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    Psychedelic psychotherapy 
    Bluelighter mr peabody's Avatar
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    Psychedelic psychotherapy - The ethics of medicine for the soul

    Psychedelic drugs are known to have profound psychological effects. Now being evaluated in clinical trials in the US as aids to psychotherapy, these substances are thought to help patients by inducing spiritual experiences that lead to improved mental health. Some people challenge the claim that authentic spiritual experiences can be induced by drugs and still others question whether spirituality and religion have any place in medicine.

    A hallucinogen is "any agent that causes alterations in perception, cognition, and mood as its primary psychobiological actions in the presence of an otherwise clear sensorium." The word psychedelic, which comes from the Greek to wander in the mind, and is perhaps more accurate since hallucinogenic drugs don't produce true hallucinations, rather they engender illusions that are not normally mistaken for reality, but understood as an effect of the drug. The majority of psychedelic drugs are classified as Schedule I compounds, which means that they are considered to be substances that have no accepted medical use, and have a high abuse potential.

    The assertion that psychedelics have no accepted medical use is a matter of contention that has been gaining a larger audience for the past couple decades. Since the first large push for the use of psychedelics in research and medicine in the 1950s and 1960s, psychedelics have largely been shunned from the medical community. Most recent evidence on the efficacy of using psychedelics in medicine has come from studies outside the U.S. or from reports of their underground use that necessarily surface to the public's attention as anecdotes. Now, however, the question of whether psychedelic drugs have any valid medical use is being revisited. More serious consideration is being given to psychedelic psychotherapy, which uses psychedelics as catalysts of transcendent experiences in order to break down psychological barriers to communication and recovery.

    The director of the Drug Policy Program at UCLA, Mark Kleiman, said that there's obviously been a significant shift at the regulatory agencies and the Institutional Review Boards. There are studies [with psychedelic drugs] being approved that wouldn't have been approved 10 years ago. Part of the reason for this change is due to organizations like the Multidisciplinary Association for Psychedelic Studies (MAPS) and the Heffter Organization, which sponsor and promote studies of the medical applications of these drugs.

    With at least four different FDA approved studies on the medical applications of psychedelic drugs currently being run in the US, it seems likely that our medical professionals and our society as a whole will soon have to face the ethical questions that accompany the practice of psychedelic psychotherapy. The paper will not discuss issues of legality, but will instead focus on psychedelics effects on people's spirituality as a possible mechanism for affecting their health, and on the question of the authenticity of a psychedelic-induced spiritual experience.

    Psychological mechanisms of psychedelic therapy

    When asked if he could see a future role for psychedelics in our Euro-American culture, Albert Hofmann responded "Absolutely! ... The pathway for this is through psychiatry, but not the psychoanalytic psychiatry of Freud and not the limited scope of modern biological psychiatry. Rather, it will occur through the new field of transpersonal psychiatry." He followed this by saying "What transpersonal psychiatry tries to give us is a recipe for gaining entrance into the spiritual world."

    The idea of mixing spirituality with medicine is for most people in Western society a foreign concept, and while many people pray for a loved ones health to improve, there exists the distinction in our vernacular between healing, which is seen as more spiritual or holistic, and curing, which is accomplished through medicine. In order to understand the ethical issues behind psychedelic psychotherapy we need to have a better understanding of how psychedelic psychotherapy can affect people?s notions of meaning and the imperishable self as well as their ability to relate to other people.

    Psychedelic-induced altered states of consciousness (ASCs) tend to include a certain list of common elements, one of which is a significant change in meaning and significance. Changes in meaning and significance can be found not only in how a patient views the world, but also in how they think of the content of their therapy. Two of the main protagonists of the field of transpersonal therapy were Stan Grof and Abraham Maslow, who both thought that a person could attain their optimal psychological health through altered states of consciousness. ASCs were thought to catalyze a therapeutic response, possibly by adding significance to therapy for the patient. In the report from a man who used ayahuasca, a hallucinogenic concoction made from a vine, to treat his colon cancer, the man talks about the thoughts that he had during his trip and says "when the vine reveals such things, the impact is far more profound."

    Psychedelics seem to be able to amplify the significance and meaning of thoughts, or at least bring people closer to certain kinds of thought. Myron Stolaroff, cofounder of the International Foundation for Advanced Study in Menlo Park, California believes that the great value in these chemicals is that, in some way still not scientifically explained, they dissolve the boundaries to the unconscious mind, which allows one to then experience "the great relief of being in touch with all aspects of ones being. The joy and thrill of being totally alive comes from having complete access to all of ones feelings." The possibility of uncovering repressed thoughts and uniting a persons fragmented mind sounds appealing, but Vivian Rakoff, the emeritus professor of psychiatry at the university of Toronto cautions us that "every few years, something comes along that claims to be what Freud called the royal road to the unconscious." Transpersonal psychotherapy may be just another empty hope, but nevertheless, Rakoff says that research in psychedelic psychotherapy should be
    allowed to continue.

    Some of today's current medical studies with psychedelics that are seeking to re-examine psychedelic drugs therapeutic potential focus on their use in palliative care. Thousands of studies on the use of psychedelics in psychotherapy were published back in the 1950s and 60s before these drugs were scheduled. But many believe that these early studies do not, meet the standards of modern psychotherapy research, and that cautious reexamination of their [the psychedelics] therapeutic potential may be in order.

    One such study is being run by Charles Grob, MD at the Harbor-UCLA Medical Center, and another is headed by John Halpern of Harvard University McLean Hospital. Both studies are looking to validate older studies that showed how the terminally ill were able to come to decrease their pain and anxiety about death through transpersonal psychotherapy. Sherwood, Stolaroff and Harmon explain how transpersonal psychotherapy might mitigate existential ills associated with the dying process with the following:

    There appears to emerge a universal central perception, apparently independent of subjects previous philosophical or theological inclinations, which plays a dominant role in the healing process...

    Much of the psychotherapeutic changes are seen to occur as a process of the following kind of experience:

    The individuals conviction that he is, in essence, an imperishable self rather than a destructible ego, brings about the most profound reorientation at the deeper levels of personality. He perceives illimitable worth in this essential self, and it becomes easier to accept the previously known self as an imperfect reflection of this. The many conflicts which are rooted in lack of self acceptance are cut off at the source, and the associated neurotic behavior patterns die away.

    This recognition of existing as an imperishable self and not the ego that is usually dissolved or partially dismantled during the psychedelic trip is what comforts the dying. It supposedly abates their fear of death by letting them believe that their entire self will not cease to exist after death, but only their physical self.

    Another perspective on the use of psychedelics by the dying comes from Joanne Lynn, president of Americans for Better Care of the Dying. She says that "even in antiquity, some groups thought is was especially important to take whatever their local psychedelic was... when confronting mortality, whether to see into the hereafter, improve spiritual growth or just numb yourself to the reality." But she followed this by saying "it's sometimes poetic, sometimes majestic, but often mundane work to wrap up one's life. I think its unlikely there's a pill that will make that go away".

    A psychedelic pill might not make the mundane work of reconciling with ones family go away, but it might make it easier. Elizabeth K., psychiatrist and author of over 14 books on coping with dying believed that "simply prompting patients to express their many thoughts, feelings, and concerns would be helpful to them..."

    Such discussions could address concrete problems and relieve the patient of responsibilities and burdens that prevented the patient from dying in peace. Considering the report by Eric Kast, M.D. that LSD is... capable of improving the lot of dying individuals by making them more responsive to their environment and family, one can see how psychedelics might be able to facilitate this process of prompting patients to express themselves.

    If the interaction between a patient and their loved ones is important for the patients well being, then it might also be pertinent to consider the well being of the loved ones as a factor in a patient's treatment. One study that measured factors affecting the global quality of life (QoL) of both cancer patients and their spouses found meaningfulness to have highest correlation with QoL in both groups. The study concluded by calling for greater attention to the existential domain in palliative care, both when measuring and when trying to improve quality of life for these patients... This call for increased attention to existential concerns was echoed in another study that found that "patients with an enhanced sense of psycho-spiritual well-being are able to cope more effectively with the process of terminal illness and find meaning in the experience."


    This idea that spirituality is related to QoL and meaning in life would suggest that transpersonal psychotherapy using psychedelics possibly mediates its effects on meaning in life, and hence QoL, by inducing authentic spiritual experiences. Given the findings that spirituality is positively related to quality of life, social support, effective coping strategies and negatively related to perceived stress, uncertainty, and psychological distress, psychedelic psychotherapy should find applications in a number of different diseases from HIV to major depression. It's only fair to mention that the studies quoted above do not qualify whether they consider drug-induced spirituality as a valid form of spirituality. Because spirituality is such a broad term, we will not assume that any form of spirituality is meant to be excluded from any measurement of spirituality unless specifically stated so by the author.

    One form of spirituality that people in Western society today are mostly familiar with is indirect rather than direct spiritual experience; they are more familiar with reading about these experiences (i.e. in scripture) than having them themselves. Some people believe that psychedelics can allow people to have such direct experiences, and for some, such as Albert Hofmann, it is important to have the experience directly. But not everyone is comfortable with the idea of obtaining spirituality from a pill. Drug-induced spirituality can be viewed as spurious and artificial or too easy and too fast. These are all valid concerns, but it is interesting to view them in the context of medicine. Few people would say that an ill person who takes a pill and gets better has only achieved artificial health. Many medications are marketed as fast acting, but no one asks whether a man with athletes foot should be made to wait and suffer for a certain amount of time before he is allowed to experience relief. The difference between people's attitudes towards taking a pill to improve a deficiency in health and making a pill to fill a lack of spirituality probably lies in the idea that health is biological and physical, whereas spirituality is mental and metaphysical, but didn't we establish before that spirituality and biological health can be interrelated?

    If spirituality can be utilized to improve biological health, why can't biological measures be taken to improve spiritual health? Why should it matter whether a persons spirituality or originated in a pill or a prayer if both types of spirituality can be shown to improve quality of life and give life meaning? It shouldn't; but for some it does because drug-induced spirituality destroys some of the comforts of dualism. The spirit or soul is a comforting concept because it is an entity which cannot be touched by the harshness of the material world around us. The concept of the soul allows for the belief that we do not lose everything upon dying, that part of us may continue. To think that a material substance, a pill, could not only alter a persons mind but their soul can be threatening to the perceived rarefaction of the soul. But as Sherwood et al. explain above, psychedelics are thought only to dismantle the ego, leaving the essential self (the soul) exposed yet untouched; in other words, the soul is revealed, but not altered. This experience could actually leave people that take comfort in body-soul dualism feeling just as secure as before if not more so since they would have had a view of the soul, unobstructed by the ego, to convince themselves of its durability.

    Even if it were agreed upon that psychedelics can cause authentic spiritual experiences, there remains the concern, as Steven Hyman, a professor of neurobiology at Harvard Medical School, states it: one worries that insights gained under... different cognitive states with illusions may seem strange and distant from the vantage of our ordinary life. Hyman is restating the problem of applying insights obtained in an altered state of consciousness to changing who we are in our ordinary state of consciousness. But this problem is a product of our culture, not a psychological fact. The content of dreams that some people may refer to as illusory or meaningless are considered to be real by some cultures. Who's never heard of people interpreting their dreams and using them as guides for how to act in their waking lives? No one knows why we dream so it is impossible to say whether insights gained in dreams are or aren't applicable to ordinary waking consciousness, no matter how strange they may seem. We'd like to think that there must be some significance to dreams since we spend about one third of our lives asleep, potentially dreaming, and since we even dream when we are awake via daydreams. So while Hymans concern is a valid one, it really only gives us more reason to rigorously investigate the potential of altered states of consciousness on our ordinary life.


    Psychedelics are powerful drugs that have great potential to help as well as harm. This paper discusses the use of psychedelics in transpersonal psychotherapy and the ethical issues that accompany their employment as medicines. After examining how these drugs are thought to work in psychotherapy and their ability to cause authentically spiritual experiences, we should be better prepared to make informed decisions about the use of these drugs that not only affect ones body, but ones mind or even soul. US law says that psychedelics have no medical application, but depending on the results of a handful of current studies this may soon change. Because, compared to many other drugs, psychedelics are relatively benign physiologically, many arguments against their use are moral, not medical, objections. And as Francis, points out: We are... unwilling to take a clear stand on drugs solely on the basis that they are bad for the soul. Whether a drug is good or bad for the soul and a person's spirituality is a tough question to ask, but that does not make it impossible to answer. The soul aside, how drugs affect consciousness is a tough question in and of itself. The psychedelic mind-state is poorly understood, but its implications for human spirituality and psychiatric health nonetheless warrant a thorough investigation, which in view of their potential benefits could even be seen as unethical not to pursue.

    Why psychedelic psychotherapy works

    Jerry Brown, Ph.D., and Julie Brown

    Steve Jobs loved LSD. The legendary Apple co-founder said, taking LSD was one of the two or three most important things he had ever done in his life. Jobs credited the multiple use of LSD as a major reason for his success and ability to Think Different, which became Apples motto.

    Jobs was not the only visionary who attributed enhanced intellectual capacity to ingesting an entheogen. Cambridge Universitys Francis Crick, co-discoverer of the DNA structure, was another. Crick revealed, when speaking with a close friend, that he had actually "perceived the double-helix shape while on LSD." The list of brilliant LSD users who have come out of the psychedelic closet includes physicist Richard Feynman; Microsoft founder Bill Gates; and neuroscientist John C. Lilly.

    None of this should come as a surprise, given the success of an earlier study in proving that psychedelic drugs significantly enhance problem-solving abilities. In 1966, a research team, which included psychologist James Fadiman and engineer Willis Harmon, conducted a Psychedelics in Problem-Solving Experiment. The researchers administered low doses of mescaline (a moderately light dose compared to doses used to induce mystical experience) to professional people (i.e., engineers, mathematicians, architects) who were highly motivated to solve a problem they had been working on for three months or more without success. Virtually all of the subjects reported making significant breakthroughs and producing solutions that were validated by independent tests and, eventually, commercial acceptance of their solutions. This promising line of inquiry was abruptly terminated by the Food and Drug Administration, which banned further research on human subjects as part of the then-growing political backlash to the 1960s psychedelic movement.

    Second coming of psychedelics

    Today this problem-solving research and other potential medical and scientific benefits of psychedelics are being revisited by researchers at some of the nations leading universities, such as Johns Hopkins, Harvard and the University of California. In an article titled The Second Coming of Psychedelics, journalist Don Lattin describes this renewed interest in sacred medicine. Paving the way for this resurgence of government-approved research is the Multidisciplinary Association for Psychedelic Studies (MAPS), a non-profit research and educational organization that develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana.

    In recent years, rigorous research has been conducted on entheogens, such as ayahuasca, LSD, mescaline and psilocybin, and on the empathogen Ecstasy. The goal is to evaluate their effects on addiction, cluster headaches, depression, trauma, cancer, epilepsy, death and dying, as well as to explore their value in the study of consciousness and mystical experience. The implications of this new science of psychedelics for brain research and psychiatry, and for religion and spirituality, have been documented in numerous articles and books. A resurgence in the study of entheogens is well underway.

    Why psychedelic-assisted psychotherapy works

    We would like to share our thoughts on why psychedelic-assisted psychotherapy is proving to be highly effective as a healing modality.

    Psilocybin has been used in traditional healing rituals for thousands of years. However, for more than 40 years it has been illegal in the U.S.

    But recent findings are tearing down the barriers surrounding psychedelic research, as it has been clinically shown that they have the ability to ease depression and soothe anxiety in patients dealing with serious illness and impending death. Two separate studies discovered that a single, moderate-to-large dose of psilocybin was able to help alleviate profound distress among cancer patients.

    Lifting the taboo on psychedelic research

    Harvard psychology professor Timothy Leary infamously sparked an aggressive promotion of LSD in the 1960s that would ultimately lead to the loss of his teaching position and a federal ban, the Controlled Substance Act of 1970, on all research on psychedelics.

    This research blackout came to an end in 1999, when Roland Griffiths of Johns Hopkins initiated a new series of studies on psilocybin. He has since become known as the grandfather of the psychedelic renaissance and a 21st-century pioneer in the field. Unlike Leary, however, he does not aspire to be a guru or shaman. Rather, as a clinical pharmacologist and author of over 300 studies on mood-altering substances, Griffith prefers the path of scientific caution.

    Griffith claims his initial curiosity about psychedelics came from his own mindfulness meditation practice. His interest was further sparked when he administered psilocybin to volunteers and found that two-thirds of the participants called their psychedelic journey among the most significant experiences of their lives.

    Today, Griffiths touts the use of psychedelic-assisted psychotherapy for its ability to treat a variety of debilitating conditions, such as depression in terminally ill patients, post-traumatic stress syndrome among war vets, and alcohol and tobacco dependence.

    Griffiths says:

    "There is something about the core of this experience that opens people up to the great mystery of what it is that we don't know. It is not that everybody comes out of it and says,
    'Oh, now I believe in life after death.' That needn't be the case at all. But the psilocybin experience enables a sense of deeper meaning, and an understanding that in the largest frame everything is fine and that there is nothing to be fearful of."

    "There is a buoyancy that comes of that which is quite remarkable. To see people who are so beaten down by cancer, and they start actually providing reassurance to the people who love them most, telling them it is all okay and there is no need to worry, when a dying person can provide that type of clarity for their caretakers, even we researchers are left with a sense of wonder."

    Why are psychedelics so effective?

    Researchers know how, but they do not know why, psilocybin has worked in these settings. One theory is that psilocybin interrupts the circuitry of self-absorbed thinking that is so pronounced in depressed people, making way for a mystical experience.

    Dr. Robin Carhart-Harriss group at Imperial College in London is doing neuro-imaging studies. These studies suggest that the positive effects of psychedelic-assisted psychotherapy are explained by changes in something in the brain called the default mode network.

    It turns out that this network is hyperactive in depression. Interestingly, in both meditation and also with psilocybin this network becomes quiescent. This may correlate with the experience of clarity, of coming into the present moment, which is the key to getting out of self-absorbing thinking and to experiencing feelings of inter-connectedness.

    Normally, information is exchanged in the brain using various circuits, or what one researcher describes as informational highways. On some highways, there's a steady stream of traffic. On others, however, there are rarely more than a few cars on the road. Psychedelics appear to drive traffic to these underused highways, opening up dozens of different routes and freeing up some space along the more heavily used ones ̶ thereby facilitating an expanded sense of awareness and access to new perspectives among participants in psychedelic therapy sessions.

    Moment of absolute clarity

    Our theory of why psychedelic-assisted psychotherapy works correlates closely with the findings of these brain imaging studies.

    What we are seeing here are neural representations of major shifts in awareness. When you have a mind-expanding experience, you can transition from fear and anxiety to confident self-empowerment. This, in turn, provides a serene sense of well-being that is essential to both emotional and physical healing.

    In this context, we can begin to understand how psychedelic-assisted psychotherapy can provide fast and effective treatment for a variety of patients suffering from addiction, depression and trauma. By fast, we are referring to positive results coming from one or two sessions, as opposed to the months and even years that traditional psychotherapy requires.

    By contrast, Dr. Stephen Ross, the lead investigator and chief of addiction psychiatry at N.Y.U., points out that antidepressants can take weeks to show benefit. "Cancer patients with anxiety and depression need help immediately," he said, "especially if you consider that they are at elevated risk for completed suicide."

    In a word: the moment of absolute clarity is the treasure that entheogens hold!
    Last edited by mr peabody; 06-01-2019 at 03:52.
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    Bluelighter mr peabody's Avatar
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    Can ibogaine help in psychotherapy?

    One ibogaine treatment session has been described as "10 years of psychoanalysis in a single night."

    - PTSD, Complex PTSD
    - Processing childhood trauma
    - Loss and grief
    - Learning forgiveness & peace
    - Unprocessed or repressed memories & experiences
    - Facing fears & phobias
    - Bringing the subconscious to the conscious
    - Perspective into one's deeper programs & thought patterns

    Forms of depression, anxiety and trauma influence the lives of us all at some point of our lives. This is all part of the human condition.

    A common thread that Dr. Some has noticed in “mental” disorders in the West is “a very ancient ancestral energy that has been placed in stasis, that finally is coming out in the person,” thus, mental disorders are spiritual emergencies, spiritual crises, and need to be regarded as such to aid the healer in being born... "If these ancestors are not healed, their sick energy will haunt the souls and psyches of those who are responsible for helping them. In indigenous cultures all over the world, young people are initiated into adulthood when they reach a certain age. The lack of such initiation in the West is part of the crisis that people are in here," says Dr. Some. He urges communities to bring together “the creative juices of people who have had this kind of experience, in an attempt to come up with some kind of an alternative ritual that would at least begin to put a dent in this kind of crisis.”

    Ibogaine is used to treat PTSD, depression, anxiety, ADHD, eating disorders and many other mental, emotional, spiritual and physical disorders. Ibogaine can help to address the root cause of the disorder as well as cleaning the mind of its unwanted and limiting negative programming, restoring you to the clarity of your pre-trauma state. A complete mind, body, spirit ‘reset’ is often described.

    It can eliminate the initial emotional pain that may have caused you to seek painkillers, alcohol, sleeping pills, anti-depressants, binge eating or other hard drugs. Your emotional body is temporarily relieved so that you can witness and process past traumas in a near-instant without getting caught up in old triggers and fears. Some say that taking journeys with other plants medicines for ten years would not be equal to one iboga journey. "Ibogaine took me away from a cycle of self (and my loved ones) destruction. It gave me the chance to reset my existence as a human being."

    Ibogaine has been found to increase levels of glial cell line-derived neurotrophic factor, or GDNF, which promotes the survival and replenishment of many types of neurons. A single dose of ibogaine can increase GDNF expression for weeks, depending on dosage. Ibogaine is also highly lipophilic and remains in body fat for months, gradually being released, further extending its influence on GDNF expression.

    - Ibogaine facilitates the deep exploration of one’s own persona and mind. The investigation is carried out by the user themselves, allowing them to choose and control what they want to deal with. Nobody knows you like you know yourself!

    - The use of ibogaine has been found to provide the majority of users with the ability to explore and openly talk about previously undisclosed and repressed personal problems. This effect has been shown to last for at least a week or so, with many users reporting a continued/ongoing ability to objectively assess and discuss deeply rooted issues.

    - In an ibogaine experience, the body is physiologically and chemically open so that when the memory comes and it is re-experienced viscerally, the chemical correlation of the insight are also experienced physiologically. Ibogaine is able to unlock the door to the unconscious mind and can assist in the healing of depression, clearing phobias and fears, and other personality disorders.

    - Ibogaine can offer the chance to revisit childhood and other past memories, providing the opportunity to meet/reconnect/make peace with people that have died.

    - Ibogaine also works to re-balance the brain chemistry, level out dopamine, serotonin, endorphins and adrenaline, and restore users to the clarity of the pre-trauma state.

    Whether you suffer from a mood disorder is in your hands to determine and examine it with your doctor. However an ibogaine therapy treatment can effectively induce a level of mental clarity which in turn helps relieving the depression and anxiety symptoms completely and directly, offering powerful insight for you to access fundamental understandings, hence achieving meaningful degrees of relief.


    History of ketamine in psychotherapy

    A number of international psychiatric investigators have utilized treatment with ketamine to create cathartic effects in psychotherapy.

    In Iran, ketamine psychotherapy was shown to be very effective in treating various psychiatric disorders. These investigators administered ketamine to 100 psychiatric patients with different mental health and psychosomatic diagnoses, including depression, anxiety, phobias, obsessive-compulsive neurosis, conversion reaction, hypochondriasis, hysteria, tension headaches, and ulcerative colitis. They reported that 91 participants were doing well after six months, and 88 remained well after one year. These investigators concluded that “ketamine’s abreactive or cathartic effect was related to its mind-expanding qualities;” however, they did not further specify their findings in clinical language.

    In Argentina, Fontana used ketamine as an adjunct to antidepressive psychotherapy in order to facilitate regression to a prenatal level through a disintegration and death experience, which
    was followed with a progression experience that was seen as similar to a rebirth. He emphasized the advantages of ketamine, which made it possible to achieve deep levels of regression.

    In Mexico, Roquet was the first clinician to employ ketamine psychedelic psychotherapy History of Ketamine in Psychotherapy in a group setting. He combined psychoanalytical techniques with the healing practices of Mexican Indian ceremonies and created a new approach to psychedelic psychotherapy that he called "psychosynthesis” (not to be confused with the same term used by Assagioli). He mainly used this procedure to treat neurotic patients, although he described some success with personality disorders and selected psychotic patients.

    One of us (Krupitsky) first began using ketamine in the former Soviet Union in 1985 for treatment of alcoholism. He developed Ketamine Psychedelic Therapy (KPT) and treated more than 1,000 patients without complications. In one of his many controlled studies, nearly 70% of his ketamine-treated patients remained abstinent from alcohol during a one-year follow-up, in contrast to only 24 percent abstinence achieved in a control group treated with more traditional therapy. In a comprehensive clinical research review on this subject, Krupitsky concluded that KPT is a safe and effective treatment for alcoholism and other drug dependencies, such as heroin and ephedrine, as well as effective for treatment of post-traumatic stress disorder, reactive depression, neurotic disorders, and avoidant personality disorders, and somewhat effective for the treatment of phobic neurosis, obsessive-compulsive neurosis, and histrionic personality disorder.

    Krupitsky and his colleagues recently conducted a double-blind randomized clinical trial comparing the relative effectiveness of high to low dose administrations of ketamine for the psychotherapeutic treatment of heroin addiction; two-year follow-up data indicated that high dose ketamine was more effective. The study reported that “high dose KPT produced a significantly greater rate of abstinence in heroin addicts within the first 24 months of follow-up than did low dose KPT.”

    The authors also concluded that “high dose KPT brought about a greater and longer-lasting reduction in craving for heroin, as well as greater positive change in non-verbal unconscious emotional attitudes.” It appears the study’s data represent both a lower rate of recidivism and a higher degree of psychological integration.Recent changes in the regulations governing such research in Russia have now brought Krupitsky’s pioneering research efforts to a halt.

    There was also an intriguing study at the University of Cambridge in the UK, in which ketamine was used to treat compulsive behavior in young women with anorexia nervosa with good results, although the publication of this study does not clearly indicate that the clinicians used a psychotherapeutic model. The study used infusions of ketamine to treat 15 patients with a long history of eating disorder, all of whom were chronic and resistant to several other forms of treatment. Nine responders showed prolonged remission when treated with ketamine infusions. There have also been various lone practitioners in other countries, usually family doctors or psychiatrists, who have used ketamine to treat psychological/psychiatric problems.

    Ketamine-Enhanced Psychotherapy

    Inspired by Krupitsky, one of us (Kolp) engaged in the clinical treatment of alcoholic clients using what he called Ketamine-Enhanced Psychotherapy. His approach was explicitly meant to replicate Krupitsky’s pioneering work and to extend it into another cultural context, the US (note: Kolp is a bi-cultural Soviet-American psychiatrist, who was originally trained as a Soviet psychiatrist, immigrated to the United States in 1981 and was re-trained as an American psychiatrist). As with Krupitsky’s KPT technique, Kolp’s KEP treatment explicitly relied on the transpersonal effects of ketamine to facilitate psychotherapeutic change. Both researchers have recently published their combined observations on clinical and empirical research of the effectiveness of ketamine-enhanced psychotherapy for treatment of alcoholism. Once more, although most psychedelic drugs are illegal to use in the US even by physicians, ketamine is a notable exception because it is readily available to physicians as an anesthetic that can be legally used off-label for psychiatric treatment. Consequently, Kolp employed ketamine in his private psychiatric practice in the US from the fall of 1996 through the spring of 1999, administering it to more than 70 clients. Several of us also recently published Kolp’s empirical observations of the effectiveness of his KEP for treatment of alcoholism.

    During this same period of time, Kolp had an opportunity to administer KEP to two patients with end-stage cancer. This paper summarizes these patients’ responses and provides Kolp’s informal retrospective observations on ketamine’s effectiveness for treatment of existential anxieties in terminally ill people. We emphasize that these clinical administrations were not conducted in a formal research context and this paper provides the informal retrospective observations on ketamine’s effectiveness for treatment of existential anxieties in terminally ill people. However, in light of the recent resurgence of psychedelic research in the US and our plans, as a research team, to now seek institutional review board approval and grant funding for formally pursuing studies on ketamine’s effectiveness in a number of clinical applications including the treatment of death anxiety, a reporting of Kolp’s clinical observations is seen as warranted.


    There has been surging interest in the use of ketamine as a potential therapeutic agent for affective disorders, particularly depression. Even a single-dose of ketamine may cause rapid antidepressant effects in otherwise treatment-resistant cases of bipolar and major depression. Remarkably, this also includes the acute reduction of suicidal ideation. Recent neuroimaging studies support potential anti-anhedonic and anti-depressant effects, demonstrating its ability to alter glucose metabolism in regions implicated in mood disorders. Repeated ketamine doses may improve depressive symptoms comparable to—and perhaps even more rapidly than—electroconvulsive therapy, and it may even be successful in treating ECT-resistant depression. Despite its observed promising antidepressant effects, however, more rigorous investigation is needed to establish its clinical use as an antidepressant. The current evidence is limited by bias, small sample sizes, and limited data on important cofounding variables. In fact, a recent Cochrane Review determined that the efficacy of ketamine as an antidepressant may be limited beyond 1 week.

    Post-Traumatic Stress Disorder (PTSD)

    One of the newer applications of ketamine is its role as a potential treatment for Post-Traumatic Stress Disorder (PTSD), although studies examining this remain limited. For instance, Feder et al. (2014) found that ketamine may reduce symptom severity of PTSD more rapidly than midazolam; however, they did not exclude previously depressed patients, and the observed results may have been due—in part—to ketamine’s known antidepressive effects. A case reported by Donoghue et al. (2015) describing ketamine-induced remission of PTSD and disruptive symptoms in a child similarly provides inconclusive evidence for effects of ketamine specific to PTSD. While it is postulated that ketamine may be useful in preventing the development of PTSD through the induction of stress resilience, more research is clearly needed to better define ketamine’s effects on PTSD.

    Models of schizophrenia

    Since its discovery, ketamine has been observed to produce symptoms similar to those of schizophrenia. As a result, researchers have used these drugs extensively as models to study schizophrenia. While it now appears that overlaps in symptoms and even receptor effects are insufficient to explain the complex neuropathology of schizophrenia, ketamine has undoubtedly facilitated and stimulated research efforts into understanding schizophrenia.
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    Falling apart, merging together: Psychedelic psychotherapy

    A terminal cancer diagnosis can inspire fierce bravery in some patients. Though there is no way to fight the disease, they accept their fate and embrace their final days with gusto
    or spiritual peace. They may be sad, but they are not clinically depressed. Others, however, sink into themselves. They cannot see a point to the time they have left.

    “They struggle for months with their worries, disabled by their fear of death,” said George Greer, a psychiatrist and the medical director of the Heffter Research Institute. Heffter, with headquarters in Santa Fe, supports research into psychotherapy for terminal cancer patients that utilizes the drug psilocybin. Greer and his colleagues are also involved in psilocybin therapy research for alcohol, nicotine, and drug addiction. Psilocybin is a psychedelic substance that, when properly synthesized, dosed, and taken in a controlled setting, shows great success in treating a range of psychological problems.

    Greer’s work and the Heffter Research Institute are included in Changing Our Minds: Psychedelic Sacraments and the New Psychotherapy, by Don Lattin, recently published by Santa Fe’s Synergetic Press. Changing Our Minds is part journalistic memoir and part advocacy expos? that weaves together the many threads of the psychedelic therapy movement — which has its origins in the 1950s, when some doctors began using LSD, or “acid,” in psychoanalysis. (Actor Cary Grant is perhaps the era’s best-known recipient of this experimental therapy.) Research in those days also showed LSD’s promise in the treatment of alcoholism. Lattin tells the stories of numerous scientists, psychiatrists, therapists and counselors, arranging history in a somewhat nonlinear fashion. The book touches here and there on Albert Hoffman’s invention of LSD in the 1940s, Timothy Leary and Richard Alpert’s Harvard Psilocybin Project in the early ’60s, and many other non-household but nevertheless important names in the field.

    Psychedelics made the leap from the lab to the street in the early 1960s, and by mid-decade in California, “a promising novelist named Ken Kesey gathered a Dionysian troupe of Merry Pranksters and put on a series of parties called ‘Acid Tests,’ where revelers dosed themselves and danced to a new band called the Grateful Dead,” Lattin writes. The backlash against what was perceived by many as a hallmark of the hedonistic hippie drug culture came first in the form of government regulations over academic and medical research and eventually as an outright ban on possession by the public. By 1970, “a new federal law ignored the findings of research scientists and declared LSD and psilocybin medically useless and easy to abuse.” MDMA emerged later, but it faced a similar fate — its recreational use characterized by the government and media as a social ill while its positive therapeutic uses were ignored or denied.

    Greer moved to Santa Fe from San Francisco in the 1980s with his wife, a psychiatric nurse. They were already involved in psychedelic psychotherapy, and began meeting others in town who were also waiting for the dark ages imposed upon their work to end. In the early 1990s, the FDA quietly changed its mind about its Nixon-era attitude towards psychedelic drug research, and studies were allowed to resume — albeit with no government funding. All money for psychedelic studies still must come from private sources, according to Greer. Heffter, founded in 1993, and the Multidisciplinary Association for Psychedelic Studies (MAPS), founded in 1986, fill this niche by reviewing research proposals and then raising money for the studies they want to support. MAPS also performs educational outreach, harm reduction at music festivals, and advocacy for the legal use of recreational psychedelics. Heffter, founded by doctors and scientists, is a pure research organization. In addition to medical uses for psilocybin, Heffter has also been involved in studying the psychological and spiritual effects of psilocybin on healthy people who meditate as well as on members of clergy.

    When used in the treatment of alcohol and addiction, Greer and other medical professionals claim, psychedelics hasten the process of a drinker or addict “hitting bottom,” which is the term often used for when an addict finally admits he or she has a problem and wants to get sober. Psychedelics open the door to a mystical, bird’s-eye view of one’s own life, in which emotional problems are transcended, replaced by a greater understanding of one’s self and one’s place in the connected whole of the universe. After a psychedelic therapy session or two, patients crave the addictive substance less and its importance in their lives declines. The effects of such sessions on the terminally ill are similar — psychedelic therapy alleviates their existential suffering. “They experience a shift in outlook about who they are, and about the meaning of life and death,” Greer said.

