Why Psychedelics Could Be the Future of Mental Health
At 6:30am, Friederike Meckel Fischer's doorbell rang. There were 10 policemen outside. They searched the house, put handcuffs on Friederike -- a diminutive woman in her 60s -- and her husband, and took them to a remand prison. After a few hours, Friederike, a psychotherapist, was taken for questioning.
The officer read back to her the promise of secrecy she had each client make at the start of her group therapy sessions. "Then I knew I was really in trouble," she says.
"I promise not to divulge the location or names of the people present or the medication. I promise not to harm myself or others in any way during or after this experience. I promise that I will come out of this experience healthier and wiser. I take personal responsibility for what I do here."
The Swiss police had been tipped off by a former client whose husband had left her after they had attended therapy. She held Friederike responsible.
What got Friederike in trouble were her unorthodox therapy methods. Alongside separate sessions of conventional talk therapy, she offered a catalyst, a tool to help her clients reconnect with their feelings, with people around them, and with difficult experiences in their lives. That catalyst was LSD. In many of her sessions, they would also use another substance: MDMA, or ecstasy.
Friederike was accused of putting her clients in danger, dealing drugs for profit, and endangering society with "intrinsically dangerous drugs." Such psychedelic therapy is on the fringes of both psychiatry and society. Yet LSD and MDMA began life as medicines for therapy, and new trials are testing whether they could be again.
LSD's inventor notices mood-boosting effects
In 1943, Albert Hofmann, a chemist at the Sandoz pharmaceutical laboratory in Basel, Switzerland, was trying to develop drugs to constrict blood vessels when he accidentally ingested a small quantity of lysergic acid diethylamide, LSD. The effects shook him.
Intrigued, he decided to take the drug a second time in the presence of colleagues, an experiment to determine whether it was indeed the cause. The faces of his colleagues soon appeared "like grotesque coloured masks," he writes.
But he seemed particularly struck by what he felt the next morning: "Breakfast tasted delicious and was an extraordinary pleasure. When I later walked out into the garden, in which the sun shone now after a spring rain, everything glistened and sparkled in a fresh light. The world was as if newly created. All my senses vibrated in a condition of highest sensitivity that persisted for the entire day."
Hofmann felt it was of great significance that he could remember the experience in detail. He believed the drug could hold tremendous value to psychiatry. The Sandoz labs, after ensuring it was non-toxic to rats, mice, and humans, soon started offering it for scientific and medical use.
Soon the whole country had heard of LSD.
In the USA, the CIA tried giving LSD to unsuspecting members of the public to see if it would make them give up secrets. Meanwhile at Harvard University, Timothy Leary -- encouraged by, among others, the beat poet Allen Ginsberg -- gave it to artists and writers, who would then describe their experiences.
When rumors spread that he was giving drugs to students, law-enforcement officials started investigating, and the university warned students against taking the drug. Leary took the opportunity to preach about the drug's power as an aid to spiritual development, and was soon sacked from Harvard, which further fueled his and the drug's notoriety. The scandal had caught the eye of the press and soon the whole country had heard of LSD.
By 1962, Sandoz was cutting back on its distribution of LSD, the result of restrictions on experimental drug use brought on by an altogether different drug scandal: birth defects linked to the morning-sickness drug thalidomide.
Possession of LSD was made illegal in the UK in 1966 and in the USA in 1968. Experimental use by researchers was still possible with licenses, but with the stigma attached to the drug's legal status, these became extremely hard to get. Research ground to a halt, but illegal recreational use carried on.
Friederike Meckel Fischer recognized that many of the problems she saw in her patients were rooted in problems with their bosses, colleagues or families. "I came to the conclusion that everything they were having trouble with was connected to relationship issues," she says.
A former professor of hers recommended she try a technique called Holotropic Breathwork. Developed by Stanislav Grof, one of the pioneers of LSD psychotherapy, this is a way to induce altered states of consciousness through accelerated and deeper breathing, like hyperventilation. Grof had developed Holotropic Breathwork in response to bans on LSD use around the world.
The first experience was breathtaking for me.
Over three years, traveling back and forth to the USA on holidays, Friederike underwent training with Grof as a Holotropic Breathwork facilitator. At the end of it, Grof encouraged her to try psychedelics.
In the last seminar, a colleague gave her two little blue pills as a gift. When she got back to Germany, Friederike shared one of the blue pills with her friend Konrad, who later became her husband. She says she felt herself lifted by a wave and thrown onto a white beach, able to access parts of her psyche that were off-limits before. "The first experience was breathtaking for me," she says. "I only thought: 'That's it. I can see things.' And I started feeling. That was, for me, unbelievable."
Ecstasy is more than just a club drug
The pills were MDMA, a drug which had entered the spotlight in 1976 when American chemist Alexander 'Sasha' Shulgin rediscovered it 62 years after it was patented by Merck and then forgotten. In a story echoing that of LSD's origins, upon taking it, Shulgin noted feelings of "pure euphoria" and "solid inner strength," and felt he could "talk about deep or personal subjects with special clarity."
