The Backward Evolution of Mental Health
“Psychoanalytic theory is the most stupendous intellectual confidence trick of the twentieth century.” –Peter Medawar, biologist, writer, 1960 Nobel Prize winner
Over the last fifteen years, psychedelics have begun to make a slow but inexorable return to the psychotherapeutic treatment space. Clinical findings from the years prior to their 1971 banishment were consistent. No other method had been found to be as effective for alcoholism, depression, drug addiction, obsessive-compulsive disorder, smoking addiction, or anorexia nervosa. That said, it’s not possible to talk about the re-emergence of psychedelics without first talking about their disappearance.
Although psychedelics had been used widely in psychiatric medicine for many years prior to their 1971 ban, the first scientific study to examine the drugs’ effects in healthy individuals took place at Marsh Chapel at Boston University on Good Friday of 1962. The Good Friday Experiment adhered to the gold standard of clinical trial protocols in that it was both placebo-controlled and double-blind. Two groups of young seminary student volunteers were given either active doses of psilocybin, or a dose of nicotinic acid (niacin). Neither the subjects themselves nor the study monitors knew who got which. The experiment, the PhD thesis project of Walter N Pahnke, a thirty-one-year-old graduate student in Religion and Philosophy at the Harvard Graduate School of Arts and Sciences was titled “Drugs and Mysticism: An Analysis of the Relationship between Psychedelic Drugs and the Mystical Consciousness.”
The Good Friday experiment was carried out under the supervision of Dr Timothy Leary as part of the Harvard Psilocybin Project at the Harvard Center for Research in Personality. Leary had originated a previous study on psilocybin – the Concord Prison experiment – as well as the better-known “Americans and Mushrooms in a Naturalistic Environment,” for which the only recorded documentation is a single unpublished nine page typescript. The latter experiment was composed primarily of Leary and his colleague, Richard Alpert (later known as Ram Dass), who was Assistant Professor of Clinical Psychology, giving psilocybin to graduate students and volunteers in the community-at-large and asking them to document the experience.
Despite the success of the Good Friday experiment, Leary’s mismanagment of the “Americans and Mushrooms” project torpedoed the positive outcome. The Harvard Psilocybin Project’s ultimate failure had nothing to do with either the scientific or anecdotal evidence Pahnke’s research yielded. The problem lay squarely with the leadership of the Project’s faculty overseers. Leary and Alpert had become increasingly lax about the screening of participants they recruited for the “Americans and Mushrooms” project.
In an editorial in The Harvard Crimson, Harvard University officials asserted: “Far from exercising the caution that characterizes the public statements of most scientists, Leary and Alpert, in their papers and speeches, have been given to making the kind of pronouncements about their work that one associates with quacks.”
In April, 1962, the Massachusetts Food and Drugs Division began an investigation of the research. Their findings concluded that Leary and Alpert failed to have physicians present when drugs were administered, a legal requirement for their research. A faculty committee was appointed to “advise and oversee” future studies of psilocybin. Neither of these fixes produced the intended consequences. There was little if any oversight. Things got worse.
“The shoddiness of their work as scientists is the result less of incompetence than of a conscious rejection of scientific ways of looking at things. Leary and Alpert fancy themselves prophets of a psychic revolution designed to free Western man from the limitations of consciousness as we know it. They are contemptuous of all organized systems of action – of what they call the ‘roles’ and ‘games’ of society,” zinged the The Harvard Crimson editorial. “They have not been professors at Harvard – they have been playing ‘the professor game,’ and their cynicism has led them to disregard University regulations and standards of good faith. They have violated the one condition Harvard placed upon their work; that they not use undergraduates as subjects for drug experiments.”
Alpert was fired from his academic post soon thereafter. In 1963, Leary was relieved of his duties for failure to show up to teach.
Pahnke continued his career as a clinician. Following the completion of the experiment and the submission of his thesis, he departed for the Georg-August University in Göttingen, Germany to train with Hanscarl Leuner in LSD-assisted psychotherapy. On his return to the US, Pahnke worked first at the Massachusetts Mental Health Center in Boston, and then went on to psychedelic therapy work at Spring Grove State Hospital in Baltimore, Maryland. He eventually became Director of Clinical Sciences at the Maryland Psychiatric Research Center in Baltimore, and Assistant Professor of Psychiatry at Johns Hopkins University School of Medicine.
In 1968, while working at the Maryland Psychiatric Research Center, where psilocybin and LSD were being successfully administered to patients to treat depression and alcohol addiction, Pahnke was invited to deliver the Ingersoll Lecture on human immortality, an annual Harvard University event in which a distinguished researcher or philosopher in the field is invited to speak. In an ensuing article discussing giving LSD to terminally ill cancer patients, Pahnke wrote:
“The most dramatic effects came in the wake of a psychedelic mystical experience.... Once the patient is able to release all the psychic energy which he has tied to the fear of death and worry about the future, he seems able to live more meaningfully in the present. He can turn his attention to the things which have the most significance in the here and now. This change of attitude has an effect on all the people around him. The depth and intensity of interpersonal closeness can be increased so that honesty and courage emerge in a joint confrontation and acceptance of the total situation.”
Nonetheless, in 1971, in response to the bad press out of Harvard, and the increasingly widespread street use of psychoactive drugs, psilocybin, heroin, LSD, marijuana and ecstasy were all summarily placed on Schedule 1 of the Controlled Substances Act, which identifies these substances as having high potential for abuse and no currently accepted medical use in the United States. Practitioners who watched the clinical benefits of psilocybin and LSD unfold on a daily basis now found their work being summarily dismissed.
