The psychedelic resurrection and the future of psychiatry

On February 21, 1971, when all member states of the United Nations signed The Convention on Psychotropic Substances – a treaty designed to control the use of psychoactive drugs around the world – there was something more than health concern at play.

The treaty not only aimed at preventing public consumption of these substances but also prohibited any scientific or medical research involving them.

Largely backed by the United States, it essentially pushed for and received a unanimous global consensus. As of today, it has been signed by 184 member states of the UN.

The treaty introduced legal controls on a class of compounds like LSD, MDMA, DMT etc. referred to as "psychoactive substances", commonly known as "psychedelics".

The political impetus that led to the creation of this treaty, however, seemingly arose from a complicated history between the US government and one particular psychedelic substance - LSD.

The saga between the two unfolded on the American culturescape throughout the 1960s.

The 60s was a time of immense socio-political upheavals. It was the decade that brought on a new era of artistic expression – from the beat poets like William Burroughs and Jack Kerouac to the inspired music of Woodstock, the new sounds of psychedelic rock, and the revolutionary pop art of Andy Warhol.

Politically, it was also a period marked by significant turmoil. The Vietnam War was happening in the shadows of Cold War paranoia, as anti-communist hysteria consumed the nation from coast to coast. At the same time, reactionary social forces rose up in revolt, through the anti-war movement and widespread student protests, sometimes escalating to direct civilian clashes with the military.

Thousands of young people were evading the draft, as they refused to march to war for a government they no longer trusted. At the same time, this was also the decade of the Civil Rights movement led by Martin Luther King Jr, and the simultaneous rise of the black liberation militia like the Black Panthers and the Weather Underground.

Meanwhile, in a parallel trend, the use of LSD was growing popular among the American youth. The substance, which was only outlawed in 1968, was legal for most of the decade.

Although this psychedelic fad may seem unrelated at first glance, many social commentators claim that the tremors that shook American society were somehow being fuelled in the zeitgeist by the spread of LSD use amongst the counter-culture.

The potent psychedelic was not only doing something mysterious to those taking it, but its impact was going far beyond them – into the depths of American social fabric – even touching those who were not taking it at all.

Edward Rothstein wrote in a 2008 New York Times article, "When it comes to LSD, I have to confess: I inhaled. But I inhaled like so many other denizens of the 1960s and early 70s, whether they actually took the drug or not. I inhaled because you couldn't fail to inhale. LSD – its aura if not its substance – was a component of the air we breathed. This hallucinogen infused the exhalations of musicians, philosophers, advertisers and activists."

Not surprisingly, the power structures in the US at the time viewed LSD as a public nuisance.

They could not explain why, but somehow LSD was propagating unsavoury tendencies of rebellion and subversion among the youth, and having "a corrosive effect on the values of the Western middle class".

In response to these perceived threats, President Nixon launched the "War on Drugs" – aimed at removing psychedelics, as well as marijuana, from the cultural platter.

The Nixon administration claimed that these substances were extremely dangerous and had no medicinal merits. Although these claims were backed by very little objective scientific evidence, the political backlash against the substances was so strong that the lack of evidence was unanimously overlooked, both in the US and the UN.

In 1994, John Ehrlichman, Nixon's domestic policy chief, said in an interview with Harper Magazine, "Nixon's War on Drugs was largely created to target specific groups that were seen as subversive forces in the country, and had little to do with a public health issue."

Ehrlichman admits, "Did we know we were lying about the drugs? Of course, we did."

The psychedelic substances only had their presence for about 20 years in the cultural stratosphere – too little time for any serious scientific study to be done on them.

The blanket ban since the early 70s meant that all scientific research came to a halt. Research projects that had begun earlier were scrapped, defunded and essentially buried.

As a result, neither the scientific community nor society at large, ever had the opportunity to really understand these substances.

What were they doing to people who were taking it? Were they really as harmful and addictive as the administration claimed? What are the mechanisms by which they impacted the brain? What did it mean that they "expanded consciousness"? How did they manage to bleed into and transform the very cultural fabric of American society?

As a result of the legal chokeholds on the substances, these and many other mysteries surrounding the psychedelics went unanswered.

More importantly, the ban also meant that the psychedelics were taken off the table for any inquiry regarding their medical benefits, specifically in the field of psychiatry.

According to American author, journalist, and activist Michael Pollan, "For most of the 1950s and early 1960s, many in the psychiatric establishment regarded LSD and psilocybin as miracle drugs."

Rightly so, as some of the earliest researches with these substances were showing astoundingly promising results. For example, in 1952 Dr Humphry Osmond and Dr Abram Hoffer began treating almost 2000 alcoholics with LSD and mescaline at Weyburn Hospital in Saskatchewan, Canada.

However, by 1966, despite the results, the study was shut down by the federal government.

Many psychiatric researchers of the era lamented the loss of a "potentially extraordinary medical technology", which had the possibility of healing many who were suffering from a variety of psychiatric disorders.

After almost half a century in the shadows, psychedelics appear to be undergone a renaissance in the cultural and scientific sphere. Despite the immense regulatory restrictions and the resulting costs involved, a number of institutions and research groups have been conducting scientifically robust and peer validated studies, on the mechanisms and effects of various psychedelic substances.

