History of Psychedelics in Psychiatry

Desiree Lano

Introduction

Psychotomimetics, entheogens, mysticomimetics, phantasticants, hallucinogens, psychotherapeutics—however you choose to describe them, psychedelics have been down a long, winding road. Coined by early psychiatrist Humphry Osmond, the term “psychedelic” originates from the Greek word for “soul-manifesting” (psyche = soul, delos = manifest). Most psychedelics are categorized as either classical or nonclassical. Classical psychedelics, which exert their effects mainly via the 5-HT2A receptor, include lysergic acid diethylamide (LSD), 4-phosphoryloxy-N,N-dimethyltryptamine (psilocybin), N,N-dimethyltryptamine (DMT). Nonclassical psychedelics include 3,4-Methylenedioxymethamphetamine (MDMA), dexomethorphan (Robitussin, Nyquil, etc.), salvinorin A (salvia), and ibogaine (Jachimowski & Kucia 2023). 

Note: While much of modern psychedelic research has focused on psilocybin and LSD, researchers have also found great benefits from other nonclassical psychedelics such as MDMA and ketamine. This article will mainly focus on psilocybin and LSD.

Effects

Effects vary somewhat between the various types of psychedelics, but usually have some type of effect on mood, cognition, sensation, time-space perception, and self-concept. Set and setting (i.e., one’s mindset going into the experience and the environment around them) have a great effect on the outcome of the “trip”, and the intensity of the effects are dependent on dosage (higher dose usually leads to a greater effect) (Geyer 2023). Users often report pleasurable, euphoric feelings as well as a “oneness” with their surroundings. At higher doses, a phenomenon known as “ego death” has been reported, where the user experiences a complete loss of self. In some cases, particularly with higher dosages or in patients with preexisting mental illness, psychotic symptoms can manifest (Geyer 2023).

In 1998, Adolf Dittrich published the Altered States of Consciousness Rating Scale which can be used to assess the subjective state of those undergoing a psychedelic experience. The scales are as follows: oceanic boundlessness (derealization and depersonalization, ego death at higher doses), disordered thinking, delusions, or loss of control during a “bad trip”, visionary restructuration (hallucinations, altered visual and auditory perception), and loss of vigilance (drowsiness, changes in cognition). Where the participant falls on each scale is often dose dependent. (Geyer 2023)

A Brief Cultural History

Psychedelics have a long and storied history, having been used in many cultures past and present for rituals, divination, and curing illness. It is thought that the use of psychedelic substances to alter consciousness has dated back as far as prehistoric times (Geyer 2023). Some even believe that Ancient Greeks used ergot (a substance chemically similar LSD) to alter consciousness. Psychedelics were commonly used by shamans in sacred rituals, and to this day indigenous peoples continue to use peyote in their spiritual practices (Geyer 2023).

Past, Present, and Future

Past

Arthur Heffter was an early pioneer of modern research of psychedelics, being one of the first to document their use in modern day by self-administering mescaline derived from peyote in 1897 to study its effects (Geyer 2023; Jachimowski & Kucia 2023).  Beringer also tried to study mental illness using mescaline in 1923, attempting to use it to mimic common symptoms of psychosis (Nichols & Walter 2020). By the early 1930’s, Erich Guttman began to investigate the therapeutic benefits of mescaline, using healthy and mentally unwell patients as subjects in his research (Nichols & Walter 2020). Soon after these initial experiments with mescaline, Albert Hoffman, a well-known figure in the world of recreational psychedelics and psychedelic research, followed suit in 1938 when he synthesized LSD for the first time, likening its effects to the symptoms of schizophrenia (Geyer 2023; Jachimowski & Kucia 2023). By 1947, LSD was being sent to researchers under the trade name “Delysid” to study its effects further. Later in 1958, Hofmann discovered the molecular structure of psilocybin, hypothesizing that its serotonin-analogous structure may be of use when studying psychosis. Psilocybin also got a rebrand, being sent to researchers along with Delysid under the name “Indocybin” (Jachimowski & Kucia 2023).

Delysid and Indocybin had a relatively successful stretch of experiments, particularly after studies showed a low risk of physiological harm. It was then that researchers began using LSD, psilocybin, and mescaline to better understand and treat mental illnesses such as personality disorders, affective (mood) disorders, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), substance use disorder, and schizophrenia. It did not take long for them to realize, however, that psychotic illness can be a major contraindication for psychedelic use and is unequivocally linked to a worsening of symptoms or triggering of episodes (Jachimowski & Kucia 2023).

Psychedelic research was showing promise for the treatment of mental illness throughout the 1950’s and 1960’s, with great potential already being predicted by eminent researchers. It was not long, however, before the reputation of psychedelics took a dark turn: some patients in these studies were not able to consent to the studies they participated in, and word got out about the CIA using LSD in their interrogation tactics. With an increase in recreational use, laws were swiftly enacted by the government to put a stop to psychedelic use completely, snuffing out any potential (legal) research (Geyer 2023).

Present

The 1990’s saw a resurgence in the scientific community’s interest in psychedelic research. Various psychedelics, both “classical” and “nonclassical” have been studied and shown evidence for its usefulness for a number of conditions, including but not limited to: Alcohol use disorder, OCD, nicotine dependence, eating disorders, chronic pain, cluster headaches, anxiety disorders, depressive disorders, and mental health problems related to terminal illness (Geyer 2023; Jachmowski 2023).

Beginning in 1993 after the Heffter Research Institute was founded, the spotlight turned to psilocybin given its long use in human history and ease of administration (i.e., not needing overnight hospital stays) (Geyer 2023). 2011 saw the first randomized double-blind trial published on its effects on anxiety in cancer patients, paving the way for a new wave of studies into this phenomenon. Shortly after, in 2016, benefits were seen not only in those terminal cancer patients with anxiety, but with depressive symptoms as well. There have been a number of other studies done in the 2010’s which have found significant reduction in symptoms related to nicotine and alcohol addiction in addition to symptoms of anxiety and depression (Jachimowski & Kucia 2023).

Future

Though we are making headway both in the research world and general society, there is still much to be done. As of now, there is not much of a standardization for treatment and there are still legal obstacles to be surmounted. Though we lost many years to such strict regulation of potentially revolutionary treatment, hopefully one day we will get to a point where we can finally help those who have lost all hope to alleviate their mental anguish.

References

Geyer, M. A. (2023). A brief historical overview of psychedelic research. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 9(5), 464–471. https://doi.org/10.1016/j.bpsc.2023.11.003

Nichols, D. E., & Walter, H. (2020). The history of psychedelics in psychiatry. Pharmacopsychiatry, 54(04), 151–166. https://doi.org/10.1055/a-1310-3990 

Jachimowski, A., & Kucia, K. (2023). Classical psychedelics in Psychiatry – Renaissance of interest and therapeutic perspectives. Psychiatria Polska, 57(3), 657–670. https://doi.org/10.12740/pp/150053