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BRITIBRI TISHSH JOURNAJOURN ALL OOFF PP SYCHIATRYSYCHI AT RY (20(2005),05), 1818 6,6, 457^458457^458

CanCan psychedelicspsychedelics havehave aa rolerole inin psychiatrypsychiatry onceonce again?again?

BENBEN SESSASESSA

PsychedelicPsychedelic oror hallucinogenichallucinogenic drugsdrugs suchsuch asas lysergiclysergic acidacid diethylamidediethylamide (LSD),(LSD), 3,4,5-3,4,5- trimethoxy-trimethoxy-bb-phenethylamine-phenethylamine (mescaline),(mescaline), psilocybin,psilocybin, 3,4-methylenedioxymethamph-3,4-methylenedioxymethamph- etamineetamine (MDMA),(MDMA), N,N-dimethyltrypta-N,N-dimethyltrypta- minemine (DMT)(DMT) andand theirtheir relationsrelations occuroccur inin abundanceabundance throughoutthroughout thethe naturalnatural world,world, andand havehave beenbeen usedused byby humankindhumankind forfor thousandsthousands ofof years.years. InIn somesome culturescultures theythey areare importantimportant toolstools forfor spiritualspiritual experiences,experiences, whereaswhereas inin othersothers theythey areare labelledlabelled asas dangerousdangerous drugsdrugs ofof misuse.misuse. WhatWhat isis lessless wellwell knownknown aboutabout thesethese substancessubstances isis thethe rolerole theythey playedplayed inin psychiatrypsychiatry forfor aa briefbrief historicalhistorical interval.interval. ThisThis articlearticle offersoffers aa shortshort overviewoverview ofof thisthis periodperiod andand questionsquestions whetherwhether interestinterest inin thesethese compoundscompounds mightmight bebe emergingemerging again.again.

CURRENTCURRENT TRAININGTRAINING ANDAND KNOWLEDGEKNOWLEDGE ABOUTABOUT PSYCHEDELICSPSYCHEDELICS

DespiteDespite theirtheir history,history, psychedelicspsychedelics havehave droppeddropped outout ofof psychiatricpsychiatric dialoguedialogue forfor today’stoday’s traineetrainee psychiatristspsychiatrists (Strassman,(Strassman, 2001).2001). InIn mymy ownown training,training, referencesreferences toto compoundscompounds likelike LSD,LSD, psilocybinpsilocybin andand MDMAMDMA werewere usuallyusually followedfollowed byby state-state- mentsments suchsuch asas ‘have‘have nono medicalmedical use’.use’. ButBut II waswas taughttaught aboutabout thethe acuteacute emergenciesemergencies andand socialsocial problemsproblems associatedassociated withwith theirtheir misuse.misuse. YetYet inin thethe yearsyears betweenbetween thethe firstfirst synth-synth- esisesis ofof LSDLSD inin thethe 1930s1930s andand thethe disappear-disappear- anceance ofof psychedelicpsychedelic researchresearch byby thethe latelate 1960s,1960s, therethere waswas aa furiousfurious growthgrowth ofof scien-scien- tifictific interestinterest inin thesethese substances.substances. ManyMany pioneerspioneers gavegave theirtheir careerscareers toto thisthis field,field, hopinghoping thatthat psychedelicpsychedelic drugsdrugs couldcould bebe toto psychiatrypsychiatry whatwhat thethe microscopemicroscope isis toto biologybiology oror thethe telescopetelescope isis toto astronomy:astronomy:

anan essentialessential tooltool toto exploreexplore thethe partsparts ofof thethe internalinternal worldworld thatthat areare usuallyusually inaccessibleinaccessible (Grof,(Grof, 2001).2001).

