- Email: [email protected]
High time we cleaned up on drugs
DISSECTING ROOM
High time we cleaned up on drugs In search of the ultimate high: spiritual experiences through psychoactives Nicholas Saunders, Anja Saunders, Michelle Pauli. London: Rider Books, Random House, 2000. Pp 256. £12·99. ISBN 0712670874. www.csp.org/nicholas/spiritualindex.html Tripping: an anthology of true-life psychedelic adventures Charles Hayes. New York: Penguin Books, 2000. Pp 486. $18·00. ISBN 0140195742. www.psychedelicadventures.com et’s face it, we’re all on drugs, and we’re all messed up. Even a casual glance at the statistics of use and abuse, the inadequacies of drug services, the costs of prevention, and the effects of a multibillion dollar global criminal drug industry, would suggest that society is in a spot of bother about its stance on drugs. Yet although most of us desire to vary our state of consciousness at times, most commonly through drugs, individual views on drugs are confusingly diverse. And the loudest voices still eschew fundamentalist positions that most recently reemerged around the 1960s: “all drugs are harmful and should be banned”, or “all drugs are beneficial and should be available”. Of course, by “drugs”, I don’t mean those things that doctors prescribe, (well, mostly not). I mean all substances that reliably vary consciousness, including the socially promoted and illicit, street, recreational, addictive, dependent, narcotic, stimulant, inebriant, intoxicant, delirient, fantasticant(!), psychotomimetic, hallucinogenic, psychedelic, psychoactive, and entheogenic substances, not forgetting the shamanic, ritualistic, and sacred or power plants, “medicine”, and sacraments. The diversity of language reflects the diversity of agents, situations, agendas, and motivations involved in such mind-alteration (drug use, administration, ingestion, misuse, abuse, and so on), yet society still
L
Tessa Newmark
THE LANCET • Vol 357 • February 10, 2001
lumps everything together as “drugs”, barely differentiating between a heavilydependent crack user and a psychonaut who uses LSD monthly for selfdevelopment. Confused? Seems mostly everyone is, even the scientific and medical communities, which should be able to offer a better-informed perspective. The paradoxes, inconsistencies, and dilemmas that are the consequence of our mixed up attitude to “drugs” are everywhere. For despite the fact that our children apparently know more about getting blissed out than we do (whirling around with arms extended is a favourite method), the biomedical community largely denies the possibility that a desire for altered states is innate, perhaps even necessary. So, each generation is left to their own devices to learn about the most common system adults use, and users who encounter clinical services are often stigmatised and marginalised. Despite the evident likelihood that some “drug”-induced states may not only be therapeutically beneficial (especially for addiction) but that they may offer profound insights into the “holy grail” of neuroscience, consciousness, most researchers, with the exception of a few notable mavericks, focus on the adverse effects of “drugs”. So, the increasing groundswell of people who find the official line confusing or naive have to rely on popular culture for evidence and experience. And, the rising number of people who are interested in trying “drugs” for increasingly specific purposes most commonly learn by taking them. Isn’t it time that we developed a clearer perspective on this dirty topic? One of the most welcome efforts to illuminate the evermore muddy waters sadly has
not come from biomedical research institutions but from the collation of “drug” experiences on the Internet and in popular literature. Two recent additions are Tripping and In search of the ultimate high, a coincidental duo of books whose authors differ somewhat in their aims and views, yet take a similarly sensitive and responsible approach to documenting profound experiences with “drugs”. The results of this informal research are both informative and highly moving. While Tripping presents a broad anthology of psychedelic states or “trips”, In search of the ultimate high is more a manual for the seeker of specifically spiritual experiences through psychoactives. Both texts also represent personal journeys for the authors (for example, after Nicholas Saunders died in a car accident, In search of the ultimate high was completed by his wife and his researcher), in which they freely contribute their own “drug” experiences. These are not “trip-heads” or “junkies” but free-thinking individuals who are fully engaged in the mainstream of life, and whose experiences undoubtedly add to their books’ abilities to provide both education and entertainment on a practice that is both relatively common and relatively hidden. For Hayes, his first psychedelic experience opened him up to “shimmering new sensibilities that shook my petty mortal concerns like so many scales from my skin”. His subsequent belief that factual, unbiased information on such phenomena should be widely available led him to compile this warts-and-all global collection of 50 astounding trips. Together with essays on the history and basic features of the psychedelic experience and a conversation with the late psychedelic guru Terence McKenna, this is Hayes’ bid, not to glorify or demonise tripping, but to “set the leper-crazies free”. And here they all are: George, the author who was given insight into the soul’s journey through the universe, then chided when he asked what it all meant; Kenny, the farmer who still believes that the only reason he suffered 60% burns after he lay in a fire was the “hyper-rational” reaction that took him out of the protection of the “group mind” generated within his circle of tripping army buddies; Julian, the inventor who once attended a London casualty department believing he was a first-stage rocket taking off and later was inspired in his inventions by LSD; and Alice, the financial adviser who asked to see God after eating cannabis cake and was rewarded with the most ecstatic experience of her life. In the cases collected by Hayes in which the original purpose of the
485
For personal use only. Reproduce with permission from The Lancet Publishing Group.
