Psychedelics

00:00:32 progress good afternoon and welcome both to our presenters today and also to our audience on zoom and on youtube i'm beverly zabriskie and i'm here to welcome you on behalf of the founder and director of the helix center at nursesian i'm a jungian analyst who is on the executive committee of helix

00:01:02 and we're very pleased to be able to address this incredibly um current and exciting field with you today and we've had a wonderful response from these panelists and i'm going to tell you just a bit about each of them and then i'm going to ask them to describe their research rather than my reading to you about their research so the program will be

00:01:35 this description this presentation of the panelists and then their discussion and then a q a at the end and please submit your questions to the panelists via either youtube or zoom so to move forth with here patricia daly is an associate professor of english and comparative literature at columbia university she's co-chair of the affect studies

00:02:06 university seminar gender and sexuality studies council in the colloquium for early medieval studies her book promised bodies looks at the way women's mystical texts of the middle ages offer us an embodied sense of living the way one reads her current research focuses on the experience of poetics and the ubiquitous of what we think of as the literary in early medieval england

00:02:37 she's translated many works and her teaching and research involves contemporary philosophy and critical theory including what these fields might teach us about the nature of psychedelic experience and its relation to memory trauma studies and ecstatic experience elias d'aquar md is an associate professor at columbia university college of physicians and surgeons an addiction and general psychiatrist

00:03:08 he's been researching novel treatments for addictions for over a decade a special focus of his research has been evaluating sub-anaesthetic ketamine infusions for cocaine use disorders as well as investigating ketamine infusions as an adjunct to mindfulness-based treatment mind-body practices motivational interviewing he has a more general interest in the impact of contemplative and non-ordinary

00:03:38 experience and of the interventions that might occasion them nsa devano is a postdoctoral assistant excuse me associate at the institute for research and centering at the university of cincinnati and he's an affiliate scholar at the center for psychedelic drug research and education at ohio state university and the medicine society and cultural research fellow with pomposia it's a

00:04:10 wonderful word pomposia she previously completed a post doctoral fellowship in the department of bioethics at case western reserve university school of medicine her research focuses on the function of metaphor and other literary devices and narrative accounts of psychedelic experiences in addition to studying bioethical approaches to psychedelic medicine

00:04:41 her group has been awarded the best humanities publication in psychedelic cities from the breaking convention in 2016 and they are currently participating in the first qualitative study of patient experience where she's the new york public library timothy leary papers and research fellow with new york university silo cylovillen cancer anxiety

00:05:11 study alex kwan is a neuroscientist whose work is focused on the neurobiology of antidepressants he's known for using sophisticated optical imaging methods to study how drugs such as ketamine and psychosyllabidin modify the structure and function of brain circuitry his research has been published in top peer-reviewed journals he has a phd in applied physics from cornell and is

00:05:42 currently an associate professor in the treatment in the department of psychiatry at yale university you can follow him on twitter and he'll tell you how else to follow his research stephen ross has been a pioneer and leader in the study of alternative medications he's a research associate professor of psychiatry and child adolescent psychiatry at the nyu grossman school of medicine

00:06:14 he's a founding member of the nyu psychedelic research group and is currently associate director of the nyu langban center for psychedelic medicine and he's director of the psychedelic medicine research training program in his 21 years at nyu in bellevue he's been involved in administration teaching research and he previously was director of the center for addiction psychiatry

00:06:45 at tisch so he will tell you some of the other venues and directions of his research in the process of our discussion and now i want to hand over to the participants and ask them to just immediately speak and share with us their profound knowledge of something that many of us are only

00:07:15 just learning about thank you well let me just add uh beverly that um i'm i'm nominally on this panel although i'm not an expert in this field i'm gerald hurwitz and i'm the associate director helix and i'm typically your um devoted or often your devoted moderator for many of these talks i'm a clinical neuropsychiatrist and psychopharmacologist on faculty at

00:07:47 columbia as well so i just found this to be a really wonderful and interesting and timely topic and thought i would love to take part also as a panelist and i'll just say that maybe what we might do is start off with a little bit of a historical background does anyone want to take a shot at that sort of describing a little about the history of psychedelics

00:08:17 thank you thank you jerry sure i could talk a little bit about the history of psychedelics and psychiatry the first wave of psychedelics started in 1943 when albert hoffman accidentally discovered lsd and over the next 25 years or so there was a really large amount of research that took place mostly with lsd it ended up being close to 40 000 participants that were studied and the most promising

00:08:47 clinical indications was the use of lsd assisted psychotherapy to treat alcoholism at the time there were thousands of people that underwent that treatment model there were several randomized controlled trials the next most studied indication was the use of lsd assisted psychotherapy to treat psychiatric and existential distress in terminal cancer and there was also work done um by eric cass looking at lsd as a treatment for refractory pain syndromes in patients that had end of

00:09:17 life cancer so those were the the two most promising researched areas but psychedelics were legal for a period of time then they were used by clinicians throughout the world including psychoanalysts used them as a tool to the unconscious there was enormous safety data that was collected on them but before they could sort of move forward to larger controlled trials to establish safety and efficacy they got caught up in the counterculture movement and the war on drugs

00:09:48 richard nixon declared timothy leary the most dangerous man in america and um the controlled substance act was enacted in 1970 and it sent psychedelic research into the deep freeze uh for a long time until recently and just a a quick note that before western psychiatry discovered psychedelics there's been

00:10:19 centuries and you know even more use of various kinds of psychedelics predominantly across the global south by indigenous groups and a lot of the indigenous groups that were using various psychedelic substances were really tamped out with uh colonization when um especially in south and central america um and i would really recommend make jay's book on masculine a global

00:10:51 history of the first psychedelic which really traces a lot of that kind of the pre-medical history of psychedelics and a lot of the medical research and psychological research owes a lot to the work that was done before by indigenous communities so i just wanted to acknowledge that as well i was struck um by the fact that uh there seems to be something slightly different about using

00:11:21 let's say alcohol as a social lubricant um an anti-anxiety treatment well anyway the precedence of services and anti-anxiety treatment it's not a very good one overall but but there seemed to be difference between the use of alcohol and the use of psychedelics in as much as their psychedelics sort of seems to bring along with it this notion of like changing one's view of reality which seems to be different from alcohol maybe you change your mood or changes

00:11:52 your anxiety level or such but not so much a change of review and reality i wonder how much that plays into the current interest in it because uh it is a little bit of a unique uh it has a sort of a unique appeal for many people hi it's a pleasure to be here with you all

00:12:22 so i should also um say before addressing your point about alcohol being somehow distinct from psychedelics uh so-called that psychedelic as a term is is a relatively modern invention and still one that may not encompass exactly what we're attending to here it was coined by a psychiatrist uh humphrey osmond who was competing with aldis huxley for the most

00:12:53 compelling name and and they landed on this grammatically incorrect portmanteau to encapsulate what they thought were the the cardinal effects of of this class of substances and it's worth mentioning um in deference to neshe's point about indigenous traditions that many of them find it objectionable to

00:13:24 refer to these compounds as as psychedelics that for many of them they're sacraments teachers medicines and it raises questions about whether we're looking at a completely novel group of compounds um or if there's something about them that's novel to western tradition um at least in in this

00:13:57 post-industrial phase alcohol as well um as as many of you know may have so-called psychedelic effects if approached in in the right spirit um you know the the dionysian rights of ancient greece involved ecstatic immersion in the mysteries and communion with with godhead with nothing more than cabernet so um you know we should really think deeply about

00:14:28 not only what these medicines these compounds are doing neurochemically but what the cultural representation might be and the ritual surrounding them how we're approaching them um so yes when we're treating anxiety with with some merlot at night that's very different from getting set up with a psychedelic psychiatrist and getting prepared and then going through

00:14:58 the experience and then going through whatever integration might be um but there are people who are using these substances regularly in a way that might be dampening their power that [Music] ways that require perhaps a great deal more preparation and intentionality than and currently we're giving alcohol at least most of us were giving alcohol

00:15:37 there's some background noise i'd like to ask all of the panelists to be sure that they're on mute when they are not speaking but thank you very much for that that very comprehensive summary of where we are now for those of you who've already speak and spoken and i think some of what jerry talked about also has a generational flavor to it so i'm hoping we could at