HISTORYOFHISTORYOF PSYCHEDELICPSYCHEDELIC RESEARCHRESEARCH

TheThe SwissSwiss chemist,chemist, AlbertAlbert HoffmanHoffman firstfirst synthesizedsynthesized LSD-25LSD-25 whilewhile studyingstudying deriva-deriva- tivestives ofof thethe fungusfungus ergotergot forfor useuse asas potentialpotential medicines.medicines. WhenWhen hehe accidentallyaccidentally absorbedabsorbed somesome LSDLSD duringduring aa laboratorylaboratory sessionsession therethere followedfollowed anan intenseintense experienceexperience ofof perceptualperceptual andand emotionalemotional effectseffects (Hoffman,(Hoffman, 1980).1980). ByBy thethe latelate 1940s1940s psychiatristspsychiatrists werewere beginningbeginning toto experimentexperiment withwith LSDLSD asas aa tool,tool, andand inin 19511951 itit waswas thethe subjectsubject ofof aa pre-pre- sentationsentation atat thethe annualannual conferenceconference ofof thethe AmericanAmerican PsychologicalPsychological Association.Association. InitialInitial workwork exploredexplored thethe possibilitypossibility thatthat psyche-psyche- delicsdelics mightmight bebe usedused asas ‘psychotomimetics’,‘psychotomimetics’, toto mimicmimic thethe mentalmental statesstates ofof patientspatients withwith schizophreniaschizophrenia (Osmond,(Osmond, 1957),1957), andand manymany healthhealth professionalsprofessionals werewere encouragedencouraged toto partakepartake inin self-discoveryself-discovery oror sharedshared psyche-psyche- delicdelic experiencesexperiences withwith theirtheir patients.patients. OtherOther researchresearch lookedlooked intointo usingusing psychedelicpsychedelic drugsdrugs asas adjunctsadjuncts toto psychotherapy.psychotherapy. TheThe therapytherapy tooktook thethe formform ofof twotwo broadbroad types:types: first,first, psycholyticpsycholytic (‘mind(‘mind loosening’)loosening’) psychotherapypsychotherapy involvedinvolved takingtaking lowlow dosesdoses ofof LSDLSD asas partpart ofof ongoingongoing psychoanalyticalpsychoanalytical therapy.therapy. TheThe drugdrug hadhad aa looseningloosening effecteffect andand facilitatedfacilitated thethe explorationexploration ofof repressedrepressed material.material. TheThe secondsecond type,type, psychedelicpsychedelic (‘mind(‘mind manifesting’)manifesting’) psychotherapypsychotherapy in-in- volvedvolved preparationpreparation sessionssessions withoutwithout LSD,LSD, thenthen oneone singlesingle large-doselarge-dose sessionsession thatthat encouragedencouraged anan intenseintense reaction,reaction, followedfollowed byby furtherfurther non-drugnon-drug sessionssessions toto exploreexplore thethe meaningmeaning ofof thethe materialmaterial thatthat emergedemerged (Grinspoon(Grinspoon && Bakalar,Bakalar, 1997).1997). ByBy 19651965 overover 20002000 paperspapers hadhad beenbeen publishedpublished describingdescribing positivepositive resultsresults forfor overover 4040 000000 patientspatients whowho tooktook psychedelicpsychedelic drugsdrugs withwith fewfew side-effectsside-effects andand aa highhigh levellevel ofof safetysafety (Masters(Masters && Houston,Houston, 1970).1970). TheThe techniquestechniques werewere appliedapplied toto thethe treatmenttreatment ofof anxietyanxiety disorders,disorders, obsessive–obsessive– compulsivecompulsive disorders,disorders, depression,depression, bereave-bereave- mentment reactionsreactions andand sexualsexual dysfunction,dysfunction, amongamong othersothers (Newland,(Newland, 1962;1962; Grof,Grof,

EDITORIALEDITORIAL

2001).2001). InIn thethe treatmenttreatment ofof addiction,addiction, repeatedrepeated controlledcontrolled experimentsexperiments demon-demon- stratedstrated aa consistentconsistent recoveryrecovery andand 6-month6-month abstinenceabstinence fromfrom drinkingdrinking inin 50–90%50–90% ofof participantsparticipants afterafter briefbrief psychedelicpsychedelic therapytherapy (Abramson,(Abramson, 1967;1967; Hoffer,Hoffer, 1970).1970). AnotherAnother areaarea wherewhere therapytherapy waswas usedused successfullysuccessfully waswas inin relievingrelieving painpain andand anxietyanxiety inin terminalterminal cancercancer (Kast,(Kast, 1964).1964).

