“Orthodoxy is the diehard of the world of thought. It learns not, neither can it forget.” – Aldous Huxley
We live in a society that allows for certain ways of being and thinking but disallows – and many a time ostracises – individuals who disagree or think differently. This process of stigmatising certain kinds of people and issues because of a variety of historical, political, cultural, and societal reasons results in taboos on certain topics. It is really difficult to talk about mental health issues, psychotherapy, and psychiatric medication openly without having to face a barrage of stereotypes and assumptions surrounding these issues.
Thus, along with addressing severe mental health issues (such as depression being one of the leading causes of ill health worldwide), there is a need for constant effort in remodelling how each one of us think of depression and how we create safe and empathetic spaces for talking about depression or any other mental health issue (for example, with initiatives such as ‘It’s OK to Talk‘).
Similarly, when it comes to the world of psychedelics, there are a lot of assumptions, myths, and stereotypes about what they are, what they do to us, and how they are used. This makes it difficult for one to even broach the topic of psychedelics. But it becomes imperative for us to engage with this topic since there has been substantial scientific research in recent times as to how psychedelics can be used to treat depression, PTSD (Post Traumatic Stress Disorder), anxiety and nicotine-addiction.
It is necessary to take another look at psychedelics when the United States FDA (Food and Drug Administration) has given a green light to phase 3 trials of MDMA to treat PTSD. This is the final phase before which MDMA, a party-drug, commonly known as Ecstasy, will be approved for legal medication. (To understand the phases of drug trials designed by the FDA, click here.)
Why are institutions such as Johns Hopkins, Imperial College of London, New York University, and many others are focusing on research surrounding psychedelics? Aren’t these substances (LSD, MDMA, and Psilocybin) banned? If they are banned, should we even consider them? How is it that some of these drugs which are listed under Schedule I (drugs having high potential of abuse) are moving towards legalisation?
Let us take a look at some of the research findings first –
- In a pilot study, 83% of the study participants, who were suffering from chronic, treatment-resistant PTSD no longer met the criteria for PTSD after having gone through MDMA-assisted psychotherapy sessions. These benefits lasted even after an average of 3.8 years.
- Another study, which was a phase 2 trial approved by FDA, showed how 78% participants no longer met PTSD criteria 12 months after the MDMA-assisted psychotherapy treatment.
- John Hopkins researchers report that a small number of long-time smokers who had failed many attempts to drop the habit did so after a carefully controlled and monitored use of psilocybin (also known as magic mushrooms) – in the context of a cognitive behavioural therapy treatment program.
These are some, among the many research studies conducted around psychedelics, its effects on our brains, and the viability of using this as a medicinal tool to enable impactful psychotherapy, and in some cases easing the anxiety associated with life-threatening illnesses.
So what is happening here?
What Are Psychedelic Substances?
Psychedelic is a word coined by combining two Greek words – ‘psyche’ and ‘delos’, which, when put together, mean making the mind manifest or revealing the soul. These substances (ranging from LSD, MDMA, Ketamine, Ibogaine, Psilocybin) alter one’s cognition and perception drastically.
In one of the studies conducted, 80% of the participants revealed that the psychedelic experiences (induced by ingesting psilocybin) that they went through were among the top five most personally and spiritually significant experiences of their lives. They compared it to the experience of giving birth to a child or the death of a parent. These positive effects seem to sustain even after a year. Similar experiences can be found in online forums.
Psychedelics are thus powerful mind-altering drugs. These substances are also found naturally in the environment (magic mushrooms/ayahuasca/iboga tree), and have been used by many cultures around the world for folk-remedies and spiritual enlightenment. However, now, many of these substances are chemically manufactured.
The key point here is that these substances are incredibly powerful hallucinogens (causing hallucinations), they cannot be treated as party-drugs, and have to be respected as they have been by certain cultures.
Why Are They Banned?
One of the central reasons for its banning was ‘The War on Drugs‘, when psychedelics entered mainstream culture. This happened during the Nixon’s presidency and had a devastating impact. Along with these impacts, the brunt of which we face even today, it resulted in demonisation and marginalisation of a lot of psychedelic substances. Even medical research of these substances was barred. Thus, right now they are listed under Schedule I.
