Psychedelic psychotherapy: The next big thing in psychiatry?

The UK Home Secretary has announced a review of cannabis for medicinal use. Does that bring psychedelic psychotherapy a step closer? When LSD was synthesized back in the 1950s psychiatrists were quick to see its potential. Research proliferated over the following decade, producing over 1,000 peer-reviewed clinical papers. The results were overwhelmingly positive and “psychedelic therapy was truly considered the next big thing in psychiatry” (Sessa, 2017).

So what went wrong? Several factors came together to stop what could have been a revolution in psychotherapy. Millions of people were taking LSD recreationally, and perhaps inevitably there were casualties. Psychedelics open us to experiences that the more reactionary elements of society find weird at best and even threatening, so it’s no wonder that the press leapt on any negative news. Psychedelics like LSD are the most powerful mind changing substances that exist and deserve to be treated with respect. There are a few basic principles to using psychedelics: Are you in the right mental state to take them? Is this the best place and time for the trip? Carefully considering these essentials – commonly known as set (mindset) and setting – will very much reduce the risk of a ‘bad trip’. In a psychotherapeutic context set and setting are carefully controlled and the whole process is facilitated by a trained professional.

A second factor was the rise of antipsychotic drugs which led to less emphasis on outpatient psychotherapy sessions. Someone with a more conspiratorial turn of mind might also point out that psychedelic psychotherapy promised a permanent cure for many mental health disorders. People who are cured don’t need a daily dose of expensive drugs to keep them feeling (kind of) OK.

The psilocybin molecule

The psilocybin molecule

The good news is that research into psychedelic psychotherapy is undergoing something of a renaissance. Clinical research using psilocybin (the active ingredient of ‘magic mushrooms’), MDMA (ecstasy), ketamine, ayahuasca and LSD is ongoing. Psilocybin looks especially promising. A recent review of seven clinical trials found “large effect sizes related to improved depression and anxiety symptoms” (Thomas et al.) The results overall are encouraging: Psychiatrist Dr. Ben Sessa concludes that psychedelic psychotherapy “is a cost effective way of treating otherwise unremitting mental illness” (Sessa, 2017).

Why is psychedelic psychotherapy so effective? According to one influential paper, one of the key processes is a shift from “disconnection (from self, others, and world) to connection” (Watts et al., 2017). I’m hugely excited by all this, not least because there are some parallels with my PhD research. My research suggests that what inspires and supports many environmental activists is a profound sense of connection. The experience of living close to nature and practices like mindfulness help facilitate this, as does the use of psychedelics like psilocybin. Could it be that a sense of connection – or reconnection – is the underlying mechanism behind our sense of wellbeing?

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2 Responses to Psychedelic psychotherapy: The next big thing in psychiatry?

  1. Juliano says:

    I am suspicious of this ‘acceptance’ and the medical authoritarian control of psychedelics. I see it as something like this: the ruling elite knowing the cat is out of the bag. IE they cannot really stop people knowing about and even using psychedelics recreationally (a word they use to put-down FREEDOM to use psychedelics independently from an authoritative group) which they have tried through various means to do since the beginning of the patriarchal oppression. So now they are trying to *contain* psychedelics by trying to limit them within the confines of the mental illness myth. Ie, now you hear psychedelic scientists like Robin Carhart Harris and many psychotherapists claiming psychedelics will be able to “treat” “treatment resistant depression”. All that is part OF the mental illness myth which sees ‘depression’ as a brain disorder which needs THEIR drugs to ‘treat’ it. By doing this the actual surrounding culture which is contributing to psychological dis-ease is rendered invisible. Understand?
    In the 1960s when psychedelics were embraced by many people recreationally there was isnpired the deep questioning of a culture obsessed with war and profit and ecocide, and all forms of exploitation, and this is one of the very reasons they were banned, and all kinds of negative propaganda was said about them!

    If you look at our past and the ancient groups who did embrace a wilder more recreational and earth-centred approach to psychedelics, you see the patriarchy come down heavy on them, because the patriarchy wants, NEEDS, slaves, to keep a small elite even more rich and for fodder for their endless wars and making babies for endless wars and so on.

    But now they want to limit psychedelics as being patented by them, and only the people with high incomes will be able to afford the ‘session’ and their sessions will be ‘very controlled”–“strictly no dancing, no funny business!!!” and it will all be about ‘facing ones fear, and overcoming your ‘depression’ bla bla bla and other psychiatric labels. And THEN, you’ve paid your money, now get back to your corporate lifestyle or whatever with you ‘depression’, ‘anxiety’, etc etc ‘treated’. But once ‘done’ how can you ‘worry’ about the unfairness of the community, country, world…? you have been ‘treated’, right? Or do you need another session to cure your ‘delusions’ …?? But NEVER take them ‘recreationally’….oh nooo! Or else we will call you a criminal and put you in jail!

  2. Adrian Harris says:

    Hi Juliano,
    Thanks for your response. I think we agree on on most of the issues you raise:

    * Historically, the ruing elite have tried – perhaps even needed – to prevent the use of psychedelics;
    * it’s wrong to treat depression as an imbalance in brain chemistry that simply needs treatment with drugs;
    * our existing culture contributes massively to “psychological dis-ease”.

    However, It sounds like you see psychiatrists like Robin Carhart Harris as the ‘enemy’, working with the ruing elite to maintain control. I don’t think that’s true. There’s a lively debate in psychiatry about whether mental distress – depression for example – is due to an imbalance of brain chemistry or social-environmental factors. Peter Kinderman is especially good on this. Kinderman is a psychiatrist who accepts that our current society is part of the problem, and we need a culture that fosters well-being if we are to address mental distress. From what I’ve read on psychedelic psychotherapy, therapists like Robin Carhart Harris are in this same camp. Ben Sessa’s book, ‘The Psychedelic Renaissance’ is recommended for an overview of psychedelic psychotherapy.

    Psychedelic psychotherapy won’t be limited to those who can afford it. It will, I hope, be available to anyone who needs it on the NHS. I firmly believe that any psychedelic psychotherapy worth the name would facilitate people to be more aware and empowered. Counseling, psychotherapy or psychiatry can – and have been – used to ‘fix’ people who can’t or won’t serve the dominant culture. That’s an abomination to me and I’m actively involved in challenging that. My work is to nurture life to fuller flowering and I’m a member of ‘Psychotherapists and Counsellors for Social Responsibility’.

    I believe psychedelic psychotherapy could be truly revolutionary. Some of the research suggests that psychedelics help with mental distress by revealing our intrinsic connectedness with the world (Watts et al., 2017). There are also frequent references to heightened spiritual awareness thorough psychedelic psychotherapy. Neither of these changes would fit someone to simply go back to the corporate lifestyle that helped create their initial distress. Psychedelic psychotherapy isn’t a sticking plaster approach. It promises to help people overcome metal distress permanently by transforming their relationship to themselves and the world. Far from creating mindless drones who will serve the system, psychedelic psychotherapy could facilitate profound personal growth, empowerment and deeper awareness.

    Could psychedelic psychotherapy lead to full legalization? Maybe. You imply that it would help keep psychedelics in a box, but I think it’s likely to bring full legalization closer.

    Having said all that, I accept that there are risks. Neo-liberal capitalism is very good at co-opting powerful processes. Ben Sessa touches on this in the conclusion of his book, and it’s vital that we remain vigilant about these dangers.

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