What Is Psychedelic Therapy?
Early Psychedelic Therapy
Psychedelic therapy, in the broadest possible sense of the term, may have originated from prehistoric knowledge of hallucinogenic plants. They grow naturally in certain cacti, seeds, bark and roots of various plants. Since ancient times, shamans and medicine men have used psychedelics as a way to gain access to the spirit world. Though usually viewed as predominantly spiritual in nature, elements of psychotherapeutic practice can be recognized in the entheogenic or shamanic rituals of many cultures.
Mid 20th Century Golden Age
Shortly after Albert Hoffman discovered the psychoactive properties of LSD in 1943, Sandoz Laboratories began widespread distribution of LSD to researchers in 1949. Throughout the 1950s and 1960s, scientists in several countries conducted extensive research into experimental chemotherapeutic, and psychotherapeutic uses of psychedelic drugs. In addition to spawning six international conferences and the release of dozens of books, over 1,000 peer-reviewed clinical papers detailing the use of psychedelic compounds (administered to approximately 40,000 patients) were published by the mid-1960s. Proponents believed that psychedelic drugs facilitated psychoanalytic processes, making them particularly useful for patients with conditions such as alcoholism that are otherwise difficult to treat. However, many of these trials did not meet the methodological standards that are required today.
Researchers like Timothy Leary felt psychedelics could alter the fundamental personality structure or subjective value-system of an individual to great potential benefit. Beginning in 1961, he conducted experiments with prison inmates in an attempt to reduce recidivism with short, intense psychotherapy sessions. Participants were administered psilocybin during these sessions weeks apart with regular group therapy sessions in between. Psychedelic therapy was also applied in a number of other specific patient populations including alcoholism, children with autism, and persons with terminal illness.
Late 20th Century Regulation and Prohibition
Throughout the 1960s, concerns raised about the proliferation of unauthorized use of psychedelic drugs by the general public (and, most notably, the counterculture) resulted in the imposition of increasingly severe restrictions on medical and psychiatric research conducted with psychedelic substances. Many countries either banned LSD outright or made it extremely scarce, and, bowing to governmental concerns, Sandoz halted production of LSD in 1965. During a congressional hearing in 1966, Senator Robert Kennedy questioned the shift of opinion, stating, “Perhaps to some extent we have lost sight of the fact that (LSD) can be very, very helpful in our society if used properly.” In 1968, Dahlberg and colleagues published an article in the American Journal of Psychiatry detailing various forces that had successfully discredited legitimate LSD research. The essay argues that individuals in government and the pharmaceutical industry sabotaged the psychedelic research community by canceling ongoing studies and analysis while labeling genuine scientists as charlatans.
Studies on medicinal applications of psychedelics ceased entirely in the United States when the Controlled Substances Act was passed in 1970. LSD and many other psychedelics were placed into the most restrictive “Schedule I” category by the United States Drug Enforcement Administration. Schedule I compounds are claimed to possess “significant potential for abuse and dependence” and have “no recognized medicinal value”, effectively rendering them illegal to use in the United States for all purposes. Despite objections from the scientific community, authorized research into therapeutic applications of psychedelic drugs had been discontinued worldwide by the 1980s.
Despite broad prohibition, unofficial psychedelic research and therapeutic sessions continued nevertheless in the following decades. Some therapists exploited windows of opportunity preceding scheduling of particular substances or, alternatively, developed non-drug techniques such as Holotropic Breathwork for achieving similar states of consciousness. Informal psychedelic therapy was conducted clandestinely in underground networks consisting of sessions carried out both by licensed therapists and autodidacts within the community. Due to the largely illegal nature of psychedelic therapy in this period, little information is available concerning the methods that were used. Individuals having published information between 1980 and 2000 regarding psychedelic psychotherapy include George Greer, Ann Shulgin (TiHKAL, with Alexander Shulgin), Myron Stolaroff (The Secret Chief, regarding the underground therapy done by Leo Zeff), and Athanasios Kafkalides.
Early 21st Century Resurgence
In the early 2000s, a renewal of interest in the psychiatric use of psychedelics contributed to an increase in clinical research centering on the psychopharmacological effects of these drugs and their subsequent applications. Advances in science and technology allowed researchers to collect and interpret extensive data from animal studies, and the advent of new technologies such as PET and MRI scanning made it possible to examine the sites of action of hallucinogens in the brain. Furthermore, retrospective studies involving users of illicit drugs as voluntary subjects were conducted, allowing data to be collected on how psychedelics affect the human brain while simultaneously sidestepping bureaucratic difficulties associated with providing illegal substances to subjects. The new century also ushered in a broader change in political attitude towards psychedelic medicine—specifically within the Food and Drug Administration. Curtis Wright, deputy director of the FDA Division of Anesthetic, Critical Care and Addiction Drugs explains a motivation for this change: “the agency was challenged legally in a number of cases and also underwent a process of introspection, asking ‘Is it proper to treat this class of drugs differently?'”
