March 7, 2022
March 5, 2022
Is the Trip Necessary in Psychedelic Healing?
Explore the significance of mystical experiences in psychedelic-assisted psychotherapy and the potential utility of non-hallucinogenic alternatives.
Mounting evidence is proving that psychedelic compounds can be effective treatments for a wide range of mental health conditions. Ongoing clinical trials are investigating the potential of drugs like psilocybin, the psychoactive component of magic mushrooms, MDMA (also known as ecstasy), and LSD to treat a variety of psychiatric disorders, from anxiety and treatment-resistant depression to post-traumatic stress disorder (PTSD).
What’s more, ibogaine, an atypical psychedelic derived from the Central West African iboga shrub, induces “oneirophrenic” experiences akin to a dreaming state. It’s widely purported to be the single most efficacious intervention for various substance dependencies.
While some researchers believe that the healing effects of psychedelic drugs lie, at least in part, in the mystical experiences they induce, others question whether the hallucinogenic effects are indeed necessary for healing to occur.
So, what exactly makes these enchanting compounds so therapeutic? Is psychedelic-assisted psychotherapy a neurological or phenomenological intervention? Can it be both? And can researchers mitigate safety concerns in drugs like ibogaine without sacrificing its healing power?
The Spiritual Aspect of Psychedelic Healing
Not so long ago, it was thought that the only way to achieve mystical states was through a life-long practice of spiritual devotion, such as meditation, fasts, sleep deprivation, or retreats. Referred to as “numinous” states by Swiss psychiatrist Carl Jung, and “peak experiences” by leading architect of humanistic psychology Abraham Maslow, mystical experiences that incorporate a sense of inexplicable unity and sacredness can have a truly transformative impact.
Humanity eventually stumbled upon certain psychedelic drugs that also powerfully provoke these spiritual realizations.
The extent of the role played by the mystical experience in psychedelic-assisted psychotherapy is yet to be fully understood. One explanation of its association with positive outcomes could be the fact that psychedelics cause the dissolution of a person’s ego, in which their felt sense of self is compromised, or in some cases completely dissolved. Ego dissolution, or ego death, is often accompanied by a transcendental sense of the interconnectedness of all living beings and a profound feeling of “at-onement” with the universe.
An experience with something that is greater than oneself and the apparent re-conceptualization of one’s place in the universe that goes along with that can be the spark needed for personal change. For many, it has been the golden snitch for improving the mundane, status quo, limiting, or problematic aspects of life, inciting fresh perspectives on self-worth and interpersonal relationships.
You can imagine a psychedelic-induced mystical experience as the first step on Joseph Campbell’s hero's journey, where one is confronted in the dark night of the soul to imbue a change. Many people claim that the unique “noetic quality” of such confrontational experiences has provided revelatory psychological insights.
In traditional ceremonial use of ibogaine in Gabon and Cameroon, initiates of the Bwiti spiritual discipline apply the trope of the path of life and death as a guide for those experiencing confusion, disorientation, or alienation to rediscover the communal path. Ritualistic use of ibogaine in Bwiti is said to restore direction in meaningful work for people who feel lost and improve relations with family members both living and dead.
Supported by fantastical visions, the path of life and death seems a particularly suitable spiritual trope. This mystical experience is not only expected by Bwiti members but relied on by individuals needing enduring positive changes.
Qualitative studies exploring ibogaine-induced visions have shown that they are often characterized by vivid insights into the impacts of the following:
- Past issues
- Human evolution
- Life reviews
- Cosmic imagery
- Empathy for oneself and others
- A sense of oneness with everything
Results indicate that these experiences have a central role in ibogaine’s use in healing substance use disorders, inducing positive behavioral changes, and influencing improvements in psychological state.
The fundamental shift in how we experience life and the re-connection to meaning that follows could have important implications for our mental health crisis.
Are Bad Trips Really All That Bad?
Psychedelic experiences aren’t all like putting on a pair of rose-colored glasses and going about one’s day. Part of the power such substances hold is in the confrontation with challenging ideas, whether a past trauma that’s still lingering or anxiety surrounding death. “Bad trips” may often come about due to an individual’s resistance to ego dissolution. However, each experience can be radically different in terms of both their causes and phenomenology.
In some cases, albeit very few, ontological shock (i.e., the bringing into question of one’s most fundamental assumptions) can incite blinding confusion. In other cases, people are spiraled into the depths of an unpleasant psychedelic state by the unique ability of these drugs to accentuate past traumatic events.
Are challenging experiences required for long-term healing? Furthermore, could they be avoided or controlled with the right supports, guidance, and resources?
Forced Confrontation With Unconscious Mental Material
Researchers and experienced members of the psychedelic community believe that the challenging confrontations that sometimes describe bad trips may be required to help people break free from the restrictive confines of an all too familiar and conditioned mental prison, returning them to a more mindful, childlike consciousness.
In a recent study exploring the nature and consequences of challenging psychedelic trips, experiences that involved uncomfortable insights into the person’s life were the most common. Participants reported being unpleasantly confronted with an element of their personal life that they perceived to be maladjusted or broken in some way.
In that same study, almost 70% of participants regarded the long-term effects of their “bad trip” to be positive. These results complement other findings in which 84% of survey respondents reported benefitting from existential and life-changing insights delivered during challenging psychedelic visions.
Stanislav Grof, expert in non-ordinary states of consciousness, insists that the best way to understand psychedelics is to view them as unspecific amplifiers of mental processes, summoning for confrontation that which lies beneath the surface of normal waking consciousness.
