Will the magic of psychedelics transform psychiatry?
Imagine a medicine that could help people process disturbing memories, sparking behavioural changes rather than merely burying and suppressing symptoms and trauma. For the millions suffering with post-traumatic stress disorder (PTSD) and depression, such remedies for their daily struggles could be on the horizon. Psychiatry is rapidly heading towards a new frontier – and it’s all thanks to psychedelics.
In an advanced phase trial published in Nature in May, patients in the US, Israel and Canada who received doses of the psychedelic stimulant MDMA, alongside care from a therapist, were more than twice as likely than the placebo group to no longer have PTSD, for which there is currently no effective treatment, months later. The researchers concluded that the findings, which reflected those of six earlierstage trials, cemented the treatment as a startlingly successful potential breakthrough therapy. There are now hopes that MDMA therapy could receive approval for certain treatments from US regulators by 2023, or perhaps even earlier – with psilocybin, the active ingredient of magic mushrooms, not far behind in the process. (A small study at Johns Hopkins University, published last year, suggested it could be four times more effective than traditional antidepressants.)
You could say interest in psychedelics is mushrooming. Last month, in a first for psychedelics since the war on drugs was launched in the 1970s, US federal funding was granted for a psilocybin study, to treat tobacco addiction, following pressure by lawmakers, including Alexandria OcasioCortez. This marks a jaw-dropping turnaround for hallucinogenic drugs. Even 10 years ago, they were effectively taboo in many academic fields and halls of power. But as the intellectual rationale behind the war on drugs has become increasingly untenable, hundreds of millions of dollars have been pumped into psychedelic pharmaceutical research. “Psychedelics are the most extraordinary tools for studying the mind and brain,” says Dr David Luke, co-founding director of the psychedelic consciousness conference, Breaking Convention. “It’s a hot-button topic with around a dozen dedicated research centres at top-level universities around the world.”
Academic and scientific enthusiasm around psychedelics has been increasing amid exasperation over the lack of advancement in psychiatry. “It has not progressed as a field of medicine relative to others for decades, and many psychiatrists have been deeply frustrated,” Luke claims. Yet there appears to be a set of longignored tools to treat causes rather than simply addressing symptoms, and psychedelics could do for psychiatry what the microscope did for biology, he says. “They work to treat the underlying commonalities of a range of mental illnesses and potentially prevent their occurrence, too.”
Unfounded claims that psychedelic drugs have no medical uses, as the US Congress once declared, and are fundamentally dangerous, kept research endeavours in a straitjacket. Possibly more accurately, there were concerns that the drugs prod people into becoming more rebellious. “It’s not that psychedelics are dangerous, it’s that they give you dangerous ideas,” says Dennis McKenna, ethnopharmacologist and author. “That was the basic reason why there was such an overreaction and clampdown, because it was such a turbulent time with the Vietnam war.” Politicians rather than scientists or clinicians were in the driving seat behind systematically suppressing research, and usage.
This was all part of psychedelics’ mind-bending ride. Their use has increased under the radar, spurred on by cultural shifts in the west. Over the past decade, the recreational and spiritual use of hallucinogens has shed its taboos, following thousands of years of continued use in the Amazon, Mexico, Siberia and elsewhere.
“I realise for the first time this is the only genuine, religious experience I’ve ever had,” pop icon Sting recently said. “For me, the meaning of the universe cracked open.” He was followed more recently by Miley Cyrus and Lindsay Lohan, who have both told of their experiences attending plant medicine ceremonies. Not long ago, UK fitness icon Joe Wicks outlined his plans to visit the Amazon to drink the hallucinogenic healing medicine ayahuasca, after his lockdown workout sessions went viral. Coldplay frontman Chris Martin has told of his “really wonderful” experience with magic mushrooms, which provided “the confirmation I needed about how I feel about the universe”. It increasingly seems that public declarations of psychedelic use are in vogue.
Former Texas governor Rick Perry, a self-described “historically very antidrug person”, is convinced psychedelics can transform the lives of war veterans suffering from severe PTSD, who are always on guard for danger, unable to sleep and behave self-destructively. “All of that properly done in the right type of clinical setting will save a multitude of lives,” he told local media earlier this year, referring to people he knows who have been abroad from the US for psychedelic treatment. With his public support, a state bill to expedite the study of psychedelics was passed in May.
“Psychedelic medicine has the potential to completely change society’s approach to mental health treatment, and research is the first step to realising that transformation,” said representative Alex Dominguez, a Democrat who sponsored the bill, in a statement at the time. “It’s said that ‘As goes Texas, so goes the nation.’ While states across the country consider how best to address the mental health crisis facing our nation, I hope they once again look to Texas for leadership.”
How did the mood music change so quickly for hallucinogens? Researchers were steadily unshackled – after groundbreaking research into the so-called “God molecule” DMT forced the door open – and promising data emerged as paradigm shifts solidified.
Ceremonies with ayahuasca are known to increasingly take place from London to Sydney. In the US, the União de Vegetal church and some
Santo Daime congregations have in the past 15 years gained the legal right to use the DMT-containing brew for religious purposes because it is central to their beliefs. The Native American Church, which has some 250,000 members, gained the right to use mescaline-containing cactus peyote as a sacrament in the US – where it grows naturally in the southwestern desert – back in 1994. Meanwhile, Decriminalize Nature, which argues humans have an unalienable right to develop their own relationship with natural plants, persuaded US authorities in half a dozen municipalities, including Washington DC, to decriminalise all plant medicines, also in May. Earlier this year, the Californian senate passed a bill to legalise the possession and social sharing of psychedelics. Oregon has already voted to decriminalise the possession of personal amounts of all drugs, while psilocybin therapy has been licensed and the state’s health department has been tasked with licensing magic-mushroom growers and training people to administer them.Denver is even training emergency first responders in psychedelic harm reduction, a US first.