00:16:08 some point get into that in terms of the different ways that the generations use some of these substances i could add one thing um i find it very interesting uh that at a moment where you could say our culture has very much valued autonomy and individualism um you find in so many uh contexts that a need for connection

00:16:40 is arising despite all of this and whether one call it um part of a greater context of ritual and community or whether that connection is now being sought in these therapeutic sec sessions um to recover a sense of connection and community and to alleviate suffering to be able to enable connection or greater connection with

00:17:10 other human beings i think it's also part of a cultural moment where there's been a greater acceptance of certain forms of [Music] uses of drugs on a larger scale when we're seeing the legalization of a variety of of other substances across the united states so i think this is also playing into the importance of the moment as well

00:17:47 we have this already the sort of division between uh its use uh or at least a partial division between its use historically in ritual and not specifically in the sort of latter-day notion of what therapy is or therapeutics is um and it's it's i wonder if um we could talk a few minutes about how this is these are being the drugs are being evaluated in terms of therapeutics and then go back and say whether is that all there is to them

00:18:18 are there other um aspects to psychedelic use that doesn't specifically fit into the mold of our sense of the therapeutics in the modern times alex maybe you'll say something about your research um on depression yeah i can definitely i think speak somewhat to that although i would i would say i mean we have clinicians here as well who can answer that question quite well

00:18:48 um but i i would i would say that yeah the current resurgent and the research to psychedelics i would say is in large part due to the therapeutic potential um the fact that there has been some pilot smaller scale clinical trial that uh i would say restarted uh coming out of the more strict scheduling in the last 15 years or so where it's shown some pretty strong efficacy in certain amounts of certain types of disorders like depression as well as substance use disorder

00:19:19 um i think it's interesting to think how it may be and we can talk about this how it may be a departure from some of the uh uh view on these compounds um in the past i think with the resurgen i think at least in my sense there's more of a try to follow a bit more strictly in terms of for medical use perspective to try to keep it a bit more scientific or to use it in a more

00:19:50 um control manner let's say um relatively in the past i think everybody is a bit more careful in that way um so yeah i i think that's a good topic to discuss uh in terms of how it's currently being studied and being used as opposed to some of the past history and also some of these very intriguing effects of these um these compounds

00:20:21 hi i'm sure steve can also give his perspective on the clinical development of these compounds i entered into this field um interested in um really correcting a misconception that was very prevalent at the time that i started doing research with ketamine which was that the psychoactive effects of ketamine are totally irrelevant to what it's doing and

00:20:51 that any effect that we're seeing therapeutically is entirely neurobiological neuromodulatory it's fairly evident from anyone who knows the history that ketamine um has been looked at as a as a so-called psychedelic um insofar as its psychoactive effects were thought to be crucial for its efficacy um but 15 years ago that would have been

00:21:22 really problematic to emphasize um it was introduced as a biological intervention something that's given much like ect or transmagnetic stimulation with the psychoactive effects something to do away with perhaps developing a new medicine that is completely innocuous psychoactively something like an ssri doing exactly the same thing neurobiologically but without the

00:21:53 experiential psychological effects but the research that i've done has looked at how we might uh integrate ketamine um at a psychoactive dose with uh various types of psychotherapy and mobilizing some of the experiential effects that occur to initiate change particularly with addiction and that's i think where things are

00:22:25 shifting in the medical domain looking at experiences that historically have been considered problematic off-limits um psychopathological and investigating their utility and how they might be important to work with now all of this is to say that there's been a counter current at the same time of

00:22:57 persisting in regarding these these compounds as entirely biological and investigating whether there are compounds we can develop that do away with psychoactive effects or that simulate what's happening neurobiologically [Music] and i think we have to really consider what um might be lost in in doing so um we stand to remain firmly in science in a paradigm

00:23:27 that that may not be doing us well first of all um and second we may be losing sight of how we might expand what human experience is or expand our understanding of human experiences so that we could work more fully with even its more perilous edges thank you for that it's it's a little difficult to hear part of you there's a great deal of background noise

00:24:02 is it possible to to to mute that background noise so we can really hear what you're saying which is quite compelling yeah i should uh apologize i'm upstate currently and in what's called a bomb cyclone and so i had to i had to run to um another town that had wi-fi and i'm i'm at a at a friend's restaurant currently um all right so i apologize for the background voice

00:24:32 but well what you're saying is so compelling we just want to hear it yeah i i should i'll finish here with um the other thing to keep in mind is that this is all happening within a very concerted kind of um financial effort to move forward with developing new compounds for medical use

00:25:03 as well as to create new academic centers and keep the research machine going so we i think we have to keep those aspects of this in mind that that this would not be happening if it didn't um involve the vested interests of certain elites i just want to clarify one thing i think i want to try i think i'd like to um

00:25:37 um make clear what i think you were getting out elias because i i some people in our audience may be confused by this i think you meant uh that uh you were making distinction between the bio quote-unquote biological effects and its um this sort of i guess what people would would loosely refer to with the psychedelic effects or the trippy effects of the of these drugs um because of course all the known antidepressants have psychoactive effects and the question is whether

00:26:09 these agents can provide positive therapeutic effects the those those psychoactive effects without the ones where there's an experiential change right which and i think you're claiming that it might be you're going to be throwing the baby out with the bath water if you don't acknowledge that these mind-altering or psychedelic type effects and the neuroplasticity that it seems to imply that without them you may be throwing the baby out with a bath is that a fair well absolutely i think ontologically

00:26:39 to reduce what we are to um brain changes is to also just do a disservice to kind of the range of of experience um you know what constitutes us and to fall into a kind of facile materialism um you know invariably there's a very significant important dimension to what we experience i mean it's it's ridiculous that i have

00:27:10 to say that but that i mean that's that's that's important to acknowledge and and reducing what these medicines do to neural effects is congruent with this really problematic materialism um so and it's all the more potent with with these substances because they blow up all of those categories i mean the experience that people describe

00:27:41 um is incredibly metaphysically challenging right we you know we are confronted with the limits of our knowledge and um i'm sure patricia can can talk about you know that that you know the cloud of not knowing um that's you know so common in mystical literature and to be just thrust into that um you know is uh

00:28:12 i think an integral part of what we're what we're seeing here with with these medicines providing benefit i've shown that in in the research that you know the experience of ineffability mediates any benefits um mediates any benefits that ketamine is having so it's kind of a crucial component and that's not unique to ketamine it's also seen with other with other substances um

00:28:44 the so-called mystical type experience is is an important part of whatever they're doing um so yeah i think that's particularly potent issue because we're seeing here a kind of explosion of traditional conventional ontology and metaphysics um accounting for the benefits that these these substances are providing and then and then doing this post-hoc shoe horning of these substances into really tired obsolete metaphysical systems i mean it just it

00:29:16 seems to me um really losing sight of the shift the great shift in paradigm and ways of thinking and ways of being that these substances could occasion not only individually but collectively can i say something um thank you so much uh elias for for that contribution the one one of the things that struck me

00:29:46 so much in all the material that i've been reading is the necessity like you said of a sense of the ineffable or restoring a sense of enigma to the world or for example allowing for the sense of potential and possibility to re-inhabit or re-inscribe ex be re-inscribed and experience and i find that that the language of science is often describing that at the neurological level but it's not producing that experience

00:30:17 that has to be effective emotive um part of a belief structure and experiential at its core so i'm really interested in this uh tension between the experiential and um and its limits too and and how this therapy allows for um something quite radical to happen um in that register

00:30:48 i think one wonderful go ahead oh i was just saying maybe i will also respond a bit to eli i think that's a very interesting point and as a basic scientist studying the actions of these drugs and animal models i mean that's something that i think about quite a lot there's definitely a limit in terms of what we can study neurobiologically these what these drugs would do we study it at the level of receptors the level of cells that there are some neurons there's obviously limits in terms of neuroscience and how we can right now

00:31:19 explain or not being able to explain things like consciousness or some of these connections that um we talked about um but i do think that uh uh i think being going full way in terms of trying to understand the therapeutic effects entirely based on neurobiology i think is fraud i would agree with you on that like i think it's that that would be ignoring the complete picture to based fully on biology um but i do think biology can still provide a lot of values in terms of