Understandably, confrontation with distressing material can be difficult to navigate in the moment, but it often leads way for the implementation of necessary behavioral and cognitive changes. Confrontational experiences could be responsible for the positive therapeutic use of psychedelics in the treatment of substance addictions.
Under ibogaine’s influence to treat opioid-use disorder, a participant claims, “I was overwhelmed with the remorse and the waste and loss, feeling empathy with my family over all their hopes for me dashed by my relentless pursuit of drugs.”
Psychedelic compounds like MDMA and ibogaine may help people to open the cellar door, shine a light on the dark corners of their mental space, and uncover unconscious material responsible for mental health issues. It may be that confrontational experiences are often beneficial because they force people to find closure with unpleasant phenomena that have been relegated to their unconscious minds.
Rediscovering Oneself Through Psychedelic Healing
Studies investigating psilocybin’s effect on end-of-life anxiety have yielded remarkably positive results, largely due to ego dissolution. Here, an encounter with death becomes the person’s most intimate reality — an otherwise inaccessible experience.
Researchers recently found ego dissolution to be strongly associated with mystical experiences characterized by a sense of connectedness, unity, and oneness with the world. On ego-dissolution questionnaires, patients report feeling significantly less absorbed by personal issues, experiencing enhanced freedom from the limitations of the self, and feeling united with something greater than themselves.
Evidently, confrontation with and triumph over death can be extraordinarily liberating.
That said, people sometimes hang on to their sense of self for dear life, and as a consequence, experience intensely challenging trips that can be psychologically destabilizing, especially if they are not properly integrated.
In fact, some research suggests that bad psychedelic trips only have valuable therapeutic effects when patients are capable of successful integration.
In Bwiti use of ibogaine, challenging experiences are expected as part of the trade-off for acquiring new insights. To consolidate these insights, the Bwiti community ensures an enduring support network that incorporates long-term aftercare. For example, regular opportunities to ingest small doses of iboga are offered in ritualistic ceremonies for continued ancestral contact. In addition, all-night ritual practices are held every week that are followed up the next morning by a meal of communion akin to a focus group.
Stripping the Tripping in Psychedelic Medicine
But could the mystical experience be a mere front on neurobiological activity that’s responsible for improved mental health outcomes?
We know psychedelic drugs bind to the 5HT2A serotonin receptor that is responsible for inducing the mystical experience, but while this is happening, global functional connectivity in the psychedelic brain dramatically increases. It could be that enhanced communication between previously estranged brain areas, in conjunction with the production of powerful neurotrophic factors that give rise to neuroplasticity, could be responsible for the lasting psychological improvements observed in clinical trials. It’s no question that both the physical reaction and spiritual confrontation influenced by psychedelics have profound effects; however, the challenge for researchers lies in developing protocols that optimize one or the other, or both.
Interest in Non-Hallucinogenic Psychedelics
While the trip itself can put some individuals off, various organizations are creating non-psychedelic versions of drugs like ibogaine in an attempt to reduce safety concerns, namely, ibogaine’s cardiac arrhythmia, which limits the drug’s usability. Ibogaine has been tied to several deaths and injuries by cardiac arrest, albeit in uncontrolled and poorly screened instances.
Non-hallucinogenic, semi-synthetic derivatives of ibogaine have been found to decrease the intravenous self-administration of various substances and show potential in treating depression, as well as multiple substance dependencies including heroin, cocaine, methamphetamine, and alcohol.
Interestingly, in a survey study involving 20 current or previously substance-dependent individuals, 65% reported that they would not be interested in a synthetic, non-hallucinogenic alternative, even if it was safer.
Such ibogaine alternatives lack a strong affinity for NMDA and sigma-2 receptors, sodium channels, or the serotonin transporter in the way that ibogaine does. This, in addition to the absence of an experiential component, suggests a narrower therapeutic index than ibogaine.
Along with attempting to narrow the safety concerns of ibogaine, researchers of non-hallucinogenic psychedelics may eventually expand access to the benefits of such substances to people resistant to hallucinogenic experiences, including the possible reaction of having one’s sense of self temporarily dissolved. By eliminating the risk of cardiac arrest, the labor and time involved in screening and preparing for sessions may be minimized.
These factors position psychedelic-assisted psychotherapy as an expensive endeavor, difficult for both clinicians to scale and for patients (while such treatment remains uninsurable).
Yes, these concerns are foundational to the success of prescriptable ibogaine, but they’re not unique to companies researching non-hallucinogenic ibogaine.
MINDCURE’s Ibogaine Project involves manufacturing fully synthetic, pharmaceutical-grade ibogaine. In addition, we’re conducting pre-clinical explorations to identify mechanisms of action and expectations, understand cognitive benefits, measure cardiotoxicity and adverse effects, and establish safety measures, dosing, and methods of administration.
Is the Future of Psychedelic Medicine Non-Psychedelic?
The true healing value of psychedelic trips beyond one’s score on a mystical experience scale is yet to be scientifically established. It seems likely that this won’t have to be an “either-or” story. Hallucinogenic and non-hallucinogenic compounds need not be mutually exclusive, and only rigorous empirical research can clarify these matters.
The sizable interaction between contextual factors and the phenomenology of the psychedelic experience makes it difficult to distinguish between neurology and experience.
There appears to be quite a strong association between the quality of people’s experiences and clinical outcomes, with evidence indicating that the experience is a pivotal piece of the puzzle. But correlation does not imply causation, and counter-scientific evidence must be respected.
For now, however, it seems reasonable to focus attention on psychedelic drugs with proven efficacy to remedy the pressing issue of a growing number of patients requiring more effective treatment options.