Some people don’t come down after taking magic mushrooms, their mood stays elevated for months. Research from Imperial College London into treatment-resistant depression has attracted increasing interest. But where might it lead? Mark Brown explores.
These are uncertain times for the treatment of mental health difficulties. Research into the development of new drugs seems to have stalled. The availability of support and treatments is pegged not to need and demand but to economic circumstances and political will. The world, it seems, is teetering on the brink of chaos as new technologies and shifting political ideas shake up the settled pieces of life.
"The unfiltered, unvarnished confrontation with your own feelings and past experiences is not necessarily a comforting and completely risk free one."
What happens in such a climate? In the 1960s people turned on, tuned in and dropped out. Psychedelic adventurers built upon Freud and mythology and art. They used drugs and other ecstatic experiences to journey into inner space in search of answers. A stew of messianic therapists and burned-out seekers imploded in the 1970s. Now, in 2018, a new generation of psychedelics researchers is clean, shiny, modest and at great pains to avoid even a hint of tie dye.
The work of the Psychedelic Research Group at Imperial College London, the subject of a documentary film to be released later this year, has been exploring ‘psilocybin’. It’s the active compound in magic mushrooms. It might be a breakthrough treatment for patients living with severe and treatment resistant depression. In a paper published on the research this month, researchers found that neuroticism decreased as a response to psilocybin. Extraversion, conscientiousness and openness all increased. The changes were observed from baseline to the three-month follow-up after psilocybin-facilitated therapy for treatment-resistant depression. People felt better, at least up to three months afterwards. Longer-term prognosis was less clear.
In the research, twenty participants were given two doses of psilocybin, one exploratory and one larger, in controlled circumstances set up to be as relaxing and comfortable as possible. Think trying to make a hospital room look and feel as much as possible like a teenage hippy’s bedroom with relaxing candles and soft mood lighting. Each trip was supported by a therapist, present throughout as both an observer and a guide. An altered state of consciousness questionnaire was used. It covered self-reported measures of sensations such as insightfulness, blissfulness, experience of unity and spirituality.
It was found that the reduction in neuroticism and increase in extraversion after three months were predicted by the level of insightfulness expressed by the participant after their trip. In other words, it might be said that the more personally meaningful the trip felt for the person, the more they felt a weight had been lifted from their shoulders. This allowed them to face outwards after years of the inward focus of depression.
Discussing the results of the trial during a 2016 Ted Talk, Robin Carhart-Harris, one of the researchers, quoted one participant’s description of their experience: “the usual negative self-narration that I have had vanished completely. It was replaced by a sense of beautiful chaos, a landscape of unimaginable colour and beauty. I began to see that all of my concerns about daily living weren’t relevant, that they were a result of a negative spiral. I also felt like I was learning without being taught that intuition was being fed. Fleeting feelings from my past came back, memories too, both of which had seemed long-forgotten. I also feel as if I’ve seen a much clearer picture. Another side to this is that I feel like I’ve had a second chance, like a survivor. I can enjoy things now the way I used to without the cynicism, without the oppression. At its most basic I feel like I used to before the depression.” Carhart-Harris admits that he is cherry picking one of the most eloquent and positive accounts, but the general narrative concurs with the positive experiences of others.
What seems common to the positive effects of such drug experiences is meaning, rather than chemical action. This is in contrast to other illicit drugs that are showing promising results for severe depression such as ketamine. It seems psychedelics are tools for meaning, providing a mechanism where psychological responses that might close down or limit the association and revelation required to bring material to conscious consideration are suspended. It also seems that the moving forwards may not be chemical, but narrative.
In odd parallel of the symptoms mental health medications are supposed to help, the majority of medications are anhedonic, ie, do not give pleasurable effects. The meaning is considered to be the measurable result, not the sensation and experience of the drug itself. The consciousness consuming the medication is merely a passenger riding the back of the stampede of chemical changes happening beneath it.
Speaking to New Scientist in 2016, Robin Carhart-Harris said of psilocybin, “People often say, as our patients did, that this isn’t a moreish drug. It’s certainly not a hedonic (pleasure-giving) drug. Some even challenge whether it’s a drug of recreation; maybe it’s a drug of exploration.”
It seems that, despite ongoing work to understand what may have been changed in brain chemistry or function, the positive outcome in part seems to derive from the meaning of the experience and the mediated engagement with difficult or challenging feelings or ideas that the individual had not been able to surface or process. Implicit is the idea that this experience could not have been reached simply by spending the same amount of time with a therapist, without the trip.
One thing that marks research thus far into psychedelics and the brain is the issue of consent and of self-selection. In the context of the current round of interest, it is notable that participants have constituted a self-selecting sample, either people who were ready for self-exploration and consciousness expansion or, as is the case with the ICL study, people who were at the end of any other possible treatment options. These, to a lesser or greater extent, are people who are already disposed toward having some kind of meaningful experience and who were supported in building upon that experience having been given a chemical helping hand to begin the journey.
Psychiatrist Humphry Osmond coined the phrase psychedelic in the 1956, combining the ancient Greek for mind or soul with the word for manifest or visible, after studying mescaline and LSD in relation to experiences such as alcoholism and what is commonly referred to as schizophrenia. For something to be psychedelic was literally for it to be revelatory, to be revealing of truth.
History is filled with people left blinded and destroyed by revelatory visions. To see a truth without preparation and support is to have to carry it unaided. The unfiltered, unvarnished confrontation with your own feelings and past experiences is not necessarily a comforting and completely risk free one.
Marrying psychedelics with therapeutic support
It would seem that context and ongoing support is vital in processing the experiences of psychedelics and minimising the potential damage that a bad trip might create. It may be that psilocybin especially produces a specific kind of revelation. I spoke to X, a young college graduate from southern California about her experiences with psilocybin. She told me: “I was in my junior year of college, I was depressed, anxious, and sedentary. I was on academic probation and at risk of getting kicked out of school because of it. I had a close friend at the time who presented an opportunity to do psilocybin mushrooms and I took him up on it.”
“It was like, ‘Wow I'm so happy I'm having this experience, I want to remember and learn from this because I'm finally being vulnerable with myself.’ But on the flipside there were also feelings of ‘How could you let yourself be so content with unhappiness?’ It's like when a friend sits you down and asks how you're doing because you've been acting strange, except that friend was myself. It’s bittersweet.”
At present, research into psychedelics such as psilocybin is difficult in the UK due to all psychoactive substances (except alcohol, nicotine and caffeine) being made illegal through the passing of 2016 Psychoactive Substances Act. It is unlikely that this status will change soon. Substances such as psilocybin, as powerful and potentially life changing as they are, will remain in the domain of illegality and personal risk, outside of being integrated into a possible new form of therapeutic intervention.
Current mental health responses, splitting as they do chemically-aided revelation and therapeutic support, maximise the risk to those who take the trips while minimising - if the work at ICL proves to be correct - the benefit to those who might most urgently benefit from them.
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