Can Psychedelics Have A Role In Psychiatry Again?

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Can Psychedelics Have A Role In Psychiatry Again?
Dr. Ben Sessa, Oxford
Br J Psychiatry. 2005 Jun;186:457

Ben Sassa's article is an official editorial of this journal, which is published monthly by the Royal College of Psychiatrists.

 

Introduction
Psychedelic drugs, such as LSD, Mescaline, Psilocybin, MDMA, DMT and their relations, occur in abundance throughout the natural world, and have been used by humankind for thousands of years.
In some cultures they are important tools for spiritual experiences, whilst in others they are labeled as dangerous drugs of abuse. What is less well known about these substances is the role they played in psychiatry for a brief historical interval. This article offers a short overview of this period and asks whether interest in these compounds might be emerging again.

Current Training and Knowledge about Psychedelics compared to 30 years ago
Despite their history, psychedelics have dropped out of psychiatric dialogue for today's trainee psychiatrists (Strassman 2001). In my own training, references to compounds like LSD, Psilocybin and MDMA were usually followed by statements such as 'have no medical use'. But I was taught about the acute emergencies or the social problems associated with their abuse.
Yet in the years between the first synthesis of LSD in the 1930s - and the disappearance of psychedelic research by the late 1960s, there was a furious growth of scientific interest in these substances. Many pioneers gave their careers to this field, hoping that psychedelic drugs could be the Holy Grail for psychiatry - like the microscope is to biology or the telescope is to astronomy - an essential tool to explore the parts of the internal world that are usually inaccessible (Grof 1993).

History of Psychedelic Research
Swiss chemist Albert Hoffman first synthesized Lysergic Acid Diethylamide (LSD-25) whilst studying derivatives of the fungus ergot for use as potential medicines. When he accidentally absorbed some LSD during a laboratory session there followed an intense experience of perceptual and emotional effects.
By the late 1940s psychiatrists were beginning to experiment with LSD as a tool, and in 1951 it was the subject of a presentation at the annual conference of the American Psychological Association. Initial work explored the possibility that psychedelics might be used as 'psychotomimetics' - to mimic the mental states of patients with schizophrenia (Osmond, 1957) - and many health professionals were encouraged to partake in self-discovery or shared psychedelic experiences with their patients. Other research looked into using psychedelic drugs as adjuncts to psychotherapy. The therapy took the form of two broad types: Firstly, Psycholytic (Mind Loosening) Psychotherapy involved taking low doses of LSD as part of on-going psychoanalytical therapy. The drug had a loosening effect and facilitated the exploration of repressed material. The second type, Psychedelic (Mind Manifesting) Psychotherapy involved preparation sessions without LSD, then one single large dose session that encouraged an intense reaction, followed by further non-drug sessions to explore the meaning of the material that emerged (Bakalar and Grinspoon, 1981).
By 1965 over 2000 papers had been published describing positive results for over 40,000 patients, taking psychedelic drugs with few side effects and a high level of safety (Masters and Houston, 1970). The techniques were applied to the treatment of anxiety disorders, obsessive-compulsive disorders, depression, bereavement reactions and sexual dysfunction, among others (Grof, 2001, Grof and Hallifax, 1977, Newland, 1962).
In the treatment of addiction, repeated controlled experiments demonstrated a consistent recovery and 6 month abstinence from drinking in 50% to 90% of subjects after brief psychedelic therapy (H.A. Abramson, 1967, Hoffer, 1970). Another area where therapy was used successfully was in relieving pain and anxiety in terminal cancer (Kast, 1964).

Problems encountered with previous research
Despite the volume of publications from this period, most of the published material refers to anecdotal case reports that are of little value by cotemporary research standards because they lack sufficient follow-up and control subjects (Grob, 1994). Even though results appeared promising, by the 1970s, under pressure from the U.S. justice department, virtually all research had ended. LSD had leaked from the scientific community to a wider audience. By 1966 LSD misuse had become a problem and its possession was made illegal. This prompted the scientific community to distance themselves from interest in these substances. Governments clamped down on research licenses and increasing reports of adverse drug reactions to psychedelics taken recreationally - as opposed to in controlled, scientific circumstances (which remained safe) appeared in the publications (Strassman, 1995). As a result, research use ceased while illicit use remained, fueled by a growing criminal distribution and financial system. Until very recently, research on psychedelic drugs has since been severely restricted - which explains our current population of psychiatrist's lack of knowledge.

