On 19 April 1943, Swiss chemist Albert Hoffmann ingested a small dose of a chemical he had synthesised and experienced the world’s first LSD trip. His experience ushered in two decades of experimentation and clinical research into psychedelic drugs until it was cut short by prohibition in 1970.
75 years on, the USA seems poised to start licensing psychedelics for the treatment of mental illness. This may not only lead to a huge breakthrough in psychiatry but may also mean that we are approaching a time when human beings are once again free to take whatever mind-altering substances they fancy without fear of sanction from the state.
The word “psychedelic” means literally “mind-revealing” and was coined by British psychiatrist Humphrey Osmond (who amongst other claims to fame gave rightwing Labour MP, Christopher Mayhew, a dose of mescaline for a 1955 BBC documentary). It refers to plants and fungi like peyote cactus, psilocybin mushrooms, ayahuasca and chemicals such as mescaline, DMT and LSD. Some people include cannabis, MDMA, ketamine and other substances.
These are not generally drugs of abuse. Unlike alcohol, cocaine, nicotine and opiates these are not habit forming or addictive. Even the most hardcore enthusiasts take these substances infrequently and usually with careful consideration to “set and setting” (i.e. their own state of mind and the environment they take the substance in). Recent research shows that these are some of safest drugs for the individual and least socially harmful.
In the brief period before these substances were outlawed they were used in psychiatry with promising results. Czech psychiatrist, Stanislav Grof used LSD in his clinic, giving hundreds of people LSD psychotherapy over a 17 year period. These involved giving patients LSD in a clinical setting and then offering psychotherapy during the trip which lasts between 8-12 hours.
Grof explains that in 1965 in Czechoslovakia LSD was “being legally manufactured by the leading pharmaceutical company, it was listed in the official medical pharmacopeia as a therapeutic agent with specific indications and contraindications... and was freely available to qualified professionals as an experimental and therapeutic agent.” He claims that by the early 60s LSD was “firmly established” in psychiatric practice and training. Grof developed a theory of how LSD facilitated mental health recovery based on direct experience of 2,500 LSD therapy sessions and from the records of 1,300 sessions run by his colleagues in USA and Czechoslovakia. He came to see LSD as an “amplifier of the unconscious” that significantly sped up the recovery seen in traditional psychotherapy.
In his book Realms of the Human Unconscious (1975) Grof describes how through successive LSD psychotherapy sessions, patients are able to process ever deeper levels of repressed psychic material. Grof describes how patients invariably work through the traumatic material of adulthood and then childhood (the psychodynamic level described by Freud) before moving onto experiences which he interpreted as related to birth trauma (following psychoanalyst Otto Rank). For his patients who reached this level there was a “dramatic alleviation or even disappearance of previous psychopathological symptoms and a decrease in emotional problems of all kinds.”
Grof claims that people who have dealt with this psychic baggage then tend to have “transpersonal” experiences defined as “beyond the usual ego boundaries of space and time.” This is the most controversial aspect of Grof’s work and led him to join others in making wild claims about mysticism and the occult.
It is perhaps because of those speculative claims that this work was never been subject to any serious criticism. Instead the use of psychedelics in psychiatry was quietly forgotten after prohibition in 1970.
A few individuals kept the memory of this groundbreaking treatment alive. The new generation are keen to not repeat the mistakes of their forebears and ensure that all their arguments are firmly grounded in empirical research.
The US-based Multidisciplinary Association for Psychedelic Studies (MAPS) has, since its humble beginnings the 1980s, been working away to get government approval for clinical trials into psychedelic drugs.
Just last year MAPS was granted FDA (Food and Drug Agency) approval to start Phase 3 trials into MDMA-assisted therapy for “treatment resistant” post-traumatic stress disorder.
The trials are about to start. Doblin believes that MDMA will be licenced for use in the treatment of mental disorders by 2021. The results of the smaller scale phase 2 trials are astonishing. Post-traumatic stress disorder is a life-threatening condition characterised by depression, anxiety, flashbacks and dissociation that affects victims of trauma — sexual assault, child abuse, war, or even a car crash. The study recruited 26 individuals, including war veterans and firefighters, some of whom had suffered with this condition for decades. None of the standard therapeutic approaches had worked.
After just two full dose MDMA-psychotherapy sessions 68% of participants no longer met the diagnostic criteria for PTSD. Follow-up after a year found that the patients had sustained their recovery without further relapse. Phase three trials involve many more patients and are the last step before MDMA can be licenced for use as a therapeutic agent.
Unlike all other branches of medicine, psychiatry has made no significant advances in the past half century. We are living in the midst of a mental illness epidemic with no treatments except the blunt instruments invented two generations ago.
