A Psychedelic Renaissance – Will we avoid tripping this time?

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A recent renaissance has occurred in psychedelic research in medicine and psychiatry. Meanwhile LSD’s Cold War reputation continues to cast a shadow over contemporary debates about its usage. Erika Dyck reports:

 

Psychedelics fell from medical grace nearly half a century ago, their reputation mired by associations with counterculture drug excesses, Cold War era enhanced interrogation, and abuse within psychiatric institutions made such pharmaceutical products objects of enduring continuing suspicion. Yet recent activity suggests that some researchers have ‘high hopes’ for their return.

 

Will they face the same historic challenges with a new generation of psychedelic enthusiasts, or have the circumstances changed sufficiently to allow for a new path forward?  The twenty-first-century incarnation of psychedelic research resurrects various earlier anticipated hypotheses. This research also explores afresh some of the same applications that clinicians experimented with fifty years ago.  As scientists debate the value of resurrecting this drug in the clinical context, it seems timely for historians to consider what can we learn by examining the changing reputation of the psychedelics since the Second World War.

 

In February 2014 Scientific American shocked readers with an editorial that called for an end to the ban on psychedelic drug research.[1] The article criticized the mental health treatment industry for failing to advance therapies beyond the golden era of the 1950s, and lambasted drug regulators for prohibiting psychedelic drugs, including LSD, ecstasy (MDMA), and psilocybin; drugs, which had historically held clinical promise but were “designated as drugs of abuse.”[2] As the editors pointed out, the situation has created a paradox: “these drugs are banned because they have no accepted medical use, but researchers cannot explore their therapeutic potential because they are banned….The decades-long research hiatus has taken its toll.”[3]

 

Lest there be any confusion as to where the editors stood on the issue, they proceeded to provide explicit instructions: “This is a shame. The US government should move these drugs to the less strict Schedule II classification…it would make it much easier for clinical researchers to study their effects.”[4] The article brought public and scientific attention to a growing contention amongst researchers, and even some regulators, that the clinical potential among psychedelic drugs had been dismissed due to a moral panic about drug abuse.   The long-standing impact of that prohibition has created a significant gap in our understanding of what these substances actually do.

 

Ever since its first synthesis in 1938, and from its earliest trial in 1943 to its contemporary renaissance in the 21st century, LSD has had a long and chequered career. This spans six decades. If it truly resurfaces, we might want to ask if it has now finally moved beyond the boom and bust cycle that ended with its criminalization in the 1960s. Might it now, instead be revived thanks to new scientific evidence that could alter its reputation and change its career path more radically?

 

Over sixty years ago Albert Hofmann at Sandoz Pharmaceutical Laboratories in Switzerland first synthesized LSD in 1938 and personally experienced its effects in 1943. This was later to be described as a voyage into madness, or a chemically induced psychosis. It was also cast as a spiritual awakening; Hofmann’s drug opened up a new era of hallucinogenic research. Over the next 15 years over a thousand articles appeared in medical and scientific publications using LSD, and ultimately it was compared with other substances, some of which had colourful organic histories connected to indigenous rituals, such as peyote/mescaline and ayahuasca. Peyote and ayahuasca had cultural reputations linking them with indigenous healing or spirituality, which added to the mystique of the exotic mind-manifesting experience. LSD, and mescaline (when separated from the peyote cactus), had reputations as products of scientific laboratories, but were nonetheless substances that could inspire spiritual and ontological explorations.

 

Albert Hoffman

 

By 1957 LSD, and to some extent mescaline, gave rise to the term ‘psychedelic’ to describe a “mind-manifesting” response. This was described by some as an experience that brought to light matters that had previously been part of the unconscious, or buried in the psyche. It became apparent to many investigators that psychedelic drugs were different from other psychopharmaceuticals. The anti-psychotics such as chlorpromazine, and anti-depressants, produced repeatable results and were primarily aimed at reducing symptoms in patients. Psychedelics, on the other hand, created an active, or conscious reaction that often changed the way people saw themselves, understood their place in the universe, or interpreted their environment.

 

During the Cold War era, some of these features even captivated researchers and military officials who were in pursuit of a ‘truth serum’ or ‘mind control’ substances. LSD emerged in this context, as a suitable candidate for interrogating spies or for getting captives to spill state secrets. It was the drug par excellence that tested the proposition that mental fortitude could be artificially dissolved. Famously, these approaches resulted in a series of experiments funded by the American Central Intelligence Agency (CIA), including the now infamous MK-Ultra study of mind control. Rumours circulated about this programme. Knowledge or half knowledge of such secret methods of mind control intensified antipathy between communists and capitalists vying for the upper hand in a supposedly global psychological war. These abuses were in fact relatively isolated by comparison with the vast majority of benign experiments that took place, but the scandals have made a lasting imprint which has overshadowed the very forms of research that contemporary scientists now believe is worth reviving.

 

Ewen Cameron, the psychiatrist at the centre of the MK-Ultra mind control experiments

 

For example, more benignly, during the 1950s and early 1960s western psychiatrists used LSD to treat alcoholism. In their view, this functioned by compressing years of psychotherapy into a single, intensive, self-reflective session that helped alcoholics achieve a new self image and the will power to move beyond their addiction. Others explored LSD as an adjunct to psychotherapy for addressing issues such as trauma; or used it to model for psychosis and to generate interest in studying schizophrenia as a chemical reaction in the brain. And some researchers flirted with the edges of science and medicine, by instead exploring LSD for what it revealed about a neurological basis for spirituality or creativity.