    Post-traumatic stress disorder (PTSD) patients in studies funded by MAPS report a reduction in nightmares, flashbacks, and intrusive thoughts after taking MDMA — known colloquially as Ecstasy or Molly — in guided therapy sessions. Changing Our Minds describes such a session from beginning to end with an Iraq war veteran named Nigel McCourry, led by researchers Michael and Annie Mithoefer. The rare glimpse inside an experience that is usually private is an unusual therapy session, to be sure, but there are no wild hallucinations or giggle fits. Contrary to MDMA’s reputation as a party drug and the behavior it stimulates, McCourry does not become helplessly sexual or need to dance. He closes his eyes, listens to New Age music over headphones, and lets his mind drift. He discusses what comes up with his doctors.

    The Mithoefers had “already completed an initial study of MDMA-assisted psychotherapy with 20 volunteers suffering from PTSD, most of them victims of child sexual abuse, adult rape and assault,” Lattin writes. “Eighty percent of the twenty patients in that pilot study had no PTSD symptoms two months following the completion of the treatment, compared to 25 percent who got a placebo pill.” McCourry was part of a second study, this one of veterans, that also showed positive results. “People with PTSD have increased activity in the amygdala, the fear center in the brain,” Michael Mithoefer says in the book. “They have a lot of trouble trusting and developing a therapeutic alliance. They can be suspicious and expect people to betray them. They might read expressions on a therapist’s face as not being safe. Something like MDMA can turn down that distortion and make them less likely to reject therapy.”

    Current studies on psychedelic psychotherapy are approved by the FDA and are considered as “Phase 2” of a three-phase testing process. Phase 1 tests, performed decades ago, established that these drugs do no lasting harm to humans. Phase 2 uses a limited number of participants to prove that a drug has the efficacy to treat a specific problem. Phase 3 allows researchers to broaden their sample sizes and test hundreds of subjects for better data. Greer said FDA approval for Phase 3 testing of MDMA and psilocybin therapy is likely only a couple of years away — and when it comes, psychedelic psychotherapy will have a home in Santa Fe, where a number of therapists are already interested in trying it with their patients.

    Changing Our Minds includes chapters on other kinds of psychedelic therapy, including ayahuasca and ibogaine. Ibogaine, a root from West Africa, has a long-acting psychedelic effect similar
    to LSD. Because it also blocks opiate withdrawal, in countries where it is legal, like Mexico, it is used to help heroin addicts get clean. Research has shown some danger of neuro- and cardiac toxicity with ibogaine, Greer said, and there have been some deaths among addicts who are in ill health, but scientists are working on a safer, non-psychedelic version. Ayahuasca, used in religious ceremonies, is a brewed mixture of Amazonian jungle plants, mainly the vine Banisteriopsis caapi, and either chacruna or chagropanga, both of which contain the psychedelic substance DMT. Though DMT is chemically similar to psilocybin, Greer said because it is a plant rather than a “pure drug,” it is difficult to study. Ayahuasca tea is legal for ingestion in the United States only by members of the Uni?o do Vegetal (UDV) church, but an ayahuasca tourism economy has sprung up in South America to capitalize on American and European interest in having profound mystical experiences. Many of the experts cited in the book warn against traveling to a foreign country and putting your physical and psychological safety in the hands of strangers trying to make a buck, or even those who are well-intentioned healers but who know nothing about you.

    Lattin is careful not to come across as evangelizing the unconstrained recreational use of any of the drugs he writes about. He covers opposing points of view among researchers, psychiatrists, and other practitioners and proponents of psychedelic psychotherapy. Some want it strictly monitored in medical and scientific settings, while others believe enough is already known about the drugs’ effects to render spending years giving control groups placebos a waste of time and money. Lattin also discusses the potential downsides of psychedelic psychotherapy — as in when a therapist abuses his power over a patient who is in a suggestive state, or when people with delusions of grandeur use the drugs to manipulate others, such as in cultic environments.

    Psychedelic psychotherapy is not recommended for everybody. It is not an easy experience and requires a patient’s willingness to “surrender, to let themselves merge or fall apart,” Greer said. Screening processes help researchers make sure they are not treating anyone with a personal or family history of schizophrenia or manic episodes, as there is some evidence that the drugs can trigger such an episode in someone who is predisposed to them. Other conditions that might disqualify someone from a study are high blood pressure and brain tumors that impair cognitive function. Greer said that "not every terminal cancer patient is a candidate for this kind of therapy. Though both psychedelics and terminal cancer diagnoses are known to bring on sudden spiritual transformation in people suddenly acutely aware of their mortality, Heffter and MAPS studies are for patients “who are not able to get to such a place on their own and are
    experiencing significant anxiety over their prognosis.”

    For those who are skeptical that a “drug trip” can have lasting psychological healing power, Greer explained that psychedelics open up additional areas of consciousness while preventing other parts of the brain from engaging in their usual running commentary on day-to-day life. While under the influence of psychedelics, people have what researchers refer to as a mystical or peak experience, which Greer described using such terms as ineffability, positive mood, and feelings of unity.

    “Psychedelics change the pattern that your brain is in when you’re in your normal personality,” he said. “The mind gets quiet and lots of other things can happen. We have the brain wiring to do this — otherwise it wouldn’t be possible at all. People who have these peak experiences are statistically more likely to have this transformational outlook on themselves and on life and death. There was one woman who was a lifelong atheist and she said that during her session she experienced God — though she was still an atheist. She said it wasn’t something she could put into words, that it was beyond language.”


    A brief history of psychedelic psychiatry

    In the 1950s a group of pioneering psychiatrists showed that hallucinogenic drugs had therapeutic potential, but the research was halted as part of the backlash against the hippy counterculture.

    On 5th May, 1953, the novelist Aldous Huxley dissolved four-tenths of a gram of mescaline in a glass of water, drank it, then sat back and waited for the drug to take effect. Huxley took the drug in his California home under the direct supervision of psychiatrist Humphry Osmond, to whom Huxley had volunteered himself as “a willing and eager guinea pig”.

    Osmond was one of a small group of psychiatrists who pioneered the use of LSD as a treatment for alcoholism and various mental disorders in the early 1950s. He coined the term psychedelic, meaning ‘mind manifesting’ and although his research into the therapeutic potential of LSD produced promising initial results, it was halted during the 1960s for social and political reasons.

    Born in Surrey in 1917, Osmond studied medicine at Guy’s Hospital, London. He served in the navy as a ship’s psychiatrist during World War II, and afterwards worked in the psychiatric unit at St. George’s Hospital, London, where he became a senior registrar. While at St. George’s, Osmond and his colleague John Smythies learned about Albert Hoffman’s discovery of LSD at the Sandoz Pharmaceutical Company in Bazel, Switzerland.

    Osmond and Smythies started their own investigation into the properties of psychedelics and observed that mescaline produced effects similar to the symptoms of schizophrenia, and that its chemical structure was very similar to that of the hormone and neurotransmitter adrenaline. This led them to postulate that schizophrenia was caused by a chemical imbalance in the brain, but these ideas were not favourably received by their colleagues.

    In 1951 Osmond took a post as deputy director of psychiatry at the Weyburn Mental Hospital in Saskatchewan, Canada and moved there with his family. Within a year, he began collaborating on experiments using LSD with Abram Hoffer. Osmond tried LSD himself and concluded that the drug could produce profound changes in consciousness. Osmond and Hoffer also recruited volunteers to take LSD and theorised that the drug was capable of inducing a new level of self-awareness which may have enormous therapeutic potential.

    In 1953, they began giving LSD to their patients, starting with some of those diagnosed with alcoholism. Their first study involved two alcoholic patients, each of whom was given a single 200-microgram dose of the drug. One of them stopped drinking immediately after the experiment, whereas the other stopped 6 months later.

    Several years later, a colleague named Colin Smith treated another 24 patients with LSD, and subsequently reported that 12 of them were either “improved” or “well improved” as a result of the treatment. “The impression was gained that the drugs are a useful adjunct to psychotherapy,” Smith wrote in a 1958 paper describing the study. “The results appear sufficiently encouraging to merit more extensive, and preferably controlled, trials.”

    Osmond and Hoffer were encouraged, and continued to administer the drug to alcoholics. By the end of the 1960s, they had treated approximately 2,000 patients. They claimed that the Saskatchewan trials consistently produced the same results – their studies seemed to show that a single, large dose of LSD could be an effective treatment for alcoholism, and reported that between 40 and 45% of their patients given the drug had not experienced a relapse after a year.

    At around the same time, another psychiatrist was carrying out similar experiments in the U.K. Ronald Sandison was born in Shetland and won a scholarship to study medicine at King’s College Hospital. In 1951, he accepted a consultant’s post at Powick Hospital near Worcester, but upon taking the position found the establishment to be overcrowded and decrepit, with patients being subjected to electroshock treatment and lobotomies.

    Sandison introduced the use of psychotherapy, and other forms of therapy involving art and music. In 1952, he visited Switzerland where he also met Albert Hoffman, and was introduced to the idea of using LSD in the clinic. He returned to the U.K. with 100 vials of the drug – which Sandoz had by then named ‘Delysid’ – and, after discussing the matter with his colleagues, began treating patients with it (in addition to psychotherapy) towards the end of 1952.

    Sandison and his colleagues obtained results similar to those of the Saskatchewan trials. In 1954 they reported that “as a result of LSD therapy, 14 patients recovered (av. of 10 treatments),
    1 was greatly improved (3 treatments), 6 were moderately improved (av. of 2 treatments) and 2 not improved (av. of 5 treatments).”

    These results drew great interest from the international mass media, and as a result, Sandison opened the world’s first purpose-built LSD therapy clinic the following year. The unit, located on the grounds of Powick Hospital, accommodated up to 5 patients who could receive LSD therapy simultaneously. Each was given their own room, equipped with a chair, sofa, and record player. Patients also came together to discuss their experiences in daily group sessions. (This backfired later, however: In 2002, the National Health Service agreed to pay a total of 195,000 pounds sterling in an out-of-court settlement to 43 of Sandison’s former patients.)

    Meanwhile in Canada Osmond’s form of LSD therapy was endorsed by the co-founder of Alcoholics Anonymous and the director of Saskatchewan’s Bureau on Alcoholism. LSD therapy peaked in the late 1950s and early 1960s, and was widely considered to be “the next big thing” in psychiatry, which could supersede electroconvulsive therapy and psychosurgery. At one point, it was popular among Hollywood superstars such as Cary Grant.

    Two forms of LSD therapy became popular. One, called psychedelic therapy, was based on Osmond and Hoffer’s work, and involved a single large dose of LSD alongside psychotherapy. Osmond and Hoffer believed that hallucinogens are beneficial therapeutically because of their ability to make patients view their condition from a fresh perspective.

    The other, called psycholytic therapy, was based on Sandison’s regime of several smaller doses, increasing in size, as a adjunct to psychoanalysis. Sandison’s clinical observations led him to believe that LSD can aid psychotherapy by inducing dream-like hallucinations that reflected the patient’s unconscious mind and enabling them to relive long-lost memories.

    Between the years of 1950 and 1965, some 40,000 patients had been prescribed one form of LSD therapy or another as treatment for neurosis, schizophrenia, and psychopathy. It was even prescribed to children with autism. Research into the potential therapeutic effects of LSD and other hallucinogens had produced over 1,000 scientific papers and six international conferences. But many of these early studies weren’t particularly robust, lacking control groups, for example, and likely suffered from what researchers call publication bias, whereby negative data are excluded from the final analyses.

    Even so, the preliminary findings seemed to warrant further research into the therapeutic benefits of hallucinogenic drugs. The research soon came to an abrupt halt, however, mostly for political reasons. In 1962, the U.S. Congress passed new drug safety regulations, and the Food and Drug Administration designated LSD as an experimental drug and began to clamp down on research into its effects. The following year, LSD hit the streets in the form of liquid soaked onto sugar cubes; its popularity grew quickly and the hippy counterculture was in full swing by the summer of 1967.

    During this period, LSD increasingly came to be viewed as a drug of abuse. It also became closely associated with student riots anti-war demonstrations, and thus was outlawed by the U.S. federal government in 1968. Osmond and Hoffer responded to this new legislation by commenting that “it seems apt that there is now an outburst of resentment against some chemicals which can rapidly throw a man either into heaven or hell.” They also criticised the legislation, comparing it to the Victorian reaction to anaesthetics.

    The 1990s saw a renewed interest in the neurobiological effects and therapeutic potential of psychedelic drugs. We now understand how many of them work at the molecular level, and several research groups have been performing brain-scanning experiments to try to learn more about how they exert their effects. A number of clinical trials are also being performed to test the potential benefits of psilocybin, ketamine and MDMA to patients with depression and various other mood disorders. Their use is still severely restricted, however, leading some to criticise drug laws, which they argue are preventing vital research.

    Huxley believed that psychedelic drugs produce their characteristic effects by opening a “reducing valve” in the brain that normally limits our perception, and some of the new research seems to confirm this. In 1963, when he was dying of cancer, he famously asked his wife to inject him with LSD on his deathbed. In this, too, it seems that he was prescient: Several small trials suggest that ketamine alleviates depression and anxiety in terminally ill cancer patients and, more recently, the first American study to use LSD in more than 40 years concluded that it, too, reduces anxiety in patients with life-threatening diseases.
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    Psychedelics and their role in treating mental health disorders

    Psychedelics such as LSD, magic mushrooms, mescaline etc. have garnered renewed interest in the scientific world because of the possible role they could play in mental health problems. Ketamine remains the only psychedelic at present that is used clinically as an anesthetic agent. The others are all classified under banned drugs.

    There have been numerous studies recently where these drugs have been tried in treatment of mental health disorders such as addictions, depression and post-traumatic stress disorder etc. These agents have shown promise in persons in whom most of the conventional therapy has failed.

    Researchers at Imperial College London are now all set to start major clinical trials to see if any of these psychedelics can be actually helpful in treatment of depression when compared to a standard drug used for treatment of depression. In their trial the team of researchers would compare magic mushroom compound psilocybin and a SSRI (selective serotonin re-uptake inhibitors) antidepressant, escitalopram. The trial is expected to run for at least 2 years. Dr Robin Carhart-Harris, study leader said that there is a “revolutionary potential” of these psychedelic drugs and this is not an exaggeration.

    The team of researchers explains that these psychedelic drugs have been in scientific interest for the last few decades. They were initially used in the 1950s and 60s for some of the mental health problems before they fell into disrepute mainly because of the abuse liability, recreational use and risk of dependence and addiction. Over a thousand studies had been conducted during that time. Soon fear of moral degeneration and overdosage related risks took over and these drugs were made illegal in America in 1968. The United Nations too convened on the status on 1971 that stopped scientific research on these drugs. Member states made these drugs illegal and classified them as Schedule 1 drugs or drugs that have no known medicinal benefits. This sealed their fates even in scientific research. Next few decades saw no research on these drugs. It is only recently that there is renewal of interest in the psychedelics especially in PTSD and depression that is refractory to standard treatments.

    In the mid-2000s these drugs underwent a “scientific renaissance” after Johns Hopkins University in the US started work on them. Psilocybin was being studied in 1990s mainly because laws governing its use in research were not as stringent as with others. Psilocybin showed that there was a reduction in symptoms of depression in 80 percent of the patients with terminal cancers who suffered from depression. This agent could also help people quit smoking more effectively than currently used therapy. Dr Carhart-Harris has been working with psychedelics for the last five decades and more and he and his team last year found that psilocybin can help “reset” the brains of people with depression and help cases of “untreatable depression”. His paper published in the journal Scientific Reports showed that two areas of the brain including the amygdala and a network of neurons are affected. The amygdala helps an individual to process emotions and feelings while the network of neurons help coordinate different parts of the brain. Dr Carhart-Harris says that it could be that the psilocybin can “heat up” and “reset” the brain to remove the rigidly held “self destructive patterns of thought”. Along with cognitive behavioral therapy, he explained, the brain could be “recalibrated”.

    Some of the problems with the use of psychedelics are the fear and anxiety bad trips may cause. There may be a sense of losing control that might trigger anxiety and even psychotic breaks, warn experts. During the trials pure, medical-grade drugs would be used under strict medical supervision and support and it is hoped that the negative effects may be lesser. One of the major problems with the use of these drugs is the temporary nature of their efficacy. They seem to lose their ability to provide relief after continued use say experts.

    Until now the studies conducted pitted the effects of psychedelics against placebo. This latest trial would be the first to try it against an established antidepressant, say researchers. Dr James Rucker, a clinical lecturer at the Institute of Psychiatry at King's College London, is soon to start his study to establish the safety of psilocybin. Once the drug is established to be safe, it could go on to become licensed and finally be prescribed by doctors. According to Dr. Rucker, this could take at least five years or longer to happen.


    Psychedelics: A paradigm shift for psychiatry

    In the UK, 1 in 4 people are affected by mental illness. 1 in 3 teenage girls suffer from an anxiety or depressive disorder, and suicide is the leading cause of death in the young. Nearly 50% of the population will develop a mental health disorder at some point during their lifetime, and the World Health Organization has declared that depression is the leading cause of disability. Mental illness costs the UK economy an estimated 100 billion pounds every year.

    The number of antidepressants prescribed in England has more than doubled in the last decade, with the most common treatment being SSRIs. Of the 30% of patients who receive no benefit from current pharmacological treatment, up to 15% will go on to kill themselves.

    Against this backdrop, it is surprising that no major breakthrough in drug development for depression and other psychological disorders has happened in the past three decades, since the discovery of SSRIs.

    In the last 20 years, research from the Beckley Foundation and others has found that psychedelics such as psilocybin can produce dramatically higher rates of efficacy than any other available treatments. As tools to aid psychotherapy, they work immediately, after a single or a few doses, with benefits lasting weeks, months or years, with no negative or long-term side-effects.

    As part of the Beckley/Imperial Psychedelic Research Program, in 2016 we investigated the effects of psilocybin-assisted psychotherapy in treatment-resistant depression. The patients we recruited had suffered from moderate-to-severe depression for an average of eighteen years, and had received no relief from conventional medicines or psychotherapy. A first session with a small dose of psilocybin confirmed that the compound was well-tolerated by each patient. In another session shortly after, a larger dose – with more intensely felt psychoactive effects – was given. Two clinicians stayed with the patients in a softly lit, comfortable room, allowing the patients to experience a mostly uninterrupted journey, with occasional ‘check-ins’ to make sure they were doing well.

    A week after the second session, all patients showed a reduction in depression severity, with 67% of them meeting criteria for complete remission. These impressive results were robust over time: at three-months 42% of all patients remained depression-free, and more than half displayed significant improvements in depression severity relative to their pre-psilocybin scores.

    Since the 1960’s I have been greatly interested in the mechanisms underlying the changing states of consciousness brought about by psychedelics. Our fMRI studies with psilocybin and LSD investigated the changes in blood supply within the brain as well as neuronal connectivity. In doing so we have begun to reveal the mechanisms underlying the significant promise of these compounds as tools to aid psychotherapy.

    One of the most striking effects we observed was a decrease in blood supply and thus activity within the Default-Mode Network (the DMN), a collection of widespread brain regions that work together to coordinate the activity of diverse areas of the brain, in doing so controlling our conscious experience and maintaining our sense of self. When the DMN disintegrates under LSD or psilocybin, the inhibitory control it normally exerts over the other areas of the brain weakens, allowing for a dramatic increase in global connectivity, allowing regions to communicate with distant partners with which they typically do not talk. As well as producing the subjective experience of ‘ego dissolution’, this process leads to the emergence of a more complex, less predictable, and more flexible state of consciousness. In this state, long-lasting changes can take place, repressed memories can be accessed, and the maladaptive thought processes of depression and other psychological disorders can be reset, like a computer being rebooted.

    The potential for psychedelic-assisted psychotherapy does not stop at treating depression. Dysfunction of the DMN is implicated in a whole host of other mental health conditions, including addiction, obsessive-compulsive disorder, anxiety, and PTSD, among others. What characterizes them all is an excessive pattern of thought or behavior becoming rigid and entrenched, almost impossible to break out of despite an awareness of their destructiveness. An experience of a ‘peak state’, brought about by a psychedelic, provides a chance for an individual to see the inner self and the outer world afresh, affording an opportunity to begin anew.

    Although a deeper understanding of brain mechanisms underlying this treatment has only been made possible by modern neuroimaging techniques, the potential for psychedelics to heal in this way is not a recent discovery. LSD was considered a wonder-drug when it first appeared in the 1950’s. Hundreds of published papers and thousands of patient reports testified to its promise for new treatments for a wide range of illnesses. A recent meta-analysis of the best-controlled studies conducted in the 1960’s using LSD for alcohol use disorder – a condition which, to this day, has notoriously poor treatment outcomes– found a single session to be more successful in treating alcohol dependence than daily doses of acamprosate or naltrexone, our current go-to pharmacological interventions. Bill Wilson, the founder of Alcoholics Anonymous, wanted to include LSD-therapy in the treatment program for alcohol dependence, understanding that the subjective effects of LSD – which we now know to be caused by the disintegration of the DNM and an increased plasticity of the brain state– can help to achieve a change in perspective that allow recovery to begin.

    Psychedelic-assisted psychotherapy can create a truly revolutionary paradigm-shift in psychiatry. This is not some far-off medical advance visible on the horizon, awaiting some technological breakthrough before becoming feasible. Psychedelic-assisted therapy could be made available in clinics right away, were it not for repressive regulation. But the psychedelics remain among the most heavily restricted compounds in the world: in the UK, they are Schedule 1 drugs under the Misuse of Drugs Act and Misuse of Drugs Regulations. Both classifications categorize the psychedelics as having no medical use, as well as being extremely dangerous.

    It is now clear that both of these accusations are demonstrably untrue. The foregoing examples provide a brief introduction to their therapeutic potential. Our studies have found that, when administered by skillful clinicians in controlled environments, psychedelics present no significant risk and are not addictive. Meanwhile, recent population studies –analyzing information from more than 120,000 people – have found no link between psychedelic use and mental health problems.

    Modern psychiatry is failing huge numbers of people. The research undertaken in the last decade has suggested many areas where psychedelics could be invaluable for alleviating the suffering of mental health issues. And yet, further research is constantly obstructed by legislation that makes it prohibitively expensive, extremely time-consuming, or impossible for researchers to access the materials we need at affordable prices.

    The hesitance of some towards reforming these regulations is easily enough understood. An entire generation has been told that psychedelics are harmful to health, that they are toxic and dangerous. But a more informed attitude is possible – indeed it is already endorsed by many, if not most. The potentially deadly opiate family contains morphine, a useful painkiller.

    Amphetamines can be prescribed as a treatment for ADHD, or become a drug of potential abuse when taken recreationally as a stimulant. With the appropriate clinical oversight, a compound’s therapeutic benefits can vastly outweigh its risks. By moving psychedelics from Schedule 1 to Schedule 2, where morphine and amphetamines currently sit, doctors can prescribe them to those in need, and further research can be carried out much more easily.

    Our approach to these drugs has so far been characterized by patterns of thought and behavior that have become rigid and entrenched, hard to break out of despite an awareness of their destructiveness. Let us put health, and the reduction of suffering ahead of political expediency and rigid-thinking: the time to act is now.
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    Psychedelics and the full-fluency phenomenon

    The healing potential of psychedelics for depression, PTSD, addiction, anxiety, and to some extent, cluster headaches, has been thoroughly documented by anecdotal testimonies, and increasingly by scientific research. Based on my personal experience and anecdotal reports that I’ve read online, one area worth deeper investigation is psychedelics for the treatment of speech disfluency: stuttering. Little is known about the etiology of stuttering, and a cure remains undiscovered for this disorder, which affects more than 70 million people worldwide. It’s unfortunate that the alleviation of disfluent speech through the use of psychedelics is not more widely known, so, as someone who stutters, I’d like to shine a light on how using psychedelics have helped do so for myself and others.

    I first discovered the potential psychedelics have for treating stuttering during an experience with psilocybin mushrooms. For the length of the trip, I was able to speak as fluently and effortlessly as I ever have – more than I ever have. A helpful analogy for understanding this is, as one person who stutters put it, “I imagine that for the non-stammerer, language must be a little like thin air, a medium so compliant that most of the time you forget you’re moving within it. But for the stammerer, speaking is like moving through water – you are constantly aware of language because it constantly resists you.”

    This resistance in one’s own speech creates wariness in any situation where social interaction is bound to occur, requiring a demanding amount of mental effort anticipating and attempting to avoid stuttering in these situations. However, while under the influence of the mushrooms, an amazing change had occurred: I was neither stuttering, nor cycling through potentialities in my mind for word or phrasing substitutions. For those brief hours my mind was at ease, and my speech flowed not as though I were treading water, but as if I were floating freely through air.

    This was a profound experience at the time, because my stuttering had recently become more severe and was increasingly disrupting my life. Then, as if by magic, the mushrooms I ate that night induced a phenomenon of full-fluency that I had never imagined possible. It showed me that I have the ability within me to speak fluently, and that I only need to discover how to unlock the full potential of my speech.

    This ignited a curiosity and passion within me to discover why psilocybin mushrooms so effectively increased my speech fluency, and whether other psychedelics could similarly do so. I was already open to experimenting with psychedelics prior to this experience, but thereafter I discovered a primary intention for engaging in further self-experimentation. Since then, I have found that, in addition to psilocybin, MDMA also reliably induces this full-fluency phenomenon.

    That is, for me, anyway.

    Curious if my experience was unique, I sought to discover whether the full-fluency phenomenon I had experienced was a one-off anomaly, or a shared phenomenon among other people who stutter.

    After scouring through numerous articles and internet forums, I compiled a fair amount of additional anecdotal evidence, which, to my surprise, largely supports my own experience. Like me, the full-fluency phenomenon has been experienced by many other people who stutter while using psilocybin and MDMA, and unlike me, while using LSD as well.

    One main distinction I’ve identified during my search, is that MDMA much more reliably induces the full-fluency phenomenon than either LSD or psilocybin. From the accounts I’ve compiled, not a single person who stutters experienced disfluent speech while under the influence of MDMA. As for psilocybin and LSD, they were less reliable in inducing the full-fluency phenomenon; for every two people that did experience full-fluency, one person did not.

    This inconsistency suggests that the full-fluency phenomenon may be dependent upon dose, mechanistic action of the substance in the brain, or physiological differences between individuals. Likely, it depends on all three. This, however, has yet to be definitively answered.

    Self-experimentation with these substances by people who stutter have led to individual discoveries of the full-fluency phenomenon, and the aggregation of these anecdotal reports has led me to believe that it is a shared phenomenon among the stuttering population. What’s left to discover now is how these substances induce the full-fluency phenomenon in people who stutter, which can only be accomplished through formal scientific research.

    As the renaissance in psychedelic research continues, it’s my hope that these anecdotal reports will pique an interest and inspire researchers to investigate this phenomenon. Just as PTSD, depression, and anxiety have been successfully treated through psychedelic-assisted psychotherapy, stuttering could similarly follow this model with psychedelic-assisted speech therapy.

    There’s also potential for immediate recovery from stuttering following a single high dose experience. One well told account of this comes from Paul Stamets, the renowned mycologist, whose stuttering stopped altogether following his first psilocybin mushroom experience. To sustain such a high increase in fluency after the effects of the drug wear off is rare, but Paul’s story gives testimony to the possibility for it to occur.

    For someone who stutters, any possibility to speak more fluently is worth consideration, and for scientists who conduct research related to stuttering, consideration should be taken to study this full-fluency phenomenon. Let it be known that the healing potential of psychedelics extends to yet another disorder that is currently treated with little success conventionally: stuttering.
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    Brain scans show how cannabis extract may help people with psychosis

    Cannabidiol reduces the brain activity linked to hallucinations, delusions and other forms of psychosis, research has found

    Brain scans have revealed for the first time how a substance found in cannabis plants may help people with psychotic disorders by dampening down abnormal brain activity that arises in the patients.

    A single dose of cannabidiol, an non-intoxicating extract of the plant, reduced unusual patterns of neural behaviour linked to hallucinations, delusions, and other symptoms of psychosis, researchers found.

    The impact of the substance has raised hopes that medical preparations of pure cannabidiol, or new drugs based on the compound, may be turned into effective treatments for young people who develop psychosis but do not respond to existing therapies.

    The most common treatments for psychosis today work on a brain chemical called dopamine, but no new drugs have been developed for the condition since they were discovered in the 1950s. “These results will clearly pave the way for developing a novel class of antipsychotic treatments,” said Sagnik Bhattacharyya, who led the research at King’s College London.

    Cannabis plants produce more than 100 active compounds known as cannabinoids. The most potent, and the substance responsible for the cannabis “high”, is THC. In the past two decades, cannabis with high levels of THC – about 15% – has come to dominate the market in the UK and elsewhere.

    While high strength cannabis is suspected of raising the risk of mental health problems in some frequent cannabis users, cannabidiol or CBD appears to have opposite, antipsychotic properties. In cannabis, there is too little CBD to have much beneficial effect, but researchers have long wondered whether doses of pure CBD may help to protect against psychosis.

    “We knew from previous studies that CBD had antipsychotic effects, but we didn’t know how it worked,” said Bhattacharyya.

    To find out, the researchers recruited 33 people who had all sought help for mild or occasional psychotic symptoms, such as hearing voices or having paranoid delusions. A single dose of cannabidiol was given to 16 of them, while the remaining 17 received an identical-looking placebo.

    The scientists then watched how the volunteers’ brains behaved as they performed simple tasks in a magnetic resonance imaging machine. While in the brain scanner, the participants were asked to say whether pairs of words, such as ‘baby’ and ‘cries’ were related or not, and later, to recall the word that completed a pair when prompted by the scientists.

    When the researchers compared scans from the different patient groups, and with scans from age and sex-matched healthy people, they found that the patients with psychotic symptoms had abnormal patterns of activity in three distinct brain regions, all of which are involved in psychosis. But in patients who had a single dose of CBD, the unusual brain activity appeared to be dampened down, making their scans more similar to those of health individuals. Details of the work are published in JAMA Psychiatry.

    “This was just a single dose of CBD and that is not going to treat or cure psychosis,” said Bhattacharyya. “But this shows us that CBD at least has an effect on abnormal brain activity that is consistent with it being an antipsychotic.”

    The King’s College researchers are now launching the first large scale trial to investigate whether pure, medical grade CBD is an effective treatment for young people who are at high risk of developing psychosis. The trial, which is expected to start recruiting early next year, is backed by the Medical Research Council and the National Institute for Health Research.

    “If the trial shows it has efficacy, then the next step will be to get through the regulatory hurdles os using CBD in the clinic to treat patients,” said Bhattacharyya. “One shouldn’t get the impression that it’s OK to start prescribing CBD tomorrow.”
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    Psychedelic psychotherapy is coming: Who will be included?

    New study finds widespread exclusion of minorities in psychedelic research.

    Recently, there has been much excitement in the potential of psychedelic-assisted psychotherapy to address a multitude of mental health conditions, including depression, post-traumatic stress disorder, addiction, end-of-life anxiety, and other conditions. The non-profit organization Multidisciplinary Association of Psychedelic Studies (MAPS) has been at the forefront of these efforts, funding studies to demonstrate the efficacy of psychedelics for mental health, including MDMA-assisted psychotherapy for people with PTSD. As a result, FDA approval of MDMA for the treatment of PTSD may soon become a reality. However, not everyone has been included or represented in this momentous process.

    The crowd is cheering as the psychedelic train pulls into the station, its inviting doors flung wide open. One by one, people with a multitude of ailments are stepping onboard – people with PTSD, anxiety, depression, and many other conditions. Yet, though there are many who need seats, the only people holding tickets are White.

    As noted by Dr. Nicholas Powers, the dominant, pervasive image of the psychedelic community is that of White affluence. This is thought to be rooted in the glorification of 1960s and 70s White hippie drug use as a “counterculture” as opposed to an illicit act. People of color have not been meaningfully included in this community. Other factors uniquely impacting people of color include prohibitive costs and lack of access to substances, negative stereotypes about people of color and drug use, and criminalization of people of color through the War on Drugs.

    However, the use of non-ordinary states of consciousness for medicinal purposes is neither novel nor modern, and actually dates back thousands of years to the spiritual practices of indigenous communities all over the world. For many indigenous people, psychedelic use is considered a both a sacred and healing act — something that requires the guidance of a highly trained spiritual leader (shaman), and entails psychoactive rituals that bring humans closer to the spiritual world, in an effort to treat both physical, psychological, and spiritual ills. Understanding the indigenous roots of psychedelic medicine within the historical origins of psychedelic-assisted psychotherapy is an crucial reference point, given that modern psychedelic medicine has struggled to include people of color and is only now beginning to acknowledge the importance of their inclusion.

    The psychedelic train is pulling out of the station, and people are giddy with excitement, waving as the train beings to move. The train itself is painted with bright colors, but there is little color within. White faces are pressed against the windows from the inside while everyone else watches from afar. Black and brown people, including the elderly, young people, veterans, and the disabled are left standing on the platform as the train chugs away.

    Western medicine’s exploration of psychedelics for treatment purposes can be divided into two distinct periods, the “first wave,” occurring between 1950 and 1985, when synthetic psychedelic compounds were just being discovered, and the “second wave” beginning around the late 1990s and continuing to today, with a renewed focus on high quality research.

    The initial “rediscovery” of psychedelics as medicine by Western science first occurred during a period in which biomedical options in psychiatry were limited, as psychopharmacology had not yet become mainstream practice. Newly synthesized psychedelics were not considered controlled substances, and therefore their clinical and research use was fairly unrestrained. Given that psychoanalysis was a mainstay of treatment, initial research on psychedelic medicine examined whether psychedelic drugs could improve the process of psychotherapy, accelerating the treatment of psychological disorders. Yet ultimately, the widespread use of these substances, serious ethical violations (i.e., administration to physically-restrained subjects, sexual abuse between therapists and clients), major methodological flaws in research, and concerns over safety led to defunding of research and eventually the designation of psychedelics as illegal substances. While many researchers and patients continued to espouse the therapeutic benefits of psychedelic-assisted therapy, this area of investigation was shut down for decades.

