The Electric Kool-Aid Medicine Test
In 1954, when the national mood was one of suspicion and conformity, Aldous Huxley wrote, "All ... the hallucinogens that ripen in berries or can be squeezed from roots -- all, without exception, have been known and systematically used by human beings from time immemorial."
Ten years later Timothy Leary was fired from Harvard for "systematically using" LSD (admittedly not from a berry or a root) with students. Leary's sensational promotion of turning on and dropping out closed the door on serious dialogue or research into the potential benefits of psychedelic substances. Yet today, in the midst of the current revival of patriotic and moral paranoia, some are beginning once again to scientifically consider their value as visionary or psychological medicine.
Charles Grob, M.D., is director of the Division of Child and Adolescent Psychiatry at Harbor-UCLA Medical Center and professor of Psychiatry and Pediatrics at the UCLA School of Medicine. He conducted the first government-approved psycholobiological research study of MDMA, was the principal investigator of an international project in the Brazilian Amazon of ayahuasca, and is now studying the use of psilocybin with advanced-stage cancer patients. He is editor of "Hallucinogens: A Reader" and recently co-edited, with Roger Walsh, "Higher Wisdom: Eminent Elders Explore the Continuing Impact of Psychedelics."
Terrence McNally: How and when did you decide to work with psychedelics?
Charles Grob: Growing up in the '60s, it was impossible to not be exposed to the controversies and the extraordinary powers of these compounds. In the early '70s, I read much of the literature that was available at the time, and I was struck by the potential these compounds had to help us understand the mind and mental illness, and to help us develop new and novel treatments. I was aware that, in order to speak out on this issue, one needed credentials, so I went back to school and got all the degrees and training I needed. It was always my intention to conduct proactive approved research in this area, though in the late '70s and early '80s there was virtually nothing going on in this country or elsewhere.
McNally: In 1973 I interviewed Stanislov Grof, who was then doing government-funded research in Maryland on the use of LSD with terminal cancer patients. Six months later I tried to follow up, and the state of Maryland wrote back that Dr. Grof was no longer in its employ. He had been let go, and the government funding had ended.
Grob: Around the same time, I heard Grof speak at the annual meeting of the Humanistic Psychology Association in New York City, and I was impressed with the enormous potential of the work he was doing.
McNally: Tell us about your study on anxiety in cancer patients.
Grob: At the L.A. Biomedical Research Institute at Harbor-UCLA Medical Center, we have full regulatory approval to conduct a study using psilocybin -- the active alkaloid in hallucinogenic mushrooms -- in the treatment of the anxiety associated with advanced-stage cancer.
McNally: What is the status of the study at this time? Do you have any preliminary results?
Grob: We've been treating individuals for the past year and a half who fit all our inclusion/exclusion criteria. To date, we've studied five subjects in entirety. We're approved for a total of 12, so we hope to treat seven more. We're finding recruitment very challenging because we have very tight inclusion/exclusion criteria. We've interviewed a number of individuals who at first seemed to fit our criteria, but whose medical condition then drastically deteriorated so that they could no longer participate. We're very interested in talking with individuals who might fit.
McNally: Where would potential candidates learn about this, and how would they apply?
Grob: Our website -- canceranxietystudy.org -- details the inclusion/exclusion criteria and provides information about the methodology.
McNally: Can you verify Huxley's contention that all plant hallucinogens, without exception, have been known and systematically used by human beings from time immemorial?
Grob: Certainly the anthropological and historical evidence is very rich that even pre-civilization cultures highly valued hallucinogenic plants. Aboriginal cultures often used them as one of the core activities for reinforcing belief systems and tribal cohesion. This is quite apparent if you look at the indigenous peoples in the Amazon basin in South America, where the plant ayahuasca is used for religious, spiritual and healing purposes. As far back as human habitation of the Amazon basin has been established, there are indications that ayahuasca was an integral part of their lives and belief systems.
