Psychedelic drugs and the future of mental health

adminJanuary 10, 2019




I had a close conversation on the second night of the ayahuasca ceremony.

I saw my teenager even melting in particles and eventually disappearing altogether. I pulled off my sleep mask and saw the people around me shifting in shadows. I thought I was dying, or maybe losing my grip on reality.

Suddenly, Kat, my guide, appeared and started singing for me. I couldn't fix the words, but the cadence was soothing. After a minute or two, the knob twisted away and I returned to a peaceful halfway.

The 12 of us – nine women and three men – who took ayahuasca in a private home in San Diego, were led by two trained guides: Kat and her partner, whom I call Sarah since she requested anonymity for legal concerns. Together, they have more than 20 years of experience working with psychedelics, including ayahuasca, a plant concentration that contains the natural hallucinogen known as DMT.

Kat (her full name is Tina Kourtney) and Sarah work as a team serving psychedelic medicine every month or so in another city. Their primary role is to create a space where everyone feels safe enough to let go of their emotional guards and open up the potential of drugs to change attitudes, moods and behaviors.

There is a lot of discomfort going into these ceremonies, especially for people who have never experimented with psychedelics. The fear of what you see or feel may be overwhelming. But guides like Kat are your port in the storm. When things become turbulent, they react with a stable, calm hand.

While psychedelic drugs remain illegal, guided ceremonies or sessions also occur throughout the country, especially in major cities such as New York, San Francisco, and Los Angeles. Guiding itself has become a viable profession, both underground and over, as more Americans seek safe structured environments to use psychedelics for spiritual growth and psychological healing. This new world of psychedelic-assisted therapy acts as a kind of parallel mental health service. Access to it is still limited, but it develops faster than you might expect.

A majority of Americans now support the legalization of marijuana, and while a 2016 public opinion poll on psychedelics suggested they are not as beneficial, attitudes may change as research results on their therapeutic potential come into the ordinary. (Author Michael Pollan's 2018 book How to change your mind, about their own experiences with psychedelics, helped spread the word.)

But what would a world in which psychedelics is legal look like? And what kind of cultural structures do we need to ensure that these drugs are used responsibly?

Psychedelic drugs that LSD seeped into the American society in the 1960s, and the results were mixed at best. They totally revolutionized the culture, but they eventually left us with drachic drug law and a cultural setback that pushed psychedelics into the subway.

Today, however, a renaissance is on its way. In institutions such as John Hopkins University and New York University, clinical trials exploring psilocybin as a treatment for treatment-resistant depression, drug abuse, and other anxiety disorders have hopeful results.

In October, the Food and Drug Administration took the extraordinary step of giving psilocybin treatment for depression a term for "breakthrough therapy". That means the treatment has shown such a potential that the FDA has decided to speed up the development and revision process. It is a sign of how far the research and public perception of psychedelics have come.

It is because of this progress that we need to think seriously about what comes next and how we integrate psychedelics into the broader culture. I've spent the last three months talking to guides, researchers, and therapists who train clinicians to perform psychedelic-assisted therapy. I've attended underground ceremonies, and I've talked to people who claim to have conquered their drug addiction after a single psychedelic experience.

Our current laws penalize various toxins, including splashes and cigarettes. These are substances that destroy life and eat addiction. And yet, one of the most striking things about the latest (limited) psychedelic study is that the drugs do not appear to be addictive or have side effects when a tutor is involved. Many researchers believe that these drugs, when used under the supervision of trained professionals, can revolutionize mental health.


Turn on, set and release?

The 60-year-old counter-cultural movement was transformational in many ways.

Among other things, the environmental movement, the civil rights movement, modern feminism and the antiwar movement were catalyzed. But it also produced a decade-long setback against psychedelic drugs that until recently made it almost impossible to conduct clinical research.

As late as 1960, psychedelics was fully legal and widely regarded as a promising line of psychological research. But just a few years later, the political and cultural winds had shifted so dramatically that the country was in complete panic over psychedelics. In 1965, the federal government banned the production and sale of all psychedelic drugs, and shortly after, the companies that produced these drugs stopped research, production.

Michael Pollan gives an exhaustive account of this in How to change your mind (a book I highly recommend), but the short version is that psychedelics could never escape the shadow of the countercultural revolution they helped spark.