    Several important factors contributed to the resurgence of psychedelic medicine in the late 1990s. Foundational research during the second wave was conducted, consisting of animal and basic science studies. With the creation of MAPS by Dr. Rick Doblin in 1986, researchers were no longer reliant upon government funding and could pursue FDA drug development. The medicinal potential for scheduled substances was also no longer novel, given that research into both cannabis and ketamine had been underway since 1975. Coupled with the fact that many psychiatric illnesses still lacked effective drug treatments, these factors paved the way for today’s second wave of psychedelic research.

    Yet despite promising initial results, research has often been limited to small, mostly White samples, limiting the generalizability of findings and excluding people of color from potential therapeutic benefits.

    To determine if the existing data on psychedelic treatments is sufficiently applicable to all people of color, we conducted an international review of inclusion across ethnic and racial groups in current published psychedelic-assisted psychotherapy studies, spanning the second wave of studies from 1993-2017.

    As reported in this month’s issue of BMC Psychiatry, we found that the White-centric focus of psychedelic drug use continues in medical research, with extremely low rates of participation by people of color in studies worldwide. Of the 18 studies of psychedelic-assisted psychotherapy that met criteria for inclusion in our investigation (n = 282 participants), 82.3% of the participants were non-Hispanic White, whereas only 2.5% were Black/African American, 2.1% were of Latino/Hispanic origin, 1.8% were of Asian origin, 4.6% were of indigenous origin, 4.6% were of mixed race, 1.8% identified their race as “other,” and the ethnicity of 8.2% of participants was unknown.

    These numbers are low when compared to the proportional amounts needed to represent the population, even when considering country-specific differences, making it unclear if current psychedelic-assisted psychotherapy protocols are effective and safe for people of color. The inclusion rates are low even compared to national rates for minority participation in US biomedical research.

    One factor contributing to low representation is the lack of cultural inclusivity within the research community itself. Historically, psychedelic research has been predominated by White men and there have been few people of color in positions of leadership. This is not only an issue of representation within the field but also of acknowledging the contributions of indigenous people and people of color in advancing the field, and directly involving these communities in the design, recruitment, and implementation of clinical trials. Only by including researchers with specific expertise in culturally-informed methods will we be able to improve representation and better understand the specific issues relevant to those communities that are resulting in their exclusion from research and the broader psychedelic mental health community.

    Given the long history of discriminatory drug enforcement practices in the United States, the stigma of drug use itself must also be addressed. White people have the privilege of publicizing psychedelic use with lesser consequences than people of color. Even if the psychedelics are administered in a legal, health-oriented setting, people of color may still feel they are playing out the stereotype of being drug users that engage in questionable or illicit activities. Further stigmatization may arise from within those communities, as people of color seeking psychedelic therapies may be criticized for engaging with the White medical establishment.

    While several efforts are currently underway to address these concerns, it will take the acknowledgement and efforts of both those without and those with privilege and power to change the field. Psychedelic psychotherapy is coming and we all need to be onboard.
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    Why psychedelic drugs are entering the world of psychiatry

    We’ve heard it over and over again: drugs are bad. But a group of medical researchers are challenging the stigma around mind-altering substances – and discovering they could hold the key to tackling a whole range of mental health issues.

    At any given time, there’s a mere handful of people truly tapped into the zeitgeist. In music right now it’s Kendrick Lamar; in fashion Virgil Abloh; in film it’s Dwayne Johnson.

    You can add author Michael Pollan to the list. His 2006 book The Omnivore’s Dilemma was part of a seismic shift in which readers and eaters began questioning where their food came from, how it was produced and who was fucked over along the way (the farmers, the animals, the planet) in order to get it to your plate.

    By the time the 10th anniversary edition was released, it had sold more than two million copies. But this year, he shifted his focus from the stomach to brain with How to Change Your Mind – The New Science of Psychedelics and cemented his rep as a writer at the very edge of public consciousness.

    The starting point was the concept of microdosing – a red-hot trend in Silicon Valley and beyond – where the most lateral of thinkers are taking small amounts of LSD, which generate ‘subperceptual’ effects that can improve mood, productivity and creativity.

    A smart drug for smart people, if you believe the hype.

    Pollan characteristically built on this by replacing the microdosing with macrodosing. By which we mean he took drugs. Many, many drugs. In quantities that make people, according to the New York Times, “feel the colours and smell the sounds”.

    Whether or not he knew it at the time, he ever so slightly wedged open the doors of perception when it comes to psychedelic drugs and their potential benefits. In so doing, he has tapped into a burgeoning movement in which, primarily, ‘recreational’ drugs, such as LSD, mushrooms, marijuana, ketamine and MDMA, are showing glimpses of clinical promise where conventional medications are not.

    It’s in the field of mental health that the results are most apparent. Which is just as well because for all the increasing openness we have about discussing this scourge, the numbers are not decreasing. Quite the opposite.

    In April this year, mental-health technology group Medibio polled 3500 Australian workers from 41 organisations across a range of industries and found that 36 per cent had depression and 33 per cent had anxiety. In contrast, the 2007 stats list anxiety at 14 per cent and depression at six per cent.

    A part of this leap is undoubtedly down to the fact that people are more comfortable discussing these issues and seeking help. That’s a very good thing. However, it’s equally clear that the current approach of counselling combined with the most common medications – selective serotonin reuptake inhibitors (SSRIs) like Lexapro – doesn’t work for everybody.

    Nothing does and nothing ever will, but in labs around the world, the go-to party drugs for everyone from bush-doofers to EDM aficionados are throwing up results that are beginning to overshadow their tarnished reputations.

    One of these is MDMA, which was invented in 1912 by a German pharmaceutical company to help medications that control bleeding. It first entered the dance party scene in the mid-’80s and quickly became as much a part of these events as tolerating Armand Van Helden, gurning wildly and finding conversations with complete strangers to be fascinating.

    Manufactured under dubious circumstances at best, there are clearly risks involved with recreational use. But transfer the setting from club to clinic and a different picture emerges. Especially as a potential treatment for people with post-traumatic stress disorder (PTSD). In a study conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS) in the United States, 56 per cent of 107 subjects no longer qualified for PTSD after treatment with MDMA-assisted psychotherapy, measured two months following treatment.

    At the 12-month follow up, 68 per cent no longer had PTSD.

    “Most subjects received just two to three sessions of MDMA-assisted psychotherapy. All participants had chronic, treatment-resistant PTSD, and had suffered from PTSD for an average of 17.8 years,” says MAPS director of strategic communications Brad Burge.

    A separate study conducted this year by the Medical University of South Carolina on an admittedly small group of 26 first responders and military personnel concluded, “Active doses (75mg and 125mg) of MDMA with adjunctive psychotherapy in a controlled setting were effective and well-tolerated in reducing PTSD symptoms.”

    There’s a bit to unpack in these qualified conclusions, most notably the terms “with adjunctive psychotherapy” and “controlled setting”. “It’s important to keep in mind that MDMA will not be a take-home drug,” says Burge. “MDMA-assisted psychotherapy is a supervised treatment – it happens in a clinic or therapist’s office, with a medical review and therapeutic supervision. This is not ‘take two and call me in the morning’. Patients would never get a prescription for MDMA to fill themselves at the local pharmacy. Unlike all other medications for PTSD, with MDMA-assisted psychotherapy, patients only take the drug two or three times over a 10-week course of psychotherapy – and research suggests that the benefits last.”

    He adds that "though the drug has side effects such as possible anxiety, lack of appetite, increased body temperature and nausea for the four to six hours it’s in your system," Burge says, “They are not as extreme or long-lasting as SSRIs” which millions of Australians take daily. “Also, nobody in the completed trials reported dependence or continued use of MDMA after participation in the trial.”

    MDMA’s benefits are, according to Burge, not restricted to the treatment of PTSD. “It has also shown promise in early research as an adjunct for psychotherapy for anxiety associated with life-threatening illnes and social anxiety in autistic adults. It is now [also] being studied in alcoholism treatment as well as cognitive-behavioural conjoint therapy (aka couples therapy).”

    At the very least, he expects it to be approved by the US Food and Drug Administration for PTSD therapy by 2021.

    Closer to home, Dr Gillinder Bedi, a senior research fellow at both The University of Melbourne and Orygen, The National Centre of Excellence in Youth Mental Health, advocates a cautious approach in the MDMA-as-therapy debate.

    “The slow progression of MDMA-assisted psychotherapy from the subcultural margins towards approval has been driven by the belief of those advocating for it,” she says. “Without this motivated community, MDMA would likely not have been developed as a medication. The downside of this robust advocacy base is that it can lead to rather extreme claims, such as being labelled ‘penicillin for the soul’. In addition to well-designed studies that control for experimenter bias, there is a need for researchers and clinicians outside the MDMA-advocacy community to be involved in the ongoing development of this research direction.”

    Clearly there are more questions than answers right now, many of them practical. “For instance, should prescribing be limited to physicians with specific qualifications?” asks Bedi. “What training should be required for those conducting the psychotherapy? How should the drug be handled and stored by pharmacists? This suggests a need for stringent training and oversight of MDMA-assisted therapy.”

    Then, there’s the proven human factor where not everyone will play by the narcotic rules. Case in point: Modafinil.

    A report by the University of Melbourne’s Brain, Mind and Markets Laboratory found that the anti-narcolepsy drug was the go-to helper for certain finance professionals and students who want to maintain their focus during long hours in the library or plundering the markets. Some is sourced online. Some comes from Australian doctors in a trend known as off-label prescribing. And if Modafinil – known as ‘Viagra for the mind’ – is in demand, wait until your local GP has pure Molly at his or her disposal.

    “Approval of MDMA will lead to off-label prescribing, with doctors prescribing the drug for conditions other than PTSD,” says Bedi. “This could include a range of conditions, such as depression and substance-use disorders.”

    This is just one of myriad red flags. Burge says MDMA’s therapeutic acceptance has been hamstrung by several additional factors. “Recreational use and abuse has been one source of the stigma, but an even greater cause of the stigma has been the misinformation, bad science, and political posturing that policymakers have engaged in for decades,” she says.

    In political terms, the issue of psychedelics as therapy is an easy knee-jerk for neo-cons.

    ‘This government is spending your tax money on street drugs’ is a convenient and divisive headline, sure to prompt enough harrumphs across the media landscape. There have also been enough tragic high-profile cases, such as that of Sydneysiders Anna Wood and Sylvia Choi – both of whom died after taking ecstasy at dance parties – to place the discussion forever on the back burner. Strike one.

    In response, researchers likes Burge are quick to point out that there is a monumental difference in the purity and dosage of the MDMA being sold on the street (and cut with any number of harmful fillers) compared with that used in clinical studies. Then, there’s the financial factor. Specifically, the issue of patents, which tend to run to 20 years in the pharmaceutical industry.

    The theory goes that this amount of time generally allows the manufacturer of the drug to recoup their R&D costs and accrue a reasonable profit before generic, lower-cost varieties are made available to the public. The problem, as far as big pharma is concerned, is that the patent on MDMA ran out some time before World War II. Which means that any significant potential turnover arising from exclusivity is immediately off the table. Strike two.

    What’s more, unlike your standard SSRI anti-depressants, which require ongoing use (and is therefore more profitable), many of these patent-free psychedelics need only a handful of doses to provide relief. With both potential volume and profit thus diminished, Burge says you have distinct “lack of interest” on the part of for-profit pharmaceutical companies. Strike three. Attitudes are slowly changing in the pharmaceutical community and Burge is confident that “within the next 10 years, we’ll see psychedelics enter psychiatry as the first new class of psychiatric drug in the last 30 years”.

    However, it’s unlikely that many Australians will be able to access legal therapeutic MDMA any time soon. Considering how long it took to convince them of the medicinal benefits of marijuana, no local politicians are waving the psychedelic flag just yet. Those who might benefit right now have to be lucky enough to qualify for one of the few small local clinical trials.

    In this respect, organisations the Sydney’s Black Dog Institute are creating some world-firsts but these options are still few and far between. Writing in April’s Australian Psychologist journal, doctors Stephen Bright and Martin Williams warned that Australia was being left behind the rest of the world on the research front. Bright noted that there is “a lot of academic conservatism” in Australia towards research involving drugs which are best known as illegal stimulants, adding that there was “a vested interest in maintaining the current paradigm”.

    And it’s not just MDMA in the firing line. Everyone’s favourite horse tranquiliser, ketamine, is also prompting words like “astounding” from medical researchers not given to hyperbole. In 2016, the University of New South Wales’ Professor Colleen Loo began a randomised double-blind three-year trial into the effectiveness of the drug as a depression treatment for people who have not responded to other medications.

    The 16 subjects were all over 60 and Loo found that half showed no signs of depression after a single dose. “I was a bit sceptical with all the reports coming out from overseas,” Loo told Triple J, “I thought, ‘I’m just not sure if I believe this, it’s unbelievable’. And I must say, the first person we treated – I still remember the very first person – he and I looked at each other and he said, ‘I don’t believe it’, and I said, ‘Neither do I’. He’d been depressed for literally 10 years and had failed more than 10 medications. He said, ‘The fact I can receive one treatment and be well after one day is just unbelievable’.”

    A 25-year-old speaking under an assumed name told the same program that after 10 years of living with depression he “felt backed into a corner and held hostage to depression that I didn’t want to be fighting so much anymore”.

    In an approach guaranteed to alarm psychedelic proponents and provide ammunition to critics, he bought some ketamine off the dark web and began experimenting. Successfully, it turned out. “My life outlook is much more positive now,” he said. “It’s allowed me to take back my life in a sense. From years of having to put life on hold, I found that it was a lot more worthwhile and cost-effective than spending my life on antidepressants.”

    Much like MDMA, the popularity of ketamine on the black market makes it vulnerable to exploitation and misuse – which is why almost every researcher GQ interviewed spent a great deal of the conversation issuing caveats.

    Yet, away from the world of dance parties and K-holes, it has the potential to save lives in the most immediate and drastic sense of the term. In the first study into esketamine (a part of the ketamine molecule) conducted by a drug company (in this case Johnson & Johnson) with Yale University, 68 people at risk of imminent suicide were treated with the drug. The authors found it not only led to a “significant” improvement in depressive symptoms within 24 hours but also leveled off at around 25 days – which is roughly the time it takes for antidepressants to kick in to full capacity in the body.

    Commenting on the data, England’s often-conservative Royal College of Psychiatrists said that it brought the drug “a step closer to being prescribed on the NHS”. Because Australian doctors have access to ketamine as an anaesthetic and pain reliever, authorities fear it too may be prescribed ‘off label’ without enough research into the long-term consequences (if any) of its use in suicide prevention.

    Israeli-American writer Ilana Masad was given ketamine by her psychiatrist in an attempt to counter her stubborn depression. Writing for The Fix, an online publication devoted to addiction and recovery, she revealed, “Shortly before my first ketamine treatment, I became suicidal for the first time in my life. If I hadn’t started ketamine treatments when I did, I don’t know whether I’d be here writing this article now.”

    While the likes of MDMA and ketamine made their way into public consciousness from the ’80s onwards, those wanting to take a trip in the psychedelic ’60s turned to LSD.

    ‘Acid’ is also experiencing its own contemporary resurgence and according to an analysis published in the Canadian Medical Association Journal, there are studies being done on the use of lysergic acid diethylamide as a treatment for post-traumatic stress disorder and anxiety.

    A more natural alternative may be found in psilocybin – the active hallucinogen in magic mushrooms. Johns Hopkins University researchers gave the drug to 51 cancer patients also suffering from mental-health issues like anxiety or depression. Six months on, it was found that about 80 per cent of participants continued to show clinically significant decreases in depressed mood and anxiety, with about 60 per cent showing symptom remission into the normal range.

    Researchers stressed that the drug was given in tightly controlled conditions in the presence of two clinically trained monitors and said they do not recommend use of the compound outside of such a research or patient-care setting. But what’s most astounding about this was that the results were again achieved in a single dose.

    Another natural compound, ibogaine, is also gaining clinical attention. A psychoactive found in plants from the Apocynaceae family, it’s being examined as a potential therapy for those battling drug dependence.

    Make no mistake; this is dangerous gear with severe side-effects including hallucinations, seizures, fatal heart arrhythmia and brain damage in patients with prior health problems. In 2014, 33-year-old West Australian Brodie Smith died on the first morning of what was supposed to be a four-day ibogaine treatment program in Thailand. He was trying to kick his dependence on illegal drugs. And yet, there are several studies that suggest that ibogaine, under appropriate conditions, could well be a habit-breaker.

    As reported in Scientific American, in May 2016 a meta-analysis examining 32 studies, mostly in mice and rats, found that ibogaine reduced self-administration of cocaine, opioids and alcohol.

    An earlier study from 2015 discovered noribogaine, the substance that ibogaine breaks down to when ingested, reduced self-administration of nicotine in addicted rats by 64 per cent.

    Californian company Savant HWP has now progressed to secondary trials for a synthetic ibogaine compound, called 18-MC, which mimics the anti-addiction properties without the trippy side-effects. The potential benefits for Australia are obvious as opioid prescriptions here increased from 10 million per year in 2009 to 14 million per year at the end of 2017 – that is an increase of 40 per cent over the past eight years. Worth a look, then.

    With new applications and (again) appropriate safeguards for once demonised substances, be they chemical or naturally occurring, in place, Burge believes we are on the threshold of a giant leap forward in the way we treat our troubled minds and bodies.

    If Australia’s growing acceptance of marijuana as a legitimate treatment in palliative care, epilepsy, chronic pain and multiple sclerosis is anything to go by, it’s clear that we are no longer as attached to the notion that because a drug can be misused it should automatically be sidelined and vilified.

    “The resistance to this notion is definitely fading,” says Burge, “and it fades more with every new study that’s completed. Researchers from multiple organisations and institutions around the world are showing real therapeutic benefits from psychedelic-assisted therapy, especially MDMA and psilocybin and also ibogaine, for specific mental-health conditions. That data, and the overall very supportive attitude of policymakers and regulators around the world, are resulting in what’s been called a renaissance in psychedelic research.”

    Unsurprisingly, it’s Pollan who best articulates the here and now.

    “What excites me is the potential of these medicines to help people for whom we don’t have a lot to offer. Mental-health care worldwide has not been that effective. We still deal with very high rates of mental illness, and that’s all getting worse,” he says. “So the idea that we might have a tool that could help with a whole range of different problems – from addiction and depression to obsession and anxiety – that’s very exciting.”

    They will not offer a silver bullet in the fight against mental-health issues – nothing ever has. But by reducing the stigma around psychedelics, there is now increasing evidence that these treatments may offer new hope to those at the very precipice of despair. Seems it might be time to open our minds.
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    San Luis Obispo

    The hidden world of underground psychedelic psychotherapy in Australia

    John puts The Passion of the Christ soundtrack on the stereo and lies on the single bed in this Melbourne house. He's a 37-year-old engineer working in the renewable energy sector, and not at all savvy about street deals, so he bought his dose of cactus, which contains mescaline, on the dark web. He takes it without ceremony, then talks to his therapist about how he's been feeling. When he starts to feel a vague effect of the drug in his thighs, John puts on his eye shades and waits for the first wave to hit.

    This is underground psychedelic psychotherapy, using illegal substances and facilitated by therapists known only through cautious word of mouth. While most people are unaware it exists, it's been going on globally since the 1950s. That's when clinical trials into the possible uses of psychedelics began, before being curtailed by LSD being made illegal.

    Now trials are underway again, in the US and UK in particular, including using MDMA (not strictly a psychedelic) for PTSD, LSD for anxiety, psilocybin for depression — and advocates believe it could transform mental health care. The most optimistic researchers hope that regulated psychedelic-assisted therapy will start rolling out slowly in 2021 with approval from bodies such as the FDA.

    But not everyone wants to wait, or to be dictated to by government bodies and pharmaceutical companies.

    What happens in an underground session?

    John is in his 11th year of treatment, which has included holotropic breathwork and regular psychoanalysis.

    "When I started I was on the brink of suicide," he says. "It stems from sexual, physical and emotional abuse when I was two to three years old." A hypnotherapist referred him to a therapist known for treating trauma. John had no idea that his new therapist facilitated psychedelic sessions. "He uses whatever works for the individual," John explains. "It might be talking therapy, meditation or relaxation techniques. Given I'd had recreational experience with psychedelics, it's something he put forward."

    With the aid of psychedelics, John says he can access memories quicker than with regular therapy. A $150 session last anywhere between 30 minutes for DMT, to five hours for MDMA and 14 hours for mescaline. The hard work comes in the ensuing sessions, when he and the therapist integrate what he experienced during the trip. As John points out, it's far from fun. He's concerned that news stories about trials make out psychedelic psychotherapy to be a quick fix. On a TV show The Doctors, for instance, a woman who took part in a clinical trial of MDMA-assisted therapy claims her PTSD was "cured" in three sessions.

    Quality control could fall by the wayside

    Dr Prash is a medical doctor and neuropsychiatry fellow at The Alfred Hospital, Melbourne. Four years ago he gave his first talk to the Alfred's psychiatry department about advances in psychedelic-assisted psychotherapy, and he's impatiently awaiting regulation. "I don't plan on being in conventional psychiatry for the rest of my life," he says. "The psychedelic sphere is where I see promise for the future." Dr Prash can understand the rise in underground practice. "The more that the Australian population reads stories about trials in other parts of the world, the more they'll get frustrated at the lack of access," he says. His concern is that anything forced underground becomes adulterated.

    "We saw that with prohibition in the 1920s and the war on drugs in the current day," he says. "In the case of medical cannabis, regulation took ages, and by that point people thought, 'I'll just give my child cannabis.' But you're not necessarily going to choose the right compound for the right problem."

    Legal consequences of underground sessions not clear

    Facilitating underground sessions is risky for therapists, particularly if they're registered with the Australian Health Practitioner Regulation Agency (AHPRA). Technically they're not breaking the law because they're not supplying the substance, but if something went wrong it's not clear what the legal consequence would be. Ethically, it could be argued that they're not acting in the best interest of their profession just by being there. "If you were called up to the medical board or the health practitioners board of AHPRA then you would be judged by your peers about what is considered to be a good standard of care," Dr Prash explains.

    A spokeswoman for the Psychology Board of Australia, which operates through AHPRA, says: "If a practitioner is placing the public at risk, National Boards and AHPRA would want that concern raised with us. Psychologists must only provide psychological services within the boundaries of their professional competence. This includes working within the limits of their education, training, supervised experience and appropriate professional experience; basing their service on established knowledge of the discipline and profession of psychology, and complying with the law of the jurisdiction in which they provide psychological services."

    It's risky for patients too, who place a lot of trust in their therapist. In California, six women accused the founder of the Interchange Counseling Institute of sexual assault after taking hallucinogens. Patients with a family disposition towards psychosis would likely be discounted from regulated psychedelic psychotherapy, but these precautions are not guaranteed with underground sessions. Similarly, some medical conditions are prohibitive: in 2014, West Australian man Brodie Smith died in a Thai rehab centre when having his methamphetamine dependence treated with ibogaine.

    Then there's the issue of seasoned "trip sitters" upgrading themselves to therapists and tackling a friend's trauma. "That's one of the biggest problems," Dr Prash says. "They might measure the dose by what they've read around clinical trials, but the purity of street MDMA could be 20 per cent. Other adulterants potentially include meth." Dr Prash thinks that even if the TGA approves psychedelic psychotherapy in Australia, the earliest clients are likely to be from the severe end of the spectrum, such as end-of-life patients who might be treated by psilocybin. "That's the first area that stigma recedes from," he explains.

    The efforts to get trials approved in Australia

    Some medical professionals and researchers worry that unsanctioned practice will jeopardise regulation later on. As psychiatrist Nigel Strauss points out: "If there's some terrible outcome where someone dies or develops psychosis, that's bad news for the rest of us trying to initiate scientific studies." Dr Strauss has a long interest in PTSD, having worked with the survivors and families of the Port Arthur massacre and the Black Saturday bushfires. "I'd always thought that the available treatments were not really adequate," he says, "so I had a look at the evidence that was coming out of MAPS and was impressed by the early results."

    He now advocates for clinical trials to be held in Australia. He and Dr Martin Williams of Psychedelic Research in Science and Medicine put in a submission to Deakin University in December 2015 for a PTSD study using MDMA. It was blocked at the last moment by a professor worried that the research would attract adverse media coverage. "These drugs are stigmatised and there are frequent headlines about young people overdosing in clubs on ecstasy," Dr Strauss says. "Universities are fragile places: they're financially dependent and under pressure. It's a generational thing as well — I think if the people making the decisions were 30 years younger, we might have more hope."

    Dr Strauss thinks trials will begin in Australia in the next five years, but acknowledges the difficulty of integrating psychedelic use into the paradigm of science. "It's up to scientists and psychiatrists who have an understanding of consciousness to find a way," he says. "I'm interested in evolving a system where there could be more synergy between the two."

    Ben Sessa is a Bristol-based medical doctor already carrying out MDMA trials to treat alcohol dependence. "There's a massive amount of knowledge within it so it's not to be sniffed at," he says, "because anecdotally the experiences can direct researchers to new avenues. But it's not going to help getting new drugs licensed. That has to be done in the way that the regulatory authorities want you to do it, based on studies."

    Dr Prash has a similar view. "If it's underground then it doesn't have the kind of vigour that the mainstream scientific model requires, and then it's not going to get much purchase anywhere," he explains. It would be no more useful than the anecdotal evidence that we're all already aware of. It can't be peer reviewed and the validity of your results cannot be assessed."

    In decades to come, perhaps we will see the MAPS vision of psychedelic centres that aren't restricted to people tackling mental health issues. But in the near future, progress will be slow. John is concerned that certain drugs will be mandated for certain conditions, as if one size fits all. He also wonders how client-practitioner boundaries will be flexible enough. "This isn't an hour-long session where the therapist says, 'Time's up,'" he says. "Sometimes afterwards I won't feel good so I'll hang about until I feel safe."

    Dr Sessa acknowledges: "Quite a lot of people say to me, 'Why do you bother trying to license these drugs? There are plenty of good underground therapists' — and that's true. But there are 70,000 untreated cases of PTSD in the UK, and the majority of those people don't want to break the law. They're the population that I'm interested in increasing access for, so you have to beat the man at his own game."
    Last edited by mr peabody; 07-09-2018 at 10:33.
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    Taking a Walk on the Dark Side

    If the wheels fall off Psychedelic Renaissance 2.0, it will be because of its greatest enthusiasts, not its sceptics. How can we help ourselves succeed?

    Psychedelic medicines are back in the research labs and in the news, after forty years in sleep mode. A second psychedelic renaissance is afoot.

    And the news is good!

    A growing stream of new studies from leading institutions over the past decade shows the increasingly clear promise of psychedelic medicine in the treatment of some of the biggest mental health challenges of our age: PTSD, depression, anxiety, addictions and end-of-life distress.

    For those who have already benefitted personally from psychedelic medicines, and for those professionals who seek to work legally with clients in need, this new influx of supportive research and public interest is especially gratifying.

    After nearly 50 years of struggle and waiting, we may well see our dream finally come true.

    Let’s celebrate how far the psychedelic movement has now come, and continue to focus our imaginations on that bright tomorrow. We’ll soon be using a whole new class of badly needed medicines to tackle issues that today’s current treatments just do not effectively address. And maybe we’ll even have centers where citizens can go for a psychedelic experience that will enhance creativity, problem solving or spirituality.

    So let’s be optimistic! We can do this together! Keep thinking positively, and we’ll reach our goal!


    No, that’s not the way it will happen. In fact, unbridled optimism may well spell the demise of Psychedelic Renaissance 2.0 just as it contributed to the downfall of 1.0 in the late 60s.

    Let me explain.

    Cognitive science has taught us some rather important things since 1.0 about how the way we think about reaching our goals affects our success in actually realizing them.

    We’ve long known that it helps to think positively about our goals. Negative thinking has a nasty way of becoming self-fulfilling prophecy. It can sap our energy and enthusiasm. It can take the wind out of our sails, setting us up for depression and anxiety.

    But we’ve more recently learned that wishing, dreaming, and thinking positively alone is not going to be enough for us to attain our goal.

    In her 2014 book “Rethinking Positive Thinking: Inside the New Science of Motivation” Dr. Gabrielle Oettingen at New York University looks critically at the standard wisdom that optimistic thinking in itself is the path to success in goal attainment, that it’s optimism and dreams that excite us and inspire us to act.

    Optimism, pure and simple, it turns out, does not motivate people; instead, as Dr. Oettingen shows in several experiments, it creates a sense of relaxation and complacency.

    It’s as if in dreaming or fantasizing about something we want, our minds are tricked into believing we have already attained the desired goal.

    And there appears to be a physiological basis for this effect. Studies show that just fantasizing about a wish lowers blood pressure, while thinking of that same wish — and then considering not getting it — raises blood pressure. It may feel better to daydream of success, but it leaves us less energized and less prepared for action.

    Oettingen explores an alternative: motivating people to act toward their goals by leading them to directly confront the real risks and pitfalls that stand in their way. In addition to envisioning the bright desired future, she leads them to fully acknowledge the dark side of the dream: all the ways in which things could go awry. She developed a technique she calls mental contrasting.

    In one study, she taught a group of third graders a mental-contrast exercise: They were told to imagine a prize they would receive if they finished a school assignment, and then to imagine several of their own behaviors that could prevent them from winning. A second group of students was instructed only to fantasize about winning the prize. The students who did the mental contrast – who took the walk on the dark side – outperformed those who just dreamed.

    Apparently, being mindful not just of our dreams, but also of the real obstacles or threats that we or the world place in their way, is a more effective way of meeting goals such as better eating habits, improved exercise, and greater control over alcohol intake.

    Oettingen hones her mental contrasting exercise into an empirically validated practical tool. She calls it WOOP: “wish, outcome, obstacle, plan.”

    Wish generously for the outcomes. Wish globally. Then focus your wish, make it more specific.

    Get clear on why you want what you do. What are the anticipated outcomes that make your goal important?

    Then list all the ways in which things could most likely go wrong. Itemize the obstacles, the threats or the pitfalls anticipated on the road ahead. Focus mainly on the things that could go wrong because of what you might mistakenly do. i.e. the things that you have some control over. Dare to stare those demons in the face!

    Make a specific plan for overcoming each obstacle or threat, so that if and when it arises, we have a pre-meditated strategy for dealing with it.

    Now, how does this program apply to us, and our goals concerning psychedelic medicine? Well, so far we’ve been pretty good at fleshing out the bright side of our vision: a variety of pharmaceutical-grade psychedelics available in specialized safe settings, care provided by trained psychedelic professionals for appropriately screened individuals.

    But now it’s time for the heavier lifting: what about the dark side? What could most likely go wrong with our psychedelic agenda? What might derail us in reaching our goal? What are the most likely threats, obstacles, quicksands, trolls, dangers or pitfalls? How might we undo ourselves again if we’re not careful?

    One way to begin to answer this question is to ask what went wrong the first time. What kinds of incidents raised the public fear level to the point that Richard Nixon, the American president at the time, would denounce Timothy Leary, the era’s most prominent evangelist of psychedelics, as “the most dangerous man in America”?

    Here, we could make our list from the news headlines of the time: several suicides, some psychiatric tragedies, some scandalous incidents involving eroded sexual or professional boundaries. These were serious incidents that should not be minimized. But they were also isolated incidents that were often sensationalized and misrepresented. The biggest tragedy of 1.0 is that these news stories about the abuse of psychedelics obscured the tremendous scientific story unfolding about their appropriate use. Yes, the mishaps may have been few-and-far-between. But it didn’t take many of them to pull the wheels off the bus.

    We will, of course, do what we can to prevent such unfortunate incidents from becoming part of 2.0’s history. If they do occur we must acknowledge them and call them out. But more importantly, we need to head these incidents off well before they occur.

    There’s an even more important focus for our vigilance than the incidents themselves. Since it is so often mistaken thinking that leads to tragic behavior, we need to be mindful about the kind of thinking that leads to those psychedelic tragedies. What were the dark-side beliefs that greased the skids to tragic behavior? Let’s shift our attention from the old misguided meme of “dangerous psychedelics” to “dangerous thinking” about psychedelics. Some of these faulty beliefs are easy to spot:

    Psychedelics are safe

    Yes, we know they’re very safe when used by properly screened individuals in the context of a protected setting under the guidance of trained professionals. At a poorly planned rave? All bets are off! And in certain settings, containing mistrust, conflict, confusion or danger, psychedelics can be deadly. Risk also increases as their use strays from the therapeutic toward the recreational.

    They’re good for everyone

    Psychedelics do appear to benefit many people. But some, with certain major mental health issues or medical contraindications, should never use them.

    More is better

    Research to date shows that many patients require more than one psychedelic session for optimum treatment results. But we also know that overuse or abuse of psychedelics can play a role in the onset of some true DSM mental disorders. And we also know that psychedelic induced peak experience has real therapeutic value only when those experiences are properly digested and “integrated” into one’s daily life so as to achieve lasting change. This “psychedelic psychotherapy” process takes time, depending on the person and the material they are trying to understand and accept. It might well take months. Over-use is inevitably counter-productive. As the 60s philosopher Alan Watts said, “When you get the message, hang up the phone”.

    Those mushrooms are magic!

    Yes, psychedelic substances do have some special properties that affect perception and cognition. But the important thing about the therapeutic use of psychedelics is that it’s not about what the medicine does to you, it’s the emotional work that you are willing and able to do with the medicine’s assistance: that’s what leads to the lasting changes. In the most productive cases, that work begins well before the medicine session, and continues well after it.

    The path to happiness lies within

    Yes, it is true that “going within” with psychedelics can result in experiences of profound peace, bliss, emotional or spiritual ecstasy, healing or redemption. But it’s an empirical fact that human beings are fundamentally social creatures, and our lasting happiness depends on our relationships with others; we all need love, friendship, and a sense of acceptance and place within community. Yes, it is true that psychedelic experiences may lead to profound healing in our relationships with others, to the letting down of emotional walls and the opening of hearts. But psychedelic experience is no substitute for human connection. Looking for happiness by simply going within is bound to disappoint if it is not balanced by our recognition that we need ongoing human warmth and connection to make life truly satisfying.

    Each of these five dark-side beliefs above contains just enough truth to make them dangerous. They are often held out of sheer ignorance, and are relatively correctable. We can help enthusiasts who mistakenly hold them by pointing to the science that can set them straight.