00:31:51 what these drugs are doing and there's so much missing right now i feel like in terms of a lot of the research it's done in the 50s and the 16 and 70s where a lot of the techniques were quite all now we can have very clear ideas on you know that we can have high resolution of what these receptors look like um we can have a complete image of the human brain under the influence of these drugs these uh i think observation experiments give us tremendous insight on how our brain looks like uh under the influence of psychedelics um so i i think yeah i'm a bit more

00:32:22 optimistic in terms of what biology can tell us i don't think it explained the full picture but i think it's a necessary part of trying to explain this whole experience if i could jump in quickly as well just to refund some points that elias brought up there's a really interesting book that came out recently by james davies called sedated how modern capitalism created our mental health crisis and in that book davies lays out some really compelling evidence that

00:32:53 the medicalized individualized approach to treating mental distress um where you kind of just give people ssris and you tell them that it's based on a chemical imbalance in the brain that that has actually fueled the the rise of mental illness because it's emphasizing this you know you take a pill you focus you don't you don't think about the environmental contextual factors that are contributing to your distress and instead you focus on just

00:33:24 you know your own brain chemistry as an individual and there's a lot of evidence in the way that the corporate approach to rolling out psychedelic medicalization is going that there's an attempt to kind of capitalize on the failure of ssris while kind of taking that same shoehorned approach of treating suffering at the level of the individual and applying it to psychedelics since just it's you know it's it's a replacement replacement of one metaphor for another so instead of chemical

00:33:54 imbalance let's fix your your chemical signaling in your brain instead it's metaphors of stuck energy and the need to increase neuroplasticity but it's still distracting attention away from the larger systemic factors that are very important to you know the extent of distress that's currently across the planet and so i i'm personally very interested in the potential of psychedelics to help bring awareness to the ways that our senses of identity our sense of self has been conditioned by living in capitalist

00:34:26 systems that are actually very harmful and and helping us to rewrite our narratives both about ourselves and our relationships to each other and kind of inspire things like solidarity and working towards systemic change and i worry that some of the the capitalist momentum behind the ways that psychedelics are being rolled out and i'm speaking as someone who's been working in the field for over a decade so i i was there before the money i've kind of been seeing the transformation that's been happening with the field and the incentives that happen when money is given to develop certain kinds of

00:34:57 visions of what psychedelic medicines are um i think that there's a risk that those larger systemic treatments that kind of psychedelics for systemic change are being underemphasized at the expense of this individualized model that's just treating an individual and trying to kind of create get get income from that rather than addressing the root causes of social necessary social change okay that was a that was a really great point um i'm reminded of a conversation i had

00:35:28 recently with someone who is very entranced by the psychedelic zeitgeist and was speculating about um how much good might come from opening up ketamine clinics to the homeless and providing support to to the homeless by you know giving access to ketamine infusions completely alighting and glancing over the the sorts of issues that niche is bringing up about

00:35:59 the the systemic problems of lack of a place to live lack of health care lack of food i mean if we really want to help the homeless we're not going to stuff them with ketamine we're going to give them a place that that keeps them warm and that that takes care of them and give them opportunity and and there is this this this kind of type machine that's going on right now i think in in tandem with the rapid corporatized rollout um or at least the fantasy of a rollout

00:36:30 of these these compounds to to proclaim benefits that far exceed what what is really possible here um and we're not going to solve our world's problems by giving everyone an experience of interconnectedness you know that that or or you know communion with the cosmos and their real work needs to be done um so yeah i you know i'm i share um

00:37:02 nashe's concern about the the challenges here with remaining caught up in a system that is more about selling products to people who can buy them rather than rather than helping the world serving others um i may i like to push back a little bit on this this discourse and anesha's point

00:37:33 about the chemical imbalance theory of antidepressant treatment i think it i know there are instances where physicians or nurse practitioners or whoever maybe who are prescribing these medicines may treat the person like a in a little black box and give them medicines and just say it's a chemical imbalance i'd say it's really a terrible caricature of what real clinicians do in real time that that's all they do with their patients they don't not they're not concerned with the patient's

00:38:03 experience it's i think it's actually uh reckless to suggest that because it's just not true typically there are plenty instances of that i'm not saying it doesn't happen i'm just saying it's wrong to render the typical treatment between a doctor or mental health clinician and the medicines they're using to prescribe that they're just you know treating them as a chemical a bag of cannabis uh chemicals i don't think that's true also elias brings up a very important point here and it's also picks up on something you said in shay which i i do agree with but

00:38:36 then i think well we're talking about psychedelics as a group of i guess well psychedelics and psychedelic experience but if we're going to talk about them as potential treatments we have to talk about them as treatments and what do they do and you're right allies to say well if it doesn't solve the world's problems to give one medication to one individual person i think the humanities are is a great place for us to enlighten people with or without the use of psychedelics so um the job isn't only on the

00:39:10 pharmaceutical companies to solve all these problems but it's it's what they do and again last point i'll shut up no of course there are some terrible um incentives in place for pharma to develop drugs in ways that are not in everyone's best interest that i agree with also as well but in general we are talking about the class of medicines and what it can do so so just if i could really quickly

00:39:41 respond to a part of that so part of my issue with the way that many of the big you know kind of millionaire billionaire funded psychedelic corporations are rolling out is that they're using aspects of the experience like you feel more connected to nature you feel empathy for people who are different from you as a justification for rapid scaling and monopolization of access to psychedelics and what's happening there is you're kind of dangling this you know partial truth about what

00:40:11 can happen under psychedelics but using it to justify promoting a system where wealth is funneled to the top there's you know gross inequality in society and it's actually that kind of phenomenon that the literature suggests is actually fueling things like um the climate change issues and political polarization so if you're saying one thing you know kind of using the uh phenomenology of psychedelic experience but you're systemically in these cases

00:40:43 of these corporations contributing to the underlying systemic issues that are actually fueling those issues so it's to me that that's part of part of the issue and just regarding the ssris there was a recent study kind of comparing uh led by rosalind watts and robin hart harris comparing ssris as a telegram to psilocybin and they came out both people in the psilocybin group and this teleprom group came out feeling it it kind of comparably roughly improved and

00:41:15 rosin watts in reflecting on that was suggesting that it speaks to the quality of the care that was being provided so while you know a lot of especially in in the uk where um james davies is writing about where the um the national health service it's cheaper to give people a pill than it is to give meaningful sustained psychotherapy and and talk therapy and so it's a run to that problem where it's like the cheaper option is rolled out when really people need relationship they need kind of interpersonal care and

00:41:47 that tends to be underemphasized when the biomechanistic approach to treating mental illness is overemphasized i i think it would be extremely helpful to me personally and perhaps to others in our audience if we could hear more about what the difference is in the various substances are and how important that might need to be i'm sure you know that there are now these

00:42:18 especially in people in their 20s these so-called psychedelic parties where six o'clock is ketamine seven o'clock is cocaine eight o'clock is sila silva you know nine o'clock is some other kind of mushroom and and we don't know what what is being sought in that kind of going into altered states and i think it would be enormously helpful to have more understanding about what what the effect of each of

00:42:50 the drugs is uh beverly can i ask one thing though one of two things that seems to be so important in relation to the actual therapeutic effect is language um as nisha was kind of describing that the communicative therapeutic process has to be also integrated into language that the experience as entertainment is i think from my my

00:43:21 understanding is a completely different thing and that this is distinct from the entertainment value of that experience in that it is so essentially dependent upon the language the the integrative communicative aspect of it and the ways in which it becomes part of a larger therapeutic context so i wonder if i could ask the people here who are more experienced obviously in that and and talk a little bit about the role of language this is also where the humanities comes into play as well in

00:43:52 terms of the role of narrative the way we narrate our experiences and the way in which that kind of narrative potential becomes altered and what narrative has to do with experience in general yes and i think that's connected to the whole motif of whether or not one can say and some of you have addressed this that an altered brain state is the same thing as the spiritual experience and i wonder if dr ross could

00:44:23 um enter in here and tell us sort of from the background of all of his research how we can place between the spiritual the biological uh the altered state where where do psychedelics fit in and which fit in where is there any distinction that we need to know about

00:44:54 see there elias do you have thoughts about that or alex yeah i'll let i'll let steve um answer the question after that so the question was about um first of all parsing between the different substances and then also parsing between the different effects that they might occasionally biological to not just effects but but like the the metaphysic domain that we're talking about yeah yeah