Timothy Leary, the renegade psychologist and the psychedelic evangelist who told the children to "turn on, tune in and escape" is the well-known syndicate. Leary, the argument goes, was too reckless, too confrontational and too scary for the ordinary. Leary was such a threat that at one point he was called "the most dangerous man in America" ​​by President Richard Nixon.

But Leary is a simple mark and hardly the only cause. The culture was simply not ready for psychedelics in the 1960s. The experiences these substances induce are so powerful that they can form a kind of rite of passage. But when they hit the stage, the population had no experience with them, no sense of their importance. As Pollan told me in an interview earlier this year, "young people had such a radically new type of experience that the right culture couldn't handle."

Psychedelics were loosened so fast that there were no cultural structures in place to absorb them, no containers or norms around them. Cultures around the world – from the ancient Greeks to the native cultures of the Amazon – have taken psychedelics for thousands of years, and each developed rituals for them, led by experienced guides. Because there were no established communities in the United States, people were left to separate entities. When you combine this with a general ignorance of the substances themselves, it is not surprising that things went side by side.

But much has changed since the 1960s. The political and cultural landscape is radically different, and far more receptive to psychedelics. Rick Doblin, a long-standing psychedelic attorney and the MAPS founder, made an interesting point to me when I sat with him in Washington, DC, recently. (MAPS is a nonprofit research and education organization that manages efforts to promote safe use of psychedelics.)

"In the 60's," he said, "the psychedelic counterculture was a direct challenge to the status quo … it was about getting out of culture. Today, things like yoga and mindfulness meditation are fully integrated into popular culture. Integrated spirituality and all those things that seemed so alien and alien in the 60's. So we have prepared culturally for this for 50 years. "

At the same time, psychedelics can also play a role in dealing with recent health threats such as the opioid crisis. (70,000 Americans died from opioid overdoses in 2017, more than the total number of Americans who died in Vietnam.) They are used to treat populations as veterans suffering from PTSD or cancer patients confronting their mortality, or people fighting depression.

Psychedelics becomes a tool for healing rather than a threat to social order. And the researchers and organizations and training institutions leading the way work in the system to reduce the potential for blowback. This is very different from the approach taken in the 60s, and so far it has been a success.

Your mind on psychedelics

Psilocybin is the drug chosen for most researchers over the past few years for various reasons. For it bears less cultural baggage than LSD, and then participants are more willing to work with it. Psilocybin also has strong safety data based on pre-ban studies, and the FDA has allowed a small number of small clinical trials to move forward.

Although the latest studies are still preliminary and sample sizes are quite small, the results so far are convincing. In a 2014 Johns Hopkins study, 80 percent of smokers who participated in psilocybin-assisted therapy remain fully sustained six months after the trial. By comparison, smoking cessation tests using varenicline (prescription drugs for smoking addiction) have a success rate of about 35 percent.

In a separate 2016 study of cancer-related depression or anxiety, 83 percent of 51 participants reported significant increases in well-being or satisfaction six months after a single dose of psilocybin. (Sixty seven percent said it was one of the most meaningful experiences of their lives.)

A typical psilocybin session lasts between four and six hours (compared to 12 hours of LSD), but it produces lasting decline in depression and anxiety for patients. That's why researchers like Roland Griffiths at Johns Hopkins believe that psychedelics represents a whole new model for treating great psychiatric conditions. Conventional treatments such as antidepressants do not work for many patients and may cause a number of side effects.

This is a great reason why many researchers believe that psychedelics will eventually be reversed by the FDA (more on this below) and legalized for medical use – although the timeline of this is far from clear. In November, officials in Oregon approved a 2020 ballot paper that could allow medical professionals to perform psilocybin-assisted therapy. If it does, Oregon will be the first state to allow licensed therapists to administer psilocybin. Other states like California are likely to follow.

For more on the psychedelic's broad medical potential, I urge you to read my colleague German Lopez's 2016 Review of Science. Here I wanted to focus on how psilocybin works and why it is so powerful for those who take it. To understand the clinical side, I traveled to Johns Hopkins to sit down with Alan Davis, a clinical psychologist, and Mary Cosimano, a research coordinator and trained tutor. Both aids lead the psilocybin sessions at Hopkins.