My own life experience is an object lesson in what is wrong with psychiatry and what is right with psychedelic therapy. Talk therapy is far less successful at treating emotional or psychological distress than popular perception suggests. Recent meta-analyses of published findings contradicts the longstanding narrative prevalent among therapists and the lay public. Only 16 (7%) provided convincing evidence that psychotherapy is effective. These pertained to cognitive behavioural therapy (n = 6), meditation therapy (n = 1), cognitive remediation (n = 1), counselling (n = 1) and mixed types of psychotherapies (n = 7). Other studies showed significant negative personality changes associated with psychotherapy.
Part of psychedelic medicine’s safety and efficacy picture has to do with how the therapeutic experience itself is structured. Psychedelic therapy has an endpoint, unlike psychoanalysis or psychotherapy, which can last for years, or decades. Patients undergo two- to eight- therapeutic sessions, some with and some without psychedelic medication. Because of the relatively short duration of the therapeutic protocol, patients are unlikely to develop attachments to their guides. And there are generally two guides present, so a vulnerable subject is never alone in a room with someone who is in the position to take advantage of him or her. The guides are not therapists, rather companions along a perilous, transformative spiritual journey. The subject’s own feelings and perceptions throughout the experience lead the sessions. Integrating the experience afterwards in non-drug therapeutic sessions plays a vital role.
The dangers presented by psychiatry are part of the DNA of the field. Michael D Cornwall, PhD, characterizes psychiatric diagnosis as a “status degradation ceremony” in which psychiatry has been granted the moral authority to vitiate anyone by diagnosing them. I call this “naming the scapegoat.” Psychiatry, he writes is a cult whose leaders turn the protestations of harm directly onto their victims. The victim him or herself is declared to be the wellspring of his or her problems, and those of people around him. This twisted logic transforms the cult leaders themselves into the victims.
It’s necessary for me to say something here about frequent and evident psychopathology of those who enter the mental health field in the first place. Over the years, I’ve witnessed medical doctors who are attracted to the profession because of their own emotional and psychospiritual maladies. Although the wish to understand oneself may activate a young person’s choice of field, the power to diagnose, and thereby become impervious to any suggestion of fallability is conjoined to professional status conferred by a psychiatric specialty. Once initiated into the medical and psychiatric elite, an aspiring psychiatrist’s perception of his or her own importance, and eventually his or her own conduct evolves along the way.
By all appearances, the goal of psychoanalysis never really was to relieve suffering. It was, rather, to make itself indispensible to the patients it purported to treat, not by building them up, but doing the opposite: keeping them subordinate and dependent, while preserving the psychiatrist’s revenue stream. Some of the most vulnerable people—abused by spouses or fathers or uncles or co-workers—have fallen prey to psychiatric gaslighting. A long-time friend in New York, a fellow divorcé, tried for months to break up with his psychiatrist. The psychiatrist’s response was to undermine him, to tell him he was not fit, implying he was an unregenerated human who still needed years of therapy. Each time he talked about the situation, I’d try to keep my mouth shut. My friend finally got wise. He used flattery; he enumerated how each and every aspect of his life had improved. He told the psychiatrist what marvelous insights he’d provided into his life. The psychiatrist still resisted. Then my friend told him he was leaving, regardless.
The new-old psychedelic therapy model will one day replace the old psychoanalytic model. The psychiatric field as it has been practiced for 160 years has to get used to the idea of its own obsolescence. Those of us who have had cancer, or suffered near-catastrophic asthma attacks are really good at accepting our impermanence. Following my breast cancer experience, I had the benefit of two guided psilocybin sessions to help me do it.
I can only repeat the advice given by the rich and powerful to every single American person whose job has ever evaporated because of NAFTA or automation—assembly line workers, elevator operators, hansom cab drivers, teachers: Get used to the idea of a world in which you don’t matter. Get imaginative. Pull yourself up by your bootstraps. Retool yourself for a life in which you can’t bill hundreds of dollars per hour, a world in which elite populations cease to run scared in fear of psychiatric declamations.
As a proud member of a profession which has been blown apart over the course of the last 25 years (journalism), I myself have been regaled on numerous occasions with helpful lists of potential career options: I could become a computer programmer, or work my way up through MacDonald’s University. I could clean houses. I just need to be more accepting about the changed world.
For psychiatrists, my suggestion would be to try a few psychedelic sessions. You might discover things you never knew about yourself, things you’ll wonder how you survived without knowing. As a profession, though, I have to say: the DSM-5 won’t save you. You’ll get to learn to adapt to a new way of doing your job, like the rest of us.
 Leary, Timothy; Litwin, George H; Metzner, Ralph. (1962). Americans and mushrooms in a naturalistic environment: a preliminary report. Facsimile typescript. Houghton Library, Harvard University, Cambridge, MA.  Russin, Joseph M; and Weil, Andrew T. “The Crimson Takes Leary, Alpert to Task: ‘Roles’ and ‘Games’ In William James.” The Harvard Crimson, 24 January 1963.  ibid.  Pahnke, Walter N. (1969). “The Psychedelic Mystical Experience in the Human Encounter with Death.” Harvard Theological Review, 63(1), pp. 1-21.