Traditional psychiatric medicine treats symptoms but does not offer a cure. Antipsychotics, mood stabilisers, anxiolytics and antidepressants all dampen down emotional distress but do not address the underlying causes of this distress. The approach of MAPS and their cothinkers is fundamentally different.
Their idea is to use psychedelic substances to facilitate a therapeutic or healing experience. The drug is taken just a few times in a safe environment with trained therapists. MDMA allows the patient to access traumatic memories without the usual extreme fear responses.
It simultaneously enhances thoughtprocessing areas of the brain that allows the patient to rethink and reframe distressing and pathological attitudes and habits.
The MAPS therapy typically involves a few drug-free psychotherapy sessions with two therapists, then psychotherapy sessions with the same therapists on the drug. Observers say that surprisingly little talking takes place during these six-hour sessions but invariably there is discussion of traumatic incidents from the past. The patient stays overnight at the clinic and returns home the next day. There is some follow-up to consolidate.
According to UK-based Consultant Psychiatrist Ben Sessa, MDMA will do for mental disorders what antibiotics did for infectious diseases. To use his analogy, it is the difference between treating an infection with paracetamol (which will help alleviate symptoms of pain and fever) versus antibiotics (which combat the pathogens causing the infection).
Whilst PTSD is a distinct diagnosis, a large body of evidence suggests that trauma plays a substantial part in most mental illness. This approach to treating PTSD could have wide application to a large number of psychiatric conditions. Many smaller scale research projects are finding promising results for a whole range of conditions from depression to (counterintuitively, perhaps) drug and alcohol addiction and these studies are looking at a whole range of class A (or in the USA schedule 1) psychedelics. US drug policy dictates drug policy around the globe. If the MAPS trial is a success — and every indication suggests it will be — then it will not only be a major step forward for mental health treatment but also in the battle to liberate us our minds and brains from a strict diet of drugs that includes only alcohol, caffeine and tobacco.
There are some important aspects of this work that are of interest to socialists. First, this approach would not have been pursued by Big Pharma. MDMA is off-patent so there is little profit to be made in producing it. Also the treatment requires only a few doses resulting in a cure — a far less lucrative prospect than daily, lifetime dependence on traditional psychiatric drugs.
The MAPS initiative shows up one of the many blind spots of the capitalist enterprise. If the giant pharmaceutical companies with their vast resources missed this opportunity to address one of the great health crises of our times then what does that mean for other sectors of the economy? What is the energy industry missing due to its profitgreed?
What might agriculture look like if it was not driven by market-forces? Second, the approach is based on the idea that our minds, like our bodies, have a natural tendency to heal from trauma given the right support and circumstances. It is a very hopeful idea that we can overcome even the most intractable mental illness and survive the most life-shattering trauma. It speaks to a humanism that is at the heart of the socialist project.
Third, for members of the Labour Party this is an opportunity to make amends for at least one crime of the Blair-Brown administrations. Leading the psychedelic field in the UK is Professor David Nutt who heads a research team at Imperial College London.
Nutt was unceremoniously sacked as Gordon Brown’s drugs czar in 2009 for having the temerity to say that the science showed MDMA, LSD and cannabis are less harmful than alcohol and tobacco.
Lastly, capitalism produces lots of wonderful things, but in 2018 it also produces a lot of mental illness. In his book The Selfish Capitalist (2008), Oliver James argues that the epidemic of depression and anxiety sweeping the advanced capitalist world is linked to the shallow values our societies nurture — dogeat- dog individualism and the pursuit of fame, beauty and wealth above all else.
If MDMA-assisted therapy is offering a breakthrough cure then it is by implication offering people a re-evaluation of their life’s values; values which, if James’ research (and our Marxist understanding) is correct, are dominated by the capitalist world we all inhabit.
If a breakthrough treatment is in sight then potentially a large number of people of previously anxious and depressed people are going to be reimagining their values and their futures. Already some interesting research has found that people who took psilocybin for depression had a significant increase in “nature-relatedness” and decrease in “authoritarian attitudes”.
21st century capitalism creates a world in which 25% of people suffer mental illness. What social change might be generated by a cure?
References Devereux, P The Long Trip (1997) Grof, S Realms of the Human Unconscious (1975) James, O The Selfish Capitalist (2008) Lyons, T and Carhart-Harris, R. Increased nature relatedness and decreased authoritarian political views after psilocybin for treatment-resistant depression Journal for Psychopharmacology (18 January 2018) Mithoefer, M.C. et al 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial, The Lancet Psychiatry (1 May 2018) Sessa, B Is MDMA psychiatry’s antibiotic? (TedX talk June 2016) http://www.youtube.com/watch?v=UygZ nBTWW0M#action=shar