Allan Tasman, MD | Editor in Chief
One pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don’t do anything at all
White Rabbit, Grace Slick, circa 1966
Hold on, Alice, this may not be true.
Last month I wrote about the hot topics in psychiatry for 2016. On the list was the emerging research on the use of ketamine for rapid response treatment of suicidal ideation and depression. I wrote that this was important both because it provides a new pathway to better understand antidepressant response, and because it opens the door to state-of-the-art research on other psychotomimetic agents. That door is opening more and more, and it’s not just perception, but becoming reality.
The study of a wide range of potential medical/psychiatric uses of hallucinogens was, of course, inhibited because of the aftermath of widespread use of “mind-altering” agents starting with the counterculture movement in the 1960s. Timothy Leary—he of “Tune in, turn on, drop out” fame—and Richard Alpert, later known as Ram Dass, both Harvard professors, were fired in 1963 because of concerns about their LSD research. A year earlier, the FDA had listed LSD as an experimental drug and restricted research on it.
The FDA research restrictions were likely not only because of scientific concerns but also political and societal pressures. In the 1950s, hallucinogens were becoming drugs of choice for those interested in finding ways to improve self-awareness in addition to psychoanalysis. Aldous Huxley was one of the more prominent experimenters. His book, Doors of Perception, published in 1954, was an essay about his own experiences.1
LSD also had been the subject of substantial academic research in the 1950s, capped by the First International Conference on LSD Therapy sponsored by the Josiah Macy Foundation in 1959.2 Among the presenters were such major figures in academic psychiatry as Jonathan Cole, an internationally known psychopharmacology researcher and later Chief of Psychopharmacology at Harvard’s McLean Hospital, and Louis J. West, Chair of Psychiatry at UCLA for 20 years.
The Second International Conference on LSD in 1965 focused on use of the drug in psychotherapy and alcoholism. That conference included such speakers as Daniel X. Freedman, who became Chair of Psychiatry at the University of Chicago a year later, and President of the American Psychiatric Association (APA) in 1981. Arnold Ludwig, another speaker, later won the APA’s research award for his work on LSD and alcoholism. I was fortunate to have him as my medical school advisor and mentor while he was Chair of Psychiatry at the University of Kentucky.
I mention these facts because hallucinogen research was seen as an important and appropriate field of inquiry in psychiatry during the 1950s and 1960s. But the US government banned possession of LSD in 1968 (the state of California had banned it in 1966) due to what was then an epidemic of hallucinogen use in the US. Having been in college in those days, I can assure those readers too young to remember that the level of concern and panic about the negative effects of hallucinogenic use, both in the medical and psychiatric community, as well as federal, state, and local governments, not to mention millions of parents, was palpable and cannot be overestimated. The national worry dwarfed the present-day focus on opiate addiction.
1. Huxley A. The Doors of Perception and Heaven and Hell. New York: Harper Collins; 2009.
2. Erowid. LSD Timeline. https://erowid.org/chemicals/lsd/lsd_timeline.php. Accessed December 12, 2016.
3. Wikipedia. Project MKUltra. https://en.wikipedia.org/wiki/Project_MKUltra. Accessed December 12, 2016.
4. Hoffman J. A dose of a hallucinogen from a “magic mushroom,” and then lasting peace. New York Times. December 1, 2016. http://www.nytimes.com/2016/12/01/health/hallucinogenic-mushrooms-psilocybin-cancer-anxiety-depression.html. Accessed December 12, 2016.
5. Ross S, Bossis A, Guss J, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharm. 2016;30:1165-1180.
6. Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: a randomized double-blind trial. J Psychopharm. 2016;30:1181-1197.
7. Phillips D. FDA agrees to new trials for ecstasy as relief for PTSD patients. New York Times. November 29, 2016. http://www.nytimes.com/2016/11/29/us/ptsd-mdma-ecstasy.html. Accessed December 12, 2016.