This year’s Interdisciplinary Conference on Psychedelics Research (ICPR) was host to high ranking institutions such as NYU, Johns Hopkins University, Imperial College, and Maastrict University, with evidence presented by researchers and clinicians, such as Kim Kuypers, Roland Griffiths, William Richards, Jordi Riba, and Robin Carhart-Harris, to name a few. The new revival of psychedelic research appears to be gaining momentum, and organisations such as the Beckley Foundation and Multidisciplinary Associations for Psychedelic Studies (MAPS) are moving to train therapists and clinicans to use psychedelics in an evidence based psychotherapeutic process.
Psychedelics such as Ayahuasca, Psilocybin, MDMA, Mescaline, and Peyote were all touched upon, as presentations ranged from the pharmacokinetic and pharmacodynamic properties of psilocybin in healthy volunteers, to the qualitative analysis of ‘ego-dissolution’ experiences from the trip report website Erowid.org. The conference also discussed much of the necessary safety protocols proposed in research and therapy, emphasising the importance of participant screening, setting of therapy, and appropriate dosage.
Clinical research using new interventions look for treatents to be able to show effectiveness in Randomised Control Trials. This is where participants are randomly allocated to either receive the treatment, or a placebo. In a double-blind trial, neither the researchers nor the participants are aware which treatment they are receiving. These trials will look out for significant changes in participants (e.g. less depression symptoms), and assess whether the same changes occured in the placebo trials. If groups aren’t significantly different, it’s quite difficult to attribute the effect to the treatment alone.
Psychedelic research in its current state is still early stage, but remains progressive, with a number of double-blind randomised control trials completed, and Phase II and III clinical trials in progress or planned. These have shown significant reductions in clinical symptoms, measured using clinical scales, such as the Beck Depression Inventory, State/Trait Anxiety Inventory, and the Hamilton Rating Scale for Depression. While these clinical outcomes have been persistent (up to around 6 months), the long term follow up results are still being collected and analysed.
The experiences associated with this form of pharmacological treatment appear to be quite unique, with qualitative and experiential evidence reporting loss of a sense of time and space, ‘ego dissolution’ (dissolving your sense of self), encountering or feeling the presence of strange beings (a sense of presence), a sense of knowing ‘ultimate truths’, as well as a host of sensory synaesthesia. There is another aspect to the experience, which is often described as ‘ineffable’, or unable to be described. This understandably makes it quite hard for science to do its thing. Nevertheless, the types of experiences that are described are often termed ‘mystical-like’ or ‘mystical’ experiences in the research, and sound a bit abstract and fantastical, but to the individuals involved in the trials it has been reported as highly meaningful and insightful.
However, the range of individuals involved in these trials are often quite narrow. The participants in the research are mostly well educated, often have previous experience with psychedelics, and are usually relatively small in number, and so it will be interesting to follow the results as differences in sample size and socio-economic status are used.
Despite this, current research suggests that psychedelics used to treat individuals who are suffering the most (such as treatment resistant depression or terminal cancer patients) provides an invaluable resource to heal, to understand their situation with a new perspective, and provide hope when all seems lost. The reports from participants presented at the conference demonstrate the great weight of depression that was lifted off their shoulders, with one individual stating ‘I felt like I did before my depression’.
Often at the end of each day at the conference, a panel of leading researchers or therapists in the field would come together to answer any questions the audience members may have. The current paradigm that seems to be favoured at the moment in therapy sessions is that of depth psychology, using psychoanalytic and psychodynamic principles, with a dyad of therapists (one male and one female) working with the client. This therapeutic work was described as a necessary preliminary phase to the dosing stage, and was around 3-4 sessions. Questions came to the panel from other health care professionals in the audience about the use of alternative frameworks to be used alongside psychedelic therapy, such as Acceptance and Commitment Therapy, and Cognitive Behavioural Therapy. Whether psychedelic therapy will have the same, worse, or better efficacy using the other frameworks will be an interesting direction of research. Because of the time and labour intensive nature of psychodynamic therapy, the current model of psychedelic treatment may mean that the treatment option is only available to a low number of individuals, or for those who can pay. This poses quite an issue for accessibility to a wide population, or those from low socio-economic backgrounds. However, these questions will hopefully be answered by future research and exploration into the therapeutic technique.
