From Shaman To Divan — Shamanic To Therapeutic

PSYCHEDELIC ASSISTED PSYCHOTHERAPY

Felipe De Nadai
Nov 7 · 10 min read

This is the first part of this essay, originaly written in portuguese with some modifications and additions. Much of this material was written during an undergraduate degree in psychology at PUCPR university and organized by the advisor who signs the book. Available in full, with brilliant touches from the publisher in conjunction with other magnificent texts. It can be bought in portuguese only at Amazon.

Illness was the especial ground
Of my creative inclination;
I might recover by creation,
Creation made me once more sound.*

Psychedelics got their chance over sixty years ago and after being associated with numerous groups, their time on the science roller coaster faced bumps that left their research trails idle for nearly half a century.

It is well documented that in 1943 Albert Hoffman, at the Sandoz laboratory in Basel, Switzerland, first synthesized the LSD-25, opening the largest door of psychedelics to the western world, and fifteen years later the opportunity to deepen its scientifical knowledge was closed¹. Psychedelics during the sixties were linked to counterculture, marginalization, substance abuse, misconduct and especially subversion. However, recent years have been promising for these drugs classified as psychedelic as to what medical science finds to be effective and safe for administration in specific therapies.

This is where we are: drugs from the past emerging during this crisis in psychiatry², where more modern drugs are scarce and new forms of treatment are needed³. And what drugs are we talking about? The promising ones are: LSD (lysergic acid diethylamide, no. 25), DMT (dimethyltryptamine, found in ayahuasca compound), psilocybin (found in psilocybe cubensis, psicilocybe mexicana e psilocybe tempanenses among others in the category)and last but not least, MDMA (methylenedioxymethamphetamine), substance that has had the most promising results and will be the focus of this study.

A line must be drawn here: MDMA is not necessarily ecstasy and ecstasy is not necessarily MDMA. On the streets MDMA has been associated with the popular name ecstasy, the "love drug", but more than 50% of the tablets sold under the name ecstasy do not contain MDMA, featuring numerous analogs and similar substances that mimic the effect of MDMA⁴.

Many of these substances (psilocybin, mescaline - found in the Peyote or St. Peter cactus) have been known to our species for millennia and others have only been synthesized in the last century, but this classification of psychedelic substances allocates them into a unique category of side effects. Associated with no risk of atrial fiber-bound cardiac arrest⁶, low risk of addiction, their therapeutic and recreational uses being safe and the subjective reports are of an nonordinary state of consciousness with vivid and intense visions even with their eyes closed, with profound alterations in the dynamics of thought, emerging within the subject feelings of unity, integration and in many cases of cure⁷, ⁸.

Richard Nixon, then president of the United States, declared the War on Drugs in 1971. We do not have got the numbers, however, drugs has been winning every year so far.

Sociopolitical aspects are relevant and yet a crucial part of the story of how we treat these substances and intertwine in power games, economic interests, idealization and demonization, so they were not the focus of this essay. But we must not forget that it is precisely the prohibition and non-regulation of these substances that has placed us in a level of ignorance regarding the pharmacokinetics, dynamics and subjective effects presented by therapeutic use. The model adopted in Brazil of total abstinence is impractical in any society, generating only a favorable trade balance for the black market and all its ills that include adulteration and unpredictable risks.

Usage of substances classified as psychedelic is not unique to the twentieth century (psukhḗ + dêlos, dêlom; soul / mind + manifestation / creation / enlightenment), after all, shamanic communities and primitive societies already use plants, roots, fungi, tree barks , cacti, among a wide range of substances as ritualistic forms for at least a millennium¹⁰. The Amerindians of the La Plata Basin, which includes Brazil, for example, religiously use the organic compost called ayahuasca (spirit vine) fermented with a mixture of various plants such as jagube, chacrona, chagropanga and black jurema¹¹ meanwhile in the Andes, San Pedro cactus is used - an allusion to the Catholic saint who holds the keys of the heavens¹². American shamans used mushrooms (Psilocybe mexicana, Amanita muscaria) as entheogens - a neologism that characterizes a substance that induces to the shamanic state. All of these substances are used for various puroses: alteration of consciousness, change of thought patterns, inner connection, healing¹³, sense of collectivity¹⁴, among countless others.

The Cueva del Chileno ritual bundle consisting of: outer leather bag (A), expertly carved and decorated wooden snuffing tablets with anthropo-morphic figurines (B and C), intricate anthropomorphic snuffing tube with two human hair braids attached to it (D), animal-skin pouch constructed of three fox snouts (L. culpaeus) stitched together (E), two camelid (L. glama) bone spatulas (F), two small pieces of dried plant material attached to wool and fiber strings (G), and a polychrome woven textile headband (H). Artifacts (E and G). Specifically, the pouch chromatograms indicated the presence of at least five psychotropic compounds: cocaine, benzoylecgonine (BZE), harmine, bufotenine, dimethyltryptamine (DMT), and a peak possibly related to psilocin.