DISSECTING ROOM
tripper was recreational, many have subsequently eschewed psychedelics. In search of the ultimate high, however, specifically details experiences of those on a spiritual quest, who consider psychoactives as sacraments, and who believe, as Anja Saunders says, that “there is more than the material reality, visible in everyday life”. The basis of In search of the ultimate high is that “drugs” and spirituality are certainly not mutually exclusive; in fact, psychoactives are a longstanding method to access the sort of transpersonal, mystical experiences that we call spiritual, whatever their catalyst. Indeed, on one LSD trip, Nicholas Saunders had the insight that mankind invented religions to provide an explanation or framework for experiences of non-ordinary consciousness. Religious contexts therefore feature prominently, including organised groups that base their religion around a psychoactive sacrament, the classic world religions, and other spiritual ways of life, from shamanism to rave spirituality. Readers may be surprised to learn of Buddhist monks who use Ecstasy for meditation, or of social worker Lee, who was led to evangelical Christianity through LSD, then later secretly used the legal cough suppressant dextromethorphan for trips that rejuvenated his spiritual weariness. No doubt by now, most readers will be buzzing with questions: Do we really need such profound experiences, and
do we need drugs to access them? What about abuse or insanity? What should be done about drug laws? And, how can we make progress on the issue? Again, these authors offer some insight. In search of the ultimate high emphasises the need throughout for information (which they admirably provide), preparation, caution, appropriate guidance (for example, in accordance with the Council on Spiritual Practices guidelines), and integration of the experience. Hayes wholly concurs, placing what he calls “reassimilation” as a particularly high priority, to mend tripinduced schisms between non-ordinary and ordinary consciousness. Perhaps this is why he is anything but a libertarian on the issue, believing that “most individuals do not need to experience something as intense and ‘otherly’ as a psychedelic experience can be”. Instead, he prefers the idea of institutionalising such enterprises for those in need, for example, through psychiatry. But to really further the debate, evidence more rigorous than anthology is surely needed, as championed by the Multidisciplinary Association for Psychedelic Studies (www.maps.org). In his recent PhD thesis for Harvard’s Kennedy School of Government, MAPS president Rick Doblin delineates both appropriate research protocols to investigate the therapeutic effects of psychedelic substances and a potential regulatory framework for
Refractory Politics and public health: democracy—or what? t is noteworthy that patient organisations have no voice in two important public health decisions. The first was at a conference organised by the UK Department of Health (DoH) for medical organisations, attended by the four Chief Medical Officers, to consider what action to take following publication of controversial findings casting doubt on the safety of the MMR triple vaccine. Predictably, the DoH announced a costly new offensive to “boost confidence in the MMR vaccine”. Passionate ministerial soundbites in the media spoke of their desire “to reassure the public”, “to win them over”. When will they learn that the public is, quite rightly, becoming extremely cynical? Where is the partnership they talk about? The second concerns non-therapeutic research with incapacitated
I
486
adult patients, which will be prohibited in Europe if Clinical Trials Directive COD/1997/0197 (which has been adopted by the Council of EU Ministers of Health) comes into force this month. Do EU Ministers realise what the impact of such a decision would be? What do carers, or adults at high risk of suffering stroke, or Alzheimers disease, think of this? If Phase I and II drug trials for these conditions are prohibited in Europe, drug development will be blocked there. What are the far-reaching consequences of protecting today’s patient at the expense of tomorrow’s? Should not “tomorrow’s patients” who believe in exercising their social responsibility in partnership with health professionals have a stronger voice in this debate? How is the bridge from trials in animals to Phase III therapeutic trials to be crossed? Before voting to prohibit this type
