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June 16, 2021

Psychedelic-Assisted Psychotherapy and Carl Jung’s Red Book

Author Affiliations
  • 1Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, Bloomberg Children’s Center, Baltimore, Maryland
JAMA Psychiatry. 2021;78(8):815-816. doi:10.1001/jamapsychiatry.2021.1207

Psychedelic research in the treatment of psychiatric disorders was shut down by the US Food and Drug Administration (FDA) in 1966, and Sandoz ended its distribution of lysergic acid diethylamide (LSD) and psilocybin to psychiatric investigators that same year. Congressional hearings addressing indiscriminate recreational use of psychedelics emphasized use that led to increased psychiatric hospital admissions for psychosis and reported suicides. The FDA commissioner, James L. Goddard, MD, concluded that even though “there have been more than 2,000 papers in the scientific literature, there is as yet no substantial evidence based on adequate and well controlled investigations to support these drugs for medical purposes.”1(p78) Earlier, he had reported to a Congressional committee that, despite 10 years of research on their use in treating alcoholism, the results remained preliminary because of difficulty finding a drug placebo usable for a control arm that would allow double-blind testing, and that this had confounded much of the research up to that point. The early research was conducted with psychedelic drugs provided by Sandoz under an investigational new drug classification. Sandoz did not apply for a new drug approval before its patent expired in 1963.

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    1 Comment for this article
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    Jung and Harris: Two great losses when we need them most
    Thomas Kosten, MD | Baylor College of Medicine
    The final question of Dr. Harris, "What criteria will the FDA use to approve psychedelic-assisted psychotherapy?" needs very careful and intelligent consideration by experts like Drs. Harris and CG Jung. The loss of Drs. Harris very recently in 2021 and of CG Jung in 1961 are separated by more than half a century, but their insights are remarkably alike and could contribute much to an FDA advisory panel about how to safely resurrect psychedelic assisted psychotherapy. Commercialization of psilocybin has become a boom industry for investment, but it comes with little discussion of the psychological material that such drug-induced sessions will elicit from participants in such drug administration sessions. Making a profit from this newly reborn intervention will be and is already being hotly pursued in the stock market. Will it be as easy as the profits from the proliferation of commercial ketamine clinics (now about 300 nationally) for every kind of depression or trauma imaginable. Six hourly sessions of ketamine infusions over a few weeks occurs at a cost of about $3000, and no psychotherapy is considered important by the anesthesiologists or nurses who administer the infusion. Such treatments with a drug like psilocybin that lasts 6 to 8 hours may produce some very disruptive outcomes in patients given repeated oral administrations over several days or weeks and potentially leaving the administration site within an hour or so. We will have an natural community experiment of this type of intervention using MDMA after FDA approval, because the Veterans Administration has already stated that it will cover this therapy as a benefit for outpatient veteran care. Can it be far away after that, when other government and commercial carriers feel pressured to cover these same types "medication assisted therapies" for PTSD, depression, substance abuse, anxiety disorders, dementias, and even psychoses? We can all hope that thoughtful and careful minds like those of Drs. Harris and Jung are vocal and impress the realm of regulators and enforcers.
    CONFLICT OF INTEREST: None Reported
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