When Stan and Christina Grof announced their plans to host an International Transpersonal Association (ITA) conference in Prague in June of 1992, I inquired as to whether any conference sessions on psychedelics were planned. Stan responded by asking whether MAPS would support the travel expenses of the discoverer of LSD, Albert Hofmann, to the conference so that the ITA could presented him with an honorary award. He also asked Charles Grob and myself to coordinate three offidal conference sessions on psychedelic research.
Because many of the pioneers of psychedelic research were planning to be present at the conference, there was a rare opportunity to organize a special MAPS seminar for some of the current and would-be psychedelic researchers to receive spedtic guidance on conducting psychedelic sessions from their more experienced teachers. In addition to the three ITA conference panels on psychedelic research, MAPS arranged for psychedelic pioneer Ram Dass, near-death researcher Ken Ring and LSD researcher Richard Yensen to speak at an invitation-only pre-conference seminar on the use of psychedelics in the treatment of the terminally ill (tape recordings of this seminar are available from MAPS). The MAPS meeting focused primarily on Dr. Grob's research protocol for the use of MDMA in the treatment of pancreatic cancer patients, in hopeful antidpation of the protocol receiving government approval at the FDA meeting scheduled three weeks after the Prague conference (full report on FDA meeting).
The Prague conference also presented MAPS with an excellent opportunity to help catalyze MDMA research in Russia. MAPS subsidized the expenses of several sdentists from Russia so that they might come to the conference, meet other psychedelic researchers and become acquainted with the transpersonal psychology movement. The Russian scientists included Dr. Evgeny Krupitsky, the psychiatrist under whose direction Dr. Igor Kungurtsev test ketamine in the treatment of alcoholics, and Dr. Andre Vrublevsky, the director of the Research Center of Addictions, Russia's primary center for the study of drug use and abuse.
What follows is an in-depth report on the psychedelic seminars at the Prague conference. For an overview of the entire conference, see the story by Kylea Taylor. The MAPS Meeting on Psychedelics and the Terminally III
On June 20, about thirty-five people all deeply interested in psychedelic research and experiences gathered together for an afternoon seminar with Ram Dass, Ken Ring, and Richard Yensen, immediately preceding the ITA conference. This seminar was, for me, the emotional high point of my time in Prague. What made it so special was that the topic of discussion was therapeutic rather than scientific, political, or administrative. We focused detail on how to treat dying patients with psychedelics, rather than on how to design a research protocol or how to gain approval to conduct such research. After having been rather single-mindedly working for many years to secure permission for psychedelic research, I felt a deep sense of reconnection with the original purpose that motivated me to found MAPS in 1986.
Ram Dass spoke first. Ironically, his remarks about working with dying people with psychedelics had a very powerful sobering effect. He pointed out that the world would have an extremely profound effect on the therapists and researchers conducting the study and would force each person working on the project to confront, and hopefully clarify, his or her own attitudes and emotions concerntng death. The project would be a fundamental opportunity for the reseachers to work on themselves while they sought to be oś assistance to others who were facing their last moments. Unless the researchers were able to come to terms with their own issues concerntng death, their ability to be of service to others was limited.
As to techniques and practices, Ram Dass emphasized that psychedelic therapists must simply come to love the people they assist in coping with terminal illness. He suggested a relatively non-directional, supportive approach whereby the therapist would try without judgement to assist the experimental subject in exploring the issues that were brought to the surface during the MDMA sessions. Since people with terminal illness commonly cycle throughout periods of acceptance and denial, a willingness to listen with a ]oving and accepting attitude would serve to model a healthy psycho]ogica] attitude. Ram Dass suggested that therapists focus on "being with" rather than "doing to" the people in their care. He spoke poignantly about helping his step-mother to die peacefully in his arms and helping prepare his father for death, easing our fears as he spoke of helping his parents.
He cautioned us to remember that one of the traps of consciousness was to hold on to a particular understanding or perspective as if it were the complete truth and the deepest reality. Dying is the ultimate letting go, yet people may cling to new and profound understandings gained during the psychedelic sessions as if they were the long-sought after Truth. Ram Dass encouraged the therapists to help people gently let go of their intellectual conceptions and seek the formless emptiness that lies beyond the conscious mind.
