When used carefully and responsibly, psychedelic substances can inspire a variety of positive health outcomes among both mental health patients and healthy individuals. This curious fact inspires a range of medical questions. In a recent scientific article published in Frontiers in Psychiatry, my colleagues and I explored whether psychedelics might target some common factor of health and be able to help prevent mental illness from occurring in the first place.
Research is increasingly suggesting psychedelic therapy is an effective treatment for different types of disorders. Why do people with very different mental health problems report healing or improvement after psychedelic-assisted therapy? Could symptoms of addiction, depression, and other mood disorders share a common foundation? And why do people without clinical problems report a wide variety of psychological benefits and personal transformations, again, with the same substance? Could it be that those substances affect some common factor that underlies the human psyche and mental health in general?
I have pondered these kinds of questions since the beginning of my academic journey. I have also asked the audience attending conferences—whether in Spain, the United States, the Czech Republic, or elsewhere—if they had used psychedelics before and if their experiences with psychedelics might have helped them stay healthy.Most of the attendees raised their hands.
I was not surprised. But what caught my attention is that this potential preventative aspect of psychedelic medicines was not reflected in the research. There are undoubtedly several reasons for this gap. It might not be simply that psychedelic research is focused on treating (rather than preventing) mental health issues. So much of mainstream mental healthcare is based upon a medical illness paradigm focused on fixing symptoms, rather than preventing them from occurring. Despite this focus on targeting symptoms, the World Health Organization released a publication more than 15 years ago recommending that prevention become a public health priority. And the current Covid pandemic which further affects our mental health significantly, emphasizes this point.
Psychedelics are interesting and unique substances. Beside their ability to help treat debilitating disorders, one of the additional fascinating aspects is surely the research and anecdotes that suggest psychedelics may enhance the quality of life, creativity, and mental states of so-called “healthy normal” people. This idea of exceeding ordinary health made us wonder: Can psychedelic therapy work not only to get rid of the problems, but can it also keep us healthy and prevent psychological problems and pathologies emerging in the first place?
I should say that I still do not feel we have enough resources to answer this question adequately. So, however attractive and sensible this idea seems to you, I suggest we consider it a hypothesis. Before discussing how psychedelics may help prevent mental health problems, first let’s take a look at the scale of the mental health problems facing humanity.
Why Prevention Is So Important
Mental health problems are one of the major challenges of humanity. Around 450 million people now live with some kind of mental or behavioral problem. And we may expect this number to be even higher due to the pandemic. Depression is the major contributor to suicides, which number close to 800 000 per year and is the 20th cause of death. In one prospective study, one in ten patients with depressive disorder attempted suicide in five years. From the economic point of view, the direct and indirect costs of mental health conditions on the global level were estimated in 2010 to be US$2.5 trillion and are expected to double by 2030, according to a study published by the World Economic Forum and the Harvard School of Public Health.
There are also high rates of comorbidity with physical health problems such as obesity, hypertension, cancer, and heart disease, among others. According to some studies, it is estimated that patients in a public mental health system live, on average, decades less compared to the rest of population. Available psychiatric treatment is not effective for everyone and often not sufficient to achieve the full recovery, e.g. it is reported that up to 50% of patients do not respond to their first treatment with antidepressant medications. It seems that purely reactive psychiatric treatments are unlikely to provide a satisfactory solution to this massive public health care problem.
Much research and practice has been focused on mental illnesses rather than well-being or optimal human functioning. I don´t think such a strict division between illnesses and health is accurate or helpful. I see it more as a scale with different levels of severity and consequence caused by our everyday life situations, choices, and mental life. This is in line with the definition of health by the WHO, which describes it as:
Desperate Times Call for Desperate Measures
To meet the global mental health challenge successfully, we must focus on finding more effective, novel treatments, and we are already doing to some extent. But I am thinking, wouldn’t it be better to give people a tool to prevent the desperation to begin with or to make us more prepared for when hard times arise? Shall we wait for the difficulties to arrive and go into damage control treatment or should we also take steps to avoid the potentially damaging situation?
Interestingly, mental health promotion and illness prevention have been underappreciated compared with those of physical health “Given the current limitations in effectiveness of treatment modalities for decreasing disability due to mental and behavioral disorders, the only sustainable method for reducing the burden caused by these disorders is prevention.”, explained the WHO.
Yoga for the Mind
Psychedelic therapy has shown promising therapeutic potential for a variety of mental health problems, including depression, anxiety, addiction, and PTSD. Although significant reductions of the symptoms have been reported, it seems like this kind of intervention doesn´t focus on the symptoms themselves. Psychedelics rather appear to target a common factor underlying mental health.
It has been suggested that a variety of psychological attributes, such as flexibility, resilience, and mindfulness are relevant to the health-promoting potential of psychedelic therapy and its ability to treat such a wide variety of disorders. For simplicity, we use the term “mind plasticity” which we define as an ability of the mind to change. It can be hypothesized that psychedelic therapy makes an individual more flexible, more open to change, more adaptive to various life situations, including stressful or traumatic events. It may provide a person with a wider range of possible reactions to those situations, allowing them to respond in a healthier way.
If I may use an analogy with the body, the idea that psychedelic therapy can prevent mental health problems, would make it something like doing “mental yoga” or going to a “mental gym”. Of course, a regular practice of exploring psychedelic consciousness may be too much for most people. But, there is a possibility that even one or few professional psychedelic sessions could strengthen the participant’s mind and make him or her more mentally robust and agile for when crises strike.
