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Psychedelics as Catalysts of Insight-Oriented Psychotherapy*
THERE is some evidence that the psychotherapeutic process can be enhanced by the use of drugs that invite self-disclosure and self-exploration. Such drugs, called psychedelic (meaning "mindmanifesting") might help to fortify the therapeutic alliance and facilitate abreaction, catharsis, understanding, acceptance, and forgiveness. One drug that may prove uniquely valuable for these purposes is the psychedelic amphetamine MDMA.
The drug revolution that began 30 years ago has transformed psychiatry, but it has left little imprint on psychotherapeutic procedures themselves. We have used psychiatric drugs as an adjunct to psychotherapy, and psychotherapy as an adjunct to psychiatric drugs. But efforts to make use of drugs directly to enhance the process of psychotherapy-diagnosing the problem, enhancing the therapeutic alliance, facilitating the production of memories, fantasies, and insights-have been very limited. In preindustrial cultures, however, drugs were used to enhance a process of psy chotherapeutic healing; and from 1950 to the mid-1960s, 15 years of experimentation took place in Europe and the United Statesan episode in the history of psychiatry that is now almost forgotten. The drugs used in these therapeutic efforts were psychedelic or hallucinogenic substances, both natural and synthetic. It is now possible that this tradition might be revived by the use of new synthetic drugs that may have many of the virtues of the older psychedelics as enhancers of the psychotherapeutic process without most of their disadvantages.
Psychedelics or hallucinogens are a large group of synthetic and natural drugs with a variety of chemical structures. The best known are mescaline, derived from the peyote cactus; psilocybin, found in over 100 species of mushrooms; and the synthetic drug lysergic acid diethylamide (LSD), which is chemically related to the lysergic acid amides, alkaloids that are found in morning glory seeds. This class of drugs also includes the natural substances harmine, harmaline, ibogaine, and dimethyltryptamine (DMT). Also widely used is ketamine, a synthetic drug that at high doses has been approved by the Federal Drug Administration (FDA) for use as a dissociative anesthetic but at lower doses can facilitate profound psychedelic experiences. There are also many synthetic drugs chemically described as tryptamines or methoxyfated amphetamines. A few of these are diethyltryptamine (DET), 3,4,-methylenedioxyamphetamine (MDA), and 2,5-dimethoxy-4methylamphetamine (DOM). The most recent addition of...