Katie Birditt delves into the world of mind-altering drugs with her review of 'Psychedelics' by Professor David Nutt. Psychedelic therapy has yet to be legalised in the UK and the substances themselves remain prohibited as Class A drugs. Is this holding back advances in the treatment of mental health issues?
I had given psychedelic research (relatively) little thought prior to reading the recently published book, ‘Psychedelics’, by Professor David Nutt. Embarking on this literary journey showed me that I had been missing out on one of the most radical, emerging fields within therapeutic neuroscience. As the famous author Aldous Huxley once said in 1950:
“these drugs are destined to play a role in human affairs at least as important as alcohol has hitherto” - Aldous Huxley
With the legislation around the use of psychedelics for scientific research beginning to change in some countries, Huxley’s statement could not seem more accurate. Evidently, it is time to start familiarising ourselves with this field!
Perhaps there is no one more suitable to tell the story of psychedelics than the neuropsychopharmacologist, David Nutt, who leads the first psychedelics research centre at Imperial College London. The engaging narrative he crafts encompasses aspects of the biological and the pharmacological, whilst also being enriched with added insights into the stigmatisation, history, and practicalities of psychedelic therapy. Probing the field through these various perspectives grounds the research - both its opportunities and challenges - in a real-world context where the forces of funding, public opinion, and governmental policy are all at play.
Delving into the pharmacology of substances like LSD, psilocybin, MDMA and ayahuasca (an Amazonian plant-based psychedelic), is truly fascinating and will encourage one to consider the related notions of consciousness and addiction. Classical and atypical psychedelics are introduced early in the book; their differences are explained by the ways in which they bind to various types of brain receptors to bring about their effects. Nutt elegantly discusses how these molecules can interfere with our brain’s perceptions of the world to cause the hallucinations characteristic of a “trip”. The power of psychedelics appears to reside in their ability to “switch off” master neural circuits, like the default-mode network (DMN) which can keep us locked in rigid thinking patterns. The DMN refers to a set of connected brain regions that seem to contribute to internal modes of cognition, such as thinking, remembering and mind wandering. Psychedelics appear to take this system “offline”, thus helping to unshackle an individual from compulsive thought and enable the formation of new connections between neurones (neuroplasticity at its finest). The therapeutic effect produced from this psychedelic-induced “rewiring” is optimal, provided that the patient is in the right mindset, the trip occurs in a controlled, safe setting and it is followed by therapy sessions that help individuals to process their experiences.
...will encourage one to consider the related notions of consciousness and addiction
Nutt’s style of writing throughout is concise, accessible and engaging, lending itself to this complex field where many unknowns still abound. So compelling is the writing that it becomes disconcertingly easy to get swept up in the “hype” that he builds around psychedelics. Many of the conditions that these substances could potentially be used to treat - such as eating disorders, depression, anxiety and post-traumatic stress disorder - have historically had unsatisfactory treatments, and devastate many lives. Given the disheartening landscape of psychiatric therapy, unbridled optimism could lead to vulnerable individuals attaching unrealistic expectations to radical therapeutics that may merely offer more “hype” than hope.
Another inherent problem with psychedelics research is related to the study of the effects of these drugs on individuals. The revered Randomised Double-Blind Clinical Control study design, that guides most therapeutic experiments, cannot be effectively employed in studies examining psychedelic effects. Blinding refers to giving participants either a treatment or a placebo and not informing them which they have been given to eliminate any confirmation bias towards taking a certain substance. Psychedelics have very distinctive effects, which introduces an inevitable and problematic bias into these experiments. For example if participants expect positive effects from psychedelic therapy and know they are receiving this treatment, a placebo effect may take place which can impact the validity of the study. This placebo effect that arises from knowing one’s treatment group, and believing a specific response will arise from that treatment, poses a significant challenge to psychedelic research.
I do not intend to discount the future potential of psychedelics. Whilst reading this book, I was frequently intrigued by the findings of studies investigating these substances. However, it is important, particularly at this stage, to remain objective. As Nutt points out, the research is still in its infancy. The long-term effectiveness of regular, psychedelic-assisted therapy sessions are unknown, as are the side effect profiles of these substances. One should also be aware that psychedelics are not a “one-size-fits-all” solution. Individuals with cardiovascular problems, and those susceptible to psychosis, are strongly advised to avoid these substances due to potential adverse effects. There would likely be significant and unprecedented implications if psychedelics were introduced into mainstream medicine too soon. Based on well-documented evidence, these substances might benefit from a reclassification that removes them from a drug category occupied by the most dangerous and addictive substances. This should accelerate research and, potentially, provide answers to some of these pressing questions.
Psychedelics are not a "one-size-fits-all" solution.
One must admire Nutt and his decades-long crusade championing the potential of these drugs. However, it is hard to escape the nagging feeling that the potentially detrimental effects of psychedelics are largely skirted around. I was left with the sense that, although the risks were briefly acknowledged, they were not meaningfully discussed. Two throwaway chapters towards the end of the book, designed to discuss concerns around the substances, felt more defensive, as if he could justify the risks associated with psychedelics by making comparisons with more dangerous drugs. Coupled with the knowledge that Nutt serves on multiple psychedelic advisory boards, the book starts to feel slightly skewed in favour of the substances’ benefits. In spite of this, I do recommend reading the book; the comprehensive information it provides, and the questions it raises, are becoming increasingly relevant in neuroscience today.
This article was written by Katie Birditt and edited by Rebecca Pope. Interested in writing for WiNUK yourself? Contact us through the blog page and the editors will be in touch!