Yuletide Enumerations

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Kaleidoscopic Interventions

If the doors of perception were cleansed everything would appear to man as it is, infinite. – William Blake (popularized by Aldous Huxley)

As a co-occurring therapist, I have spent more time discussing the liabilities of illegal drug use and how to avoid its psychosocial consequences than I have spent considering the potential utility value of specific substances for therapeutic purposes. Admittedly, it would seem counter intuitive and taboo for a mental health specialist to suggest that using a legally prohibited drug could be explored as a supplemental method for treating drug addiction in treatment-resistant patients let alone for mitigating symptoms of anxiety, depression, or recurring headaches.

In 1938 a Swiss scientist named Albert Hofmann synthesized an ergot derivative (grain fungus) to produce a molecular compound know as LSD (Lyseric acid diethylamide) for the purpose of creating a respiratory stimulant. After an unexpected lab accident, Mr. Hofmann experienced the direct effects of this mind-altering agent on human cognition and realized an endless sea of psychic possibilities. By the 1940s, LSD was intended to be a used for psychiatric prospects as a Schedule III drug (accepted for medical use with potential for abuse). However, after subsequent experimentation with LSD by the CIA and as a cautionary reaction against widespread public recreational use during the 60s, LSD became classified as a Schedule I drug (illegal, with no accepted medical use). Vilification and prohibition by the Federal Government further reinforced ideas about the inherent dangers of psychedelic substances and prematurely ended psychiatric experimental research on LSD. Nonetheless, many cultural icons of the 60s (Timothy Leary, Allen Ginsberg) continued to espouse the usefulness of the drug for tapping into unexplored reservoirs of consciousness. Fast forward to the twenty-first century, when a resurgence of interest in psychedelic research and its potential for therapeutic applications has reignited both fascination and controversy among the psychiatric community and general public.

What do we actually know about psychedelic drugs and why are they considered dangerous by many? In fact, there are several other hallucinogenic substances that have also been the source of recent debate in today’s sociopolitical atmosphere (MDMA, marijuana, psilocybin). In 1970, psilocybin (the molecular compound in “magic” mushroom spores) became classified as a Schedule I drug under the Controlled Substances Act with severe penalties for consumption or possession. Likewise, the federal laws for medical marijuana use have never been eager for rapprochement despite minor exceptions in select states. Certainly this reputation cannot be justified by scientific research since we know that drugs with the most potential for dependence coupled with the greatest risks to long-term health are already legal for consumption (i.e., alcohol, tobacco). Furthermore, there has been no evidence to demonstrate that hallucinogenic drugs can actually lead to physiological dependence. Without turning this essay into a platform for drug legalization polemics, it may be best to understand why exactly so many psychiatric specialists have taken an interest in psychedelics as potential treatment for those who have failed to respond to normative modalities. But, before we do that, we must first make sure we are being transparent about what these specialists are suggesting. To be clear, unregulated drug use for therapeutic purposes is not advisable and no responsible mental health clinician that I know of has proposed otherwise. Any potential treatment benefits from psychedelics are meant to be ascertained after the drugs are administered in a controlled environment with a carefully calibrated dose under close supervision. An inspection of how psychedelic properties are theorized to work at the level of the brain may provide a more comprehensive understanding of why they may be useful in particular circumstances.

Psychedelic-assisted psychotherapy has been implemented primarily in treatment-resistant patients suffering from PTSD, social anxiety, substance dependence, and cluster headaches. Although many details are opaque, the proposed mechanism of action for psychedelics such as LSD and psilocybin purportedly involves a combination of reduced blood flow to the cerebral cortex while innervating serotonin receptors throughout the brain. The agonist properties of specific hallucinogens create a simulacrum of serotonin and are referred to as serotonergic. The intended effect of therapeutically administered psychedelics would be to elicit the “optimum arousal zone” of the brain by allowing regulatory cognitive filters in the cerebral cortex to diminish thereby eliciting the sensory and emotional areas of the brain below the thalamus. A described synergistic effect of vivid realization may take place where the patient is able to purge psychic detritus such as anger or excessive fear.

Neuroscience has shown that the brain evolved for purposes of processing limited information without becoming overwhelmed by competing neuronal data streams. As a result, the brain’s navigation system provides an automatic elimination process so that unnecessary neuronal activity can be pruned to ensure optimum mental focus for purposes of daily functioning and basic survival. Serotonergic psychedelics increase neurotransmitter activity to stimulate areas of the brain that have been deactivated or over-activated because of trauma, anxiety, depression, chronic pain, or substance abuse. However, the psychological effects of psychedelics can vary greatly depending on the individual, the therapeutic setting, and the dosage. Likewise, screening patients who are willing to try psychedelic intervention is equally important. Of course, a caveat remains regarding the possible over-stimulation of the limbic system in some patients who cannot tolerate any diversion from a neurotypical range of experience. For these individuals, a strong dose of psychedelics in the wrong setting may result in a “bad trip” that could lead to adverse emotional reactions, increased anxiety, or terrifying experiential results. Emphasis on the importance of dosage purity, the amount ingested, and careful monitoring in a clinical setting could make all the difference between patients experiencing euphoric cognitive breakthroughs or descents into unhinged paranoia. One must also keep in mind that these substances would only be used intermittently as a catalyst for activating dormant neuronal pathways and are not intended to be a comprehensive solution for eradicating mental illness.

Several non-profit organizations, including the Multidisciplinary Association for Psychedelic Studies (MAPS), have been promoting new research into psychedelic treatment possibilities for a variety of psychiatric disorders. In addition, a recent book by author Tom Shroder entitled Acid Test: LSD, Ecstasy, and the Power to Heal has been keeping this topic in the forefront of modern psychology while documenting many success stories from advocating practitioners and their patients.

If your eyebrows have lifted beyond peak elevation after reading this, keep in mind that modern psychiatry is not promoting the lifestyle of Jim Morrison as a means for achieving optimum well-being. One day chemists may be able to isolate the hallucinogenic properties of psychedelic compounds to make these substances eligible for pharmaceutical use. Until then, what a long, strange trip it will continue to be.

For more information contact: www.maps.org

(This article is scheduled to appear in the NPI Newsletter, Winter 2014).