The classic psychedelics – LSD, psilocybin, DMT – are psychoactive compounds known to elicit a repertoire of hallucinogenic, ego-dissolving effects. Subjective experiences largely converge to portray a picture of transcending the ego, feeling an ineffable unity with nature, and the inability to shake the feeling that you’ve been let in on a secret, termed a ‘noetic’ quality by William James. In short, these compounds are often described as keys to unlocking an alternate version of consciousness. One cannot deny how mystical this sounds, but sceptics, bear with me.
Classic psychedelics are far from being modern discoveries, dating back to indigenous rituals. Over the last century, they reached the hands of figures who extolled their benefits, kicking off Western psychedelic culture. One such figure was none other than Aldous Huxley, author of Brave New World, and enthusiastic mystic. “We were back at home, and I had returned to that reassuring but profoundly unsatisfactory state known as ‘being in one’s right mind’” he writes in ‘The Doors of Perception’, one of his seminal psychedelic-influenced novels.
Due to the openness observed in people influenced by psychedelics, it was speculated that they could treat psychological conditions. Soon after, positive results were seen in those being treated for treatment-resistant depression, substance use disorders, end-of-life anxiety and PTSD by psychedelics. These results were truly unmatched, only making the antiquity of conventional treatment options more apparent.
Notably, treatment outcome relied heavily on ‘set and setting’, a household phrase for those in the field. While ‘set’ refers to the mindset of the patient, the expectations they carry into their psychedelic ‘trip’, ‘setting’ highlights the difference the patient’s surroundings makes to the trip. Substitute the conventional doctor’s office for a cozy, dim-lit room, and the patient is likely to recount a dramatically improved experience.
“All pharmaceutical drugs in psychiatry are over 35 years outdated and we haven’t had a new drug come into the industry in a very long time”
Exciting though the research was, unregulated dissemination of psychedelics led to a period now known as the 1960s-1970s ‘counter-culture’. Psychedelics became associated with fatalities, largely owing to unregulated dosage and quality of such compounds. As societal and legislative resistance increased, so too did disagreement within the field itself. Some researchers preferred preaching the spiritual benefits of psychedelics (see Ram Dass, for example), some remained steadfast in their pure medical interest, and many, indeed, encountered difficult questions in the face of a rapidly unfurling psychedelic scene. However, resistance against the scientific welcoming of psychedelic medicine arguably had a larger culprit. It was simply uncomfortable to marry mysticism with science, to endow seeming shamanism a scientific space.
Modern psychedelic medicine is therefore a product of a face-off between regulatory barriers and persistent research. One cannot have a full appreciation of how this field came to be without acknowledging the many layers of complexity and disagreement it is mired in. At this point, I must also mention the dark turn history took. MK-Ultra was an egregious ‘experiment’ run by a paranoid, cold-war-age CIA aiming to create ‘brain warfare’, and involved dosing vulnerable and unwitting people.
In conversation with Dr. Ayla
I first encountered the topic of psychedelic medicine through the university’s newsletter. “Psychedelic medicine could revolutionise how we treat mental illness,” I read, eyebrows raised and ears trained to sieve out sweeping hyperbolic claims. Soon, I found myself engrossed in Michael Pollan’s book ‘How to Change Your Mind’, and dove head-first into the field’s colourful but complex history. If anything, understanding the neurobiological basis was the easy part. The deeper I dug, the more difficult but interesting parts were the questions that surfaced. It quickly became clear that psychedelic medicine was a tricky one to unpick, whether on the strictly medical, political or philosophical front. I certainly will not do the topic justice, for that I look to Pollan and applaud his journalistic talents, but I hope to welcome further discourse on this topic, and to invite the expertise and opinions of Dr. Ayla Sela, whose time and nuggets of wisdom I’d like to express my heartfelt gratitude for.
“The best way forward is for scientists, doctors, and advocacy groups to work together with the government to reclassify psychedelics as lower class drugs”
Dr. Ayla is a former Trinity postdoc whose work included screening a list of 95+ psychedelic compounds. Her motivation is clear: “all pharmaceutical drugs in psychiatry are over 35 years outdated and we haven’t had a new drug come into the industry in a very long time,” she explains. Most SSRIs are ineffective: up to 50% of patients with depression and PTSD are considered treatment-resistant, and long-term pharmaceutical drugs often come with side effects and low adherence. Psychedelic medicine offers more effective treatment, she explains, as merely 1-3 sessions may be enough to notice a substantial positive effect, and crucially, there will be no issues of dependence since psychedelics are non-addictive substances.
For Dr. Ayla, it is clear that the importance of “targeting the root causes of trauma or psychological disorders rather than providing temporary relief” cannot be understated, which is where she sees the promise of psychedelic medicine. Psychedelic medicine acts as “personalised medicine,” she argues. After all, no two patients present with identical psychological profiles and histories.
What follows this subjectivity, however, is the heterogeneity of the patient psychedelic experience. How can clinical trials be designed to account for this inherent variation? What’s more, clinical trials are only considered credible if they are designed to be double-blind and placebo-controlled. A psychedelic experience isn’t exactly subtle, so how could placebos be administered?
“Combine traditional psychiatric oversight with culturally sensitive, trauma-informed care, and psychedelic protocols”
Dr. Ayla nods, agreeing that strong drug effects and individual variability are key experimental difficulties the field grapples with. She explains that the best way to design experiments is “to control for set and setting, use randomisation, crossover designs to manage variability, and active placebos or blinded assessors to preserve credibility. When blinding fails, alternative trial designs are used.”
However, even if experimental hurdles are overcome, how psychedelic medicine will be implemented and regulated is another matter of contention. She explains that the current status of psychedelics in the UK represents a “major barrier” in the field. “The best way forward is for scientists, doctors, and advocacy groups to work together with the government to reclassify psychedelics as lower class drugs, to facilitate medical access,” she argues. Three things prove important: firstly, the establishment of proper clinical training and certification pathways for professions in psychedelic medicine. Secondly, the medicine’s accessibility to patients of all socioeconomic backgrounds. She estimates that the initial cost of psychedelic therapy, were it legalised, would reach £5000-10,000 per treatment protocol, and would likely be limited to private clinics or pilot NHS centres unless subsidised or insurance-backed. Thirdly, the creation of regulatory frameworks that “combine traditional psychiatric oversight with culturally sensitive, trauma-informed care, and psychedelic protocols.” Moreover, she suggests that we should learn from countries that have legalised some forms of psychedelic therapy, such as Canada and Australia.
With experimental, policy and regulatory barriers discussed, this leaves arguably the biggest factor to consider: public perception. In her work, Dr. Ayla firmly carries the ethos “use, not abuse” and believes we have come a long way since the incorrect use of these substances that plagued the 1960s-70s ‘counter-culture’. Addressing misconceptions surrounding psychedelic medicine, she emphasises the fact that psychedelic therapy alone is not a panacea; it should be in tandem with parallel efforts to improve the patient’s wellbeing
Overall, it is clear she believes supporting psychedelic therapy must be concomitant with advocating for strict protocols, thorough patient screening and responsible regulation over their use in experiments and clinics. Only when this is achieved will trust be built among researchers, patients, regulators and the public, and we will see this field unfold globally in a responsible, beneficent way.
