Psychedelic Therapy and Arguments for Its Utilisation

The term “psychedelic” is a derivation of the Greek word psykhe (mind) and deloun (to reveal or make visible), combining to mean “mind-revealing”. Psychedelic drugs, in turn, refer to various substances that produce strong altering effects on conscious experiences. There are several categories of psychedelic drugs. Classic psychedelics, which are found in plants and fungi, include drugs such as LSD and psilocybin, while entactogens are serotonin-releasing agents such as MDMA. This essay will briefly discuss the history of psychedelic therapy, its popularity trajectory in the twentieth century followed by an overview of its practices to date and an argument advocating its utilisation in local setting.

While psychedelic drugs have long been used for spiritual or folk healing across cultures for centuries, interest from a psychotherapy perspective only sparked in the 1950s. The underpinning of the psychedelic drug revolution was due to the proposition that drugs could aid in altering the experiences of distressed patients suffering from psychiatric disorders. The first known synthesis of psychedelic drugs was LSD by Albert Hoffman in the 1940s and helped to pave the way for future clinical treatments. Driven by the belief that psychedelics could “serve as new tools for shortening psychotherapy”, medical research proceeded with much anticipation and expectation. In the following decade, research on the use of psychedelic-assisted therapy (PAT) became rampant, as psychedelic drugs were freely accessible to medical professionals. It was estimated that over 15 years, PAT were a common form of treatment, with more than tens of thousands of patients being treated with psychedelic psychotherapy.

Majority of research conducted was on LSD. Known then as Delysid, the drug was used in conjunction with psychotherapy to aid in the relief of alcoholic addiction, anxiety and obsessive neuroses. A study exemplifying the effectiveness of LSD reported that compared to 18% of the control group, 66% of patients treated with LSD abstained from alcohol. Further cementing the power and value of psychedelics were the remarkably high remission rates of over 50% by patients suffering from chronic neuroses who were treated with LSD. Despite such optimistic results, enthusiasm for the research and utilisation of psychedelics came to a screeching halt in the 1970s when it became associated with counterculture. Fear of psychedelics was exacerbated due to slowly increasing media reports on its dangers, although many were filled with misconceptions. Viewed as detrimental to society, several acts such as the Controlled Substance Act, were passed that prohibited the distribution of drugs, ceased research, and imposed penalties for possession of any psychedelic drugs across nations. Such policies resulted in the downfall of PAT as most psychedelics were either deemed to have no medical value or required strict approval. Given the controversial academic climate, pursuing psychedelic research was equivalent to career suicide. Since the turn of the century, interest in this field has started to reignite.

The revival of psychedelic drug therapy popularity began after a 25-year hiatus largely in thanks to the scientists in Europe, as well as the Multidisciplinary Association for Psychedelic Studies (MAPS), which is an organisation at the helm of psychedelic research by providing not only funding but working around legislations to advance psychedelic research. In one of the early revival studies, MAPS funded a study on MDMA, which included survivors of childhood sexual abuse and rape. Results showed that out of 12 people who underwent two MDMA-assisted psychotherapy, nearly 85% showed improvements as compared to only 25% in the placebo group. In light of such promising findings, the US Food and Drug Administration committee and National Institute of Drug Abuse issued a recommendation resuming the research on psychedelic drugs under the condition that the same regulations used for other drug reviews being imposed. Agendas were stratified according to three phases – first, gathering of evidence for the safety of the medication; next, exemplifying how these drugs can be used to treat medical conditions; finally, proving that medicine is as, if not more, effective than current medication or treatments available. To their credit, researchers have learned from past mistakes; by altering research paradigm by including control comparison groups, opting for substances perceived to have the highest probability of clinical efficacy, as well as ensuring the elicitation of minimal negative impressions.

One of the strongest advocations for psychedelic drug therapy would lie in its ability to treat depression. In a study conducted by Browne and Lucki (2013) among patients who were non-responsive to conventional antidepressants, a single dose of ketamine were shown to have fast-producing effects by alleviating depressive symptoms within a few hours. Furthermore, these effects were still present more than a week later. Ketamine aside, Carhart-Harris and colleagues (2017) found similar results in their study with psilocybin. Twenty patients with varying severities of Major Depressive Disorder were administered with two different psilocybin doses. Post-treatment surveys conducted five weeks later showcased a marked decrease in depressive symptoms among nearly half of the participants. More encouragingly, psychedelics have been associated with decreased suicidal thinking, planning and attempts. This is a vital point of consideration as lifetime suicide rates for those treated or untreated with depression may be as high as 15%.

