Psicoterapia com Psicodélicos

Portas da Percepção

hempadao 7 agosto, 2015

por Fernando Beserra

Mais um texto aqui no Portas da Percepção sobre Psicoterapia com Psicodélicos. É que sou insistente. Padrão de tempo: loop. Estava escavando um material sobre Psicoterapia com Psicodélicos e retornei a um livro dos mais antigos, dentre os livros da temática escritos por terapeutas latinos. Trata-se do livro: “Psicoterapia com LSD e outros alucinógenos” do médico argentino Alberto Fontana.

 

O prefacio do livro, capaz de assombrar parte da psicologia e da medicina contemporânea, traz as belíssimas palavras: “Ainda é tempo de os cientistas, sobretudo, dos psiquiatras, psicólogos e hipnólogos retomarem a caminhada na estrada desbravada por Albert Hoffman, em 1943 na Suíça, ao descobrir a dietilamida de ácido lisérgico. Os horizontes são amplos. Não devemos parar. Há muito a fazer pela saúde integral do homem”.

No capítulo 4 do livro: “Psicoterapia individual com alucinógenos”, Alberto Fontana começa comentando o fato do uso de psicodélicos ter modificado significativamente a própria psicoterapia. Embora a relação transferencial, a relação interpessoal, permaneça o centro da terapia, houveram muitas inovações. Diferente do modelo de Grof, a perspectiva de Fontana para psicoterapia com psicodélicos é mais ativa. Além disso, o entendimento dos psicodélicos aparece, neste modelo, como um coadjuvante da psicoterapia e não como o centro da terapia. Portanto, os psicodélicos aumentam o insight e favorecem a conexão entre terapeuta e paciente. Frederking, em 1955, analisa que o uso de psicodélicos encurta o tempo necessário dos tratamentos. Neste ponto, Fontana aproxima-se da abordagem da psicologia analítica, especialmente a partir dos trabalhos pioneiros de Sandison, isto é, trata-se de mais uma prova de que a abordagem junguiana sempre foi valiosa para compreensão da experiência psicodélica, mesmo que Jung, propriamente, não tenha sido favorável ao uso de psicodélicos na terapia. Há de considerar que o pesquisador suíço tinha pouquíssimo conhecimento sobre estas substâncias.

Nas palavras de Fontana, ao longo do processo terapêutico com psicodélicos: “Produz-se assim um verdadeiro processo de individuação ao longo do qual se renasce e se revive, tratando-se de reestruturar as relações deformadas com os objetos internos e externos”. Trata-se de uma análise que vai ao ponto central. Psicodélicos promovem modificações e tem a capacidade de trans-formar mesmo sistemas com importantes mecanismos de defesa contra a mudança e o olhar atencioso a auto-organização de seu sistema psíquico. A saúde mental envolve a capacidade de libertar-se ao porvir, isto é, de um contato complementar entre consciência e inconsciente, no qual ambos reúnem em símbolos unificadores, possibilitando a ampliação da consciência.

Sobre a técnica em si, sobre houve muita discordância de como deve e quem deve operar a psicoterapia com psicodélicos. Sandison, por exemplo, no começo, deixava o paciente com um(a) enfermeiro(a) durante a sessão e, apenas depois, conduzia a terapia e interpretação dos materiais emergentes.

Acerca dos riscos, Fontana traz dados clínicos absolutamente importantes para esta pesquisa, muito mais relevantes que o preconceito de muitas pessoas: “Nós, com mais de 600 pacientes tratados e em torno de 5.000 sessões combinadas, não temos tido mais inconvenientes do que quando realizávamos psicoterapia sem psicodélicos”. Eu lamentei, neste caso, apenas Fontana não mostrar dados quantitativos precisos ou qualitativos que viessem a contribuir com este número incrível de sessões e pesquisas. Estas informações, em conjunto com outras, como as de Stanislav Grof, são fundamentais mesmo para o tempo contemporâneo, com o forte retorno neste campo de pesquisas e práticas terapêuticas. Cohen em um estudo bastante antigo chegou a reunir, segundo Fontana, 25 mil sessões, nas quais avaliou um risco mínimo, que poderia ser atribuído mesmo a um manejo inadequado do terapeuta. Fontana julgou as seguintes contra-indicações:

1. Pacientes com enfermidade somática crônica;
2. Pacientes pré-psicóticos ou psicóticos quando o ambiente familiar não tolera um desequilíbrio em seu contexto;
3. Pacientes com um eu muito desintegrado (incapacidade de integração);
4. Histerias graves;
5. Afecção orgânica aguda (pela possível redução da imunidade – julgada na época);
6. Gravidez;

Muitas das fantasias em bad trips, dentro ou fora do contexto terapêutico, remetem a uma tentativa de evitar a transformação, em decorrência do medo de transformar-se; o medo do desconhecido.

Indicações: solicita-se ao paciente que não tome medicações nas últimas 24 horas antes da psicoterapia com psicodélicos. A interação medicamentosa poderia alterar o efeito psicodélico. Frenquel, Ácido Nicotínco, dentre outros, poderiam reduzir ou mesmo eliminar o efeito. Em casos de maior ansiedade, por vezes dava-se Clorpromazina ao paciente, o que diminuiria a ansiedade e favoreceria, por consequência, o insight e a conexão.

Fontana relata que o lugar/cenário deve ser agradável e, além disso, contar com aparelhos para reprodução musical. Os terapeutas argentinos, neste local, utilizavam, como possibilidade, algum dos seguintes psicodélicos aliados a psicoterapia: LSD, psilocibina e mescalina. Posteriormente contavam também com o Sernil. As quantidades utilizadas variavam da seguinte forma:

· LSD: 2 ug/kg de peso corporal;

· Psilocibina (CY39): Oral – 6 a 17mg; Intramuscular – 8 a 12mg; Sublingual – 6 a 20mg;

· Mescalina: 0,2 a 0,6 g.

Apesar das quantidades bem definidas, Fontana indica que o mais importante é o setting e o relacionamento transferencial, que alteram radicalmente o efeito. A primeira sessão com psicodélicos pode haver bastante ansiedade e o aguçamento de mecanismos de defesa, como a negação, na qual o paciente achava que foi enganado (foi me dado apenas água… algum placebo) ou que ele é invulnerável a substância, ou seja, nele não faz efeito. Outra defesa é o próprio temor de conexão. No processo de desfazer este temor, tornar-se-ia possível a conexão oceânica que tanto agrada os psiconautas.

Caminhando para o fim: acerca das músicas escutadas na sessão, Fontana observou que alguns pacientes compram, posteriormente, um ou vários discos dos sons ouvidos na sessão, como maneira de recriar as experiências experimentadas e de ter uma relação mágica – porém ao mesmo tempo controlada – com o terapeuta. No fim da sessão de psicoterapia com psicodélicos neste modelo argentino, oferece-se comida e bebida ao paciente (o que não significa que não possam comer, ao longo da sessão, quando solicitem). O próprio ato de comer e beber é interpretado analiticamente. Finalizada a sessão administrava-se Meletril, Admital, Ampliactil e Secontal, separados ou combinados de acordo com a necessidade observada. A proposta é que o paciente deite até que durma.

Outros textos no Portas da Percepção sobre o tema:

Psicoterapia com LSD: riscos e resoluções .:. Psicoterapia psicodélica: terapia hipnodélica .:. Breves palavras sobre o uso terapêutico do LSD .:. Psicoterapia assistida com LSD: novos estudos .:. Psicoterapia com MDMA .:. MDMA e Depressão – Parte 1 .:. MDMA e Depressão – Parte 2



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