    But there are two additional beliefs that are more insidious than these first five, beliefs whose prominence today would pose a grave threat to our goal of psychedelic medicine for Canadians. These next two are harder to spot, and they cannot be easily dispelled by simply pointing to research fact. Unlike the five above, they are philosophical beliefs rather than empirical ones.

    Psychedelic experience leads us to find our “true self”

    Psychedelic exploration can lead to “ego loss” or “ego death” – a temporary dissolution of sense of self in which the individual melts into a cosmic oneness, often experienced as merging with the divine. (This experience sounds strikingly similar to the Hindu idea of enlightenment: the discovery that atman, the individual self, is actually Brahman, the divine universal self underlying all things.) This so-called peak or “mystical” experience can play a very important role in personal healing with psychedelics. Many who experience it become less self-aggrandizing, egocentric, and egotistical. They become more open, tolerant and compassionate in a lasting way.

    But some misconstrue this experience, falling into the mistaken belief that if our true self is the divine, we should try to rid ourselves of our “false” self, our ego.

    However, our ego-self is our interface with others. Without it, we are helpless in the world we share with others, and are unable to exercise discernment, agency and efficacy, the very qualities we now need to move toward our goals for psychedelic medicine. Without ego we are incapable of real interpersonal relationship. We’re defenseless, and vulnerable to the machinations of others.

    Rather than disparage the ego or seek to annihilate it, we need to build healthy ego-selves, real selves that can stand up for ourselves and take care of business, but also treat others with respect and compassion. It may be that our deep self is indeed identical to the cosmic Godhead, and that our ego is some kind of “surface” self. But that doesn’t mean that the ego is any less real a self than the divine self. Balanced psychedelic veterans agree with the truth shared by many spiritual traditions: In addition to being the thousand-petal lotus flower, we are equally truly other possible selves, perhaps a magician, a warrior, a lover, or a sovereign. Each aspect or facet of self contributes to the rich unity of who we really are. The goal following psychedelic experience is not to spend as much more time as possible in some “true-self” egoless state, but to develop a self in the material world that has solidity, agency and efficacy, openness to other selves, and compassion for others. The true message from mystical experience seems to be that we can come to honour all facets of self, not just the lotus flower. The ultimate step in spirituality is to come to fully honour our incarnated humanity, to live fully and joyfully through our embodied egos. So keep that warrior-self handy; you’re going to need her (or him)! Sometime soon! There will be plenty of time later for that egoless state.

    Psychedelic experience yields a truth that trumps science

    The science around psychedelics is now getting pretty clear: it seems to be a brute clinical fact not only that many patients experience profound healing and growth through psychedelic experience, but that a good measure of that transformative healing comes through having mystical, or “noetic” experiences – ones in which subjects have the sense that deep personal, emotional, metaphysical or spiritual truths are being revealed to them.

    This juxtaposition of scientific thinking and mystical experience creates an interesting cognitive tension that runs right through the center of our understanding of psychedelics. Scientific thinking leads to the development of the psychedelic medicines themselves in a chemist’s laboratory. Research on the effects of those psychedelics aspires to reach “evidence-based” conclusions through a “scientific method” using conceptual tools such as randomized controlled trials (RCTs), double-blind placebo design, statistical and phenomenological analysis. Scientific thinking leads to the development of the psychedelic medicines themselves in a chemist’s laboratory. Research on the effects of those psychedelics aspires to reach “evidence-based” conclusions through a “scientific method” using conceptual tools such as randomized controlled trials (RCTs), double-blind placebo design, statistical and phenomenological analysis. But mystical experience involving “revealed truths” plays a really big role in the actual personal healing or growth.

    Most of us can find a place of comfortable balance in this cognitive polarity between science and mysticism, where these two perspectives become integrated into a kind of binocularity that adds a sense of richness and depth to our understanding of our lives and our world. Science has its rightful place in its own domain – the empirical, or observable world. Science does not tell the complete story of reality; it has nothing to say about the domains of spirit or metaphysics, nor should we expect it to. But, operating within its rightful domain, science does its job pretty well. And vice-versa; the deeply intuitive truths coming from mystical experience pertain to another much older and deeper realm of human experience. Mystical truth is silent with respect to the world of empirical science, but it provides the deep personal meanings, understandings and interpretations of the human condition that are necessary for healing and living fully.

    However, some thinkers about psychedelic experience are not able to find this natural balance between these two domains, and their thinking falls to one pole or the other. It lapses into a kind of fundamentalism. Some become so stuck in the scientific mindset that it becomes scientism; they reduce, devalue or dismiss mystical experience as mere fantasy, illusion, delusion or psychosis. Others, conversely, get so entranced by mystical experience that the findings from psychedelic experience lead to a demeaning, disrespect or even repudiation of science. They allow mystical truth to overrule science.

    And here is exactly where big-time risk creeps in. The more we honour intuitive mystical truth at the expense of empirical science the more we stray toward disregard of the cautions, practice standards and protocols established for safe use by scientific researchers, the more we are likely to see the precepts of professional ethics, boundaries and accountability as too limited, or no longer relevant, or somehow not fully applying to us anymore. When intuitive truth trumps science, the door opens to cult thinking, to authoritarianism, to the rise of a new priestly caste of psychedelic savants, and to a climate in which emotionally and spiritually hungry people are vulnerable to exploitation. Psychedelic experience can indeed lead to the growth of humility, authenticity and compassion. But among evangelists who hold this mistaken belief, it can lead to hubris on steroids.

    If the wheels come off of 2.0, it won’t be because of what the researchers in the labs tell us. The science has already advanced to the point where it is reasonable to believe that future research will much more likely to confirm the current promise of psychedelic psychotherapy than to diminish it. No, the biggest risks to our venture come from our movement’s most enthusiastic and evangelical proponents – underground psychedelic therapists and voyagers who hold these mistaken beliefs that pave the way for tragic results. So let’s be vigilant for these seven deadly-thinking sins, and vocally resist them when they appear.

    Psychedelic experience, and our thinking about it, contains many paradoxes. Isn’t it a delightful paradox that the ingestion of a particular molecule that affects certain neurons can lead to the deep conviction that the world consists of so much more than just molecules and neurons! It’s also a paradox that the more psychedelic voyagers ignore or evade the dark side of their process, the more that dark side is likely to find them. This is true similarly on the collective level regarding our shared dreams of a psychedelic future: it’s a paradox that taking a walk on that dark side – facing up to the things that could go wrong and the beliefs that could most likely take us there – increases our likelihood of reaching our goals and confirming our optimism. Let us embrace this paradox as we move forward.

    Last edited by mr peabody; 09-09-2018 at 03:56.
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    Ketamine and Quantum Psychiatry

    Karl Jansen, Stanislav Grof, Rick Strassman, Sylvia Thyssen, Lester Grinspoon, James B. Bakalar, Dale Pendell, Jon Atkinson, Louise Theodosiou, Kevin Brunelle, Dave Cunliffe

    The word 'psychedelic' was invented by an English psychiatrist (Humphry Osmond) and means 'mind-revealing'. A psychedelic drug may tell us more about how the mind constructs reality, personality and a sense of meaning and sacredness. It is sometimes said that ketamine is not a psychedelic drug because it has anaesthetic properties not seen with LSD, DMT, psilocybin and mescaline. Nevertheless, it can access all of the realms of consciousness mapped out by psychiatrist Stanislav Grof on the basis of LSD research. Ketamine is mentioned in (for example) Psychedelics Encyclopedia, Psychedelic Drugs Reconsidered and The Essential Psychedelic Guide.

    Ketamine is relatively safe when used in hospitals. There is a wide margin between the top end of the medical range and a lethal dose. Psychedelic doses are usually only 10-25% of surgical doses, given by the same route for the same person. At these levels, it behaves more like a stimulant than a sedative and does not usually suppress the breathing or heart rate, although exceptions do occur. The higher brain is switched on rather than shut down. This state is different from being unconscious, where the light-bulb is turned off and if the person goes too far they may stop breathing. There are cases of accidental injections with 10 times the amount required for surgery, with no obvious, lasting ill-effects. When ketamine is taken outside a medical setting, the main dangers arise from the physical incapacity it produces.

    Dose, how the drug is taken, set and setting have an influence on the experience. 'Set' refers to the personality, past experiences, mood, motivations, intelligence, imagination, attitudes, what is going on in his or her life and the expectations of the person. Expectations are affected by what people hear and read about the drug. 'Setting' refers to the conditions of use, including the physical, social and emotional environment and the other people present. Empathy with the person giving the drug is a very important factor, even with an anaesthetic.

    Near-Death and Near-Birth Experiences

    A 'near-death experience' (NDE) is a report of leaving the physical body, and sometimes going through a tunnel towards 'the light'. Ketamine can reproduce all aspects of the NDE, including the conviction of being dead, having a telepathic communion with God, seeing visions, out-of-body trips, mystical states, entering other realities, re-experiencing old memories, and a life review which may have therapeutic value Most NDE's occur in people who are not physically near death.

    An NDE can be therapeutic. After-effects can include an enhanced joy in living, reduced fear of death, increased concern for others, reduced levels of anxiety and neurosis, reduced addiction, improved health and a resolution of various symptoms. Positive changes can also follow ketamine -induced NDE's (K-trips) which occur within a therapeutic alliance, in an appropriate set and setting. This is called death-rebirth psychotherapy.

    Where do these experiences originate? I have written at some length about the physical basis for them in the past. In this article I will consider more speculative suggestions that the brain can act as a transceiver, converting energy fields beyond the brain into features of the mind, as a television converts waves in the air into sound and vision. Advances in quantum physics suggest that certain drugs, and the conditions which produce NDE's, may 're-tune' the brain to provide access to certain fields and 'broadcasts' which are usually inaccessible. This re-tuning is said to open doors to realms which are always there, rather than actually producing those realms, just as the broadcast of one channel continues when we change channels.

    The Quantum Mind

    Some people believe that ketamine is a mental modem which can potentially connect the mind to 'everything else', allowing a peek behind the curtain at the inner workings of this and other realities. In the old Newtonian universe, the mechanical view declared that all possible forms of energy and fields had already been discovered; that the ordinary, everyday perception of space, time and matter and energy was the only scientifically correct reality; that all people were separate from each other and the rest of the universe; and that consciousness could not exist without a living brain.

    Some of these declarations can be reassessed in the light of new discoveries in physics. A subatomic particle can be in many different places at once. When a photon changes in one place and time, it's 'linked photon' changes simultaneously, even if it is on the other side of the universe. It's as if there was no space between them at all. This means that some physical boundaries could be arbitrary. A messy explanation for this is tachyon theory, faster-than-light particles which carry messages between the photons. Bell's theorem is more attractive. This involves a hyperspace where all realities exist at a single point, so no messages are required.

    If entry can be gained to the quantum realm, awareness (the 'disembodied eye') might travel through different realities without the body itself going anywhere.

    It was like a cosmic assembly line that was constantly churning out the alternate universes that some physicists theorise about in which every conceivable possibility becomes an actual reality. I even had brief flashes in which I experienced some of these alternate realities as they sprouted forth out of this cosmic womb...quick glimpses into what felt like other incarnations, other lives I could have led, darting journeys through seas of pure information. (Trey Turner, 100 mg ketamine i.m.)

    A person is not a photon, and it is a real quantum leap to go from the subatomic world to human events. Nevertheless, to improve our understanding of psychedelic experience we may need to reconsider some of the material which has been dismissed as hallucinations, psychosis, suggestibility, stupidity and fraud. Hallucination is only another descriptive term - it doesn't really explain anything. 'Quantum' based explanations for certain mental states have started to appear, and we should be wary of dismissing these new theories out of hand. Some of the most significant advances were opposed by the most renowned scientists of the day. Einstein himself opposed quantum physics, declaring that God did not play at dice. Einstein described this physics as 'absurd, bizarre, mind-boggling, incredible, beyond belief...' and 'the system of delusions of an exceedingly intelligent paranoiac, concocted of incoherent elements of thought'. However, Einstein was wrong. The 'system of delusions' worked very well, and its 'psychotic' advocates won many Nobel prizes. Subatomic particles could indeed behave as if time and space were non-existent.

    It was next observed that there are similarities between quantum processes and human thought processes. Leading physicists suggested that consciousness may involve quantum events, with profound implications for understanding certain altered states of being. Professor Stephen Hawking, who sits in Newton's former chair at Cambridge, believes that the universe has no boundaries in space or time, and is made up of super-strings which vibrate in 'extra dimensions', balancing vibrations in the usual dimensions: positive and negative energies cancelling each other to produce the our universe, based on a 'new' kind of symmetry called 'super symmetry'. The latest atom smasher may provide evidence of this super symmetry, producing the world's most expensive Yin-Yang symbol. Has the division between physicists and psychedelic mystics become one of whether instruments or the mind itself is used to make the same observations about 'the ground of being'? The language of LSD trips can resemble the language of the older quantum physics, involving white light and dancing particles, but new reports in physics journals use terms which are much closer to 'the language of ketamine'. Super-string theory is being supplanted by the discovery of whole groups of extended objects called p-branes . These may be viewed as types of membranes, with a string being a one-brane as its only dimension is length. There are other types of 'branes' with far more dimensions. Becoming an across-the-universe membrane is a typical ketamine effect. Before p-brane theory was widely known, ketamine and isolation tank explorer John Lilly MD wrote:

    At the highest level of satori from which people return, the point of consciousness becomes a surface or a solid which extends throughout the whole known universe. This used to be called fusion with the Universal Mind or God. In more modern terms you have done a mathematical transformation in which your centre of consciousness has ceased to be a travelling point and has become a surface or solid of consciousness...It was in this state that I experienced 'myself' as melded and intertwined with hundreds of billions of other beings in a thin sheet of consciousness that was distributed around the galaxy. A 'membrain.

    Thus transpersonal events may be possible within the new physics, if subatomic events are involved in consciousness. Ketamine may be a drug which 're-tunes' the brain to allow awareness to enter the quantum sea. If this is indeed the case, then we may have to regard some of the reports of eternity, infinity, multiple universes and linkage with other beings as phenomena demanding a more sophisticated explanation than a brief dismissal as 'hallucinations and mental illness' requiring no further consideration.

    Ketamine Psychedelic Therapy (KPT)

    Over the past 15 years, ketamine has been given to over 1,000 patients in St. Petersburg as an aid to psychotherapy, mainly to assist in the treatment of alcoholism in well-planned trials with proper clinical control groups. The scientific rigour of these studies is impressive. Long-term follow-up of patients has been very encouraging, and the treatment has been extended to heroin addicts and some forms of neurosis. Not a single patient has had complications such as prolonged psychosis, flashbacks or non-prescribed use of ketamine. This work has been carried out by psychiatrist Dr. Evgeny Krupitsky and his team. Evgeny is Chief of the Laboratory, and was recently awarded an honorary Doctor of Science. He spent a year with the ketamine research team at Yale, sponsored by the conservative National Institute of Drug Abuse.

    Sessions are supervised by two physicians, a psychotherapist and an anesthetist. A return to normal usually began after 45 minutes to an hour, with a recovery period of 1- 2 hours.

    In addition to very good rates of sobriety at one and two year follow-up compared to the control group, on tests of personality change there are significant improvements in many scales including depression, anxiety and ego strength. People become more confident about their own ability to control their lives and to accept responsibility. Non-verbal emotional attitudes are brought to the surface and made known, resulting in less conflict between verbal /conscious and non-verbal/unconscious attitudes involving alcohol, the personality and other people.

    There was also a shift in values towards creativity, self improvement, spiritual contentment, social recognition, achievement of life goals, independence, and improvement of family and social life. Life became more meaningful, and the ability to live according to that meaning increased. KPT can reconnect the ego with denied parts of the self. It can also lead to a perception of reconnection with 'wider fields' such as the family, community, planet and universe in general - a form of spiritual experience. Changes in spirituality were assessed using scales designed to measure spiritual change in the Alcoholics Anonymous approach, and the Life Changes Inventory developed to assess the outcome of NDE's.

    We try to assist in the patient's psychological integration of the spiritual transformation which can result from the psychedelic experience. The uniquely profound and powerful experience often helps them to generate new insights that enable them to integrate new, often unexpected meanings, values and attitudes about the self and the world. (Krupitsky and Grinenko, 1997)

    'I saw the Light' conversions have long been linked with spontaneous recovery from addiction and criminality. All of the 12-step programs, such as Alcoholics Anonymous, have a spiritual orientation and require acceptance of the guidance of a 'higher power'. This may be seen as part of the psyche or a separate entity, depending on personal belief.

    Death-Rebirth Psychotherapy

    An NDE can be a pivotal turning point, encouraging significant and positive life changes. People who attempt suicide have a subsequent risk of making further attempts which is at least 50 -100 times greater than the normal population. In contrast, suicide attempts which result in NDE's are followed by a reduced risk of further attempts, despite an increased belief in an after-life. Of those who survived a jump from the Golden Gate bridge and had an NDE, none went on to completed suicide, and all were united in their support for a barrier to prevent further attempts. These findings suggested that the artificial induction of NDE's by relatively safe means, within a therapeutic alliance in an appropriate set and setting, might have positive benefits in some people.

    The Back Pages

    Throughout human history, altered states of being have played a part in healing. The roles of priest and doctor came together in one person (e.g. shaman, 'witch-doctor' etc.) who entered 'mental realms', perhaps aided by psychoactive plants, to speak with spirits for the good of the people. Sometimes, they took the ill person into these realms with them.

    The belief that inducing such states for therapeutic purposes was a mis-guided idea of the 1960's, now abandoned due to lack of efficacy and unacceptable risks, is incorrect. This was not a minor curiosity of the lunatic fringe. From 1950 to 1970, more than 1,000 peer-reviewed publications appeared on the clinical use of LSD, in over 40,000 patients. The aims included strengthening the therapeutic alliance, diagnosis, gaining access to memories, and improving insight and the relief of symptoms. Conditions treated included anti-social behaviour, alcoholism, obsessional neurosis, and the psychological problems of the dying. Many of the professionals involved were not at all radical, or even liberal, in outlook. This large enterprise came to a sudden halt when LSD was placed in class A/schedule 1.

    New treatments have frequently been greeted with widespread and inappropriate use, and extravagant claims. They then sink to their proper place in the medical cupboard. In some cases, this can be affected by political, social and ideological factors. The only psychedelic drug which can be used in medicine is ketamine, where it may be used to prevent pain in the body but is not licensed for the treatment of pain in the mind.

    In the normal course of events, treatment involving psychedelic drugs would have eventually found its proper place, after the extravagant claims phase had passed, with the usual list of possible adverse effects, indications and contra-indications, cautions and precautions, advocates and opponents -as exist for all forms of treatment. Psychedelic drugs, however, became caught up in an intense ideological battle. The result was that not only did all therapeutic use come to an abrupt halt after 20 years, but almost all research projects were also suppressed. This did not happen because a serious new side-effect emerged, or because there was absolutely no evidence of efficacy. The complete ban on psychedelic drug research appears to have arisen from issues which are largely ideological. Ketamine provides an example of the processes involved. It has been given to millions of patients, and there are numerous reviews affirming its safety (when used in a controlled medical context) and value. In most countries it is not even a controlled drug. Nevertheless, if a research proposal is made involving 10% of the normal anaesthetic dose, to be given to healthy informed volunteers, and the word 'psychedelic' appears anywhere in the proposal, there is immediate and grave concern amongst ethical committees where anaesthetic trials may proceed with relative ease. It is difficult to explain this anomaly using scientific and health concerns. These anomalies have led to suggestions that this era has a taboo against having certain aspects of the mind revealed. Ketamine may provide an example of this taboo: a relatively safe medicine which is suddenly seen as unsafe because it is described as a psychedelic drug rather than a dissociative anesthetic. Nevertheless, research with this substance is proceeding in several countries and may eventually lead to the development of a 'quantum psychiatry', just as Freudian psychiatry , which saw psychic energy as a head of steam in the mind, took its cue from Newton's mechanical outlook 100 years earlier.
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    Healing Mind and Body: A Short History of Psychedelic Psychotherapy

    by Bradley Foster

    "We are not human beings having a spiritual experience. We are spiritual beings having a human experience." - Pierre Teilhard de Chardin

    It’s hardly news when a therapist helps heal a client. But when a therapist has a patient use a psychedelic, the media notices. That’s because psychedelics can heal in ways that pharmaceuticals and talk therapy cannot—ways that science has not yet begun to understand.

    Psychotherapy-assisted psychedelic medicine is set to leap-frog over conventional methods in the treatment of addiction, PTSD, depression, and anxiety.

    It is predicted that MDMA and psilocybin will be available under controlled conditions within the next five years. At first it will only be for the terminally ill or for those with severe PTSD. Finally, the door will be open.

    Psychotherapy-assisted psychedelic experiences will revolutionize how we treat mental illness. Rather than being given pills we have to take for life, we can take just one dose and be transformed. Of course, psychedelics aren’t for everyone. So there will still be a role for pharmaceuticals and conventional therapy.

    Pundits are already speaking of our age as the psychedelic renaissance, a phenomenon that can be clearly witnessed within the rapidly expanding ayahuasca tourism industry as ayahuasca obtains an increasingly globalized popularity and reputation.

    The techniques and philosophy of psychedelic psychotherapy have evolved over the past 50 years to work effectively with psychedelic medicine. I invite you to follow me back in time to see how psychotherapy evolved to help make the magic happen.

    Psychedelic-assisted Psychotherapy

    Psychedelics open a door to usually hidden vistas of the psyche by putting the client into a non-ordinary state of consciousness: deviation from the normal waking mental state caused by physiological, psychological, or pharmacological agents.

    When given appropriate support and framework, deeply entrenched personal problems can be safely worked out. It’s the therapist’s job to stay out of the way and to gently encourage self-healing of the body and mind. The patient’s inner work, enhanced by psychedelics, goes much deeper and is more rapid than it would be through talk therapy alone.

    Survivors of trauma tend to be well defended or in denial about the dark places inside of them. Psychedelics help them access and come to terms with their demons or darkness. Once these previously hidden traumas are resolved, the problems they cause disappear.

    In a psychedelic session, only the client uses the psychedelic. The therapist sits quietly with the client to help with any arising difficulties and to ensure a safe experience. The therapist must be open to whatever may come up for the client during the trip, gently encouraging them to confront any fears that appear.

    The psychotherapist’s job is to encourage self-direction and to trust that the client can find a path to healing. The notion that each person has an inner healer who, when encouraged by a therapist, can help them overcome trauma, is unconventional in the world of psychotherapy and psychiatry, where the therapist is seen as more of an expert or a guide.

    There are several classes of psychedelics that work in different ways. For instance, LSD reduces the subject’s ego and quiets the Default Mode Network, and at the same time facilitates signaling throughout the brain. MDMA appears to reduce signals from the amygdala , which allows a client to go deeper into frightening memories or trauma with less fear.

    A Bit of History

    The last few hundred years represent the only time in human history that psychedelics have been repressed throughout most of the world.

    It is thought that humans have used psychedelics since the first conscious being ingested (likely) magic mushrooms. Almost every culture in every part of the world used some form of psychedelic plant for ritual or healing throughout history. In the age of colonialism, conquistadors and the church took a dim view of natives with their psychedelics. The prohibition of psychedelics spread to most modern nation states, with little regard or respect for their efficacy and healing potential.

    Few psychologists recognized the significance of non-ordinary states of consciousness until LSD was discovered. Patients of mainstream psychiatrists who presented with religious experiences, different states of consciousness, or who were undergoing a spiritual crisis were likely to be diagnosed as having had a psychotic experience, mania, delirium, or delusions.

    After its discovery during World War II, LSD was sent to psychologists and researchers who were told that it mimicked psychosis. A great deal of experimentation took place, much of it misguided and immoral due to misunderstanding how the drug worked.

    The U.S. Army launched MKUltra, which studied the feasibility of using LSD as a weapon to disorient enemy soldiers. The CIA hired noted psychiatrist Dr. Ewen Cameron of McGill University to conduct experiments in mind control.

    LSD therapy at that time often involved no informed consent, unwilling victims strapped to a stretcher for hours at a time, being interrogated and studied like rats. The results ranged from sad to hilarious, as in the case of a British army platoon on LSD, and fortunately didn’t prompt follow-up studies.

    Several research projects used psychedelics as a psychotherapeutic tool, but personal growth is difficult to quantify. Early researchers quickly realized that LSD was an amazing tool for probing the psyche and studying consciousness. But they had a lot to learn before they knew how to control its effects and use it properly.

    By the mid-1950s psychoanalysts started using LSD with their clients in a more humane manner. They discovered that set and setting were crucially important in treating clients successfully. Set and setting means creating a safe, comfortable environment, preparing their clients for what to expect, and encouraging them to reflect on their intention before the trip.

    The client lay down on a couch in a living room, wore eye shades, and had headphones that played gentle instrumental music. Typically, two therapists sat with them to observe and ensure a safe and consistent experience. This is when therapists sitting with their clients became known as sitters because they limited their intervention during the trip and just sat with the client.

    Much of the research published in the 1950s and 60s showed promise for treatment, particularly when psychotherapy was used as an adjunct with a psychedelic. During this period, LSD was taken by researchers themselves, who, far from finding schizophrenia-like psychosis, discovered astonishingly kaleidoscopic paths to self-enlightenment and heightened states of consciousness. In a letter to Zip Reilley in 1957, Psychoanalyst Betty Eisner famously quipped that "taking LSD was like going through four years of analysis in six hours."

    By 1960, the pace of innovation increased as journal articles were published and conferences on psychedelic psychotherapy were held. Researchers met and exchanged information in a rapidly growing field.

    Psychedelic research clearly demonstrated LSD’s promise in helping people with addiction and many trauma-related illnesses. But it was a difficult drug to work with, and many of its properties were unknown. Some people had adverse reactions, from psychosis to difficult and frightening experiences.

    Many alcoholics treated with a dose of LSD stayed sober for up to six months but many relapsed. In other cases, psychedelics produced profound effects but dissipated over time. Clinical research is hampered because it is impossible to have a control group when it is very clear which participants are on psychedelics. It was also difficult to replicate results of previous experiments because the studies were not up to modern standards. Much of the research at the time was being conducted in an informal manner with little state or corporate sponsorship.

    Walter Pahnke, a researcher at Harvard University, conducted the Good Friday Experiment in 1962. Twenty divinity students were given either a dose of psilocybin or niacin (which mimics some symptoms of psilocybin) to see if psilocybin would react reliably in a group of religious scholars. The participants then spent Good Friday in contemplation in a chapel. Pahnke discovered that psilocybin had a profound effect on the students, most of them had a life-changing religious experience.

    Rick Doblin’s follow-up study 30 years later demonstrated that its effects can still be as profound. The study also showed that it was equally important to prepare the participants as well as help them integrate their experiences. Pahnke’s study made it generally accepted that psychotherapy was the key to helping people integrate and find meaning in their experiences. Having a religious experience on a psychedelic is often an overwhelming experience that needs to be processed and integrated to have meaning in our more ordinary state of consciousness. This work is continuing at Johns Hopkins, studying the effects of psilocybin on religious leaders ​and their practices.

    At the time, the most popular psychotherapeutic modalities were derivatives of Freudian analysis. Carl Jung’s ideas of the collective unconscious were more compatible with psychedelic therapy than many of Freud’s concepts. In England, the most popular use of psychotherapy and LSD involved using a psycholytic, or a low dose, whereby participants took a dose a few times a week and participated in group therapy. In North America, less frequent but larger psychedelic doses were used. Both methods were effective in different ways.

    Psycholytic has become popularized these days as microdosing, which helps people on a daily basis. A psychedelic dose tends to be a much more powerful tool for interrupting old patterns and requires much more intervention from professionals.

    Some psychedelic therapists realized that working with clients in different states of consciousness opened up new ways of working with the psyche. Bill Richards and Walter Pahnke were the first therapists to understand that:

    “Each person’s psyche is infinitely wiser than the egos of the patient and the therapist (or traveler and guide), and, if trusted, will manifest the experimental sequences or imagery, memories, emotions, revelations and insights needed to facilitate conflict-resolution, and communication with the sacred realms of the Self, and healing.”

    Think of an elevator where you can press a button to access the floor where traumatic events are stored or where your self-healer lives. Psychedelics offer a simple and effective method of getting clients into a state where they get into their psychic vaults without the ego and its defenses getting in the way.

    Stanislav Grof

    Research into psychedelic psychotherapy began in earnest at the Spring Grove State Hospital (1960-1965) and continued at the Maryland Psychiatric Research Center (1965-76). Much of the credit for advancements in understanding the use of psychotherapy with psychedelics is due to pioneers like Walter Pahnke, Bill Richards, and Stan Grof. Building on research during the previous decade, they developed new techniques that transformed psychedelic psychotherapy for the treatment of psychological and spiritual distress.

    It’s significant that Pahnke and Richards were students of theology, not just psychology. They understood that psychedelic trips were manifestations of spirituality. They also made the connection between the spiritual and the inner healer, which is what makes it therapeutic.

    Traditional psychoanalysis and newer modalities arising from the “human potential movement” wanted little to do with anything that had the taint of religion. They were striving to be “scientific.” Religious leaders wanted even less to do with a drug that could induce religious experiences. Therapists working with psychedelics in the mid-1960s were often working without much support from the medical, religious, or psychiatric establishments.

    Researchers at Maryland developed key guidelines for “travelers” or clients embarking in different states of consciousness:

    1. It is important to trust the therapist so you will be capable of expressing honesty, courage, and curiosity.

    2. The paradox of ego strength and ego transcendence means that one must have a reasonably strong ego, a developed sense of self, before you begin your journey. Experiencing a higher state of consciousness means the traveler must trust himself on the threshold of ego transcendence.

    3. Being must be accepted and experienced without judgment no matter what state you’re in.

    4. Whether embedded trauma emerges from the depths, or one has a transcendent experience, it must be simply accepted.

    5. Through the magic of therapists staying out of the traveler’s way, and through the transcendence of self-acceptance, the client learns how to heal herself.

    In 1971, U.S. President Richard Nixon declared drug abuse to be public enemy number one. Psychedelics were placed on Schedule One of the Controlled Substances Act, which included a set of policies that forbade their consumption, manufacture, and distribution, effectively shutting down all clinical research.

    Just when the wheels of research were beginning to spin with new and effective psychedelic treatments for alcoholism, anxiety, and depression, they were forced to stop immediately. It is a cruel irony that scheduling was intended to keep psychedelics out of the hands of youthful experimenters, but its main effect kept psychedelics out of the hands of researchers, not teenagers. It’s tragic that so many people could have been healed during this time, and we could be in an era of psychedelic medicine were it not for the intrusion of politics.

    In Part 2, we’ll take you through the long, dark years between 1972 and 1993, explore why and how psychedelic research came to a standstill during that period, and then bring you up to date with the psychedelic renaissance.

    Part 2

    We knew we couldn’t make it illegal to be either against the war or blacks, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.” – John Erlichmann, aide to Richard Nixon, 1994

    In part one we took a journey through the milestones of psychedelic research up to the point where all studies were shut down.

    Now let’s go forward in time through the government’s ban on psychedelics, the cauterizing effect of prohibition on psychedelic research, and into its tentative re-ignition, exploring how this has blossomed into the psychedelic renaissance.

    The Curtain Comes Down

    Until the mid-1960s, modern psychedelic interest was confined to the lab or the psychotherapist’s couch. Timothy Leary, a psychiatrist at Harvard, along with Richard Alpert took them mainstream. Suddenly hippies were everywhere, throwing a spanner into the works of U.S. postwar conformity.

    The mayhem at the 1968 Democratic convention, the burning cities, and Vietnam War protests prompted Nixon to criminalize all psychedelics by placing them on Schedule One of the Controlled Substances Act, which is reserved for drugs with a high likelihood for abuse and which have no medical value. Psychedelic research screeched to a halt, and for decades it became impossible to get access to psychedelic drugs for clinical study, and it was illegal to make, buy, sell, or use. Research into different states of consciousness was set back 30 years.

    One of the few bright spots in the years of prohibition was Stan Grof’s work with holotropic breathwork. When Stan was prevented from having access to LSD and the Maryland clinic closed down, he moved to California where he pioneered the use of rapid, deep breathing, which can make the breather experience a different state of consciousness. While not as intense as many types of psychedelic experiences, holotropic breathing was much safer and could be used on many clients where psychedelics were inappropriate or hazardous, such as on pregnant women or children. Stan also pioneered new techniques of integration, including the concept of prenatal trauma, which are finally being recognized by a wider community of therapists.

    Alexander Shulgin

    Psychedelic chemist Alexander Shulgin introduced Leo Zeff, a Jungian psychotherapist, to MDMA, which he dubbed “Adam” because he believed it returned those who took it to a primordial state of innocence. Zeff was another pioneer who incorporated LSD in his practice in the early 1960s. Shulgin felt that MDMA was the perfect drug to use with psychotherapy. Zeff was so excited by it, he shelved his retirement plans and became known as “the Johnny Appleseed” of MDMA as he traveled around the country, turning over 4,000 psychotherapists onto MDMA couples counseling.

    An Opening

    Beginning in the 1990s, there was a small blip in research as the gatekeepers loosened control of psychedelics, allowing clinical studies access to MDMA and psilocybin. More studies were spawned, with interesting results. Modern protocols, careful screening, and the addition of psychotherapy to the use of psychedelic medicine resolved many of the old problems, produced more reliable results, and increased the effectiveness of the medicine.

    Psychedelic therapists are trained to deal with people who experience different states of consciousness, not only those produced by taking drugs. Psychedelic therapists play an important role helping clients work through transpersonal states such as loss or change of faith, existential and/or spiritual crisis, experience of consciousness or different states, psychic openings, spiritual emergence, possession, grieving, near-death experience, kundalini awakening, shamanic journey, and difficulties with a meditation practice.

    Unfortunately, many otherwise well-trained psychiatrists and psychotherapists may not be able to make sense of these states and may do more harm than good, for instance by diagnosing the person experiencing them as having a mental illness and medicating it.

    Pahnke noted, “Without competent psychiatric supervision, such experiences may, at best, remain frightening memories and, at worst, cause a person to decompensate under the stress.”