Since then, there has been a taboo when it comes to engaging with psychedelic substances, even within the field of psychotherapy and psychiatry, but that is changing slowly.
Are Psychedelic Substances Addictive?
As demonstrated in the above video, no, they are not. One should be careful from falling into the trap of categorising all substances under the same bracket and then creating a taboo around them. The ways in which alcohol, nicotine, heroin, cocaine work on our bodies are significantly different from how psychedelic substances work.
In fact, psychedelic substances, as explained above, are being used and researched for alcohol, opioid, and nicotine de-addiction. But, psychedelic substances can surely be misused and abused. They are powerful substances and thus, they can result in permanent mental and physical damage.
Aren’t Psychedelic Substances Party Drugs?
Yes, they have been used many times for recreational purposes. But it would be very limited to box these substances as just ‘party drugs’. As seen with the research and anecdotal evidence, their potential is huge, especially when it comes to the field of psychotherapy.
What Is The Relationship Between Psychedelics And Psychotherapy?
With respect to the controlled-trials done till now with many participants, psychedelic-assisted psychotherapy is showing significant outcomes in treating “treatment-resistant” depression, anxiety and PTSD as seen above. The impact seems to last even after a year’s follow-up.
How does this happen? Does this mean you can ingest a psychedelic and cure yourself?
Not at all. Legalisation doesn’t mean free use of these substances.
Here are some of the most important things that happen in psychedelic-assisted psychotherapy:
- The research is conducted in a safe and controlled space generally with the presence of experts, psychotherapists, doctors. There is a tracking of various indicators such as heartbeat, blood pressure, etc.
- It is different from traditional psychotherapy. There has been an emphasis on the setting. The participants in the study are provided explanations as to the possibility of having anxiety-related or paranoid situations (temporary adverse effects). The environment is made conducive through music, headsets, eye-patches, etc.
- Generally, a male and female psychotherapist assist the participant after administering the psychedelic substance, wherein the participant is talked through, throughout. There are also post -‘integrative’ sessions to understand and comprehend the overwhelming, emotional ‘trip’ that one might have gone through. A manual is followed.
- Many indicators and tests are used to understand both the physical and mental impacts of administering psychedelic substance (both short term and long term).
- Psychedelic substances aren’t harmless. They do have adverse effects. While some “bad trips” are useful, some can be detrimental. Regulated, careful, curated, and assisted environments are very much necessary when exploring psychedelic substances. Since the research is still nascent, one doesn’t fully understand the impacts that these substances have on our mental health and how it functions yet.
What Happens In Our Brains?
While there has been a study conducted to understand what happens in our brain on psychedelics, here, I will just emphasise on the basics of psychedelic-assisted psychotherapy based on a particular research.
Image Credit: Marcela Ot’alora & Bruce Poulter: MDMA as Profound Change Agent in PTSD Research
The above image represents how one’s identity is formed by a traumatic experience. It shows how individuals create certain coping mechanisms to deal with their trauma. In this process, they create defensive structures which in turn protect the trauma too.
Image Credit: Marcela Ot’alora & Bruce Poulter: MDMA as Profound Change Agent in PTSD Research
When a person is administered MDMA, the drug induces a state which allows for a window to change these defensive structures. These defensive structures are loosened because of MDMA (Image 2).
This state allows individuals to explore and understand how these structures help them manage their lives and in some cases kept them from living life fully with the guidance of psychotherapists present. They understand how they might have disconnected from themselves while disconnecting from their trauma.
Image Credit: Marcela Ot’alora & Bruce Poulter: MDMA as Profound Change Agent in PTSD Research
Psychotherapists use this ‘window of integration’ to guide the individual to a more complete sense of self (Image 3), wherein new structures are formed because of the new information that the individual has during this drug-induced state. And as explained above, these sessions seem to imprint these new structures in the brain such that the impact lasts for months together.
These results from research are fascinating to read and understand. What does the future hold for these banned drugs? Will the doors open to legal psychedelic-assisted psychotherapy? Will it reshape the psychiatry industry and its ideas on drugs? Will it lead to a one-shot therapy mechanism to treat/cure depression, PTSD, anxiety etc? Only time will tell.