As of 2014, global treaties listing LSD and psilocybin as “Schedule I” controlled substances continues to inhibit a better understanding of these drugs. Much of the renewed clinical research has been conducted with psilocybin and MDMA in the United States with special permission by the FDA, while other studies have investigated the mechanisms and effects of ayahuasca and LSD. MDMA-assisted psychotherapy is being actively researched by MAPS. Phase two trials conducted between 2004 and 2010 reported an overall remission rate of 66.2% and low rates of adverse effects for subjects with chronic PTSD. Only six formal studies on the applications of LSD occurred between 1990 and 2017. No complications of LSD administration were observed.
Psychedelic substances which may have therapeutic uses include psilocybin (the main active compound found in magic mushrooms), LSD, and mescaline (the main active compound in the peyote cactus). Although the history behind these substances has hindered research into their potential medicinal value, scientists are now able to conduct studies and renew research that was halted in the 1970s. Some research has shown that these substances have helped people with such mental disorders as obsessive-compulsive disorder, post-traumatic stress disorder, alcoholism, depression, and cluster headaches. Some of the well known particular psychedelic substances that have been used to this day are: LSD, DMT, psilocybin, mescaline, 2C-B, 2C-I, 5-MeO-DMT, AMT, ibogaine and DOM. In general, however, the drugs remain poorly understood. Their effects are strongly dependent on the environment in which they are given and on the recipient’s state of mind.
Studies by Humphrey Osmond, Betty Eisner, and others examined the possibility that psychedelic therapy could treat alcoholism (or, less commonly, other addictions). One review of the usefulness of psychedelic therapy in treating alcoholism concluded that the possibility was neither proven nor disproven. Another thorough meta-analysis from 2012 found that “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. This treatment effect from LSD on alcohol misuse was also seen at 2 to 3 months and at 6 months, but was not statistically significant at 12 months post-treatment. Among the three trials that reported total abstinence from alcohol use, there was also a significant beneficial effect of LSD at the first reported follow-up, which ranged from 1 to 3 months after discharge from each treatment program.”
Early studies of alcoholics who underwent LSD treatment reported a 50% success rate after a single high-dose session. However, the studies that reported high success rates had insufficient controls, lacked objective measures of genuine change, and failed to conduct rigorous follow-up interviews with subjects. The lack of conclusive evidence notwithstanding, individual case reports are often dramatic. Bill Wilson, the founder of Alcoholics Anonymous conducted medically supervised experiments in the 1950s on the effects of LSD on alcoholism. Bill is quoted as saying “It is a generally acknowledged fact in spiritual development that ego reduction makes the influx of God’s grace possible. If, therefore, under LSD we can have a temporary reduction, so that we can better see what we are and where we are going—well, that might be of some help. The goal might become clearer. So I consider LSD to be of some value to some people, and practically no damage to anyone. It will never take the place of any of the existing means by which we can reduce the ego, and keep it reduced.” Wilson felt that regular usage of LSD in a carefully controlled, structured setting would be beneficial for many recovering alcoholics. However, he felt this method only should be attempted by individuals with well-developed super-egos. In 1957 Wilson wrote a letter to Heard saying: “I am certain that the LSD experiment has helped me very much. I find myself with a heightened colour perception and an appreciation of beauty almost destroyed by my years of depressions.” Most AA members were strongly opposed to his experimenting with a mind-altering substance.
In terminal illness
Richard Yensen, Albert Kurland and other researchers collected evidence that psychedelic therapy could be of use to those suffering from anxiety and other problems associated with terminal illness. In 1965, research consisting of providing a psychedelic experience for the dying was conducted at the Spring Grove State Hospital in Maryland. Of 17 dying patients who received LSD after appropriate therapeutic preparation, one-third improved “dramatically”, one-third improved “moderately”, and one-third were unchanged by the criteria of reduced tension, depression, pain, and fear of death.