    It’s become a rite of passage for many youth to attend outdoor concerts while high on assorted substances. In 2006, MAPS spawned the Zendo Project as a harm reduction strategy at Burning Man to help people having difficult trips. Zendo was also a unique opportunity for training psychedelic psychotherapists. At any given festival there are dozens of participants who are freaking out. Zendo provides care for people having difficult experiences. They have developed effective strategies for psychedelic harm reduction to help festival-goers. Many other organizations such as Kosmicare, ​EnergyControl, The Loop, DanceSafe, TripProject and also practice psychedelic harm reduction within their communities.

    Richard Yensen

    Inside the Zendo tent, sitters provide a safe container for people going through difficult psychedelic experiences. The sitter provides a compassionate, calm, grounded presence. In order to do this, the sitter has to start with a beginner’s mind and be curious. There is no analyzing, leading, or agenda, just safety and support. Richard Yensen, one of the psychologists at the Maryland Research Center, likens the psychedelic therapist to a stained-glass window. The power is in the light that shines through each pane of glass onto the client.

    - Zendo’s Rules for Psychedelic Harm Reduction
    - Safely sitting through difficulty
    - Creating a safe space
    - Sitting, not guiding
    - Talking through, not down
    - Difficult is not the same as bad

    The integration of the experience of different states of consciousness is vital. There is little therapeutic value gained unless it can be transformed into meaning in our everyday lives. Some feel strongly that recreational users who experience these states don’t get the benefit from them due to a lack of integration. Experiencing something as vast as the universe, or feeling God-like while on a psychedelic does not lend itself well to day-to-day reality. We all might need a little help unpacking it. A psychedelic therapist helps make sense of these experiences which can be so profound that old habits and addictions can easily be broken.

    Because psychedelic medicine is currently illegal in most Western countries, therapy occurs only in clinical trials, in retreats in countries where say, ayahuasca or iboga is legal, or through underground therapists. Integration therapists or integration circles create a safe space for users of psychedelics to tell their stories after the fact.

    Once a client has had a different state of consciousness, the most important role for the therapist is to help their client integrate their experiences. Integration involves understanding the meaning and bringing it into their daily life. Therapists who offer integration services have backgrounds in many modalities, though most tend to have a psychodynamic orientation. Psychotherapists with training in transpersonal or shamanic modalities are becoming increasingly common among practitioners.

    Amanda Feilding

    Psychedelic therapy remains a work in progress. When psychedelics are approved for use, psychiatry will have access to medication that promotes healing, rather than simply treating symptoms. And we will need a lot more psychedelic therapists. As research moves forward, it appears likely that psychedelics will revolutionize our understanding of the mind for decades to come. Nearly all psychedelic studies are small scale and sponsored by foundations like MAPS, the Beckley Foundation, and university departments. Even so, psychedelic research is expanding rapidly despite being hobbled by having no corporate money behind it. Researchers are suggesting many more uses for psychedelics, so we can expect to hear about the results of new studies far into the future.

    A small group of therapists working within the limits of clinical protocols are pulling off amazing results. Psychedelics offer tremendous insights into understanding and healing the causes of a wide range of mental health issues. Just imagine the flood of findings and discoveries that could be unleashed if public money was invested in more research. As it is, we are barely scratching the surface.

    An accumulating body of clinical research finds psychedelic-assisted therapy highly effective in healing PTSD, trauma, anxiety, depression, existential anxiety, addiction, eating disorders, and even cluster headaches. Crucially, for those with these conditions, present-day psychiatry treatments provide very modest improvements.

    There are many hurdles psychedelic research has to jump over before treatments become mainstream. We may see MDMA-assisted psychotherapy treatment for PTSD within a few years. Treatment of death anxiety for cancer patients may be permitted on compassionate grounds in some more progressive countries in the near future. As each day passes, more evidence supports the assertion that psychedelics are a miracle cure for people who suffer from a wide variety of mental distress.

    Psychedelic therapy will revolutionize psychiatry and psychotherapy for years to come. Patients who suffer from a wide range of debilitating mental health conditions will be healed through novel treatments that we are beginning to discover. One day, many years from now, the psychedelic renaissance may become known as the psychedelic revolution.
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    Treating mental disorders with psychedelic psychotherapy

    Every day in Australia, more than eight people die by suicide. Millions more suffer mental health issues. We have treatments available, but we are missing out on therapies that are showing great promise in other parts of the world. Why? Because they use psychedelic drugs.

    Psychedelic drugs and mental health issues may sound like a terrible combination—and can be in the wrong setting. But increasing evidence suggests that using controlled portions of these drugs with trained psychotherapists could help people overcome several mental health disorders. Even healthy people might be able to benefit in the future.

    Dr Stephen Bright is Senior Lecturer of Addiction at Edith Cowan University (ECU) and Vice President of Psychedelic Research in Science and Medicine (PRISM). He’s hoping to bust the myths about psychedelic drugs and push through the politics so that Australians may one day benefit from these potentially life-saving therapies.

    What is psychedelic psychotherapy?

    Psychedelic psychotherapy involves using small amounts of psychedelic drugs in a controlled, clinical setting. Psychotherapies aim to help patients overcome problems—usually by facing them head on. For example, someone with PTSD may avoid thinking about the bad experience they had. In psychotherapy, the therapist will actually direct them towards facing that bad experience to help them to work through it.

    Adding psychedelic drugs to the mix generally helps patients get there faster. The therapists ‘hold the space’, allowing the patient to mostly guide the session. The therapists will usually only need to intervene if the patient is avoiding facing their issues or bad feelings.

    “It never fails to amaze me how much spontaneous insight people gain in the MDMA sessions. It would take 10+ weeks of normal psychotherapy to guide a person to the insights that the patients spontaneously come up with while on MDMA,” Stephen said. Stephen explains that this is a technique he often used while ‘trip sitting’ at festivals.

    “The further they push against bad feelings, the worse their experience becomes. So we try to talk to them about what they’re experiencing and allow them to approach it and work through it rather than avoid it, and doing so seems to have a therapeutic response.”

    But patients aren’t thrown in the deep end like someone having a difficult trip at a festival. Psychedelic therapy involves planning and preparation. The preparatory sessions are thorough, so the patient knows exactly what they need to do, and therapists know how to best support them.

    “The person is fully prepared beforehand for what they’re going to experience, and they have some coping strategies.”

    A mystical experience

    So what is it about psychedelic drugs that patients find therapeutic? Neurologically, we’re not sure. But Stephen said the secret often lies in the mystical experience you can have on psychedelic drugs. It’s difficult to explain, but it’s a spiritual sense of oneness. Kind of like having an epiphany. The mystical experience usually happens with the more psychedelic drugs like psilocybin, rather than MDMA. A study at NYU found that patients with life-threatening cancer who had a mystical experience from psilocybin psychotherapy had improved quality of life and decreased depression and anxiety. This has huge implications for palliative care.

    “That spiritual experience seems to be the catalyst in allowing them to come to terms with their situation,” Stephen explains. But this isn’t exactly a new discovery. The co-founder of Alcoholics Anonymous, Bill Wilson, said the spiritual awakening he experienced on LSD is what started his own sobriety. “The problem is spiritual experiences are hard to create but we know, with psychedelics, we can induce these mystical experiences in a clinical setting in the right context with the right trained therapists involved,” said Stephen.

    This is why research has also looked into psychedelic psychotherapy as a treatment for addictions like smoking. One study found that psilocybin psychotherapy helped people quit smoking, with 60% still smoking-abstinent after 12 months.

    “That’s remarkable when you consider Champix—which is the leading pharmacotherapy for nicotine cessation—that has a success rate of 21% at 12 months,” said Stephen. “The subjects in this study reported that this mystical experience that’s induced by the psilocybin is ranked as one of the top five most significant experiences of their life.”

    Your brain on psychedelics

    Not only has this therapy shown good results in PTSD, palliative care and addiction, it’s also being looked at as a treatment for depression because of the effect it has on the brain.

    “Another area that’s in its infancy is psilocybin and depression. There’s been an open label study published by Imperial College in London among people who hadn’t responded to other treatments for depression. They found a number gained significant benefits from psilocybin-assisted psychotherapy.”

    In this study, they also took a look at what was going on in the brain of patients with neuroimaging. Using this, they found a change in the brain was linked to a reduction of depressive symptoms. It turns out psilocybin can temporarily switch off a part of the brain called the Default Mode Network, which correlated with patients having that mystical experience.

    “The Default Mode Network is a series of interconnected neural pathways. It is activated all the time when we are in a waking state. It allows us to have this conversation because we can concentrate on what we’re doing,” said Stephen. “If we turn off the default mode network, we end up with a lot of cross-talk happening in the brain. In the context of depression, perhaps having all those different interconnected pathways allows the person to see the world, themselves and others in a completely different perspective.”

    He likens the default mode network to a conductor in the brain. Turning off the Default Mode Network with psychedelics is like putting the conductor on “paid service leave for 6 to 12 hours”. Without the conductor, the orchestra starts playing all kinds of things.

    “In that cacophony of noise comes epiphanies.”

    Inducing everyday epiphanies

    If you’re like me, by now you’re probably thinking you could use an epiphany too. Surely this can’t only be useful for mental health disorders? I asked Stephen to play the hypothetical game of looking into the future and letting me know if there will ever be a day this could be accessed by anyone needing to make a big life decision.

    “People can go when they want to engage in some sort of spiritual contemplation or they’re not sure about something in their life, and they can utilise the psychedelic experience to help them with that.”

    But before we get there, we have some serious catching up to do.

    What’s stopping us?

    You may have noticed that all the studies referenced in this article have been from the US and the UK. That’s because Australia lags way behind in psychedelic research. Stephen says there are a few reasons for this, namely “academic conservatism”, which is why I swell with pride when Stephen tells me that ECU has thrown their support behind psychedelic science.

    “We’ve been banging our heads against the wall for about 8 or 9 years now, and things are now really starting to look quite positive. I don’t want to get too optimistic, but things are starting to look really positive,” he said. “The fact that ECU is supportive of it is fantastic.”

    Stephen’s worked in both the policy and scientific spheres to try and get Australia to embrace and get involved in psychedelic research. In particular, he’s been leading the charge for MDMA-assisted psychotherapy. Right now, the Multidisciplinary Association for Psychedelic Studies (MAPS) is in the process of phase 3 trials for MDMA-assisted psychotherapy for PTSD, after phase 2 yielded promising results.

    “What we’re hoping in Australia, and what ECU’s supporting, is that Perth will be a site for a phase 3 trial,” said Stephen. “If we can demonstrate we have the people and infrastructure to do MDMA-assisted psychotherapy, then we can come on board as a phase 3 site, and so all we need to do to demonstrate that is just run a very small pilot feasibility study. And so that’s what we’re working on at the moment.”

    Getting Australia on board means we will be able to access psychedelic psychotherapies and won’t be left behind.

    “Hundreds of thousands of Australians will no longer needlessly suffer from depression. We'll see less suicides occurring among war veterans,” said Stephen. “Australians won’t need to travel overseas to access these treatments because we will have clinics and trained therapists available in Australia who can provide these therapies.”

    So it’s probably time that Australia had an epiphany and took psychedelic science a little more seriously.
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    Eduado Schenberg

    Psychedelic-assisted psychotherapy: a paradigm shift in psychiatric research and development

    by Eduardo Schenberg - 2018 Jul 5

    Mental disorders are rising while development of novel psychiatric medications is declining. This stall in innovation has also been linked with intense debates on the current diagnostics and explanations for mental disorders, together constituting a paradigmatic crisis. A radical innovation is psychedelic-assisted psychotherapy (PAP): professionally supervised use of ketamine, MDMA, psilocybin, LSD and ibogaine as part of elaborated psychotherapy programs. Clinical results so far have shown safety and efficacy, even for “treatment resistant” conditions, and thus deserve increasing attention from medical, psychological and psychiatric professionals. But more than novel treatments, the PAP model also has important consequences for the diagnostics and explanation axis of the psychiatric crisis, challenging the discrete nosological entities and advancing novel explanations for mental disorders and their treatment, in a model considerate of social and cultural factors, including adversities, trauma, and the therapeutic potential of some non-ordinary states of consciousness.

    The current psychiatric crisis

    Mental disorders increasingly contribute to the global burden of disease, with huge socio-economic costs. However, research and development in psychopharmacology—psychiatry's primary mode of intervention—came to a halt in 2010. Approval of new molecular entities for psychiatric conditions by the US Food and Drug Administration (FDA) fell from 13 in 1996 to one in 2016, with 49 approved between 1996 and 2006 and 22 from 2007 to 20161 In pharmacology conferences in the period, just about 5% of presentations were dedicated to human studies involving drugs with novel mechanisms of action. These occurrences are part of a complex picture clearly dissected as a triple crisis in psychiatry: of therapeutics, diagnostics and explanation.

    Problems surrounding psychiatric diagnosis also surfaced in 2010, when the UK Medical Research Council published a strategy for mental health and wellbeing and the US National Institute for Mental Health (NIMH) launched its Research Domain Criterion (RDoC). It proposed five domains based on specific neural systems that can be impaired in mental illness, a radical departure from the hundreds of discrete conceptual disorders of the much older Diagnostic and Statistical Manual (DSM). Thus, the RDoC advanced a multidimensional approach to diagnosing mental disorders in a continuous spectra. At around the same time, a network psychopathology perspective was conceptualized and empirically assessed with statistical models for psychometrics based on thousands of patient reports' and hundreds of symptoms.

    The treatment and diagnostic axes of the crisis are connected by the explanatory domain: despite huge investment in neuroscience as the ultimate source for understanding mental illness, both classification and diagnosis as well as knowledge about pathogenesis and etiology still faces many challenges. The explanatory debate about mental disorders is summarized by the contrasting declarations that “mental disorders are brain disorders,” or that psychiatry runs the risk of “losing the psyche.”

    Clinical developments with psychedelics

    Synthetic substances like LSD, MDMA, Ketamine, and naturally occurring alkaloids including Psilocybin, and Ibogaine have been used in a series of studies as well as Phase 2 clinical trials (Table ​1). These substances are orally active but have different mechanisms of action. LSD and psilocybin effects' critically depend on 5-HT2A agonism, MDMA inhibits monoamine transporters, especially for serotonin, while ketamine is an NMDA antagonist and ibogaine non-specifically binds to many receptors.

    The most studied is ketamine, which in higher doses is an anesthetic in use for decades. In lower dosages it temporarily modify consciousness including changes in mood and cognition. It is the experimental intervention in almost 70 Phase 2 trials for psychiatric disorders and two Phase 3 trials for depression. Protocols involve single or repeated administrations in different doses, routes of delivery and research designs. Most are for depressive disorders, but is also studied for Obsessive-Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), suicide, alcohol, and cocaine use disorders. Nine meta-analysis from depression trials show low frequency of serious adverse events in the short term, with short-term positive outcomes for a significant proportion of patients.

    MDMA is investigated in 17 Phase 2 trials and was designated a breakthrough therapy for PTSD by the FDA, a status that can expedite approval. Also studied for social anxiety in autistic adults, existential anxiety and alcohol use disorder, MDMA is commonly confused with the street drug “ecstasy.” However, these illegal products frequently do not contain MDMA, only adulterants. This loose terminology creates unfortunate confusion about MDMA's safety. In research with healthy volunteers, occurrences of hypertension, tachycardia and hyperthermia are below 1/3 of cases, not leading to serious adverse events. In clinical populations, serious adverse events were very rare, with only one brief and self-limiting case of increased ventricular extrasystoles in more than 1,260 sessions. Therapeutic results obtained with severe, treatment-resistant PTSD patients in Phase 2 studies were considered “spectacular,” with approximately 70% or more of participants no longer qualifying for the diagnosis after 12 months, while the remainder third had less intense symptoms. Furthermore, the improvements lasted up to 4 years, mostly without additional treatments and without inducing drug abuse or dependence. An independent preliminary meta-analysis found MDMA-assisted psychotherapy was superior to prolonged exposure when evaluated by clinician-observed outcomes, by patient self-report outcomes and also by drop-outs.

    Psilocybin is the third most studied psychedelic substance for clinical applications. It has a very high safety ratio and very low risk profile even in unsupervised settings. It is orally administered in eight trials for major depression, cigarettes, alcohol, and cocaine use disorders and existential anxiety in life-threatening diseases, mostly cancer. Despite moderately increasing blood pressure and inducing transient headaches, it has been safely administered to more than a 100 volunteers in neuroscientific research and another 100 in clinical studies with notable results.

    LSD, the most potent psychedelic currently administered in clinical trials, has very slow dissociation kinetics at the human 5-HT2A receptor and thus long lasting effects. It has a very high safety ratio, and is not associated with major health impairments after unsupervised use. It is the active substance in just two recent Phase 2 trials for existential anxiety in the terminally ill. This paucity is perhaps due to stigma surrounding large-scale recreational use since the 1960's, with considerable political implications. However, before political turmoil, more than a 1,000 studies including 40,000 patients were done, mostly showing positive potentials. LSD was thus the prototypical substance in the development of radically new forms of psychotherapy, including psychedelic-assisted psychotherapy, and another approach based on repeated low doses (10 to 50 μg) to potentiate psychoanalysis, known as psycholytic psychoherapy. Despite the paucity of recent trials, a recent meta-analysis with rigorous research from 60 years ago confirmed LSD also has important potential for alcohol use disorders.

    Finally, ibogaine is the less advanced psychedelic in the development pipeline, with no interventional clinical trials executed or registered since the National Institute on Drug Abuse (NIDA) cancelled efforts to develop this compound to treat opioid addiction in the 1990's. And indeed there are important safety concerns, given ibogaine can prolong QT interval, potentially evolving to fatal cardiac arrhythmias. This critically differentiates ibogaine's safety profile from other psychedelics. However, given the seriousness of drug addiction and the difficulty to treat these patients, observational and retrospective studies for opioid and psychostimulant addiction reporting considerable success suggests Phase 2 trials focusing on cardiac safety should be performed. Given ibogaine is unscheduled in many countries and currently used as an alternative treatment with an unfortunate series of fatalities, financial support is needed.

    Psychedelic-assisted psychotherapy (PAP)

    Safeguarded important differences regarding safety and mechanisms of action, the grouping of these substances in a prototypical PAP model has important practical and theoretical implications. The main feature is the therapeutic use of a potent psychoactive substance (currently most are scheduled compounds) in very few sessions. These are generally accompanied by drug-free sessions before and/or after drug sessions, usually called preparatory and integrative psychotherapy, respectively. With ketamine positive results were obtained with one to 12 administrations, with MDMA just three and with psilocybin and LSD only two, while ibogaine may be effective after a single administration. During drug effects, patients are continuously monitored and supported by trained mental health professionals following available guidelines. Generally patients listen to instrumental evocative music, and are encouraged to stay introspective and open to feelings, attentive to thoughts and memories, being free to engage in psychotherapy at any time. Frequency and type of psychotherapeutic interventions varied from a minimum in ketamine studies, sometimes including only music during drug effects, to a more intensive protocol with MDMA including 12 non-drug sessions, which follow a detailed manual based on non-directive transpersonal psychology. Between these two ends of the spectrum are psilocybin, LSD and ibogaine studies, which used a variety of interventions. Psilocybin studies used psychological support comprised of non-directive preparation, support and integration in few non-drug sessions. LSD included three post-drug integrative sessions. Ibogaine, used in different clinics for drug dependence, included a series of more or less standardized psychotherapies for addiction, pre- and post-drug, like 12-steps, individual and group counseling, among others. Increasing focus on types and frequency of psychotherapeutic interventions can arguably help improve outcomes, as exemplified by older ketamine studies with existentially oriented psychotherapy for drug addiction, and as recently tested with cognitive behavioral therapy for relapse prevention after ketamine for depression. As results from most trials reliably show, PAP can be more effective and faster than current treatments, even for patients considered “treatment resistant.” And these outcomes were not only statistically significant but had large effect sizes, which is encouraging for Phase 3 trials.

    Beyond potential novel treatments, PAP has important practical and theoretical consequences for the three axes of the crisis. The combination of psychotherapy with psychedelics can be conceptualized as the induction of an experience with positive long-term mental health consequences, rather than daily neurochemical corrections in brain dysfunctions. Thus, a comprehensive understanding of PAP suggests a conceptual expansion of “drug efficacy” to “experience efficacy4” Instead of conceiving the drug as correcting functional imbalances in the brain through a specific receptor, PAP is a treatment modality in which specific pharmacological actions temporally induce modifications in brain functioning and conscious experience. When appropriately mediated, these can be deeply meaningful experiences that elicit the emotional, cognitive and behavioral changes reported. Attempts to develop ketamine and ibogaine analogs devoid of the subjective “psychedelic” effects, e.g., lanicemine and 18-MC, will further illuminate this question. However, available therapeutic results for depression with ketamine analogs with less dissociative effects were only modest, while ketamine administration without preparatory psychotherapy and music support recently resulted in an interrupted trial. Furthermore, positive correlations between subjective features like ketamine's dissociative effects or psilocybin peak-experience with positive treatment outcomes in depression corroborates the notion that the meanings of the psychedelic experience plays an important role in therapeutic outcomes.

    It is thus very hard to strictly reduce PAP to neuropharmacology. In this sense, PAP can benefit from potentially rich interactions with other fields like psychodynamic psychotherapy. Furthermore, PAP can help solve many pressing safety concerns in current psychopharmacological treatments by bridging a current gap in knowledge between research and clinical practice. This gap is created because psychiatric clinical trials rarely last longer than 6 months, while the products approved based on these trials are later prescribed for chronic daily use for years, sometimes decades. Many current adverse consequences from the use of psychiatric prescription medications arise from this gap, including decreasing drug adherence over time, toxicity from increasing polypharmacy, addiction to prescribed medications causing severe withdrawal symptoms, and a plethora of side effects arising after prolonged daily drug use, e.g., weight changes, stomach pains, constipation, mood swings, confusion, abnormal thoughts, delusions, memory loss, restlessness, akathisia, tardive dyskinesia, sexual dysfunction, anxiety, dizziness, sleep problems, and even suicidal ideas. By administering medications only under supervision, PAP can reduce or even eliminate drug adherence problems and polypharmacy. By administering psychoactive drugs just a few times, PAP can prevent addiction and the development of side effects after chronic use of medications. And by exclusively licensing psychedelics for especially licensed therapists and physicians, rather than prescription and dispensation to patients, PAP can reduce risks of diversion and abuse. Considered together, these PAP features can arguably help reduce psychiatry's alarmingly high-rate of post-market safety events, reported at more than 60% after 10 years.

    Psychedelic-Assisted Psychotherapy (PAP) mapped onto the triple-axis psychiatric crisis. The icon in the center represents the PAP model, located inside the triangle projecting the three axes of the current psychiatric crisis: therapeutics (bottom), diagnosis (right), and explanation (left). The outermost black circle represents the main conceptual formulation for each axis in current psychiatric theory, i.e., brain dysfunctions diagnosed as discrete categorical disorders treated with specific drugs. The innermost white circle represents the concepts supported by PAP: mental injuries diagnosed as a multidimensional spectra treated holistically.

    Besides critical consequences for the therapeutic axis, PAP is also relevant for diagnostic concerns. The fact that ketamine and psilocybin, substances with radically different pharmacological mechanisms of action, can induce positive outcomes in a single disorder, like depression; or that a single substance like psilocybin can be used to treat different disorders, like depression or drug dependence, challenges nosologies which discriminate disorders in mutually-exclusive categories. Thus, PAP supports a multidimensional spectra. However, proposals such as the RDoC were criticized by its biomedical reductionism, while psychedelic research recognize the concept of set and setting as crucial for the results obtained with these treatments. Set includes circumstances and factors other than drug and pharmacological targets, including people's beliefs, attitudes, preferences, choices and motivations. Setting refers to environment, context, therapists, supporting team etc. Thus, PAP supports other conceptually richer diagnostic approaches considerate of biopsychosocial factors.

    This does not imply that neuroscience is not fundamental to understanding PAP and its consequences for psychiatric research and development. On the contrary. Current limitations of neuroimaging in psychiatry include long-term confounders like smoking, weight and metabolic variations, and low prognostic accuracy and predictive validity. By developing faster treatments and bridging the gap between research and clinical practice, PAP can allow the use of within-subject designs in shorter time spans, reducing the impact of confounders and improving reliability of neuroimaging data. Thus, confidence in translating results from acute psychedelic neuroimaging to clinical applications which will more closely resemble research designs is increased.

    Finally, detailed study of the subjective aspects of PAP has enormous consequences for the explanatory axis. Recent qualitative and phenomenological research shows that psychedelic experiences involve meaningful autobiographical and social psychological concerns. Therefore, PAP can deepen understanding of which psychological contents of the therapeutic experience are most relevant for treatment outcomes. This can not only foster improvements in PAP but corroborates the importance of biopsychosocial aspects in psychiatric explanations. A rich methodological integration can help develop theoretical constructs that are not excessively reductionistic. Thus, PAP can conceptually enrich psychiatric explanations for mental disorders and their treatment. If neglect, trauma, childhood adversities, poverty, abuse, and deprivation—i.e., mental injuries—can have lasting negative consequences for mental health, it is also logically plausible that positive, cathartic experiences, sometimes of the mystical type, reliably achieved in PAP, can induce long lasting positive mental health outcomes. Indeed, in the 1950's and 60's, before drug scheduling and cessation of clinical studies with psychedelics, and before neuroscience took central stage in psychiatric understanding of mental disorders, pioneer psychiatrists like Stanislav Grof and Sidney Cohen already questioned the fundamental theoretical grounds of mental disorders. Based on theirs' and others' experiences in non-ordinary states of consciousness with positive therapeutic outcomes (termed “holotropic” and “unsane,” respectively), they made radical theoretical proposals that can still be relevant to psychiatry, as it was for psychology. It is thus possible that instead of brain dysfunctions causing discrete disorders treated with specific drugs, psychiatry can conceptualize mental injuries causing suffering that can be optimally treated with holistic approaches, including those which modulate the state of consciousness. This can greatly contribute to the understanding of how social circumstances and adverse life experiences shape mental health and brain activity, and how meaningful treatment experiences foster resilience.
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    Exploring the Nonordinary Mind: An Interview with Stanislav Grof

    with David Brown

    I interviewed Stanislav Grof on March 23, 2007. I found Stan to be unusually elegant with words. We spoke about psychedelics and creativity, the reality of encounters with otherworldly beings, what happens to consciousness after death, and the difference between a spiritual emergency and a psychotic episode.

    David: What originally inspired your interest in psychiatric medicine?

    Grof: When I was eighteen years old, I was finishing what we call “gymnasium” in Europe — the equivalent of high school in America. I love to draw and paint and my original plan was to work in animated movies. I had already had an introductory interview with the brilliant Czech artist and film-producer JirĂ­ Trnka, and I was supposed to start working in the Barrandov film studios in Prague. But that situation change radically when a friend of mine lent me Freud’s introductory Lectures to Psychoanalysis. I started reading the book that very evening and I couldn’t put it down. I read through the night and into the next day. Then, within a few days, I decided that I wanted to be a psychoanalyst and I let the animated movies go. I enrolled in the medical school and got in touch with a small group of people in Prague interested in psychoanalysis; it was led by Dr. Theodor Dosukov, the only psychoanalyst who had survived the Second World War in Czechoslovakia. Most of the psychoanalysts were Jewish, and those who did not leave ended up in gas chambers.

    David: How did you become interested in psychedelics and non-ordinary states of consciousness?

    Grof: When I began my career as a psychiatrist, I was initially very excited about psychoanalysis, but then – when I tried to apply psychoanalysis in my clinical practice – I started seeing its great limitations. I was still very excited about the theory of psychoanalysis, but was increasingly disappointed with what you can do with it as a clinical tool. I was realizing that there was a very narrow indication range. You had to meet very special criteria to be considered a good candidate for psychoanalysis, and even if you met those criteria, you had to be prepared not for months, but for years. And I realized that, even after years, the results were not exactly breathtaking. I found it very difficult to understand why a system that seemed to explain everything would not offer some more effective solutions for emotional and psychosomatic disorders.

    In order to become a psychoanalyst one had to first study medicine. In medicine, if you really understand a problem, you are usually able to do something quite effective about it –
    or if you can not, then you can at least understand the reasons for your failure. We know exactly what would have to change in relation to cancer or AIDS for us to be able to more successful in the treatment of these diseases. But in psychoanalysis I was asked to believe that we have full understanding of what’s happening in the psyche, and yet we can do so little over such a long period of time. So I found myself in a crisis, where I started to regret that I had chosen psychiatry as my profession. I was thinking back nostalgically about the animated movies, wondering if that would have been a better career choice.

    At that time, I worked at the Psychiatric Department of the School of Medicine in Prague and we had just finished a large study of Mellaril, one of the early tranquilizers. This was the beginning of the “golden era of psychopharmacology.” The first tranquilizers and antidepressants were being developed and it was believed that most of the problems in psychiatry would be solved by chemistry. So we conducted a large study with Mellaril, which came from the pharmaceutical company in Switzerland called Sandoz. We had a very good working relationship with Sandoz, which meant the usual fringe benefits that psychiatrists get from pharmaceutical companies: compensation for the trips to conferences where one reports about their preparations, supply of relevant literature, and free samples of various new preparations that they produce.

    As part of this exchange, the psychiatric department where I worked received a large box full of ampoules of LSD. It came with a letter which said this was a new investigational substance that had been discovered in the laboratories of Sandoz by Dr. Albert Hofmann, who happened to intoxicate himself accidentally when he was synthesizing it. The letter described how the son of Albert Hofmann’s boss, Zurich psychiatrist Werner Stoll, conducted an early pilot study with a group of psychiatric patients and group of “normal” volunteers.
    He came to the conclusion that LSD could have some very interesting uses in psychiatry or psychology. So Sandoz was now sending samples of LSD to different universities, research institutes, and individual therapists asking for feedback if there was a legitimate use for these substance in these disciplines. In this letter they suggested two possible uses.

    One suggestion was that LSD might be used to induce an experimental psychosis. It could be administered to “normal” volunteers and conduct all kinds of tests — psychological, biochemical, physiological, electro-physiological — before, during, and after the session. This would provide insights as to what is happening, biologically and biochemically, in the organism at the time when the mental functioning is so profoundly influenced by the substance. This could be a way of discovering what is happening in naturally occurring psychoses. The basic idea behind it was that it is possible that – under certain circumstances – the human body could produce a substance like LSD and that psychoses, particularly schizophrenia, would actually be chemical aberrations, not mental diseases. And if we could identify the chemical culprit, then we could also find another substance which would neutralize it. Such a test-tube solution for schizophrenia would, of course, be the Holy Grail of psychiatry.

    So this was very exciting. The Sandoz letter also offered another little tip, which became my destiny. It suggested that this substance might also be used as a very unconventional training or educational tool for psychiatrists, psychologists, nurses, and students of psychology and psychiatry. The idea was that LSD would give these people a chance to spend a few hours in a world that would be very much like the world of their patients. As a result they would be able to understand them better, be able to communicate with them more effectively, and – hopefully – be more successful in treating them. So this was something that I wouldn’t have missed for anything in the world. I was in a deep professional crisis, feeling very disappointed with the therapeutic means we had at our disposal at the time. So I became one of the early Czech volunteers and had a profound experience that radically changed my life and sent me professionally and personally to a whole other direction.

    David: How can LSD psychotherapy be helpful in overcoming traumatic life experiences, alcoholism, or facing a terminal illness?

    Grof: We have done studies in all those areas. Psychedelic therapy revealed a wide array of previously unknown therapeutic mechanisms, but the most profound positive changes happened in connection with mystical experiences. We were very impressed with what you could do with very difficult conditions, like chronic alcoholism and narcotic drug abuse. But the most interesting and the most moving study that we did at the Maryland Psychiatric Research Center was the one that involved terminal cancer patients. We found out that if these patients had powerful experiences of psychospiritual death/rebirth and cosmic unity, it profoundly changed their emotional condition and it took away the fear of death. It made it possible for them to spend the rest of their lives living one day at a time. We also found out that in many patients LSD had very profound effect on pain, even pain that didn’t respond to narcotics.

    David: Why do you think that holotropic states of consciousness have so much healing potential and do you think that psychedelics can enhance the placebo effect?

    Grof: What do you mean by “the placebo effect” in connection with psychedelics?

    David: The placebo effect demonstrates the power of the mind over the body. We know that placebos–or biologically inactive substances–can have a measurable healing effect simply because people believe in their power. Do you think that part of the healing potential of psychedelics comes from enhancing what we call the placebo effect in medicine?

    Grof: Well, when you call something a placebo, you assume that there is no real biochemical effect.

    David: I don’t mean placebos, I mean what’s been called “the placebo effect,” which one can measure. The whole reason that we use placebos in medical studies, when we’re testing a new drug, is because of the “placebo effect”–because our beliefs have the power to influence our wellbeing in measurable ways. We know that just believing that something will have an effect can create a measurable effect and neuroscientist Candace Pert’s research showed that positive emotions can effect the immune system and neuropeptide levels. Do you think that what psychedelics are actually doing, when they assist with healing, is enhancing that power of the mind to effect the body’s own natural healing system?

    Grof: Well, I never thought about psychedelics as enhancing the placebo effect, because their psychological effects are so obvious and dramatic; one of the major problems we had in psychedelic research was actually to find a believable placebo for them. But I guess if you put it the way that you put it, you could see it as enhancing the placebo effect–because it certainly enhances the power of the mind over the emotional psychosomatic processes.

    David: Can you talk a little about the relationship between certain psychological conflicts and the development of certain cancers, which you witnessed as a result of some psychedelic sessions that you ran?

    Grof: We have never really systematically studied this. What I have written in the book The Ultimate Journey are mostly anecdotal reports of the insights that came from the patients themselves. For example, sometimes patients had the feeling that their cancer had something to do with their self-destructive tendencies, or that it had something to do with an energetic blockage that occurred in a certain part of their body as a result of traumatic experiences. Sometimes they actually made attempts during their sessions to find psychological ways to heal their cancer, but we never studied this systematically to the point that I could make any definitive statements about it.

    Carl Simonton made a large study where he tried to demonstrate participation of emotional factors in the etiology of cancer. One finding was particularly interesting and constant – a pattern of serious loss eighteen months prior to the diagnosis of cancer. But I think that those cases are all really anecdotal, and I don’t think anybody has really shown this beyond any reasonable doubt.