PROBLEMSPROBLEMS WITHWITH PREVIOUSPREVIOUS RESEARCHRESEARCH

DespiteDespite thethe volumevolume ofof publicationspublications fromfrom thisthis period,period, mostmost ofof thethe publishedpublished materialmaterial refersrefers toto anecdotalanecdotal casecase reportsreports thatthat areare ofof littlelittle valuevalue byby contemporarycontemporary researchresearch standardsstandards becausebecause theythey lacklack sufficientsufficient follow-upfollow-up andand controlcontrol participantsparticipants (Grob,(Grob, 1994).1994). EvenEven thoughthough resultsresults appearedappeared promising,promising, byby thethe 1970s,1970s, underunder pressurepressure fromfrom thethe USUS justicejustice department,department, virtuallyvirtually allall researchresearch hadhad ended.ended. LSDLSD hadhad leakedleaked fromfrom thethe scientificscientific communitycommunity toto aa widerwider audience.audience. ByBy 19661966 LSDLSD misusemisuse hadhad becomebecome aa problemproblem andand itsits possessionpossession waswas mademade illegal.illegal. ThisThis promptedprompted thethe scientificscientific communitycommunity toto distancedistance themselvesthemselves fromfrom interestinterest inin suchsuch substances.substances. GovernmentsGovernments clampedclamped downdown onon researchresearch licences,licences, andand increasingincreasing reportsreports ofof adverseadverse reactionsreactions toto psychedelicspsychedelics takentaken recreationallyrecreationally asas op-op- posedposed toto thosethose usedused inin controlled,controlled, scientificscientific circumstancescircumstances (which(which remainedremained safe)safe) appearedappeared inin thethe literatureliterature (Strassman,(Strassman, 2001).2001). AsAs aa result,result, researchresearch useuse ceasedceased whilewhile illicitillicit useuse remained,remained, fuelledfuelled byby aa growinggrowing criminalcriminal distributiondistribution andand financialfinancial system.system. UntilUntil veryvery recently,recently, researchresearch onon psy-psy- chedelicchedelic drugsdrugs hashas beenbeen severelyseverely restricted,restricted, whichwhich explainsexplains thethe currentcurrent lacklack ofof knowledgeknowledge amongamong psychiatrists.psychiatrists.

CURRENTCURRENT RESEARCHRESEARCH

SinceSince thethe 1970s,1970s, MDMAMDMA psychotherapypsychotherapy hashas seenseen anan emergingemerging undergroundunderground useuse byby analysts.analysts. MDMA,MDMA, strictlystrictly speakingspeaking anan ‘empathogen’‘empathogen’ ratherrather thanthan aa psychedelicpsychedelic drug,drug, isis lessless intenseintense andand shorter-actingshorter-acting thanthan LSD.LSD. ItIt appearsappears toto offeroffer aa similarsimilar thera-thera- peuticpeutic potentialpotential forfor loweringlowering aa patient’spatient’s defencesdefences andand aidingaiding thethe psychotherapeuticpsychotherapeutic processprocess (Holland,(Holland, 2001).2001). AA liftinglifting ofof thethe governmentgovernment banban onon psy-psy- chedelicchedelic researchresearch inin SwitzerlandSwitzerland betweenbetween 19881988 andand 19931993 allowedallowed aa briefbrief recom-recom- mencementmencement ofof psycholyticpsycholytic psychotherapypsychotherapy usingusing LSDLSD andand MDMAMDMA forfor patientspatients withwith

