|
Lawrence Bush: Three of you have
been researching MDMA, and the new Harvard study is focused on that
compound, too. Is there something in its effects that seems
especially promising for therapeutic use, or are you mainly
motivated by its widespread presence in the culture?
Julie Holland:
The fact that it’s a very popular drug certainly makes it into a
public health issue, and we’re obligated to study it and understand
its effects. That being said, I do think there is something unique
about MDMA that makes it very well suited for use as a catalyst to
help the psychotherapeutic process go deeper, more quickly, and
possibly more comfortably. MDMA also doesn’t last as long as LSD, so
it may be better suited to short psychotherapy sessions. And the
shift in consciousness from MDMA is not as profound as from LSD, so
it might be easier for the person to stay focused on the therapeutic
tasks at hand.
Charles Grob: A unique aspect of MDMA is its capacity
to induce states of empathy, more so than the classic hallucinogens.
Empathic rapport between the patient and the therapist is about the
best prognostic indicator you can find for the success of
psychotherapy.
Rick Doblin: I generally say that psychotherapists
will be better able to use these substances in therapy if they’ve
experienced the substances themselves. But a lot of therapists are
terrified of taking LSD. MDMA is a more gentle, less challenging
drug. Rabbi Zalman Shachter-Shalomi [the spiritual leader of the
Jewish Renewal movement in the U.S. — L.B.] put it really well when
he compared taking MDMA to observing the sabbath. It brings you into
the moment, and there’s a certain restfulness of self-acceptance,
which by itself can sometimes produce updated perceptions or ideas
or emotional flow. That means we can really integrate it into
psychiatry and psychotherapy.
Howard Lotsof: The therapist is going
to have to work hard when these drugs are used. The therapy is more
active, the patient is more divulging, and the drug has both
psychotherapeutic and physical effects that the therapist has to
address.
Lawrence Bush: Some of you have made public statements
disapproving the recreational use of these drugs, in part because of
how it has interfered with the research you’re trying to do into
their possible medical uses.
Howard Lotsof: The issue of
recreational use should not dissuade the investigation of medical
utility. A drug can be a drug of abuse but also have an approved
medical purpose.
Charles Grob: But practically speaking, the mass
popularity and illegal status of MDMA, and the sensationalized media
coverage, have been a real disincentive for many potential
investigators.
Rick Doblin: That’s very true. Yet paradoxically, the
fact that MDMA has been so demonized means that there’s about $150
million’s worth of safety data about MDMA in the public domain
that’s been paid for
December, 2005 by governments intent on its prohibition. This gives
us the opportunity to turn it into a medicine at a price that we can
afford; we would not have to repeat all that safety research.
Lawrence Bush
: What do you think draws adolescents to experiment
with
psychedelic drugs? They’re powerful and can be frightening, and
they’re not “escapist” in the ways that we usually think of cocaine
or heroin or other opiates.
Charles Grob: That’s a great question.
To some degree, it’s about adventurousness, the generalized
risk-taking that we see among young people. For some, it’s about the
need to transcend — the search for the numinous. The trap that many
young people get into is this: While they may have
a drive to experience an optimal altered state of consciousness, the
conditions under which they take the compounds — and often the
compounds themselves, which are seriously sub par and adulterated —
lead them into very, very serious trouble. If you take these
compounds
at the wrong place, at the wrong time, with the wrong people, under
the wrong conditions, you can have severe adverse effects.
Howard Lotsof: Those are the
outcomes of a society that condemns normal experimental use of
psychoactive substances. These substances, and their use, can be
traced back to the very beginnings of history. If society is not
going to take responsibility for the health and welfare of its
children, it’s left up to them to do as best they can. And parents
are prevented from intervening in any way,
except to say "No," which doesn’t get
you anywhere with your kids.
Charles Grob: The great irony of
the situation is that while these drugs
are allegedly the most controlled
group of drugs, classified as Schedule
1, they are actually out of control:
Anybody can get them, and can get
into terrible trouble with them. In
many respects, the whole premise
of current drug policy has failed,
because it has not at all prevented
young people from easily accessing
dangerous drugs and using them in
the most adverse settings.
Rick Doblin: The people who can’t
get them are the researchers!
The government seems to want to
maximize the harm done by these
drugs, so they can maintain prohibition.
They’re putting forward a vast
amount of misinformation. People
have been told, for example, that the
marijuana smoked today is twenty
times more potent than the marijuana
they smoked as young people — so
they support prohibition for their own
kids. Those kinds of false arguments
are amazingly effective. We need to
focus on how to counteract that kind
of propaganda. The best response is
scientific information.
