Cause_and_Effect wrote: ↑Mon Jan 24, 2022 4:28 am
Coëmgenu wrote: ↑Mon Jan 24, 2022 1:47 am
I felt Tennok's post was highly sensible and informed.
Then you are either being very dishonest, or else your earlier youthful descent into recreational drug use which involved many substances of which psychedelics were only one category, was far worse than I thought.
Also he and you could find no evidence or research to support the above claims.
We find the opposite, more research on the benefits if used correctly and even brain mechanisms involved.
https://pubmed.ncbi.nlm.nih.gov/31941394/
I am not being dishonest, and I've never had a "descent into recreational drug use" in the manner that you have decided to deceptively spin things. I've already quoted Dr. Fried of Leiden University in the other thread deconstructing one of these phony drug trials. For every successful drug trial involving ayahuasca, there is a host of honest and upright academics scratching their head in disbelief that such nonsense gets published.
I allow you to misrepresent my youth as some kind of drug-filled wasteland because I have no desire to defend the "psychonaut" lifestyle that I was interested in in my late teens and early 20s. At this point however, you have escalated things to the point of telling lies about my youth. Furthermore, you're protesting far too much. Most of your content is now attacking me based on this paranoid narrative you've formed in your head about my past drug use and its excessively recreational nature. This is merely because you are in denial about the fact that
your drug use is merely recreational as well. Your denial is that your drug use is a great spiritual voyage in the style of the psychonauts of the 50s and 60s from whom you receive all of your rhetoric surrounding these substances. The doors of perception are shut closed and cannot be opened by simple material substances. Huxley never saw them open, but he did see the door frame wave in the air like a mirage and got awfully excited about it.
The fact that you've taken four admittances from me, namely that I smoked an extraordinary amount of weed in university (a proper "wake & baker" for 5ish years), that I have taken high doses of DMT on more than one occasion (I never disclosed how many times), and that I have taken high doses of LSD and mushrooms similarly, and have spun these as a "descent into recreational drug use" merely shows your own hypocrisy. According to you, three out of four of these drugs are not classified at the same level at all as other drugs. This means that you are objecting to heavy weed usage during university, which is rather common for a young man in university to experiment with. That you are willing to consider taking LSD, DMT, and magic mushrooms a "descent into recreational drug use" merely shows the hollowness of your own argumentation and the double-standards that you will resort to in order to defend your own drug use.
You’ve probably heard about ayahuasca before. You might not know what it is, but you’ve probably heard its name slither across your ear drums. Maybe you read about it here on Highsnobiety a few weeks ago, or in ELLE a while back.
You might be one of those oh-so-fashionable people who’ve flown out to the Amazon to consume it in recent years, because it has become so very fashionable lately, just like yoga and paleo diets and reiki, or whichever other brand of pseudo-spiritual nonsense cosmopolitan people like to believe in these days. Either way, just about everything you’ve likely heard is a load of rubbish that shouldn’t be believed.
But before I continue further, let me explain what ayahuasca is to those just tuning in: in short it’s a drug. A very potent psychedelic that’s been consumed by tribes indigenous to the Amazon basin for hundreds of years – some say thousands.
It comes in the form of a disgusting brown sludge brewed from a combination of the banisteriopsis vine and the psychotria viridis leaf, but any plant that contains dimethyltryptamine (DMT for short), like chacruna or chagropanga, can be used because DMT is the key element here – that’s what makes you hallucinate.
While DMT usually comes in a smokeable crystallized form, when inhaled the trip only lasts for a few minutes. The ayahuasca brew contains a Monoamine Oxidase Inhibitor that, when consumed orally, allows you to trip balls for several hours.
The Amazonian people regard ayahuasca as a sort of religious sacrament, using it in shamanistic ceremonies to look into their souls and speak to the spirits and the Gods and what have you, a process that gives them insight into the secrets of the universe. Or so the story goes.
Now that it has caught on with Westerners that shop at Whole Foods, ayahuasca is marketed as this magical potion that can instantly cure depression (“it’s like 20 years of therapy in one night,” an avid user of the drug once told me), wash away life’s problems, and reveal your true destiny, allowing you to quit that dull, pointless job of yours that makes you so unhappy. This is all bullshit.