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SESSASESSA

personalitypersonality disorders,disorders, affectiveaffective disordersdisorders andand adjustmentadjustment disorders.disorders. ThereThere areare currentlycurrently projectsprojects underunder developmentdevelopment inin Spain,Spain, IsraelIsrael andand thethe USAUSA lookinglooking atat MDMA-assistedMDMA-assisted psychotherapypsychotherapy inin thethe treatmenttreatment ofof post-traumaticpost-traumatic stressstress disorderdisorder andand asas aa treatmenttreatment forfor anxietyanxiety andand depres-depres- sionsion associatedassociated withwith cancer.cancer. BetweenBetween 19901990 andand 19951995 extensiveextensive studiesstudies ofof DMT,DMT, aa strongstrong butbut short-actingshort-acting agent,agent, werewere con-con- ductedducted withwith humanhuman participantsparticipants inin thethe USAUSA (Strassman,(Strassman, 2001).2001). OtherOther researchresearch includesincludes aa double-blinddouble-blind placeboplacebo controlledcontrolled studystudy inin RussiaRussia usingusing ketamineketamine inin thethe treatmenttreatment ofof heroinheroin addiction,addiction, whichwhich hashas demonstrateddemonstrated improvedimproved ratesrates ofof abstinence,abstinence, maintainedmaintained atat 2-year2-year follow-upfollow-up (Krupitsky(Krupitsky etet alal,, 2002).2002). AlsoAlso inin progressprogress areare studiesstudies lookinglooking atat psilocybinpsilocybin inin thethe treatmenttreatment ofof obsessive–obsessive– compulsivecompulsive disorderdisorder andand forfor reducingreducing anxietyanxiety andand painpain inin cancercancer patients.patients. AllAll ofof thisthis researchresearch isis wellwell summarisedsummarised onon thethe MultidisciplinaryMultidisciplinary AssociationAssociation forfor PsychedelicPsychedelic StudiesStudies (MAPS)(MAPS) websitewebsite (www.maps.org).(www.maps.org).

ONGOINGONGOING PROBLEMSPROBLEMS WITHWITH CURRENTCURRENT RESEARCHRESEARCH

AlthoughAlthough drugdrug misusemisuse remainsremains aa growinggrowing phenomenonphenomenon inin ourour globalglobal societysociety thethe publicpublic andand governmentsgovernments areare suspicioussuspicious ofof psychedelicpsychedelic research.research. TheThe imageimage ofof psyche-psyche- delics,delics, severelyseverely damageddamaged byby thethe 1960s1960s drugdrug culture,culture, isis furtherfurther spoiledspoiled byby drugdrug useuse inin today’stoday’s ‘rave’‘rave’ scene.scene. FindingFinding unbiasedunbiased informationinformation aboutabout psychedelicpsychedelic researchresearch isis oftenoften difficult.difficult. However,However, manymany ofof thethe earlyearly pioneerspioneers ofof psychedelicpsychedelic researchresearch continuecontinue toto promotepromote itit forfor thethe fieldfield ofof mentalmental health.health. DrDr HumphreyHumphrey Osmond,Osmond, thethe BritishBritish psy-psy- chiatristchiatrist who,who, inin communicationcommunication withwith thethe authorauthor AldousAldous Huxley,Huxley, coinedcoined thethe termterm ‘psychedelic’‘psychedelic’ inin thethe 1950s,1950s, stronglystrongly sup-sup- portedported psychedelicpsychedelic researchresearch untiluntil hishis deathdeath lastlast yearyear agedaged 8686 years,years, whenwhen hehe receivedreceived aa fittingfitting tributetribute inin thethe BMJBMJ (Hopkins(Hopkins Tanne,Tanne, 2004).2004). AlbertAlbert Hoffman,Hoffman, whowho