00:45:25 um well i think uh as as was said earlier language is important and it's first of all important to emphasize that psychedelic as a as a category subsumes a variety of different agents acting in a in diverse neurobiological ways um the encompassing agents that work on the serotonin system

00:45:56 the 5-ht-2a agonist so-called the classical psychedelics there are also serotonin releasers like mdma cannabis is historically considered a psychedelic um which the back to the metabolite of which is equal gain is is a very mysterious psychedelic it's still not clear what it does so there there's a

00:46:27 variety of different immediate neurobiological effects of these substances the shared final common pathway neurobiologically appears to be a modulation of global brain activity um where the usual um that you know i don't want to get too too far afield with with neurobiological explanations but the the usual organizing schemes that

00:47:01 the brain falls into electrically they become modulated and um connections that ordinarily are very tight between different regions become weaker and areas that ordinarily aren't in communication begin communicating more and that may lead to more protracted [Music] effects on [Music] the

00:47:32 neuroplasticity of the brain insofar as there's opportunity for new neural connections to form and states that are comparable to this has been seen in rodents when the animal is best capable of learning new things um to put it very simply so there's there's there's a clear neurobiological correlate to all that's happening um

00:48:03 at the same time you know to return to language there are also these very um difficult to understand and articulate um experiences that occur that that require a kind of um a responsive framework to help the person articulate make sense of them and move forward with them in the past in indigenous traditions for example that framework was cultural communal right now it's um

00:48:36 uh let's call it psychedelic um in the in the new wave of research that's been happening where there's a a um kind of syncretic quasi-new age mindfulness-based um recognition of a certain mystery that these these experiences occasion and providing various um opportunities for the person to mobilize

00:49:06 those experiences in a manner that might have a therapeutic impact and and that process begins from the very beginning and how the process is talked about how the person is prepared for the experience there's a certain style of providing the medicine or the compound to allow for the experience to unfold in a relatively uh benign way again i'm sorry about the background noise um and and then afterwards there's again

00:49:38 this this this integration process as it's called to help the person move forward with whatever new inside perspectives might have been might have been gained you know that is a very different process than the the parties that you mentioned which i don't think are are recent i imagine they've been going on since at least the 1920s but um you know so that this this um recreational use that doesn't involve

00:50:08 the same intentions motivations the same of course context and a clinic as in the case of recent research and that leads to very different engagement with whatever is produced um it's less about inside or or um or uh it may be about inside but it's it's less about therapy and and and more about a kind of personal

00:50:38 engagement whatever that might look like recreational sexual psychosexual magical um so i you know i i'm yeah i i think context is important and you know i don't need to bring out the the set and setting thing i'm sure everyone's heard it a thousand times but you know that's that's a it's an important um aspect of work with not only these medicines but any kind of you know surgery for example isn't something we do in a kitchen on saturday

00:51:09 night you know it it requires a great deal of preparation context guidance so i hope that answers your question i didn't get to the whole you know uh you know what's the what's the connection between the mind and the brain because i i don't think that over the course well i thought we might pick up a little bit more on this topic of i think the

00:51:41 you know neuroplasticity whatever uh however much a double edged sword it might be in terms of the distribution of these treatments uh it does seem to be where there is an interface between the biology of uh this research the therapeutics and also narrative and language it is it is felt by those who endorse this sort of treatment that we are at least taking some sort of shortcut towards

00:52:13 neuroplasticity and opening of the brain up when it may otherwise be in sort of a stuck position in one way or another and for whatever reason and they're multiple those those reasons there were there are there is some indication that we are opening up these pathways in the brain um um i'm sure some of the others can speak to this and that allows for the narrative to take a different path and that narrative may include my what my life is like what sort of person i am etc how i

00:52:43 relate to others maybe some of the others might want to speak more to maybe explaining this information about the neuroplasticity in the brain cells steve what do you think about this i think alex is the best person here to explain neuroplasticity but about the other question that beverly asked in terms of clinical issues

00:53:13 which part of the question beverly you want to repeat your question to steve um i i don't know if i could repeat it exactly but i was wondering about the different effects on the brain and then we have to also think about on the mind of the different sorts of substances that we're talking about and i'd like to add into the question of context the

00:53:44 the whole idea of the trust and the transference into the person who is administering this but that'll take us off and do another piece but we are not knowledgeable about the distinctions and what does what yeah i think elias did a good job of answering that question it's a very very broad question well what would could you add from your own very particular experience and long experience

00:54:15 how we should best approach this well what i could add is um you know the my experience working with patients so i've done work um with psilocybin patients that have advanced cancer and that work is has been very moving and i think is one of the areas that is the most promising and we're going to be doing more work in that area out of that body of research we started looking at major depressive disorder and there are

00:54:46 a lot of different programs now looking at major depression and they're sort of converging signals that it may work for that disorder which is very important it's uh one of the most disabling neuropsychiatric conditions in the world in addition to that addiction is a very promising area here and uh we just finished up a trial using psilocybin assisted psychotherapy to help people that have alcohol use disorder and uh that's um kind of picking up from the promising work of lsd and alcohol

00:55:18 use disorder and there are several other programs of research looking at other substances of abuse matt johnson hopkins is studying psilocybin assisted psychotherapy to help people with tobacco use disorder nicotine use disorder peter hendricks in alabama is studying psilocybin to treat cocaine addiction uh there are other groups looking at opiate addiction um so i think the most mature programs of research are with psilocybin in advanced

00:55:48 cancer and not just advanced cancer other life-threatening medical conditions where there's existential distress we were one of the groups along with johns hopkins to find psilocybin reduced demoralization in advanced cancer and that's the area that i've become probably the most interested at this point and we have a group of new studies looking at psilocybin and lsd in patients that have advanced or terminal cancer and also looking to do work in early stage cancer like breast cancer that the

00:56:19 rates of distress can be as high in early stage cancer than it can be in an end of life and important to intervene early so i think you know these are all promising signals around efficacy but these are all been small pilot studies and we need to do bigger studies to see you know if there's true efficacy we need to continue to do the work so that we can optimize safety it's very important um that we have good safety outcomes um

00:56:50 so i think those are the most promising areas but there's so many different directions to go that it's a really exciting time to be in the field thank you very helpful others thoughts i just was going to ask steve in terms of cancer patients what is it your especially advanced cancer patients what is it you are trying to achieve

00:57:22 and what is it you observe when uh you are giving them the uh psilocybin or whatever you uh uh lsd yet you give them but in other words what is the goal and how do you see the benefits yeah well patients that let's take advanced cancer advanced cancer has very high rates of anxiety and depression about a third of people will have some form of anxiety or depressive spectrum disorder and then if you look at

00:57:52 existential distress like death anxiety demoralization syndrome upwards of 50 percent with end of life cancer and other medical illnesses will have that distress and having anxiety depression and existential distress in cancer is associated with both poor medical outcomes like decreased survival and poor psychiatric outcomes like increased suicidality and what we found in a pilot study that we published in 2016 that single dose psilocybin in conjunction with the manualized psychotherapy that

00:58:24 was existentially oriented produced rapid reductions in anxiety and depression that we found lasted many months we even did a long-term follow-up suggest the effects may have gone out as long as four and a half years but uniquely we found reduction in existential distress we found patients uh then these were patients where they had um kind of like advanced cancer they got stuck they felt that life no longer had any meaning they no longer felt connected to sources of love or spirituality and they kind of have this

00:58:56 haste and desire to want to be dead and what we found is that psilocybin pretty rapidly changed their outlook created a very meaningful experience an experience of unitary consciousness experience of being in touch with infinite love strange experiences they were often very challenging very difficult rated among the most significant and personally meaningful experiences of their entire lives and that they they said that that opened a kind of door for them and allowed them

00:59:27 to think about their relationship to cancer and death differently and the last parts of many of our patients lives were filled with meaning love connection they were able to die these good deaths so that that work was very very moving and very like surprising and so the idea is to replicate that so we're going to be doing a much larger study in 200 participants looking at single dose psilocybin in conjunction with psychotherapy to treat stage 3-4 cancer