Researchers at Hopkins have been working with a number of populations since they received FDA approval to study psilocybin in 2000 healthy adults without any psychological problems, cancer patients suffering from anxiety and depression, smokers and even experienced meditators.

An important part of the process at Hopkins is what they call "life audit." Before giving the drug, they will know who you are, where you are in your life, and what kind of emotional or psychological walls you & # 39; ve built up around yourself. The idea is to work with patients to find out what holds them back in life, and examine how they can overcome them.

Davis and Cosimano both say psilocybin has delighted every single people they have worked with. "It's not for everyone," Cosimano told me, "but for the right person at the right time, it can be positively transformative." (They don't accept patients anywhere on the spectrum of psychosis – it's just too dangerous.)

The Psilocybin sessions are intense, and in some cases lasts all day. The rooms they use are a curious blend of the murder office's office furnishings and New Age decoration. It is a vanilla-colored sofa covered with embroidered pillows and the murder of both sides of American art. Near the couch, on an end table, is a ceremonial cup and mini sculptures of magic mushrooms; It's not quite an altar, but it can also be.

The important thing Cosimano and Davis say is to make the patient as comfortable as possible. They even encourage people to bring personal items with them, or letters from loved ones, or basically everything with deep emotional resonance. Like the underground guides, scientists do everything they can to create a safe psychological space.

The sessions can unfold in several directions, depending on the depth of the experience (which is difficult to predict) and the individual's mental state. For the most part, patients lie on the couch with a sleep mask covering their eyes. Cosimano, Davis and other clinical guides work as lodestars – keeping the patient's hand and helping them treat what they see and what it means. "I never get tired of this," Cosimano told me. "Every session is different, each experience is different, and I'm just blown away to see each person's journey."

Nevertheless, it is not entirely clear to the researchers what it is about these experiences that give such profound changes in attitude, mood and behavior. Is there a sense of awe? Is it what the American philosopher William James called the "mysterious experience", something so overwhelming that it destroys everyday consciousness and changes our perception of the world? What is clear at least is that psychedelic trips are often outside the language courses.

The best metaphor I have heard to describe what psychedelics does for the human mind comes from Robin Carhart-Harris, a psychedelic researcher at Imperial College London. He said we should think of the mind as a ski slope. Each ski slope develops tracks that more and more people are making their way down the hill. As these tracks deepen over time, it becomes more difficult to ski around them.

As a ski slope, Carhart-Harris claims our minds develop patterns as we navigate the world. These patterns cure as you grow older. After a while you stop to realize how conditional you have become – you only respond to stimuli in predictable ways. Finally, your brain like Michael Pollan is called an "insecurity machine" obsessed with securing the ego and locked in uncontrollable loops that reinforce self-destructive habits.

Taking psychedelics is like shaking the snow globe, Carhart-Harris said. It interferes with these patterns and explodes cognitive barriers. It also interacts with what is called the standard mode network (DMN), the part of the brain that is associated with mental chats, self-absorption, memories and emotions. Whenever you are anxious in the future or pampering the past, or engaged in compulsive self-reflection, this part of the brain lights up. When the researchers looked at images of brains on psychedelics, they discovered that DMN is almost completely closed.


This figure is from a 2014 study in Journal of the Royal Society Interface. The image on the left is of a human brain on a placebo, and the image on the right is of a brain on psilocybin.

Think about it this way: You spend your whole life in this body, and because you're always in the middle of your experience, you get caught up in your own drama, your own story. But if you pay close attention, say in a deep meditation exercise, you will find that the experience of self is an illusion. Still, the feeling is that it is a "you" sign and apart from the world, very difficult to shake; It's like we're connected to seeing the world this way.

The only time I've ever been able to cut through this ego structure is under the influence of psychedelics (in my case, ayahuasca). I was able to see myself outside myself, to see the world from an instant and everywhere all at once, and suddenly this horror show stopped of self-respect. And I think I learned something about the world that I couldn't have learned anything else, which changed how I think, well, everything.

At Johns Hopkins, the drug experience is only part of the treatment. Equally important is the therapy as follows. People regularly tell researchers that the psilocybin session is the most personal and spiritual significant experience of their lives, including birth and loss of loved ones.