prescribing psychedelic psychotherapy. For example, he proposes fourarm studies that compare three groups receiving high, medium, or sub-threshold (placebo) doses of psychedelic psychotherapy with an unblinded group receiving the best alternative treatment. If found effective, he suggests that such treatment could be prescribed within a similar framework to that used for methadone or electroconvulsive therapy, with prescribing authority restricted to specially-licensed and trained psychiatrists working within clinical settings meeting minimum standards. When valuable case series are being published as popular literature, when research is being led from outside the mainstream scientific community, surely this is a wake-up call to move the debate forward in an open-minded, rational way, whatever our personal views on “drugs”, however complex the issue. If these authors can respect the potentially negative effects that non-ordinary consciousness can have on the fragile mind, and nevertheless appreciate the need for further exploration, research, and debate on the issue, then why can’t the biomedical community? We should not make our whirling children re-discover the truth about “drugs” on their own. Kelly Morris [email protected]
of non-therapeutic research “for the protection of trial subjects” why not widen the debate to find constructive ways of dealing with the dilemma? Why not consider a UK initiative for a randomised controlled trial card held by patients at risk of developing incapacitating conditions, signifying willingness whilst still of sound mind and body, to participate in appropriate ethically approved trials, at the later discretion of relatives/carers/doctors? The lay public frequently makes irreconcilable demands, ignorant or unaware of the moral dilemmas raised by these conflicts. Ministers, politicians, and professionals should, rather than hurriedly and autocratically legislate, work to achieve better public understanding of the conflict between social responsibility and personal autonomy where the rights of the individual can be at odds with the good of the community. Including citizens in these debates could result in greater public spiritedness. Refractor [email protected]
THE LANCET • Vol 357 • February 10, 2001
For personal use only. Reproduce with permission from The Lancet Publishing Group.
High time we cleaned up on drugs In search of the ultimate high: spiritual experiences through psychoactives Nicholas Saunders, Anja Saunders, Michelle Pauli. London: Rider Books, Random House, 2000. Pp 256. £12·99. ISBN 0712670874. www.csp.org/nicholas/spiritualindex.html Tripping: an anthology of true-life psychedelic adventures Charles Hayes. New York: Penguin Books, 2000. Pp 486. $18·00. ISBN 0140195742. www.psychedelicadventures.com et’s face it, we’re all on drugs, and we’re all messed up. Even a casual glance at the statistics of use and abuse, the inadequacies of drug services, the costs of prevention, and the effects of a multibillion dollar global criminal drug industry, would suggest that society is in a spot of bother about its stance on drugs. Yet although most of us desire to vary our state of consciousness at times, most commonly through drugs, individual views on drugs are confusingly diverse. And the loudest voices still eschew fundamentalist positions that most recently reemerged around the 1960s: “all drugs are harmful and should be banned”, or “all drugs are beneficial and should be available”. Of course, by “drugs”, I don’t mean those things that doctors prescribe, (well, mostly not). I mean all substances that reliably vary consciousness, including the socially promoted and illicit, street, recreational, addictive, dependent, narcotic, stimulant, inebriant, intoxicant, delirient, fantasticant(!), psychotomimetic, hallucinogenic, psychedelic, psychoactive, and entheogenic substances, not forgetting the shamanic, ritualistic, and sacred or power plants, “medicine”, and sacraments. The diversity of language reflects the diversity of agents, situations, agendas, and motivations involved in such mind-alteration (drug use, administration, ingestion, misuse, abuse, and so on), yet society still
L
Tessa Newmark
THE LANCET • Vol 357 • February 10, 2001