Among them are the Center for Psychedelic Research at Imperial College London, and the Center for Psychedelic and Consciousness Research at John Hopkins University.

Over the last two decades, these institutions managed to slowly overcome the immense regulatory hurdles, and have now started to publish research studies on LSD, Psilocybin, DMT, Mescaline and MDMA, the first of their kind since the 1960s.

These studies are already showing that these compounds have immense and lasting therapeutic benefits for a range of psychiatric illnesses, including treatment-resistant depression and Post Traumatic Stress Disorder (PTSD), as well as relieving anxiety and depression amongst terminally ill cancer patients in palliative care.

While still in its early days, the success rates being reported often surpass even the most optimistic estimates.

Many of the recent studies have already addressed two of the most contentious questions that had caused these substances to be banned in the first place.

Firstly, are they harmful for human consumption? Secondly, are they addictive?

In an almost comical twist, the results of these inquiries are astoundingly counterintuitive when compared to the historical paranoia surrounding the substances.

According to the National Institute of Health (NIH), psychedelics "are generally considered physiologically safe and do not lead to dependence or addiction."

Dr David Nutt, the former drug advisor to the UK and professor at Imperial College, claims that psychedelic substances rank much lower than heroin, cocaine, alcohol, even tobacco, in terms of their harm to the human body.

With the exception of MDMA (whose mechanism of action is different from the rest), all the serotonergic psychedelics (i.e. the compounds that chemically resemble the neurotransmitter serotonin) are generally considered physiologically safe.

Researchers are hopeful as the regulatory bodies that have been holding the doors closed for these substances have begun to recognise their potential in medical science and psychiatry.

For example, the Food and Drug Administration (FDA) "recently designated psilocybin — the psychoactive component in magic mushrooms — as a 'breakthrough therapy' to treat major depression."

The FDA has also designated MDMA-assisted psychotherapy as a Breakthrough Therapy for PTSD and recently gave approval to the Multidisciplinary Association for Psychedelic Studies (MAPS) to conduct Phase-3 of double-blinded placebo-controlled trials.

This means that "the FDA could approve the treatment as early as 2022." This trend in bureaucratic easing is also reflective of the rising importance of mental health globally, as demonstrated by the focus of discussions at Davos this year as well.

However, even as the field slowly opens, the forces that had suppressed these compounds in the first place are still present. Psychedelics remain a prohibited Schedule 1 substance, and are still technically out of bounds even for scientific research, according to the US Federal Law.

It is important to note, the fact that research in the field has been stunted for close to 50 years means that many of these claims are made from the subjective perception of risks, unanchored in any objective scientific studies.

Bridget Huber, a public health researcher, says that these claims are based on some of the early research done in the 50s and 60s, from studies which "wouldn't meet today's scientific standards" and are more like "urban legends; and sensational, unsubstantiated news stories."

While early research shows these substances to have great benefits in treating psychiatric disorders, some say that researchers should be careful not to make blanket claims about them being completely risk-free either.

Even though the substances do not leave any physiological impact on the body, a "user could still get high and act impulsively, walking into traffic or leaning too far out of a window in a tall building".

Denial of these risks did not go down well in the past when researchers like Dr Timothy Leary became dogmatic proponents of the psychedelics, making sweeping claims of their merits while being blind to any criticism.

Native tribes in the Amazon rainforests, who have been ritualistically taking the psychedelic brew Ayahuasca (comprised of orally active DMT) for more than 5000 years. These cultures claim it to be a medicine for the body, mind and soul. Photo: Wikimedia

John Hogan writes in the Scientific American that it was Leary's "aggressive proselytising" of LSD that was largely to blame for the backlash against these substances.

As of today, keeping value judgements aside, studies conducted in controlled environments, however, are demonstrating that the indirect risks of taking psychedelics can be significantly mitigated with proper screening and by ensuring a psychologically safe environment.

Many questions still remain, like, what are these compounds doing to the subjective experience of the people who take them? How could they have had an impact on society as a whole beyond the individuals who were taking them?

Science may be able to shed some light on these questions in time. But till then, all we have are anecdotal accounts of people who have taken psychedelics and have returned to tell the tale.

Some of these "psychonauts" include certain native tribes in the Amazon rainforests, who have been ritualistically taking the psychedelic brew Ayahuasca (comprised of orally active DMT) for more than 5000 years. These cultures claim it to be a medicine for the body, mind and soul that allows them to connect to the "spirit of nature" and other forces beyond material reality.

In more recent years, there are also references to the psychedelics in popular culture. For example, Steve Jobs writes in his biography that "Taking LSD was a profound experience, one of the most important things in my life."

While many were understandably shocked to read Jobs' words, it was not a surprise to those who had lived through the 60s.

Nonetheless, while the truth about what exactly the psychedelic experience remains elusive, the medical benefits that they can bring in the field of psychiatry are becoming more apparent.

Through rigorous research, conducted without bias in either direction, these benefits are beginning to see lights, paving the way to revolutionise the psychiatric treatments of the future.