When approaching this issue in a scientific manner, the recent research into the use of psychedelics seems to be creating quite a strange dilemma in psychiatry. The experiences associated with psychedelic journeys and mystical experience have often been most associated in main stream psychology with low impact research, dubious methods, new age spirituality, or pathologised as psychotic experience. Yet now psychiatry and psychology is faced with a situation where the strange process of delving into the mind using psychedelics has been suggested as an exciting revived potential for healing.
Since the enlightenment, our understanding of ourselves and our environment has moved further away from religious ideals and embraced a scientific understanding of the human experience. However, the movement toward psychedelic therapy and research is now on the rise, which brings an experience which has been traditionally described exclusively by mystics and religious figures throughout history. With religion and the belief in a literal external personification of God receding, and secular reason, science, and philosophy persevering to fill the space, we are currently left with a sort of spiritual vacuum. In our modern society, clearly there is still a very human need to connect and experience something which brings a new clarity on ourselves, or to experience something transcendent and out of our ingrained and rigid thought processes. So, how can a scientific society aim to fulfil this requirement without using the potential baggage and issues of traditional religious frameworks?
Early 20th Century psychology and anthropology attempted to fill this difficult void by proposing a psychological perspective on the dive into the human experience. Individuals such as Carl Jung, Karl Jaspers, and Joseph Campbell, while often criticised, nonetheless saw anomalous experience associated with psychosis or acute religious experience as potentially meaningful and transformative. This was thought to be shared across cultures in the form of mythological and spiritual frameworks, to guide and shepherd those through challenging times, and provide understanding into the human experience.
In psychosis research, the discovery that many individuals outside of clinical care experience anomalous perception is very interesting. This suggests the need for a more sensitive to anomalous perception than simply labelling it as a pathological disorder, and asks psychiatric research to also look at the context in which we have our experiences, whether that leads to a destabilising, benign or positive effect.
In psychiatric research, the context of mystical experience appears to be something which has so far only been accepted in religious or spiritual frameworks, or is often pathologised as psychotic. Now however we have emerging psychedelic research that suggests a controlled and safe context in which to potentially encounter these experiences. Psychiatry has discredited the role of the traditional Shaman and the Mystic in offering a viable healing practise to treat our modern crises, so where are individuals to turn to try and understand the strange experiences that may await them through the use of psychedelic therapy? Anthropological and cultural research has demonstrated the diversity and oddity of the human experience, and now psychiatric thought must tread carefully and thoroughly to understand the psychedelic experience without diminishing the different levels of meaning and depth that this therapy may hold for those using it.
To progress, psychiatry may work together with multiple disciplines so that a broad and comprehensive understanding of the experience is generated to create the best support for those using it. This is alongside careful research that documents and inquires into the variety of experience, neurologically, psychologically, and socially. The role of the secular shaman may be making an appearance in Psychiatry, with health care professionals taking on the role of an individual who is able to empathise and understand the deep and strange internal experience of those who use psychedelic assisted therapy.
Moving forward, there are many research avenues left to explore. The creation of a broad and comprehensive qualitative database of varying psychedelic experience is underway, as are the biochemical, clinical, and physiological effects of the experience. The ability for psychiatry and psychology to have a rich and open minded scientific attitude, with evidence based research, will support this exciting new option that may be opening up for those who have no where else to turn. This includes understanding when it may be supportive or destabilising, along with the mystical and the ordinary aspect of the process. This will highlight for whom is may be appropriate for, as well as the proper grounding work that may need to be done first before individuals are ready to take the leap. The emphasis of set, setting, and dose was constantly highlighted at the ICPR 2016, and progressing in this way will mean the topic is approached with proper guidance, care, and maturity.