lumps everything together as “drugs”, barely differentiating between a heavilydependent crack user and a psychonaut who uses LSD monthly for selfdevelopment. Confused? Seems mostly everyone is, even the scientific and medical communities, which should be able to offer a better-informed perspective. The paradoxes, inconsistencies, and dilemmas that are the consequence of our mixed up attitude to “drugs” are everywhere. For despite the fact that our children apparently know more about getting blissed out than we do (whirling around with arms extended is a favourite method), the biomedical community largely denies the possibility that a desire for altered states is innate, perhaps even necessary. So, each generation is left to their own devices to learn about the most common system adults use, and users who encounter clinical services are often stigmatised and marginalised. Despite the evident likelihood that some “drug”-induced states may not only be therapeutically beneficial (especially for addiction) but that they may offer profound insights into the “holy grail” of neuroscience, consciousness, most researchers, with the exception of a few notable mavericks, focus on the adverse effects of “drugs”. So, the increasing groundswell of people who find the official line confusing or naive have to rely on popular culture for evidence and experience. And, the rising number of people who are interested in trying “drugs” for increasingly specific purposes most commonly learn by taking them. Isn’t it time that we developed a clearer perspective on this dirty topic? One of the most welcome efforts to illuminate the evermore muddy waters sadly has
not come from biomedical research institutions but from the collation of “drug” experiences on the Internet and in popular literature. Two recent additions are Tripping and In search of the ultimate high, a coincidental duo of books whose authors differ somewhat in their aims and views, yet take a similarly sensitive and responsible approach to documenting profound experiences with “drugs”. The results of this informal research are both informative and highly moving. While Tripping presents a broad anthology of psychedelic states or “trips”, In search of the ultimate high is more a manual for the seeker of specifically spiritual experiences through psychoactives. Both texts also represent personal journeys for the authors (for example, after Nicholas Saunders died in a car accident, In search of the ultimate high was completed by his wife and his researcher), in which they freely contribute their own “drug” experiences. These are not “trip-heads” or “junkies” but free-thinking individuals who are fully engaged in the mainstream of life, and whose experiences undoubtedly add to their books’ abilities to provide both education and entertainment on a practice that is both relatively common and relatively hidden. For Hayes, his first psychedelic experience opened him up to “shimmering new sensibilities that shook my petty mortal concerns like so many scales from my skin”. His subsequent belief that factual, unbiased information on such phenomena should be widely available led him to compile this warts-and-all global collection of 50 astounding trips. Together with essays on the history and basic features of the psychedelic experience and a conversation with the late psychedelic guru Terence McKenna, this is Hayes’ bid, not to glorify or demonise tripping, but to “set the leper-crazies free”. And here they all are: George, the author who was given insight into the soul’s journey through the universe, then chided when he asked what it all meant; Kenny, the farmer who still believes that the only reason he suffered 60% burns after he lay in a fire was the “hyper-rational” reaction that took him out of the protection of the “group mind” generated within his circle of tripping army buddies; Julian, the inventor who once attended a London casualty department believing he was a first-stage rocket taking off and later was inspired in his inventions by LSD; and Alice, the financial adviser who asked to see God after eating cannabis cake and was rewarded with the most ecstatic experience of her life. In the cases collected by Hayes in which the original purpose of the
485
For personal use only. Reproduce with permission from The Lancet Publishing Group.