He introduced it to his friend Leo Zeff, a retired psychotherapist who had worked with LSD and believed the obligation to help patients took priority over the law. Zeff had continued to work with LSD secretly after its prohibition. MDMA's potential brought Zeff out of retirement. He travelled around the USA and Europe to instruct therapists on MDMA therapy. At the same time, it had acquired another name in nightclubs: ecstasy.
In Switzerland, a small group of psychiatrists persuaded the government to permit the use of LSD and MDMA in therapy. From 1985 until the mid-1990s, licensed therapists were permitted to give the drugs to any patients, to train other therapists in using the drugs, and to take them themselves, with little oversight.
I have had fear but I didn't feel the fear.
Believing that MDMA might help her gain a deeper understanding of her own problems, Friederike applied for a place on a "psycholytic therapy" course in Switzerland. In 1992, she and Konrad were accepted into a training group run by a licensed therapist named Samuel Widmer.
The course took place on weekends every three months at Widmer's house in Solothurn, a town west of Zurich. Central to the training was taking the substances a number of times, 12 altogether, to get to know their effects and go through a process of self-exploration.
"I can detect relations, interconnections between things that I couldn't see before," she says of her experiences with MDMA. "I could look at difficult experiences in my life without getting right away thrown into them again. I could for example see a traumatic experience but not connect to the horrible feeling of the moment. I knew it was a horrible thing, and I could feel that I have had fear but I didn't feel the fear."
How to test illegal drugs
Robin Carhart-Harris, a psychedelics researcher at Imperial College London, is conducting the first clinical trial to study psilocybin as a treatment for depression. He is one of a few researchers across the world who are pushing ahead with research on psychedelic therapy.
Twelve people have taken part in his study so far. The patients have two therapy sessions: one with a low dose, then one with a high dose. Afterwards, they have a follow-up session to help them integrate their experiences and cultivate healthier ways of thinking.
I meet Kirk, one of the participants, two months after his high-dose session. Kirk had been depressed, particularly since his mother's death three years ago. He experienced entrenched thought patterns, like going round and round on a racetrack of negative thoughts, he says. "I wasn't as motivated, I wasn't doing as much, I wasn't exercising any more, I wasn't as social, I was having anxiety quite a bit. It just deteriorated. I got to the point where I felt pretty hopeless. It didn't match really what was going on in my life. I had a lot of good things going on in my life. I'm employed, I've got a job, I've got family, but really it was like a quagmire that you sink into."
That suppressed feeling has gone.
During the therapy sessions, there were moments of anxiety as the drug's effects started to take hold, when Kirk felt cold and became preoccupied with his breathing. But he was reassured by the therapists, and the discomfort passed. He saw bright colors, "like being at the funfair," and felt vibrations permeate his body. At one point, he saw the Hindu elephant god Ganesh look in at him, as if checking on a child.
Although the experience had been affecting, he noticed little improvement in his mood in the first 10 days afterwards. Then, while out shopping with friends on a Sunday morning, he felt an upheaval. "I feel like there's space around me. It felt like when my mum was still alive, when I first met my partner, and everything was kind of OK, and it was so noticeable because I hadn't had it in a while."
There have been ups and downs since, but overall, he feels much more optimistic. "I haven't got that negativity any more. I'm being more social; I'm doing stuff. That kind of heaviness, that suppressed feeling has gone, which is amazing, really. It's lifted a heavy cloak off me."
What about bad trips?
Since the 1950s, psychiatrists have recognized the importance of context in determining what sort of experience the LSD taker would have. They have emphasized the importance of "set" -- the user's mindset, their beliefs, expectations, and experience -- and "setting" -- the physical milieu where the drug is taken, the sounds and features of the environment and the other people present.
A supportive setting and an experienced therapist can lower the risk of a bad trip, but frightening experiences still happen. According to Friederike, they are part of the therapeutic experience. "If a client is able to go through or lets himself be led through and work through, the bad trip turns into the most important step on the way to himself," she says. "But without a correct setting, without a therapist who knows what he's doing and without the commitment of the client, we end up in a bad trip."
The participants feel as though they were reliving traumatic memories.
Her clients would come to her house on a Friday evening, talk about their recent issues and discuss what they wanted to achieve in the drug session. On Saturday morning, they would sit in a circle on mats, make the promise of secrecy, and each take a personal dose of MDMA agreed with Friederike in advance. Friederike would start with silence, then play music, and speak to the clients individually or as a group to work through their issues. Sometimes she would ask other members of the group to assume the role of a client's family members, and have them discuss problems in their relationship.
In the afternoon they would do the same with LSD, which would often let the participants feel as though they were reliving traumatic memories. Friederike would guide them through the experience, and help them understand it in a new way. On Sunday, they would discuss the experiences of the previous day and how to integrate them into their lives.