00:59:57 patients that have anxiety depression and demoralization syndrome and we have a new pilot study going back to the work of eric cast using lsd to treat cancer pain i designed a study a controlled trial using lsd assisted psychotherapy to treat pain in patients that have advanced cancer as well as anxiety depression and demoralization so so many areas to go with with the end of life existential stuff and that's the an area that i think is really worth exploring further

01:00:34 i find it really interesting that many of these conditions well end of life is really seem to be well no i let me let me correct that i'll get my point out i i going back to this notion of neuroplasticity and narratives being stuck i said in the most general way a lot of these conditions that we're seeking to help and overcome suffering involves some sort of stuck state um some people who are interested in networks network theory talk about attractor states uh addiction where

01:01:06 someone returns over and over again to a drug even when oftentimes it causes discomfort or pain at the advanced stages of the addiction people with ocd who keep repeating certain things and of course the death when you're facing death this is why i corrected my first opening comment it's difficult not to be stuck in a particular groove because each of us approach each of us approaches death with a set of fantasies and ideas of what it might entail and i dare say many of us would start to

01:01:37 pretty quickly converge just towards something that may not be wonderful for us to experience or easy for us to experience um so the idea that the neuroplasticity opens up the brain there's this research showing that it affects the default mode network maybe others could also talk that a little bit and bdnf levels that get changed with uh psychedelic treatment and this opens up the possibility for moving that you can call it those different parallel ways of describing this the narrative

01:02:08 the attractor state you know the way the brain is able to be plastic those three different ways describing the same process that might bring relief in some cases um and allow for a new narrative um i wonder alex does that make sense to you from where from where you sit yeah so my lab yeah has done some research on on how some of these drugs or psychedelics could uh influence neuroplasticity so we studied this in the animals and um i think steve was

01:02:39 referring to one of our recent study where we we can track the different neuronal connections within the animal's brain and what was striking about psychedelic in particular we studied psilocybin was that when you give one dose of this compound to the mouse uh we do see a growth of some new neural connection within the brain that appear really fast within a day and then uh quite different from other drugs that we've observed it lasts for also a long time uh so previously my lab has also studied ketamine and we can see increases and also you know the number

01:03:10 of neuron connections that lasts for about a week or so but now with cybin we can go back in about a month you can still see some of those connections being present so that seems like the these compounds psychedelics at least the pseudoscience that we've studied have quite a remarkable ability to enhance the plasticity potential of the brain and that's quite unusual because usually in adults our brain is quite fixed you know you might not want to change the wiring of your brain you learn certain skills you learn how to speak in language you don't

01:03:40 want to disrupt those things and then if you ask you know when do then you usually see we form new normal connection even as adult is when we try to learn something yeah when we try to be flexible um so in fact i i you you brought a point before and i was trying to respond to it but i agree completely with you i don't think this biological narrative of how things work in terms of neuroplasticity and some of the um acute subjective experiences necessarily in conflict in fact i think they can be compatible in the sense that the plasticity allows

01:04:11 one to learn to be to facilitate uh the integration of new experiences and then i'm not arguing the animal could have similar kind of experiences most definitely they might not have some similar kinds of mystical experiences and of personal sufficience as humans do but uh the plasticity process might be quite similar and then on human on top of that you could add those mystical like experiences that then integrate onto the system um let's just go back a little bit more to my work as scientists uh

01:04:41 we have an opportunity to study plasticity in animals and what we can study is you know how these species arise like what are some of the molecules involved maybe they allow us to control how to enhance the plasticity when those are ready to occur when does it occur um so we can better harness it i think um you know if psilocybin can do this can we uh open the window processing with some other way with some other drugs uh or can we somehow prolong it or can we make it better can we target a certain brain area i think all of those

01:05:12 could have a lot of usage in terms of improving some of these treatment options are there any studies of the background personality or existential experience of those who are able to make meaning in those who are not in this process or is that outside the realm of the

01:05:43 research what what the person brings to to it in the first place uh people are starting to kind of wonder about that we don't yet have the data to see what sort of predisposing personality factors might predict response but very interestingly research has been done showing that a single or two doses of psilocybin and lsd can lead to enduring changes in trait openness when you give the neo personality scale and so being

01:06:14 you know being more open to new ideas and experiences is you know one of the core things we tried to do in psychotherapy and change in general so it's uh we think of personalities pretty fixed by our early 20s but this research that first started johns hopkins kind of implied that you could get even from you know few doses long-term personality changes which is very interesting to to consider uh what how that may be leveraged therapeutically or in general

01:06:44 and that's more pertains to the psilocybin itself versus let's say ketamine it was found with psilocybin and lsd i'm not aware of lice is there any data on um ketamine and personality changes there isn't yeah um are those personality changes always positive that's a very interesting point a very interesting point just to follow up on what steve said um unfortunately that that finding has

01:07:14 not been replicated yet a recent study failed to find enduring openness after psilocybin so i i mean this this is an example i think of one finding kind of fitting into the zeitgeist of what these medicines are thought to do and then people running with it and again you know the neuroplasticity openness thing that we're hearing is also part of that though it is a very compelling story and gur dolan johns hopkins has shown that

01:07:46 the so-called critical period after these substances can vary in length um depend which correlates pretty well with what we're finding in in humans as far as the endurance of benefits with ketamine having a fairly short critical period after after a single dose to rats um followed by mdma by sulciben and by iba gang which

01:08:18 had a very long critical period so um you know that the neuro biology of these compounds can definitely shed some light on on what's happening but but i think we have we return again to that question of okay that then what so yeah um like what what do we what do we do with that and yeah um might we be uh kind of disproportionately focusing on things that are interesting but not quite relevant um to

01:08:48 how how to really engage with these compounds in in clinical and and communal ways um i um i wanted to make a point that i um in response actually beverly's question because i think uh many people who may be listening in the audience may get the false notion i know this does happen among patients that i see that the research is much more

01:09:19 wide-ranging and extensive than it really is i mean one of the reasons i think those were excellent questions you asked properly but one of the problems is there aren't yet enough studies to be able to tease out all these things and as elias just said there are many instances where we don't know exactly yet what we should be looking for even in some instances like what is the pro what are the parameters most related to to what not being depressed the being more open or there's just a almost an infinite range of possibilities we need we just need to

01:09:49 have more studies to be able to finally get to all of this i think i want to go back to this narrative notion again which i'm stuck on because i think it raises a second problem that is how long lasting will this be now there have been some studies suggesting that the results last out to six months this is something i've run into with patients i have with ketamine namely what do you do exactly if it doesn't last like what's the next step and what's the protocol to follow as a comparison to ect it took decades with ect not only to refine the treatment so it wasn't so

01:10:21 terrible to go through it's still not a picnic but it's gotten improved but it's taken a long time to be able to establish well what sort of protocol might one follow in cases of relapse or recurrence etcetera etcetera that's taken decades to work that helped we're at the very beginning of where there aren't even hardly any patients who've taken this in a therapeutic setting so far so we have that issue what as a practicing psychiatrist what i work worry about in patients who just let's say approach me with a problem of depression

01:10:51 is that i might get them feeling better between talking to them which i always do and giving them a medicine i might get them to be better in the near term but i think a lot of practicing psychiatrists feel that the patients i'll call it their narrative has a kind of inertia to it and some of those people move back into trouble because of that inertia now the question is is that based on their personality traits because that's one certain parameter is it the social setting they're living in is our social determinants playing a

01:11:22 role in this and if we go back to what neshe and patricia were saying earlier in many instances you have to go back and look at the actually the systemic the level of the of the system if that's not corrected for certain people how would you expect to have long lasting benefits no matter what we've done within the neuroplasticity i think it's an important problem it is there's individual it's like the biopsychosocial model there's the individual's brain there's their social life their family life their their network with friends and then the wider social setting

01:11:56 joe that's a really good question um i have to say i i i flinch a little bit whenever i hear about people changing their stories it's just it's another like psychedelic platitude that's kind of emerging um and while it's true you know that stories can become fossilized this notion that suddenly we're you know going through an experience that we have an opportunity to live in a new story um you know i think like a lot of the missteps of the so-called psychedelic renaissance um

01:12:28 michael pollan gave a lot of voice to um to these things i think that's the first time i saw kind of a mainstream way this notion that our stories are being rewritten by these these substances um but as anyone who who's a practicing therapist knows um that's that idea of a a story is is is a metaphor it's kind of useful metaphor but our patients aren't like living in their stories you know that that's