Richard Yensen spoke next about his research using LSD and DPT (a shorter acting but powerful psychedelic) with terminal patients at the Maryland Psychiatric Research Center. Rather than focusing on specific psychodynamic issues in treating patients, he chose instead to emphasize the fundamental importance of the therapists' reverent attitude. Richard discussed his meetings with the Mexican Shaman Maria Sabina, the medicine woman who introduced the secrets of the psilocybin mushrooms to the West, and suggested that her time-tested religious approach be considered a model for our work. Richard suggested that the therapists needed to beware of being trapped by the cold, clinical medical model exemplified by the placebocontrolled, random-assignment double-blind experiments required by the FDA. He did not object to working within such a context but stressed that researchers should approach the use of psychedelics in a sacramental, spiritual manner even in the midst of a scientific experiment conducted in a clinical research laboratory.
Ken Ring spoke about his study of the near-death experience and its relevance for the clinical treatment of the terminally ill. He acknowledged that while he had not actually worked with terminal patients (and that all of his subjects had had by definition only near-death experiences), he felt that he could offer some useful insights. He noted that the reports of the near-death subjects often matched those of people whose psychedelic experiences included ego-death and death/rebirth sequences. In addition, the changes in lifestyle and personal values that often accompanied near-death experiences were similar to the changes reported by people who had experienced death/rebirth sequences in their psychedelic sessions. From this evidence, he suggested that psychedelic experiences most likely can provide people with preparation for the actual experience of their own death. Finally, Ken suggested that a questionnaire that he developed to measure the attitude and lifestyle changes resulting from near-death experiences could be of value in researching psychedelic therapy with the terminally ill. [This questionnaire was used in the Russian studies of the use of ketamine with alcoholics.]
A question and answer period, and time for participants to discuss their own work, concluded the seminar. (Two 90-minute audiotapes of the meeting are available from MAPS)
The Three ITA Conference Sessions on Psychedelics
The three panels on psychedelic research at the ITA conference were organized around the themes of past lessons, current research, and prospects and were moderated psychiatrist Charles Grob. Speakers on the first panel included psychedelic pioneers Stan Grof, Ram Dass, Ralph Metznet, and Richard Yensen. The second panel included US DMT researcher Rick Strassman, Russian ketamine researcher Evgeny Krupitsky, and Swiss MDMA and LSD researcher Juraj Styk. The third panel included Danish ketamine researcher Gustav Hansen, Russian psychedelic researcher Dimitri Spivak, Russian director of the Research Center of addictions Andre Vrublevsky, US public policy experts Ethan Nadelman and Mark Kleiman, US research chemist Alexander Shulgin, and myself. Unfortunately, Albert Hofmann attended a family gathering and could not participate in the conference as originally planned.
The First Panel: Past Lessons
The first session was a joy to behold. about a thousand people had gathered in Prague's 200-year old ornate concert hall that had seen many of the great European composers of the last two centuries present their work, as well as Nazi, Communist and Democratic rallies.
Stan reviewed the reasons why psychedelics were so controversial in the past and discussed what has changed over the last thirty years. He thought that much of the problem with psychedelics during the 1960's had to do with the fundamental inability of the psychiatric profession and the entire Western culture to deal conceptually with the nature and potential of the psychedelic experience. He also noted that early military and CIA research with psychedelics was often conducted unethically and contributed to the backlash against psychedelics. More significantly, psychedelics were assodated with an erhption of the Dionysian spirit which dashed with the dominant Puritan ethic and mainstream culture.
Stan then remarked that over the last decades he has observed a gradual increase in the cultural acceptance of the value and therapeutic validity of near-death, past-life, rebirthing, out-of-body, age-regression and mystical experiences. The psychiatric profession is now more open to these experiences and, through the use of powerful non-drug techniques such as the holotropic breathwork developed by Stan and Christina, more psychiatrists have become comfortable playing a role in catalyzing powerful experiences of altered states of consciousness.