    One thing that I would like to add is that – because of my medical background – I used to doubt that cancer could have something to do with emotions. This was at a time when it seemed that the key problem in the genesis of cancer was what transforms a cell into a cancer cell. This changed radically when new research showed that the human body produces cancer cells all the time. So the problem is not what makes a cell a cancer cell, but what causes the immune system to fail destroying them. And it is certainly possible to imagine that psychological factors could cause a breakdown of the immune system, either generally or in certain specific parts of the body.

    David: What kind of an effect do you think that psychedelics have on creativity and problem-solving abilities?

    Grof: Oh, a tremendous effect. We have extensive evidence in that regard. In the 1960s, James Fadiman, Robert McKim, Willis Harman, Myron Stolaroff, and Robert Mogar conducted a pilot study of the effects of psychedelics on the creative process, using administration of mescaline to enhance inspiration and problem-solving in a group of highly talented individuals. In 1993, molecular biologist and DNA chemist Kary Mullis received a Nobel Prize for his development of the Polymerase Chain Reaction (PCR) that allows the amplification of specific DNA sequences; it is a central technique in biochemistry and molecular biology. During a symposium in Basel celebrating Albert Hofmann’s 100th anniversary, Albert revealed that he was told by Kary Mullis that LSD had helped him develop the Polymerase Chain Reaction. Francis Crick, the Nobel-Prize-winning father of modern genetics, was under the influence of LSD when he discovered the double-helix structure of DNA. He told a fellow scientist that he often used small doses of LSD to boost his power of thought. He said it was LSD that helped him to unravel the structure of DNA, the discovery that won him the Nobel Prize.

    In his book “What the Dormouse Said: How the Sixties Counterculture Shaped the Personal Computer Industry,” John Markoff described the history of the personal computer. He showed that there is a direct connection between the psychedelic use in the American counterculture of the 1950s and 1960s and the development of the computer industry. Steve Jobs said taking LSD was among the two or three most important things he had done in his life. He has stated that people around him, who did not share his countercultural roots, could not fully relate to his thinking.

    Willis Harman collected in his book Higher Creativity many examples of high-level problem-solving in non-ordinary states of consciousness. I think that studying the effect on creativity is by far the most interesting area where psychedelics could be used. Offer them to people who are experts in certain areas, such as cosmology, quantum-relativistic physics, biology, evolutionary theory, and so on – individuals who hold an enormous amount of information about a particular field and who are aware of the problems which need to be solved. Several of my friends from the Bay area who are physicists, such as Fred Alan Wolf, Jack Sarfatti, Nick Herbert, and Fritjof Capra, have had some really interesting insights into physics in non-ordinary states of consciousness. Some had spontaneous experiences of non-ordinary states of consciousness and others psychedelic sessions. For example, Fred Wolf spent some time in South America doing ayahuasca.

    David: Nick Herbert lives nearby and is a good friend. We’ve actually discussed the following question quite a bit. Many people report unexplained phenomena while under the influence of psychedelics, such as telepathic communication or uncanny synchronicities. What do you make of these types of experiences, which conventional science has great difficulty explaining, and seem to provide evidence for psychic phenomena?

    Grof: The number of these seemingly unexplainable phenomena is growing, and it’s occurring in all kinds of disciplines. In astrophysics, you have the anthropic principle. In quantum physics you have a vast array of problems that cannot be explained, such as the Bell’s Theorem, which points to nonlocality in the universe. We can add some of the dilemmas that Rupert Sheldrake points out in biology, when he talks about the need to think in terms of morphogenetic fields and so on. Ervin Laszlo, in his book The Connectivity Hypothesis, actually looked at all these different disciplines and showed all the so-called “anomalous phenomena” that these current theories cannot explain. He also specifically discusses transpersonal psychology and all the challenging observations that cannot be explained by current theories in psychology or psychiatry. I think Ervin’s concept of the psi- or Akashic field is the most promising approach to these paradigm-breaking phenomena.

    So I think that all this points to the fact that the current monistic/materialistic world view is seriously defective and that we need a completely different way of looking at reality. But there is tremendous resistance against the new observations in the academic world because the revision that is necessary is too radical, something that cannot be handled by a little patchwork, by little ad hoc hypotheses here and there. We would have to admit that the basic philosophy of the Western scientific worldview is seriously wrong and that in many ways shamans from illiterate cultures and ancient cultures have had a more adequate understanding of reality than we do. We have learned a lot about the world of matter, but in terms of basic metaphysical understanding of reality, Western science went astray.

    David: What sort of lessons do you think a conventional western physician could learn from an indigenous shaman?

    Grof: It would be above all the knowledge concerning the healing, transformative, and heuristic potential of non-ordinary states of consciousness. This would be especially true for shamans who are using in their practice psychedelic plants. They use these extraordinary tools that provide insights into the psyche and therapeutic possibilities that by far surpass anything available in Western psychiatry and psychotherapy. When I had my first psychedelic sessions and started working with psychedelics, I felt very apologetic toward shamans. The image of shamans that I inherited from my teachers at the university was very conceited and dismissive; it described them as primitives, riddled with superstitions and engaged in magical thinking. Our own rational approaches to the study of the human psyche, such as behaviorism or psychoanalysis, were seen as superior to anything the shamans were doing.

    So, when I discovered the power of psychedelics, I saw the arrogance of this kind of attitude. The potential of the methods used by modern psychiatry did not even come close to that inherent in psychedelics or in various native “technologies of the sacred,” which induce non-ordinary states by non-pharmacological means. Then I began understanding what had happened historically. Three hundred years ago, the Industrial and Scientific Revolution brought some important scientific discoveries, which spawned technological inventions that started radically changing our world. This led to glorification of rationality and intoxication with the power of reason. For example, during the French Revolution the Notre Dame Cathedral in Paris was declared the Temple of Reason. In its juvenile hubris, the Cult of Reason rejected without discrimination everything that was not rational as embarrassing leftovers from the infancy of humanity and from the Dark Ages. The overzealous reformers did not realize that not everything that is not rational is irrational; there exist phenomena which are transrational. The mystics are not irrational; they can be perfectly rational in everyday situations, but as a result of their experiences they also transcend the realm of the rational. We are now slowly realizing that in this historical process, the baby was thrown out with the bath water and are learning to make the distinction between the irrational and transrational.

    David: What are your thoughts on the extraterrestrial encounters that many people report on high-dose psychedelics and do you think that the beings encountered on high-dose psychedelic experiences – such as DMT or ayahuasca – actually have an independent existence?

    Grof: I have seen those experiences frequently. We have seen them in psychedelic sessions, in holotropic breathwork, and in some spiritual emergencies. I have spent a lot of time with my close friend John Mack, who conducted at Harvard extensive research of the alien abduction phenomena. Did you know John?

    David: I interviewed John for my book Conversations on the Edge of the Apocalypse.

    Grof: Unfortunately he was killed by a drunken driver in London and is not with us any more. Like John, I believe that these experiences belong to the category of “anomalous phenomena,” paradigm-breaking observations for which we do not have explanations within the current conceptual frameworks. The kind of explanations that have been given by traditional researchers just are not satisfactory–that these phenomena are hallucinations, various meteorological events, new secret US spacecrafts, balloons, birds, satellites, planets and stars, or optical effects such as reflections, mirages, “sprites,” “sundogs,” and refractions caused by inversion layers in the atmosphere.

    I think that these are painfully inadequate, and that there are significant aspects of the UFO abduction phenomena or even UFO sightings that simply cannot be explained within the current scientific world view. One possible explanation is that the source of these phenomena is the collective unconscious, as C. G. Jung suggested in his book Flying Saucers: A Modern Myth of Things Seen in the Skies. As Bud Hopkins and others have shown, people who have the UFO experiences often report very similar things, often with great detail, even if these observations occur completely independently and there is no connection between these people. One of the most astonishing examples was a sighting in Africa, which involved a group of school children and a teacher. The interviews with these witnesses were done by John Mack and resulted in a remarkable video.

    In the past, similar things were described in The Bible, in the Book of Ezekiel, and other places. Jung has shown that these sightings have been described repeatedly n certain periods of human history. The collective unconscious certainly is a reasonable source of these phenomena. If something comes from the collective unconscious then individual people can have intrapsychic access to it but, at the same time, they can receive consensual validation from other witnesses in the same way in which consensus can be reached on visions of archetypal figures or realms from different mythologies. The distinction between the subjective and objective is transcended. Jungians refer to this realm as “imaginal” to distinguish it from the “imaginary.”

    When I think about the collective unconscious, I see the parallels with the world that we have created with modern electronics. As we are sitting here right now, we are immersed in an ocean of information. It’s coming from the different short wave radio stations around the world, from the television satellites, from the Internet, the i-phones, and so on on. So, if we had what it takes to access this information, we could have a vast array of experiences right here, where we are sitting, and it would not be your experiences or my experiences. We would be tapping into something that is objectively real, although under normal circumstances it is invisible. When different people tune into these programs, they can reach a consensus that they have experienced the same kind of thing. So, from this perspective, the UFOs would be phenomena that are not just intrapsychic or just objective in the usual sense, but would lie in the twilight zone in between the two.

    David: Do you think that the archetypes and information that is stored in the human collective unconscious is of a genetic origin–that is, stored in our DNA–or do you see them as being more like a morphic field that permeates the biosphere and incorporates cultural as well as genetic information?

    Grof: I don’t think it’s in the DNA or in the brain. I don’t think it’s in anything that we can consider to be material substrate, at least not in the ordinary sense.

    David: So do you see it more like a morphic field?

    Grof: Yes. The best model that we currently have is Ervin Laszlo’s concept of what he used to call a “psi field;” now he calls it the “Akashic field,” In his last two books, The Connectivity Hypothesis and Science and the Akashic Field, he describes it as a subquantum field, where everything that has ever happened in the universe remains holographically recorded, so that under certain circumstances we can tune into it, and have the corresponding experiences. For example, in non-ordinary states of consciousness, we can have experiences of scenes from ancient Egypt or the French Revolution, because there’s an objectively existing record of these events in that field, and people who tap that information can reach consensus that they experienced the same kind of things.

    David: How does transpersonal psychology differ from conventional psychology, and could you talk a little about your involvement with it?

    Grof: I was part of the small group that formulated the basic principles of transpersonal psychology, together with Abe Maslow, Tony Sutich, Jim Fadiman, Miles Vich, and Sonya Margulies. Transpersonal psychology was a reaction to a number of “anomalous phenomena” described by mystics of all ages, scholars of the great Eastern religions, anthropologists who had done field research with shamans and native cultures, and psychedelic researchers.

    In the first half of the 20th century, psychology was dominated by two schools of thought — Freudian psychoanalysis and behaviorism. In the 1950s, there was increasing dissatisfaction with the limitations of these two systems and Abe Maslow became the main spokesman for this increasing dissent. He and Tony Sutich launched humanistic psychology, which in a very short time became very popular in professional as well as lay circles. However, within the first ten years of the existence of humanistic psychology, Abe and Tony became dissatisfied with the field they had created, because it did not include important aspects of human nature, particularly the spiritual and mystical dimensions, creativity, meditation states, ecstatic experiences, and so on. When I met them, they were working on yet another new branch of psychology, which would incorporate the elements that humanistic psychology was lacking.

    They originally wanted to call this new psychology “transhumanistic,” going beyond humanistic psychology. I brought into this group the data from ten years of my psychedelic research in Prague and a vastly extended cartography of the psyche that had emerged from this work. Part of this cartography was a category of experiences that I called “transpersonal,” meaning transcending the limits of our personal identity, of the body-ego. Abe and Tony liked this term very much and they decided to change their original term “transhumanistic psychology” to “transpersonal psychology.”

    The best way of describing transpersonal psychology would be to say that it studies the entire spectrum of human experience, including what I call “holotropic” experiences. This includes the experiences of shamans and their clients, of initiates in the rites of passage, in healing ceremonies, and other native rituals, of the initiates in the ancient mysteries of death and rebirth, of the yogis, Buddhists, Taoists, Christian mystics, Kabbalists, and so on. Transpersonal psychology includes all of these experiences.

    David: What’s the difference between a spiritual emergency and a psychotic episode?

    Grof: After we had had extensive experience working with psychedelic therapy and with the Holotropic Breathwork, it became increasingly difficult to see many of the spontaneously occurring episodes of non-ordinary (holotropic) states as being pathological. They included the same elements as the psychedelic sessions and the sessions of Holotropic Breathwork – experiences of psychospiritual death and rebirth, past life experiences, archetypal experiences, and so on. And if they were properly understood and supported, they were actually healing and often led to a positive personality transformation.

    So it became increasingly difficult to see as pathological experiences, which a sample of “normal” people in our workshops and training would have after forty-five minutes of faster breathing. Moreover, if these experiences could be healing and transformative when they are induced by faster breathing and music, or by miniscule dosages of LSD, why should they be considered pathological when they occur without any known causes? So we coined for these spontaneously occurring episodes the term “spiritual emergencies.” It is actually a play on words, because it shows the potential positive value of these experiences. They certainly are a nuisance in people’s lives and can produce a crisis, an “emergency,” but – if correctly understood and properly supported – they can also help these individuals to “emerge” to a whole other level of consciousness and of functioning.

    Now, the question that you ask — the question concerning “differential diagnosis” — is difficult to answer for the following reasons: The concept of differential diagnosis comes from medicine, where it is possible to accurately diagnose diseases on the basis of what you find in the blood, in the urine, in the cerebral spinal fluid, on the X-rays, an so on. You can accurately establish the diagnosis, and if you make a mistake, another doctor can show you that you made a wrong diagnosis and – as a result – prescribed the wrong treatment. In psychiatry, this is possible only for those conditions that have an organic cause. There is a group of psychotic states, where this is the case – the so called “organic psychoses.” However, there exists a large group of conditions diagnosed as psychoses for which no biological causes have been found. These are called “functional” or “endogenous psychoses.”

    Anybody familiar with medicine knows that this essentially means admission of ignorance wrapped in a fancy title (endogenous means “generated from within”). This is not a medical diagnosis backed by laboratory data. It is a situation characterized by unusual experiences and behaviors for which the current conceptual framework of psychiatry has no explanation. To make a differential diagnosis, we would first have to have a diagnosis established as rigorously as it is done in somatic medicine. Because that is not the case, we have to use a different approach. We can try to identify the criteria that would make the person experiencing a non-ordinary state of consciousness a good candidate for deep inner work. If they meet these criteria, we try to work with them psychologically to help them get through this experience, rather than indiscriminately suppressing their symptoms with psychopharmacological agents.

    The first criterion there is the phenomenology of the individual’s condition. A positive indication is presence of elements that we see daily in participants in Holotropic Breathwork sessions or psychedelic sessions – reliving of traumatic memories from infancy or childhood, reliving of biological birth or episodes of prenatal existence, the experience of psychospiritual death and rebirth, past life experiences, visions of archetypal beings or visits to archetypal realms. Additional positive indications are experiences of oneness with other people, with nature, with the universe, with God.

    The second important criterion is the person’s attitude. The individual in spiritual crisis has to have some sense of understanding that this is a process with which is happening internally. Very bad candidates for alternative psychological work are people who use a lot of projections, who deny that they have a problem and that they are dealing with an internal process. They are convinced that all their problems are caused by outside forces: it is the neighbor who is poisoning their soup and placing bugging devices in their house; it is the Ku Klux Klan trying to destroy them; it is a mad scientist attacking them by a diabolic machine, or the invading Martians. So there is a tendency to blame that condition on somebody or something outside of them and being unwilling to accept the possibility that there is something within their own psyche that they can work on. So, unless that attitude changes, it is very difficult to do this type of work.

    David: Why do you think that the conditions surrounding one’s birth have such a lasting effect on one’s outlook toward life?

    Grof: Birth is an extremely powerful, elemental event that for many children is a matter of life and death. This is especially true for those who were born severely asphyxiated – dead or half-dead – and had to be resuscitated. In any case, it is a major trauma that has a physical as well as an emotional dimension. The position of current psychiatry and psychology toward birth is unbelievable – contrary to elementary logic, we see a massive denial of the fact that birth is a major psychotrauma. The usual reason given for the fact that birth is psychologically irrelevant – inadequate myelinization of the newborn’s cortex – is hard to take seriously. It is in sharp contrast with data from both postnatal and prenatal life.

    There exists general agreement among child psychiatrists that the experience of nursing is of paramount importance for the rest of the individual’s emotional life. Obstetricians and pediatricians even talk about the importance of “bonding” – the exchange of looks between the mother and the child immediately after the child is born – as the foundation of the future mother-child relationship. And extensive prenatal research of people like Alfred Tomatis has shown extreme sensitivity of the fetus already in the prenatal period. How should we reconcile this with the belief that the hours of life and death struggle in the birth canal are psychologically irrelevant?

    It seems really bizarre that psychiatrists and psychologists believe that there is no consciousness in the child during the passage through the birth canal, but then suddenly appears as soon as the newborn emerges into the world. And the argument about the lack of myelinization of the newborn’s cortex violates elementary logic and doesn’t make any sense either. We know from biology that memory does not require a cerebral cortex, let alone a myelinized one. There are organisms that don’t have any cortex at all and they certainly can form memories. Several years ago, the Nobel Prize was given to Austrian-American researcher Eric Kandel for studying memory mechanisms in a sea slug called Aplysia. So it’s very difficult to imagine how people in the academic circle think, if they can accept that the sea slug can form memories but a newborn child, with an extremely highly developed nervous system and brain, would not be able to create a memory record of the hours spent in the birth canal.

    David: What do you think of applying Konrad Lorenz’s notion of biological imprinting–as opposed to conditioning or learning–to the lasting psychological effect that psychedelic experiences often produce?

    Grof: The term “imprinting” is most relevant here in relation to the very early situations in an organism’s development. As you know, ethologists have shown that the early experiences of life are extremely influential. For example, there is a period of about sixteen hours in the early life of ducklings when whatever moves around becomes for them the mother. So if you walk around in red rubber shoes, they ignore their mother and follow the shoes. Psychedelics can induce deep age regression to the early periods in one’s life and offer the opportunity for a corrective psychobiological experience. This new experience then seems to have the same powerful influence on the individual’s life as the natural imprinting.

    I ultimately don’t believe that the memories we experience in psychedelic sessions are stored in the brain, certainly not all of them. I think that many of them obviously don’t have any material substrate in the conventional sense – ancestral, collective, phylogenetic, and karmic memories, archetypal matrices, etc. Recently, there has been much discussion about “memory without a material substrate” – for example, Rupert Sheldrake’s Morphogenetic Fields or Ervin Laszlo’s Akashic field. So I don’t believe that what we experience is stored the brain. I believe that the brain is mediating consciousness, but does not generate it, and that it mediates memories, but does not store them.

    David: Why do you think it is that the LSD experiences have such a lasting effect on people?

    Grof: Isn’t that true about every powerful experience? The more powerful the experience is, the more of an effect it has. It is true even for experiences that we have forgotten, repressed, dissociated from consciousness. Everything that we experience in life is shaping us with a lasting effect. Some of these influences are more subtle, and some of them more dramatic, but certainly traumas that people experience in childhood can have tremendous impact. Events in human life can have everlasting impact of people.

    David: What do you personally think happens to consciousness after death?

    Grof: I have had experiences in my psychedelic sessions — quite a few of them – when I was sure I was in the same territory that we enter after death. In several of my sessions, I was absolutely certain that it had already happened and I was surprised when I came back, when I ended up in the situation where I took the substance. So the experience of being in a bardo in these experiences is extremely convincing. We now also have many clinical observations suggesting that consciousness can operate independently of the brain, the prime example being out-of-body experiences in near-death situations (NDEs).

    Some out-of-body experiences can happen to people not only when they are in a state of cardiac death, but also when they are brain dead. Cardiologist Michael Sabom, described a patient he calls Pam, who had a major aneurysm on the basilar artery and had to undergo a risky operation. In order to operate on her, they had to basically freeze her brain to the point that she stopped producing brain waves. And, at the same time, she had one of the most powerful out-of-body experiences ever observed, with accurate perception of the environment; following her operation, she was able to give an accurate description of the operation and to draw the instruments they were using.

    So what these observations suggest is that consciousness can operate independently of our body when we are alive, which makes it fairly plausible that something like that is possible after our body is dead. So both the experiential evidence from my own sessions and what you find in the thanatological literature, certainly suggest that survival of consciousness after death is a very real possibility.

    David: What is your perspective on the concept of God?

    Grof: When Jung was over eighty years old he had an interview with a BBC reporter. At one point this BBC reporter asked him “Dr. Jung, do you believe in God?” A smile appeared on Jung’s face and he said, “No, I don’t.” Any Jungians who are watching this tape cannot believe it: “What? Dr. Jung doesn’t believe in God?” Then, after a dramatic pause, Jung says: “I know. I had the experience of being grabbed by something that was by far more powerful than I could even imagine.” Like Jung, I had experiences – actually quite a few of them over the years – of what I would refer to as God.

    I have experienced in my sessions many gods – archetypal figures of many forms from different cultures of the world. But when I refer to God, I am talking about an experience, which is beyond any forms. What I experienced as God is difficult to describe; as you know, the mystics often refer to their experiences as ineffable. It could be best described as an incredibly powerful source of light, with an intensity that I earlier couldn’t even have imagined. But, it doesn’t really do it justice to refer to it as light because it was much more than that. It seemed to contain all of existence in a completely abstract form and it transcended all imaginable polarities. There was a sense of infinite boundless creativity. There was a sense of personality and even a sense of humor (of a cosmic variety).

    The experience of God seems to be under certain circumstance available to all human beings. If you haven’t had the experience, then there’s no point in talking about it. As long as people have to talk about believing in God or not believing in God or, for that matter, believing in past lives or not believing in past lives, it is irrelevant because they do not have anything to go by. Their opinion doesn’t have any real basis; it reflects the influences of their parents, their preacher, or something they have read. Once you had the experiences, you know that the experiences were real and very convincing.

    David: What types of research and therapies do you foresee for psychedelics in the future?

    Grof: I think that the most interesting area waiting to be explored is to use psychedelics for enhancing creativity, as we talked about it earlier. It is something that would facilitate completely new ways of looking at various areas and generate extraordinary new insights into the nature of reality. But I am afraid it will take some time before we see research of this kind. The most difficult challenge has always been to get permission to use psychedelics in populations where there is no serious clinical reason (e.g. terminal cancer, chronic alcoholism, etc.).

    David: What are you currently working on?

    Grof: Christina and I are writing a long overdue book on the theory and practice of Holotropic Breathwork. It will be a very comprehensive book, covering a wide range of topics from the history of the breathwork to the therapeutic use of breathwork sessions andits social implications. It will include the description how to prepare a session and how to run a session, as well as the complementary methods that you can use following the session. It discusses the therapeutic effects, the possibilities of developing a new worldview and new life strategies, as well as the possible importance of working with holotropic states as a means of alleviating the current global crisis.

    David: Is there anything that we didn’t speak about that you would like to add?

    Grof: One of the areas I am particularly interested in is the revolutionary development on various scientific disciplines and the emergence of the new paradigm. I firmly believe that we are rapidly moving toward a radically new world view and that transpersonal psychology and spirituality will be integral parts of it. A worldview that will synthesize the best of science and the best of spirituality and would demonstrate that there is really no incompatibility between science and spirituality, if both of them are properly understood.
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    Stanislav Grof

    Observations from 4000 LSD sessions: A dialog with Stanislav Grof

    Dr. Richard Louis Miller, MA, PhD: You started out as a psychiatrist doing Freudian work. You were initially deeply interested in psychoanalysis, but then something happened that brought you into the field of research with LSD.

    Stanislav Grof, MD, PhD (SG): I was born in Prague, Czechoslovakia, and originally wanted to go into animated movies. Just before I made the final commitment, I read Freud's Introductory Lectures on Psychoanalysis and I got very excited. That week I decided not to work in animated movies but to study medicine and to become a psychiatrist. As I was getting deeper into psychoanalysis I became disappointed, not with the theory but with the practice of psychoanalysis: how long it takes, how much money it costs, and how much energy it consumes. And the results were not exactly breathtaking. I started nostalgically returning in my mind to animated movies, feeling that it would have been a better career.

    Then the psychiatric department I was working in received a large supply of LSD-25 from the pharmaceutical company Sandoz in Basel, Switzerland. It came with a letter describing the serendipitous discovery of its psychedelic effect by Albert Hofmann, a chemist who intoxicated himself accidentally when he was synthesizing it. It was supposed to be one of the substances used in gynecology and for relief of migraine headaches, which were the main indications of the ergot alkaloids, though Hofmann's discovery was a very unexpected fringe benefit from this research. It was not considered a particularly interesting substance, so the research was discontinued. Those of us who knew Albert Hofmann frequently heard the story that he somehow could not get this substance off his mind for irrational reasons. He felt the pharmacologists must have overlooked something. So in 1943 he decided to synthesize another sample and this is when the intoxication occasion happened.

    An unconventional experimental tool

    RLM: So Sandoz sent LSD around the world, and you were one of the people to whom it was sent. You received the package, and what happened?

    SG: The letter accompanying the package suggested on the basis of the pilot studies conducted in Zurich that LSD could be used for inducing experimental psychosis. We would have a model that we could study. There was another suggestion that this could be a kind of unconventional educational tool that psychiatrists, psychologists, nurses, and students would have the chance to spend a few hours in a world that seemed to be like the world of some of their patients. This would help them to understand their patients better, to be able to communicate with them more effectively and hopefully be more successful in treating them. That was something that was sorely needed at the time; psychiatric therapy was truly medieval; electroshock, insulin comas, cardiazol shocks, dunking in cold water, straitjackets, and so forth.

    RLM: So the therapists would have an experiential understanding of the psychoses of their patients by going into that realm for a limited number of hours?

    SG: Yes, that was the idea. At that point I was quite disappointed with psychoanalysis, and this seemed like a new possibility. I became an early volunteer in Prague, and I had an experience that within a day transformed me professionally and personally.

    Transformation: From Materialist to Mystic

    RLM: I heard you talk about that transformation at the Bently Reserve presentation. How can you start out as Stan Grof, take a substance, and at the end of the experience be a different Stan Grof?

    SG: I was brought up in a family where there was no religious affiliation. My parents did not commit me or my brother to any religion. I had a very materialistic worldview and went from this family upbringing straight to medical school, which certainly does not cultivate mystical awareness. Czechoslovakia was at that time controlled by the Soviet Union, and we had a very strong materialistic education. Yet within those few hours in this experience I basically became somebody with a spiritual, mystical worldview and a completely transformed perspective on life. Also, my interest shifted from psychoanalysis to non-ordinary states of consciousness. Research into these states has now been for over half a century my profession, my vocation, and I would say passion. I have done very little in this half century that has not been related to these special states of consciousness.

    RLM: Talk to us more about this transition. What does it mean to be a materialist, and what does it mean to you to be more spiritual or mystical?

    SG: I was trained to believe that this was a material universe, which in a sense created itself without any guiding intelligence. There was no place for spirituality. If we believe that this is a universe of matter and that life, intelligence, and consciousness are latecomers after billions of years of the development of matter, then they are just side products or epiphenomena of material processes. This worldview rejected spirit; to be spiritual meant to be ignorant and superstitious, not having studied what material science discovered and says about the universe.

    This was a completely different perspective than one saying the universe is permeated by superior intelligence and that consciousness is a fundamental aspect of the universe, not the side product of the human brain. It was a very radical transformation.

    RLM: Are you putting forth that there is a consciousness floating through the universe? Perhaps some strip of consciousness that is always around us? How do you conceptualize this spiritual consciousness?

    SG: Consciousness for us is like water for fish. It is a fundamental aspect of our existence. If I had to name an existing conceptual framework for what I have experienced, I would go to the great spiritual philosophies of the East: Hinduism, Buddhism, and Taoism. These cultures were involved in systematic exploration of consciousness, with the same kind of focus and enthusiasm that we have for the material world. They were not particularly interested in developing technologies and industry. Their focus was on exploration of consciousness. Their understanding of the human psyche and consciousness was way beyond what we have now in the materialistic science in the West.

    A new worldview

    RLM: I'm beginning to understand what you mean by being transformed in a day. Starting out with a materialistic framework has political implications for how we live our lives in terms of the importance of acquiring material things and living in a culture that values material things as the goal. It is light years away from a conceptual framework in which spirituality and consciousness are paramount. Therefore, the value system that would come out of a spiritual worldview would be much more aligned with feelings and people in terms of their nature and in terms of connecting with nature rather than connecting with things. Is that correct?

    SG: Yes. We have now the most advanced worldview in Western science, the new or emerging paradigm, and we see that it is rapidly converging with this spiritual worldview of ancient systems, particularly the great spiritual philosophies and religions of the Far East. There are repeated reports now from quantum relativistic physics that come to the same conclusion, that consciousness is somehow fundamentally involved in the creation of the experience of the material world itself.

    RLM: Yes.

    SG: The new science is converging with mysticism. What we were experiencing and finding in our psychedelic research was fundamentally incompatible with the Cartesian-Newtonian worldview, basically the seventeenth-century philosophy, but perfectly reconcilable with the emerging paradigm.

    Observations from 4,000 LSD sessions

    RLM: Some time after you had this transformation, you moved to the United States.

    SG: Yes. I had my first psychedelic session in 1956, and I moved to the United States in 1967. I had worked in psychedelic research in Prague for eleven years before leaving the country.

    RLM: Were you able to do LSD research during those eleven years?

    SG: Yes. We were doing something that we called psycholytic therapy, a large number of medium dosages of LSD, something that one of my patients called onion peeling of the unconscious. We were able to remove layer after layer and map the unconscious, moving from the Freudian individual, or personal unconscious, through what I call the perinatal unconscious, related to the memory of birth, to what Jung called the collective unconscious, both its historical and mythological, or archetypal, aspects.

    RLM: During that period, Stan, from 1956 to 1967, eleven years, approximately how many people were treated with this dosage of LSD?

    SG: If I add up the sessions in Prague and later in the United States, I have been personally involved in about four thousand psychedelic sessions.

    RLM: What is a medium dose?

    SG: Maybe about 150 to 200 micrograms. Once we go to 250 and up to 500 micrograms, we would call them high-dose sessions.

    Neither Panacea nor Devil's Drug

    RLM: The American public is traumatized by the very mention of LSD as a result of the terrible publicity that came out of the 1960s. But here we have someone who has done actual scientific research, 4000 cases, to tell us whether this is a dangerous medicine. Are the side effects such that your patients were jumping out of windows? Did they have to be institutionalized?

    Humphry Osmond

    SG: Well, it is a very powerful tool. The perspectives ranged from calling it a panacea to the devils drug. What is overlooked is that this is a tool. Humphry Osmond [the English psychiatrist and researcher who coined the term psychedelic] compared it to a knife. Is a knife a terribly dangerous tool or is it a useful instrument? Imagine a discussion where the chief of the New York Police Department would describe the murders committed in the back streets of New York City, and the Surgeon General would say, Well, if you have the right kind of education you can do amazing medical interventions with the knife. And we would have in the same discussion a housewife talk, who would think about a knife primarily as a tool to cut salami and vegetables, and an artist whose emphasis would be using it for carving wood. It would be absolutely clear that we are not talking about the knife, we are talking about the various human uses of the knife for different purposes and different intentions.

    Psychedelics were used for many different reasons, from therapy of difficult psychiatric patients and alleviation of fear of death and physical pain in terminal cancer patients, through facilitation of mystical experiences or artistic inspiration, to means of compromising of foreign diplomats and chemical warfare. What would happen if you put it into peoples water supply? If you would use it in aerosols in the field? If you would smuggle it somehow into the drinks of diplomats and politicians and military leaders and so on? Those are all human uses with very different motivations. Psychedelics are powerful openers of the mind, so they can be used for all those different purposes. So it is a question of set and setting, who is giving psychedelics to whom, in what physical environment, with what kind of intention, and for what kind of purpose.

    In industrial civilization we have so far abused everything. We have abused biology for biological warfare, chemistry for chemical warfare, atomic energy for nuclear warfare, laser and rockets for destructive purposes, and so on. Why would psychedelics be different? We are incredibly developed in terms of the neocortex and intellectual capacity, but we stayed stuck in the Stone Age with our emotion. As a result, we are using nuclear weapons and other means of mass destruction with the same kind of mentality with which the Neanderthals were using stones and sticks.

    Understanding our ecological interconnectedness

    RLM: Well, there is a reason that LSD has such a psychological effect on the public: the fact that the medicine itself can change consciousness; for example, your experience of starting out as one Stan Grof, with a materialistic framework for how the world works, and then achieving a new Stan Grof, with a different worldview: expanded from materialism to spiritualism plus mysticism. That is a radical transformation. This medicine could be seen, and I think it is seen by many, as revolutionary, because it has the potential to change consciousness on a grand scale; is that not accurate?

    SG: It has tremendous potential for individual therapy, but it is also associated with a radical transformation of worldview and bringing in the spiritual perspective. If it could be applied on a large enough scale, it could significantly increase our chances for survival on the planet. If we continue our ignorant strategy, bringing a linear focus into a biological system that is basically circular, we do not have great chances for survival. Plundering of nonrenewable resources and turning them into pollution is the last thing we need as biological entities. We need clean water, clean air, and clean soil in which we grow our food. Nothing is more important, no economic, political, ideological, military, or religious concerns. Nothing should be more important than protecting life and creating optimal conditions for survival on the planet. We are violating this and are polluting the very environment that we depend on.

    This can change through these transformative experiences, where people can work through the traumas that they experienced in childhood, in infancy, during birth and prenatal existence. We need to be open to the mystical, spiritual perspective, recognizing our fundamental connection with other people and the way we are embedded in nature. We cannot do anything to harm nature that will not ricochet and hurt us.

    Caution required

    RLM: We have millions of people in the United States, and I do not know how many around the world, who are experimenting on their own with LSD. We do not have alarming reports from emergency rooms around the United States about mass occurrences of psychotic breakdowns. We do not have reports from police departments around the United States of incidents being created by LSD. These people are taking it on their own as you well know, as we all well know. Some of them have guides, some of them do not have guides. They are taking this substance that has huge potential for transformation. Why are we not hearing more, over these decades, about emergency room incidents, and police, and people killing people?

    Sidney Cohen

    SG: There was a big study conducted by Sidney Cohen, one of the early pioneers.