How do I know? Well, because someone who definitely isn’t me –because why would anyone incriminate themselves admitting on the internet that they’ve taken an illegal drug before?– someone who we will refer to as “Bruce” throughout the course of this article, has spent a grand total of 14 nights drinking ayahuasca. Bruce knows multiple shaman and upwards of 100 people who have consumed the magical brew before, so Bruce knows what he’s talking about.
Bruce’s first ceremony was four and a half years ago. Bruce was feeling a bit depressed, rudderless, and life was generally pointless and miserable. One of Bruce’s friends, a high-rolling lawyer on a six-figure salary, with countless friends, an incredible social life and a rotating lineup of very hot girlfriends, had recently drunk ayahuasca.
The lawyer, who revealed that he suffers from terrible bouts of depression that therapy couldn’t alleviate, told Bruce that ayahuasca has changed his life. It had cured his depression, helped him find God (who happens to be a woman, btw) and convinced him to quit his job and move to the Amazon to become a shaman. The lawyer is now living somewhere in the jungles of Peru doing ayahuasca ceremonies of his own. He claims to have never been happier.
This sounded incredible to Bruce. Who would say no to a magic reset button that heals away all the bruises they’ve accumulated through the process of living, consigning them to the bowels of memory, and immediately transforming them into the self-actualized person they’ve always fantasized of being? Bruce is not the sort of man to say no to that offer. So Bruce asked the now-former lawyer to put him in touch with the shaman because he too wanted a simple solution for everything.
To cut a long story short, it was incredible. Well, the aftermath was incredible – the process itself was one of the worst things Bruce has ever experienced. Excruciating nausea. Cold chills. Such forceful puking that it felt like being turned inside out. Terrifying, terrifying hallucinations. People who’ve never done psychedelics think that you just see patterns, no. This was like being on a completely different plane of consciousness. An alternate dimension. There aren’t words to describe it.
When it was finally over, Bruce had some new clarity on his life and its frustrations. Some Freudian-type stuff that had something to do with his father. Basic psychology, really, but comprehending something intellectually and understanding it innately are two very different things. Bruce felt beaten, drained, melancholic, and then suddenly felt himself welling up –he was going to burst into tears– so he quickly ran to the nearest shower and wept like a refugee for a solid hour. Uncontrollable sobbing that felt so, so good.
Bruce went home with a feeling of anxiety. He was fixed now. Right? Everything was better, no? The missing pieces of the puzzle were all in place, surely? Of course they were. That’s what happens when you drink ayahuasca. Except that Bruce quickly realized it wasn’t all better.
He felt fantastic for two weeks: light, airy, free of anxiety, his internal monologue had quietened. He felt at ease with himself, but going back into his everyday routine he encountered the same problems that drove him to drink ayahuasca in the first place. So he went back another dozen times searching for The Solution.
And he would encounter many of the same people again and again and again. New ones would come, then they would return. Probably because, like Bruce, they were chasing a blissed-out state of Nirvana that they had been promised by other ayahuasca acolytes.
And I’m not exaggerating here, aya devotees speak about the drug in the sort of absolutist hyperbole common to religious fundamentalists. Think Christian televangelists only softer, more hippy-like, less fire-and-brimstone and more infinite love. Yes, it’s fairly benign, but there’s a soft fanaticism to it that makes Bruce wary.
Now this is Bruce’s problem with the ayahuasca community: they so desperately want to believe in all this New Age spiritual nonsense, that they have to tell other people loudly and forcefully that yes, this is The Answer, just so they can drown out the sound of their own cognitive dissonance. There’s an unspoken fatwa among ayahuasca drinkers that denounces this sort of critical thinking. It’s very cultish and cults have little time for dissidents.
Bruce doesn’t think they’re bad people, they’re just misguided and desperate to validate something that gives them a feeling of security in a terrifying world. But by doing this they set other people up for disappointment. And there are some truly desperate people that seek out ayahuasca ceremonies.
At these ceremonies Bruce has met child abuse victims, drug addicts, bulimics, countless conspiracy theorists that probably suffer from varying mental health problems, and a variety of other stragglers doing their best to limp through life.
One heroin addict became his friend, and after ayahuasca failed to make him better, the junkie in question turned to iboga, a similar psychedelic substance that is often paraded as a miracle cure for addiction. After his first iboga ceremony, said junkie asked Bruce if he could lend him some money. Later that evening he went and bought himself some more heroin. Not much of a miracle cure, then.
