Benito Diaz
The use of alternative therapies to treat mental health issues is beginning to spread throughout the medical community. Ailments such as anxiety, addictions, post-traumatic stress, or depression are treated with psychedelics like LSD, psilocybin, ketamine, ayahuasca or MDMA with promising results. We talked about it with Josep Maria Fàbregas, psychiatrist and member of the Beckley Foundation.
Josep Maria “Mía” Fàbregas, born in 1952, got his degrees as a medical surgeon in 1978 and as a psychiatrist in 1980, both times from the University of Barcelona. He studied certain subjects at the Marmottan Hospital (Paris, France) where he worked with the prestigious doctor Claude Oliveinstein. In 1984, after working in various parts of the world, like Thailand, Mexico or Brazil, he founded the CITA Clinics. In addition, he is part of the Beckley Foundation, an organization specializing in psychedelic therapies.
“Psychedelics have the ability to enter more deeply into the mind, behind reality, behind the will, behind consciousness, given a series of conditions”, explains Fàbregas. “In mental health, this path opens up an extraordinary field for us, beyond perception and awareness, it is a treasure that today seems to be recognized as a therapeutic option. Twenty years ago, mentioning these therapies was outrageous, crazy. Nowadays, universities are opening the space for scientific evidence to expose material that will allow us, in the future, something more extensive”.
Alternative psychotherapies
Dr. Fàbregas’s explanation regarding the use of psychedelics in psychotherapy begins by exploring the problems it faces. “Psilocybin from magic mushrooms has been used to quit smoking; for example, ayahuasca is used in cases of complicated grief. In this case, we are conducting research with Dr. Débora González, and the results are very encouraging. When people have had a difficult experience coping with a loss, ayahuasca has shown it can help to deal with those emotions and allows patients to overcome this trauma in a positive way”, he comments. “We are talking about a complicated grief process at a time like this, in which many people have not been able to say goodbye to their loved ones due to the pandemic. We can also refer to post-traumatic stress, we have the opportunity to safely relive a dramatic, very intense situation and bring those emotions out again in a controlled way. Psychedelics offer possibilities that are not available to normal psychiatry”.
“There are problems the Western psychiatry cannot deal with, all it does is treat the symptoms. If you are depressed, an antidepressant; if you are distressed, an anxiolytic. With a psychedelic you can relive a situation, get to the core of the problem, treat it. Reality cannot be altered, what happened, happened. But the way in which you remember it and the way in which this affects your normal life, that can be changed, at least in the case of post-traumatic stress”, recalls Dr. Fàbregas, claiming that, from this point of view, this therapy has extraordinary potential.
The constitution and effectiveness of these treatments have been established using the previous experience of many people. Even so, the doctor warns that we are not facing a miracle cure or a panacea for mental illnesses. It will not be possible, obviously, to cure all the sick in the world. However, Fàbregas defends the effectiveness in many cases and calls for more scientific research on psychedelics.
Proven uses in psychiatry
“There seems to be hope in Psilocybin for depression and its causes. At John Hopkins University they have made an investment to research the relationship between quitting tobacco and this therapy. In the case of MDMA and post-traumatic stress, much progress is being made in research. It seems that, currently, mounting evidence and bibliography support its effectiveness. Ayahuasca and complicated grief, Ayahuasca and addictions, here’s another opportunity. LSD microdoses are also being applied to deal with certain problems. It is also worth mentioning Ketamine, a legal substance, which can be used to relieve depression. The spectrum is wide, experience and research will adjust the expectations”, adds Fàbregas, who insists on warning that we are not facing a magical solution. “These substances are powerful, they amplify the good and the bad. Like any medicine, it has applications and contraindications. Be careful with self-medication, it is not valid for everything”.
Treatment with psychedelics, as Fàbregas observes, can be dangerous in certain cases. “They are powerful tools that release material from the unconscious and cause emotions to emerge, sometimes in a disorderly way. It is not only about the pharmacological action of the substance, it is necessary that the substance is in good hands. You need a good guide, a therapist, an experienced professional who knows how to use this material and can order, channel or direct it”.
