Marcelo Leite
Bioenergetic Analysis • The Clinical Journal of the IIBA, 2024 (34), 25–29
https://doi.org/10.30820/0743-4804-2024-34-25 CC BY-NC-ND 4.0 www.bioenergetic-analysis.comIt was somewhat surprising to receive an invitation to give a talk at the 26th International Conference of the IIBA in Vitória, Brazil, August 2023. Not being a medical doctor nor a therapist, just a science journalist and book author, in no way was I in the position of making recommendations about the use of powerful substances that remain controlled in most countries. But there are nations where psychedelics are being considered for rescheduling under the influx of many clinical trials suggesting that they have a significant potential for handling disorders such as treatment resistant depression and post-traumatic stress, what has been labeled the psychedelic renaissance, a subject I have been writing about for more than six years now.
Media stories have appeared in many news outlets in recent times, such as The New York Times, The Financial Times, Wired, The Guardian, Folha de S. Paulo and so on. Entertainment programs like Oprah popular TV show have dealt with the matter as well. Their attention has been caught mainly by the bestseller How to Change Your Mind (2018) by the prominent American journalist Michael Pollan, a book that inspired a Netflix series as well. Behind all that buzz is a flurry of clinical trials that took place in the last ten years or so, initiated by mainstream biomedical academic institutions such as the Imperial College, Johns Hopkins University and Yale University.
On September 14, 2023, for instance, the Nature Medicine journal published a second part of a phase III randomized controlled trial focusing on MDMA (ecstasy, molly) as an adjuvant for psychotherapy to treat post-traumatic stress disorder (PTSD). A sample of 104 patients with moderate to severe PTSD received either MDMA or placebo in the course of nine therapy sessions, three of which involved dosing, preceded by three other preparation sessions, and subsequently by three integration sessions. The treatment group had a 23.7-point reduction in scores obtained with the Changes in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), whereas in the placebo group the reduction was -14.8.
It is called a “renaissance” because psychedelic science has a long and respectable pre-history that remains unknown by many people. The War on Drugs propaganda unleashed by Richard Nixon’s administration in the 1970’s was effective in tainting psychedelics (and marijuana) as terribly dangerous mind-altering drugs that would drive one to jump off high-rises or engage in murder rampages in Charles Manson style. It comes as a big surprise for many to learn that psychedelics like LSD, mescaline, DMT and psilocybin have a good safety profile, much better than alcohol, anyway, and a low potential for addiction. In fact, both MDMA and LSD have been extensively prescribed by doctors and therapists in the 1950’s and 1960’s to treat alcohol abuse.
The first four above mentioned substances, LSD, mescaline, DMT and psilocybin, constitute the so-called classic psychedelics. They are agonists of the serotonin receptor 5-HT2A, considered to be the main initiator of the psychedelic effect. There is still much discussion as to what exactly happens in the brain-body system that induces the characteristic and profound change in consciousness marked by varying degrees of ego-dissolution, distortions in the perception of space and time, and visual perturbations (frequently referred to as hallucinations, although they are not to be confused with psychotic delusions, as the tripping person usually remains aware that the images are not external realities).
Besides MDMA, not a classic psychedelic that some researchers prefer to call empathogens or entactogens, there are trials taking place with ibogaine (mainly for substance abuse) and ketamine (depression). Ketamine, in fact, is a registered drug that can be prescribed off-label by medical doctors in many countries, and a wave of ketamine clinics have been started in the USA and other places. In Australia, prescriptions of MDMA and psilocybin to treat PTSD and depression, respectively, are now legal, provided that the doctor procures a special license for that. Both are also under examination by the Food and Drug Administration (FDA) in the US, a process that is expected to result in licenses by 2024 or 2025. Oregon and Colorado recently authorized psilocybin service centers, where accredited facilitators (not necessarily health professionals) can offer Psilocybe mushroom capsules to adult clients. Other states, such as California and Washington, are about to follow suit.
There is a growing number of conditions under consideration for psychedelic assisted psychotherapy (PAP). Here is an incomplete list:
With that much clinical potential, there are not many reasonable grounds to keep psychedelics on Schedule 1, as the most restrictive list of controlled substances is better known. With the exception of ketamine, they carry a low risk of abuse. It is true that both MDMA and ibogaine can elicit cardiac impacts such as arrythmias, but they are generally not severe and can be managed if the person has no history of health issues. On the other hand, microdosing, a growing popular use as cognitive and wellness boosters, might entail problems with heart valves. The main risk around psychedelics, though, is triggering psychotic breaks, but personal or familial history of psychosis are already considered an exclusion criterion for clinical trials and will certainly remain so if and when PAP is approved as a treatment.
