, and the interaction at the neuromodulations sites causes modulatory signal interference that results in the sensations associated with these psychedelics: heightened awareness, mystical experiences, time distortion, visual hallucination and dreaminess or presence of other entities (Strassman, 2001).
Strassman’s (1995) study utilised the powerful and endogenous hallucinogen, DMT (di-methyl-tryptamine). DMT is found in most biological organisms (plants & animals); endogenous, being naturally, biologically occurring. The endogenous dose levels are not enough in themselves to produce the effects noted at higher levels, and part of Strassman’s work was to identify what purpose DMT serves in the human body. The pineal gland, lungs and intestines are the main locations of the molecule; as with other serotonergic psychedelics, the main mechanism of action takes place at the 2A receptor (Strassman, 2001). DMT was synthesised for Strassman’s experiment in a lab in Switzerland, sent to the US for testing, and the DMT crystals were then assimilated intravenously by the twelve participants. DMT was selected due to its hallucinogenic potency, as well as its fast acting, short lasting properties. Assimilation across the blood brain barrier is less than 1 minute, with effects peaking at 2 minutes, and effects fully resolved by 30 minutes (Strassman, 2001). The experiment itself was double blinded, and of the four dose (ranging from, low 0.01mg to high 0.4mg) amounts delivered to each participant. One of Strassman’s conclusions was that “DMT can be safely administered to experienced hallucinogen users in fully ‘psychedelic’ doses”(Strassman, 2001).
A study by Krebs and Johansen (2013) drew data from a US national survey (between 2001-2004) on lifetime psychedelic drug use and mental health. Their analysis comprised of 21,967 respondents and revealed no negative links between serotonergic psychedelics (LSD, mescaline and psilocybin) and their effects on mental health. Conversely, “they found some significant associations between the use of psychedelic drugs and fewer mental health problems”(Krebs and Johansen, 2013). Krebs and Johansen further noted how perceptions that are commonly associated or reported such as “flashbacks” were not supported in their review of nearly 22,000 lifetime users of serotonergic psychedelics, and more notably that the “results are consistent with assessments of the harm potential of psychedelics and with information provided by UN, EU, US, and UK official drug education programs; insofar as these sources do not conclude that psychedelics are demonstrated to cause lasting anxiety, depression, or psychosis” (Krebs & Johansen, 2013).
In Krebs and Johansen’s earlier (2012) study; utilising controlled doses of LSD (lysergic acid diethylamide), were found to have a significant effects on reducing the misuse of alcohol (paired with therapeutic intervention) across 583 participants. Their assessment stated “in a pooled analysis of six randomized controlled clinical trials, a single dose of LSD had a significant beneficial effect on alcohol misuse at the first reported follow-up assessment, which ranged from 1 to 12 months after discharge from each treatment program” (Krebs and Johansen, 2012). Given that their study had comprised data from a number of existing trials from the 1960’s and a sporadic amount from the 1970’s, their conclusion was one of surprise, as they go on to note “it is puzzling why this treatment approach has been largely overlooked” and that one of the four possible reasons was “the complicated social and political history of LSD led to increasing difficulties in obtaining regulatory approval for clinical trials” (Krebs and Johansen, 2012)
MAPS has supported a number of studies into therapeutic interventions using psychedelics and psychoactive substances. One study (Thomas, 2013) utilised an ayahuasca ceremonies paired with four day counselling, for problematic substance abuse. Participants, of indigenous Canadian origin, self-reported abuse of nicotine, alcohol and cocaine. Conclusions founded:
“This form of ayahuasca-assisted therapy appears to be associated with statistically significant improvements in several factors related to problematic substance use among a rural aboriginal population. These findings suggest participants may have experienced positive psychological and behavioral changes in response to this therapeutic approach, and that more rigorous research of ayahuasca-assisted therapy for problematic substance use is warranted” (Thomas, 2013)