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BENBEN SESSA,SESSA, MBBS,MBBS, BSc,BSc, MRCPsych,MRCPsych, TheThe ParkPark Hospital,OldHospital,Old Road,Road, Headington,OxfordHeadington,Oxford OOX3X3 7L7LQ,UQ,UK.K. E-mail:E-mail: drbensessadrbensessa@@hotmail.comhotmail.com

(First(First receivedreceived 2727 JanuaryJanuary 2004,2004, finalfinal revisionrevision 1212 NovemberNovember 2004,2004, acceptedaccepted 21November21November 2004)2004)

celebratedcelebrated hishis 99th99th birthdaybirthday thisthis year,year, maintainsmaintains contactcontact withwith organisationsorganisations promotingpromoting scientificscientific researchresearch intointo medicalmedical usesuses forfor psychedelicpsychedelic drugs,drugs, suchsuch asas MAPSMAPS andand thethe HeffterHeffter ResearchResearch InstituteInstitute (www.heffter.org).(www.heffter.org). ResearchersResearchers believebelieve thesethese drugsdrugs areare importantimportant toolstools forfor furtherfurther academicacademic study.study. TheirTheir recognisedrecognised psychologicalpsychological effectseffects fitfit wellwell intointo anan approachapproach lookinglooking forfor thethe neurobiologicalneurobiological linkslinks betweenbetween mentalmental andand physicalphysical states.states. AlsoAlso fromfrom aa clinicalclinical pointpoint ofof view,view, thethe practicepractice ofof traditionaltraditional psyche-psyche- delicdelic psychotherapypsychotherapy –– usingusing thethe drugsdrugs asas anan adjunctadjunct toto brief,brief, time-limitedtime-limited psycho-psycho- therapytherapy –– hashas muchmuch inin commoncommon withwith thethe currentcurrent practicepractice ofof cognitive–behaviouralcognitive–behavioural therapy.therapy.

CONCLUSIONCONCLUSION

PerhapsPerhaps itit isis surprisingsurprising thatthat therethere remainsremains suchsuch considerableconsiderable ignoranceignorance aboutabout thethe potentialpotential ofof thesethese substancessubstances fromfrom withinwithin psychiatrypsychiatry itself.itself. AsAs withwith Galileo’sGalileo’s telescopetelescope andand Darwin’sDarwin’s suggestionsuggestion ofof ourour ascendancyascendancy fromfrom apes,apes, radicalradical scientificscientific challengeschallenges tendtend toto taketake thethe formform ofof anan attackattack onon thethe anthropocentricanthropocentric modelmodel ofof thethe world.world. InIn thethe lightlight ofof this,this, researchresearch thatthat exploresexplores alternativealternative statesstates ofof consciousnessconsciousness andand thenthen offersoffers aa viableviable neurobiologicalneurobiological substratesubstrate forfor thethe veryvery humanhuman experienceexperience ofof religiousreligious encounterencounter isis boundbound toto meetmeet withwith objectionobjection fromfrom aa generationgeneration ofof psychiatristspsychiatrists whowho havehave beenbeen conditionedconditioned toto considerconsider suchsuch workwork asas ‘mysticism’.‘mysticism’. PerhapsPerhaps aa moremore dispassionatedispassionate criticismcriticism basedbased uponupon scientificscientific reasoningreasoning andand notnot influencedinfluenced byby socialsocial oror politicalpolitical pressurespressures isis calledcalled forfor ifif wewe areare trulytruly toto investigateinvestigate whetherwhether thesethese substancessubstances cancan havehave aa usefuluseful rolerole inin psychiatrypsychiatry today.today.

DECLARATIONOFDECLARATIONOF INTERESTINTEREST

None.None.

REFERENCESREFERENCES

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ReconsideredReconsidered NewNew YYork:ork: LindesmithLindesmith Center.Center.

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whatwhat havehave wewe

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Grof,Grof, S.S. (2001)(2001) LSDLSD PsychotherapyPsychotherapy Sarasota,Sarasota, FL:FL:

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