McNally: I've traveled a bit in the rainforest of Ecuador, and among the Achuar people it is an important and seldom-used ritual taken at key passages in life.
Grob: These are not by any stretch of the imagination recreational compounds. Indigenous peoples use them for very serious purposes, often having to do with healing.
McNally: Do you view the recent Supreme Court decision to allow ayahuasca to be taken in a religious context as an isolated instance based on specifics of the particular case or something more?
Grob: On February 21st, the court ruled unanimously that a branch of a Brazilian syncretic church, the Unial de Vegetal, or UDV, in Santa Fe, N.M., had legal sanction to continue to utilize ayahuasca as a psychoactive sacrament in their religious ceremonies. This is really an extraordinary decision and establishes a remarkable precedent, although at this point I believe it only applies to the UDV.
I was an expert medical witness for the UDV, and so followed the case very closely. I had been the principal investigator of a series of research studies in Brazil, using members of the UDV as subjects. I did not expect the case to win in a conservative federal court in the throes of a vicious decades-long drug war.
McNally: This was one of the first decisions of the Roberts-Alito court, wasn't it?
Grob: I believe it's the first decision that Chief Justice Roberts penned himself. Though Alito was not part of the decision because he had not heard the arguments, he subsequently stated that he would have gone along with the majority.
The Justice Department appealed, and the appeal was heard by a panel of the Circuit Court of Appeals in Denver. Again I was not overly optimistic and again I was surprised: the UDV's position prevailed. It was then appealed to the full Circuit Court of Appeals and won again. Then it went to the Supreme Court, where on February 21st they issued their unanimous decision.
McNally: There was the precedent of the peyote churches of the Native Americans, yes?
Grob: The Native American Church has for some time had permission to use peyote as part of their religious ceremonies. Whereas peyote use among native peoples is established by treaty between the sovereign Indian nations and the United States, the Santa Fe case does not involve indigenous people. This was the first time in almost 1,600 years that a nonindigenous people had gained permission from the government to use a plant hallucinogen for religious ceremonial purpose -- not since Alaric the Hun sacked Elevsis in the year 396.
McNally: I guess you can't use that as precedent. What leads you to believe that psychedelic substances might have therapeutic use?
Grob: There's a very rich body of literature dating back to the mid-late 1950's that demonstrates it. Though methodologies at the time were not like methodologies today, they offer ample indication that we should at least study this further.
There were a number of studies which demonstrated therapeutic response among patient populations that did not normally respond well to conventional psychiatric and medical treatments -- first and foremost, chronic hardcore alcoholics and drug addicts. In the late '50s and early '60s, Humphrey Osmond in Western Canada demonstrated that some seriously ill alcoholics who had not responded to any conventional treatment did remarkably well after even a single dose treatment.
McNally: So your mission is to reopen the pursuit of this knowledge for the benefit of society?
Grob: Absolutely. My goal has always been to get this research back on track. By the early 1970s, all of the exciting and promising studies were forced to terminate because of the cultural turmoil of the time. Thirty-plus years later, I think it's high time that we review the old data and initiate new research.
McNally: In addition to your cancer anxiety study, are there other studies ongoing?
Grob: Dr. Francisco Moreno at the University of Arizona just completed a pilot study using psilocybin to treat chronic refractory obsessive-compulsive disorder. A psychiatrist named Michael Mithoffer in Charleston, S.C., has permission to use MDMA in the treatment of chronic post-traumatic stress disorder.
Though there are no clinical application treatment studies in Europe, Franz Volenwieder (also affiliated with Heffter) at the Burhholzi Clinic and the University of Zurich has done extraordinary work mapping the effects of MDMA and other hallucinogenic substances on the brain, using state-of-the art brain imaging technology.
McNally: What's your aim in the new book, "Higher Wisdom," which includes Ram Dass, Hofman, Sasha Shulgin, among others.