Current Research
Since the 1970s MDMA psychotherapy has seen an emerging underground use by analysts. MDMA, strictly speaking an 'empathogen' rather than a psychedelic drug, is less intense and shorter acting than LSD. It offers a similar therapeutic potential for lowering patient's defences and aiding the psychotherapeutic process (Holland, 2001). A lifting of the government ban on psychedelic research in Switzerland between 1988 and 1993 allowed a resumption of psycholytic psychotherapy using LSD and MDMA for patients with personality disorders, affective disorders and adjustment disorders. A similar rethinking of psychedelic research policy took place in the US FDA and NIDA in 1990 (MAPS Newsletter, 1994-95). There are currently projects under development in Spain, Israel and the USA looking at MDMA-assisted psychotherapy in the treatment of Post Traumatic Stress Disorder and as a treatment for anxiety and depression associated with cancer. Between 1990 and 1995 extensive studies of DMT, a strong but short acting agent, were conducted on human subjects in the USA (Strassman, 2001). Other research includes a double-blind placebo controlled study in Russia using Ketamine in the treatment of heroin addiction, which has demonstrated improved rates of abstinence, maintained at 2 year follow-up (Krupitsky et al, 2002). Also in progress are studies looking at Psilocybin in the treatment of Obsessive Compulsive Disorder and for reducing anxiety and pain in cancer patients. All of this research is well summarized in the MAPS website.

On-going problems with current research
Whilst drug abuse remains a growing phenomenon in our global society the public and governments are suspicious of psychedelic research. The image of psychedelics, severely damaged by 1960s drug culture, is further spoiled by the drug use in today's rave scene. Finding unbiased information about psychedelic research is often difficult. But many of those early pioneers of psychedelic research continue to promote this research for the field of mental health. Dr. Humphrey Osmond, the British psychiatrist who in communication with the author Aldous Huxley coined the term psychedelic in the 1950s, strongly supported psychedelic research until his death this year aged 86, when he received a fitting tribute in the British Medical Journal (Tanne 2004). Albert Hoffman, who celebrated his 98th birthday this year, continues to campaign for research into medical uses for psychedelic drugs (Multidisciplinary Association for Psychedelic Studies website).
Researchers believe these drugs are important tools for further academic study. Their recognised psychological effects fit well into an approach looking for the neurobiological links between mental and physical states. And from a clinical point of view, the practice of traditional psychedelic psychotherapy - using the drugs as an adjunct to brief, time-limited psychotherapy - has much in common with the current practice of CBT.

Conclusion
In this respect perhaps it is surprising there remains such considerable ignorance about the potential of these substances from within psychiatry itself. As with Galileo's telescope and Darwin's suggestion of our ascendancy from apes, radical scientific challenges tend to take the form of an attack on the human-centric model of the world. In the light of this, research that explores alternative states of consciousness and then goes on to offer a viable neurobiological substrate for the very human experience of religious encounter, is bound to meet with objection from a generation of psychiatrists who have been conditioned to consider such work as 'mysticism'. Perhaps a more dispassionate criticism based upon scientific reasoning and not influenced by social or political pressures is called for if we are to truly investigate whether these substances can have a useful role in psychiatry today.

Dr. Ben Sessa MBBS BSC MRCPsych
Specialist Registrar in Child and Adolescent Psychiatry
Warneford Hospital, Oxford, UK
September 2004

Declaration of interest

None

References

1. Abramson, H.A. (1967) The Use of LSD in Psychotherapy and Alcoholism - Bobbs-Merrill, New York.
2. Grob, Charles (1994) Psychiatric Research with Hallucinogens: What have we Learned? - The yearbook for Ethnomedicine and the Study of Consciousness, Issue 3.
3. Grof, Stanislav (1980 / 2001) LSD Psychotherapy - Multidisciplinary Association for Psychedelic Studies
4. Osmond, Humphrey (1957) A Review of the Clinical Effects of Psychotomimetic Agents - Annals of the New York Academy of Sciences. 66: 418-434.
5. Hoffer, Abram (1970) Treatment of alcoholism with Psychedelic Therapy From: PSYCHEDELICS, The Uses and Implications of Psychedelic Drugs Doubleday & Company, 1970.
6. Hoffman, Albert (1980) LSD: My Problem Child. Published by McGraw-Hill Book Company
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10. Kast, Eric (1964) Pain and LSD-25: A theory of Attenuation and Anticipation In Solomon 1964:241-256.
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14. Mogar, Robert E. (1965) Current Status and Future Trends in Psychedelic (LSD) Research -- The Journal of Human Psychology, Vol. 2, pp147-166
15. Multidisciplinary Association for Psychedelic Studies web site - www.maps.org
16. Newland, Constance (1962) My Self and I Published by: The New American Library, New York
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20. Strassman, Rick (2001) DMT: The Spirit Molecule Pub by: Park Street Press, Rochester, Vermont, Canada.
21. Strassman, Rick (2004) Private correspondance via email.
22. Tanne, Jannice Hopkins (2004) Obituary for Dr. Humphrey Osmond British Medical Journal, Vol. 328 No. 7441

Dr. Ben Sessa's article from the British Journal of Psychiatry debates whether psychedelics can have a role in psychiatry again. On October 15, 2005, the Journal published four letters and a reply, commenting on the editorial and its urging for the resumption of psychedelic research. Ben also conducted an interview with Dr. Ronnie Sandison, inventor of the word "psycholytic.