Jakab, R. L. and P. S. Goldman-Rakic. 1998. 5-Hydroxytryptamine-2A serotonin receptors in the primate cerebral cortex: Possible site of action of hallucinogenic and antipsychotic drugs in pyramidal cell apical dendrites. Proceedings of the National Academy of Sciences USA 95:735–40.
Leung, A. Y. and A. G. Paul. 1968. Baeocystin and nor-baeocystin: new analogs of psilocybin from Psilocybe baeocystis. Journal of Pharmaceutical Sciences 57:1667–71.
McKenna, T. 1992. Food of the Gods. New York, N.Y.: Bantam Books. Metzner, R., ed. 1999. Ayahuasca: Hallucinogens, Consciousness, and the Spirit of Nature. New York: Thunder’s Mouth Press.
Migliaccio, G. P., T. L. N. Shieh, S. R. Byrn, B. A. Hathaway, and D. E. Nichols. 1981. Comparison of solution conformational preferences for the hallucinogens bufotenin and psilocin using 360 MHz proton NMR spectroscopy. Journal of Medicinal Chemistry 24:206–9.
Murray, M. T. 1999. 5-HTP: The Natural Way to Overcome Depression, Obesity, and Insomnia. New York, N.Y.: Bantam Books.
Nichols, D. E., and S. Frescas. 1999. Improvements to the synthesis of psilocybin and a facile method for preparing the O-acetyl prodrug of psilocin. Synthesis (6):935–38.
Ott, J. 1993. Pharmacotheon: Entheogenic Drugs, their Plant Sources and History. Kennewick, Wash.: Natural Products Company.
Shulgin, A. and A. Shulgin. 1997. TiHKAL (Tryptamines I Have Known and Loved): The Continuation. Berkeley, Calif.: Transform Press.
Stamets, P. 1996. Psilocybin Mushrooms of the World. Berkeley, Calif.: Ten Speed Press.
Strassman, R. 2001. DMT: The Spirit Molecule. Rochester, Vt.: Park Street Press.
Vollenweider, F. X., M. F. Vollenweider-Scherpenhuyzen, A. Babler, H. Vogel, and D. Hell. 1998. Psilocybin induces schizophrenia-like psychosis in humans via a serotonin-2 agonist action. Neuroreport 9:3897–3902.
Wasson, R. G. 1968. Soma: Divine Mushroom of Immortality. New York, N.Y.: Harcourt Brace Jovanovich.
———. 1971. The Soma of the Rig Veda: What was it? Journal of the American Oriental Society 91:169–87.
Wasson, R. G., A. Hofmann, and C. A. P. Ruck. 1998. The Road to Eleusis: Unveiling the Secrets of the Mysteries. Los Angeles, Calif.: William Dailey Rare Books. (Originally published in 1978).
Williams, G. V., S. G. Rao, and P. S. Goldman-Rakic. 2002. The physiological role of 5-HT2A receptors in working memory. Journal of Neuroscience 22:2843–54.
Willins, D. L., A. Y. Deutch, and B. L. Roth. 1997. Serotonin 5-HT2A receptors are expressed on pyramidal cells and interneurons in the rat cortex. Synapse 27:79–82.
David E. Presti, Ph.D., is a neurobiologist and clinical psychologist who teaches in the Department of Molecular and Cell Biology at the University of California in Berkeley. He has doctorates in molecular biology and biophysics from the California Institute of Technology and in clinical psychology from the University of Oregon. He can be contacted at: [email protected].
David E. Nichols, Ph.D., is Professor of Medicinal Chemistry and Molecular Pharmacology at Purdue University. He has over 230 published research reports, book chapters, and symposia proceedings, and six U.S. patents. In 1993, he was the lead founder of the Heffter Research Institute (www.heffter.org), a nonprofit institute to support research into the scientific and medical value of hallucinogens. He can be contacted at: [email protected].
5
A HISTORY OF THE USE OF PSILOCYBIN IN PSYCHOTHERAPY
TORSTEN PASSIE, M.D.
INTRODUCTION
The Application of hallucinogens in modern psychotherapeutic methods can be traced back to the 1950s. At first, lysergic acid diethylamide (LSD) was the most commonly used of the psycholytics, as LSD and mescaline were then categorized (Abramson 1960, 1967; Passie 1997). In the early 1960s, psilocybin (4-phosphoryloxy-N, N-dimethyl-tryptamin) was discovered in Mexican mushrooms (Hofmann et al. 1958; 1959). Shortly thereafter it was synthesized and applied in psychotherapy under the name Indocybin by Sandoz.