How Is It Linked To Other Phenomena We See in Psychedelic Research?
It is possible to have a spiritual or mystical experience after taking a high-enough dose of a psychedelic, and the research shows it is correlated with mental health improvements, suggesting it may be the effective factor of psychedelics. Might it be that spiritual experience is a special phenomenological experience that we are likely to have during extreme states of mental and neuronal plasticity? Psilocybin produced mystical experiences in 72 % of volunteers under supportive conditions in a clinical trial. The word “mystical” has deep cultural and religious resonance apparently capable of mirroring the experiences of unity, awe, ego-dissolution, and interconnectedness described by psychedelic users.
On a neurological level, “ego dissolution” was proposed to be associated with the more entropic brain, increased global interconnectivity and “relaxed” high-level networks (such as the default mode network which is supposed to underlie an “ego” function). The latter is described in recent “REBUS and the Anarchic Brain” model by Dr Robin Carhart-Harris and Prof Karl Friston. Those mechanisms are products of the psychedelic effect, which enhances neuroplasticity, which is presumed to be an important way psychedelic therapy works. According to a study by David Nichols et al., psychedelics can help to kind of “reset” the brain, thus allowing it to reconnect in new and healthier ways that are similar to a pre-disease state. And this experience is associated with improvements in well-being that persist after the experience. Importantly, the same mechanisms of ego dissolution and “relaxed” high level brain networks may also result in harming a person, rather than improving one´s health, which is why the context of the psychedelic experience is so important.
Can Psychedelic Therapy Make People Healthier?
There is already rich evidence supporting the claim that psychedelics do not worsen the mental health of responsible users, but can even help to promote it in a positive way or maintain it at the same level.
In a population study of more than 130 000 adults in US, psilocybin use was associated with a lower rates of serious psychological distress and psychiatric medication use. Similarly, recent review of 77 studies of clinical trials and epidemiological studies with 9876 clinical as well as healthy participants concluded that psychedelics used in clinical, recreational, and ceremonial setting is associated with long-term positive effects on mood, wellbeing, and other positive psychology factors.
Are Psychedelics Psychological Immunity Boosters?
Based on known mechanisms and studies of psychedelics carefully used in a controlled and safe context, we can hypothesize that psychedelic therapy can also be of great value to healthy people, boosting a kind of psychological immune system that helps prevent mental health issues from occurring. Stimulating mental plasticity in an appropriate context might be a special factor in maintaining mental health as well as improving the health of those suffering from various disorders as it may open a window for a healthy change.
According to a review by Kashad and Rottenburg “after all, a healthy person is someone who can manage themselves in the uncertain, unpredictable world around them, where novelty and change are the norm rather than the exception.” What if the current boom of psychedelic therapy is connected with the demands of the dynamic and fluid world we live in nowadays?
In my opinion, mental health care and research could significantly benefit from a paradigm shift away from predominantly symptom-specific and illness-treatment approach and towards a more universal strategy relevant to those considered “healthy” or otherwise.
Although we have many anecdotal reports of psychedelic therapy boosting “mental health immunity”, the available scientific evidence is not sufficient to support the hypothesis. It is my hope that bringing this idea forward might facilitate further research and possibly also change how we think about this novel kind of therapy.
In the future, research could help address how best to deliver psychedelic therapy to boost the mental immunity also of “healthy people”. We may expect the protocols will have to be different from the treatment models. Questions regarding adequate dose and context, frequency of sessions, possible indications and contraindications, which substances, as well as the age of the possible target group for this indication, have not been addressed yet.
Regardless of the promising results from current psychedelic research and practice, we should not forget that psychedelics – or maybe better to say inadequate ways of their use – come with risks, which I did not address fully here. As one of the pioneers and one of the most experienced experts on altered states of consciousness, professor Stanislav Grof, stated in his book LSD: The Doorway to the Numinous:
So, I am here proposing a radical change of perspective in how to look at psychedelic therapy as well as mental healthcare in general. Increasingly moving our focus from fixing the pathologies toward maintaining mental health and preventing pathologies appears crucial to me. This means not just using psychedelic therapy as a tool to become healthy again, but also simply to stay healthy so no or less treatment is needed.
Maybe the risks and costs will be too great and maybe this idea will not be supported by evidence. But who knows, maybe one day healthy people will consider going from time to time to a specialized clinic or retreat for a psychedelic session to boost their psychological immunity. In a similar way we now go to get vaccinations against physical diseases, we will strengthen our capacity to face stress and trauma. Although I am aware of the weaknesses of this analogy, I trust you get the point. Maybe a whole psychedelic healthcare system will be established where healthy people as well as patients can find help.
It is still more of an idea, a hope, than an actual practice. But I believe that despite the huge amount of work which would need to be done to explore it further, it is worth it. Given the known costs associated with mental suffering, it could have a broad positive impact on public health and mental health care in general. Even more, I personally consider it to be our human responsibility to explore real potentials of novel ways of safeguarding the quality of life of people who may be in danger of suffering from some mental health problems. And who can today say with any certainty, that they are safe in this regard?
This article is based on the manuscript: Kočárová, R, Carhart-Harris, RL, Horáček, J. “Does Psychedelic Therapy Have a Transdiagnostic Action and Prophylactic Potential?” Frontiers in Psychiatry, 2021.
- Could Psychedelics Help Prevent Mental Health Problems? - July 20, 2021