But there is a need, said Davis, "to understand these experiences and bring them into your daily life in a way that does not diminish the meaning." It does not necessarily have to be therapy or an -on-a-guide with guidance, but it is important to integrate the experience into your daily life, whether it takes a new practice such as yoga or meditation, spending more time in nature, or just cultivating new relationships.

The point is that it is not enough to take the tour and move on; It's about establishing new habits, new mental patterns, new ways of being. Psychedelics can start this process, but for many it is at least everything they can do.

When I returned from my first ayahuasca retreat, I struggled to deal with what had happened to me. I had no formal help, no instruction, no real support. It turns out to push back to the routine after your inner world has turned upside down so. I have adopted new practices (such as meditation), and it has gone a long way in keeping up with the first meeting with psychedelics, but there are limits to what you can do alone.

Recognizing the need for more integration, schools like the California Institute of Integral Studies and psychedelic researchers like NYU's Elizabeth Nielson are focused on training professional therapists to work specifically with psychedelic users. Nielson is part of the Psychedelic Education and Continuing Care Program, which does not perform psychotherapy, but provides instructions to clinicians who want to learn about psychedelics.

"People who have used psychedelics or want to use psychedelics in the future will need help integrating their experiences, and many will feel safer at a therapist's office," she told me. "That means we need more therapists who understand these experiences and know how to have such conversations with patients."


Meanwhile, we have seen parallel growth in a more informal support system for people who are experimenting with psychedelics, one that exists mostly underground.

Psychedelics and underground

For decades, a community of guides has worked quietly in the shadows, serving psychedelics to people all over the country. And they are not so different from their superior colleagues – or at least not as different as you might expect. Many of them have spent years apprenticing under traditional healers in places like Peru and Brazil, following a strict code of conduct designed to formalize practices and ensure safety.

This was probably true of Kat, the guide I was sitting with in San Diego. She studied under a Peruvian mentor for eight years and estimates she has used ayahuasca more than 900 times and led hundreds of ceremonies in Europe and the United States.

She calls herself a "tone setter", someone who controls the space. For the most part, she puts everyone at rest by projecting a calm and soothing presence. "I take a pulse in the room, and when I have to go over to someone, I'm trying to be as grounded as the earth itself – that kind of calm is contagious," she said. "The most important thing is to be adapted to what is happening and how people feel and respond to it."

Her role is a close walk between letting people go through what they go through and intervene when they are too close to the abyss. If everyone is fine, she is somewhere in the room that sings media songs and keeps a beautiful eye on things. If someone panic, Kat must talk and do it in a way that doesn't overwhelm everyone else in the room.

Just a few months ago, she told me that a woman on one of her ceremonies was convinced that demons had taken over her body. She became hysterical and threatened to call 911. Situations like this all the time, and the guide has to figure out the plane.

Unlike the Hopkins clinics, Kat manages trips from multiple people at a time, sometimes dozens, and risks. I asked her why do this? Why risk someone reacting to ways she can't control, or risking jail?

"Because it heals people," she told me. "I see it every time I keep a circle every time I go through a group of people through this experience. People go with one perspective and go with another. Sometimes it means they see the world with new eyes, and sometimes it means that they realize that they are more than their addiction, that their mistakes do not define them. "

Kat, now 43, has had many of his own games. Before discovering ayahuasca 13 years ago on a trip to Peru, she had alcoholism, bulimia and bipolar disorder – at one point she attempted suicide. "The drug was not a paradise," she said, "but it put me on a different path, and basically I dedicated my whole life to this work."

She tried traditional therapy for several years, mostly treating her bipolar disorder and bulimia. When it failed, she dabbled in self-help workshops, from Radical Awakening seminars to Mastery in Transformational Training. "I was obsessed with finding some kind of relief," she told me, "but nothing worked, nothing fixed."

Anyone who performs at Kat's ceremonies has its own reason to be there. Some are psychonauts – people who want to explore altered states of consciousness through the use of psychedelics. Others, like Laura, a 35-year-old woman from Philadelphia, are drawn to plant medicine as a final blur to conquer an addiction.

In Laura's case, there was a 14-year dependence on heroin. "I was on the verge of death. I tried all the conventional methods you can think of – detox, counseling, rehab – and nothing worked," she told me. She eventually found ibogaine, a psychedelic connection derived from the roots of a West African bush. "Ibogaine was like a myth on the streets, this miraculous modality that could reset your brain and save you from the kind of addiction."

