What got Friederike in trouble were her unorthodox therapy methods. Alongside separate sessions of conventional talk therapy, she offered a catalyst, a tool to help her clients reconnect with their feelings, with people around them, and with difficult experiences in their lives. That catalyst was LSD. In many of her sessions, they would also use another substance: MDMA, or ecstasy.Friederike was accused of putting her clients in danger, dealing drugs for profit, and endangering society with "intrinsically dangerous drugs". Such psychedelic therapy is on the fringes of both psychiatry and society. Yet LSD and MDMA began life as medicines for therapy, and new trials are testing whether they could be again.
At 4 PM the patients would convene and discuss their experiences, then a driver would take them home, sometimes while they were still under the influence of the drug
Believing that MDMA might help her gain a deeper understanding of her own problems, Friederike applied for a place on a "psycholytic therapy" course in Switzerland. In 1992, she and Konrad were accepted into a training group run by a licensed therapist named Samuel Widmer.The course took place on weekends every three months at Widmer's house in Solothurn, a town west of Zurich. Central to the training was taking the substances a number of times, 12 altogether, to get to know their effects and go through a process of self-exploration. Friederike says the drug experiences showed her how her whole life had been coloured by the loss of her father at the age of five and the hardship of growing up in postwar West Germany."I can detect relations, interconnections between things that I couldn't see before," she says of her experiences with MDMA. "I could look at difficult experiences in my life without getting right away thrown into them again. I could for example see a traumatic experience but not connect to the horrible feeling of the moment. I knew it was a horrible thing, and I could feel that I have had fear but I didn't feel the fear."***People on psychedelic highs often speak of profound, spiritual experiences. Back in the 1960s, Walter Pahnke, a student of Timothy Leary, conducted a notorious experiment at Boston University's Marsh Chapel showing that psychedelics could induce these.
He called it "Adam" because it put the patient in a primordial state of innocence
"When the experience can be really useful is when they feel a connection even with someone who has caused them hurt, and an understanding of what may have caused them to behave in the way they did," says Robin Carhart-Harris, a psychedelics researcher at Imperial College London. "I think the power to achieve those kinds of realisations really speaks to the incredible value of psychedelics and captures why they can be so effective and valuable in therapy. I think that can only really happen when defences dissolve away. Defences get in the way of those realisations."He compares the feeling of connection with things beyond oneself to the "overview effect" felt by astronauts when they look back on the Earth. "All of a sudden they think, 'How silly of me and people in general to have conflict and silly little hang-ups that we think are massive and important.' When you're up in space looking down on the entirety of the Earth, it puts it into perspective. I think a similar kind of overview is engendered by psychedelics."
"I feel like there's space around me. It felt like when my mum was still alive, when I first met my partner, and everything was kind of OK, and it was so noticeable because I hadn't had it in a while."
Ben Sessa, a psychiatrist working around Bristol in the UK, is preparing to carry out a study at Cardiff University testing whether people with PTSD respond to MDMA in the same way. He believes that early negative experiences lie at the root not just of PTSD but of many other psychiatric disorders too, and that psychedelics give patients the ability to reprocess those memories."I've been doing psychiatry for almost 20 years now and every single one of my patients has a history of trauma," he says. "Maltreatment of children is the cause of mental illness, in my opinion. Once a person's personality has been formed in childhood and adolescence and into early adulthood, it's very difficult to encourage a patient to think otherwise." What psychedelics do, more than any other treatment, he says, is offer an opportunity to "press the reset button" and give the patient a new experience of a personal narrative.Sessa is planning a separate study to test MDMA as a treatment for alcohol dependency syndrome—picking up the trail of Humphrey Osmond's LSD research 60 years ago.He believes psychiatry would look very different today if research with psychedelics had proceeded unencumbered since the 1950s. Psychiatrists have since turned to antidepressants, mood stabilisers and antipsychotics. These drugs, he says, help to manage a patient's condition, but aren't curative, and also carry dangerous side-effects."We've become so used to psychiatry being a palliative care field of medicine," Sessa says. "That we're with you for life. You come to us in your early 20s with severe anxiety disorder; I'll still be looking after you in your 70s. We've become used to that. And I think we're selling our patients short."Will psychedelic drugs ever be ruled legal medicines again? MAPS are supporting trials of MDMA-assisted psychotherapy for PTSD in the USA, Australia, Canada and Israel, and they hope they will have enough evidence to convince regulators to approve it by 2021. Meanwhile, trials using psilocybin to treat anxiety in people with cancer have been taking place at Johns Hopkins University and New York University since 2007.Few psychiatrists I asked about the legal use of psychedelics in therapy would give their opinions. One of the few who did, Falk Kiefer, Medical Director at the Department of Addictive Behaviour and Addiction Medicine at the Central Institute of Mental Health in Mannheim, Germany, says he is sceptical about the drugs' ability to change patients' behaviour. "Psychedelic treatment might result in gaining new insights, 'seeing the world in a different way'. That's fine, but if it does not result in learning new strategies to deal with your real world, the clinical outcome will be limited."Carhart-Harris says the only way to change people's minds is for the science to be so good that funders and regulators can't ignore it. "The idea is that we can present data that really becomes irrefutable, so that those authorities that have reservations, we can start changing their perspective and bring them around to taking this seriously."***After 13 days under arrest, Friederike was released. She appeared in court in July 2010, accused of violating the narcotics law and endangering her clients, the latter of which could mean up to 20 years' imprisonment. A number of neuroscientists and psychotherapists testified in her defence, arguing that one portion of LSD is not a dangerous substance and has no significant harmful effects when taken in a controlled setting (MDMA was not included in the prosecution's case).The judge accepted that Friederike had given her clients drugs as part of a therapeutic framework, with careful consideration for their health and welfare, and ruled her guilty of handing out LSD but not guilty of endangering people. For the narcotics offence, she was fined 2,000 Swiss francs and given a 16-month suspended sentence with two years' probation."I have been blessed by a very understanding lawyer and an intelligent judge," she says. She even considers the woman who reported her to the police a blessing, since the case has allowed her to talk openly about her work with psychedelics. She gives occasional lectures at psychedelic conferences, and has written a book about her experience, which she hopes will guide other therapists in how to work with the substances safely.This story originally appeared on Mosaic with the headline, "Psychedelic therapy." It is published under a CC BY 4.0 license.
"I have been blessed by a very understanding lawyer and an intelligent judge."