01:12:58 um that's um one way of well i like i wanted to interface with the term narrative which i do subscribe i get your what you're saying is exactly right that and certainly any simplistic notion i'm going to give you a new story listen i'll tell you what your story should be that's ridiculous and it's probably harmful even right but i'm saying let's think about in a broader sense of narrative not so much what a person tells themselves into the story how they how they fit into their lives well i'm thinking yeah i i say all of this

01:13:29 because it it can inform the clinical engagement we have with our patients if our mindset is you know we're helping them move towards a certain story right um even even as we may have a very expansive notion of what that means um there are certain metaphysical commitments that come with that and also commitments that may not recognize the the real gist of what's happening i i brought up ineffability earlier right the approach that i've taken um in

01:14:02 the research i've done with ketamine is not the traditionally psychedelic one um so the psychedelic um heuristic is there's an experience we prepare for it the experience is kind of a very powerful moment that can then lead to change and and that's a very compelling story but another way of of approaching it is is um to see that moment as

01:14:33 like any other and um to not perhaps invest it with the kind of weight the psychedelic weight that the psychedelic framework does and instead to allow it um a kind of catalytic force whereby a certain momentum that is being generated within the therapy can then continue accelerating through that experience um

01:15:03 so we have narrative building versus a kind of more fluid process oriented approach and the the approach i've taken with ketamine is to look at it from a mindfulness based lens to the mindfulness is the from the buddhist tradition it's about a capacity for acceptance for moment-to-moment detention for non-reactivity and also for um a sense of the mystery um that there

01:15:34 there's very little we can know absolutely about our condition there's a there's a certain um suspension of the kinds of stories let's say that can organize our experience and approaching the the experience um where the medicine is administered through that framework can help deepen this capacity so that it's not so much about a certain perspective that is then

01:16:06 attained as it is about a process that can be very enduring being cultivated and then practiced and reinstantiated through engagement with the with the therapist um so more of a practice oriented mindfulness-based approach um so that's you know that's yet another way to do it i'm not saying that any has um you know validity over the others but you know if we're if we're thinking about um a certain fossilized

01:16:39 perspective on things accounting for so much of our suffering perhaps what we need aren't new perspectives but uh but a vantage point beyond um perspective altogether right where you can kind of be more be more fluid and and practice that capacity well let me let me just add this then maybe we can

01:17:10 get back to this um idea about let me try to redefine what i meant by narrative again because i think it's totally corresponds with what you just said alive which is not narrative as text as let's say derrida my site text is sort of a living thing and it's growing and it's sort of something that isn't fixed and that's open to the sorts of changes i think you just described that's how i intended the word um so i think i think

01:17:43 we're going to i think we're uh an agreement there just just words right yeah no well but they could be important but i think that's that's how i meant it i and i know because i think from a practical point of view for me again i find that well whatever it is that thing and i'll it's i'm happy to call it a mystery whatever it is that causes some folks to sort of drift back into a state of woe or anxiety i want to help them not do that right so what is it and the medicines only go so far in some instances in many instances unfortunately right we

01:18:15 know that so what are those other things and i'm open to the the fact that there is there are these other very um open-ended uh and developmental issues i mean even developmental as an adult that need to be addressed for people to feel better in a lasting way or fulfilled in a lasting way um and that's why i think also the whole notion that there may be social determinants and other things that play a really important role in sustaining someone's sense of well-being

01:18:46 i think one one often sees that the narrative changes when in fact the person's narrative has been more what they've been told by family by society who they are and what they are and perhaps some of of the experience they have in going even if it's only into their bodies through these these different uses therapy or the work that you are all doing is because there's something that

01:19:18 happens where they get more into themselves and then their own story begins to come out and i'd be interested to hear what patricia and nashe have to say about that with their different forms of research which also bring in imagination which is so crucial to the idea of change maybe it's access to imagination that happens so patricia nache

01:19:54 sure i can i can say something um so uh two things about the question or the the word narrative i was intrigued in my readings about uh treatment and the role of narrative especially in relation to people with ptsd and the ways in which the inability for the

01:20:26 the effective trauma that encapsulated narrative in a certain way or gave it a certain kind of cathexis and avoidance or whatever certain relation to language that somehow the experience is allowed for a distance an ability to read oneself that enabled narrative there where it had not been so that narrative wasn't necessarily a fixed trajectory or a story or a

01:20:59 but rather was able to create a new experience and this is where for me i find the comparison with some of these therapeutics be really interesting with for example poetry and the ways in which for example you can think of literature as providing experience that you don't have and enabling a kind of experience of the impossible and so i think that for example poetry

01:21:30 also allows for certain kinds of simultaneous registers of meaning um and that that opens up uh a kind of otherwise determined field and lets it play so to speak so i found that important in regard to the the question of imagination it was interesting i was reading francois houston's uh book on uh what is hypnosis which i find parallels some of the discussions

01:22:01 about psychedelic therapy and uh he um wrote that on the relation of imagination to transformation for him and i think this speaks to to psychedelic therapy he said the imagi it wasn't simply an indulgence in imaginative play i.e the status of of um the hypnotic state it wasn't the an acceleration of the imagination that engendered hypnosis um and i think he says he talks about in

01:22:32 terms of a paradoxical wakefulness that allows the imagination to unfurl and transform our relations with beings and with things so the imagination stands in as an innate power to give order to the world or you know to give a different kind of sense of interaction with it so i found that that idea of this paradoxical wakefulness was really um uh an interesting one to think about in relation to um [Music] the use of psychedelics and

01:23:03 i i would i would just appreciate thinking kind of in my own future research about the kinds of interconnectedness between um different kinds of forms of practice aesthetic experience for example and ways in which that might also um parallel uh enabling other forms of generative meaning put it that way and i i also have some some thoughts on narrative and just speaking from my

01:23:35 personal experience i became interested in going into the field over 10 years ago when i was in college and i grew up neurodivergent and feeling very kind of incapable of interacting socially with people and have panic attacks all the time and just didn't know what was wrong with me but felt like there was something wrong with me and then i was introduced to psychedelics and for the first time i was able to i didn't even realize i had all these

01:24:06 expectations of myself based on a kind of neurotypical society about how i should be and how i should interact with others but it was this liberation from these expectations and impositions is how i experienced it and so i went from you know having panic attacks not being able to speak to you know people very easily to them when i went on to work in the field giving lectures in front of hundreds of people which speaks to sort of the how profound the effect had been in my case so in that case it was these kind of unconscious stories that i was holding

01:24:37 on to based on what i was exposed to that i was able to let go of and then feel my way into my own kind of form of being and let go of the anxiety the other point um i wanted to mention was i've been working on qualitative so in addition to my literature work which is my phds in literature i've been working on some qualitative studies with uh psychedelics the first one was um uh with dr ross's the nyu study with uh cancer anxiety with psilocybin and then more recently

01:25:08 i'm currently wrapping up a qualitative study looking at um smoking cessation with psilocybin at johns hopkins university and um what's really interesting with smoking cessation is that the literature they've found it's very hard to prevent people from relapsing and one of the only things that has kind of consistently shown promise in preventing protecting against relapse is for people who don't identify as a smoker there's something about the identification with smoking that is

01:25:41 linked to returning to those those habits and so part of the smoking cessation literature generally and the psychedelic assisted smoking cessation studies is kind of working to see if it can shift people away from identifying with the smoker in order to affect long-term behavior and one of the interesting things about this that speaks to how the field should be developing in the future is that a lot of what goes into that includes things that are in the treatment manuals but that are not

01:26:11 published or explicitly studied by scholars just based on how the publication conventions of the sciences for example but because there are things that are being done in the treatment rooms in addition to the dosing such as guided imagery auto suggestion hypnotic scripts that are being sort of put in addition to the substances it's going to be important to look at the full package of what's going on how can we best get what's that what's actually being done therapeutically and being able to study

01:26:42 the full set and setting package that's leading to positive treatment outcomes rather than focusing narrowly on the substance itself may say something about imagination um you know in in medicine uh imagination is sort of the bane of traditional clinical trials because that's what accounts for the placebo response