There are some hypotheses going around to explain the healing potential of psychedelics that might someday bring respite to so many suffering causing conditions. Brain images during psychedelic trips have shown a relaxing of the Default Mode Network (DMN), a well established pattern of communication between brain regions that accompanies introspection, when the person is not busy with some operational task. As this is precisely the network that becomes too active in rumination, the circular repetition of negative ideas, beliefs and feelings characteristic of severe incapacitating depression, a DMN relaxation seems to bring just enough entropy in the rigid pattern as to allow alternative thoughts and interpretations to find their way to conscience. Psychedelics are also known to induce neuroplasticity, the production of neuronal connections spurred by augmented levels of the compound BDNF (brain-derived neurotrophic factor). Psychedelics can also exert an anti-inflammatory effect, and brain inflammation is correlated with depression, for example. Finally, brain waves under the influence of psychedelics mimic some aspects of sleep, although the person remains fully awake, which may indicate some of the restorative functions of sleep are in action too.
With so much going on in the field of psychedelic research, it comes as no surprise that the Psychedelic Science 2023 conference held last June in Denver, CO attracted 12,000 attendees, four times as much as the previous PS 2017 event in Oakland, CA six years before. Although the tsunami of private, usually philanthropic research funds is long gone, an amazing number of commercial exhibitors and investors filled the Convention Center, along with many dozens of scientists, advocates and journalists. Indigenous peoples’ representatives took the stage during the closing ceremony to protest against patents and commodification of age-old sacred medicines, as they see psychedelics like mescaline, psilocybin and ayahuasca’s DMT. There were also cautionary presentations about false beliefs provoked by psychedelics and the vulnerability of patients under their effect, easy suggestible preys to abusive healers. Altogether, though, a general optimistic tone prevailed, despite the regrettable mystical undertones and messianic promises that appeared to motivate many a participant.
Psychedelics are no panacea to the ills of the 21st Century, for sure, which depend on societal transformations to be eradicated. But they represent a credible promise of preventing and healing a lot of unnecessary suffering in the world. Before Denver, quite a few observers of the psychedelic science field were skeptical of the potential of such drugs to treat so many conditions, but at least some of them came out of the conference convinced that this apparent weakness might in fact be its most notable strength: the capability of undoing or at least relaxing entrenched ideas and beliefs, the common core of that encompassing list of disorders and conditions, sometimes referred to as their transdiagnostic potential. In a world at odds with post-Covid depression afflicting three in ten adults, PTSD and anxiety boosted by climate change’s storms, wildfires and heatwaves, and suicide as the 4th cause of death among youths, one cannot leave any medicine locked up in a prejudice closet.
Getting back to the motto of the IIBA conference in Vitória, “Giving Voice to the Body in Challenging Times”, one has to consider the fact that such prevailing maladies affect not only people’s souls, but manifest themselves primarily, in many cases, as bodily suffering. Pain, in a word –and it is not a coincidence that our language equates mental hurt with physical harm. Fibromyalgia, sleep disruption, anorexia nervosa, bulimia, frigidity, tremors … there is no shortage of physical symptoms associated with ills of the psyche. And psychedelics are known to blur the boundaries between body and mind and to make the person aware of the obvious unity and its participation in a much grander totality one might want to call Nature, Mankind, Cosmos, Divinity, Nirvana, Ultimate Reality, The Great Beyond – your pick. Besides, psychedelics also involve the body in its tentacles, leading trippers to cry, dance, tremble, shout, laugh, purge, incorporate entities, defecate and so on. Usually those manifestations are managed by experienced guides and shamans with the help of chants, movements, gentle lighting, scents, mantras, bonfires, herbs, smoke etc. In summary, an arsenal of techniques not at all foreign to body therapists.
Rosalind Watts, a psychologist deeply involved in psychedelic clinical research and outreach, has already said that resorting to psychedelics might help the afflicted individual to dive beneath the waves of depression (i. e. rumination) into the depths of the body and then back to the surface. Sidarta Ribeiro, one of the neuroscientists leading first class research on the subject in Brazil, always recommends psychonauts to go beyond the surf and not to fear the open ocean.
Yes, it can get very dark and overwhelming sometimes, but bathing in sea waters more frequently feels like going home. In any case, it is always advisable to procure a guide and learn how to swim – why not rely on a knowledgeable and trained body therapist?
Marcelo Leite, PhD, Science journalist based in São Paulo, Brazil. His 2021 book Psiconautas: Viagens com a Ciência Psicodélica Brasileira (Psychonauts: Trips with Brazilian Psychedelic Science) was launched in Portuguese by Fósforo Editora.