Laura told me she eventually went to her family and said, "Put a gun in my mouth and pull the trigger or send me to an ibogaine clinic." They sent her to an ibogaine treatment center just north of Cancun, where she did a few sessions. She has now been clean for the last eight years.

Ibogaine is not as well-researched as psilocybin or LSD, and it is relatively dangerous, but it is one of the most powerful known psychedelic drugs, and preliminary research suggests that it can be an effective treatment for opioid and cocaine addiction.

Another woman, a 48-year-old from Kansas I call April, told me she spent 15 years at Adderall, a stimulant prescribed for attention deficit hyperactivity disorder. "It took my whole life – every decision, every plan, basically every moment." She tried to quit several times, but the withdrawal was too much. On a whim, she decided to look at psychedelics and found her way to Kat's website. A few weeks later she sat in a ceremony.

Her first ayahuasca tour was in September, almost three months ago, and she hasn't touched the Adderall side. "The experience was rough," she said. "It was like seeing myself and my life through a mirror, and I could see all the stitches I wear, how Adderall had become this crutch, this source of false energy that drove me through my life. I feel it is recalibrated my whole being. "

These stories are inspiring, but it is not clear how representative they are. Psychiatry is not a magical elixir, and there are physical and mental dangers to taking them randomly, especially if you are on medication or have been diagnosed with a psychiatric condition. But used in a proper setting with a trained guide, they can be remarkably therapeutic. (As far as I know, there are no documented "bad trips" in the research literature.)

Kat believes this work can be more influential if it was not forced to become underground. "If this were legal, I'd spend more time with people before and after the experience. I want to build my team and do this over the earth as a regular business and take care of people from start to finish. Because we're in this legal gray area, people often enter the ceremony, and then they are shot all the way back to the world, and it can be traumatic. "

I asked Kat if she noticed a shift in the kind of people who attended her ceremonies. It used to be mainly psychonauts, she told me, but lately there are people, old and young, who want to make peace with mortality or face deep trauma. She works with more and more veterans who are struggling with PTSD, many of whom tell her they couldn't find relief from traditional mental health.

Yet she hesitated when I asked her for legalization. "They should definitely be legal, but I'm not sure they should be legal tomorrow," she said. "We need a solid foundation in place, a way of keeping reverence around these drugs. If we lose it, if psychedelics becomes another substance like marijuana, I worry that we will inflate this and burn it down as we did on 60's.

Kat's concern, shared by many people in this room, is that the ceremonial aspects of psychedelics will be lost if they are legalized overnight. There is nothing inherently wrong with recreational use, but for those who see psychedelics with some kind of sacred awe, there is a real fear that these drugs will be trivialized if we do not make this transition wise.


So how do we integrate psychedelics into culture?

For better or worse, psychedelics, like all drugs, will be used Outside the safer connections of research facilities or private sessions with experienced guides. According to Geoff Bathje, a psychologist at Adler University working with high-trauma patients, the question is therefore: "What kind of harm reduction do we need to protect people?"

Several people I talked to pointed out the "damage reduction" model. Harm reduction focuses on reducing the risk associated with drug use, as opposed to punitive models aimed at completely eliminating use. It is a practical and humane approach that has worked well in places like Portugal, where all drugs for personal use have been decriminalized.

Although the injury reduction model is not typically associated with psychedelics, the principles all apply the same.

For Bathje, it is about doing good medical education in the population, "making sure people understand the risk of psychedelics – how they can be abused, how people can be exploited when they are under influence, etc." There are already national harm reduction organizations like Zendo Project focused on peer-to-peer counseling for people who are experimenting with psychedelics.

Bathje and some of his colleagues have established a harm reduction group in Chicago, called Psychedelic Safety Support and Integration. The goal is to promote safety and help people treat their psychedelic experiences. It is a critical container that brings into society, spreading awareness of the risks associated with psychedelic drug use, and creating a space for connectivity.

Currently, there is a gap between the damage reduction and the psychedelic research environment. "You go to a psychedelic conference and it's focused on science and therapeutic potential," Bathje said. "And the general assumption is that if we only produce good science, these drugs will be approved as medications and everything will only fall into place."