Kumar’s (2008) current study is investigating the uses of Psilocybin-assisted Psychotherapy in the management of anxiety associated with Stage IV Melanoma. The utilising of psychedelics as a form of psychotherapy must fully recognise and take into consideration the associated ethical and moral principles. As with all non-ordinary states of consciousness, there is no way of knowing how a given individual will react; however careful medical and psychological screenings must be taken. Two large studies surveyed clinicians or researchers who had conducted LSD research or LSD-assisted psychotherapy and found the prevalence of psychiatric symptoms after participation to be very low (Kumar, 2008). Timothy Leary famously referred to “set and setting”, being that the mental set of the individual should be considered (psychotic, prone to psychosis, schizophrenia) and the environment in which the experience is conducted (peaceful, safe, relaxed). As Kumar (2008) notes comparatively, existing depression and anxiety treatments for those with stage IV Cancer include “benzodiazepines, and these can come with unwanted side effects such as sedation, memory impairment and physical dependence”. This is not to suggest psilocybin is without its risks to the user, though, if used correctly:
“Psilocybin likely produces intensely beautiful or moving and transformative experiences through the same processes as produce anxiety and panic. Psilocybin has minimal toxicity, and no one has reported a verifiable fatality from psilocybin”.(Kumar, 2008)
It would be naïve to assume that the body of knowledge and research conducted so far was sufficient to introduce these substances as a fully-fledged therapy. Psychedelic Psychotherapy is a model currently under investigation; it should be subjected to the same testing and scrutiny as any other form of therapy, medicinal or otherwise. There are innumerable therapies available to our societies, with no single intervention holding a primacy over any other. We do not understand how mind/consciousness is operating, let alone understand the ability of why it may not function “normally”, coupled with no real certainty of how to address our psychological issues. Whether employing CBT, ACT, Psychoanalysis, Psychotherapies, Counselling or medicinal Psychiatry, there is no guarantee these can resolve any mental difficulties for the individual. It is for the very reason that we all have individual perceptions and experiences of Reality; that a “cookie cutter” therapy approach will possibly never work. However, if we continue to explore and investigate the world around us, we will identify methods and approaches that appeal to different individuals, and if any one of the approaches identified works for any one person, then there is every reason to sustain and develop it, without prejudice.
Presently, what is of greater importance is the scientific right to investigate these substances, their properties, their effects and their potential use(s). Both LSD and DMT are well known for inducing spectacular and profound effects on the mind (Henderson and Glass, 1994; Passie et al., 2008; Strassman, 2001). The culturally historic use reveals a long history and relationship of humans exploring and investigating their conscious experience. One unique and fascinating aspect of psychedelics is that the experience is very real. The reports from the studies yielded some positive descriptions from participants:
“Some subjects emerged from the intoxication with new perspectives on their personal and/or professional lives. One said, “It changed me. My self-concept seemed small, stupid and insignificant after what I saw and felt. It’s made me admit that I can take more responsibility; I can do more in areas I never thought I could. It’s so unnatural and bizarre you have to find your own source of strength to navigate in it.” (Strassman, 2001)
As evidenced in this paper, a tide is slowly turning with respect to how our society views psychedelics; if we can utilise these substances to actively assist people in their lives, improve their mental well-being, provide them new perspectives, rebuild their perceptions of themselves, with no residual dependence on the substance, why would we not? People have and will continue to alter their consciousness with different substances (sugar/caffeine /alcohol/nicotine); this is part of human experience. However, it is only through research and experiment that we can make informed decisions about which substances are beneficial, or acceptable for recreation, to both the individual and society.
Feyerabend, P. (1975). Against Method. New York, USA. Verso Publications.
Kent, J.L. (2010) Psychedelic Information Theory: Shamanism in the Age of Reason. Seattle, WA: PIT Press & Supermassive LLC.
Krebs, T.S.; Johansen, P. (2012) Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials. Journal of Psychopharmacology, DOI: 10.1177/0269881112439253
Krebs TS, Johansen P-Ø (2013) Psychedelics and Mental Health: A Population Study. DOI:10.1371/journal.pone.0063972
Kumar, S (2008). Psilocybin-assisted Psychotherapy in the Management of Anxiety Associated With Stage IV Melanoma.
McKenna, T. (1992) Food of the Gods. Reading, GB. Bantam Books, Random House Group.
Strassman, R. (2001). DMT: The Spirit Molecule. Rochester, Vermont. Park Street Press.
Thomas, G. (2013) Ayahuasca-Assisted Treatment for Addiction. Current Drug Abuse Reviews.