During the question period, I asked Stan whether working to legitimize psychedelic research was worth the struggle in light of the many alternative non-drug therapeutic methods he cited. He replied that each method has its unique advantages and attendant disadvantages, psychedelics included. He elaborated by outlining his longstanding dream of a transpersonal center where people could come for extended periods of study and personal growth. Here they would be able to experience psychedelics maybe once a month, breathwork sessions several times a week and daily meditation, along with a spectrum of other opportunities such as bodywork, Jungian sandplay, expressive paintings and gardening, each potentiating the other.
Ralph Metzner stressed the important contribution of the set and setting hypothesis developed during the early psychedelic research, which stated that both psychological set and physical setting play a defining role in the creation of each psychedelic session. He emphasized the differences between states of consciousness, which is a model for an experience in time, traits of consciousness, which may pertain to qualities in one or more states, and levels of consdousness, which pertain to permanent features of the psyche such as the subconscious and the personal and collective unconsdous. He concluded by emphasizing that changed consciousness (transcendence) does not necessarily result in a changed life (transformation). The later requires the slow patient work of grounded integration and involves internal intrapsychic changes as well as changes in the relationships between the individual and family, peers, co-workers and others.
Ram Dass delighted the audience by suggesting that the psychedelic revolution had already happened because many people who have had positive transformative psychedelic experiences are currently making their unique contributions to the culture. He felt that responsible underground use of psychedelics might even be more important in changing the culture for the better than psychiatric attempts to conduct legally sanctioned research. He warned that in our zeal to gain acceptance for psychedelic research we should be mindful not to trivialize and scientifically dissect and drain the life out of something that is, in essence, sacred. Nevertheless, he wholeheartedly encouraged us to continue seeking permission to conduct research.
Richard Yensen reviewed his early work with psychedelics at the Maryland Psychiatric Research Center. He emphasized the spiritual nature of psychedelics and the need for psychedelic research to be integrated into a spiritual, sacred setting.
The Second Panel: Current Research
The second panel provided a more detailed view of current research. Rick Strassman discussed his FDA-approved research with DMT, about which he has previously written in the MAPS newsletter. He mentioned that he will soon conduct a study to see how the effects of DMT in women depend on where they are in their menstrual cycles. Russian researcher Evgeny Krupitsky discussed his study of ketamine in the treatment of alcoholics. He reported that 70% of the alcoholics receiving one ketamine session (after several months of in-patient treatment) were able to stay alcohol-free for one year or more. Only 24% of the control group, which received only the in-patient treatment, were alcohol-free after one year. Evgeny expressed the hope that he will be able to obtain approval to research MDMA in the treatment of alcoholics. Swiss psychiatrist Juraj Styk reported on the use of MDMA and LSD in Switzerland by a small group of specially licensed psychiatrists ( details here). He indicated that MDMA and LSD have been used successfully in a wide variety of indications. Currently, however, the Swiss psychiatrists can only work with patients they have previously treated and are negotiating with the government on the design of protocols for treating new patients.
The Third Panel: Future Prospects
The third session focused initially on clinical research. Danish psychiatrist Gustav Hansen discussed his therapeutic use of ketamine, which he found quite valuable. Russian psychiatrist Dimitri Spivak spoke about his work over the last thirty years supervising psychedelic research, in his capacity as director of such research for the Russian military. He. expressed his belief that such drugs had significant therapeutic potential and indicated his support for initiating such research in Russia outside the military context. Andre Vrublevsky followed with a discussion of his role in directing the Russian Research Center of the Addictions. He previously had helped secure approval for Evgeny's research treating alcoholics with ketamine and announced his intention to seek permission from the Russian Pharmacological Committee to conduct MDMA research in the treatment of alcoholism.
The third session then turned in a more political direction. Ethan Nadelmann, assistant professor at the Woodrow Wilson School at Princeton and leading academic proponent of legalizing drugs, outlined four strategies that proponents of psychedelic research might adopt to further their goals in the face of the War on Drugs, which he called a "regressive hangover of a repressive theocracy." One strategy, the political, is to engage in the overall debate on legalizing drugs with the hopes that access to psychedelics might be a consequence of legalization. The opposite strategy, the underground, is to ignore the laws and develop a discrete network of chemists, therapists, researchers and volunteers working outside the law to advance the field, much in the way some early AIDS research activists tested drugs outside of FDA-approved studies.