DISSECTING ROOM
tripper was recreational, many have subsequently eschewed psychedelics. In search of the ultimate high, however, specifically details experiences of those on a spiritual quest, who consider psychoactives as sacraments, and who believe, as Anja Saunders says, that “there is more than the material reality, visible in everyday life”. The basis of In search of the ultimate high is that “drugs” and spirituality are certainly not mutually exclusive; in fact, psychoactives are a longstanding method to access the sort of transpersonal, mystical experiences that we call spiritual, whatever their catalyst. Indeed, on one LSD trip, Nicholas Saunders had the insight that mankind invented religions to provide an explanation or framework for experiences of non-ordinary consciousness. Religious contexts therefore feature prominently, including organised groups that base their religion around a psychoactive sacrament, the classic world religions, and other spiritual ways of life, from shamanism to rave spirituality. Readers may be surprised to learn of Buddhist monks who use Ecstasy for meditation, or of social worker Lee, who was led to evangelical Christianity through LSD, then later secretly used the legal cough suppressant dextromethorphan for trips that rejuvenated his spiritual weariness. No doubt by now, most readers will be buzzing with questions: Do we really need such profound experiences, and
do we need drugs to access them? What about abuse or insanity? What should be done about drug laws? And, how can we make progress on the issue? Again, these authors offer some insight. In search of the ultimate high emphasises the need throughout for information (which they admirably provide), preparation, caution, appropriate guidance (for example, in accordance with the Council on Spiritual Practices guidelines), and integration of the experience. Hayes wholly concurs, placing what he calls “reassimilation” as a particularly high priority, to mend tripinduced schisms between non-ordinary and ordinary consciousness. Perhaps this is why he is anything but a libertarian on the issue, believing that “most individuals do not need to experience something as intense and ‘otherly’ as a psychedelic experience can be”. Instead, he prefers the idea of institutionalising such enterprises for those in need, for example, through psychiatry. But to really further the debate, evidence more rigorous than anthology is surely needed, as championed by the Multidisciplinary Association for Psychedelic Studies (www.maps.org). In his recent PhD thesis for Harvard’s Kennedy School of Government, MAPS president Rick Doblin delineates both appropriate research protocols to investigate the therapeutic effects of psychedelic substances and a potential regulatory framework for
Refractory Politics and public health: democracy—or what? t is noteworthy that patient organisations have no voice in two important public health decisions. The first was at a conference organised by the UK Department of Health (DoH) for medical organisations, attended by the four Chief Medical Officers, to consider what action to take following publication of controversial findings casting doubt on the safety of the MMR triple vaccine. Predictably, the DoH announced a costly new offensive to “boost confidence in the MMR vaccine”. Passionate ministerial soundbites in the media spoke of their desire “to reassure the public”, “to win them over”. When will they learn that the public is, quite rightly, becoming extremely cynical? Where is the partnership they talk about? The second concerns non-therapeutic research with incapacitated
I
486
adult patients, which will be prohibited in Europe if Clinical Trials Directive COD/1997/0197 (which has been adopted by the Council of EU Ministers of Health) comes into force this month. Do EU Ministers realise what the impact of such a decision would be? What do carers, or adults at high risk of suffering stroke, or Alzheimers disease, think of this? If Phase I and II drug trials for these conditions are prohibited in Europe, drug development will be blocked there. What are the far-reaching consequences of protecting today’s patient at the expense of tomorrow’s? Should not “tomorrow’s patients” who believe in exercising their social responsibility in partnership with health professionals have a stronger voice in this debate? How is the bridge from trials in animals to Phase III therapeutic trials to be crossed? Before voting to prohibit this type
prescribing psychedelic psychotherapy. For example, he proposes fourarm studies that compare three groups receiving high, medium, or sub-threshold (placebo) doses of psychedelic psychotherapy with an unblinded group receiving the best alternative treatment. If found effective, he suggests that such treatment could be prescribed within a similar framework to that used for methadone or electroconvulsive therapy, with prescribing authority restricted to specially-licensed and trained psychiatrists working within clinical settings meeting minimum standards. When valuable case series are being published as popular literature, when research is being led from outside the mainstream scientific community, surely this is a wake-up call to move the debate forward in an open-minded, rational way, whatever our personal views on “drugs”, however complex the issue. If these authors can respect the potentially negative effects that non-ordinary consciousness can have on the fragile mind, and nevertheless appreciate the need for further exploration, research, and debate on the issue, then why can’t the biomedical community? We should not make our whirling children re-discover the truth about “drugs” on their own. Kelly Morris [email protected]
of non-therapeutic research “for the protection of trial subjects” why not widen the debate to find constructive ways of dealing with the dilemma? Why not consider a UK initiative for a randomised controlled trial card held by patients at risk of developing incapacitating conditions, signifying willingness whilst still of sound mind and body, to participate in appropriate ethically approved trials, at the later discretion of relatives/carers/doctors? The lay public frequently makes irreconcilable demands, ignorant or unaware of the moral dilemmas raised by these conflicts. Ministers, politicians, and professionals should, rather than hurriedly and autocratically legislate, work to achieve better public understanding of the conflict between social responsibility and personal autonomy where the rights of the individual can be at odds with the good of the community. Including citizens in these debates could result in greater public spiritedness. Refractor [email protected]
THE LANCET • Vol 357 • February 10, 2001
For personal use only. Reproduce with permission from The Lancet Publishing Group.