Lawrence Bush
: What do you
make of the opposition to psychoactive
drugs in our society? Why do the
authorities fear them so much?
Rick Doblin: One of the very first
things the Spanish conquerors did in
the New World was to unleash the Inquisition
to go after the sacramental
use of peyote. The community-building
effect of sacred peyote use was
seen as threatening to the religious
and political authority of the new rulers. Today, we have symbolic politics at work: Psychedelics emerged
in the 1960s, a time of tremendous social turmoil, and because they
inspired people who later became prominent in the anti-war and
social movements, the drugs became symbols of cultural rebellion.
Charles Grob: They were catalytic in fostering opposition to the
Vietnam War — and their role is very underappreciated.
Howard Lotsof:
I was in Berkeley during the Free Speech Movement. There was a
tremendous flow of information among young people, including from
within the university and Livermore Lab, and I can tell you that the
core of government opposition to LSD and drugs of that type, the
really heavy FBI moves against them, had everything to do with their
use within the anti-war movement.
Lawrence Bush
: So do you see the
work you do now as being on a continuum with the social causes of
the 1960s?
Charles Grob: Well, during the 1960s, we had a sense that
we were on the threshold of achieving a new society. That was naive.
If you look at society today, there are enormous problems.
Howard Lotsof: But great changes did occur: through the civil rights
movement, the women’s rights movement ...
Charles Grob: Yes, and
whereas the war ended and all of the other hot-button causes
achieved some measure of acceptability, the putative role of
psychedelics in society has been swept back under the rug.
It’s been very hard even to talk about it. Yet those compounds
represent a potential treatment model that might very well have
strong efficacy and applicability, particularly for psychiatric
conditions that do not respond well to conventional treatment. For
example, there is hardly an area in medicine in which we have
progressed less over the last half century than in the treatment of
alcoholism. We have very impressive data from studies in the 1950s
and ’60s that the psychedelic treatment model, when optimally
utilized, may have a great degree of efficacy with alcoholism. We
should be examining untapped treatment potentials, particularly for
disorders that do untold damage to individuals, families and
society.
Lawrence Bush
: What about “hard core” mental illnesses? Is
there much known about the effects of different psychoactive drugs
on schizophrenia or other difficult mental disorders?
Julie Holland
:
There is precious little data about that, only anecdotal reports.
Schizophrenics are considered a particularly fragile patient
population, and there are also many issues about informed consent
with them. It’s very controversial to give psychoactive drugs to
schizophrenics. These patients should certainly not be at the
forefront of our research. In the book I edited about MDMA, there
are four testimonials about positive experiences with the drug by
schizophrenics. All four said that they were helped by it acutely,
and some chronically. I would say, however, that people with a
history of psychosis should stay away from psychedelic drugs,
especially those drugs that tickle or agonize the NDMA receptor
centers, which are part of the glutamate system and are implicated
in the psychosis of schizophrenia.
Lawrence Bush
: All right, then:
You can get FDA permission to work with terminally ill patients or
patients with severe post-traumatic stress disorder. To what extent
do you see these substances as tools for people in great distress,
and to what extent would you like to see the use of these drugs in a
therapeutic way by the broader population?
Charles Grob: At this
point, it’s essential that we focus on their potential utilization
in a therapeutic context. If psychoactive drugs are ever to achieve
legal status, there will no doubt be credentials that individual
practitioners will have to apply for before they could legally
administer them in treatment.
Howard Lotsof: All of my work has been
involved with ibogaine as a treatment for drug addiction. I just
want to make it possible to take this population out of harm’s way,
and ibogaine seems to do that more directly and abruptly than other
treatments.
Rick Doblin: One good example of a possible broader use
of MDMA is offered by Israel, where MAPS [the Multidisciplinary
Association for Psychedelic Studies, which Doblin heads — L.B.] is
now negotiating a contract for the Ministry of Health to study
MDMA’s impact on post-traumatic stress disorder. There is so much
widespread, baseline stress and PTSD in Israel that they’re willing
to look at other tools. The person we’re working with in Israel, Dr.