The desire to understand the interactions of psychedelic substances in organism and society enters concurrently with the state in which we have lived: even though such drugs have been banned in the past, recent studies have proven their efficacy and safety in treating specific disorders such as PTSD (Post Traumatic Stress Disorder) with MDMA assistance and assisted psychotherapy (PAP), depression with psilocybin; anxiety in terminal patients with LSD. The MDMA study as mentioned before was the focus of this survey.

And this is an unexplored field by psychology in Brazil. Upon entering this theme I found myself in an amorphous and controversial area, where there was enough literature for countless individual researches, but they were not effectively shown. Currently, at PUCPR, I know another student who studies psychedelic therapies - focusing on LSD - where there was resistance from the orientation. In fact, little is known at the academy about the use of psychedelics with psychotherapy. They are still classified as "illegal drugs" and in the minds of colleagues, teachers, doctors and psychologists, their therapeutic value would be null.

However, the 21st century, shamanic communities and their substances meets functional magnetic resonance technology¹⁵ explaining the pharmacokinetics and pharmacodynamics in the individual under the effect of the substance. LSD and psilocybin depend solely on binding to the 5-HT2A neurotransmitter. MDMA inhibits serotonin reuptake and reopens the reward center for a time, leading to "self-regulation of oxytocin dependence on major depression". ¹⁶

Although the title contains shaman in the name, we cannot make the mistake of relating to millennial practices. “Divan” is the classical psychoanalytical couch perpetuated in sosciety by Freud and many others. The wordplay came from a class in the course of Psychedelic Medicine, taught by neuroscientist Eduardo Schenberg, principal researcher of the MDMA study with assisted psychotherapy here in Brazil. If there is any approach required to practice psychedelic therapy, take the Psychedelic Therapy training course from MAPS (Multidisciplinary Assossiation for Psychedelic Studies).

IV — POST TRAUMATC STRESS DISORDER AND SUBSTANCE

PTSD is traditionally organized into three subgroups: a) related to traumatic reexperience, b) avoidance and emotional distancing, and c)psychic hyperexcitability¹⁷. Traumatic reexperience is characterized by a constant memory of trauma, a psychic rumination that leads to motor inactivity. This reexperience is lived from a fragmented recollection of the event whether it is an odor, an image or sound activated by an external trigger of the simplest or most sophisticated, such as thunder or perfume, even the direct quote of trauma leads the individual to relive all the physiological aspects that were experienced during the trauma¹⁸.

The avoidance and emotional distancing are symptoms related to this traumatic repetition caused by the smallest stimuli, leading the individual to avoid feelings, people, places, actions, movies, corners, perfumes in order not to encounter these stimuli in the real world. And all this brings a very violent psychic hyperexcitability where the level of CNS (CNS) and ANS (autonomic nervous system) tension that accompany a wide range of symptoms such as tachycardia, paresthesias, sweating, dizziness, cold extremities in constant hypervigilance.

Sharm Murugiah

Brazil, which, through collective funding through the NGO Plantando Consciência in partnership with MAPS, hosts the replication of a Phase 2 study already conducted in the United States, is in the focus of psychedelic medicine. The proposed treatment with psychedelics is for Post Traumatic Stress Disorder, where in the US there are only numerous patients from wars who relive their trauma from external triggers or just the memory of the event. PTSD involves a deficit in the extinction of fear conditioning, making it impossible for patients to elaborate new feelings about their memories¹⁹. The case of Brazil is peculiar: although we have no declared wars, the United Nations Office on Drugs and Crime (UNODC) analyzes that Brazil, in 2014 have had 53 thousand homicides. This shows a very sad and daenin icture around brazilian reality, that mantins daily traumas²⁰.

The first Phase 1 (first administration of the substance to a healthy human without diagnosis of the disease) researches were carried out in Spain in the 2000s, but with some inconsistencies in the method, with application of a wrong substance. Other Phase 2 trials (individuals who have the disease or condition to verify efficacy) were completed, one in 2004 with 19 participants and another in 2007 with follow-up 17–74 months after the last ingestion of the substance during therapy²¹.

This Phase 2 replicated study in Brazil maintains the MAPS procedures assigned to this type of therapy from preliminary research that predicts the amount of substance to a healthy adult already diagnosed with PTSD, which professionals will be present, how it is administered and the therapeutic procedures performed by psychologists.

All this theoretical and practical basis abroad supports the procedures adopted in research conducted in Brazil.




* Heine, in his "Songs of Creation" (1844), quoted by Freud in 1914 in the book Introduction to Narcissism. The voice that speaks is that of God.

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Felipe De Nadai

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