The Rise of Psychedelic Psychotherapy

By Daniel Oberhaus on December 4, 2018

November 22, 1963 is a date that most people remember for the assassination of John F. Kennedy in Dallas, Texas. Yet on that same day, Aldous Huxley was grappling with death a thousand miles away at his home in Hollywood, California. The acclaimed author of the dystopian novel Brave New World and noted mescaline evangelist had spent the last few months grappling with an aggressive laryngeal cancer that left him unable to speak. As the last of his strength began to leave his body, he beckoned his wife Laura to his bedside where he scrawled the four words on a sheet of paper: “LSD 100 µg, intramuscular.” She complied with his request and injected Huxley with the psychedelic. An hour later she gave him a second dose.

“There was absolutely no jolt, no agitation, nothing,” Laura Huxley later recalled of her husband’s last few hours under the influence of LSD. “It was like music that becomes less and less audible, his fading away. Eventually his breath stopped, and there was a beautiful expression on his face.”

At the time of Huxley’s death, LSD was a drug associated with beatniks and hippies, and its therapeutic value was only just beginning to be appreciated by the medical establishment. Yet Huxley, whose literary visions of the dystopian future would turn out to be prophetic, was always ahead of his time, even on his deathbed.

Today, psychedelics are experiencing a renaissance after decades of prohibition, being explored as a potent form of psychotherapy by some of the world's most prominent doctors. Restricted substances like MDMALSDpsilocybin and DMT are all being explored as avenues for treating post-traumatic stress disorder (PTSD), depression, anxiety and even fear of death in terminally ill patients. The clinical results of these trials have been overwhelmingly positive thus far, but psychedelics still have a long way to go before they gain widespread acceptance within the medical community. Yet if the history of the rise of psychedelic psychotherapy can teach us anything, it’s that the evidence speaks for itself.

The Early Days of Psychedelic Therapy

Psychedelics have arguably been used as therapy for thousands of years. Many indigenous cultures, especially in Central and South America, consider natural hallucinogens such as psilocybin, peyote, San Pedro, ayahuasca and salvia to have potent medicinal qualities. However, it wasn’t until the mid-1950s that Western doctors realized the potential of natural and synthetic psychedelics for treating a variety of mental disorders.

Following Albert Hoffmann’s accidental discovery of lysergic acid diethylamide in 1943, the drug was quickly adopted by clinicians for a variety of therapeutic uses. In fact, the Harvard psychiatrist Lester Grinspoon estimates that between 1950 and 1965, more than 1,000 papers were published on psychedelic therapy that involved the treatment of more than 40,000 patients. Of particular interest to many researchers was the drug’s efficacy in treating alcoholism, a disease that was just beginning to be recognized in the early '50s.

At the center of the movement to treat alcoholism with LSD was Humphry Osmond, an English psychiatrist whose interest in psychedelic therapy began with his investigations into the psychoactive properties of mescaline derived from peyote cacti. In 1951, Osmond took a job as the lead psychiatrist at the Canadian Mental Hospital in Weyburn, Saskatchewan, a small city in central Canada. After his move across the Atlantic, Osmond continued to research psychedelics and was introduced to LSD by the young Canadian doctor Abram Hoffer. In 1953, Hoffer and Osmond began treating diagnosed alcoholics with acid, a research program that laid the foundation for the medicalization of psychedelics.

According to Erika Dyck, a researcher at the University of Saskatchewan and an expert on the history of psychedelic psychiatry, Hoffer and Osmond hit upon the idea of using LSD to treat alcoholism during a sleepless night ahead of a conference they were supposed to give a presentation at the following day. In the course of their conversation, Hoffer and Osmond remarked that LSD experiences were strangely similar to delirium tremens, the intense confusion and hallucinations experienced by alcoholics during a sudden withdrawal.

As Hoffer later recounted the conversation, the comparison of LSD and delirium tremens “seemed so bizarre that we laughed uproariously. But when our laughter subsided, the question seemed less comical and we formed our hypothesis… would a controlled LSD-produced delirium help alcoholics stay sober?”