It’s scientifically proven that psychedelic drugs have huge therapeutic potential for treating depression, anxiety and numerous other conditions. Bruce believes in this wholeheartedly. But he also believes that they should be administered by psychologists or qualified medical professionals in a scientific setting – a bit like those end-of-life clinics in Switzerland that use LSD to help terminal cancer patients come to terms with their impending deaths – not someone who thinks that they can talk to ghosts.
Bruce took ayahuasca in Europe, but most adherents to the cult of ayahuasca will tell you that you need to travel to the Amazon to get the true experience, because “that’s where the magic happens.” But Bruce, as an atheist with a university degree, takes a dim view of this. There’s no such thing as magic. It’s a drug-induced chemical reaction in the brain that makes you hallucinate uncontrollably. This can be proven, ghosts can’t. Bruce is skeptical of anyone that asks for his absolute blind faith.
What’s often overlooked is that ayahuasca powers an entire micro-tourism industry that has sprung up in the Amazon. Opportunistic shaman prey on naive Westerners for cash and compete with each other by sometimes using dangerous ingredients to create ever-stronger brews that will reel in customers that want more bang for their buck. People have died as a result. This isn’t magic, it’s capitalism at its crudest.
But what can you expect? The shadow of the War on Drugs creates a dank breeding ground for crooks and hacks. Legalization and regulation is the only sane answer. Moral puritanism costs lives.
The point of this whole rant isn’t to try to put people off of ayahuasca or insult the people who worship it – not at all. Bruce thinks it certainly has its benefits and would recommend it to everyone. Bruce just thinks that there’s a lot of vested interests out there trying to sell easy answers to complex problems, and too few people scrutinizing their hyperbolic claims.
Ayahuasca is almost certainly not going to magically make all of your problems go away. Neither are anti-depressants. Your psychiatrist is not your Fairy Godmother. We live in a transaction-oriented culture where we’re taught that if you buy this shoe you will feel cool. If you wear this perfume you will feel sexy. If you take Zoloft you will be fixed.
Life is much more complicated than that. That’s what they won’t tell you, because how do you sell someone an easy solution to complication? This is something that needs to be shouted loudly, clearly and often. Some problems can’t be solved, only managed. And accepting that is often the first step in moving forward.
(Why Ayahuasca is a New Age Spiritual Scam, Aleks Eror)
Earlier, the OP criticized Tennok for correctly identifying the source of this trendy New Age snake oil, namely the "set and setting" of the 50s-70s psychonauts Leary et al. We see this terminology in the present influencing ayahuasca researchers to the point where it appears in the abstracts of their papers:
Ayahuasca has gained the attention of researchers over the past decade as psychedelic-assisted therapy for MDMA and psilocybin have progressed through FDA approved clinical trials. In spite of the increase in research, there are relatively few clinical studies of ayahuasca and little qualitative research on the therapeutic or healing uses of psychedelics in general. The present study included 41 Western participants who were interviewed about their participation in facilitated group ayahuasca experiences (e.g., in shamanic, neoshamanic, spiritual, and religious settings). Participants were interviewed about their intentions for participating, along with the perceived impact of the experiences. In particular, we focused on impacts that participants perceived to be sustained and enduring. We identified an impressive range of beneficial impacts, including improvements in areas that are often a focus of psychotherapy, such as mental health and substance use, health behaviors, interpersonal relationships, sense of self, attitude. Extratherapeutic effects were also observed in areas such as changes in creativity, somatic sensations, physical health/pain, sense of connection to nature, spirituality, and concern for the greater good. Two participants also reported problematic experiences, apparently related to set and setting. Implications for research and practice, along with a humanistic framework for interpreting these findings is provided.
(A Qualitative Study of Intention and Impact of Ayahuasca Use by Westerners, abstract)
So we see that Tennok was correct and that the OP is being hasty to shut down any naysayers to ayahuasca and psychedelics.
There’s been an explosion of interest in the use of psychedelics in psychiatry. Like everyone else, I hope this works out. But recent discussion has been so overwhelmingly positive that it’s worth reviewing whether there’s a case for skepticism. I think it would look something like this:
1. Psychedelics have mostly been investigated in small studies run by true believers. These are the conditions that produce a field made of unreplicable results, like the effects of 5-HTTLPR. Some of the most exciting psychedelic findings have already failed to replicate; for example, a study two years ago found that psilocybin did not permanently increase the Openness personality trait. This was one of the most exciting studies and had shaped a lot of my thinking around the issue. Now it’s gone.