    RLM: I remember him, yes.

    SG: A psychoanalyst in Los Angeles. He wrote a review of the side effects and complications of LSD and mescaline sessions, drawn from twenty-five thousand administrations. The side effects and negative aftereffects were minimal as long as it was done responsibly. In the early years, we did not know very much about the effects of these psychedelics, but it was understood that if somebody had this powerful experience, there had to be somebody around in the usual state of consciousness to hold the kite string. You had to keep people overnight and talk with them in the morning before you sent them home. Under those circumstances the incidence of complications was minimal. It was ridiculous compared with what we had with electroshocks or insulin comas, where 1 percent mortality was considered an acceptable therapeutic risk.

    All these were procedures with incredible risk compared to the responsible use of psychedelics. People were using psychedelics in places like Woodstock, where they were handing out all kinds of substances of unknown origin, quality, and dosages, handing it out with both hands. It's a miracle that there were not more complications under such circumstances, if we compare it with what can happen with alcohol.

    Psychedelics are certainly powerful tools. It makes me very uncomfortable when I see that young people play with them in open public places where nobody is holding the space, knowing that they are doing something illegal and that police might show up any minute. This kind of use significantly increases the risks and diminishes the potential benefits and gains. I hope that the recent renaissance of interest in psychedelic research will generate new unbiased information and eventually lead not only to mainstream therapeutic use but also eventually to the creation of a network of facilities where people who want to experiment with psychedelics will have the chance to do it with known doses of pharmaceutically pure substances and under expert guidance. This will take us far in the direction that Albert Hofmann wanted to see for LSD, a New Atlantis in which psychedelics potential for healing, enhancement of creativity, and spiritual opening will be integrated into future society and contribute to international peaceful coexistence.
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    Dr. Attila Szabo

    LSD as an immunotherapy and treatment for mental illnesses*

    Research is being done into the use of LSD as an immunotherapy and to treat mental illnesses.

    The recent association established between the 5-HT receptors and psychedelics have sparked renewed interest in the use of LSD and other psychedelics as immunotherapies. Szabo calls this the “Biomedical Renaissance of Psychedelic Research,” which they date to have started in the early 2000s. It is understood by the vast amount of research that the mechanism of action of LSD and other psychedelics begin by triggering neurotransmitter receptors in the brain, which creates altered cognition and perception in the user. The immune and nervous systems had not been vastly studied in relation to each other until recently, but it is now understood that immune cells have neuroreceptors associated with them (Beck, 2013).

    The 5-HT1 and 5-HT2 receptors have a high expression profile in the lymphoid tissues of mammals and a re associated with different immunological processes, including anti-tumor and anti-viral immune responses. Immune homeostasis is also regulated by neuroendocrine regulation of inflammation that happens through serotonin. The ability of psychedelics to enhance immune response or inhibit functions related to inflammation pose psychedelics as possible remedies to treat diseases with chronic inflammatory etiology and pathology, including atherosclerosis, rheumatoid arthritis, type I diabetes, multiple sclerosis, schizophrenia, Alzheimer’s disease and depression (Szabo, 2015).

    *From the article here:
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    A Conversation with Albert Hofman

    On November 26, 1996, Charles Grob, M.D. visited with Albert Hofmann in Rheinfelden, outside of Basel, Switzerland.

    CG: I would like to speak with you about your views on psychedelic drugs. To start with, do you believe it is possible to re-establish psychedelic research as a respectable scientific field?

    AH: I think there are many good signs. After years of silence, there have recently been some investigations in Switzerland and Germany, and also in the United States. We had a meeting in Heidelberg last year (European College for the Study of Consciousness), and there were many good presentations. In Heidelberg I enjoyed meeting with Rick Doblin (of MAPS) and Professor Nichols (of the Heffter Research Institute), and I think both of their organizations are doing fine work. Their approach appears to be quite different than that of some of their predecessors from several decades ago.

    CG: Are you referring to Dr. Leary?

    AH: Yes. I was visited by Timothy Leary when he was living in Switzerland many years ago. He was a very intelligent man, and quite charming. I enjoyed our conversations very much. However, he also had a need for too much attention. He enjoyed being provocative, and that shifted the focus from what should have been the essential issue. It is unfortunate, but for many years these drugs became taboo. Hopefully, these same problems from the Sixties will not be repeated.

    CG: From the vantage point of where we are now, in the late 1990s, what implications do psychedelic drugs have to the field of psychiatry?

    AH: I believe that shortly after LSD was discovered, it was recognized as being of great value to psychoanalysis and psychiatry. It was not considered to be an escape. It was a very important discovery at that time, and for fifteen years it could be used legally in psychiatric treatment and for scientific study in humans. During this time, Delysid, the name I gave to LSD, was used safely, and was the subject of thousands of publications in the professional literature. Actually, just last week, I had visitors from the Albert Hofmann Foundation, to whom I gave all of the original documentation, which had been stored at the Sandoz Laboratories. This early work was very well documented, and shows how well research with LSD went until it became part of the drug scene in the 1960s. So, from originally being part of the therapeutic pharmacopeia, LSD became a drug of the street and inevitably it was made illegal. Because of this reputation, it became unavailable to the medical field, and so the research, which had been very open, was stopped. Now it appears that this research may start again. The importance of such investigations appears to be recognized by the health authorities, and so it is my hope that finally the prohibition is coming to an end, and the medical field can return to the explorations which were forced to stop thirty years ago.

    CG: What recommendations would you give to researchers now who want to work with these substances?

    AH: When LSD was distributed legally by Sandoz, there was a little brochure which was given together with the Delysid, which explained how LSD could be used. As an aid to psychoanalysis and psychotherapy, and also as a means for psychiatrists themselves to experience these extraordinary states of mind. It was specifically stated on the package insert that the psychiatrist who was interested in using Delysid should first test it on himself.

    CG: So, you would say that it is very important that the researcher, the psychiatrist, know first hand the psychedelic experience?

    AH: Absolutely, absolutely. Before it can be used in clinical work, it must most definitely be taken by the psychiatrist. From the very first reports and guidelines written for LSD, this was clearly stated. And this remains of utmost importance today.

    CG: Are there lessons we can learn from the past insofar as what went wrong with the research, why it was stopped, that we should be attentive to, so mistakes are not repeated?

    AH: Yes, if it would be possible to stop their improper use, their misuse, then I think it would be possible to dispense them for medical use. But as long as they continue to be misused, and as long as people fail to truly understand psychedelics and continue to use them as pleasure drugs and fail to appreciate the very deep, deep, psychic experiences they may induce, then their medical use will be held back. Their use on the streets has been a problem for more than thirty years. On the streets the drugs are misunderstood, and accidents occur. This makes it very difficult for the health authorities to change their policies and allow medical use. And although it should be possible to convince the health authorities that in responsible hands psychedelics could be used safely in the medical field, their use on the streets continues to make it very hard for the health authorities to agree.

    CG: It appears that young people are once again becoming interested in psychedelics and MDMA. We also have this new phenomenon of the rave, where young people take substances like MDMA and dance all night. What is your view on why these young people seek out such experiences? How can we respond to what they are doing?

    AH: This is a very, very deep problem of our time in that we no longer have a religious basis in our lives. Even with religion, with the churches, they are no longer convincing with their dogma. And people need a deep spiritual foundation for their lives. In older times it was religion, with their dogmas, which people believed in, but today those dogmas no longer work. We cannot believe things which we know are not possible, that are not real. We must go on the basis of what we know, that everybody can experience. On this basis, you must find the entrance to the spiritual world. Because many young people are looking for meaningful experiences, they are looking for this thing which is the opposite of the material world. Not all young people are looking for money and power. Some are looking for a happiness and satisfaction which is of the spiritual world, not the materialistic world. They are looking, but there are no sanctioned paths. And, of course, one of the ways young people are using is with psychedelic drugs.

    CG: What would you say to young people?

    AH: What I would say would most certainly be: Open your eyes! The doors of perception must be opened. That means these young people must learn by their own experience, to see the world as it was before human beings were on this planet. That is the real problem today, that people live in towns and cities, where everything is dead. This material world, made by humans, is a dead world, and will disappear and die. I would tell the young people to go out into the countryside, go to the meadow, go to the garden, go to the woods. This is a world of nature to which we belong, absolutely. It is the circle of life, of which we are an integral part. Open your eyes, and see the browns and greens of the earth, and the light which is the essence of nature. The young need to become aware of this circle of life, and realize that it is possible to experience the beauty and deep meaning which is at the core of our relation to nature.

    CG: When did you first acquire this visionary appreciation of nature?

    AH: When I was a young boy, I had many opportunities to walk through the countryside. I had profound and visionary encounters with nature, and this was long before I conducted my initial experiments with LSD. Indeed, my first experiences with LSD were very reminiscent of these early mystical encounters I had had as a child in nature. So, you see that it is even possible to have these experiences without drugs. But many people are blocked, without an inborn faculty to realize beauty, and it is these people who may need a psychedelic in order to have a visionary experience of nature.

    CG: How do we reconcile this visionary experience with religion and with scientific truth?

    AH: It is important to have the experience directly. Aldous Huxley taught us not to simply believe the words, but to have the experience ourselves. This is why the different forms of religion are no longer adequate. They are simply words, words, words, without the direct experience of what it is the words represent. We are now at a phase of human development where we have accumulated an enormous amount of knowledge through scientific research in the material world. This is very important knowledge, but it must be integrated. What science has brought to light is true, absolutely true. But this is only one part, only one side of our existence, that of the material world. We have a body, and matter gets older and changes, so therefore as far as our having a body, we must die. But the spiritual world, of course, is eternal, but only insofar as it exists in the moment. It is important that we realize this enormous difference between these two sides of our lives. The material world is the world of our body, but the material world is also where man has made all of these scientific and technological discoveries. We must see, then, that science and technology are based on natural laws. But we must also accept that the material world is only the manifestation of the spiritual world. And if we attempt to manifest something, we will have to make use of the material world. For you and I to speak with one another, we must have tongues, we must have air and so forth. All of this is of the material world. If we were to read about spiritual things, it is only words. We must have the experience directly. And the experience occurs only by opening the mind, and opening all of our senses. Those doors of perception must be cleansed. And if the experience does not come spontaneously, on its own, then we may make use of what Huxley calls a gratuitous grace. This may take the form of psychedelic drugs, or perhaps without drugs through a discipline like yoga. But what is of greatest importance, is that we have personal experience. Not words, not beliefs, but experience.

    CG: Projecting into the future, do you envision that there may be an accepted role within Euro-American culture for psychedelics?

    AH: Absolutely! I am convinced that the importance of psychedelics will be recognized. The pathway for this is through psychiatry, but not the psychoanalytic psychiatry of Freud and not the limited scope of modern biological psychiatry. Rather, it will occur through the new field of transpersonal psychiatry. This transpersonal view takes into account both the material world, including our body, as well as the spiritual world. It recognizes that we are simultaneously part of the material and the spiritual worlds. What fits with the concept of transpersonal psychiatry is that we open our doors of perception. What transpersonal psychiatry tries to give us is a recipe for gaining entrance into the spiritual world. This fits exactly with the results of psychedelics. It stimulates your senses. It opens your perception for your own experience. How this phenomenon affects our existence in the material world can be understood through scientific research, and how we can integrate this knowledge with our spiritual selves can be achieved through the transpersonal path.

    CG: Dr. Hofmann, you have lived through two World Wars and a Cold War. When you look ahead into the future of mankind, are you hopeful or not?

    AH: I am hopeful for the long distant future, but for the near future I am terribly, terribly pessimistic. I believe that what is occurring in the material world is a reflection of the spiritual state of mankind. I fear that many terrible things will occur around the world, because mankind is in spiritual crisis. But I hope that over time mankind will learn, finally learn, and that there will be hope. I just re-read the twelve lectures Aldous Huxley gave in San Francisco in 1959, called The Human Situation. I think that everything that we are concerned about today, about the ego, consciousness, the survival of mankind, it can all be read in this book. I would like to recommend it. Everything we are now trying to say, the ideas we are formulating, has been discussed by Huxley.

    CG: What can we learn from the so-called primitive cultures who used psychedelic substances as part of their religious practices?

    AH: I think the most important thing is that they use it in a religious framework and we don't. We must learn from them, we must identify the right structures, we must find new uses. I could imagine that it may be possible to create meditation centers for psychedelic use in natural surroundings, where teachers could have experiences and train to become adepts. I perceive this as being possible, but first psychedelics will have to become available to medicine and psychiatry. And then it should be made available for such spiritual centers. Basically, all that we need to know we can learn from how the primitive people use psychedelics as sacraments, in a religious framework. We need such centers, but we also need the psychiatrists. These psychiatrists must become the Shamans of our times. Then I think we will be ready to move towards this kind of psychopharmacopeia.

    CG: Back in the Sixties many people became frightened of LSD and other psychedelics, including many psychiatrists. Why was that?

    AH: They did not use it the right way, and they did not have the right conditions. So, they were not adequately prepared for it. It is such a delicate and deep experience, if used the right way. But remember, the more powerful the instrument, the more the chance of damage occurring if it is not used properly. And back at that time, there were unfortunately many occasions where psychedelics were not treated with proper respect, and used in the wrong way, and consequently caused injury. That is the great tragedy, that these valuable medicines were not always respected and not always understood. So, the psychedelics came to be feared, and were taken out of the hands of responsible investigators and psychiatrists. It was a great loss for medicine and psychiatry, and for mankind. Hopefully, it is not too late to learn from these mistakes, and to demonstrate the proper and respectful way psychedelics should be used.

    In my childhood I experienced spontaneously some of those blissful moments when the world appeared suddenly in a new brilliant light, and I had the feeling of being included in its wonder and indescribable beauty. These moments remained in my memory as extraordinary experiences of untold happiness, but only after the discovery of LSD did I grasp their meaning and existential importance.

    It was my experiences with LSD that caused me to think about the essence of reality. The insights I received increased my astonishment about the wonder of existence, of which we become conscious in enlightened moments.
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    Trials of Psychedelic Therapy

    When I began exploring the history of LSD psychotherapy research in 2008, I had little idea that the momentum was in fact building on a new era of psychedelic research. In the 1950s and 60s, researchers reported impressive results using LSD in conjunction with psychotherapy to treat a range of psychiatric conditions, and an astounding 50% success rate treating chronic, treatment-resistant alcoholics. From my initial research, two narratives quickly emerged explaining the drug’s medical downfall: either LSD’s significant therapeutic potential fell victim the moral panic and government crackdown following its rising recreational use in the 1960s, or, by contrast, that the research had had little scientific rigor, had since been largely debunked, and had been spearheaded by enthusiasts such as Timothy Leary whose objectivity was significantly skewed by their own use of the drug.

    The new era of research, underway at prominent institutions including Johns Hopkins University, New York University, and the University of New Mexico, has largely picked up from where the previous era left off, exploring the effectiveness of the same treatment methods developed in the 1950s and 1960s. This research has therefore naturally been in close conversation with the past, as researchers attempt to avoid the pitfalls of the previous era. The primary focus has been on addressing the perceived lack of scientific rigor in past studies, which stemmed from studies being cut short by LSD’s prohibition before they reached scientific maturity. Now that the dust of the 1960s has settled, promising treatment approaches can be revisited, and given a more sober, rigorous evaluation through the modern controlled clinical trial methods required by the Food and Drug Administration.

    In this way, the common historical narratives of LSD psychotherapy’s decline provides a clear path for modern scientists. Yet as I explored more deeply the regulation of LSD research in the 1960s and the fate of the studies of that era, elements of the common narrative began to come apart. Although I initially approached the topic convinced that government interference had terminated research, I struggled to find evidence that any legislation prohibiting the non-medical use of psychedelics significantly restricted medical research. Instead, I found that government agencies had actively supported research for much longer than had been recognized: to my great surprise, in FDA files I discovered that in 1966, when LSD’s manufacturer, Sandoz Pharmaceuticals, withdrew its sponsorship of research in response to the increasing controversy surrounding the drug—which had already lead to its partial criminalization—the FDA, National Institute of Mental Health, and Veterans Administration had stepped to in ensure legitimate research continued. At this point, had these agencies not acted, all LSD research would have ended. Instead, although it declined over the 1960s, limited but significant studies continued into the mid-1970s.

    Secondly, looking more closely at the later clinical research with LSD showed that research methods evolved considerably over the 1950s-70s and largely reflected the evolving state-of-the-art. As well as a period of social and cultural upheaval, the 1960s saw a significant transformation of pharmaceutical research and development, with the passage of legislation that introduced FDA oversight of clinical research and the need to provide proof of drug effectiveness for FDA approval. While small uncontrolled studies had indeed characterized the LSD research of the 1950s, this was common for drug research in this era. In the 1960s researchers attempted to follow-up these studies with larger, and often sophisticated, controlled clinical trials. So neither prohibition nor a lack of scientific rigor seemed to explain the disappearance of LSD psychotherapy from psychiatry.

    However, comparing the research and treatment techniques employed in the later studies revealed the challenges of demonstrating the effectiveness of LSD psychotherapy through the controlled trial methods required by the FDA: blind administration could not effectively be maintained, and the incorporation of significant psychotherapy was unconventional for drug treatments and complicated efforts to establish objectively comparable control conditions. As researchers attempted to overcome these hurdles, some altered the treatment techniques of those earlier researchers who had claimed remarkable results in order to establish a more standardized and easily testable treatment. This influenced often negative or lackluster results. Ultimately, I found that LSD psychotherapy’s decline was due less to prohibition than to the growing disinterest of the psychiatric community in a drug that had apparently failed to live up to the hype.

    The history of LSD psychotherapy I discovered was therefore ultimately one of an unconventional but highly promising treatment that did not fit within an increasingly rigid model of pharmaceutical research and development. Rather than dominated by controversial figures such as Leary, little-known researchers such as Charles Savage and Albert Kurland persevered through the 1960s and 70s at a far remove from the counterculture and continued to publish their studies in leading psychiatric journals. Yet they struggled to design studies that would allow them to uphold both the integrity of their treatment and the scientific standards expected by the FDA and wider scientific community. From this perspective, the lessons that can be gleaned from the history of LSD psychotherapy become more complex, revealing scientific and regulatory challenges that remain for contemporary researchers and that have wide implications for American medicine and psychiatry.
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    Set and Setting in Psychedelic-Assisted Psychotherapy

    If someone had told us a few years ago we would be legally using MDMA and ketamine in psychotherapy, we’d have laughed at the notion as impossible. However, while highly implausible to imagine it only a few years back, this is where our professional development has taken us. We are currently working as psychedelic therapists in the roles of facilitators, caretakers, midwives, and witnesses, helping individuals to reconnect with, process, and resolve past traumas and alleviate symptoms of severe anxiety and depression. It seems we are indeed successfully treating their otherwise intractable treatment-resistant symptoms with the aid of psychedelic catalysts.

    To the extent that we, as therapists, have explored our own inner terrain, we also act as ambassadors to these same, hitherto neglected or forgotten inner realms within our patients. It is a common view in the psychoanalytic community that “the symptom” is an expression of threatening or unmanageable psychic material that has been pushed into the unconscious, so that it is unprocessed, un-metabolized, even unknown. What if our responsibility as therapists to facilitate access to these uncharted subterranean catacombs can be catalyzed, indeed expedited, by psychedelic medicines to more efficiently bring repressed material into the light of conscious awareness? If that is the case, then not using these tools, at least in some cases, would be a disservice to our patients and to the search for truth.

    Set – Short for “Mindset” – in Psychedelic-Assisted Psychotherapy

    The patients’ set involves their current state of mind, mood, attitude, interpersonal or professional concerns, beliefs about psychedelic medicines, and expectations about the specific therapeutic session. As therapists, we also must consider our own set, and its influence on the patient and treatment. Our set involves our own current frame of mind, mood, outside concerns, and hopes for the session and the treatment as a whole.

    The broader socio-cultural values and perceptions need to be also carefully considered as influences on the patient’s set: their “social set.” What are the collective social beliefs, cultural values, and stigmas regarding psychedelic use? How do their friends, family, and loved ones perceive the use of psychedelics in general and in treatment? We recognize that these collective perceptions, expectations, judgments, and fears play an important role in how the patient anticipates and interprets the work.

    We strive to be mindful that every phone contact, email, and in-person meeting will naturally influence our patient’s perception (i.e., his or her set) far in advance of a session with the medicine. The essential foundation of the patient’s set is their well-informed understanding of all aspects of the treatment. Following the intake, they should have a good sense of the specific rationale for the chosen treatment protocol, dosage strategies, common physiological and psychological effects and duration of the medicine(s), the typical stages and progression of a psychedelic journey, and all known risks and benefits of the treatment. Patients are informed about their right to discontinue treatment at any time for any reason. Side effects, possible use of emergency and support medicines, if needed, and alternative treatment options are also discussed. In preparation for a psychedelic session, we try to cultivate a trust in the process, understanding that it may not be linear or predictable and may come with unexpected twists and turns.

    In these preparatory sessions, the intentions and motivations of the seeker are explored and openly examined. What multiple factors have brought them to the point of consider taking a mind-altering substance in treatment? What are they hoping to get out of the treatment? Where are they in their process of psychospiritual development? Sincere and uninhibited self-inquiry is encouraged to identify patterns of thinking, feelings and behaviors that are reinforcing their dis-ease. We endeavor to support and facilitate the freedom of the “traveler” to go wherever he or she wishes and make meaning of and understand their symptoms, with the ultimate goal of liberating themselves from the shackles of old, rigid, fear-based beliefs and dictates.

    Trusting the Patient’s Inner Healing Intelligence

    Perhaps the most important core principle in the work is encouraging patients to trust the medicine and their own inner healing intelligence. This concept and its implications are elucidated in the MDMA study treatment manual: “It is essential to encourage the participant to trust their inner healing intelligence, which is a person’s innate capacity to heal the wounds of trauma. It is important to highlight the fact that the participant is the source of their own healing. The [medicine] and the therapists are likely to facilitate access to a deep healing process, but they are not the source of this healing process.” We trust that our patients’ natural ability to heal, along with a sincere desire for healing, will guide them to the material that needs attention, processing, and integration.

    Because the inner healing intelligence goes to where it is needed, the healing process not only involves letting go, on both the part of the client and the therapist, but also trusting that any challenging material that arises is “coming up for healing.” There is a well-known maxim in our field: There are no bad trips, only challenging ones. The healing process is not about avoiding challenges but rather engaging with them in new ways, and discovering a more expansive, harmonious, accepting, empathic, and loving way of relating to them. In fact, Myron Stolaroff, an influential pioneer of psychedelic psychology, felt the most significant transformational healing and growth resulted from encountering dark thoughts and emotions, and unresolved fears and trauma during a psychedelic session. Challenging experiences can be incredibly valuable and important, sometimes even essential, to the journey towards wholeness.

    Setting in Psychedelic-Assisted Psychotherapy

    The setting, at its most concrete, is the physical space where the experiential session takes place. At our ketamine psychotherapy clinic, Polaris Insight Center, we do our best to make the setting cozy and comfortable and to minimize outside distractions and disruptions. The room’s decorations are carefully chosen to create a welcoming ambiance that is aesthetically appealing, simply adorned, and not overwhelming in any manner. We try to avoid using trappings of a traditional institutional, medical, or clinical environment. Instead, we strive to curate a familiar, living-room-like setting conducive to relaxation and surrender. These conditions create an optimal space for the patient to let go and for the journey to unfold and flow of its own accord.

    More subtly, considerations of setting include various environmental influences on the patient and the process. For example, the setting of a therapy suite in San Francisco will have a different impact on the experience than that of a therapy center in the mountains of Colorado. A psychedelic psychotherapist must keep in mind how the larger socio-cultural context might impact the psychedelic experience.

    Music as Part of Setting in Psychedelic-Assisted Psychotherapy

    Music plays an important role in our work. It provides a container for the patient’s emotional processing while guiding the forward movement of the journey. Stanislav Grof describes the role of music as creating “…a continuous carrier wave that helps patients to overcome difficult parts of the sessions and move through impasses”. Furthermore, the practice of listening to music puts the listener into a more receptive, meditative state, which, in turn, facilitates the process of letting go; an important component of the psychedelic experience.

    Thoughtful care is put into curating specialized playlists with the intention of taking the listener on an ultimately uplifting and healing journey. Playlists are arranged to mirror the drug effects. In our work with MDMA, atmospheric ambient tracks are used for the come-up period, faster and more emotionally evocative tracks are played during the peak, and tender heart-opening pieces are selected for the come-down period. In ketamine sessions, more spacious, textured ambient electronic tracks are used. As the participant’s journey unfolds, the music fosters emotional openness for connecting or reconnecting with old memories and deep emotions of sadness, grief, surrender, joy, and love. Some samples of playlists curated specifically for psychedelic journeys can be found at Chacruna’s Psychedelic Therapy Music Forum.

    Planning for Integration as a Part of Set and Setting in Psychedelic-Assisted Psychotherapy

    The integration process in the days and weeks following the psychedelic experience is important to consolidate the insights gained during the journey and implement changes in one’s life. During this period, we help patients find words for their experiences, unpack insights, and develop new personal narratives. We further discuss strategies and practices to retain and actualize this new knowledge. These sessions tend to involve a more directive approach where we suggest specific techniques (e.g., journaling, drawing, listening to music, dancing, meditation, connection with nature). The questions we pose to the patient during this period support these efforts: In what ways, if any, have your psychedelic sessions shifted how you see and understand yourself now? How has it informed your view of reality, your role in it and your understanding of your life’s journey? Has it changed your relationships, motivations, self-criticisms, and criticisms of others?

    Training and Approach of Psychedelic Psychotherapists as a Part of Set and Setting

    To be effective in the role of psychedelic psychotherapist, we believe well-trained therapists should have some familiarity with, and experience navigating, non-ordinary states of consciousness (NOSC). This preparation may involve therapists having their own personal experiences with psychedelic-assisted therapy, or alternatively, having non-drug NOSC experiences such as with floatation tanks, immersive meditation retreats, or holotropic breathwork. However, we feel strongly that, without direct experience of the psychedelic-assisted therapy, the therapist will be less prepared to navigate the terrain of NOSC in psychotherapy. One of our colleagues captured this idea in a colorful metaphor: If you’re climbing Mount Everest, you would want to know that your sherpas have climbed it before, are familiar with characteristic challenges of the terrain, and are acquainted with the particularly scenic routes and viewpoints along the way.

    In training psychedelic therapists, we want to cultivate a professional ethic of mindfulness and patience, as we carefully tend and till the soil of patients’ psyches in preparation for the harvest. This approach inevitably involves a good amount of waiting and not-doing. The apprentice gardener may earnestly believe that more directive interventions will lead to more growth. However, each patient’s path is unique, and the healing process is best served when the therapist is able to trust the process and put aside their own plans, expectations, and judgments.

    Recommendations for Further Education and Training

    Dr. Janis Phelps, Director of the Center for Psychedelic Therapies and Research at the California Institute of Integral Studies, has developed a set of best practices to achieve optimal outcomes in psychedelic therapy.4 Among the core competencies of psychedelic therapists are empathetic abiding presence, trust enhancement, knowledge of the physical and psychological effects of psychedelics, and therapist self-awareness and ethical integrity. Her recently published article in the Journal for Humanistic Psychology is highly recommended for further reading on this subject.

    Furthermore, for those interested in more formal training in psychedelic-assisted psychotherapy, we recommend the following programs:

    • MAPS: MDMA-Assisted Psychotherapy Training Program
    • CIIS: Certificate in Psychedelic-Assisted Therapies
    • The Center for Transformational Psychotherapy: Phil Wolfson, MD and Julane Andries, LMFT
    • Kriya Institute: Raquel Bennett, PsyD
    • Grof Transpersonal Training
    • ZENDO Project
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    The rise of underground LSD guides

    Some Americans searching for alternative paths to healing have turned to psychedelics. But how does one forge a career as a guide when the substances are illegal?

    Steve has cops in his family, so he doesn’t tell many people about his work as an underground psychedelic guide. The work takes up a significant amount of his time – around once a week, he’ll meet a client in their home or in a rented home, dose them with MDMA or hallucinogenic psilocybin mushrooms, and sit with them while they trip for up to 10 hours – but he doesn’t tell his siblings, parents or roommates about it, nor his fellow psychology PhD students.

    They would probably never guess, either: Steve doesn’t display any signs of involvement with a stigmatized counterculture that many Americans still associate with its flamboyant 1960s figureheads. He’s a bespectacled, soft-spoken former business school student who plays in a brass band and works part-time as an over-the-phone mental health counselor. After one glass of wine, he says: “Whoa, I’m feeling a little drunk.”

    But if you probe, he might tell you about the time he took psilocybin and a “snake god” entered his body and left him convulsing on the floor for an hour. (The snake god was benevolent, he says, and the convulsing was cathartic, “a tremendous discharge of anxious energy”.)

    In early October, Steve attended a Manhattan conference called Horizons: Perspectives on Psychedelics, which bills itself as the world’s “largest and longest-running annual gathering of the psychedelic community”. I went with my 51-year-old cousin, Temple, a relatively mainstream psychotherapist. She had come to learn more about psychedelic-assisted psychotherapy, which underground guides like Steve facilitate illegally. She hopes to incorporate this type of therapy into her practice if and when substances such as psilocybin, MDMA, LSD and ayahuasca become legal.

    Like many attendees, Temple had recently read How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, a bestselling 2018 book by Michael Pollan. It convinced her that psychedelic-assisted psychotherapy “might really be the way of the future”.

    Indigenous people are believed to have used plant-based psychedelics for millennia; now, factions of the western medical establishment seem to be catching on. But most psychedelics are still Schedule I controlled substances, in the same category as heroin and cocaine; possession or sale has been punishable by prison sentence since 1971. With rare exceptions, the only way you can legally consume psychedelics in the US is as a participant in one of a few clinical research trials conducted at universities such as New York University and Johns Hopkins.

    These studies have yielded astounding results: they suggest that, when administered to carefully screened patients by trained health professionals, psychedelics are safe and potent tools for alleviating PTSD, addictions, cluster headaches, anxiety and depression.

    Amid a broken healthcare system and rising rates of opioid addiction and suicide, Americans are searching for alternative paths to healing, which is where underground guides come in. The industry has its share of charlatans, but many guides hold themselves to ethical standards and protocols comparable to those established in clinical settings.

    Unlike psychotherapists, however, underground guides have no accredited educational institutions, no licensing and no way to publicly market their services. How, then, does one make a career as a guide?

    Steve was one of many guides I spoke to who described feeling spiritually “called” to do this work. Like doctors who provided abortions pre-Roe v Wade, he breaks laws that he believes are unjust; he considers legal violations a risky but necessary part of his quest to alleviate people’s pain. He charges on a sliding scale that ranges from around $15 to $50 an hour.

    As is the case with most guides, his own psychedelic experiences convinced him the job was worth the risk.

    “During an early guided psilocybin session, I realized I’d never adequately dealt with the pain caused by my parents’ divorce,” Steve says. “There was clearly still this 11-year-old part of myself that was like, ‘I want to be part of a coherent family unit.’ During the experience, I was given this vision – there’s no way to say this that doesn’t sounds silly – but there was this mother figure who was like, half-Vedic goddess, with a million arms and a million eyes, and half-space alien, with gray skin. She was this space mother, surrounded by this space family, and she just beamed to me this incredible welcoming feeling of, this is the divine family that you stem from.”

    In addition to keeping quiet about his work, Steve uses an encrypted messaging app to communicate with clients – precautions he takes to avoid the kind of legal trouble that has befallen some underground guides, such as Eric Osborne, a former middle school teacher from Kentucky.

    The felon-turned-psilocybin retreat entrepreneur

    On a July afternoon in 2015, state troopers showed up at Eric’s gourmet mushroom farm in Indiana with search warrants.

    They searched his house, then trawled through his mushroom fruiting chambers, inspecting racks of shiitakes, turkey tails and reishis, which he sold to upscale local restaurants. Eric was confident the police would find nothing incriminating there – he grew his psilocybin mushrooms far from his restaurant-bound crops – but when he saw them heading towards the woods on his property, he panicked.

    Two nights earlier, Eric and his then fiancee had sat around a campfire with a new friend, all tripping. A self-described “recovering Catholic” with a southern drawl who, in 2009, became Indiana’s first state-certified wild mushroom expert, he had been offering underground psilocybin therapy sessions for years. (He has no formal training in psychology; he says the mushrooms, which he’s consumed at high doses around 500 times, are his teachers.)

    The friend had hoped a session might help resolve a years-old trauma. After the mushrooms took effect, she went to lie down in her tent. Minutes later, Eric saw a glow of headlights through the trees. As a safety precaution, he had hidden the woman’s car keys in the house, but now, her car was speeding down his driveway.

    “My heart just dropped,” Eric says. “I was sure she was going to die.”

    Eric and his fiancee spent 14 hours searching for her before she texted, saying she was safe. She had crashed into a ditch near the farm after retrieving a spare key hidden under her car’s transom. No one was hurt, but after police found her, disheveled, she told them everything about Eric’s psilocybin operation to avoid being charged with drug possession.

    “I knew the cops were coming for me,” Eric says. Before they arrived, he stashed a pound of dried ‘Mr E’ psilocybin mushrooms – a unique strain he had bred and named himself and didn’t want to lose – inside a hollow log in the woods.

    Somehow, the police managed to find it: “That was the end, there.”

    He spent a week in jail contemplating the effects of the drug war on the mental healthcare system. “The horrible irony was, I sat in this cell with people who had drug addictions that psilocybin can help remedy,” he says. After being released, he was put on house arrest with an ankle monitor for eight weeks, forbidden from speaking to his fiancee, whose parents had bailed her out of jail after a day. He was facing a minimum of 10 years in prison for each of three B-felony charges – Schedule I substance manufacturing, distribution and possession.

    “The night our friend drove off was the most terrifying, gut-wrenching moment of my life, but in the eight weeks that followed, when I sat on those 87 acres alone, there were moments of complete despair. I had to take my shotguns to a neighbor,” he says. “I have uncles who were cannabis growers who spent years in prison. I was certain I’d follow in their path.”

    The judge at his trial was mercifully liberal, however. The B-felonies were pleaded down. Eric was convicted of “maintaining a common nuisance” and sentenced to two and a half years probation.

