Psychedelics, Psychiatry, and Moving Toward the Monstrous

My personal psychiatric guru, Nazi survivor Dorothea Buck, described one of psychiatry’s great failures as its utter lack of dialogue with patients about what they experience.

“By being declared ill in a medicinal sense,” Buck wrote, the diagnosed “are deprived of the human significance of [our] thoughts and feelings.”

Buck was not a psychiatrist but a patient, diagnosed, as I once was, with schizophrenia. I share her wonder at the assumption that what someone depressed, or hearing voices is experiencing—to give two examples--doesn’t in and of itself matter. I hear voices, which can be frightening or enlightening. I’ve had depressive periods that came from nowhere and others that signaled a need for change in my life. According to our diagnostic criteria, any non-consensus experience just counts as a "symptom" and indicates the need for drugs.

Therapeutic Psychedelics

What could bring the value of all consciousness back to psychiatry? I’ve wondered about this question for a long time. I would never have guessed one answer that’s emerged over the past few years: therapeutic psychedelics.

A great discussion of this movement lies in Michael Pollan’s book How to Change Your Mind, which explores the use of mind-altering drugs to address problems like trauma, facing death, and depression. Pollan himself tries drugs like psilocybin, finding under its influence a world “jeweled with light.”

Patients and Pollan use substances like psilocybin with trained guides and explore their mental imagery. What they see and feel—think—matters.

It's a riveting book and upbeat, which didn’t stop me from finding myself at many points wiping away tears. Tears that came from sadness and a complex envy, because the therapeutic process for handling a trip offers exactly what all psychiatric patients should experience, deserve to experience—and don’t.

The "Ideal Patient"

“In many ways, he was the ideal patient; he didn't talk, he didn't cry, he didn't even move.” These words come from Dr. Sam Loomis in the second installment of the horror classic Halloween. Loomis is the character who gets that underneath it all, Michael Myers is actually “pure evil.” Which seems to matter less to Sam’s colleagues than the killer’s apparent docility.

Anyone who’s been in a psych hospital will appreciate Loomis’s (non-ironic) statement. I have, and the dead air and sense of being watched rather than engaged with left me despairing in ways I’ve never been outside of one.

Patients using psychedelics are told their guide/therapist will keep them safe. The key advice is “always to move toward, rather than try to flee, anything truly threatening or monstrous you encounter—look it straight in the eyes.” A guide tells Pollan, “Dig in your heels and ask, ‘What are you doing in my mind?’ ‘What can I learn from you?’”

Safety, and seeing what I can learn from what might seem monstrous. These words represent exactly what I’ve needed, again and again, to hear —in doctors’ offices and hospitals. There is no meaningless psychosis, depression, or anything like that, as there is no meaningless thought. Sometimes it takes years to understand what voices or visions have been telling me. But when I look, some sense is always there.

The night my mother died, 11 years ago, a newscaster with an astonishingly monotonous voice droned all night as I tried to sleep. There was, of course, no actual newscaster. I barely remember the words: Weather, thefts, a car stalled on a bridge. The voice sounded both eerie and startlingly mundane. Terrified, I heard it for about eight hours.

I might say, discussing this, what Pollan said to those who dismissed his insights as just the drugs talking: “Yet even a moment’s reflection tells you that attributing the contents of the psychedelic experience to ‘drugs’ explains virtually nothing about it. The images and the narratives and the insights don’t come from nowhere . . . They come from inside our minds, and at the very least have something to tell us about that.”

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This is equally true with thoughts or images the mind generates: they come from us, not some walled-off “disease process” in the brain. My mother’s Alzheimer’s and slow death spread over surreal weeks of conflicting diagnoses, emergency flights, and dealing with a difficult person who became even more difficult in her dying. I needed, somehow, to be dragged out of that strange world and back into this one. I realized years later that my mind confabulated this eight-hour soak in the mundane for a reason.

I wrote to Michael Pollan after feeling mournful that my newscaster would be deemed valuable only if it came from an outside substance. He responded, “The dismissal of psychedelic experience as ‘a drug experience’ is no different than the dismissal of fantasy, dream, and psychosis-- it is all real, products of our minds and therefore worthy of interpretation and potentially useful.”

I’m in favor of any mind-care approach that brings back considering mental content, and that increases human well-being.

There’s currently a national movement to decriminalize (Washington, DC) or legalize (Oregon and Colorado) psychedelic drugs. As this movement spreads, therapeutic guided tripping will doubtless become more common.

But if this, in Pollan’s words, “novel hybrid of pharmacology and psychotherapy” becomes a practice, please let it be a roadmap for all interactions involving mind care.

I was talking to a psychiatrist—a friend—recently, who pointed out that these decisions are a matter of resources. Meaning, no one wants to put time into dealing with psychiatric patients, any more than Dr. Sam Loomis’s colleagues did. Our current biological psychiatry has led toward brief appointments based on symptom lists, not dialogue.

Increasing the "Pool of Variation in Thought"

If I need to offer a selfish reason to make resources available Pollan also wrote me, “One of the values of psychedelic experience, and this would apply to all forms of ‘non-consensus’ thinking, is that it increases the pool of variation in thought, which has the potential to advance culture as a whole.”

As we grapple with novel problems, we need novel thought. Psychedelics may offer us one way out of restrictive “Perception Boxes.” But maybe moving toward, rather than trying to flee, what’s different is always the right call.