In post-traumatic stress disorder
Studies conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS) seek to understand how MDMA could be helpful in the treatment of post-traumatic stress disorder. The Phase 2 trials of these studies consisted of 107 participants who had chronic, treatment-resistant PTSD, and had suffered from PTSD for an average of 17.8 years. Out of the 107 participants, 61% no longer qualified for PTSD after three sessions of MDMA-assisted psychotherapy two months after the treatment. At the 12-month follow-up session, 68% no longer had PTSD. As of 2019 MAPS is continuing their research in Phase 3 trials.
The effects of psychedelic drugs on the human mind are complex, varied and difficult to characterize, and as a result many different “flavors” of psychedelic psychotherapy have been developed by individual practitioners. Some aspects of published accounts of methodologies are discussed below.
Psycholytic therapy involves the use of low to medium doses of psychedelic drugs, repeatedly at intervals of 1–2 weeks. The therapist is present during the peak of the experience and at other times as required, to assist the patient in processing material that arises and to offer support when necessary. This general form of therapy was utilized mainly to treat patients with neurotic and psychosomatic disorders. The name, coined by Ronald A. Sandison,[note 1]literally meaning “soul-dissolving”, refers to the belief that the therapy can dissolve conflicts in the mind. Psycholytic therapy was historically an important approach to psychedelic psychotherapy in Europe, but it was also practiced in the United States by some psychotherapists including Betty Eisner.
An advantage of psychedelic drugs in exploring the unconscious is that a conscious sliver of the adult ego usually remains alert during the experience.:196 Throughout the session, patients remain intellectually alert and remember their experiences vividly.:196 In this highly introspective state, they also are actively cognizant of ego defenses such as projection, denial, and displacement as they react to themselves and their choices in the act of creating them.:196
The ultimate goal of the therapy is to provide a safe, mutually compassionate context through which the profound and intense reliving of memories can be filtered through the principles of genuine psychotherapy. Aided by the deeply introspective state attained by the patient, the therapist assists him/her in developing a new life framework or personal philosophy that recognizes individual responsibility for change.:196
In Germany Hanscarl Leuner has designed a psycholytic therapy, which was developed officially, but was used also by some socio-politically motivated underground therapists in the 1970s.
Psychedelic therapy involves the use of very high doses of psychedelic drugs, with the aim of promoting transcendental, ecstatic, religious or mystical peak experiences. Patients spend most of the acute period of the drug’s activity lying down with eyeshades listening to nonlyrical music and exploring their inner experience. Dialogue with the therapists is sparse during the drug sessions but essential during psychotherapy sessions before and after the drug experience. There are two therapists, one man and one woman. The recent resurgence of research (see § Early 21st Century Resurgence above) uses this method. It is more closely aligned to transpersonal psychology than to traditional psychoanalysis. Psychedelic therapy is practiced primarily in North America. The psychedelic therapy method was initiated by Humphry Osmond and Abram Hoffer (with some influence from Al Hubbard) and replicated by Keith Ditman.
In Czechoslovakia, Stanislav Grof developed a form of treatment that appeared to bridge both of these main forms. He analyzed the LSD experience in a Freudian or Jungian psychoanalytic context in addition to giving significant value to the overarching transpersonal, mystical, or spiritual experience that often allowed the patient to re-evaluate their entire life philosophy.
The Chilean therapist Claudio Naranjo developed a branch of psychedelic therapy that utilized drugs like MDA, MDMA, harmaline, and ibogaine.
The term anaclitic (from the Ancient Greek “ἀνάκλιτος”, anaklitos – “for reclining”) refers to primitive, infantile needs and tendencies directed toward a pre-genital love object. Developed by two London psychoanalysts, Joyce Martin and Pauline McCririck, this form of treatment is similar to psycholytic approaches as it is based largely on a psychoanalytic interpretation of abreactions produced by the treatment, but it tends to focus on those experiences in which the patient re-encounters carnal feelings of emotional deprivation and frustration stemming from the infantile needs of their early childhood. As a result, the treatment was developed with the aim to directly fulfill or satisfy those repressed, agonizing cravings for love, physical contact, and other instinctual needs re-lived by the patient. Therefore, the therapist is completely engaged with the subject, as opposed to the traditional detached attitude of the psychoanalyst. With the intense emotional episodes that came with the psychedelic experience, Martin and McCririck aimed to sit in as the “mother” role who would enter into close physical contact with the patients by rocking them, giving them milk from a bottle, etc.
Hypnodelic therapy, as the name suggests, was developed with the goal to maximize the power of hypnotic suggestion by combining it with the psychedelic experience. After training the patient to respond to hypnosis, LSD would be administered, and during the onset phase of the drug the patient would be placed into a state of trance. Levine and Ludwig found the combination of these techniques to be more effective than the use of either of these two components separately.
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