MDMA e psicopatia: um amor possível?

Portas da Percepção

hempadao 19 fevereiro, 2015

por Fernando Beserra

Estava estudando as perversões – em especial a psicopatia e a sociopatia – quando um insight me veio a mente. O diagnóstico de perversão foi retirado dos principais manuais diagnósticos e não se encontra nos atualmente utilizados: a 5ª edição do Manual Diagnóstico e Estatístico dos Transtornos Mentais, organizado pela American Psychiatric Association (APA) e a 10ª edição da Classificação Internacional das Doenças (CID), organizada pela Organização Mundial de Saúde (OMS/WHO). Tal como o diagnóstico de histeria, a perversão foi diluída em alguns transtornos. Hoje estes diagnósticos encontram-se diluídos no DSM V da seguinte forma:

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No processo de reflexão sobre estes diagnósticos, suas terapêuticas e os limites das terapias atuais, fiquei pensando sobre de que forma uma pessoa com um diagnóstico de um transtorno mental psicopático, que tem na ausência de empatia e falsa de senso moral seus sintomas centrais, poderia se beneficiar de uma psicoterapia aliada ao uso clínico de MDMA, MDA ou outros empatógenos.

A psicopatia, etimologicamente, significa uma paixão da alma, uma doença da alma ou, finalmente, um sofrimento que provém da alma (psycho + pathos). Na psicologia complexa (mais conhecida como psicologia analítica) o principal livro de referência para discussão sobre o assunto chama-se: “Eros de muletas: reflexões sobre amoralidade e psicopatia” do psiquiatra, psicólogo e teólogo suiço Adolf Guggenbuhl-Craig. Neste livro, o pesquisador, falecido em 2008, faz uma discussão sobre o modelo de tratamento da medicina ocidental, orientada de forma unilateral para a saúde e totalidade; este modelo, para o autor, pecaria quando omite o arquétipo do inválido, isto é, há casos nos quais a cura não apenas não é possível, mas como sua busca a todo custo é, inclusive, iatrogênica. Segundo Craig, a psicopatia é um dos casos nos quais não se trata de pensar uma cura, pois haveria uma ausência do que a psicanálise veio a denominar – baseado no deus grego de mesmo nome – de Eros. Em direção oposta, uma psicóloga junguiana Fiona Ross, autora do livro: “Perversion: an jungian approach” compreende que as perversões são consequências estruturais das relações das pessoas com situações ambientais, como abusos e outras experiências traumáticas, sendo possível, embora custoso, uma mudança mais radical da personalidade e dos comportamentos.

No campo do DMS V, é no Transtorno de Conduta grave com “emoções pró-sociais limitadas” que encontramos os sintomas típicos da conduta psicopática como: ausência de remorso, falta de empatia, afeto superficial ou deficiente e despreocupação com o desempenho, em conjunto com os sintomas tradicionais divididos nos critérios gerais: agressão a pessoas ou animais; destruição de propriedade; falsidade ou furto; violações graves de regras.

Timothy Leary e sua equipe já realizaram uma experiência que ficou conhecida como Experimento da Prisão de Concord, na qual deram psilocibina a detentos[1] entre 1961 e 1963[2]. Outros dois estudos da época focaram no uso de LSD para detentos.

Embora o LSD incida de forma profunda sobre a reflexão dos sujeitos promovendo a ampliação da consciência – seja por uma experiência serena e luminosa ou por uma via dolorosa e ansiogênica – seu principal princípio organizador não direciona-se à empatia. De forma distinta, o MDMA – embora com menor potencial de transformação dos referenciais de compreensão de si e do mundo – incide diretamente sobre o campo da empatia. Quando tive estes insights, resolvi fazer distintas buscas nos mecanismos de pesquisa na internet. Em termos acadêmicos, um vazio. Nas profícuas discussões de grupos de usuários e ativistas, a situação foi um pouco diferente. A discussão sugeriu em alguns fóruns como Blue-Light e o Drug-Fórum. As opiniões foram distintas e muitos citaram situações pessoais. Para alguns, o uso de MDMA não é capaz de promover empatia naqueles que não a possuem, isto é, naqueles que teriam uma deficiência empática sem a capacidade de reabilitação. Outros relatos sugerem o oposto, isto é, pessoas conseguiram avanços importantes por meio do uso de MDMA – e isso fora do setting clínico. É importante lembrar que os mecanismos cerebrais relacionados aos efeitos do MDMA são estruturalmente semelhantes aos da “Psicopatia”, por um lado, e antagônicos por outro, isto é, o MDMA promove maior biodisponibilidade de serotonina (5HT2), principalmente no lobo frontal.

Outro dado relevante: segundo uma pesquisa sobre usuários de MDMA, os maiores transtornos encontrados nos usuários seriam transtorno depressivo e transtorno de personalidade antissocial (aqui) . É bem conhecida a fundamentação de que o uso e a dependência de substâncias psicoativas é mais prevalente naqueles grupos que buscam na substância uma forma de automedicação. Esta pode ser uma hipótese promissora para compreender este quadro geral.

Enquanto não temos pesquisas de campo, com grupo experimental, grupo controle, metodologia duplo cego ou metodologias alternativas, é importante que possamos, como tem feito os fóruns citados, reunir casos com fins de respaldar futuras investigações.


[2] – No experimento da penitenciária de Concord, os psicólogos Timothy Leary, Ralph Metzner e equipe, ministravam 20mg de psilocibina para um grupo experimental de presidiários. O planejamento era reduzir as taxas de reincidência e obter sucesso na transformação da personalidade. É verdade que houve redução dos escores de depressão e hostilidade, além de maior cooperação e responsabilidade. Assim como uma redução significativa da reincidência (o que ainda é objeto de discussões). Fico imaginando a experiência destes desbravadores em um setting terrível (penitenciaria), dando psicodélicos aos presos e tomando-os junto com eles. Um pequeno relato de uma experiência de Ralph Metzner

"Metzner começou a ter o efeito da droga. Ele começou na parede cinza atrás dele. Era como um filme de terror. Todos seus medos foram projetados nas paredes da prisão. Era como um noticiário de todos os atos maus na história humana. Metzner começou a soar, ranger e gemer. Então Gunther Weil (estudante de pós-graduação que participava da pesquisa) veio até ele e gentilmente colocou suas mãos sobre Ralph e disse: ‘Cara, como você está?’. Subitamente tudo mudou. Gunther era a mãe de Deus, cheio de compaixão, fluindo com bondade humana. O horror se tornou compaixão. Tudo isso com um simples toque". (Don Lattin. The Harvard Psychedelic Club).

Também é possível ler sobre o experimento nas reflexões de Ralph Metzner e no follow up de Rick Doblin do MAPS: http://www.maps.org/news-letters/v09n4/09410con.html



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