Psilocybin in the treatment of anorexia nervosa: The English transition of a French 1959 case study

In this case study (n=1) the authors revisit the first known documented case of psilocybin being used to treat anorexia nervosa. After two separate injections of psilocybin, the patient stated she was able to understand the psychological cause of her illness. With clinical trials now underway exploring the effects of psychedelics on eating disorders, this case study offers interesting insight.

Abstract

“Psilocybin is a psychotropic molecule that is a partial agonist of serotonin 2A receptors and is the main psychoactive compound in hallucinogenic mushrooms. After the observation in 1953 in Mexico of ritual practices involving ingestion of such mushrooms, psilocybin was chemically characterized and synthesized in 1958 thanks to the collaboration between the Muséum national d’Histoire naturelle in France and the Sandoz pharmaceutical laboratories in Switzerland. The interest of this substance in psychiatric therapy was then evaluated for the first time at the Sainte-Anne Hospital in Paris, by the team of Professor Jean Delay. Among the patients who received this substance was a 35-year-old woman who was hospitalized for compulsive manifestations emblematic of anorexia nervosa and who experienced an immediate and lasting improvement. The original 1959 article (published in the Annales de la Société Médico-Psychologique) gives details of the patient’s family background, biography and clinical examination. It then outlines the observations after two injections of psilocybin four days apart, in particular the autobiographical verbal statements that allowed the patient to understand the psychogenesis of her illness. After a long hiatus, psilocybin is once again the subject of medical research, with clinical trials now underway assessing psilocybin in the treatment of anorexia nervosa (NCT04505189; NCT04052568; NCT04661514) and this 1959 case study, is the first known demonstration of the safety and efficacy of psilocybin treatment of anorexia nervosa. This case study thus provides an interesting insight into possible therapeutic mechanisms and is of great interest to the field moving forward.”

Authors: Vincent Verroust, Rayyan Zafar & Meg J. Spriggs

Summary

A woman with anorexia nervosa was treated with psilocybin at the Sainte-Anne hospital in Paris, France. The title of the article contains a misprint, and the thesis should read ”compulsive” instead of ”convulsive”.

AN is a severe nutritional restriction, intense fear of gaining weight, and a disturbance of one’s bodily self-perception condition that is the most fatal of all psychiatric conditions. Fewer than half those diagnosed reach remission after specialist treatment.

Psilocybin is a psychotropic molecule produced by different species of mushrooms that has been used by Amerindian peoples in the Mesoamerican cultural area for several centuries. It was discovered in 1958 by Roger Heim and Albert Hofmann at Sandoz laboratories, Switzerland.

Roger Heim had tablets and injectable solutions of psilocybin transferred from Sandoz laboratories to the department of psychiatrist Professor Jean Delay at the Sainte-Anne mental hospital in Paris, where Miss Henriette B. . . received two injections of psilocybin and had her case study published.

Psilocybin is one example of a classic serotonergic psychedelic, which exerts its subjective effects through the partial agonism of the Seretonin type 2a receptor (5-HT2A).

Psilocybin is the most commonly utilized psychedelic compound in therapy, and is usually delivered in a supportive context. Psychotherapy is typically enveloped by the dosing and is considered central to achieving therapeutic success.

The Relaxed Beliefs Under pSychedelics (REBUS) model and the pivotal mental states hypothesis propose that psychedelics induce a hyper-plastic state that promotes rapid and deep learning which can mediate psychological transformation.

On the basis of this growing body of evidence, three studies are now underway in the UK and North America exploring psychedelic assisted therapy as a novel treatment avenue for AN. The case study presented by Jean Delay and his collaborators at the early stages of experimentation with psilocybin shows that this compound has therapeutic potential, and that acute emotional breakthrough is an important mediator of post-acute change.

Funding sources

Miss Henriette B, 35, presented with depressive-like symptoms including asthenia, insomnia, dark thoughts and lack of confidence. She was hospitalised in service on the 23rd March 1959 for compulsive mannerisms concerning food.

Henriette B. was born to a small and functional family where there was no history of previous psychopathy or psychosis. Her parents were strict moralists and her mother was a hyperactive perfectionist who always compared her two daughters to devalue the older one.

She was born on the 7th June 1924, breastfed for a year, and had one indisputable episode of anorexia. Her schooling was marked by a great psychomotor inability, but she passed her school exams in 1941.

The patient became discouraged and interrupted her studies, but adapted very well to her work environment where they consider her quite eccentric.

The start of her problems was in 1943, when she voluntarily stopped eating and lost 20 kg in 1 year. She was hospitalized twice under the care of Prof. Heuyer, where she was force fed, but her periods did not come back.

The patient described to us her troubles, and above all it was about cravings. She stole food when she was with her parents or sisters, and she did not establish any rite of defence against this need that she considered irresistible.

Her way of life hit us as extreme regularity. She exercises intensely every day, limits her spending on clothes, and tries to rationalise her existence by saying that there are people living without basic essentials.

She is aware of the self-centeredness of her life, and through religion she tries to fill her emotional void. Religion also offers her the dream of a future where she can finally be liberated from her ‘body’.

The subject had a higher than average level of intelligence as measured by the Wechsler-Bellevue scale, the Binois-Pichot vocabulary test, and the visual retention test of Benton.

The culmination of received tests do not indicate a pathological character or a significant and precise diagnosis. Instead, there are some discrete neurotic traits and weakly structured mechanisms of obsessional and especially compulsional type.

The patient was isolated and subjected to treatment with Largactil (Chlorpromazine), but the result was almost no result.

The patient had ordinary neuro-vegetative and short-lived reactions, but the psychological reactions showed a bit later, when she was in her room by herself. She had poly-sensory hallucinations, physical metamorphosis, and changes to her mood.

Our patient’s expansive mood and gift for poetic expression permitted her to describe her delirious experience in a relatively easy to understand verbal portrayal. She experienced a vision of paradise, in which time does not exist anymore and she felt free of carnal bonds.

A second injection of psilocybin was given 4 days later while treatment with Largactil had been suspended. The patient presented with intense psychological reactions, including semi-confusional state, physical discomfort, and dreamlike scenes with mystical themes.

The author accuses her mother of pulling her hair, and says that she is responsible for her illness, even though it’s not her fault. The author also says that she knows the origin of her illness, but she feels guilty about it.

Fixation on father: ‘My dad is very good, comprehensive, very in the shadows, and he used to get angry about my homework’.

In her childhood, 2 women played a very important role in her emotional life: a neighbour, Mrs F, and a schoolteacher, Ms D. She portrayed to her the image of the teacher that she would have wanted to be.

Feelings of guilt have always been present in her life, and were probably caused by the way she was fed by her mother.

She felt inferior to her family and stole something from them intellectually, so she had to steal bread in secret.

Sexual difficulties: She was not told about the first day of her period and didn’t dare ask for anything. Luckily she has Bruno.

In this patient, psilocybin had an indisputable therapeutic action. The second injection, given without Largactil, led to a flux of memories, which exposed to us the psychogenesis of her illness and her gripes against her mother.

Mr Dublineau – The presence of slow waves on the EEG examination could support a hypothesis of para-convulsive type.