Thursday, June 13, 2024

Psychedelic Renaissance or a new drug dark age? (Ruminations)

Hundreds of Ketamine "clinics" have sprung up across the country; Business Wire PR statements celebrate FDA designation of various psychedelic drugs as "breakthrough therapies" to allow pharmaceutical company trials with acid, shrooms, and ecstasy, as promising new cures for various mental illnesses; LSD flows again in the streets and through the veins of American youth, to start the walls breathing and wake the sleeping demons.

As many people know, at the end of the 20th Century psychiatry's hot new drugs and great, vaunted "Decade of the Brain" all failed miserably. The theories and "diagnoses" were revealed as nonsense, and the "medicine" (only laughably called "antidepressants" and "antipsychotics") is now popularly recognized as abuse and snake-oil poison rather than science. People who do not want their life expectancy to be reduced by twenty years refuse psychiatric drugs, and the men in white coats may finally lose their legal facility to coerce anyone to be an unwilling patient. These developments amount to a dire threat to a scam profession, which once believed it had locked up the invaluable status of "medical specialty."

The threat might only be handled or lessened, if new and better "cures" for human problems in thinking, feeling and behaving can be miraculously developed. Two possibilities are: 1) new drugs, and 2) a resurgence (or actually an advent) of effective talking therapies.

Enter the so-called "Psychedelic Renaissance," which may bear directly on either or both of these two potential saves for psychiatry.

Psychedelic drugs do create huge effects on thinking, emotion and personality. Those effects can seem good or bad, they can make you think you're a holy superman or quickly kill you. But for psychiatry (especially American psychiatry), the drugs all by themselves are an obvious "Hail Mary" play. They do something.

But nobody knows what they do. Do they bring new brotherhood with the universe or horror and suicide? The answer is far too unpredictable, thus inspiring a regime called "Psychedelic-Assisted Therapy" or "PAT". PAT consists of two or more sessions with a trained therapist before and after a person trips on the drug. The preparatory session attempts to evaluate and optimize aspects of "set and setting" so the person will be more likely to have a "good" trip. The sessions after tripping help with "integration," or a hoped-for useful assimilation of the unusual and occasionally ("bad" trip) traumatic experiences caused by the drug. 

There is a great deal of speculation about this talking therapy element of PAT, whether it's necessary, how it can be standardized or researched, and whether it presents risks of abuse. "Set and setting" (respectively, the mindset of the person who trips, and the environmental influence when he trips) was researched in the 1950's and 60's. Arguably, the concepts of set and setting have not changed in more than half a century; the knowledge that these factors are the largest determinants of a person's experience on psychedelic drugs has not changed.

Of course, the orthodox, APA-type psychiatric establishment gave up on helpful psychotherapy long ago. They became a medical specialty instead, brain doctors, under the arbitrary, vain presumption that all the secrets of life can eventually be found in the brain. Psychiatrists thus fell under the economic whip of health insurance actuaries and capitalist third-party payers. So they cannot officially push PAT, and they can't really push psychedelic drugs alone, until those drugs are proven safe and effective (which may never happen).

The current rage for LSD, ecstasy, shrooms and special K, comes from a weird collection of people who call themselves the Psychedelic Renaissance. They've raised a lot of money and bought some success, e.g., with state legislatures in Colorado and Oregon, and with European drug regulators. However, they recently had an epic failure with the FDA in Washington, D.C.

The most high profile organization in this weird collection is the Multidisciplinary Association for Psychedelic Studies (MAPS), headed by 71-year-old Rick Doblin, a charismatic Harvard Ph.D. MAPS and Doblin have historical ties going back to the original psychedelic movement in the mid-20th Century, but they don't talk much about that. They are covert religious fanatics, but their public focus and the image they carefully cultivate is of 21st-Century scientific research into sorely-needed treatments for mental disorders, and potential improvements in people's mental and emotional lives.

The falsity of MAPS' PR image is obvious in a single, stark contradiction: psychedelic drugs are promoted as both scientific medicine and religious sacrament. Tripping is (simultaneously) treatment for brain disorders and a religious ritual for spiritual revelation.

The Psychedelic Renaissance is a weird group of people mostly because they strategically believe one or the other of these contradictory things, at different times and in different circumstances, and pretend not to notice any problem. As a movement they promote both views because if tripping isn't medical treatment that private insurance or Medicaid pays for, it will never be scalable or show profit. Talking psychotherapy is expensive, and even if it ever did work, it didn't appeal to regular people, just the wealthy. Broad, booming, popular interest goes to big things, prospects for true breakthroughs: life-changing expanded consciousness, brotherhood with the universe, victory over death. 

Tim Leary was a trained scientist who found deep faith in LSD. Ken Kesey was a bratty college kid who cared about nothing but "pranking Amerika." They were both apparently part of the same movement. But a lesson of history warns us to notice differences better than we did then. The good trip of 1967 music and love became the bad trip of Watergate, Manson murders, and Jonestown. By 1970, hippies were (quoting Jules Evans' and Steve Rolles' charming characterization of present-day psychedelic drug enthusiasts) "boring dickheads."

Generations ago, Western culture was alive and powerful enough to survive psychedelics, but it might not be so resilient now. We must pay closer attention, and above all we cannot any longer alienate an honest study of the mind from religion; we cannot condone the degenerate parody of such honest study in non-religious fields. 

"Set and setting," brother. Peace!

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