 

Promising as these studies appeared to be (particularly in the field of alcoholism), they also invited critics who argued that LSD did not perform well in randomized controlled trials (RCTs). Many claimed that the drug was too enticing as a substance for abuse, or that it was an altogether dangerous product given its capacity for conjuring visual hallucinations or producing psychosis. Critical scientific reports alongside negative media exposure began emerging in the early to mid 1960s. Within a few years the scientific criticism was somewhat moot; psychedelic research came to a halt largely because it become synonymous with countercultural activities, hedonism, drug abuse, and a black market in acid. By the end of that colourful decade, LSD became in many jurisdictions a prohibited substance and its clinical applications moved to the margins of acceptable medicine.

 

Meanwhile, many other psycho-active substances had more lucrative applications. They enjoyed widespread commercial success after performing well in the new gold standard for rigorous pharmaceutical tests: the randomized controlled trial. LSD did not produce regular, or repeatable responses, making it difficult to classify the reactions and identify common patterns. Neither the methodology nor their single-dose applications convinced commercial distributors that it was worth investing in.

 

Investigators in the so-called ‘golden era’ had not yet articulated a coherent plan for regulating psychedelics in a manner that balanced the appetite for non-clinical use with the desire to retain psychedelics within the clinic. Famously, ex-Harvard University psychologist Timothy Leary proselytized for the use of LSD, exclaiming that everyone should take it. He is rumoured to have recommended its use even more indiscriminately – by putting it in water supplies – but no thought was given to how much, or whether such a move should only be done on public holidays, whether they should use microdoses, or combine it with ‘car free’ days. By contrast, Abram Hoffer in Saskatchewan recommended that it be tightly controlled and regulated by governments, permitting its use exclusively in medical contexts. Others were more elitist, suggesting that understanding psychedelics required experimentation. But that experimentation, it was thought, should involve intellectuals, physicians, theologians, and neuroscientists. In short, a particular strand of highly educated individuals who might then harness the powers of psychedelics to improve society.

 

The_Psychedelic_Experience

 

A new generation of researchers has now taken up the torch with an eye to resurrecting the psychedelic science of the 1950s. They are particularly committed to pursuing the paths of addiction research, post-traumatic stress disorder (PTSD), and palliative care. Will this new group of enthusiasts be more nimble, or have cultural circumstances changed sufficiently to embrace psychedelics anew?

 

The new phase has a lot in common with the historical beginnings – enthusiasm and awe, and hyperbolic claims about the drug’s potential impact on a wide range of medical concerns. There has been only limited discussion about how psychedelics might be effectively regulated. The science of psychedelics continues to generate sustained interest. However, much remains unclear about how psychedelics might function in a clinical context. In the twenty first century, a mass of information exists about the impact of psychopharmaceuticals; far more so than in the 1950s the marketplace was only really beginning to embrace psychopharmacology with real intensity. Indeed, as Nikolas Rose suggests, this period also witnessed the dawn of the ‘psy-ences’ – a term that he uses to describe the pervasiveness of psychiatry, psychology, and social work in the everyday lives of citizens. In the new century, a return of psychedelics is perhaps neither regarded as off-putting or obscene. The possibility of chemically altering our consciousness as a ‘natural’ response to everyday living seems thinkable again.

 

In spite of these trends, the return of psychedelic science seems to run the risk of tripping over the same fault lines as its predecessors. The scientists may well be credible, ethical, and enthusiastic, but problems around official control loom large.

 

In considering the long-term trajectory of LSD’s regulation and revival, it is vital to acknowledge the modes in which it has been used in the laboratory, to consider how it is evaluated by governments, and regarded by scientific communities. According to British psychopharmacologist David J. Nutt, LSD, among other psychoactive drugs, possesses therapeutic applications, yet existing restrictions in both laboratories and clinical trials have prevented exploration of its therapeutic potential. He laments the “daunting bureaucratic labyrinth” that dissuades “even the most committed investigator.”[5] The regulatory framework has more to do with facilitating the marketability of a drug, than promoting new discoveries that challenge our therapeutic paradigm.[6]

 

In 1963 Aldous Huxley received LSD on his deathbed and suggested that its effects bathed him in a vision of warmth and spiritual belonging, such that he could face his own passing without fear. Palliative care has been an area identified for its potential use of psychedelics, for precisely this reason, not as a treatment, but as a psychological therapy that helps people face the anxiety of dying. Will the growing demand for palliation change the context sufficiently to warrant a second look at LSD in the clinic? It would be the ultimate historical irony if the baby boomers, who have been at least superficially blamed for abusing drugs and giving rise to a moral panic about LSD, are the very same actors whose collective agitation for end-of-life care re-invents acid as a humanitarian, medically sanctioned palliative intervention. In doing so, they might also force us to reconcile bigger questions about how we consume drugs, what we are willing to endure as pain, and the meaning of life.

 

Professor Erika Dyck is Canada Chair in the History of Medicine at the University of Saskatchewan. She has written on the history of eugenics, mental health and human experimentation, and is the author of Psychedelic Psychiatry: From Clinic to Campus (Johns Hopkins University Press, 2008).

 

References:

 

[1] Editorial, “End the Ban on Psychoactive Drug Research,” Scientific American (2014) 310 (2), pp. 1-2.

[2] Ibid., p. 1.

[3] Ibid.

[4] Ibid., p. 2.

[5] “End the Ban on Psychoactive Drug Research,” Scientific American (2014) 310 (2): 33. Consulted at http://www.scientificamerican.com/article/end-the-ban-on-psychoactive-drug-research/

[6] Several people have made this point, chief among them are: Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (Cambridge: Cambridge University Press, 1997); David Healy, Let Them Eat Prozac: the Unhealthy Relationship Between the Pharmaceutical Industry and Depression (New York: New York University Press, 2004); and Richard DeGrandpre, The Cult of Pharmacology: How American Became the World’s Most Troubled Drug Culture (Durham, Duke University Press, 2006).

 

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