Skeptics may point out that these results may be subject to biases due to the participants’ and experimenters’ awareness of the drug consumption and therefore participant or experimenter effects. However, a double-blind study found quick improvements to those who failed to respond to standard antidepressants, with 35% of patients reportedly feeling better one week after treatment as compared to none in the placebo group. Biological explanations suggest that psychedelics may be effective due to alterations in the number and function of certain synaptic connections. Cerebral scans posit that the heightened activity in brain circuits associated with negative emotionality and weakened links with positive emotions contribute to the manifestation of depression. These findings help substantiate past studies proving the efficacy of psychedelics in treating those suffering from depression, particularly for those who struggle with conventional therapies.

Psychedelics have been found to reduce anxiety in individuals. MDMA, in particular, has been reported to increase effectiveness of treatment by strengthening therapeutic relationship and alliance through raised oxytocin levels, reducing avoidance of anxiety-provoking situations and allowing access to internal emotional states. Despite its limited number of studies, preliminary evidence support the use of low dosages of cannabidiol in decreasing subjective anxiety as well as social phobia, thereby hinting at the possible effects if its full potential and mechanisms are discovered. There have also been heartening results that psychedelics may lower anxiety and provide a sense of comfort for those who are nearing the end of their lives. In a double-blind randomized study, subjects with terminal cancer who were diagnosed with some form of anxiety disorder were given psilocybin. Apart from mood elevation that persisted for two weeks, there was a significant reduction in anxiety 3 months after treatment. Gasser, Kirchner and Passie (2014) not only replicated these findings among subjects with terminal illness, but also found additional information reporting that subjects possessed more insightful and cathartic experiences, with many reporting more than 70% increase in quality of life. Qualitative analyses depict a psychotherapeutic pathway of how psychedelics may work their magic through three experiences. Cognitively, problems are seen from a novel perspective due to lucid thoughts and altered associations. Patients may also undergo a psychodynamic experience in which subconscious materials are brought to the surface. Understanding the symbolism of past conflicts may serve as a form of catharsis.

Finally, the pinnacle of therapy is derived from the psychedelic peak experience in which there is a transcendence of time and space, loss of the sense of self, meaningful new insights and a sense of awe and reverence. The culmination of these three experiences amasses into the alteration of the psyche, by providing individuals with new perceptions that tie their fears and thoughts together, thereby enabling them to confront and accept their inevitable death. This offers a humane perspective of psychedelic therapy that remains largely under-reported by media and is unknown to the masses, but is a crucial consideration that may affect government policies in allowing the usage of psychedelic drugs in therapy. Psilocybin-assisted therapy has also been found to suppress addiction. Psilocybin administered to individuals qualifying for alcoholic addiction under the DSM-IV criteria led to a decrease in 50% on active alcohol dependence. More importantly, these changes arose after there was a failure to find significant improvements through psychosocial measures (counseling without drug administration), suggesting the prevailing effectiveness of psilocybin over non-psychedelic measures. Similarly, psilocybin is said to play a role in controlling smoking addiction.. Participants administered with increasing doses of psilocybin listed vivid and positive insights into their self-identity as one of the main reasons for cessation in smoking. Through themes of interconnectedness and awe, the reasons for smoking fell through. Furthermore, these experiences overshadowed any short-term withdrawal symptoms; further allowing addicts to cut back on their addictive behaviors with lesser hindrance. Therefore, despite the worry surrounding the hallucinogenic nature of psychedelics, it is possible that they may actually be beneficial if right doses are administered.

Last but not least, patients suffering from Obsessive Compulsive Disorder (OCD) have benefitted from psychedelic consumption. Moreno and colleagues (2006) conducted a study in which nine patients with treatment-resistant OCD were administered with various doses of psilocybin. The findings supported the psychedelic therapy approach, with all subjects experiencing a significant decrease in OCD symptoms, and concluded that safe administration of psilocybin in a controlled clinical setting can lead to acute reductions in core OCD symptoms of up to 100%. Despite the open-label research paradigm, the success of this study is promising given that an estimated 25% of individuals suffering from OCD are non-responsive to treatments, and only 30-50% when medication is effective. Therefore, it is imperative that any drug associated with helping people with OCD be explored.

Taking into account the plethora of evidence behind the effectiveness of psychedelic drugs, Singapore’s government should consider allowing the incorporation of these drugs into contemporary practices. It is common knowledge that Singapore has some of the strictest drug laws globally. Psychedelic drugs such as MDMA, ketamine, LSD and psilocybin are listed as Class A drugs, meaning that they should not be consumed under any circumstance. However, when considering the prevalence rates of the disorders mentioned above, local authorities should consider altering their laws. Lifetime prevalence rates in Singapore for depression fall at 5.8%, 3.1% for alcohol abuse, 3% for OCD and 0.9% for GAD. Furthermore, since relatively low dosages are required for prevailing effects, psychedelic therapy may not only be less of a hassle but more cost-effective for individuals.