Psychedelic Psychotherapy in the 21st century

Psychedelic Psychotherapy in the 21st century

 

                                           “Anything goes” –Paul Feyerabend

 

 

Introduction:

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.

 

Pharmacology:

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).

Research:

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)

 

Therapeutic model:

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)

 

Conclusion:

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.

 

 

References:

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

Retrieved From:

http://www.west-info.eu/files/LSDvsALCOLISMOJ-Psychopharmacol-2012-Krebs-0269881112439253.pdf

Krebs TS, Johansen P-Ø (2013) Psychedelics and Mental Health: A Population Study. DOI:10.1371/journal.pone.0063972

Retrieved From:

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0063972#pone-0063972-t004

Kumar, S (2008). Psilocybin-assisted Psychotherapy in the Management of Anxiety Associated With Stage IV Melanoma.

Retrieved From:

http://www.maps.org/research/cluster/psilo-lsd/pca1protocol.pdf

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.

Retrieved From:

http://www.maps.org/research/ayahuasca/

Mindaeterna interview with John Searle

John Searle is an American philosopher. He is most notably recognised for his pioneering “Chinese room” thought experiment and his contributions to AI arguments. A great deal of his work has focused on the philosophy of mind and the philosophy of language. He is presently Professor of philosophy at the University of Berkeley, California. I caught up with Professor Searle over email recently, to ask him some questions about his influences and his opinion of contemporary attempts to reverse engineer the brain.

Q.What sparked your interest on studies of consciousness; was it inherent from youth, or was it a particular influence / inspiration?

 A: I got into the study of the philosophy of mind from my studies in the philosophy of language.  I assumed that language was based on pre-linguistic mental capacities, and I needed an explanation of those in order to provide a foundation for my studies in the philosophy of language.  This incidentally is characteristic of philosophy: you build the foundation after you build the house.  First I developed the theory of language, and then I explored the foundations of that in the theory of mind.

To my utter amazement, I found that most contemporary philosophers and psychologists said things about the mind which were not just false but ridiculous.  Some of them even denied the existence of consciousness.  So I started engaging in debates.

Q. Your pioneering “Chinese Room” thought experiment features in most  psychological/philosophical textbooks; when you were studying at college level, what were some of the theories  that had a big impact on you?(positive or negative).

A: The book that made the biggest impression on me was Wittgenstein’s Philosophical Investigations, which was published when I was an undergraduate.  I read it carefully and in a sense much of my work was an attempt to answer it.  Wittgenstein says it is impossible to develop general theories of mind and language.  I am trying to do exactly that — general and comprehensive theories of mind and language.  So Wittgenstein had a negative influence on me in that he challenged me to try to refute him, and I have in fact tried to do that.

The work that had the most obvious influence was Austin’s Theory of Speech Acts, which I knew only from his lectures, and in a way my first two books were an attempt to develop that theory of speech acts that went beyond Austin’s.  The single greatest philosophical influence on me was my tutor in philosophy, Peter Strawson; he provided me with a model of philosophical investigation and that had a big influence on me.

Q. Current experiments, such as Henry Markram’s ( IBM supported)” Blue Brain project are aiming to reverse engineer the human brain with supercomputers.  Given the technological advances (and Moore’s law), what is your opinion on this type of present day research?

A: I believe we will understand how the brain works when we figure out how it works as a biological mechanism. That means we have to respect the specific physiology and biochemistry of the phenomena in question.  Computer simulations of the brain have the same usefulness in studying the brain as computer simulations of the stomach have in studying the stomach.  The computer is a useful tool, but it is no substitute for investigating the organ itself.  The idea that all the brain does is compute in some technical computational sense is absurdly false because we know that the computation is defined purely syntactically in terms of symbol manipulation, and we know that the brain has something in addition to that, it has actual mental contents both conscious and unconscious.  Nobody has the faintest idea how to make a conscious computer, and Moore’s Law is no help since it is in general irrelevant to the creation of consciousness.  So, to repeat, computational simulations will be useful in a science of consciousness in a way that they are useful in a science of digestion, or for that matter a science of geology or biology.  You cannot do any advanced science nowadays without using computers probably because the sheer amount of information processing that you have to undertake requires some mechanical aid.  The mistake is to suppose that the computer simulation is somehow the real thing.

There are two mistakes that are pervasive in this discussion.  The first, as I have already mentioned, is that it is a mistake to suppose that syntax is sufficient for semantics.  It is not.  But another mistake is to suppose that somehow or other computation names an intrinsic feature of nature.  And of course except for conscious computations done by a conscious human being, all computation is observer relative.  A phenomena is computational only relative to some outside interpretation of it.  This has the consequence that there could not be a computational account of consciousness because computation requires consciousness.  You cannot explain consciousness with computation, because the computation in question can only be explained in terms of consciousness.  All computation is either performed by a conscious agent or it is the kind of thing that some conscious agent could use or interpret as computational.  Either way, computation depends on consciousness.

Q. We do not (presently) know the locality of consciousness; and we believe that there is global network of neurons firing /communicating; how do you think we arrive at the sensation (or nomination) of “I”?