Psilocybin was used almost exclusively in Europe as an agent to help activate unconscious material in depth psychology (psycholysis).This procedure utilizes the properties of hallucinogenic substances to stimulate the emotions and promote a fluid, dreamlike state that is experienced in clear consciousness and with good recollection of what is occurring. In this manner, subconscious conflicts and memories can be re-created and made accessible to psychotherapy. It is understood that it is not the pharmacological effect that causes the therapeutic result, but the long-term therapeutic processing of material that has been exposed.
In utilizing this pharmacologically-aided method, many previously therapy-resistant patients could be treated. Psilocybin, as well as its quick-acting derivative, CZ 74 (4-hydroxy-N-diethyltryptamine), distinguishes itself by its unique properties of short duration of effects, mild neurovegetative side effects, few instances of depersonalization or anxiety provocation, as well as a stable and positive influence on the emotional experience (Hofmann 1959; Leuner et al. 1965; Baer 1967). Since it offers a more gentle and direct control of the altered state than LSD, it appears to be a substance of choice for future applications in psychotherapy (Leuner 1968, 1981).
In regard to its use in psychotherapy, I will introduce four types of treatment that have been studied on approximately fifteen hundred patients. To start, the following discussion will elaborate on differences and similarities between traditional and modern applications.
EARLY HISTORY OF PSILOCYBIN USE
In the monumental work Historia General de las Cosas de Nueva Espana (1598) by the Franciscan monk Berhardino de Sahagún, we find descriptions of natives in the New World who ingested certain intoxicating mushrooms during religious ceremonies. The clergy of the Inquisition deemed these rituals the work of the devil, whereas the natives regarded the effect of the mushrooms as the direct work of god and consequently named the mushroom teonanácatl, which means “divine mushroom” (Wasson 1958). In the same source there are further references to the fact that these mushrooms are not only used during religious ceremonies, but also for healing purposes by a medicine man. Reportedly, ingesting these mushrooms gave the medicine man certain visionary powers that enabled him to not only recognize the cause of an illness but also guided him in its treatment.
In the framework of such shamanistic treatment, psychological as well as social conflicts of the patient are addressed. The therapeutic sessions usually take place in the presence of relatives, who selectively will be involved in the ceremonial treatment. Frequently, only the healer actually will ingest the mushrooms for diagnostic purposes, or on other occasions the patient, the healer, and the attending relatives will ingest the mushrooms. This procedure is applied to diagnose not only the character and cause of the illness, but to simultaneously utilize the sensitization in the altered state of consciousness for healing catharsis and its manipulation (Wasson 1980; Passie 1985, 1987). By including direct family members and relatives, a positive healing outcome is made much more likely.
The first modern psychopharmacological research with psilocybin was presented between 1958 and 1960 (Dealay et al. 1995; Ruemmele 1959; Quetin 1960). Reports included dreamlike experiences that approximate the effect of other well-known hallucinogens such as LSD and mescaline, namely the intensification of the senses, illusions, pseudohallucinations, extreme tendency toward introversion, synaesthesia, changes in the experience of time, space, and the body, symptoms of depersonalization and the nonspecific increase in emotional qualities. Special attention was given to the frequent reliving of vivid memories with pronounced emotional undertones. This patient profile was observed particularly among neurotic subjects (Delay et al. 1959, 1961, 1963; Quetin 1960).
During the 1960s, other research that addressed different aspects was conducted by scientists of various nationalities, occasionally with a substantial number of subjects (Leary 1961; Salgueiro 1964). These studies confirmed the above-described psychopharmacological effects, the controllability of the state of inebriation and the physiological harml
essness of psilocybin (Malitz et al. 1960; Hollister 1961; Heimann 1961; Sercl et al. 1961; Rinkel et al. 1961; Nieto Gomez 1962; Leuner 1962; Aguilar 1963; Perez de Francisco 1964; Reda et al. 1964; Keeler 1965; Metzner et al. 1963; Da Fonseca et al. 1965; Steinegger et al. 1966; Flores 1966; Dubansky et al. 1967; Fisher et al. 1970).
