Ritalin-assisted therapy: 5 Questions for historian of pharmacy Lucas Richert

Richert discusses the drugs that have made their way onto the therapist’s couch.

Editor’s Note: We’re thrilled to announce that Shayla Love is joining The Microdose as a contributing writer. She’ll be working on 5 Questions. This is her first post. Shayla is a science journalist based in Brooklyn who writes about psychology, history, social science, wellness trends, and the shifting ways we understand our bodies and minds. She also covers research on psychedelics for the treatment of mental illness, and the sociocultural impacts of the psychedelic renaissance. Shayla has a master’s degree from Columbia University, and was previously a staff writer at The Atlantic, Vice, Psyche, and The Guardian. Her work has also appeared in The New Yorker, The New Republic, Scientific American, Wired, Esquire, The New York Times, Nautilus, and more. Now over to Shayla.

In the late 1950s, the American psychologist Betty Eisner gave a drug to some of her patients in psychotherapy. She didn’t know exactly how it worked, but Eisner found the drug could “enhance verbalization, facilitate the expression of anger, and sometimes lead to explosive catharsis.” One 18-year old girl burst into tears shortly after the injection. “A session was held with real affect and insight on her part,” Eisner wrote in her unpublished autobiography.

While Eisner was an early pioneer of LSD-assisted psychotherapy, the drug she gave the 18-year old girl, the one eliciting catharsis, wasn’t a psychedelic. It was methylphenidate, known by the brand name Ritalin and used today mostly for the management of ADHD symptoms. Compounds like MDMA or psilocybin take up much of the spotlight when it comes to drug-assisted mental health treatments, but there’s a more varied history of substances that have been paired with therapy. The Microdose spoke with Lucas Richert, a historian of medicine and pharmacy at the University of Wisconsin-Madison, about other drugs that have made their way onto the therapist’s couch.

Many people know of psychedelics being combined with therapy, yet there have been other drugs too. What are some examples?

The one that immediately comes to mind had to do with Freud. When he published Über Coca in 1884, he was praising cocaine as a magical drug. He was using it for treating melancholia and depression, and also enhancing mental clarity and energy. Besides that, you had barbiturates, amphetamines, and sodium amytal. Of course, you already referenced psychedelics, like mescaline and LSD. So, this isn’t the first time that you’ve got a pairing of some sort of psychoactive agent with psychotherapy.

How did psychologists like Betty Eisner use Ritalin? How was it different from the other drugs you mentioned?

When Eisner came across the use of Ritalin in psychotherapy, there were reports in the Los Angeles area that Ritalin, when paired with psychotherapy, helped patients to communicate more effectively, demonstrate empathy, and possibly temporarily break down ego defenses. The quotation that I’ve read is that they experienced “explosive catharsis.” Drugs like sodium amytal or pentothal induced a sort of sleepiness, and trace-like states. Ritalin, by contrast, was a stimulant based approach—same with MDMA, also used in psychotherapy—meant to increase alertness, or increased cognitive engagement during the session.

In early advertisements for Ritalin, the drug was even marketed as a psychotherapeutic tool. One ad promised the drug would make an alcoholic patient “more accessible to psychotherapy” by releasing subconscious material, if administered 10 to 15 minutes before a therapy session. Yet today, when people take this drug for ADHD, they may not associate it with unearthing subconscious material. How can both of these experiences with Ritalin occur?

This gets at some of the social and institutional forces which shape the way drugs are used in therapeutic settings, and what becomes legitimate and illegitimate. When you look back on the use of Ritalin and psychotherapy, that goes back to the mid-1950s before it was associated with ADHD, before it was paired up with that particular therapeutic category. Ritalin was marketed as something of a magic bullet at the time, promising all sorts of fixes, in particular, in children, which led to use in the clinics and schools. Drugs and disease categories co-evolve, and that’s essential when considering why we have these therapy-drug pairings.

If Ritalin-assisted therapy worked for some people, what does that say to you about the use of altered states in combination with psychotherapy?

You only have to go back to the 1920s, when alcohol was prohibited, to get therapeutic prescriptions for alcohol. Altered states of consciousness, whether induced by psychedelics, sedatives, or stimulants, have developed a long history as gateways to therapeutic insight. The idea of an altered state of consciousness producing some sort of breakthrough or therapeutic effect is long standing, so that’s not particularly new.

In the future, do you think that people will use a drug-assisted therapy that would surprise us? A drug that we use for a different purpose right now?

I don’t think I’d be overly surprised by any novel emerging substance being paired in that setting. What history shows us is that there’s essentially a revolving door of different types of brain altering drugs that are in that space. What we’re talking about here is both a drugs’ direct impacts on the body, but also these other extra-pharmacological issues: the preparation, the situation itself, and also the therapist’s skill, the therapist’s intention. Those are extremely important elements of the process that sometimes get lost when we’re thinking too much through the lens of the drug itself.

This interview has been edited and condensed for clarity and length.