The doctor highlights the integrating action of psychedelics and the amount of information that is obtained, which needs to be used in some way. “The recommendation would be to always be accompanied by someone who knows what to do in each situation. When entheogens are used, there is always a person who carries out this task. I think it’s essential”. The doctor, however, does not refer to someone who is a qualified doctor, but to a person specifically instructed in this psychological framework.“It is one of the challenges. The instruction of people in these techniques that allows them to learn, investigate, experiment and take responsibility for the use of these substances”.
Substances under investigation
It is not legal nowadays to freely administer this type of substance to patients. It is necessary to go through an ethics committee, present a series of characteristics, tests, training, requirements that would allow researchers to be able to obtain the active ingredients or the precise plant materials, without committing an offence.
“Luckily, the use of some of these substances is an ancestral practice. For example, Ayahuasca has been used for thousands of years, Psilocybin, Ibogaine. There is previous experience that allows some abrupt changes in the toxicity of the substances to be overcome because it already is a common practice”, comments the doctor before describing the substances. Regarding Ayahuasca, its toxicity can be controlled and in fact that has been proven. The effects are short and manageable, there is no depersonalization. Psilocybin opens a whole scope regarding depression. Used together with therapy, its effects are very encouraging. Ibogaine can reset opiate receptors in addicts to this type of toxin. “We must once again point out the contraindications. For example, ibogaine is a cardiotoxic, it is not a game”, warns Fàbregas. It continues with MDMA, used by many professionals in couples therapy, post-traumatic stress situations. LSD has great potential, used for a long time in psychotherapy, until its trivialization by psychonauts like Timothy Leary produced a movement against it by Richard Nixon, causing any research initiative to be cut short.
Dr. Fàbregas had the opportunity to work with the permission of the Brazilian government on an investigation into the matter that took place in the heart of the Amazon jungle. There he carried out observational studies, publishing several articles in specialized journals. It was there that the IEAA center (Institute of Applied Amazonian Ethnopsychology) was inaugurated with legal coverage, since ayahuasca is traditionally used. Fábregas comments that now similar places are beginning to be opened with all kinds of health authorization for the use of these substances, with the permission of ethics committees, documentation, etc.
Treatments in Spain
Current legislation makes our country an attractive destination to perform this type of therapy, in the opinion of the specialist. “Unlike other countries, where pure substances to be used, vegetable bases can be used here. In the US, for example, if you want to experiment, you need a specific permit to access pure psilocybin. In Spain, one has the possibility to do research with fresh mushrooms. We have “flexible” legislation that allows us to approach these substances more directly. In addition, it seems that the authorities, ethics committees, are more open to these possibilities. There is a very interesting opportunity that we cannot miss or harm with trivializations”.
In the medical community, there are still prejudices, negative experiences that work against these practices, regulations designed only for the pharmaceutical industry, complicated to comply with for psychedelics. “Let’s reflect: these substances cannot be used as a common drug. There is no possibility of double-blind trials, in which the patient does not know what he is consuming and nor does the facilitator know what he is giving (clinical trial designed to establish reliability of results by using placebos). And it is not about just the pharmacological intervention, it is the substance combined with psychotherapy. Medicinal and recreational cannabis have opened a path that did not exist before”, he relates. “It’s time,” says Fàbregas. “Society is prepared, open. The scientific world is no longer so reticent and stalled, and there are private and institutional interests that will help carry this forward.”
The interest of pharmaceutical industry
For Dr. Fábregas, it is undeniable that there is a growing interest on pshychedelics from the drug-producing industry. “The fact that there are people willing to invest so that other people can research is something very positive. But there is a negative side, which is the commodification of ancestral knowledge. There are also pressure groups that can deflect attention from the true meaning of these developments. We are forced to live with a series of rules, one of them is the law of the market. That opens the door for these industries to behave generously or for someone to patent ayahuasca”, he sums up.
Dr. Fábregas continues to lead the CITA Clinics, he is also a member of the Beckley Foundation in the investigation of alternative psychotherapies.