2. Some of the most impressive stories involve psychedelic-assisted psychotherapy, where people who talk with a therapist, while on a substance, obtain true insight and get real closure. But every psychotherapy has amazing success stories floating out there. Back when psychoanalysis was new, the whole world was full of people telling their amazing success stories about how Dr. Freud helped them obtain true insight and get real closure. I think of psychotherapy as a domain where people can get as many amazing success stories as they want whether or not they’re really doing anything right, for unclear reasons.
3. Ketamine is the best comparison for psychedelics. Like psychedelics, it’s often used as a recreational drug, and produces profound experiences. Like psychedelics, it got hyped as an exciting new innovation that was going to revolutionize everything in psychiatry (in this case, depression treatment). But it’s been in pretty common (albeit non-formulary) use for five years now, and nothing has been revolutionized; my (very anecdotal) impression is that most patients who seek ketamine treatment find it only about as helpful as anything else. The gold-standard FDA studies are abysmal, worse than most other antidepressant medications. I’m sure ketamine works great for some people, just as SSRIs, therapy, and diet/exercise work well for some people. But at least so far it hasn’t been revolutionary.
4. Another good comparison is NSI-189. Again, a totally revolutionary new drug with a totally revolutionary new mechanism, with so many anecdotes of amazing success that depressed people started getting it on the black market before the FDA trials were even underway. People were posting testimonials that NSI-189 changed their life and that it was going to destroy the market for every other antidepressant. When the FDA trials finally finished, it was discovered to be ineffective. Seriously, the graveyards are littered with revolutionary new treatments for treatment-resistant depression that have great success in anecdotes and preliminary studies.
5. Between 10% and 50% of Americans have tried psychedelics. If psychedelics did something shocking, we would already know about it. I occasionally hear stories like “I did LSD and my depression went away”, but I also occasionally hear stories like “I did LSD and then my depression got worse”, so whatever. I know plenty of people who use heroic amounts of LSD all the time, and are still nervous wrecks. It’s possible there’s some set and setting that will improve this, but see part 7 below.
(one exception to this might be microdosing, which is a pretty new idea and might work differently from regular trips.)
6. In my model of psychedelics, they artificially stimulate your insight system the same way heroin artificially stimulates your happiness system. This leads to all those stories where people feel like they discovered the secret of the universe, but when they recover their faculties, they find it was only some inane triviality. This sounds very likely to produce people who think their psychedelic experience has changed everything and solved all their problems, which means we should discount these impressions as evidence that psychedelics really do change everything and solve all your problems. Granted, feeling like you truly understand the universe may itself help with depression, but I worry this is not a very lasting effect. See my posts on PIHKal and Universal Love, Said The Cactus Person.
7. Even if all of the above are wrong and psychedelics work very well, the FDA could kill them with a thousand paper cuts. Again, look at ketamine: the new FDA approval ensures people will be getting the slightly different esketamine, through a weird route of administration, while paying $600 a pop, in specialized clinics that will probably be hard to find. Given the price and inconvenience, insurance companies will probably restrict it to the most treatment-resistant patients, and it probably won’t help them (treatment-resistant patients tend to stay that way). Given the panic around psychedelics, I expect it to be similarly difficult to get them even if they are legal and technically FDA-approved. Depressed people will never be able to walk into a psychiatrist’s office and get LSD. They’ll walk into a psychiatrist’s office, try Prozac for three months, try Wellbutrin for three months, argue with their insurance for a while, eventually get permission to drive to a city an hour away that has a government-licensed LSD clinic, and get some weird form of LSD that might or might not work, using a procedure optimized to minimize hallucinations. I don’t know what the optimal set and setting for LSD is, but if it’s anything other than “the inside of a government-licensed LSD clinic, having a government-licensed LSD therapist ask you standard questions”, you won’t get it.
(Is There a Case for Skepticism of Psychedelic Therapy?, Scott Alexander, clinical psychologist)
Earlier among these cited articles, Aleks Eror described
"the cult of ayahuasca." This dissertation from the University of Denver further analyses ayahuasca enthusiasts as constituting a "religious diaspora."