Grob: In the late 1980s, when I moved from Johns Hopkins to the University of California, I established a friendship with Roger Walsh, a psychiatrist at UC Irvine, who felt that it was important to preserve the stories and experiences of the leading early investigators and theorists on the issue of psychedelics. Along with Gary Bravo, another UC Irvine psychiatrist, we interviewed anyone we could find who had established a reputation in the field of psychedelic research in the 1950s and 1960s.
McNally: What were a couple of the big lessons you drew from your conversations with them?
Grob: These individuals were profoundly influenced personally by their experiences. They shared the vision that, under optimal circumstances and with all the proper safeguards in place, these compounds had an extraordinary capacity to help heal, to help enlighten and to help us learn.
McNally: MDMA was originally used in therapy, wasn't it?
Grob: In the late '70s and early '80s a large number of psychotherapists, mostly in California, formed an underground where MDMA was used for a variety of clinical indications, though very little of their clinical work was published.
Unfortunately the secret got out to the greater society at large, and it became a very popular recreational drug, particularly among the youth culture in California and Texas. It then spread throughout the country, over to Europe and around the world, setting off the ecstasy rave phenomenon.
McNally: What are the dangers, warnings and cautions with MDMA?
Grob: Oh, there are certainly dangers with MDMA, and individuals really need to be apprised and not to take foolish risks. There's a serious danger of malignant hyperthermia, or overheating, which is exacerbated by vigorous exercise in a hot, stuffy environment, and the failure to replace lost body fluids. This is just what happens in the rave setting, and there have unfortunately been some fatalities secondary to malignant hyperthermia.
The flipside risk is water intoxication. Several young people have actually drunk so much water that they have lowered their serum sodium and experienced seizures, and died as well. It can be a very tricky compound.
Perhaps the biggest danger, though, is drug substitution. A large percentage of what passes as ecstasy actually does not contain MDMA, but other drugs. Some are relatively benign like caffeine or aspirin, but others are potentially dangerous or lethal, like paramethoxy amphetamine, PMA, the most potent and potentially lethal amphetamine known. You have no idea what you're getting.
McNally: Because it's illegal, the greatest danger comes from buying something on the street with no oversight or regulation, correct?
Grob: There are absolutely no controls. In fact, I can't think of a drug which is more frequently misrepresented and substituted than the ecstasy MDMA compound.
McNally: In other words, the fact that we have closed our eyes and pushed all of these psychedelic substances aside as illegal creates many of the problems associated with them.
Here's a big two-part question. Do you suspect that the roots of any cultural or scientific trends grew out of the use of psychedelics in the '60s and '70s? For instance, the rise of Buddhism or other Eastern spiritual and health practices, or the internet or electronically networked organizations?
Grob: Yes, of the several million people who presumably took psychedelics back in the '60s in this country and in Europe, many were profoundly influenced. It influenced their attitude towards their own career choices, their relationships, their attitudes towards peace and conflict. During the '60s there was a tremendous sense that these compounds, if utilized optimally, could catalyze very salutary changes around the world.
Until his death in 1963, Huxley held the vision that if these compounds were introduced wisely, quietly and discreetly to the leaders of our culture, there would be a ripple-down effect with enormous positive changes. He believed it might be a mechanism through which the very likelihood of world survival would be enhanced.
The cultural turmoil, with youth culture radically split off from mainstream culture, led to a move not only to shut down research but also to distance mainstream culture, mainstream scholars and scientists from even exploring the potential benefits of the use to individuals, families and culture.
McNally: Final question. What do you know of the current cultural context? What's happening out there these days?
Grob: There's certainly a concern for widespread misuse and abuse of compounds like ecstasy. Serious use of these compounds has had to go deeply underground. There's increased interest in ayahuasca, particularly in the Amazon basin. A big article in a recent National Geographic Adventure magazine highlighted ayahuasca shamanism, and has had a very strong apparently positive response.
I think individuals are starting to wake up to the possibility that, when taken under optimal conditions, these plants might have profound potential to facilitate positive change. That being said, one also has to employ all the essential safeguards to minimize the likelihood of harm.