"Qualitative research has a rich tradition in the study of human social behaviour and cultures. Its general aim is to develop concepts which help us to understand social phenomena ... Qualitative approaches have particular potential in psychiatry research, singularly and in combination with quantitative methods."  Stephen Agius

"The brains of human beings seem built to process stories better than other forms of input"   Thomas Newman, Professor of Epidemiology & Biostatistics

Between 1969 and about 1973, I took a dozen or so psychedelic 'trips'.  Mostly these involved LSD, although one was claimed to be mescaline by the drug's provider.  These experiences were very powerful for me and have affected my life.  But like an old heap of discarded rocks at the edge of a mining town, I know there are still lessons in those explorations that I didn't extract at the time.  Now with more 'modern technology' - a greater understanding of both human psychology & the effects of psychedelics - I think I can 're-mine' those experiences and find rich new learning.

I have written about these experiences before on this blog - see the post from 6 years ago "Going back for a university reunion: self-esteem, hallucinogens, wonder & the transpersonal", where I said: "Not that I used LSD at university as a clinical intervention, but as the 2011 paper "Voice of the psychonauts: coping, life purpose, and spirituality in psychedelic drug users"  highlights "Psychoactive drug use shows great diversity, but due to a disproportionate focus on problematic drug use, predominant nonproblematic drug use remains an understudied phenomenon.  Historic and anecdotal evidence shows that natural sources of "psychedelic" drugs (e.g., mescaline and psilocybin) have been used in religious and spiritual settings for centuries, as well as for psychological self-enhancement purposes.  Our study assessed a total of 667 psychedelic drug users, other drug users, and drug nonusers ... Results indicate that the use of psychedelic drugs with a purpose to enhance self-knowledge is less associated with problems, and correlates positively with coping and spirituality.  Albeit the meaning of "spirituality" may be ambiguous, it seems that a spiritually-inclined attitude in drug use may act as a protective factor against drug-related problems."  And another study from last year - "Psilocybin occasioned mystical-type experiences: immediate and persisting dose-related effects" - reported "This dose-effect study extends previous observations showing that psilocybin can occasion mystical-type experiences having persisting positive effects on attitudes, mood, and behaviour ... Psilocybin produced acute perceptual and subjective effects including, at 20 and/or 30 mg/70 kg, extreme anxiety/fear (39% of volunteers) and/or mystical-type experience (72% of volunteers).  One month after sessions at the two highest doses, volunteers rated the psilocybin experience as having substantial personal and spiritual significance, and attributed to the experience sustained positive changes in attitudes, mood, and behaviour ... At 14 months, ratings were undiminished and were consistent with changes rated by community observers.  Both the acute and persisting effects of psilocybin were generally a monotonicall increasing function of dose, with the lowest dose showing significant effects. Conclusions: Under supportive conditions, 20 and 30 mg/70 k psilocybin occasioned mystical-type experiences having persisting positive effects on attitudes, mood, and behavior.  Implications for therapeutic trials are discussed."  Other research teams have reported similar findings.  There is risk here - although at orders of magnitude less than in the ubiquitous use of alcohol & tobacco.  The 2007 Lancet paper "Development of a rational scale to assess the harm of drugs of potential misuse" makes no bones about classifying both alcohol & tobacco as significantly more damaging than LSD for physical harm, addictive potential and societal cost.

