The Long Psilocybin Goodbye

Dried Cubensis

Public Domain photo by Eric Fenderson.

I’ve got PTSD and depression both after reading today’s article on ecstasy, psilocybin (psychedelic mushrooms) and ketamine for depression and post-traumatic stress disorder. The author, Ann Harding, quotes retired FDA medical officer Bruce Stadel, M.D., as saying, “These drugs in the 60s were just let loose without any proper study. [Now] they’re going through the FDA, through the process of clinical trials.”

What’s traumatizing is reading the description of the hoops the researchers have to jump through to generate a reasonable placebo environment. These measures are not without their necessity, I’ll admit — after all, a placebo control for magic mushrooms is not like one for statins in a cholesterol study. Assuming the drug has any effect at all and was given at an effective dose, what kind of a pinhead wouldn’t notice they’d eaten mushrooms? It kind of nullifies the placebo control when the psychotherapist’s face starts melting, right? Kinda hard to miss that.

So here’s what they do in an NYU study led by Stephen Ross, an addiction expert.

Patients are given a silver chalice containing either a psilocybin pill or a placebo.The patient then lies down on a brown sofa surrounded by artwork, sculptures of Buddha, and, on a nearby bookshelf, a little glass mushroom with a red cap. For the next six hours, the patient listens, with eyes shaded, to a combination of classical, Eastern, and tribal music.

A pair of therapists — who don’t know whether the patient has taken an active drug or placebo — stay in the room for support, though they encourage the patient to remain in a meditative state.

I’ll concede that this sort of thing may be a reasonable accommodation for a study on psychedelic drugs, but…tribal Music? Buddha? Really?

While the article comes across as fairly neutral, it’s strongly pro-drug, or at least pro-drug-research. The thing that bugs me most about it is that it opens with the story of Pamela Sakuda, a 57-year-old in the late states of terminal colon cancer who takes psilocybin as part of psychotherapy. Who wouldn’t be depressed in that situation? How much applicability do the experiences of a patient in extreme circumstances have for those not in that situation?

To my mind, the answer is maybe a lot, but for more general reasons than the article covers.

The problem with most medical thinking about recreational drugs is that medicine does not allow for recreation, and the medical idea of recreation doesn’t allow for thought, insight, or the random development that comes from out-of-the-ordinary behavior like using drugs. If I lose my job, get drunk, roll my car and find Jesus in the process, can you design a clinical trial to recreate that event to measure the clinical outcome of Jesus-finding in a placebo-controlled setting with half the recently-unemployed study subjects drinking Lipton’s Iced Tea?

Extreme behavior and extreme experience are often transformative, but the fact of extreme behavior or experience also transforms people; recreating it clinically is sort of like playing laser tag. If psilocybin generates extreme experience that can be of utility in a psychotherapeutic setting, so be it. But the use of it clinically is nothing like the use of an SSRI, Lithium, or other psychiatric drugs. To use the tools of drug studies to evaluate psilocybin, ketamine, or ecstasy misses a whole range of imaginative human behavior that is, generally speaking, not studied.

My prescription? A session of bungee jumping and a re-read of Hunter S. Thompson’s Hells Angels.

Possibly related posts:

One comment on “The Long Psilocybin Goodbye
  1. Pingback: The Long Psilocybin Goodbye « Skid Roche

Comments are closed.