APPLICATIONS IN PSYCHOLYTIC THERAPY
The longstanding traditions of healing rituals using hallucinogenic substances, particularly mescaline (Passie 1995), in central and South American societies was reported from extensive research conducted during the first half of the twentieth century (Beringer 1927; LaBarre 1938). Experiments with the extremely potent hallucinogen LSD (Stoll 1947) led Busch et al. (1950) to conduct the first trials including these substances in psychotherapy for neurotic patients. Later research was conducted in the context of psychoanalytical methods by Frederking (1953–1954). The English scientists working with Sandison et al. (1954) were particularly interested in the potential use of these substances as adjuncts to psychotherapeutic treatment. They reported improvements among their neurotic patients after a single treatment with LSD.
Initially, some scientists thought that the drug was responsible for the therapeutic effect. However, it quickly became evident that because of the unproductive structure and short-lived nature of experiences induced by the drugs, lasting benefits could only be realized with long-term therapy. The substances served as supporting agents in revealing unconscious material and gaining a more profound understanding of the self.
Psycholytic agents, such as LSD and psilocybin, possess the capability to aid in psychotherapy because they cause a fluid, dreamlike state experienced in clear consciousness with good recollection of what is occurring. Thus, unconscious conflicts and memories that have been suppressed can be activated and vividly recalled. Additionally, psychological defense mechanisms are relaxed and psychotherapeutically valuable types of regressive experience, such as age regression, can be evoked. Stimulating affectivity allows the recollection of long-past emotional experiences as well as recent ones. The transference relationship between the therapist and the patient is intensified and is sometimes accompanied by illusionary distortion of the therepist’s features and identity. Hence, the patient clearly experiences the projective character, possibly that of infantile transference.
Under the influence of low dosages of psycholytic agents, a peculiar distancing enables the patient, or the reflective core of the self, to observe the altered state. This assures continuous understanding by the patient of the artificial cause of his altered state of experience.
Furthermore, the patient focuses on and associates separate emotional facts and reminiscences, personal relationships or wrongful evaluations of character, differently from an enlarged perspective. In this process, several areas of consciousness are addressed simultaneously and a broad integration of unconscious matter is achieved. The patient gains wide introspective access into delusional neurotic behavior. Due to the extraordinary emotional involvement, this process is particularly convincing, all the while intensifying and accelerating the therapy.
With the above-mentioned effects in mind, a considerable number of therapists thought it possible to expand the spectrum of psychotherapy by including patients who were formerly thought to be untreatable, due to their serious and chronic neuroses. These patients were characterized by their rigid defense and displacement mechanisms, lack of ability to form interpersonal relationships, and inability to process unconscious material through regular channels such as free association and dreams. Most psychotherapeutic treatments were ineffective for these patients. Psychotherapists recognized the potential of psycholytics to treat these difficult patients by stimulating a dreamlike alteration of experiences (Arendsen Hein 1963).
During the following ten years, the application of hallucinogens in psychotherapy treatment of extremely disturbed neurotic patients was tested internationally, improved, and established as clinical procedure (Sandison et al. 1954; Leuner 1962; Ling et al. 1963; Hausner et al. 1963; Grof 1967; also Abramson 1960, 1967; Passie 1995, 1997). Initially, LSD was the agent in these experiments, but very shortly after the discovery and synthesis of psilocybin, experiments were conducted with it as a psychotherapeutic drug (1958–1961). The basic psychopharmacological effect on individual neurotic patients was studied without psychotherapeutic preparation and postanalysis of the experience (Delay et al. 1959; Vernet 1960; Quetin 1960; David et al. 1961; Duche 1961; Sercl et al. 1961). Leuner described early treatments with psilocybin in a psycholytic setting (Barolin 1961; Leuner 1962). Until the 1980s, Leuner and his group of scientists treated more than 150 neurotic patients with psilocybin or its short-acting derivative, CZ 74, in a longitudinal study at the University Clinic of Goettingen, Germany (Leuner 1981, 1987, 1995; Fernandez-ceredeno et al. 1967).
The advantages of psilocybin in comparison to LSD were: short-term effectiveness, fewer neurovegetative side effects, less tendency to experience depersonalization, a stable, positive experience, and little distress while reliving conflicts and traumatic material. The entire experience under the influence of psilocybin was found to be altogether gentler and less confrontational than with LSD.