When they returned to the Canadian Mental Hospital after the conference, Hoffer and Osmond put their hypothesis to work on two test subjects—one male and one female—who had been diagnosed as alcoholics. After giving their two subjects 200 micrograms of LSD, the male subject quit drinking and abstained for six months, but the female subject did not. This suggested that LSD could have a 50 percent chance of success in treating chronic alcoholism. Over the course of the next 10 years, Hoffer and Osmond would administer LSD to more than 700 alcoholics with similar results.

In 1961, Hoffer and Osmond were concluding their pioneering LSD trials in Canada, and psychedelic therapy came into its own in the United States. This was the year that Myron Stolaroff, an electrical engineer who quit his job after a particularly profound LSD experience, founded the International Foundation for Advanced Study in California. IFAS quickly became the American center for medical research on psychedelics.

During its first five years, the institute conducted a number of clinical trials on the therapeutic effects of LSD and mescaline that resulted in six published scientific papers. In total, Stolaroff and his colleagues treated 350 patients with psychedelics. As recounted in the Albert Hoffman biography Mystic Chemist, an initial LSD study on 153 patients found that “83 percent of subjects found the psychedelic experience to positively influence their personal development” and the “improved capacity to love and be loved was noted by 78 percent, and 69 percent experienced more profound communication with others.”

In the face of all the politics, the future of psychedelic psychotherapy was looking bright by the mid-1960s. Initial studies had shown promising results in the use of LSD and other psychedelics for everything from treating alcoholism and depression to boosting creativity and interpersonal relationships. Then in 1965, everything came crumbling down. That was the year Sandoz Labs in Switzerland, where Hofmann first synthesized LSD, stopped producing the substance in the face of mounting government scrutiny. Although psychedelics had gained legitimacy in medical circles, at the same time academics like Timothy Leary evangelized their non-medical use by the general public. Leary and his acolytes had placed LSD at the center of the budding countercultural movement that the U.S. government sought to repress, and restricting access to LSD became a top priority for lawmakers.

In 1966, California and Nevada became the first states in the U.S. to criminalize the possession and manufacture of LSD, and the rest of the country quickly followed suit. The Drug Enforcement Administration (DEA) justified making LSD a Schedule I controlled substance in 1970 by claiming that its use was out of control and that psychiatric professionals and students were taking the drug to better understand the mindset of schizophrenics.

“Although initial observations of the benefits of LSD were highly optimistic, empirical data developed subsequently proved much less promising,” the DEA wrote. “The study of LSD and other hallucinogens increased the awareness of how chemicals could affect the mind, [but] its use in psychotherapy largely has been debunked. It produces no aphrodisiac effects, does not increase creativity, has no lasting positive effects in treating alcoholics or criminals, does not produce a ‘model psychosis’; and does not generate immediate personality change.”

The revolution in psychedelic psychotherapy was over.

The Prohibition Years

In 1968, Thomas Ungerleider and Duke Fisher, two psychiatrists from UCLA, traveled to the outskirts of Los Angeles to visit an LSD cult. It was the eve of American LSD prohibition, and Ungerleider and Fisher could hardly have been more out of place. Two years earlier, the researchers had authored a high-profile report titled “The Dangers of LSD,” which outlined the multitude of negative psychiatric effects induced by LSD in their patients. After giving a presentation on their research, they were approached by a member of an LSD cult who called themselves Disciples and who invited them out to the commune where he and other members took acid every weekend without incident.

When Ungerleider and Fisher arrived at the compound, they found Disciples doing small scale farming and practicing syncretic religious rituals that combined aspects of Buddhism, Christianity and New Age beliefs. After interviewing several of the Disciples, the researchers learned that many of them were successfully recovering addicts and former criminals. This didn’t click with the researchers’ data on admissions to their hospital by patients suffering psychosis from taking LSD and raised the troubling prospect that they had perhaps been too reductive in their appraisal of the “dangers” of using LSD.

As the U.S. government ramped up its war on drugs in the 1970s, institutional research on psychedelic therapy almost completely disappeared, but individual researchers weren’t ready to give up the fight just yet. Despite the crackdown on LSD production, psychedelics continued to be taken therapeutically by groups like the Disciples, and some psychiatrists continued performing psychedelic therapy in an “unofficial capacity.”

Perhaps the most famous therapist in the psychiatric underground of the '70s and '80s was Leo Zeff, who was simply known as “Jacob” or “The Secret Chief” by those in the know. Zeff was first introduced to LSD in the early '60s while working as a Jungian therapist, and he developed a fascination with the therapeutic potential of psychedelics.