A: I think we do not have and could not have a sensation of “I.”  However there is no question that I have all of my experience as experienced by a single self.  Now the question is, How does the brain achieve that?  How does the brain achieve what Kant called the Transcendental Unity of Apperception?  And I think that is a fascinating question in neurobiology, and we will not understand the neurobiology of consciousness until we understand not only how the brain creates conscious feelings in the first place, but how it creates all of our conscious feelings at any moment as part of a single unified conscious self.  Now maybe the secret to answering the first question is to answer the second question.  If we got an account of how the conscious self was created, then it might be relatively easy to account for specific conscious experiences.  I do not know.  That is simply a speculation on my part.

Q. I’m a big fan of your “start with the facts” logic to looking at consciousness. It seems to me in this day and age with the amount of knowledge so far amassed, that this approach would benefit most disciplines; why do people dogmatically deny facts? 

A: Usually when people deny the facts, it is because they are in the grip of an ideology.  For a long time people denied the fact of consciousness, because they thought that somehow if you grant the existence of consciousness then you will be guilty of some sort of mystification.  To believe in consciousness you have to believe in the existence of the soul or something like that.  The important thing to see is that consciousness is a biological phenomenon like others, like digestion or photosynthesis.  It is biological and as such requires a biological explanation.  But people resist that because they are in the grip of an ideology.

Q. Wittgenstein said “It is not how things are in the world that is mystical, but that it exists” What do you think he meant?

A: What Wittgenstein was driving at is this: it is tempting to think that specific local features of our environment are mystical powers of wonder. Think of the fantastic power and complexity of the human brain, for example, or the very existence of the diverse forms that life takes in all the different parts of the world, or the sheer human achievements in such fields as philosophy, science, and poetry.  What Wittgenstein is saying is that there is a much more astounding, much more mystical, fact than any of these, and that is the fact that anything exists at all.  It is not how things are, but that anything exists at all, which is an amazing, astounding, and mystical truth.

Q. You have been given the opportunity to place one earthly possession into a capsule. The capsule will sent out into the cosmos; only to be found by an intelligent alien species millions of years from now. What will you send?

A: I think it is part of our provincial egotism that we think we have to select what would be most interesting to some future civilization.  I would like to turn the question around.  Suppose there were an intelligent alien species millions of years ago and they wanted to send something in a capsule to be found by people like us, that is to be found by “an intelligent alien species millions of year hence.”  What should they have included in the capsule?  We will assume, which is not at all obvious, that they had both a language rich enough to represent the things that most interested them, and furthermore that they had a written form of the language or some form that enabled it to be preserved through time.  What sorts of linguistic artifacts should they then send us?  I think an account of what sort of beings they were, what sort of lives they led, what mattered to them and what did not, what sort of intellectual achievements they made, if any, all of those things would be interesting to us.  And I think those are the kind of things that we might put the mirror image of what I think is the correct question.  The correct question is, What should the people in the past have sent us?  And given the answer to that question, we can answer the question what should we send to intelligent beings in the future?

On Structural Differential: A brief overview

Alfred Korzybski’s structural differential represents the process of abstraction that is occurring at any given moment as we perceive reality. Korzybski utilises the word “abstraction” because as we move from the event, or happening, up to the point that we can communicate it (to others, or to ourselves linguistically and form inferences) there is a chain of abstraction occurring. That is to say, that the word is not the thing it represents. Furthermore, our knowledge of anything should always be viewed as somewhat incomplete; there are many complex processes occurring that are beyond what we can actually perceive. Our perception involves the brain making a representation. The objects you perceive look how they do because of your nervous system; so there is no “true” way anything can appear, only your representation, how it appears to you (or to clarify, how it appears to a human nervous system). “Science and Sanity”(1933) is a unforgiving 900 pages, and not the easiest thing you’ll ever read, however Korzybski’s concepts are fascinating. Here is my own (crude!) guide to the structural differential.

This is my interpretation; I do not claim to be in anyway proficient at general semantics. I just wanted to share the viewpoint.

To fully appreciate this, try reading:

Korzybski, Alfred (1933) Science and Sanity: An introduction to non –Aristotelian systems and General Semantics, 5th Ed., Englewood, New Jersey, USA, The Institute of General Semantics.

Event process level (Reality)

Quantum processes* / Cellular & Molecular processes. With the correct instruments we can detect these processes, but our nervous systems without these instruments cannot. However these processes are occurring all the time. *Our present model dictates there is a limit to how much we can know at this level; as per Bohm’s interpretation; it is not inconceivable that there is a level beyond this (hidden variables).

Object level (experience)

This is what we perceive (abstract) through our nervous system. Note: This is still on a silent level; we have not “said” anything yet, internally or externally. We have abstracted from a previous level. External energies (quanta) to biological/neurological processes (e.g transduction) to the perception of the object itself.

Descriptive level:

An “Apple”; the word – apple. Linguistically, we have given a description to our perception; this in turn is a further level of abstraction. The word is not the same as the thing it describes.

Inference level (etc.)

We make inferences about objects / beliefs /events contained in the world. E.g “All apples taste sweet” or “I think all apples are horrible”. These inferences continue to form lower/higher inferences; E.g “People that eat apples are great to be around” based on anything we wish to consider true/false. Our inferences are infinite. These inferences connect back to the descriptive level, back to the objective level, back to the event level. We see then that all levels are contained in the event level.