PROCEDURES IN PSYCHOTHERAPY WITH PSILOCYBIN
Psilocybin psychotherapy can be categorized in the following four types:
A. Individual psychoanalytic therapy including out-patient or residential psycholytic treatment and follow-up visits in psychoanalytic one-on-one sessions.
This method concerns the application of psycholytic substances in the course of psychotherapeutic individual treatment. It was developed and perfected for clinical application by various teams (Sandison et al. 1954; Leuner 1959; Hausner et al. 1963; Ling et al. 1963; Grof 1967). The first psycholytic session is almost always preceded by psychoanalytic treatment that has lasted for months. Psychoanalytic individual treatment with additional weekly or monthly psycholytic sessions sets the framework for the procedure that Sandison was the first to call “psycholysis” in 1960 (Barolin 1961). Experiences gained in psycholytic sessions are subsequently analyzed during intervening sessions without the use of drugs and with the help of documentation and memories.
The setting is arranged in such manner that the patient is able to surrender to his experiences uninhibitedly. All authors recommend a darkened room and quiet music to subtly stimulate the experience. The continuous presence of the therapist or a specifically trained assistant offers the patient protective support during the sessions. Occasional visits by the treating physician complement the care. These professionals do not intervene with interpretation during the course of the experience.
During the early sessions, the dosage is gradually increased from low dosages of LSD (50–150 mcg) or psilocybin (3–15 mg) up to the level at which the patient produces the most productive experiences. Psychodynamic encounters as well as the intensification of the transference relationship are deemed the most important indicators of adequate dosage.
Interpretation and integration take place during drug-free intermediate sessions. During the 1960s, much success was reported in treating more than a hundred neurotic patients with psilocybin (Fontana 1961; Heimann 1962; Leuner 1962; Alhadeff 1963, 1963; Hausner et al. 1963; Stevenin et al. 1962; Gnirss 1963, 1965; Kristensen 1963; Geert-Jörgensen et al. 1964, 1968; Massoni et al. 1964; Cwynar et al. 1966; Derbolowsky 1966; Johnson 1967; Fernandez-cerdeno et al. 1967; Clark 1967–1968; Berendes 1979–1980). Major indications for treatment were character neuroses, fear and compulsion, neurotic and reactive depressions, perversions and sexual neurosis. Counter indications would include hysterical neurosis, psychosis, and borderline cases, as well as patients that exhibit constitutionally infantile and weak-self properties. B. Individual psychoanalytic therapy with psycholytic one-on-one sessions and follow up meetings in group therapy.
Early classic psycholytic setting, with attending nurses and physician in the background. (See: Bierer et al. 1961)
First developed by Sandison et al. (1
954) and tested with LSD on a great number of patients during the 1960s, this same methodology but using psilocybin was established by therapists using psychoanalysis (Fontana 1961; Derbolowsky 1966; Hausner et al. 1963; Geert Joergensn et al. 1964; Gnirss 1965; Johnsen 1967; Alnaes 1965; and particularly Leuner 1962).
This procedure followed the same premises as described in section A. The psycholytic one-on-one sessions were conducted at weekly or monthly intervals with the help of the therapist or an assistant. Patients were admitted to a clinic for several days to conduct each session. Before and after the psycholytic sessions in private rooms, the patients were brought together in a group to interpret and analyze the material through depth psychology. Their sensitized psychic condition could be utilized in the postsession analysis, while the effects of the drug were abating and the openness to discussion under the influence of the experience remained. In the next step, the patients had the opportunity to engage in artistic activities, such as painting or modeling with clay, to express their experiences. The following day, more single and group therapy sessions were conducted to further integrate the experience.
A reliable alternative to this procedure was stationary interval treatment used by Leuner (1964), Derbolowski (1966), Fontana (1961, 1963), Geert-Jörgensen et al. (1964), Alnaes (1965), and Johnsen (1967). Here five to six patients being treated in ambulatory psychoanalytic one-on-one sessions were admitted for two to three days and treated according to the procedure outlined above. This combined the advantages of a long-term ambulatory psychotherapy with the possibility of intensification and deepening through psycholytic sessions. Additionally, the safety of the procedure was increased through constant monitoring during and after the sessions.
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