Moshe Kotler, used to be the chief psychiatrist for the Israel
Defense Forces and is now the head of the Department of Psychiatry
at Tel Aviv University. One of Israel’s most well-known Holocaust
writers, Ka-Tzetnik, underwent LSD therapy in the Netherlands for
concentration camp syndrome and then wrote about his experience in a
book called Shiviti, which caught the attention of a lot of
Israelis. The psychiatrists who supervised his therapy also
emigrated to Israel. So the idea that psychedelics work to bring
emotions to the surface and can help with these disorders has become
widely accepted there. Still, it took seven years of work in Israel
for us to get permission. It’s a delicate situation. There is a
tremendous amount of Ecstasy use in Israel. Young people leave the
army at the end of their service, travel around the world and find
spots where they can lie around on the beach and do drugs,
particularly Ecstasy. The Ministry of Health has special teams that
go to India and elsewhere to rescue young Israelis who are having
difficult drug experiences. So there’s a reluctance to sanction
research that might inspire young people to do even more
experimentation. They are also scared of pressure from the United
States. Israel is totally dependent on U.S. aid and is not going to
move out in front on drug policy. They are also sensitive to
Israel’s reputation as a center of Ecstasy manufacture and
smuggling. But now that they see that Harvard is undertaking its
MDMA study, and now that they’ve seen our data on PTSD, they’re
ready to move forward. They’re actively considering an ibogaine
research project as well.
Charles Grob: An example of the use of
these compounds outside a strictly medical setting is the Brazilian
ayahuasca church, União de Vegetal (UDV), which I’ve studied
extensively. The church uses the powerful hallucinogenic plant
ayahuasca in religious rituals and has legally protected status. The
ayahuasca sacrament is administered by the ministers of the
religion, yet there’s a very active medical division of the church
that screens all new members and monitors the responses of members
with medical or psychiatric histories who start to participate in
the religious ceremonies. This is a way of giving the medical
profession a role in a religious setting regarding the sacramental
use of these drugs. We did a study of adolescents in the UDV; our
findings are in the latest issue of the Journal of Psychoactive
Drugs. Many of these kids were exposed in utero to ayahuasca, were
baptized with it as babies and had the option of participating in
ceremonies once they hit puberty. They look very healthy and are
functioning very well. So from a health and safety standpoint, under
optimally controlled conditions, there is some potential that these
substances might be widely used in a beneficial and salutary manner.
The UDV also believes that adolescent participation in ayahuasca
ceremonies prophylaxes them against abusing alcohol or other drugs.
Many of the adult subjects in our first ayahuasca research study, in
1993, reported that their alcohol- and drug-abuse disorders had
remitted following their regular participation in UDV ceremonies.
This reduction of psychopathology was a salient finding of our
investigation, and one we believe has serious implications for our
own society. In November, the Supreme Court will be hearing a case
involving the use of ayahuasca by the União de Vegetal in the U.S.
The outcome of this case will have important implications. If the
Court rules in support of the lower court’s decision in favor of the
UDV’s right to use ayahuasca for religious purposes, it will be an
extraordinary precedent.
Rick Doblin: That case was initiated by
Jeffrey Bronfman, who heads the U.S. version of the UDV. He’s a
member of a very prominent Jewish family who seems to have found the
rituals of Judaism to be spiritually lacking. I did, too. In fact,
it was my own bar mitzvah experience in 1966 that led directly to my
appreciation for psychedelics, in that my bar mitzvah didn’t turn me
into a man. I had expected, naively, that the traditional training
and ritual that Conservative Judaism provided would somehow make me
feel really different. But they didn’t seep down to the levels of my
psyche the way I needed them to. Five years later, when I took LSD,
it was like: This is what should have happened through my bar
mitzvah!
Lawrence Bush: Then let’s make a leap: Let’s say that the
Jewish community decided to introduce a psychedelic experience as a
rite of passage. There’s bar and bat mitzvah, there’s marriage, and
now there’s a mystical psychedelic experience for those adults who
want it. Is that the kind of broad use that you envision?
Charles
Grob: I need to raise a cautionary point. In our society, one of the
hot-button issues guaranteed to get people to oppose any
investigation of psychedelics is to talk about their sanctioned use
by young people.
Rick Doblin: I think the policy that might one day
prevail is a “family values” approach, which asks, “Whose decision
should it be about whether young people use substances?” In the União de Vegetal, it tends to be a family decision.
Charles Grob:
But those are multigenerational communities with adult leaders! To
talk about the use of these compounds by young people, you’d have to
clearly distinguish between the unsafe, recreational and thoughtless
use that we often see in our own culture and the use of them by
indigenous people in ritualized rites of initiation that are
facilitated by elders and socially sanctioned. Those are very
different models.
