Psilocybin and spirituality: treatment for suicidal behavior, PTSD and moral injury

Dr. Marek Kopacz, M.D., Ph.D, is a truly innovative thinker within the Veterans Administration. The VA needs more of these heroic researchers/therapist to help the needs of the many Veterans who are not being adequately treated by current means.  Dr. Kopacz clearly sees the relationship between suicidality, moral injury, and spirituality. A federal researcher promoting research into spiritual issues is very rare and refreshing.  Spirituality does not threaten the separation of Church and State as spirituality is non-denominational, non-judgemental. In this new article (Complement Ther Med. 2016 Feb) Veterans Administration researchers Dr. Kopacz, Dr. Craig Bryan and others advocate for the use of mindfulness meditation to treat moral injury.

Over the past decade, the concept of 'moral injury', first introduced by Dr. Johnathan Shay,  has developed into a workable hypothesis that is showing good potential in facilitating treatment of PTSD and suicide. Dr. Shay, initially a neuroscience researcher, went to work at the Veterans Administration after suffering a stroke himself where he became very impassioned by Veterans issues especially PTSD.  He has since written 2 excellent books on the PTSD in Viet Nam Veterans which follow the theme of Homer's the Iliad and the Odyssey titled Achilles in Vietnam: Combat Trauma and the Undoing of Character and Odysseus in America: Combat Trauma and the Trials of Homecoming.  Dr. Kopacz discusses spirituality and moral injury in a recent podcast from Spirituality Mind Body Institute at Teachers College, Columbia University.

A moral injury 'refers to an injury to an individual's moral conscience resulting from an act of moral transgression which produces profound emotional shame. The concept of moral injury emphasizes the psychological, cultural, and spiritual aspects of trauma'. 'A cognitive dissonance occurs after a perceived moral transgression resulting in stable internal global attributions of blame, followed by the experience of shame, guilt, or anxiety, causing the individual to withdraw from others. The result is increased risk of suicide due to demoralization, self-harming, and self-handicapping behaviors' (Wikipedia). Pulitzer Prize winning journalist David Wood wrote a penetrating series on moral injury present in Iraq and Afghanistan veterans for the Huffington Post.

In the past, I've contributed a number of posts on the role of spirituality in mental health issues. Since I am not a mental health professional, creating this website has been a process of profound discovery for me that is gradually tying together many past experiences.  For instance, in regards to this current post, I first read Johnathan Shay's Odysseus in America in 2006 the same year that Griffith et al. at Johns Hopkins published their seminal study "Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance". From a previous post, the concept of Set and Setting, basic tenets for a therapeutic psychedelic session, was made clear to me by re-reading a book that I had read in the late 1980's, Power of Myth, by Joseph Campbell and Bill Moyers.  Now, after years of trying to encourage the VA and/or DoD to run a Clinical Trial for PTSD utilizing psilocybin (this website), it appears as though a VA researcher is heading in that direction.

Justification for the use of psilocybin to treat both PTSD and suicidal behavior is as follows. First, the link between suicide and PTSD has been clearly stated by the VA.  Next, the link between suicidal behavior and the use of psychedelic substances has produced many recent publications which decidedly point to a reduced risk, especially for psilocybin:

• Psychedelics not linked to mental health problems or suicidal behavior: a population study.
• Classic psychedelic use is associated with reduced psychological distress and suicidality in the United States adult population.
• Psychedelics and Mental Health: A Population Study.
• Psilocybin, psychological distress, and suicidality (PDF).

From the 2015 article Psilocybin, psychological distress, and suicidality (PDF) by researchers at Johns Hopkins and the University of Alabama at Birmingham, the following points are made:

• ... an analysis of the specific relationships of psilocybin use with psychological distress and suicidality may help inform decisions by the United States Food and Drug Administration and regulatory bodies of other nations (to remove it from Schedule 1 status). 
• In sum, the contrasts showing multiple significantly improved outcomes in the Psilocybin Only group and among those who have ever used psilocybin suggest that even among the broader class of classic psychedelics, psilocybin may be associated with the greatest therapeutic potential.
• ... these findings suggest that lifetime use of psilocybin but no other classic psychedelic may be especially protective with regard to psychological distress and suicidality. This finding is consistent with data indicating that psilocybin may have the most favorable safety profile of all classic psychedelic substances 
• Psilocybin in particular may thus hold promise as an innovative mental health intervention and suicide prophylaxis.
• ... based on the highly sensationalized cultural history of classic psychedelics, some in the public may be concerned that controlled clinical prescription application of psilocybin may increase the risk of suicide. The present data do not provide support for this concern and are consistent with recently renewed clinical research suggesting possible therapeutic applications of psilocybin.

Finally, the link between spirituality and psilocybin has been pointed out in the 2006 research by Griffiths et al. cited above and reinforced by additional research that has cited the 2006 Griffiths article. Psilocybin may enhance the spiritual experience by means of ego dissociation. As Griffiths et al. explained in the 14 month follow-up study of the original 2006 study cited above "several themes from these unstructured comments include a sense of the unity of all things, a separate “self” ceasing to exist, and merging and/or an encounter with ultimate reality (or God)". Experimental studies involving spirituality frequently utilize the Mystical Experience Questionnaire which has been validated by a number of followup studies:

• Validation of the revised Mystical Experience Questionnaire in experimental sessions with psilocybin
• Factor Analysis of the Mystical Experience Questionnaire: A Study of Experiences Occasioned by the Hallucinogen Psilocybin

We are in need of some 'heroic investigators' like Dr. Kopacz to take the next logical step - a Clinical Trial using psilocybin to treat Veterans and Warfighters with mental health issues related to their heroic service to our country.  What is needed are some investigators at the VA and/or DoD with that same kind of courage to overcome the bias currently stymying this research.  The science is there, it only needs to be followed.

Some final thoughts:

Something I've noticed in the research literature is that most articles on the therapeutic effects of psilocybin are free to the public (hint: check Google Scholar).  It appears as though the researchers have such a keen sense of the value of their research and its importance to humanity that they ensure it will be accessible to everyone.  Thank you!

The problem of dealing with issues involving the 'mind' is that trying to solve those problems using the 'mind' may not work.  You may need to get past what we refer to as 'mind' and deal with those issue on a different level.  Psilocybin facilitates getting past the 'mind' to work out those 'mind' issues.  Perhaps that process can be described medically as an inhibition of the top-down control and increasing bottom-up information transfer in the human brain. For more details on  decreasing top-down emotional control to lower defense as an adjunct to psychotherapy see 'Implications for psychedelic-assisted psychotherapy: functional magnetic resonance imaging study with psilocybin' from The British Journal of Psychiatry Mar 2012, 200 (3) 238-244.