01:27:12 and we want to figure out ways to investigate the the really important mechanisms of a of a compound the biological mechanisms while doing away with any of the other factors that play into imagination suggestion expectancy anticipation the narrative that's constructed around the experience i'm coming to get this medicine and it's changing my brain chemistry and therefore i get better

01:27:43 doing away with all of those things when it comes to investigating these compounds because of how integral those processes are to the emergence of their benefits it can be difficult if not impossible to really test them adequately in the traditional manner where we're trying to do away with the placebo effect what we might be seeing and and i'm sure steve can speak to this as well

01:28:14 is a heightened placebo response we might be really playing with leveraging these innate capacities for imagining one's way to health and um you know creating a uh an intensification or a or a or a true experience uh of that narrative um within the administration context um that

01:28:46 consolidates those processes um brings them into greater play so that that you know when you mentioned imagination that that's also a very important and and clinically relevant academically relevant aspect of this work and and last i'm sorry go ahead steve oh um yeah it's it's possible that there are kind of super placebo effects going on

01:29:16 there is a lot of suggestion that goes in um right before the session we have people hold hands with their therapist state their intention for the day they lie down we give them my shades we have them focus internally we give them pre-selected music that's very evocative um yeah so there is a whole package and there's a lot of extra stuff going on i mean that's why i think it's important to have a control group and as much as you can it's very hard to

01:29:48 have a drug that can obscure some of the effects of the psychedelic without having therapeutic effects itself well last year we had a round table on placebo and the placebo effect and catherine walker presented her work on it among others suggesting or actually stating that there is in in the mind a placebo receptivity that's ready to go into action

01:30:18 with certain kinds of suggestion so out of that round table we really had a sense of the reality of the placebo effect not being me if this is really a stupid question but i'm thinking about ian mcgill chris book the master and the emissary and his emissary where he talks about left brain process and right brain process do you find that

01:30:50 in any way could you suggest if you think of those as relevant categories that these psychedelic experiences activate more right brain or is that irrelevant well that's an interesting question i you know i i've worked with people who have also been casualties of psychedelics and who aren't simply

01:31:22 entering into ineffable non-narrative states for therapeutic benefit but who develop these hyper-connected totalizing visions of the world that are basically psychotic and you know the direction that they take the brain um again if we're going to be using that kind of neural vocabulary is um

01:31:52 is variable um and so i i think we have to be very careful about falling prey to mythology about what what these substances are doing and mythology about what the brain is i mean i i think the right left hemisphere hemispheric thing is also something to be to be careful about um yeah i think the most compelling neural story i've heard is is the kind of this predictive coding story um

01:32:23 you know where you know that the brain is constantly generating um a map a paradigm by which to understand and interpret what's going on um and it's it's intended to help predict so these hypotheses are thrown out constantly to hone in on you know what um meets experience in the in the most fruitful predictive way

01:32:53 and sometimes that map can become very fossilized and constraining and and so the um things that should be interpreted with more nuance are interpreted in in very rigid ways a lot of psychiatric disorders can be understood as disorders of predictive coding where a very fossilized story comes to capture the flow of experience and what what these substances have been shown to do is to increase

01:33:24 the the entropy um so that that usual constraining process the order's experience is loosened with it um and you know that can lead to opportunities for refreshing our narratives used to use that phrase or to open up to experience more fully but it can also lead to such a a torrent of experience that the person drowns um and kind of is seeing is seeing a cat as

01:33:54 his grandmother and hearing on the television that um he needs to go and brush his teeth right away or he's going to catch cancer you know they're you know the usual things that um [Music] ambiguity um can create if it's too entropic um so yeah it can go in so many directions you know totalizing visions that are paranoid and hyper-connected or or you know an ocean of experience that

01:34:25 that one drowns in thank you thank you elias we can reference uh carl fristen on with some of the thoughts you just expressed yeah exactly great the free energy theory yeah i think it's beverly it's time for questions yes and before before we do go into that i would just like to say that our next round table will be on april 30th

01:34:56 and you'll see what the segway here which will be on what is the current understanding of metaphysics so we're moving right along in terms of of the these spectrums but we'd like to open up to questions either that you have already put up or that you now would like to put up so alex will you read the questions that have already come in uh yeah also i just want to address some comments i just want to thank everyone who commented

01:35:28 um for billy i hope we address neuroplasticity to your liking um to joseph and darren i appreciate your funny commentary on smoking toad venom darren i hope your friend's okay after smoking the toast paratha gland or the secretions at least was entertaining um and lastly uh to lawrence's comments on i guess the woke politics i guess i would just say politely push back that um given how messy psychedelics are to expect the straight-laced

01:35:59 conversation of psychedelics i think is a bit wanting um especially also if you consider the history of it if a sociological i guess critique comes about that one may not agree with i mean that's what i guess that's i think comes with the territory with regards to talking about psychedelics all right so with that um i think to uh sorry let me rephrase that so one comment early on uh johannes uh owetke i hope i pronounced that correctly they asked a few questions but i think one

01:36:29 that i think sort of is a good addendum to something elias was talking about with regards to people who are sort of suffering from psychedelics potentially or showing the negative effects of it they were talking about are there potential downsides to psychedelics or in particular they questioned about um overdosing so any just anything you want to add to that i just say that psychedelics if you're talking about the classic psychedelics

01:36:59 like psilocybin lsd they're remarkably safe from a physiologic perspective um the there are some psychedelics that are associated with death ivy gain is one um of them that causes uh potential uh arrhythmia and um bromo dragonfly there's some very potent two-way agonists that have been associated with death but in general the main harm of psychedelics is in the adverse psychological realm that they can produce acute

01:37:31 psychotic-like states they are really problematic for people that have underlying psychotic illness like schizophrenia or severe bipolar one disorder with psychotic features so we pretty strenuously rule out or screen out anybody that has psychosis and in uncontrolled settings psychedelics have been associated with all kinds of bad outcomes ranging from panic attacks to people engaging in dangerous behavior it's not a typical that you know this happens every couple

01:38:01 years an nyu undergraduate takes too many mushrooms and becomes psychotic and jumps off a building that was one of the reasons why psychedelics were shut down in the 60s is you can have really bad outcomes in people who are unprepared and that their psychedelics are administered in an environment that's not safe so there you would think that what's going on now we're kind of in the first wave of psychedelic research there was this moment in psychiatry they were touted as wonder drugs

01:38:32 and then soon became demonic drugs and i fear now we're kind of in this irrational exuberance phase that psychedelics are going to cure everything there's nothing can go wrong and i think we have to really pay attention to history so that does not repeat itself uh okay should i go into the next one okay thank you johannes um hopefully that addressed some of your questions

01:39:03 i would recommend um for the purposes of of also looking beyond simply the therapeutic research and the risks that come from you know recreational use to look at some of the experiments that occurred surreptitiously in the 50s there's a great book poisoner in chief that investigates mk ultra and the the

01:39:36 pretty nefarious uses that the american government had kind of dreamt up for how these compounds might be um helpful militarily and [Music] it's a it's a pretty horrendous read poisoner in chief i i recommend it okay so on to the next one uh from paul browdy thank you paul um so they're they're psychiatrists

01:40:07 they're talking about how they refer patients the ketamine treatments and the anesthesiologists remarks oh it's just the brain changes that result in the positive outcome the more experiential effects are side effects and so they were concerned that the patient just being in a setting playing on their phone while receiving the infusion misses the point of of the treatment um so yeah so how how does that potentially affect the efficacy of getting a ketamine treatment

01:40:41 well it's you know i've studied ketamine in several several studies primarily for substance use disorders and have also investigated psychoactive effects and at least in that domain psychoactive effects have clear significance all of that is with the caveat that i was approaching ketamine with the um the recognition could be potentially causing helpful psychoactive effects and so i had a framework in place that allowed for people to attend to those experiences

01:41:12 potentially fruitfully um you know they were guided through a meditation first it was a no cell phone policy in my lab you know they weren't allowed to be playing fruit ninja while while getting getting ketamine um but um all of that is to say that i've also had patients who don't seem to have any psychoactive effects but who still have some apparent benefit um you know and we are brains so i'm sure the brain has something to do with um

01:41:44 our well-being um and ketamine uh in in um animal models has shown um pretty reliable effect on neurogenesis prefrontal neurogenesis as well as increases in bdnf and mtor and um those other mechanisms which i'm sure uh alex can speak to

