A New Psychiatry to Overcome the Pandemic – Basic Science

by Eduardo Schenberg

Why do we need “Thought Manifestators”

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São Paulo is the world capital of mental disorders. Although not officially recognized, the title weighs heavily. In 2012, Harvard University coordinated a study on planetary megalopolises with USP, and the city took the gold. Brazil is also on the podium in several other psychiatric polls. We’re not all crazy, but we have high prevalence of depression, anxiety disorders, and trauma from epidemic violence that affect more than 80% of the population in cities like São Paulo and Rio de Janeiro.

The challenge is enormous and requires public action for prevention and containment. But psychiatry seems ill-equipped for the size of the task. Large pharmaceutical companies withdrew from the sector in 2010, an “annus horribilis,” and that withdrawal was reflected in improvements in pharmaceuticals: Current drugs offer small profits compared to those of four decades ago. Even more: Across all of medicine, psychiatric treatments are the most likely to have adverse events, affecting 80% of drugs, twice as often as in neurology.

When the situation worsened during the pandemic, a previously small and marginal field moved into focus: research into the therapeutic use of psychedelic substances. In the past few years, private investment rose from one to three hundred million dollars after seven scientific journals dedicated their front pages to the subject. Just as science has brought us the much-needed vaccines against the coronavirus, it will be able to provide new psychiatric treatments that are faster, safer, and more effective.

The psychological nature of the effects of psychedelics (Greek, “manifestos of the spirit”) does not need to be introduced: kaleidoscopic visualizations and multicolored fractals, synaesthetic feeling (fusion of the senses such as sight and hearing), fragmentation or dissolution of the ego, and intense emotional peaks form the core a life-defining experience. About 70% of the study participants rated the effects of psilocybin as one of the five most important moments in life. A psychedelic experience can enable us to profoundly redefine ourselves and our human and non-human relationships. Why did it take nearly eighty years to take such a possibility seriously?

Had it not been for the stigmatization and semantic pitfalls of the drug war, history could have turned out differently. When I decided to study the subject fifteen years ago, I was told it was going to be a “professional suicide.” Fortunately, they were wrong. In São Paulo, I mapped the electrical brain waves of volunteers under the influence of ayahuasca. At Imperial College, London, I took part in the first neuroimaging study with LSD that revealed what happens in the human brain when millions of neurons are activated by the famous psychedelic. Back in Brazil, we conducted the first research on MDMA in the treatment of severe post-traumatic stress disorder, and its prescription use is expected to be approved in the US in 2023. The substance is administered in a model called psychedelic. Assisted psychotherapy (PAP), whose selective effect is comparable to a “psychiatric operation”, with an almost immediate and lasting effect.

And we’re ready for so much more. We found a significant lack of knowledge on the subject among Brazilian health professionals. In 2020 we started an online course on psychedelics and mental health from the Phaneros Institute and will initiate specialist training in PAP for doctors, psychologists and psychotherapists in 2021. To put this into practice legitimately and safely, we have received approval from the National Research Ethics Commission for a series of studies involving MDMA and psilocybin in nearly three hundred patients with mental disorders related to the Covid-19 pandemic who are sadly emerging and extend unnecessarily in Brazil.

The devastation of this pandemic will only be overcome if we also take care of mental health.

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Eduardo Schenberg holds a PhD in neuroscience from the USP and is director of the Phaneros Institute.

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