    “Yeah, that’s what I do – ‘maintaining a common nuisance’,” he says. “I’ve turned it into a career now.”

    He’s not joking: in October 2015, instead of quitting the mushroom world, he founded MycoMeditations, an above-board psilocybin-assisted therapy retreat center in Jamaica, one of the few countries where psilocybin is legal.

    “I felt I had no other option,”
    he says. “The landlord kicked me off the farm, I was working in a Louisville restaurant – I couldn’t go back to teaching with a felony – so I just pushed full speed into this. I felt like the medicine was so needed that I couldn’t not do it.”

    In the three years since, about 400 people from around the world have attended MycoMeditations’ seven- to 10-day group retreats in Treasure Beach, on Jamaica’s remote southern coast. Guests trip on psilocybin every other day in a fenced-in field surrounded by mango and coconut trees. “All I do is just sit there with people, supporting them silently, sometimes holding their hands,” Eric says.

    While every guide has a unique approach, above-board and underground psychedelic-assisted therapy tends to follow a similar structure. Before a trip, clients have preparatory therapy sessions with guides, discussing their mental health issues and intentions for treatment. (Some guides won’t work with people who take psychiatric medications; they caution that prescription antidepressants can have potentially dangerous interactions with certain psychedelics, especially ayahuasca.)

    During the trip, guides sit with the client, ensuring their safety, and, if necessary, helping them navigate what researchers call “difficult struggle experiences”.

    “What we find in talking with patients is that this ‘difficult struggle’ is not a bug in the experience, but actually a feature,” says Dr Alex Belser, who co-founded the psychedelic research team at NYU in 2006. “When they take these medicines, people go into difficult places – they deal with past grief, trauma and suffering, and feel those feelings intensely, for a time … Without a strong sense of safety and trust with a therapist, that may lead to what’s been called a ‘bad trip’. But if there’s enough intention put into supporting that experience, it’s the beginning of an arc of healing that can lead to something extraordinary.”

    After a trip, guides facilitate “integration” sessions, in which the client strives to incorporate lessons from the experience into their everyday lives. At MycoMeditations, after integration sessions, guests get massages and swim among sea turtles and coral reefs.

    One attendee, a stage four cancer patient, felt so healed by the retreat that she donated a year’s salary to Eric, which allowed him to quit his job at the Louisville restaurant – he had been splitting his time between Jamaica and Kentucky – to focus full-time on the center. “Now she’s in remission, traveling the country fly-fishing in her Mercedes Winnebago,” Eric says. “Miracles are becoming – not mundane, but pretty normal around here.”

    The social worker-turned-medicine woman

    I meet Hummingbird at Alice’s Tea Cup, an Alice in Wonderland-themed cafe in Manhattan. Wearing a lavender shawl and a gold turtle-shaped brooch, Hummingbird matches the decor. One of six children of Cuban immigrant parents, she calls herself a “medicine woman”; her approach to guiding is ceremonial rather than clinical.

    As a teenager in New Jersey in the 1980s, she was a star cheerleader and an enthusiastic participant in the Drug Abuse Resistance Education (Dare) program. Since age 10, she’d dreamed of becoming a social worker; after getting her master’s, she “tried basically every social work job” she could find, including working at a methadone clinic and as a family therapist in the Bronx. “I was very googly-eyed,” she says. “Quite the idealist. I wanted to change the system.”

    After several years, though, “apathy was building”, she says. “I was very dissatisfied with the system, getting burnt out, very ill – constant bronchial infections, flus.”

    During one such illness, while she was managing a program aimed at reducing psychiatric hospital recidivism, she tried treating herself with herbs – elderberry root and slippery elm – instead of visiting a doctor. This induced a fever dream of sorts, she says: “I’m having cold sweats and chills, and I feel this weight on me – this being, making this purring noise, in a language I now understand a lot better. It was calling me. I wake up and say: ‘OK, I’m leaving my job.’”

    Shortly after she quit, a friend took her to a ceremony in Upstate New York and introduced her to “abuela”, as many devotees call ayahuasca, a plant-based tea containing the natural hallucinogen DMT. “By then, I’d tried everything – mushrooms, LSD, ecstasy, cocaine – but this was different,” Hummingbird says. “The sky opened up. At the end of a walkway of stars was this feeling, like, you’re home. I was flooded with tears of gratitude. And I started talking in this other language, chirping away, talking to birds in the woods.”

    On sabbatical, she backpacked through Guatemala, where she attended eight more ayahuasca ceremonies led by indigenous curanderas. “When I came back to my luxurious home, I was shocked at the US way of life,” she says. “I couldn’t believe I’d let myself become part of this system.”

    Instead of returning to social work, she studied indigenous healing traditions with a New York-based shaman, Irma StarSpirit Turtle Woman. In 2015, after adopting a “medicine name” – Hummingbird, translated from Zunzun, her Cuban grandmother’s nickname – she began leading ayahuasca ceremonies herself.

    At ceremonies, which cost $230 a night, Hummingbird blows a tobacco snuff called rape up the noses of her guests, then serves ayahuasca and sings icaros – medicine songs – while they purge. “There’s a lot of crying, laughing, vomiting, urinating, sweating – what I call ‘getting well’,” she says.

    Also on offer is sananga, a psychoactive eye drop that burns like habanero chilis, and Kambo, a drug made from the venom of the Amazonian giant monkey frog.

    Hummingbird’s work with the psychiatric healthcare system left her concerned that the millennia-old spiritual traditions surrounding psychedelics risk being sidelined in the process of medicalization. Despite psychedelic researchers’ attempts to quantify results with tools like the “Mystical Experience Questionnaire”, trip experiences – such as encounters with “snake-gods” – tend to fall outside the realm of contemporary scientific understanding.

    “Abuela is an ever-evolving quantity,” Hummingbird says. “There are no final end results, which science loves to have.”

    The former labor nurse who helps people ‘give birth to themselves’

    Since his book’s publication, Pollan’s readers have bombarded him with requests for referrals to underground guides – requests he turns down to protect his sources.

    “The demand [for psychedelic therapy] far outweighs the supply and care we have, whether in clinical trials or in the underground,” Pollan said at Horizons. “I was struck by how many people are really suffering. I wish people could just go to 1-800-Underground Guide."

    Steve’s schedule is at capacity; he finds himself turning away roughly three-quarters of referrals he gets, some of which come from licensed psychotherapists, who may risk losing their licenses by pursuing interests in illegal substances.

    But many are optimistic about the future of legalization for medicinal use. In 2017, the Food and Drug Administration (FDA) granted “breakthrough therapy designation” to MDMA-assisted psychotherapy for PTSD, acknowledging that it “may demonstrate substantial improvement over existing therapies” and agreeing to expedite its development and review. In October, researchers from Johns Hopkins University recommended that psilocybin be reclassified to a schedule IV drug, with accepted medical use.

    The push for legalization has received bipartisan support: Rebekah Mercer, the billionaire Republican and co-owner of Breitbart, recently donated $1m to the Multidisciplinary Association of Psychedelic Studies (Maps), a not-for-profit organization conducting much of today’s psychedelic research.

    In anticipation of expanded access, the California Institute for Integral Studies, in San Francisco, offers a training and certification program for medical and mental health professionals who hope to eventually facilitate legal psychedelic-assisted therapy.

    ‘I’m a super joyful person now’

    While underground guides tend to fiercely support decriminalization, a few, such as Jackie, say that even if psychedelics were to be legalized medically, they would continue to work underground.

    “I don’t want to work under the medical model,” Jackie says. “It’s too regimented for me.”

    Before she became a guide, Jackie worked as a birth doula and a registered labor and delivery nurse. “I used to sit with people as they gave birth to humans,” she says. “Now I sit with people as they give birth to themselves.”

    After leaving her “tumultuous, fucked-up family” at 17, she tried LSD for the first time with the man she would later marry. While raising her kids in the 1980s, she suffered from “persistent emotional pain” and tried everything to treat it: decades of psychotherapy, yoga, meditation, neurofeedback, self-help workshops. Nothing worked.

    In 2016, on the recommendation of her 30-year-old daughter, she attended a shaman-led ayahuasca retreat in Costa Rica. “Even as I was throwing up on the jungle floor, I was like: ‘Thank you. This is why I came here,’” she says. “Afterward, I felt like all the trauma stuck inside my body had been released.”

    Upon returning home, she broke up with her psychotherapist. “I haven’t felt a need to go back,” she says. “I’m a super joyful person now.” She began attending Horizons and training as a guide with several mentors.

    Now, at 57, she works full-time as a guide for two to four clients a month, either in her New England home or an Airbnb, charging several thousand dollars for 48-hour sessions and “unlimited post-trip integration”.

    Many of her clients are “genius entrepreneurs”; most, she says, have little experience with drugs. She gets word-of-mouth referrals from all over the world and also mentors newbie guides.

    “As underground therapists, we have to think, what if the worst thing happened and we went to jail?” she says. “But if I went to jail, I think I’d still find a way to serve. And I know it sounds woo-woo, but I somehow feel protected by the mushrooms.”
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    How to safely access psychiatric support in times of psychedelic crisis

    Psychedelics are revolutionizing modern medicine, offering new opportunities for mental health where current medical technology is stuck. The psychedelic renaissance is here and, with its excitement and hopefulness, it is important to recognize that, while psychedelics hold tremendous healing potential, they are only one possible solution, among a spectrum of interventions. They are on a spectrum that Western medicine exists on along with them; one is not better than the other, although one may be more appropriate than the other, depending on an individual’s unique needs and make up.

    The psychedelic movement has a necessary resistance towards Western allopathic medicine. We’ve fought for decades against power dynamics and stigma towards us for our beliefs in holistic and indigenous frameworks, as well as our activism for cognitive liberty. However, there is a time and place for every lens and approach in health care; how do we psychonauts turn to mainstream medicine as an ally during a critical time when it could be the best care to offer someone in need?

    My intention in this article is to remove some of the shame that may arise if a person in the psychedelic community needs to seek conventional psychiatric intervention, identify when seeking psychiatric support maybe helpful, and lay out how to utilize the medical system in times of crisis safely, while holding a psychedelic framework.

    When might psychiatric support be helpful?

    First off, let’s discuss the belief that medications will suppress an individual’s psycho-emotional healing process with psychedelics. Yes, it is true that over-medication happens in our culture, and when people are over-medicated, their symptoms can be masked in a way that prevents insight into what exists at their core. However, for individuals in crisis, it is also true that if symptoms are overwhelming, they may become exhausted trying to manage them so that they no longer have enough energy left over to be curious about what lies deep within themselves. If a person internally feels so chaotic that they are in survival mode, their priority is to live, not to look at their healing or spiritual process. There is a concept known as “the window of tolerance.” When we are within our window of tolerance, we can be rational, receptive to feedback or therapy, engage with ourselves and others, and explore our spiritual connections. However, when we are outside of our window of tolerance, all we can focus on is survival.

    This concept of the window of tolerance is useful in understanding and differentiating between spiritual emergence, spiritual emergency, and underlying psychopathology. According to Stan and Cristina Grof, spiritual emergence is, “The movement of an individual to a more expanded way of being that involves enhanced emotional and psychosomatic health, greater freedom of personal choices, and a sense of deeper connection with other people, nature, and the cosmos. An important part of this development is an increasing awareness of the spiritual dimension in one’s life and in the universal scheme of things.” Exploring psychedelics does not guarantee a spiritual emergence; however, it certainly increases the likelihood that individuals may have insights and reflections that lead them to deeper spiritual and emotional connections. For most, spiritual emergence is an inherent component of psychedelic experience, and for a spiritual emergence to take place, the individual must be within their window of tolerance.

    That being said, in the same way that psychedelics can precipitate a spiritual emergence, they also have the potential to induce a crisis. This crisis could indicate a spiritual emergency or, in extreme cases, underlying psychopathology. Spiritual emergency is an “experientially difficult stage of a profound psychological transformation that involves one’s entire being. This is a crisis point within the transformational process of spiritual emergence. It may take the form of non-ordinary states of consciousness and may involve unusual thoughts, intense emotions, visions, and other sensory changes, as well as various physical manifestations”. A spiritual emergency is a form of being out of the window of tolerance. Some individuals find their way through a spiritual emergency, get back into their window of tolerance, and move towards spiritual emergence.

    Additional resources and support are typically required for spiritual emergencies to be worked with in a productive way. This may range from peer support to professional support. Some extremes of spiritual emergency make it difficult to transition into spiritual emergence, and seeking psychiatric care may be helpful. Psychiatric interventions such as medication can bring individuals who are out of their window of tolerance back into it so they can access deeper healing resources, begin to engage with their personal processing or spiritual work, and assimilate profound insights learned with psychedelics. In other words, when necessary, psychiatry can help support transition from spiritual emergency to spiritual emergence. The balance lies in how medications are being used to help bring someone into their window of tolerance without blunting the individual to the point of preventing the transformation.

    Indicators that someone may be out of their window of tolerance after a psychedelic experience are: a) not sleeping for more than one night; b) inability to attend to occupational, family, or other social responsibilities and needs; c) inability to attend to activities of daily living, such as feeding, dressing, and bathing; d) posing potential danger to themselves or others; and e) caretakers and loved ones are depleted from tending to them.

    How do we use the medical system safely while holding a psychedelic framework?

    First, be prepared. Always know the medical and psychiatric history, as well as emergency contacts, of the friends you may be tripping with and the clients you may be facilitating experiences for. Being prepared also means having a plan for emergencies. The essentials for any psychedelic emergency plan are: 1) Get basic first aid training; 2) make sure food and water is available, that the environment is safe, and decrease stimulation (e.g., noise and lights); 3) do not leave a person alone at any time; 4) have a list of local health care providers who are psychedelic-friendly to call in an emergency. Alternatively, if you can’t find a psychedelic- friendly healthcare provider, have a list of people who are familiar enough with medical terminology and systems to advocate for the person in crisis when interfacing with the medical system; and 5) be prepared to accompany a person in need of medical care so they are with someone who is familiar and they trust.

    Ideally, the best ally will be a psychedelic-friendly healthcare provider in your local community that you trust; so, do some research and make contacts ahead of time. Psychedelics are gaining momentum, and there are many more clinicians who are familiar with them out there than you think. We can assess the level of crisis a person is in and the level of care they may need, prudently prescribe medications as needed to slow the chaos of a spiritual emergency, and support the unfolding of a spiritual emergence, hopefully preventing the need for hospitalization. In the event of a hospitalization, we can help advocate for the individual within the hospital setting so that they are seen from a spiritual perspective rather than a pathological one. Once out of the hospital, we can taper people off of medications to allow for deeper internal work to occur.

    Remember that if someone enters the medical system from a place of care, there is a greater possibility of having the experience of care while in it. It is critical to create a kind and loving container for someone in crisis. This container is created by having allies in the medical model, as well as the support of friends and family in holding a spiritual and psychedelic framework for the individual in crisis while they are within an allopathic system. Have fun and be safe out there!


    How LSD breaks down Reality Tunnels, and the science behind psychedelic ego death

    LSD and other psychedelics are powerful medicine for the mind, and goodness knows the Western psyche has a deep sickness embedded within it. Our health and the wellbeing of the environment continue to suffer from preventable causes such as stress, over consumption, and resource depletion, all underpinned by the narrative that this is “normal” and that visions of a better, healthier way are unrealistic. We’re largely addicted to fast food, fossil fuels, and entertainment, yet at the same time, share a deep and murky sense of unease that perhaps this way of life is neither sustainable or fulfilling. This is the world created by the ego —the sense of personal and social identity that is propped up by long stories of justification — and it is the favorite target of psychedelics like LSD, which love to shatter realities and let you know, in cathartic and sometimes terrifying ways, that everything you know is wrong. And this can be a very good thing, if you’re ready to hear the message.

    What are Reality Tunnels?

    Psychedelic advocate Timothy Leary described this ego-generated perception of self and the world as a “Reality Tunnel.” As one of LSD’s earliest and most committed adopters, he was among the first to have his own reality tunnel ripped apart by psychedelics, revealing its existence much like a fish comprehending water for the first time after being pulled out of it. It’s no surprise that Leary and subsequent psychonaut philosophers like Robert Anton Wilson honed in on the concept of reality tunnels as essential to understanding the value of psychedelics, because it dovetailed perfectly with other new understandings that were coming to the fore in the 20th century such as yoga, radical changes in arts and music, dissatisfaction with conventional culture, and mistrust of corporate and government power.

    Psychedelics like LSD dissolved these propped-up realities and made it clear that life and our perception of it has infinitely more potential than commonly thought, revelations that were supported by millennia-old Eastern philosophy and evidenced in the incredible force behind the cultural revolution of the 60s.

    Leary’s message and the explosion of psychedelics in the 1960s affected Western culture much like an LSD trip would affect someone not ready to take it. Things got kind of weird and scary, and with one foot over the threshold of our reality tunnel, we decided as a society to take two fearful steps back and shut the door, convincing ourselves that what we briefly witnessed was dangerous nonsense. But times are changing, and the abyss is beckoning us to move towards it once again, this time more slowly and carefully. Today, we are ready to take the dose with the right set, setting, and intention.

    The science of psychedelic ego death

    Fast forward to the 21st century, and today we have new scientific understandings of what psychedelics are and how they influence our brain and psyche. Plunging off the diving board out of your reality tunnel with LSD just because you can is rightfully considered reckless by today’s psychedelic advocates, and instead we are honing in on the therapeutic applications of this medicine and understanding how exactly it’s neurological magic works. While the approach has become more careful and nuanced, the goal remains essentially the same - to harness the incredible power of psychedelics and integrate the lessons they have to teach us in a lasting way.

    A recent groundbreaking study on LSD by Imperial College London and the Beckley Foundation is a shining example. Using advanced brain imaging techniques, they were able to see which parts of the brain became active under the influence of LSD, allowing researchers to better understand the psychedelic experience. Dr. Robin Carhart-Harris who lead the experiment explained:

    “Normally our brain consists of independent networks that perform separate specialised functions, such as vision, movement and hearing — as well as more complex things like attention. However, under LSD the separateness of these networks breaks down and instead you see a more integrated or unified brain.”

    A unified brain is more free to make associations that are not commonly made, like how the foods we choose to consume effect geopolitics, or how a recurring conflict you have with your spouse stems from a childhood trauma. These unveilings allow subconscious unease to be brought to light and released, and they make way for the larger ultimate realization that we are not bound to any of our egoic thought-patterns other than by our habitual reinforcement of them. The reality tunnel we live in is malleable, and we are free to choose at any time to change its shape and scope. Psychedelics can be properly understood as a medicine to assist in this process, with the ability to target very harmful thought patterns such as those that underlie PTSD and addiction.

    Dr. Harris also went on to describe the relationship between LSD and ego death:

    “Our results suggest that this effect underlies the profound altered state of consciousness that people often describe during an LSD experience. It is also related to what people sometimes call ‘ego-dissolution’, which means the normal sense of self is broken down and replaced by a sense of reconnection with themselves, others and the natural world. This experience is sometimes framed in a religious or spiritual way — and seems to be associated with improvements in well-being after the drug’s effects have subsided.”

    At the end of the tunnel

    Leary would certainly be happy to see this research being done, and one would hope, embrace the present-day resurgence of interest in psychedelics with science and therapy at its head rather than overt cultural revolution. What is clear is that he was right about LSD’s ability to break down reality tunnels and the immense benefits that can come from such an act. Slowly but surely, this work for the advancement of psychedelic studies that Leary and all psychedelic researchers and advocates are part of is expanding and altering the course of our shared reality tunnel, and that is a very good thing.
    Last edited by mr peabody; 06-01-2019 at 10:07.
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    Iboga found to resolve and heal childhood trauma

    Imagine being able to go back in time to relive those experiences from your childhood which have had the greatest impact on your life. Imagine being able to witness yourself as a child, but from the perspective of yourself today, looking at traumatic events with the understanding and compassion of an adult.

    On the cutting edge of mental wellness is the exploration of the effects of childhood trauma on the long-term health of human beings. Dr. Robert Block, former President of the American Academy of pediatrics remarked, “adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today.”

    American pediatrician Nadine Burke Harris looks at how exposure to adversity and trauma during their developmental years leads to mental health diagnoses such as ADHD, anxiety and depression. She points out the negative effects of trauma on the developing brain and immune systems of children, as well as how traumatic events can develop into chronic stress, and even PTSD.

    Her viewpoint that health issues can be rooted in adverse childhood experiences (ACE) runs counter to the popular understanding of illness, which presumes strictly material causality and dismisses intangible psychological factors. A 1990’s study on ACE, however, demonstrates significant corollaries between trauma and lifelong health, linking them to illnesses and high-risk and impulsive behaviors such as drug addiction.

    "Adverse childhood experiences underlie many health problems. As researchers followed participants over time, they discovered that a person’s cumulative ACEs score has a strong relationship to numerous health, social, and behavioral problems throughout their lifespan, including substance use disorders. Furthermore, many problems related to ACEs tend to be comorbid (co-occurring with a primary disease or disorder)."

    Counseling, psychotherapy and even prescription psychotropic medications may be used to help people resolve traumatic experiences, but some view this type of healing as an issue of spiritual health. Dr. Gabor Mate looks at severe drug addiction as the result of childhood trauma, treating some patients with the ceremonial use of Ayahuasca.

    Approaching trauma with the use of psychedelic plant medicines can be quite effective, and the African plant medicine iboga is uniquely powerful in this regard. Ingestion of this sacred medicine is known to induce a powerful and visionary psychological experience which allow the participant to review and relive key moments of their past.

    "Iboga is a psychoactive plant medicine derived from the root bark of the Iboga tree, found in certain parts of Africa. It is administered ceremonially in rites of passage and healing ceremonies tended to by master shaman who have successfully negotiated the spiritual realms into which the medicine plunges its participants. It is known for its power to bring a person into direct contact with the realms of the deceased, and also for allowing a person to see deeply into their past in a way that permits open communication with themselves as they were in the past. The psychoactive journey typically lasts for up to 36 hours and dramatically detoxifies the physical body, as well as the psycho-spiritual body."

    Remarking on how iboga assists patients with sever PTSD, Gary Cook of Iboga Wellness in Costa Rica said:

    "People that have gone through the iboga process to work on their PTSD describe the experience as comparable to 10 years of therapy compacted into a week. Iboga gives you a chance to go deep. It not only helps with detoxing the body, but the mind as well. As long as the person is open and willing to work on themselves, iboga is a powerful tool. Many people have said that it gave them a chance to relive a traumatic event from an observer’s point of view. During a retreat they were able to forgive and move on, experiencing closure for the first time. Also, it gave their body a chance to detox from anti-depressants that they have tried with no success. Every person has a unique life, therefore every person has a unique journey."

    The journey itself is an adventure through the timeless realms of consciousness and the cosmos, looking at the entire library of information about one’s life, and making corrections and connections to rewrite the present by re-integrating the past and understanding the future.

    I commented on this experience in a 2014 article entitled Opiates, Iboga and the Roots of Self-Destruction:

    “…the shaman will guide the patient in iboga journeys, opening up an introspective experience where a connection is made with an over-soul or cosmic consciousness that assists the mind in a deep examination of the self from an objective, omniscient and timeless perspective. In this, a process unfolds which unravels one’s past, offering life-changing insights and liberation from accumulated self-judgments and harmful thought patterns."

    "For 12-24 hours the patient lies still, with blindfolded eyes, in a dream-like state where the brain behaves as if in REM sleep, but while the conscious mind remains awake, very alert and able to interact with and direct the content of the mental journey."

    "As the experience deepens, the barrier between the conscious and sub-conscious mind seems to dissolve, and the information in the sub-conscious mind becomes available for review and rejection by the reflective self. During this experience, a lifetime’s worth of memories, emotional impressions, false judgments and psychological conditioning that combine to inform and instruct the self are presented to the patient in rapid fire fashion… a high velocity behind-the-scenes tour of one’s personality. A new impression of one’s character emerges, and they are given an incredible opportunity to re-assess or reject misunderstood feelings, traumatic events, negative self-images, and habitual behaviors.”
    ~Dylan Charles

    While the term adverse childhood experiences typically refers to severe physical or sexual abuse and/or emotional neglect, often, seemingly less significant events can also cause a lifetime of problems.

    As an example, I like to tell the story of a friend who was able to overcome 54 years of emotional turmoil in one night during a powerful iboga journey. Going into the ceremony, she set the intention of working to understand why she had always had night terrors and high anxiety over an event which happened when she was less than two years-old.

    For her entire life, she was carrying around the terrorizing imprint of this shocking event, which had all this time remained incomplete in her mind, leaving her confused and resentful. All she could remember was being stuck in a crib, screaming for help, as her mother and aunt came and went in a frenzy, totally ignoring her.

    During her journey, she asked to relive this moment, and she did so, but from the perspective of herself as an adult, having a better understanding of human behavior and dramatic situations. Seeing herself in the crib in startling clarity, she was able to explore this event, and she discovered that this terrible memory was of the day her father had a heart attack.

    She was able to see her father, collapsed in the hallway outside of her room, as her mother and aunt worked frantically with the medical crew to ensure his survival. Until this moment, she had never before understood why she felt so scared, confused and ignored,

    Iboga gave her the ability to see what had really happened, and she was able to instantly forgive her family and herself of any enduring blame or guilt about the traumatic event. In the morning she was a brand new person, with a light and bright smile on her face. It was a life-changing and liberating realization for her.

    Final thoughts

    The efficacy of psychedelic plant medicines in treating the root causes of trauma, addiction, disease and behavioral disorders is being demonstrated by a growing body of research and experiential evidence. And as more and more personal accounts of such journeys are presented online, we inch closer to an integration of these medicines into the contemporary scientific worldview.
    Last edited by mr peabody; 04-01-2019 at 07:13.
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    How psychedelic drugs are changing lives and transforming psychiatry

    Meet three people whose lives have been transformed by psychedelic drug research

    For decades, hallucinogens have been associated with technicolour dance floors, sitar-driven Beatles tunes and the controversial evangelism of Timothy Leary.

    But today, drugs like LSD and MDMA are undergoing a radical transformation — from party drug to potentially revolutionary treatment tool.

    Around the world, clinical trials are examining psychedelic drug therapy as a possible treatment for everything from PTSD to cigarette addiction.

    To date, many of the studies have been preliminary, with small sample sizes.

    But experts say MDMA and psilocybin — better known as ecstasy and the key ingredient in magic mushrooms — could be available for prescription use within the next five years.

    Earlier this year, Day 6 spoke with the researchers behind the studies — and the patients who say psychedelic therapy has changed their lives.

    Here are some of their stories.

    The army veteran

    On Christmas Eve in 2006, Sergeant Jon Lubecky put a gun to his temple and pulled the trigger.

    He was at peace with the decision to end his life. But the bullet never came.

    Earlier that year, Lubecky had suffered a traumatic brain injury during a mortar strike on the base where he'd served in Iraq. When he returned to the United States, he was diagnosed with severe post-traumatic stress disorder.

    "I'd wake up hearing explosions that weren't there," he recalled.

    For eight years, Lubecky struggled with traumatic flashbacks and severe depression. None of the treatments he tried made a meaningful difference.

    Then, in 2014, a medical intern handed him a cryptic note that said: "Google MDMA PTSD."

    Later that year, with a trained therapist at his side, Lubecky took ecstasy for the first time.

    He was one of 24 participants in a small study in Charleston, South Carolina using MDMA-assisted psychotherapy to treat severe, treatment-resistant PTSD.

    Years later, he says his PTSD symptoms are largely gone.

    "It was a miracle that changed my life."

    He wasn't alone: 67 per cent of the study's participants were still PTSD-free one year after their treatment.

    In 2018, researchers launched a Phase 3 clinical trial looking at MDMA-assisted psychotherapy in collaboration with Health Canada and the FDA.

    If their findings line up with earlier studies, they say MDMA could be a legal prescription drug by 2021.

    Other psychedelic compounds could be on a similar path — and mental health advocates aren't the only ones taking note.

    George Goldsmith first became aware of the renaissance in psychedelic drug research when his son, who suffered from treatment-resistant depression, was treated with ketamine.

    In 2016, Goldsmith became the co-founder of Compass Pathways, one of the first for-profit companies seeking capitalize on psychedelic drug research.

    He believes psilocybin, the key ingredient in magic mushrooms, could be a legal prescription drug as early as 2022.

    Lubecky believes psychedelic therapy has the potential to eradicate PTSD.

    "I have really high hopes."

    The medical student

    Octavian Mihai was officially declared cancer-free in 2013, but his mental health was steadily getting worse.

    At 21, the NYU student was terrified that the cancer might come back. After his treatment ended, those worries spiralled out of control.

    "It was just crippling anxiety," he said.

    Deeply concerned for his mental health, his doctor put Mihai in touch with a team of researchers at NYU who were studying psychedelic therapy as a possible treatment for anxiety in cancer patients.

    Later that year, after weeks of careful preparation, Mihai put on a pair of noise-cancelling headphones and ingested a little white capsule of psilocybin.

    He spent the next eight hours on an intense psychedelic journey — one that lifted him outside himself, and ultimately helped him overcome his fear of dying.

    "I lost complete sensation of my body, and I just lifted myself to a different plane," he said.

    Researchers are still working to determine exactly how psychedelic drugs affect the mind.

    According to psychologist Alison Gopnik, psilocybin decreases activity in the brain's "default mode network," which is responsible for generating our sense of self.

    Gopnik believes the disruption of that network could increase our flexibility in thought, paving the way for new perspectives.

    "What psilocybin seems to do is to push an adult brain back more to that state of exploration and learning," she said.

    Five years later, Mihai's cancer-related anxiety has never returned.

    "I've lived every day not worried about it."

    The lifelong smoker

    For nearly 40 years, cigarettes were Alice O'Donnell's constant companion.

    "Cigarettes were the crutch," she said. "I finally reached the point that I could not go to sleep at night unless I knew I had at least a half a pack of cigarettes available for morning."

    Over the years, she tried unsuccessfully to quit many times. But after a Pilates class left her on the verge of collapse, she decided to ditch the habit for good.

    Shortly thereafter, in 2012, she enrolled in a Johns Hopkins University study using psilocybin as a tool for smoking cessation.

    The drug induced powerful hallucinations, including a disturbing vision of her own damaged lungs.

    Alice never smoked again, but she says the drugs had other benefits as well: "Just the whole expansion of my thought processes; realizing how great the universe is out there," she said.

    Researcher Matthew Johnson, who helped facilitate Alice's psychedelic therapy, likened the experience to a "crash course in meditation."

    Those apparent benefits lead some academics, including Jules Evans, a philosopher who studies "ecstatic experiences," to speculate that psychedelic drug therapy could eventually become a mainstream wellness practice.

    Is psychedelic drug therapy on track to become as ubiquitous as meditation?

    Evans believes many people could benefit from access to the drugs. But he also warns that experiences like Alice's are far from inevitable.

    Rather, they tend to be shaped by the expectations of researchers and therapists who serve as guides.

    "The music that they play is going to affect your trip; the instructions that you get on the trip are going to guide it," Evans said. "The way that your therapist helps you to make sense of your experience will shape it as well."

    Moreover, for people who are predisposed to conditions like schizophrenia, the drugs can have negative long-term consequences.

    Nonetheless, O'Donnell hopes clinical psychedelic therapy will become more widely available in the future.

    "I definitely think others could benefit from it."
    Last edited by mr peabody; 06-01-2019 at 10:04.
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    Psychedelic Psychedelic - A Conversation With 3 Underground Providers

    Psychedelic psychotherapy is coming.

    In the face of excellent science and fine-tuned bureaucratic efforts, psychedelics are making their way out of their Orwellian prohibition and back into medicine. Psychedelic psychotherapy, including substances like MDMA, psilocybin, LSD, ketamine, and Ibogaine, are being shown to be effective treatments for post-traumatic stress disorder, treatment-resistant depression (and here), (cigarette, alcohol, and opiate) addiction, and existential anxiety at the end of life.

    Psychedelic psychotherapy is on the verge of bursting into the mainstream institutions. MDMA (methylenedioxymethamphetamine) is currently in phase 3 trials in the united states for the treatment of post-traumatic stress disorder. It has been labelled a breakthrough therapy designation by the FDA. COMPASS pathways, (like ’em or not), have recently received FDA approval for psilocybin clinical trials for treatment-resistant depression. Furthermore, doctors in Canada are on the verge of offering therapeutic psilocybin for people in end-of-life distress based on scientific evidence and a strong legal argument.

    Yes, psychedelic psychotherapy is coming… in fact, it’s already here.

    As the legal, academic, and medical institutions work steadily to bring psychedelic psychotherapy into the mainstream, a thriving underground network of psychedelic therapists are already operating despite the potential legal ramifications of their action. Free from institutional oversight, underground psychedelic psychotherapy is a mixed bag.

    The vast network of underground psychedelic psychotherapy is able to explore whole new realms of potential benefit through experimentation and following what works. Yet this same capacity can lead to unethical, ineffective, or even damaging results. It is being offered discreetly by aboveground certified clinical professionals in counselling and therapy, it is also being provided by people with no training at best or even megalomaniacal delusions of grandeur at worse. But, let’s not dwell too deeply on the antagonists of this network and instead focus on those providing quality care, and risking their careers and their freedom to offer people therapy that works where none other did, changing people’s lives for the better.

    Today’s guests for the podcast — three female, underground psychedelic therapists from Canada — are on the show anonymously to share their wisdom, experience, and knowledge of psychedelic psychotherapy. Specifically, we talk about psilocybin, MDMA, and 3-MMC assisted psychotherapy; their methodologies and practices; cautions and concerns; and an in-depth look at both what it is like and what it takes to be an underground psychedelic psychotherapist.

    This is an episode for anyone interested in psychedelic psychotherapy, be it as a current or future provider, or someone who is seeking it for their own health and healing.

    Episode breakdown

    - What models of therapy are being offered and what substances are being used

    - How they decide what substance is best for each client

    - What are the differences in methodology for different substance?

    - Red flags

    - Does the therapist take the dose as well?

    - Who’s in the room? How many therapists, sitters, clients and why?

    - How to address panic and anxiety attacks during psychedelic sessions

    - Some cautions in finding a psychedelic therapist

    - Specific needs for providing psychedelic therapy to people in their sick time.

    - Death anxiety within psychedelic therapy

    - Providing psychedelic therapy to minors

    - Integration practices and perspectives.

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