Friederike's practice, however, was illegal. Therapeutic licenses to use the drugs had been withdrawn by the Swiss government around 1993, following the death of a patient in France under the effect of ibogaine, another psychotropic drug. (It was later determined that she died from an undiagnosed heart condition.)
The early LSD researchers had no way to look at what it was doing inside the brain. Now we have brain scans. Robin Carhart-Harris has carried out such studies with psilocybin, LSD, and MDMA. He tells me there are two basic principles of how the classic psychedelics work.
The first is disintegration: the parts that make up different networks in the brain become less cohesive. The second is desegregation: the systems that specialize for particular functions as the brain develops become, in his words, "less different" from each other.
These effects go some way to explaining how psychedelics could be therapeutically useful. Certain disorders, such as depression and addiction, are associated with characteristic patterns of brain activity that are difficult to break out of.
The mind gets sucked into these whirlpools and gets stuck.
"The brain kind of enters these patterns, pathological patterns, and the patterns can become entrenched. The brain easily gravitates into these patterns and gets stuck in them. They are like whirlpools, and the mind gets sucked into these whirlpools and gets stuck."
Psychedelics dissolve patterns and organization, introducing "a kind of chaos," says Carhart-Harris. On the one hand, chaos can be seen as a bad thing, linked with things like psychosis, a kind of "storm in the mind," as he puts it. But you could also view that chaos as having therapeutic value.
"The storm could come and wash away some of the pathological patterns and entrenched patterns that have formed and underlie the disorder. Psychedelics seem to have the potential through this effect on the brain to dissolve or disintegrate pathologically entrenched patterns of brain activity."
Will psychedelic drugs ever be legal medicines again?
In the wake of MDMA's prohibition, American psychologist Rick Doblin founded the Multidisciplinary Association for Psychedelic Studies (MAPS) to support research aiming to re-establish psychedelics' place in medicine.
When MAPS' first PTSD study in the USA was published in 2011, the results were eye-opening. After two psychotherapy sessions with MDMA, 10 out of 12 participants no longer met the criteria for PTSD. The benefits were still apparent when the patients were followed up three to four years after the therapy.
Ben Sessa, a psychiatrist working around Bristol in the UK, is preparing to carry out a study at Cardiff University testing whether people with PTSD respond to MDMA in the same way. He believes that early negative experiences lie at the root not just of PTSD but of many other psychiatric disorders, too, and that psychedelics give patients the ability to reprocess those memories.
He believes psychiatry would look very different today if research with psychedelics had proceeded unencumbered since the 1950s. Psychiatrists have since turned to antidepressants, mood stabilizers, and antipsychotics. These drugs, he says, help to manage a patient's condition, but aren't curative, and also carry dangerous side-effects.
"We've become so used to psychiatry being a palliative care field of medicine," Sessa says, "that we're with you for life. You come to us in your early 20s with severe anxiety disorder; I'll still be looking after you in your 70s. We've become used to that. And I think we're selling our patients short."
The clinical outcome will be limited.
MAPS are supporting trials of MDMA-assisted psychotherapy for PTSD in the USA, Australia, Canada, and Israel, and they hope they will have enough evidence to convince regulators to approve it by 2021. Meanwhile, trials using psilocybin to treat anxiety in people with cancer have been taking place at Johns Hopkins University and New York University since 2007.
Few psychiatrists I asked about the legal use of psychedelics in therapy would give their opinions. One of the few who did, Falk Kiefer, Medical Director at the Department of Addictive Behaviour and Addiction Medicine at the Central Institute of Mental Health in Mannheim, Germany, says he is skeptical about the drugs' ability to change patients' behavior. "Psychedelic treatment might result in gaining new insights, 'seeing the world in a different way.' That's fine, but if it does not result in learning new strategies to deal with your real world, the clinical outcome will be limited."
Carhart-Harris says the only way to change people's minds is for the science to be so good that funders and regulators can't ignore it. "The idea is that we can present data that really becomes irrefutable, so that those authorities that have reservations, we can start changing their perspective and bring them around to taking this seriously."
What about Friederike?
After 13 days under arrest, Friederike was released. The judge accepted that Friederike had given her clients drugs as part of a therapeutic framework, with careful consideration for their health and welfare, and ruled her guilty of handing out LSD but not guilty of endangering people. For the narcotics offense, she was fined 2,000 Swiss francs and given a 16-month suspended sentence with two years of probation.
"I have been blessed by a very understanding lawyer and an intelligent judge," she says. She even considers the woman who reported her to the police a blessing, since the case has allowed her to talk openly about her work with psychedelics. She gives occasional lectures at psychedelic conferences, and has written a book about her experience, which she hopes will guide other therapists in how to work with the substances safely.
This story, by Sam Wong, originally appeared on Mosaic Science. It has been edited for length, and subheads have been added. Edited by Mun-Keat Looi, fact-checked by Lowri Daniels, originally copyedited by Tom Freeman.
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