Perplexing Psychedelic Propaganda

Psychedelics are a Helpful Tool but No Panacea (Vol. 3; Issue 45)

After practicing psychoanalytic psychotherapy for 44 years, I confidently proclaim that instantaneous body-mind transformations rarely, if ever, occur. Personal transformations take time; they rarely if ever occur in a flash. Many persons wish their painful but normal life transitions—like divorce, problematic teenage children, loss of meaning, or thinking about mortality—would quickly vanish; others hope their diagnosable mental conditions, like severe anxiety, depression, or psychosis, would similarly swiftly disappear.

But now, voilà, chew a mushroom, smoke a weed, ingest a toad’s secretion (DMT*) or drop some acid (LSD) and these problems end. Per the enthusiastic promises revealed in simple internet searches, print ads, or billboards for private clinics, you can (allegedly) find an instant, magical metamorphosis of whatever bothers you. In brief, and oh so popular during my youth**, psychedelics are BACK. People flock to Oregon, where psilocybin*** has been decriminalized; others venture to a shamanic retreat in South America to participate in an ayahuasca**** experience. Today, I focus just on psilocybin, with a few words about ketamine*****, to demonstrate how these substances join an array of means of reducing suffering in the body-mind with one catch:

The changes they elicit are neither instantaneous nor mysterious.

I begin by marginalizing ketamine based on my own personal experience. Numerous research studies have shown some promise in this anesthetizing agent—in at least temporarily reducing depression. Here is one of my, per usual, fictionalized cases (based on real events). A young man, 28, began consulting me due to recurrent major depression. He feared he’d be unable to find a romantic partner. Marriage was big on his mind, and he wanted a family as well. We made some headway together, the two of us. His dating life, in particular, picked up. When he turned 30, he faced a “real crisis.” He’d not yet found steady romance, feared he’d miss the marriage and childrearing “imperative” to him, and fell into a deep depression. He seriously contemplated suicide.

Although refusing referral for psychotropic medication, he found an “infusion clinic” just a few blocks from my office. The clinic, operated by an anesthesiologist rather than a psychiatrist, offered sets of ketamine infusions for $5,000 cash. They helped. In fact, they reduced his depression remarkably. Several months later, the depression returned with a vengeance. He returned to the IV clinic. The ketamine no longer worked. It only caused him to feel “spacey.” During that briefer round of infusions, he mentioned suicidal ideation to the nurse-anesthetist. She called me in a panic, fearing he would kill himself. I reassured her, she altered the dosage, and soon thereafter my patient gave up on ketamine. He concluded it was not the answer for him, and we continue to slog through his painful life. As Lacan (1978) would say, I hold the hope for his life. Perhaps ketamine benefits some patients, even long term, but again: It offers no quick fixes.

Regarding psilocybin, I garnered most of my information from Michael Pollan’s (2019) excellent book, How To Change Your Mind. Psilocybin and similar psychedelic substances alter the way your brain functions much differently than ketamine. The word psychedelic, which literally means “mind revealing,” has come into common usage to describe hallucinogens (also known as entheogens). According to the many studies Pollan reviews, psychedelics work in two basic ways:

First, they create a profound shift in your sense of self and consciousness. Your sensory perceptions are altered. Second, in terms of neurophysiology, they temporarily disable the default mode network. This set of structures connects parts of the neocortex (frontal lobes) to deeper brain levels where emotion and memory reside. The frontal lobes are the areas from which consciousness emerges. It's the part of the brain active when you think about the future or the past or reflect on your mind and others’ minds. It forms the “autobiographical self.” Many persons, all Buddhists, and yours truly consider our self-images variations of delusions. However, they are certainly useful ones.

Here’s the key point:

The default mode often contains awful, repetitive stories about ourselves: It tells us we’re worthless, unlovable, worthy of neglect, infuriated at the world, and so on. Psilocybin and similarly configured drugs turn off the default mode network, temporarily, inviting you to incorporate new narrations of self and other. These alterations—which do occur within 30 to 60 minutes—create the arguably dangerous fad.