The third strategy, the non-drug approach, is typified by Stan and Christina Grof's development of holotropic breathwork. The non-drug strategy involves working to develop non-drug methods of modifying consdousness to help open a conceptual and emotional space for this sort of work. The fourth and final strategy Ethan labeled "the conservative strategy". This strategy involves seeking to conduct FDA-approved research on the government's terms with the aim of eventually obtaining for psychiatrists prescription access to psychedelic drugs, exactly the approach taken by MAPS. It would be difficult to describe the mixture of pleasure and outrage that I felt hearing my work described as conservative.
Mark Kleiman, an assistant professor of public policy at Harvard's Kennedy School of Government and an expert on drug policy largely critical of legalization, challenged the group to consider the "yoga of policy analysis". He indicated that practidng that particular yoga requires three kinds of non-attachment in increasing degrees of difficulty, non-attachment to one's own interests, to one's own opinions, and to the opinions of one's dosest friends. Successful yogis are able to set aside their prejudice in search of a dear understanding of a public issue, all things considered.
In terms of psychedelic research, Mark advocated "vicarious problem solving" or putting oneself in the place of the regulators and trying to see the world as they see it. He noted that as general rule, regulators of all sorts are "pig-ignorant" of what they are supposed to regulate. Because of informational asymmetries, regulators have to rely for their education on the people they regulate. Building a trusting relationship with the regulators, becoming their ally rather than their opponent, is the key to making progress. This can be accomplished only be presenting to them all of the data one generates, disasters as well as triumphs, patients killed as well as patients cured.
Mark then posed a question. Are we trying to model our cultural integration of psychedelics on other cultures which have successfully done so, namely most every indigenous native culture in the world with its shamans and medidne men and women? If so, who are our shaman-equivalents? They are not necessarily or obviously psychiatrists. It thus may not be the best policy to seek to provide psychiatrists with a monopoly on the use of psychedelics. However, because the only way that our culture might sanction the use of psychedelics is as medidnes to cure illness, Mark concurred with MAPS' strategy of seeking first to develop the medical potential of psychedelics. He specifically encouraged research into the treatment of addiction and terminal illness.
Sasha Shulgin, a research chemist specializing in the structure/activity relationships of psychedelics and co-author of PIHKAL, was surprisingly pessimistic about the future of psychedelic research. He saw no reason to assume that the last decade's relentlessly escalating War on Drugs would change course. He dismissed the theory that the pendulum had to eventually swing back toward the center by saying that every time it swung to the fight it was nailed in place by new laws that were harsher than the ones that preceded. Yet even he made the optimistic prediction that progress in drug development would continue. He indicated that new compounds would inevitably be invented, "teased out of other drugs such as MDMA", that would have a higher degree of specificity for catalyzing human emotions such as the fear of death, the awareness and suppression of anger, and the feeling of guilt.
As the last speaker, I sought to integrate the lessons of the past, build on the experiences of the current researchers, and respond to the challenges of the future with a strategy of hope. I took as the primary lesson of the past the need for the development of a cultural context for psychedelic research that was supportive and appreciative. This led me to the conclusion that psychedelic research should focus first on using the sdentific method to explore the medical applications of psychedelics, in the process dealing with the burden of fears placed upon these drugs. Western culture values and trusts science, generally more than is appropriate, and may be willing to consider the use of psychedelics for medical purposes. I noted that the FDA had already permitted several studies with psychedelics and seemed willing to give us a chance to prove our claims about MDMA's therapeutic potential.
I reported that there are some very good people at the FDA who are willing to try to let science, and not ideology, govern the medical uses of psychedelics. It behooves us to see them as individuals, not merely as representatives of an agency that halted research for 30 years but as people who realize that their loved ones may someday need the medical benefits that MDMA or other psychedelics might provide. Good sdence can have a major impact, though not necessarily a decisive one, on controversial policy debates. I noted that the worldwide community of people appreciative of psychedelics, which I estimated spent $100 million a year on MDMA alone, was large enough to support a research budget of $1 million a year if better organized. I suggested that people offer up a sacrifice of some portion of their funds to support research and proposed that people think of MAPS not just as a research and educational organization but also as a non-profit pharmaceutical company with research funds raised through donations rather than stock purchases.
With that, the psychedelic panels concluded.