“When I first started out I had the traditional psychological or psychiatric attitude towards this stuff,” Zeff recalled in The Secret Chief, a book-length interview with Stolaroff about his research on psychedelic therapy. “This is dangerous, this is bad, you shouldn’t do it and anybody who does it is crazy. My first trip dispelled all my doubts. Since then there was never any problem.”

Although Zeff overcame his professional prejudice toward psychedelics, he didn’t really make his mark on the field until 1976, the year Alexander Shulgin, a chemist famous for synthesizing hundreds of hallucinogenic compounds in his home laboratory, introduced him to MDMA. Although neither men likely knew it at the time, this fateful encounter would end up shaping the course of psychedelic psychotherapy in the future.

More commonly known as ecstasy, MDMA was first synthesized in 1912, but its therapeutic potential had never really been explored due to patent restrictions on its synthesis. In the mid-'70s, Shulgin figured out a new synthesis pathway and began producing MDMA. When he gave some to Zeff for the first time, he was so moved by the experience that he came out of retirement to sing its virtues. Over the next decade, Zeff would end up giving the substance to “about 4,000” therapists as well as hundreds of patients he would treat in his apartment.

It is difficult to overstate the risk that Zeff was running by hosting these underground psychedelic therapy sessions. Not only could he lose his ability to practice medicine professionally, he also risked serious prison time.

“I definitely suffered considerably with fears, what I call ‘just in case’ fears or ‘what if fears,’” Zeff recalled. “What if we’re sitting there, laying there and having a trip, you now, everybody’s all laid out and stoned out of their god-damned mind, their pupils are as big as saucers, and somebody knocks on the door and it’s the police raiding us. I don’t know how many times that’s come across my mind.”

But for Zeff, the risk was worth the reward.

“I’ve looked at it and I’ve said, ‘Jacob, for Christ’s sake what are you exposing yourself to all this shit for? You don’t need it,’” Zeff told Stolaroff. “Then I’d look and I’d say, ‘Look at the people. Look what’s happening to them.” I’d say, ‘Is it worth it?’ Inevitably I’d come back with ‘Yeah, it’s worth it,’ especially at the end of a weekend when I’d see what fantastic things have happened to these people. I would say clearly to myself, ‘Jacob, it is worth it! Whatever you have to go through it’s worth it to produce these results!”

By 1980, nearly all institutional studies on psychedelic therapy had ceased in the United States due to a lack of funding and the immense difficulty of procuring the appropriate licenses to administer the chemicals to human subjects. As MDMA became demonized as a party drug called “ecstasy,” psychiatrists like George Greer, who can be credited with pioneering clinical research on MDMA, had an increasingly hard time justifying the therapeutic use of the substance in research settings. MDMA was eventually criminalized in 1985, which quickly put an end to formal research on this promising psychedelic therapy. 

Yet as unofficial research on the therapeutic potential of LSD continued after its prohibition, so too did MDMA-based therapies. On the east coast, a group of researchers associated with MIT’s Artificial Intelligence lab began synthesizing LSD in the late '70s and distributing it to a small network of individuals, including Rick Ingrasci, one of the first psychiatrists to explore MDMA therapy in his clinics with terminally ill patients. On the West Coast, a group of prominent psychedelic researchers formed the Association for the Responsible Use of Psychedelic Agents (ARUPA), which became an active resistance group following the scheduling of MDMA in 1985. Many members of ARUPA would also join the Earth Metabolic Design Laboratories, Inc. (EMDL), another group dedicated to organized opposition to the criminalization of MDMA.

After criminalization in the U.S., however, research on MDMA therapy continued abroad. Jack Downing, a psychiatrist who had experimented with treating alcoholism with LSD in the '60s and began researching MDMA therapy in the mid-'80s, founded the Exuma Island Institute. Located in the Bahamas, Downing offered a stress-relieving “psychocatalytic” program at the institute that “included MDMA sessions devoted to personal introspection and interpersonal communication.” Taken together, these underground psychedelic psychiatrists laid the foundation for the psychedelic renaissance underway in the United States today.

