Faculty Bibliography

The psychological mechanisms of action involved in psilocybin-assisted psychotherapy are not yet well understood. Despite a resurgence of quantitative research regarding psilocybin, the current study is the first qualitative study of participant experiences in psilocybin-assisted psychotherapy. Semistructured interviews were carried out with 13 adult participants aged 22 to 69 years (M = 50 years) with clinically elevated anxiety associated with a cancer diagnosis. Participants received a moderate dose of psilocybin and adjunctive psychotherapy with an emphasis on the process of meaning-making. Verbatim transcribed interviews were analyzed by a five-member research team using interpretative phenomenological analysis. General themes found in all or nearly all transcripts included relational embeddedness, emotional range, the role of music as conveyor of experience, meaningful visual phenomena, wisdom lessons, revised life priorities, and a desire to repeat the psilocybin experience. Typical themes found in the majority of transcripts included the following: exalted feelings of joy, bliss, and love; embodiment; ineffability; alterations to identity; a movement from feelings of separateness to interconnectedness; experiences of transient psychological distress; the appearance of loved ones as guiding spirits; and sharing the experience with loved ones posttreatment. Variant themes found in a minority of participant transcripts include lasting changes to sense of identity, synesthesia experiences, catharsis of powerful emotion, improved relationships after treatment, surrender or letting go, forgiveness, and a continued struggle to integrate experience. The findings support the conclusion that psilocybin-assisted psychotherapy may provide an effective treatment for psychological distress in cancer patients. Implications for theory and treatment are discussed.

BACKGROUND: Clinically significant anxiety and depression are common in patients with cancer, and are associated with poor psychiatric and medical outcomes. Historical and recent research suggests a role for psilocybin to treat cancer-related anxiety and depression. METHODS: In this double-blind, placebo-controlled, crossover trial, 29 patients with cancer-related anxiety and depression were randomly assigned and received treatment with single-dose psilocybin (0.3 mg/kg) or niacin, both in conjunction with psychotherapy. The primary outcomes were anxiety and depression assessed between groups prior to the crossover at 7 weeks. RESULTS: Prior to the crossover, psilocybin produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life. At the 6.5-month follow-up, psilocybin was associated with enduring anxiolytic and anti-depressant effects (approximately 60-80% of participants continued with clinically significant reductions in depression or anxiety), sustained benefits in existential distress and quality of life, as well as improved attitudes towards death. The psilocybin-induced mystical experience mediated the therapeutic effect of psilocybin on anxiety and depression. CONCLUSIONS: In conjunction with psychotherapy, single moderate-dose psilocybin produced rapid, robust and enduring anxiolytic and anti-depressant effects in patients with cancer-related psychological distress. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00957359.

In considering a Bionian primal scene, the author first reflects on adult sexuality as it was shown and known to him in childhood through The Ernie Kovacs Show, an innovative television show from the 1950s. The pleasurable emotions evoked during that writing were complicated by the emergence of highly disturbing memories of his discovery and consumption of early psychoanalytic texts on male homosexuality. This desire to discover his fate occurred in a context of familial preoccupation with the Holocaust and a child's experience of the threat of nuclear annihilation. This imbrication led to an expansion of his limits regarding the work of the primal scene as a psychoanalytic concept.

Anal eroticism between men has been a recurrent focus in psychoanalytic theory for over a century. Many theorists conflate anal eroticism with danger, particularly danger to masculinity and male gender identity. Defensive resistance to aggressive penetration and fear of receptivity are repeatedly invoked to understand anal erotic excitement and actions. The author reviews numerous papers on this topic from a broad spectrum of psychoanalytic theories, including drive theory, queer theory, and relational psychoanalysis and seeks to expand the discourse on anal eroticism between men. Although danger and dangerousness may be an aspect of individual anal erotic experience, it is not an essential or obligatory aspect of it; its construction as dangerous restricts the meanings that anal sexuality can carry. This imposes a defensive function on anal erotic desire or marginalized identity upon the practitioner when this is unwarranted.

Reply by the current author to the comments made by Stephen Hartman (see record 2010-14821-004) and Eve Kosofsky Sedgwick (see record 2010-14821-006) on the original article (see record 2010-14821-003). In my response to commentaries by Hartman and Sedgwick, I examine the positions from which each chose to speak. Hartman's rather light approach performs a particular function: the mentalization of anal erotic and homoerotic desire through the introduction of surplus meaning. I explore the relationship of this approach to the absence of rigorous theoretical critique in his essay. I question Sedgwick's decision to limit her critique to the confines of queer theory; this results in a constriction of meaning rather than the expansion she purports to offer. I challenge her notion of growth through mutual recognition with a model of change that is based in psychoanalytic theory and practice. Contrary to her assertion, I do not jettison danger or gender destabilization from the discourse on anal eroticism between men, but I question these as obligatory or constitutive to its meaning.

On May 1, 2004, the Association of Gay and Lesbian Psychiatrists (AGLP), with co-sponsorship from St. Luke's-Roosevelt Medical Center, The Haworth Press, and the William Alanson White Institute, organized an all-day conference in New York City entitled Homosexuality and Psychoanalysis: New Directions. The proceedings of the third panel focused on Clinical Perspectives.' The first contributor is Deborah F. Glazer, PhD, who discusses the impact of homoerotic desire and same-sex object choice on the intrapsychic world and the experience of one's self, including one's sense of adequacy in one's body based, gendered self, and the ability to feel sexual desire. Jeffrey R. Guss, MD, asks, What does psychoanalysis have to say about homosexuality?' He acknowledges that gay and lesbian therapists have much to say about gay life and therapy with gay and lesbian patients. Ann D'Ercole, PhD, shifts the focus to clinical work with same sex couples. She underscores the importance in the clinical work with same sex couples of attending closely to expressions of feeling different' as such feelings can often obscure shameful feelings that can infiltrate and contaminate a relationship. Scott Masters, MD, concludes the panel with clinical material from an ongoing treatment.

Anal sex between men has been constructed in many ways throughout the last century. In this paper, I describe three realms of discourse that have offered ideas regarding the meanings and motivations of anal sex: (1) Freud's exploration of anal erotism using classical psychoanalytic language, (2) a radical sex theorist describing transcendence and community through anal sexuality, and (3) a Lacanian perspective that questions the idea of the anus as passive. Recurrent themes regarding power dynamics, identity and gender are identified and explored, and the role of anal sex as cultural signifier is examined. (journal abstract)

The past 5 years have witnessed a great increase in the use of the stimulant drugs crystal methamphetamine and smoked cocaine (crack) as part of a pattern of hypersexual behavior inextricably interwoven with substance dependence among gay men. With these patients, the problems are not independent, and exist almost exclusively in the company of one another. The paper describes a framework for evaluating patients and assessing their readiness for treatment in office based individual treatment that is informed by psychoanalytic principles. Typical resistances at each stage of treatment are described, with clinical recommendations for management. Common transference and countertransference paradigms are described. The paper includes psychoanalytic exploration of the possible meanings of the experience of drug/sex addiction, abstinence and fantasies that often precede relapse.