Can psychedelics have a role in psychiatry once again?

Psychedelic or hallucinogenic compounds such as LSD, mescaline, psilocybin, MDMA and DMT occur widely in nature and have a long history of human use for spiritual and ritual purposes. Abramson frames these substances as having an under-appreciated chapter in psychiatric practice: between the 1940s and 1960s there was intense clinical and scientific interest in their potential therapeutic and investigative uses, but that work largely disappeared amid legal restrictions and social controversy. This paper offers a concise historical overview of that era and of more recent developments, and asks whether interest in psychedelic compounds is re-emerging for psychiatry. It aims to sketch what was known from earlier clinical work, to describe ongoing research lines, and to highlight barriers and opportunities for reconsidering these drugs in modern psychiatric practice and research.

Abramson summarises the historical trajectory of psychedelic research and the clinical reports arising from mid-20th-century work. The Swiss chemist Albert Hofmann's accidental discovery of LSD in the 1930s initiated experimental use of psychedelics in psychiatry by the late 1940s. Two broad psychotherapeutic approaches were described in that period: psycholytic therapy, involving repeated low doses of LSD within ongoing psychodynamic therapy to loosen defences and allow exploration of repressed material, and psychedelic (or 'mind-manifesting') therapy, consisting of preparatory sessions, a single high-dose experience and subsequent non-drug integration sessions. By 1965 over 2 000 papers had been published reporting positive results among more than 40 000 patients treated with psychedelic drugs, with reported few side-effects and a high level of safety according to the literature cited. Clinical applications reported in the historical literature included treatment trials for anxiety disorders, obsessive–compulsive disorder, depression, bereavement reactions, sexual dysfunction and addiction. In addiction treatment, Abramson reports that repeated controlled experiments from that era showed consistent recovery and 6-month abstinence rates of 50-90% after brief psychedelic therapy. Another reported area of benefit was relief of pain and anxiety in terminal cancer patients. The paper also documents methodological and contextual problems with that earlier body of work: much of the published material consisted of anecdotal case reports lacking adequate control groups and follow-up by contemporary standards, and by the 1970s research had largely ceased following legal prohibition and public concern about recreational misuse. Abramson notes that illicit use and the 1960s drug culture damaged the public and governmental perception of these substances, leading to restrictive research climates that persistently limited clinical investigation. More recent research activity is summarised next. MDMA has seen underground therapeutic use since the 1970s and is described as an 'empathogen' with potential to lower defences and aid psychotherapy. A temporary lifting of restrictions in Switzerland between 1988 and 1993 permitted a brief recommencement of psycholytic psychotherapy using LSD and MDMA for personality, affective and adjustment disorders. Ongoing projects in Spain, Israel and the USA are reported to be exploring MDMA-assisted psychotherapy for post-traumatic stress disorder and for anxiety and depression associated with cancer. Between 1990 and 1995, extensive human studies of DMT were conducted in the USA. A double-blind placebo-controlled ketamine trial in Russia for heroin addiction is cited as demonstrating improved abstinence rates maintained at 2-year follow-up (Krupitsky 2002). Abramson also notes emerging studies of psilocybin for obsessive–compulsive disorder and for reducing anxiety and pain in cancer patients. The Multidisciplinary Association for Psychedelic Studies (MAPS) and the Heffter Research Institute are identified as organisations summarising and promoting current research efforts.

Abramson interprets the historical and contemporary material as indicating both promise and substantial caveats. He emphasises that while early reports suggested broad therapeutic potential and relative safety in controlled settings, most of that literature would not meet modern methodological standards because of limited controls and follow-up. The legal prohibition and the drugs' association with recreational misuse and 1960s counterculture are presented as major non-scientific factors that halted systematic research and left contemporary psychiatrists with little training or knowledge about these compounds. In positioning current research, the paper suggests that psychedelics and related agents could be valuable tools for probing neurobiological links between mental and bodily states and that traditional psychedelic-assisted psychotherapy—used as a brief adjunct to psychological treatment—shares features with modern cognitive–behavioural approaches. Abramson acknowledges ongoing public and governmental scepticism, and he highlights the role of advocacy and research organisations in re-establishing clinical trials. Key limitations are reiterated: stigma, restrictive regulatory environments and the uneven quality of past studies. Finally, the author calls for renewed, dispassionate scientific enquiry. Rather than allowing social or political pressures to determine the research agenda, Abramson urges that psychedelic compounds be examined with rigorous scientific methods to establish whether they can have a useful and evidence-based role in contemporary psychiatry.

Abramson concludes by noting the surprising degree of ignorance about the therapeutic potential of psychedelic substances within psychiatry itself. He draws an analogy to past scientific revolutions that challenged prevailing worldviews, arguing that studies of alternative states of consciousness and their neurobiological substrates are likely to provoke resistance from clinicians who equate such work with 'mysticism'. The paper closes with an explicit appeal for criticism grounded in scientific reasoning, free from social or political bias, to properly investigate whether these substances can play a useful role in psychiatry today.