Psychedelic Psychotherapy Today

Although some research on psychedelics occurred in the '90s, most notably Rick Strassman’s studies on DMT at the University of New Mexico, it wasn’t until the mid-2000s that psychedelic psychotherapy was considered a serious research paradigm once again. Over the last decade, the new wave of research on psychedelic therapy has largely focused on psilocybin and MDMA, but ayahuasca, LSD and even ketamine are increasingly commanding the attention of psychiatric professionals.

A substantial portion of the psychedelic renaissance has occurred due to the efforts of two institutions: the Multidisciplinary Association for Psychedelic Studies (MAPS) and Johns Hopkins University.

MAPS was founded in 1986 by Rick Doblin, who was also involved with MDMA researchers affiliated with groups like ARUPA and EMDL. In 2008, MAPS made history by completing the first FDA-approved pilot study on the use of MDMA to treat patients suffering from PTSD. This initial study involved 20 individuals whose PTSD was caused by experiences such as military service, violent crime and sexual abuse. Today, MAPS is conducting a final phase 3 FDA trial for MDMA as a treatment for PTSD and expects MDMA to become a legal form of therapy for those with PTSD by 2020.

Meanwhile, at Johns Hopkins University, psychiatrists have spent the last decade investigating the role of psilocybin, the psychoactive compound in magic mushrooms, in treating depression and anxiety in patients with terminal diseases. In 2016, researchers at Johns Hopkins enrolled 51 terminally-ill patients in a pilot study that involved dosing the patients with psilocybin in the clinic. The results were unambiguous: 80 percent of participants showed “significant” decreases in depression and anxiety related to dying, and a similar number reported an increase in well-being and life satisfaction.

“The most interesting and remarkable finding is that a single dose of psilocybin, which lasts four to six hours, produced enduring decreases in depression and anxiety symptoms, and this may represent a fascinating new model for treating some psychiatric conditions,” Roland Griffith, a Johns Hopkins psychiatrist, said of the study. “I could imagine that cancer patients would receive psilocybin, look into the existential void and come out even more fearful. However, the positive changes in attitudes, moods and behavior that we documented in healthy volunteers were replicated in cancer patients.”

MAPS conducted a similar study on the use of LSD in patients with life-threatening illnesses in Switzerland in 2014. Like the Hopkins psilocybin study, the use of LSD resulted in a remarkable improvement in the attitudes and moods of the patients.

These positive results in modern psychedelic psychotherapy are not just limited to the the terminally ill. Johns Hopkins researchers also showed that psilocybin can be used to help smokers kick their habit, researchers in Brazil concluded the first randomized, placebo-controlled study on ayahuasca (a psychoactive brew made in the Amazon) last year and found it significantly reduced depression symptoms, and the University of New Mexico did a pilot study that suggested psilocybin can successfully treat alcoholism and is currently designing a similar study for LSD.

Unfortunately, the federal prohibition on psychedelic substances makes it exceedingly difficult for researchers in the United States and many countries around the world to study the therapeutic potential of psychedelics in a clinical setting. Although researchers at Johns Hopkins and elsewhere have called upon the DEA to loosen restrictions on psychedelic substances, there are few signs that this will change any time in the near future. In the meantime, many psychiatrists continue to practice psychedelic therapy underground. Yet according to the journalist Michael Pollan, who recently wrote a book on psychedelic therapy called How to Change Your Mind, even those researchers who are conducting clinical research on psychedelics at institutions are ultimately indebted to the underground clinicians that came before them.

In his book, Pollan details his experiences with “Mary,” an underground psychedelic therapist. Mary was the first person to introduce Pollan to psilocybin and had been practicing psychedelic therapy for decades. As he listened to a cello concerto by Bach, Pollan experienced synesthesia, ego-disillusion and a number of other profound psychological experiences. Through it all, Mary was there to guide him. Although Mary was practicing her therapy outside the confines of institutions like Johns Hopkins, Pollan said this didn’t detract from the profundity of the experience—if anything he had gone straight to the source of psychedelic psychotherapy.

“Though the university researchers seldom talk about it, much of the collective wisdom regarding how best to guide a psychedelic session resides in the heads of underground guides like Mary,” Pollan wrote in an adaptation of his book for the New York Times.

This is, in a way, reassuring. Even if the federal government persists in its moratorium on psychedelic research, history has shown that there will always be an underground network of dedicated therapists who understand the potential of psychedelic therapy. Perhaps one day our elected officials will.

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