The Lancet: MAPS: The Trip of a Lifetime

The Lancet reviews Acid Test: LSD, Ecstasy, and the Power to Heal by veteran journalist Tom Shroder, highlighting how the growing field of psychedelic research is helping people overcome treatment-resistant medical conditions. The review examines the history of psychedelic research, details how drug policy laws are based on politics over science, and looks at how psychedelic therapy research has impacted the lives of MAPS Founder Rick Doblin, MDMA-assisted psychotherapy researcher Michael Mithoefer, and study participant Nicholas Blackston. "Everyone in this inspiring book comes to the same basic conclusions: that shifts happen when difficult feelings are accepted rather than repressed, and that psychedelic drugs do not create new worlds, but simply reveal what is already in the mind,” writes Tania Glyde of The Lancet.

Originally appearing here.

The last time I took an entire ecstasy tablet was some time in 1994. I was in a fragile mental state, with not really-friends, at a big, bassy, sweaty house party where I knew hardly anyone. This situation was pretty much the worst possible set of circumstances in which to take a psychedelic drug. I wouldn’t call what I took “MDMA”, because I suspect that was a relatively minor component of it. Black and white diamond patterns jittered before my eyes, and my throat dried up completely. I drank an enormous amount of water that I then threw up, partly over the host. Having found a bed in the almost unfurnished space, I remained there, alone, until dawn. 2 days later I got halfway to work before sensing a panic attack coming on, and returned home, not to reappear for several days. The experience imprinted on me at a difficult time, and I touched ecstasy only infrequently after that.

I now regret this exploratory dead end. With the benefit of hindsight, I have often wondered whether a kind, supportive psychedelic intervention around that time might have set me on a very different life path. My hindsight is validated by Acid Test, an exciting and energising book about how psychedelic drugs came to be used therapeutically in the US and then banned, and how successive governments have kept a political shroud over them, despite much evidence as to their usefulness. It charts Hofmann’s discovery of LSD, Shulgin and MDMA, Grof’s therapeutic work, and two decades of legal LSD experiments before moral panic shut them down in the early 1970s. It covers the subsequent therapeutic use of MDMA and, after it was made illegal in the USA in 1985, one man’s ongoing quest to make it legal again. But Acid Test is much more than just a history book. What makes Tom Shroder’s account special is that it’s built around three very personal stories.

Rick Doblin was a baby boomer with great native intelligence and well-off parents who were astonishingly liberal. Experimenting first with LSD, he kept meeting obstacles to the self-actualisation that others seemed to find so easily. He dropped out for 10 years, continuing to experiment, but after MDMA was made illegal, he changed strategy and set up the Multidisciplinary Association for Psychedelic Studies (MAPS). He rallied heavy users to come and prove that MDMA had no serious long-term effects and, with astonishing tenacity and patience, he has spent decades attending hearings and fundraising in order to jump through the endless hoops held up by the FDA and various review boards, all in the name of getting clinical trials approved.

Michael Mithoefer is an emergency room medic and psychonaut who trained as a psychiatrist. He felt it was unethical not to be able to tell his trauma patients about the psychedelics that could help them when there was nothing left to try. Serendipitously, Mithoefer and his therapist wife Annie met Doblin at an ayahuasca conference in California (the book is full of similar amazing coincidences and charming period detail) and joined his crusade. Finally, there is Nicholas Blackston, sent home from Iraq in 2005 with full-blown post traumatic stress disorder. Antidepressants were no help. It was only by happy accident that he noticed Doblin’s call for participants in the study of the therapeutic effects of MDMA on people experiencing post traumatic stress disorder. For Blackston, the outcome of this experiment—as with most participants—was powerful and profound.

Everyone in this inspiring book comes to the same basic conclusions: that shifts happen when difficult feelings are accepted rather than repressed, and that psychedelic drugs do not create new worlds, but simply reveal what is already in the mind. What is also noted is that, taken in the right environment, the positive changes brought on by these drugs (including the older drugs psilocybine, mescaline, ayahuasca, and ibogaine) can be fundamental and long lasting, for depression and addiction as well as trauma.

So why the strict binary between legal and illegal forms of drug-based mental health treatment? Selective serotonin reuptake inhibitors, for example, are accepted despite their very variable success rates, potential for dependency, and multiple casualties. But it seems morally wrong to ignore a whole class of substances that have the potential power to heal, some of which have been used for millennia. Legality seems largely predicated on whether a drug has a dual use as an intoxicant—ie, for hedonism. Discussion of psychedelics often has moral overtones, and is usually accompanied by either lurid images of people collapsing in clubs, (even though ecstasy deaths are usually related to heatstroke rather than chemical poisoning) or naked hippies at festivals. The extensive damage to mental (and physical) health caused by the legally available alcohol barely gets a look-in.

In view of the suicide rate of combat veterans, and the ongoing trauma suffered by the millions of victims of violence and rape, to deny them the chance of a cure is actively cruel. Their debilitation also costs billions in lost productivity. Given the emerging positive stories about psychedelics, what is needed now are many more clinical trials, to create a solid, scientific, evidence base. I wait in hope for a new dawn of far-sighted policymakers and wish Rick Doblin well in his endeavours.