Not that all this was going through my mind back in the late sixties & early seventies when I took a series of a dozen or so acid trips.  Most of the trips were gone into carefully, almost religiously.   I remember thinking at the time that it felt a bit sacrilegious that people were selling LSD as a drug for profit.  Mostly I would just spend the time in one of the beautiful college gardens, quietly in ecstasy for hours on end watching the dance of sunlight on a tree trunk, the movement of a stream, the flight of birds.  Dissolving.  Yes drug-induced but, for me, certainly some of the deepest spiritual, self-transcendent experiences of my life.  I might well not be a doctor now if I hadn't gone through those experiences.  I think I would be a different person without them.  I don't want to overplay it, but I don't want to underplay it either.  And as for self-esteem, I still remember walking high on acid into one of the college communal shower areas.  I was in a place of deep wonder, of awe at the extraordinariness of our amazing world.  In William Blake's words "If the doors of perception were cleansed everything would appear to man as it is, infinite."  And I saw myself in the mirror.  Another fragment of this stunning, immense, beyond-all-description universe.  No better than anybody else, no worse than anybody else ... actually these terms, this way of looking at personal value seemed ridiculous, profoundly stupid. As I wrote during one of these experiences "Everything is and almost bursts with being so".  And it tied in with a dream I had at this time (I already described another dream in the post "Going back for a university reunion: emotional intelligence, group work & learning to relate more deeply") - I dreamt that I could see God.  "He" was a presence way up above the earth, looking down, poised to "bless" any human being he became aware of.  Unfortunately he couldn't distinguish one human from another when they were marching around in their lives psychologically & spiritually asleep.  The individuals operating on automatic pilot like this weren't visible to him.  They just merged into each other like cogs in a big machine.  However if anyone "woke up", became aware/mindful, then for those moments they became visible to him and - like a lightening strike - he sent down his love, energy & blessings.  After a while the acid trips began to feel to me like being given a temporary leg up so for a few hours I could see over a wall into some kind of magic garden.  I felt it was time to go look for a ladder and so I took up the practice of yoga & meditation.  I changed subject too from philosophy to medicine.  Life speeded up and gradually I see now that so much of that wonder, that waking to be "blessed", so much of that has ebbed away in the course of what has in many other ways been a life that I have felt immensely grateful for."

Possible areas include (to be expanded):

Contrast between the current 'non-evidence based' focus on providing research subjects with psychedelic trips while they are wearing 'visors' and listening to experimenter-selected music ... while the majority of my 'trips' were outside in nature, surrounded by trees, birds & sunlight.  As I wrote at the time "Everything is and almost bursts with being so".  Remember William Blake's statement "If the doors of perception were cleansed everything would appear to man as it is, infinite.  For man has closed himself up, till he sees all things thro' narrow chinks of his cavern."  I am deeply glad that, on my LSD trips, I was not cooped up inside a building, eyes closed, listening to someone else's selection of man-made music.  I'm shocked & a bit horrified that this is where the research focus has got to.

And note, the music is not neutral - see Kaelen et al's 2018 paper "The hidden therapist: evidence for a central role of music in psychedelic therapy" with it's abstract reading "RATIONALE: Recent studies have supported the safety and efficacy of psychedelic therapy for mood disorders and addiction. Music is considered an important component in the treatment model, but little empirical research has been done to examine the magnitude and nature of its therapeutic role. OBJECTIVES: The present study assessed the influence of music on the acute experience and clinical outcomes of psychedelic therapy. METHODS: Semi-structured interviews inquired about the different ways in which music influenced the experience of 19 patients undergoing psychedelic therapy with psilocybin for treatment-resistant depression. Interpretative phenomenological analysis was applied to the interview data to identify salient themes. In addition, ratings were given for each patient for the extent to which they expressed "liking," "resonance" (the music being experienced as "harmonious" with the emotional state of the listener), and "openness" (acceptance of the music-evoked experience). RESULTS: Analyses of the interviews revealed that the music had both "welcome" and "unwelcome" influences on patients' subjective experiences. Welcome influences included the evocation of personally meaningful and therapeutically useful emotion and mental imagery, a sense of guidance, openness, and the promotion of calm and a sense of safety. Conversely, unwelcome influences included the evocation of unpleasant emotion and imagery, a sense of being misguided and resistance. Correlation analyses showed that patients' experience of the music was associated with the occurrence of "mystical experiences" and "insightfulness." Crucially, the nature of the music experience was significantly predictive of reductions in depression 1 week after psilocybin, whereas general drug intensity was not. CONCLUSIONS: This study indicates that music plays a central therapeutic function in psychedelic therapy." 

Ouch ... a psychedelic trip is very personal.  But "set and setting" seem to make a huge difference.  Experimenters ideally should explore the effects of varying set & setting.  Would my experience of taking trips in nature be more or less helpful than taking trips indoors, attention turned inwards, in some ways "safely packaged" to suit the experimenters nicely-contained-in-a-laboratory typical work conditions?  At least researchers are looking at what kinds of music might be particularly helpful - see Barrett et al's "Qualitative and quantitative features of music reported to support peak mystical experiences during psychedelic therapy sessions".  But to limit optimisation of setting to just "What kind of music?" seems like a chef only asking diners "How do you like your steak done?" without actually checking to see whether they might do better with fish or a salad! 

More to follow ...