When a dear friend tried psilocybin around a year ago, she took a strong dose: five grams. She was home, with friends, in a safe environment. What happened? She experienced the home where she’d lived for years in an entirely new way. She had other sensory changes as well, but the sparkly new vision of her house makes Pollan’s point. For several hours, she walked around noticing details she’d previously ignored. The plaster walls she’d passed by for years became fascinating. She noticed cracks and the imperfections; she saw the swirls of plaster made by the craftsman who created them in 1931. The wood floors, and even the tile ones, were newly intriguing. Artwork hanging on the walls she’d looked at for many years became enchanting. She experienced a sense of euphoria not caused by the drug, but from the freshness of her perceptions.

The enthusiasm for psychedelics makes sense, as long as it evades exaggeration. The idea is, again, that they “reset” the default mode to more of a blank screen onto which newer and more positive narratives can be written. Most psychoanalytic practitioners experimenting with psychedelics agree that it works best in combination with the depth psychotherapy they employ. Only that mode of therapy, which probes the unconscious mind, offers the possibility of more permanent, and more positive edits of the default mode network. By the way, once the psilocybin wore off later that evening, my friend returned to ignoring the many attractive features of her home. In like manner, a few psychedelic trips, no matter how long or powerful, will not allow you to make major changes in self-image.

In preparation for this week’s newsletter, I surveyed recent research on psychedelics. As expected, I found nothing marvelous. A recent study done by Ohio University researchers (2023) found that two treatments of psychedelic drugs, including DMT, helped lower depression in a sample of veterans. Eighty-six participants in a clinic in Mexico completed pre- and post treatment questionnaires. Anyone familiar with research design will understand the problems raised by sample size, testing instruments used, and the lack of any control group.

Another study at Stanford (Lili et al, 2023) involved the use of ketamine. The researchers found that, even if the subjects simply thought they were given ketamine, they felt less depressed. They recruited 40 participants with moderate to severe depression who were scheduled for routine surgery. A dose of ketamine or placebo was administered when the participants were in surgery and under general anesthesia. This study also suffers from a small sample size and no control group. It confirms what we already know about the powerful effects of suggestion on human beings.

Another research team (Dölen, 2023) studied mice brains to see if psychedelics reopened “critical periods” in brain development. They found that it did, seemingly replicating Pollan writings. They used five psychedelic drugs—ibogaine, ketamine, LSD, MDMA and psylocibin—because these enable a sense of discovery about one's self or the world. Their findings, published in the prestigious journal Nature, suggested that further research—including for stroke and deafness—as well as anxiety and depression be conducted. Somewhat helpful as a study, but who knows how well mice brains replicate ours.

Finally, a group of researchers (Garcia-Romeu et al, 2019) performed a meta-analysis of 343 individuals who had participated in psychedelic research. They concluded that studies using LSD for alcohol use disorder (AUD) showed large, significant effects compared to control conditions. These findings suggest potential anti-addiction effects of LSD for alcohol and other substance use disorders. At least this sample size was larger, but meta-analyses have their own statistical validity problems.

The problem with the prolific psychedelic popularity is that it is dangerous for some, ineffective for others, and is being oversold as a panacea. Over ‘lo these many years, I’ve witnessed many similar fads in treatment and diagnoses. Beginning with the former, I remember how excited everyone became about any of the TLA (three-letter acronym) regimens. EMDR remains fairly popular, and so is CBT, EFT, TFT, and others. [Thanks to Trump, we’re all more familiar with FBI, CIA, DOJ, etc.] I’ve written about these TLAs in prior newsletters, usually including rants on how they constrict clinicians’ subjectivities by cramming their perceptions of patients into some manual-like model.

You older readers will remember the recovered memory movement of the 1990s, which didn’t work out well. Long gone now are primal screen therapy, EST, and Transcendental Meditation. The latter is most noteworthy for the other TM, standing for trademark, following its name. Any variety of meditative and mindfulness methods are extremely effective, if practiced over time. No need exists to pay $3,000 for a mantra (as you do for TM).

Fads are equally present in terms of diagnoses. These usually concern how to name categories of patients whom clinicians tend to dislike. Therefore, instead of the way more common borderline personality disorder (BPD), there have been recent trends towards diagnosing Bipolar Disorder. Anyone with impulsive behavior (especially regarding purchases or sexual activity) or rapidly shifting moods are often incorrectly diagnosed as Bipolar. In truth, mood changes, irritability, and thoughtless behavior occurs in depression, other personality disorders, substance abuse, or even just as a result of stress. This has led to an epidemic of overmedicated people and some who suffer from under-treated depressions.