‘Ayahuasca’ is a plant mixture with a variety of recipes and localized names native to South America. Often, the woody ayahuasca vine (Banisteriopsis caapi) is combined with chacruna leaf (Psychotria viridis) in a tea, inducing psychedelic effects among its users. While social usage varies among Indigenous Peoples of South America, during the twentieth century new religious movements in Brazil began employing the mixture as religious sacrament. Additionally, various centers for ayahuasca “healing” have emerged both inside and outside of the Amazon Rainforest, frequently with the aim of helping people addicted to other substances. As interest grew, ayahuasca use in South America attracted large numbers of tourists. Use of it also began a worldwide diaspora. Due to the mixture’s ability to produce intense effects from Dimethyltryptamine (DMT), a controlled substance in many countries, legal use of the tea varies even when the importation of the plants separately is not necessarily prohibited. Negotiating with various nations, religious groups such as the União do Vegetal (UDV) and Santo Daime
have successfully been granted legal use of the mixture by appealing to state recognition of bona fide religious use as sacrament. Due to prohibitionist rhetoric surrounding “War on Drugs,” the political and economic hegemony of the United States has influenced legal reception of ayahuasca globally. In the United States, arguments for legally protected use of ayahuasca emerged as appeals for religious freedom, which necessarily interact with rationales for the exemption of peyote used as sacrament by the Native American Church (NAC). Such exemptions are imbricated within a long history of oppressive and genocidal conditions faced by Indigenous Peoples since the Doctrine of Christian Discovery.
This dissertation examines the phenomenon of the ayahuasca diaspora in light of the long history of such doctrine, arguing that appeals to religious freedom and analogies to exempt status for Native use of peyote perpetuate a long history of colonialism inherently genocidal to Indigenous Peoples. While use of ayahuasca itself may not perpetuate such history, the politics of recognition in liberal democratic society employed to determine bona fide religious use evidences the continued institutionalized and legally instrumental impulses of eurochristian political theology, even in nations that present themselves as secular. Such an analysis of ayahuasca reveals deeply problematic tendencies affecting the recognition of religion in society, ongoing Indigenous struggles, drug policies, and drug treatment. This project is based on the premise that in order to address both the problems and the potentials of the growing ayahuasca diaspora, we must attend to the longer history of Indigenous genocide and its continued presence with respect to regimes of power in the wake of the Doctrine of Christian Discovery. Because my focus is on a longer historical attention to deep framing, this is not a study of the richly diverse ways ayahuasca is used by various groups. It is, rather, a contextualization based on an interdisciplinary, Critical Discourse Analysis of the emergence of ayahuasca as a global commodity and sacrament against the Doctrine of Discovery. Liberal politics of recognition and aspirations to personal spiritual growth through ecstatic experience are often underwritten by eurochristian deep frames. In the end, I argue that pleas for the state recognition and “exemption” of ayahuasca for religious use inadvertently perpetuate colonial forms harmful to Indigenous People through the politics of recognition.
(Ayahuasca’s Religious Diaspora in the Wake of the Doctrine of Discovery, abstract, Dr. Roger K. Green)
The mother of a man who drowned while using a shamanic hallucinogenic drug has filed a lawsuit against the New Age spiritual retreat where the incident occurred.
Garth Dickson, according to his mother, was under the influence of an herbal mixture known as ayahuasca when he walked into Shasta Lake and drowned in 2012 while at a retreat called the White Flame Institute, according to a lawsuit filed last week in Las Vegas, Nevada.
The White Flame Institute for Consciousness and Liberation offers "transformational life classes" and a "shamanic certification program" along with classes on healing and personal growth, according to the institute's website. Mrs. Dickson accuses the institute and its leader, Bonnie Serratore, of negligence and encouraging the use of ayahuasca as part of the treatments.
This is, of course, not the first time that people have died in New Age services: In February 2010, guru and motivational speaker James Arthur Ray was charged with three counts of manslaughter for his role in staging a sweat lodge ceremony in Sedona, Arizona, according to CNN. After an hour inside the small, steam-filled tent, some participants collapsed and others began vomiting. People tried to leave because they were getting sick, but Ray allegedly encouraged them to stay and endure the discomfort, which he said was a form of cleansing that would make them stronger. Three people died in the sweat lodge, 18 were hospitalized, and more were sickened; Ray was eventually convicted of negligent homicide and sentenced to two years in prison.