Lawrence Bush
: One reason these drugs seem to have
sacramental value is that they can evoke an experience of religious
mysticism. Part of the mystical experience, however, is that the
perceptions you gain often seem more profound and real than the
perceptions of normal waking consciousness — which makes users
susceptible to a kind of “conversionary” experience or religious
awakening. Don’t you think that also leads to gullibility,
involvement in religious cults, other kinds of quackery?
bound up with my Jewish identity.
I also think about the fact that the
Inquisition’s repression of the use of
sacred plants by peoples in the Americas
was concurrent in time with
the Inquisition’s attacks in Europe
against the Jews. In many respects, I
see our current drug policies as heirs
to the Inquisition.
Howard Lotsof: Not unless
groups like the Moonies were involved
in psychedelics. Remember,
the history of cults extends far back
before the advent of modern psychedelics!
In my forty-plus years of observing
drug use — and participating in
my younger years — I find that people
remain basically who they are.
The vulnerable ones are vulnerable
to begin with and may have been
headed to a place of dysfunction even
without psychedelics.
Charles Grob: Actually, I think
that many of the young people who
joined cults did have psychedelic
experiences and found them to be
shattering. They then went looking
for new structures in which to stabilize
their psyches. Young people in
the 1960s were reinventing the wheel
when it came to these substances.
There were no elders or road maps
to guide them. Many people had experiences
that positively influenced
the course of their lives, but we can’t
lose sight of the fact that there were
people who went off the deep end and
never came back.
Rick Doblin: The question is
whether the unitive experience,
which seems so self-confirmatory
— "This is so true!" — puts a person
at odds with skepticism and questioning.
I think it’s often the opposite:
Once you have these experiences,
which you feel are so deeply true,
you want to know more about what
is really true — which is why the
scientific quest takes over.
"While these Schedule 1 drugs are allegedly the most controlled
group, they are actually out of control. Anybody can get them,
and can get into terrible trouble with them."
Lawrence Bush: Apart from Rick
Doblin’s bar mitzvah reflections, are
there other "Jewish connections" in
the work you’re doing?
Howard Lotsof: I can’t separate
anything about me from my Jewishness,
even though I’m not an actively
practicing Jew. I was born in 1943,
during the Second World War, and
my mother taught me that regardless
of what I considered myself to be, the
Nazis would have killed me. That has
had a potent effect on my identity.
To me, Jewishness and healing are
inseparable. I feel that my involvement
with ibogaine is basically following
a path established by Moses,
Jesus, Einstein, Freud, Salk ...
Charles Grob: I echo a lot of
what Howard said. My mother was
a refugee, escaping Nazi Germany to
Sweden in late 1939. Her father was
a decorated German Army veteran of
World War I who was imprisoned for
several months at Dachau. My father,
a U.S. Army medical officer, was
the first American doctor to arrive
at Dachau the day it was liberated
in 1945. These experiences of my
parents and grandparents were the
stories I heard during my childhood,
and they had a very deep impact on
me.
On my mother’s side of the family,
I’m actually a direct descendant of a
long line of rabbis going back forty
generations to Rashi. I see myself as
coming from the tradition of healing,
the tradition of compassion, the
tradition of service, the tradition of
exploring religious experience, all
bound up with my Jewish identity.
I also think about the fact that the
Inquisition’s repression of the use of
sacred plants by peoples in the Americas
was concurrent in time with
the Inquisition’s attacks in Europe
against the Jews. In many respects, I
see our current drug policies as heirs
to the Inquisition.
Rick Doblin: There is a large percentage
of Jews in science, but even
a larger percentage in psychiatry. I
think this Jewish focus on diseases
of the mind reflects our own history
of being victims of cultural insanity
and irrationality for so long.
For me, the goal is to transform
society. And I do think that large scale
social change can be motivated
by that unitive mystical experience,
because once you have identified
"across boundaries," it’s less possible
to get involved in scapegoating
or demonizing others, or in wars
that rely upon religious or national
hatreds. That’s why I would say
that my work with psychedelics was
motivated primarily as a response to
the Holocaust.
But it’s an appropriate strategic
decision to work on these medical
applications first. I think that’s
particularly true of the work with
the terminally ill. Everybody has a
certain fear about dying, and if we
can show that there is some sort of
response that we can provide that can
be helpful, people may be able to get
over the symbolism of these drugs as
tools of cultural rebellion.
 |