Increasing numbers of trials have reported steady doses of dazzlingly promising results for people with a risk of psychological issues. A study in the Lancet last year found that a high dose of psilocybin significantly reduces depressive syndromes and markedly improves anxiety for sustained periods. This appears to be due to the fostering of stronger communication between usually disconnected parts of the brain, engendering a higher state of consciousness as people are less constrained and more able to process emotions.
“The fact that a drug given once can have such an effect for so long is an unprecedented finding,” New York University psychiatrist Stephen Ross told theNew Yorker of a 2016 study that laid the groundwork for further research. “We have never had anything like it in the psychiatric field.” One of the key mooted advantages of psychedelics over existing drugs is that they work holistically to make the neuroplastic brain more malleable, therefore freeing people from long-held beliefs and memories – opening them evermore to new concepts and states of mind. Thus, they allow the brain to reset and rewire itself, rather than simply dampening down symptoms and even causing serious side-effects. This positions psychedelic therapies as revolutionary for addiction and OCD treatment, and a host of other treatment-resistant conditions, too. A large trial by scientists at the University of São Paulo also shows ayahuasca – a mixture of Amazonian shrubs – significantly reduces the severity of patients’ depression.
Extinction Rebellion co-founder Gail Bradbrook credited her use of ayahuasca and iboga, the psychedelic African shrub used in coming-of-age ceremonies and to combat addiction, with inspiring her campaign strategy, which has helped force environmental issues to the forefront of the debate in the UK.
“There’s a growing body of research indicating that psychedelics tend to greatly increase our connection to nature, even if you take them in a sterile research environment,” says Luke. Attitudes and ecological behaviours also change positively. In one survey, he found that the majority of people who used psychedelics stated that taking them had made them more concerned for the natural environment, had changed their diet and increased the amount of gardening they did. Users were also found to become more involved in environmental activism as feelings of compassion deepened. “Given that we are in the grip of an extremely fast, manmade, mass extinction event, the largest in millions of years, then we need every tool at our disposal, including psychedelics, or we might not even make it as a species ourselves,” he says.
As with renewable energies, markets are responding to the gargantuan potential profits to be made amid the new consciousness and the wheels of capitalism are now in full motion. The multi-billion-pound alcohol, pharmaceutical and wellness markets are facing serious disruption thanks to the ascendance of psychedelics. Magic mushrooms are even being legally imported into the US for the first time, for research, after a maiden delivery earlier this year. On the recreational side, highstreet psychedelic dispensaries have been popping up in Canada despite their sale remaining illegal. Brazen vendors say there is already enough research to prove the drugs are safe.Naturally, there is a clamour among the disrupters to consolidate their companies’ positions at the forefront of the
pharmaceutical psychedelics market.
Mental health company Compass was the first to be granted a patent for synthetic psilocybin in early 2020. It was subsequently granted another two in March for an oral psilocybin depression treatment, but faces criticism for an alleged intellectual property land grab that may hinder scientific research by limiting competition. Another 37 patents are being considered by US authorities, with 66 already granted, according to a patent tracker. One company even patented LSD for eating disorders before they had begun investigating whether it was effective.
Françoise Bourzat, a trainer of psychedelic guides in the Mazatec tradition and co-author of Consciousness Medicine, takes a dim view of how big capital is attempting to monopolise treatments rooted in thousands of years of wisdom traditions and discovered by indigenous people. “Money talks. We can’t stop this tsunami. But we need to emphasise the importance of reciprocity, social justice, accessibility and the sacredness of the work,” she implores. Companies should support education and healthcare provision in indigenous communities, given the profit they stand to make, she argues, since the medicines more belong to them – “they just didn’t patent”.
She also has concerns over the manner in which treatment with psilocybin, and other psychedelics, could be delivered. “This work is rooted not in medical treatment but in the sacred practice of connecting with traditions that are both indigenous in nature and spiritual in practice,” says Bourzat, who is advising in Oregon on the state’s development of facilitator training. “The Mazatec community in Mexico use the mushroom for connection with the divine and curing tensions and physical ailments that for them are connected to a spiritual blockage or absence of energy circulating in the body and the heart. They connect sickness with unprocessed emotion, which is probably a sound conclusion.”
Many of the medicines (though not magic mushrooms, which are simple to grow and relatively ubiquitous) are finite resources, and already face serious pressure.
The manner of patenting and overharvesting carries a dark paradox given that psychedelics are supposed to engender more enlightened and selfless states. “The purpose of medicine is to create a bigger, deeper, more thorough experience of our inner functioning, our physical functioning, our emotional functioning, our energetic functioning, our spiritual functioning, our relational functioning, how we are with the land,” Bourzat told podcast Berkeley Talks. “Mushrooms bring it to your face, like, ‘This is your illness.’ By knowing your illness, you resolve your illness, you deal with it, you treat it from within yourself. The mushroom helps you see the truth.”
The fear among psychedelic advocates is that a potential deprioritisation of the human aspect of care – whether through sterile environments or through prescriptions where patients chart their development through apps without human contact – could be detrimental to the benefits of the treatment. “The mainstream medicalised approach that is emerging is minimising the value of human support. This work is supposed to be done within relationships,” Bourzat says.
McKenna agrees that it would be foolish for the pharmaceutical industry to ignore the culture and historical context of psychedelic usage, particularly if only those who are ill are allowed access. He believes everyone should have access to them, and not just in private clinical settings as appears the case with recently approved ketamine. The icon among psychonauts declares: “Any future regulatory frameworks should not set up situations where you have to be sick in order to take a psychedelic legally.”
Psychedelics will change society’s approach to mental health