Garth Dickson's death is also not the first to be blamed on what has become known as "ayahuasca tourism." In April, a British backpacker traveling in Colombia, Henry Miller, died after taking part in a "shaman experience" advertised to tourists as a jaunt that included taking ayahuasca, according to The Guardian. He was part of a group of tourists from his hostel who paid $50 for the tour; others survived without harm, but Miller apparently experienced an allergic reaction to the herbal hallucinogenic drink. He became sick during the event and was left to die by the side of a dirt road, The Guardian reported.
In his book "Magic and Witchcraft: From Shamanism to the Technopagans" (Thames and Hudson, 2003), anthropologist Nevill Drury says that "in the upper Amazon basin (Colombia, Peru and Ecuador) shamans make extensive use of ayahuasca, a psychedelic drink made from the tree-climbing forest vine Banisteriopsis caapi. Taking this sacrament allows the shaman to enter the supernatural realm, to have initiatory visions, and to make contact with ancestors and helper-spirits." The hallucinogen is chemically similar to psilocybin, the active ingredient found in magic mushrooms, which have been used for similar purposes by shamans in Central America.
New Age beliefs have co-opted and commercialized many Native American and indigenous traditions, from dream catchers to sweat lodges to "traditional" ceremonies staged for tourists. "Ayahuasca tourism has brought new attention, new money and new problems to traditional healers and their communities, and has created a market for the misrepresentation of traditional practices and the exploitation of eager and innocent tourists," writes anthropologist Stephan Bever in his book "Singing to the Plants: A Guide to Mestizo Shamanism in the Upper Amazon" (University of New Mexico Press, 2009).
Bever notes that "the marketing of ayahuasca shamanism is in many ways akin to the marketing of Amazonian household goods at Macy's... Ayahuasca tourists are primarily white, urban, relatively wealthy, well educated, and spiritually eclectic outsiders.... And in almost every case, the goal is not an increased intellectual or scholarly understanding of the indigenous culture but rather personal spiritual growth, healing, and transformative experience."
Ayahuasca tourists who fail to understand the importance of the cultural context in which the drug is used are often disappointed in the experience, perhaps expecting to receive some sort of indigenous-inspired cosmic insight instead of an otherwise ordinary hallucinogenic drug trip, Bever adds.
Like psilocybin, ayahuasca by itself is not particularly toxic, though it may result in nausea, vomiting, psychological distress and cardiovascular effects such as increased blood pressure. The fact that it is "natural" appeals to many people, though, of course, many perfectly natural substances are dangerous or lethal, including snake venom, arsenic, mercury, and toxic plants.
The bigger concern is what killed Henry Miller; when mixed with other drugs and ingredients by a shaman or traditional healer instead of a pharmacist, anyone taking the drugs is taking a risk. People with food or drug allergies who must exercise care in ordering food at restaurants have no way of knowing what they're being given to eat or drink as part of an informal shamanic experience.
(Shaman's Herbal Hallucinogen a Fatal Lure for New Age Tourists, Benjamin Radford)
Earlier, Dr. Fried of Leiden University was quoted exposing flaws in a clinical trial of ayahuasca to cure depression. Two researchers from Durham University and the University of London respectively will expose further flaws in the current mainstream practices used in these drug trials:
Introduction
The publication in April 2021 of the Imperial College London Phase II study investigating the efficacy of psilocybin-assisted therapy vs. escitalopram for depression reported differences in the primary outcome measure (the QIDS-SR16) between experimental and control arms as statistically insignificant (1). However, secondary measures of depression, and other relevant measures (see Appendix), favored psilocybin to escitalopram. Soon thereafter, a range of expert commentaries offered interpretations, including that the researchers were unfortunate in their choice of pre-registered primary outcome, the trial was underpowered perhaps revealing an overconfidence in designing the study, and the limitations of depression rating measures to capture the return of positive mood and well-being.
Partially in response to these publications, discussions in research and online communities have grown around the over-hyping of psychedelic treatments, bringing into focus concerns over psychedelic therapy trial methodology [for a peer-reviewed critique, see (2)]. This opinion piece explores these concerns to propose a response to this special issue's question, “Can Psychedelic Therapies Open a New Frontier in Mental Healthcare (Or Will the Bubble Burst)?” Drawing on our experiences of working within psychedelic clinical trials and NHS psychiatry, we offer here a deflationary answer to this question, suggesting both will occur and outlining some of the facets, stakes and opportunities entailed.
