TIFT #134: Psychedelics and Shame?

Happy Thanksgiving to all those in the US!   

Oh, my! I missed my usual Tuesday publication date. I have been focused on creating a the new Substack (for which I’m soliciting stories from readers). It’s called Therapy Lab: Solving the tough cases with Dr. Smith. Passing by the usual deadline gave me a bit of space to realize that there is more to say about shame, the subject of my last post and also the latest Substack. In those posts, I talked about how values or standards are the key to understanding and treating inappropriate shame.

What I didn’t write about in TIFT #133, was how values are internalized and that’s where psychedelics come in. Spoiler alert: I won’t have a definitive answer to this, but I’ll share observations and examples. Some years ago, I took a deep dive into this question and found the following distinctions and factors relating to both internalization of new values and bringing change to existing ones.

Slow adoption of values: According to Alan Schore, myelination of the prefrontal cortex at about 18 months allows the conscience to start functioning. By my observations, it’s around age three that children begin to want to be “good.” That means the conscience has come on line and is ready to reward behavior that complies with internalized values and to discourage out-of-bounds behavior with shame. An example of slow acquisition of values is toilet training, where most of us gradually acquire a value of cleanliness and feel shame if we soil ourselves. That value lasts a lifetime to the extent that the entirely involuntary incontinence of old age or illness is still a source of shame.

Rapid internalization: Trauma is often a source of nearly instantaneous internalization of negative attitudes towards the self. Ideas of low self worth reflect the attitudes of perpetrators, often in what are very close to their own words. What it is that triggers this sudden learning and why is it so hard to change? My research led me to Conway and Siegelman’s book, Snapping (1995), where they write about brainwashing and cult indoctrination. Freud’s account of identification with the lost object is also relevant. These instances represent massive internalization of values, some forced and others voluntary. I came to believe that the common denominator is “connection anxiety.” That is, the very powerful need to feel connected, especially when one’s own existence is under threat. Those who seek to belong to a cult are generally individuals with a fragile sense of identity. They may feel alienated and alone. Victims of brainwashing are experiencing an extreme sense of threat to their identity, being forced to choose between loyalty to the self and death or its equivalent. And, returning to slow internalization, the driver of healthy acquisition of values is the desire to be welcome in the family or community.

Physiological drivers of internalization: In addition to connection anxiety, the authors of Snapping show how bodily stress is a powerful facilitator of rapid internalization. As echoed by Shakespeare in the last scene of The Taming of the Shrew, deprivation of food and sleep, along with powerful sensory experiences like smells, music, and confusing, intense talk, are often part of the experience. This is where voluntary cult induction and forced brainwashing make use of similar methods.

Psychedelics: Over the years, I have been reluctant to talk about psychedelics because, as a teen, I lived through a period of enthusiasm about psychedelics very similar to the one we are experiencing today. In the late 50s and early 60s these drugs were going to cure alcoholism and other mental problems. I witnessed how, in the end, they didn’t live up to the hype, and, as bad experiences and treatment failures mounted up, they led to disillusionment. On the other hand, more recently I have heard of remarkable results and have experienced the possibility through my own practice. Next I’ll share what may make the difference.

Readiness for change: In one instance from my own practice, a client was working hard in psychotherapy on overcoming a strong inhibition to finishing a work of art. He had struggled for more than a year without success. Entering therapy, we were focused on his inhibition, and he had progressed to the point of readiness to overcome what held him back. One day, he came to session with a smile, announcing that he had been to an Ayahuasca weekend and had overcome his inhibition. He stopped therapy, feeling cured, and on a follow-up call several months later, he said that he remained inhibition-free and had brought his artwork to completion. While the evidence is too limited for full confidence, the story is similar to others I have heard. These examples lead me to a working hypothesis that readiness for profound change may be the determining factor. When added to the desire for change and clarity about the change envisioned, the intensity of an extreme emotional and sensory experience may be just what is needed for a revolutionary and transformative change in internalized standards.

Revival meetings: This American religious tradition and similar ones in other cultures embody many of the same elements as those of cult induction. Music and dance provide bodily experiences along with the emotional and psychological impact of charismatic preachers. The social context adds a powerful sense of joining together as one. What does this do? Most of the participants go home carrying energy and enthusiasm that last for a few days to weeks, then gradually return to “normal.” A few are transformed. What is the difference? Perhaps this is another instance of the same phenomenon described above.

Change in psychotherapy: In the context of talk therapy, we have a disadvantage. Where low self-esteem has been internalized as a result of trauma, most of us don’t want to repeat the controlling, coercive approach of perpetrators. We want to invite change, not to force it. Perhaps hypnotherapy comes the closest to duplicating the conditions of cult induction or a psychedelic-induced state. Done correctly, it still emphasizes consent. What we are left with in standard talk therapy is largely the slow kind of change, where the client takes in a new understanding of the wrongness of their own values and the need to act in ways that contradict their erroneous values and attitudes. Over time and with the level of effort kept up, this does result in change in values and standards.

Spontaneous rapid change: I have also been witness to a few instances of rapid, spontaneous change even in the context of exploratory talk psychotherapy. Two cases involved people with dissociated inner selves. In those instances, the trigger for change was a sudden realization that the internalized values were inappropriate and did not belong to the self. Perhaps what made such rapid change possible was the internalized presence of a separate and healthier version of the self, ready to supply a radically divergent point of view. More commonly the core being has cooperated by practicing self-directed abuse over the course of much of a lifetime and has left little sense of self-worth ready as a replacement. Instead self-esteem may need to be built, one positive experience at a time.

Evidence of memory reconsolidation: While I have described this change process as distinct from others like changes in beliefs, the difference is in the degree to which the inner self fights change. There is no reason to believe that the actual mechanism of change is different. For that, we still have only one good explanation, memory reconsolidation. That is the one mechanism known to be able to rewrite contents held in established, nonconscious memory. The combination of an internal drive for change with disorienting and even bewildering experiences appears ample to fulfill memory reconsolidation’s requirements of activation of the old pattern juxtaposed with the delivery of disconfirming information and new mental contents to rewrite the old memory.

I offer these thoughts because the literature is thin on the details of internalization of values and standards. This is an area ripe for research. One factor that seems to have blocked researchers is the frequent failure to give significance to the distinction between core values, the basis of judgments, and core beliefs, which simply reflect the prediction that one set of conditions will lead to another, without reference to an internal standard.

Call for comments:

Please do share your experiences and thoughts. The reasons for my willingness to hold and share a working hypothesis is that doing so helps us be better observers as we wonder if our thinking is correct. If you have trouble leaving a comment on my website at www.howtherapyworks.com, it is easier to do so on the new Substack, Therapy Lab.

Jeffery Smith MD