Tuesday, 21 July 2009

Can LSD have a role in psychiatry again?

One British psychiatrist is asking the medical community to re-evaluate the possibility of using psychedelics in psychotherapy

Dr. Ben Sessa, looking wide-eyed toward the future of psychedelics in medicine.

Courtesy of Ben Sessa

Two generations ago, psychedelics were considered to have a promising future in psychoanalysis. Yet in name of the ‘War on Drugs’, this research was essentially erased from medical history. After 30 years of institutional silence in the Royal College of Psychiatry in the United Kingdom, Dr. Ben Sessa, a child psychiatrist and graduate of the University of London, published an editorial in the British Journal of Psychiatry calling for a re-examination of the role of psychedelics in psychoanalysis. Last week, The Daily caught up with Dr. Sessa to talk about his research, the language of psychotherapy, and the future for psychedelics in medicine.

McGill Daily: What attracted you to psychedelics in psychotherapy?
Ben Sessa: I’ve always had an interest in psychedelics in the sixties drug culture, which started with an interest in psychedelic music. Then I got into reading a lot of sixtiess literature. And I did all that before I got into medicine. So I knew all about the use of psychedelics in psychiatry. At school, I found that there was no mention of any of this in my education. I’d look into my psychiatric textbooks, and I’d look up LSD, and it would say: ‘Has no medical use.’ There was no mention of all the research done in the fifties and sixties, when there was an immense amount of medical interest in these drugs.
MD: What are the drawbacks and benefits of psychedelics in medicine?
BS: These drugs offer the possibility of speeding up and increasing the depth of normal psychotherapy. The way they work is not dissimilar from the normal psychotherapeutic method, where you’re encouraged to relax, and let go of your ego defenses, recall past memories, in a controlled environment with a therapist. What these drugs do is they allow you to get right to the heart of that information in a much quicker and deeper way.
This was all going along happily from 1950 to 1965, and the psychiatrists who were using it were very pleased with the results. Then it leaked from the medical community. People started taking it recreationally, and you started to hear the scare stories. These drugs, while they’re fascinating, are also potentially very dangerous drugs. It’s probably the drug most dependent on set and setting than any other psychotropic drug. If those two issues aren’t controlled for, the experience can be a hellish one. But if they are, it can be a very valuable experience.
The main reason I wanted to bring this to the attention of doctors is that the research stopped for socio-political reasons, not for scientific reasons. It’s just bad science. I think this is a topic that at least deserves to be looked at again.
MD: How have you been approaching this re-evaluation?
BS: I’ve had to be quite consistent with being evidence-based. This whole subject has quite an unhealthy crossover with mysticism and pseudoscience. Some of it, I’ve got time for, but when I’m trying to preach this message to my very hard-nosed, boring colleagues, I’ve got to steer well clear of that. That’s one of the mistakes that happened in the past with the psychedelic movement.
MD: How would the modern approach to psychedelics in psychotherapy actually work?
BS: The current trials and research going on [in the United States] are very scientific, using outcome criteria in a systematic way. The current trials are based more on CBT [Cognitive Behavioural Therapy], with 12 or 20 sessions. It would look something like four sessions, then a session with a dose of the drug, than another four sessions, then another dose of the drug.
MD: Unfortunately, past government research hasn’t been so careful.
BS: Not at all. The irony is that it was the U.S. government, which called LSD ‘public enemy number one,’ that conducted by far the most inhumane and unethical trials during the fiftiess, with MKULTRA, the CIA program, giving people these drugs without telling them and watching what happens to them. That’s probably propagated more to the negative press than anything else.
[Ed. note: McGill’s Allan Memorial Institute, in the Ravenscrag building, was host to MKULTRA tests commissioned by the CIA. The tests were conducted under Dr. Ewan Cameron from 1957 to 1964.]
MD: Do you ever feel trapped by the walls of psychiatry? I mean, perhaps a bit of mysticism in our lives would make us all happier people.
BS: I agree. I have a lot of time for mysticism. But I must admit it is difficult for me to put that into a scientific context when trying to push what’s actually a very novel and contentious subject. The other thing is that psychiatry is changing, medicine is changing. Patients are asking for a broader approach to psychiatric problems, and this includes taking into account some of their spiritual needs. But it’s really hard to say that to many of my colleagues. They don’t like language like “enlightenment” and “illumination” and “bliss.”
MD: Does that frustrate you?
BS: Not really, because I’m a scientist myself. But I also do feel that these are words that should have a place in modern psychiatric language. I think that states of bliss, states of illumination, and enlightenment, are mental states. Religions have hijacked these words. I don’t think it’s fair; they are mental and psychological states, and therefore we need a medical language to describe them.
If we can get psychedelics into the medical profession using the traditional medical model, then it’s getting transpersonal psychotherapy in by the back door, and that can lead the way to talking about alternative states of consciousness.
MD: You’ve turned into a bit of a mouthpiece for this movement. Do you feel like you’re shouting out to an empty room, or are you getting results?
BS: Not at all, I feel that there’s broad support. In terms of being a mouthpiece, I don’t really mind because I’ve got a very scientific approach. For 30 years there’ve been plenty of hippies talking about this stuff. But there’s been silence in the medical profession. I’m just the first person as a doctor to come out and start talking about them again in a medical sense.


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