In my experience, only one in five patients who tell me they have Bipolar Disorder actually meet the criteria for the condition (which is indeed a serious one). A few years ago, I opened my waiting room door and noticed another patient, waiting for one of my colleagues, reading The Dummies Guide to Bipolar Disorder. Multiple Personality Disorder (MPD), now known as Dissociative Identity Disorder (DID), is another popular diagnosis of late. Most often these patients have BPD but clinicians are either fooled by patients presenting themselves as “multiples” or they believe themselves so specialized in them that they see them in half their patients.

Alas, another rather cynical rant comes to an end. And, apologies to a few of my colleagues who are enthusiastic about psychedelics and others who practice one of the TLAs. In conclusion, psychedelics offer short-cuts of sorts, but nothing instantaneous. Anyone traumatized by an abusive or neglectful attachment to caregivers, or exposed to serious life-threatening trauma in adulthood, must forge their way through the painful fields in which their own unique, personal life histories have shaped them.

I certainly agree that, per Pollan, psilocybin in particular, and perhaps LSD too, offers a chance to rewrite repetitive patterns on a newly erased canvas. Nonetheless, and here I shamelessly plug the psychoanalytic approaches, these painful life narrations require many sessions to alter. It seems like these substances enable or assist in transformation; they do not instantly create it by themselves.

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And check out my new book, Lover, Exorcist, Critic: Understanding Depth Psychotherapy, available on Amazon.

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*Released when the now-threatened Sonoran desert toad is threatened, a toxin, 5-MeO-DMT, aka DMT, can be dried into crystals and smoked in a pipe, producing an intense experience generally lasting 15 to 30 minutes; most other psychedelic substances involve hours of hallucinating.

**I’m telling none of those stories!

***Psyilocybin, psychoactive ingredient in “magic mushrooms,” is a naturally occurring substituted tryptamine that features an indole ring linked to an aminoethyl substituent. It is structurally related to serotonin, a monoamine neurotransmitter which is a derivative of the amino acid tryptophan.

****Ayahuasca, which requires users to undergo full-days of nausea and vomiting, is a traditional Amazonian decoction with psychoactive properties, is made from bark of the Banisteriopsis caapi vine (containing beta-carboline alkaloids) and leaves of the Psychotria viridis bush. The substance is similar to the chemical properties of DMT noted above.

*****Ketamine is a dissociative anesthetic used usually for induction and maintenance of anesthesia. The substance is a novel compound, derived from phencyclidine in 1962 in pursuit of a safer anesthetic with fewer hallucinogenic effects. Many clinics now offer it for treatment of mental disorders like recurrent major depression.

References

Garcia-Romeu, A; Davis, AK; Erowid, F; Erowid, E; Griffiths, RR, and; Johnson, MW. (2019) Cessation and reduction in alcohol consumption and misuse after psychedelic use. Journal of Psychopharmacology, 33(9):1088-1101. doi:10.1177/0269881119845793

Ohio State University. "Psychedelics improve mental health, cognition in special ops veterans." Science Daily. 5 October 2023 <www.sciencedaily.com/releases/2023/10/231005110741.htm>.

Lacan, J. (1978). The Seminar of Jacques Lacan, Book XI: The Four Fundamental Concepts of Psychoanalysis. Miller, J. (Ed.). Sheriden, A. (Trans.). New York: Norton.

Lili, TR; Smith, AE; Flohr, JR; Okada, RL; Nyongesa, CA, Cianfichi, LJ; Hack, LM; Schatzberg, AF; and; Heifets, BD. (2023) Randomized trial of ketamine masked by surgical anesthesia in patients with depression. Nature Mental Health, DOI: 10.1038/s44220-023-00140-x

Pollan, M. (2019). How to Change Your Mind: What The New Science of Psychedelics Teaches Us About Consciousness, Drug Addiction, Depression and Transcendence. New York: Penguin.

Dölen, G.; Nardou, R; Sawyer, E; Song, Y.J; Wilkinson. M.; Padovan-Hernandez, Y; de Deus, J.L.; Wright, N; Lama, C.; Faltin, S.; Goff, L.A., and; Stein-O’Brien, G.L. Psychedelics reopen the social reward learning critical period. Nature, 2023; DOI: 10.1038/s41586-023-06204-3