Part I: The Bursting Bubble
The enthusiastic reception and excitement over the potential of psychedelics in academic, medical, public, and even political arenas is buttressed by the growing call for new psychiatric treatments, concerns over the long-term prescription of antidepressants to growing patient numbers without a concomitant reduction in psychiatric morbidity, and increasing evidence of withdrawal effects (3, 4). We define the “psychedelic therapy bubble” as an overestimation of its promise that is not justified by what is and can be known about its therapeutic potential. Coining the term promissory science, Davis and Abraham describe how,
“in connection with the manufacturer's promotion of apparently hopeful clinical trial results in the lead up to a new drug application for marketing approval.both the hopeful results and the novelty of the new drug's hypothesized mechanism of therapeutic efficacy may be elevated to great clinical significance to an expectant medical profession, patient population and stock market” [(5), p.268] [see also (6, 7)].
Understanding the psychedelic therapy bubble in terms of promissory science highlights the feedback loops whereby inflated expectations are themselves shaping psychedelic therapy's potential (8). Economically, the bubble sustains sufficient initial investments to offset the direct and infrastructural costs of bringing psychedelic therapies to market. Consequently, commercial imperatives of efficiency, standardization, and scalability are steering ongoing research. Advocates of these processes argue that this is either appropriate or at least necessary, in order to re-invigorate psychiatry's tired pharmacopeia (9). Culturally, the success of psychedelic therapy has been steered by actors seeking redemption for psychedelic-assisted and related healing practices in the wake of psychedelic prohibition at the end of the 1960s, and the researchers among them have brought particular interpretive frameworks for understanding the nature and value of psychedelic experiences. This includes the foregrounding of the therapeutic value of the mystical-type experience, which has begun to be problematized from various quarters as overly simplistic [e.g., (10)].
The concern with psychedelic therapy being a bubble that may burst is sometimes reduced to a warning against a repeat of drug prohibitionist laws and policies [e.g., (11)]. Yet the more colorful narrative of psychedelic research as a casualty in Nixon's fight against the counterculture has in recent years been tempered by historical investigation into the effects of an impasse between paradigms for conducting psychedelic therapy research and the growing imperatives of standardized randomized controlled trial (RCT) designs (12, 13). Moreover, today's situation is different in key ways: firstly, scholars have documented how medical professionals, regulators, and patient groups have pushed for “pragmatic” and “adaptive” trial designs in the intervening decades (14). Secondly, today's psychedelic clinical researchers are self-consciously aware of, and keen to prevent, a return to psychedelic prohibition, carefully proffering a “sober objectivity,” and emphasizing psychedelics as therapeutic agents as opposed to subversive agents of social and political change (15). Thirdly, we suggest psychedelic therapy is well-suited to the growing calls for psychiatry to be more oriented to the relational (16).
Nevertheless, bubbles burst, and we offer four axes along which to consider this in relation to psychedelic therapies. Firstly, critiques of psychedelic therapy trial publications have warned of common features of the RCTs that are likely to be inflating effect sizes: participant self-selection, stringent screening procedures, small sample sizes, and difficulty in maintaining blinding in research trials (2). Secondly, as the therapies gain legitimacy, the psychedelic research community is itself changing. Until recently, this community has comprised researchers who were willing to accept the professional ramifications of working in a stigmatized area. While the early advocates of any new treatment can be expected to be enthusiastic, the interaction effects of any researcher bias with psychedelics' sensitivity to the context of their use would contribute especially large outcome confounders, leading to limited replication of the early findings. Thirdly, we should anticipate a growth in adverse outcomes as the hype grows, the participant/patient pool is widened, and psychedelic therapies are provided in more streamlined ways. Increasingly diverse patient populations hopeful of being cured will experience rocky “landings” post-treatment, the cost of which will be borne downstream of trial analysis end points, thereby falsely inflating favorable health economic calculations. And fourthly, we are yet to understand the nature and extent of ethical dilemmas that will emerge. For example, with regards to “false memory syndrome,” the complexity of working with the veracity of unmediated knowledge has recently been explored (17), posing a challenge for manualized and protocolized therapy training programs.
(New Frontiers or a Bursting Bubble? Psychedelic Therapy Beyond the Dichotomy, Tehseen Noorani, Durham University, & Jonny Martell, Imperial College London)