"If you go to a harm reduction conference," he added, "it is about cultural change and how politicians don't care about science. The focus is much more on organizing and who has power and how we can reduce risk and do things safe. "This is one of the reasons why the damage reduction movement can be useful for psychedelics. Science can be critical to legalization, but public health programs must help integrate these substances into the broader culture.

Harm reduction groups like the Bathjes and the Zendo project are the best models we have for this type of integration and we need to scale them up if psychedelics are legalized for medical use.

There are reasons to be careful, but we should welcome the development of psychedelic research

Having spent months thinking about these issues and talking to people involved at almost every level, I am convinced that the new culture of therapeutic psychedelics is evolving rapidly. Just this week, a group of fellow citizens in Denver gathered enough signatures to approve a ballot paper in the spring that would decriminalize magic mushrooms.

As Rick Doblin pointed out, the social and political environment is much different today than it was in the 60s, and there is no reason to suspect a similar setback. The cultural containers and knowledge are there, and they can increasingly be taken out of the shadows.

What this larger scale transition will look like and how long it takes is less clear. Guardians like Doblin seem wise to continue playing the long game. Given the progress of the research, it is possible that psilocybin will be reclassified from a schedule 1 drug (drugs without known medical value) to a schedule 4 drug (drugs with low potential for abuse and known medical value) for the next three or four years.

However, the process of drug rearrangement is somewhat confused. According to federal law, the US Attorney General may move to rephrase drugs alone, but they must collect data and medical research from the Health and Human Services Secretary before doing so. Congress can also pass laws to change drug planning and, if they chose, could persuade a lawyer's secretary.

We are unlikely to see much progress on this front during the current administration, but the political wind can shift in a hurry, especially if the research continues apace. That the Drug Enforcement Agency is already comfortable with the possibility of rescheduling psychedelics is a very positive sign.

“We’re happy to see the research progressing at institutions like Johns Hopkins,” Rusty Payne, the DEA’s spokesperson, told me in a phone interview. “When the scientific and medical community come to the DEA and say, ‘This should be a medicine, this should be recategorized as a schedule 4 or 5 instead of a schedule 1’; then we will act accordingly.”

Support for psychedelics is also one of those rare issues that can, in some cases, cut across conventional political lines. Rebekah Mercer, the billionaire Republican financier and co-owner of Breitbart, has donated a $1 million to MAPS to fund studies and legalization effort. As the research advances, we could see more bipartisan support like this.

One big remaining question has to do with access. If you spend any time at all in the psychedelic subculture, you can’t help but notice that it consists mostly of privileged white people. This is largely a product of who’s holding these spaces, how much they cost (anywhere from $600 to well over $1,000 per session), where they’re being held, and the networks of people propping them up. That many people simply don’t know about the therapeutic potential of psychedelics is yet another barrier. All of this has to change, and hopefully it will when psychedelics aren’t relegated to the underground.

Within the psychedelic community itself, there are concerns about commodification. Companies like Compass Pathways are seeking to turn psilocybin into a pharmaceutical product. (Compass’s psilocybin study is the one that received the breakthrough therapy designation from the FDA in October.)

Compass began as a nonprofit venture with an interest in starting a psychedelic hospice center but has since pivoted to a for-profit approach. With major investors like Peter Thiel behind it, Compass is threatening to seize control of the medical supply chain of psychedelics from synthesis to therapy. It’s also blocking the research efforts of nonprofit companies like Usona that are developing their own psychedelic medicines. If the market becomes monopolized, or if a few pharmaceutical companies control critical patents, lots of people could be priced out of access.

Despite all these concerns, we should welcome the evolution of psychedelic research. We need bigger studies, and we need to include more diverse populations in them to learn as much as we can about how these drugs work. As Richard Friedman, a clinical psychiatrist at Cornell University, told me, “I’m all for optimism, but show me the data. I embrace the enthusiasm for the therapeutic potential of psychedelics … but as to whether it’s justified, the answer will be the data. And nothing but the data.”

So far the data is encouraging, yet there’s plenty we don’t yet understand. But we know enough to say that psychedelics are powerful tools for reducing suffering at least for some people. And we simply don’t have enough of these tools to justify their prohibition.



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