01:42:14 so the psychoactive effects may not be crucial for everyone but they are important to recognize as um likely to occur and having a setting that doesn't provide at least safety that that if they do emerge um there's a readiness to attend to them fruitfully um that i think that's crucial um so calling them side effects uh seems to me um you know not only dismissing um their

01:42:44 their potentially therapeutic value but also um losing sight of their inevitability in most cases i think for ketamine um i i would say that maybe the jury is still out right i i think there are some historical um differences with ketamine right by the time when it started i think the the world or at least the clinical world

01:43:14 maybe or also the basic science was maybe not as ready for uh for a paradigm that does involve kind of a sudden setting or assisted therapy or to leverage that psychoactivity effect it was still pretty much a world of uh pharmaceuticals so it was treated that way in both the basic science study as well as the clinical trial is also run that way um so i i think the evidence is thin i don't think many people have tested um yeah whether some of that setting effect is important or not so um

01:43:45 i think it's good to try to see if that's true or not i should also say when i first started doing research with ketamine to echo alex's point i i was given a lot of pushback because i was approaching it with some eye to how the psychoactive effects might be helpful and even hypothesizing and this was 12 years ago 13 years ago even hypothesizing that there may be a psychoactive a psychoactive relevance um was anathema to the institution at the

01:44:15 time and you know things have shifted and now nih is you know open to funding this kind of research but yeah that um ketamine emerged um very much with this biological apparatus in place of this will work primarily as a as a neuromodulator as a neurogenesis promoter and anything that it does apart from that is epiphenomenal and needs to be potentially

01:44:46 taken out of the equation moving forward um you know there's one other uh aspect to this issue that hasn't been raised i'd like to touch on it briefly and that is um for some patients the notion that they need to have that uh a psychoactive effect that it's it's an aw it's a disincentive to do it they're frightened of it um so that's interesting that's an interesting dilemma uh you know that doesn't mean

01:45:19 if it's if in the end it looks like that is crucial to its efficacy then then so be it and just like with some other treatments people are frightened of like surgery on their gall bladder they might you might say well if you're suffering enough you might want to overlook this it's not gonna it'll be good for you in the long term and let's see how far we can get with it but it is right now something that puts off a lot of people from that kind of treatment i'm also aware that in the actual practice i think you'll agree this is true elias um some of the uh when the patients start to have sort of a more trippy experience

01:45:50 the the treatment tends to be dosed down a little bit so to keep them on the verge of that let's say not fully in that sort of trippy head state um and i wonder whether that's counter to its therapy potential therapeutic benefit i think that varies um as you know there are a lot of so-called psychedelic ketamine clinics right emerging and seizing on the great public interest and people accessing these treatments and you know they turned into cash cows and often we'll sell you four infusions

01:46:22 up front before you've had a single one um they're not so concerned about keeping people um um just before that tipping point but anesthesiologists tend to yes be careful they may administer ketamine with the benzodiazepine um keep things cool um you know we didn't even get into and i you know i don't want to anger anyone who's upset about wolf politics we didn't even get into the

01:46:52 the issue of how um [Music] ketamine might provide a precedent for the direction these substances are going if we do roll them out like ketamine is the cheapest drug available really i mean it takes cost a few dollars to administer but we're having these clinics charging several hundred dollars um to primarily affluent um white people and not considering

01:47:23 how this medicine which is generic um might be made more accessible to um you know people of of other backgrounds with less means how we might change the existing healthcare structure so that it might be more available or other treatments might be more available you know there's a there's a concern here that if if these medicines follow the track of ketamine you know

01:47:53 we're not really going to be helping too many people i i don't know how many insurers are going to be funding um compensating a dyad which is what most has looked at having two therapists in the room with people several several sessions i mean we have enough trouble getting therapy um compensated right now with psychiatrists you know to to presume that insurance companies will just hand it over for several hours session with two therapists and is that going to lead to less

01:48:25 therapy being provided and potentially having um less of the interpersonal engagement that um you know nashe was talking about earlier i think i mean these these are these are really important questions and this isn't simply well politics you know this is this is this is crucial to to answer if we're going to be providing support to people in the right way and that that actually relates to another i think i saw a chat comment earlier about the other models that are being rolled

01:48:56 out like with oregon the supported adult use approach and some of the people who are advocating for that approach which um you know potentially you'll be taking psychedelics with people who have just a ged or a high school diploma and don't have therapeutic training part of my concern around that is that a lot of the we were talking about harms or dangers cause potentially caused by psychedelics historically a lot of the harms not all but a good percentage of

01:49:28 them relate to you know unscrupulous providers people who are either not trained enough or are have some kind of personality disorder themselves you know anti-social or abusive personalities that take advantage of people in some cases under highly suggestible context like that so i think part of my concern of how this is going to be ruled out will be to ensure that people do have you know are not in in context that put them at risk due to the

01:49:59 the personalities in the room um and i would just uh point people towards the the power trip podcast that's currently going out with new york magazine and symposia which is highlighting some of the the risks of harm interpersonal harm from unscrupulous providers uh sorry sorry yeah go for it i i just wanted to add that in addition to all these concerns there's also the kinds of

01:50:30 i don't know what to call it but the ecotourism of that's going into kind of the into indigenous communities to have an ayahuasca experience or these other kinds of things that raises the question of indigeneity and um there's an interesting institute the chakruna institute um that uh via laby is a part of and they have a indigenous reciprocity initiative that is just raises the question about

01:51:02 the kinds of ways in which these experiences take place and what they rely on and the kinds of power dynamics and economic dynamics that get associated with it i just wanted to bring that up that's a super important point i you know it is worth um remembering how psilocybin entered into um our world or western world is um you know a banker

01:51:33 who happened to be an amateur mycologist went down in search of this um sacred mushroom um a native woman maria sabina um provided him the the mushroom which he took back gave to hoffman who then identified the active component being psilocybin but we're finding that it's in the hands of bankers and financiers yet again again this isn't work politics this is

01:52:03 this is real and and you know this is kind of creating um not only challenges with how we might move forward with a true paradigm shift that that benefits everyone um but how we might give give um give back to where these medicines came from how we might honor um the in some cases millennia of tradition and and learning

01:52:36 that went on to inform how we engage with these substances currently it's worth also mentioning that the person who coined the term psychedelic had attended peyote ceremonies in order to better understand what the proper engagement with them might be so yes uh you know there's a there's a real need for um recognizing that this isn't simply about shoehorning these substances into

01:53:07 existing medical social structures that that they're revealing um by virtue of raising raising awareness um to long-standing problems they're revealing that we could be doing things differently we could be honoring where the you know where these substances came from we could be honoring the depth of ontological and epistemological complexity that they revealed

01:53:37 um all right thank you i could so there's a there's a bunch of questions and obviously we're about to push on two hours so are we feeling two more questions so i'll have to probably just select two of the group everyone's okay with that um i think that's right okay okay so apologies if i don't get your question but i think just to find questions that sort of fit what was just said um [Music] uh let's see i'm going through them

01:54:09 so lisa uh to benedict hopefully i didn't mangle your last name felicia was asking because i think uh something touching that the shea was discussing about the democratization of these therapeutic experiences given that the lake community is potentially becoming more empowered through either training or grassroots work and so how do you how do you think it's going to work between um like should psychedelics mostly stay within the professional medical community

01:54:40 or you know like how i guess um like how do you balance it between keeping it professional and then potentially the skepticism within the medical community that doesn't see it as necessarily medical work and sort of goes more to that like folks medicine that was sort of being touched upon with regards to um traditions of of of of natives and such

01:55:11 i'll just quickly say that i i'm personally in favor of decriminalization i don't think that i don't think that the medical establishment should be the only way that people have access to these substances i don't think the there's evidence to suggest that you know that prohibition is justified in any way that said i'm concerned with a lot of the a lot of like with the issue i mentioned with oregon there's a lot of certificate trainings and things popping up that are

01:55:42 kind of meeting this need or this desire that people have to be able to engage outside of the medical framework with these substances and a lot of those certificate programs can cost thousands of dollars and they're not really based in any evidence or any kind of any kind of expertise in many cases and it's it's sort of there's a lot of risk of people just kind of trying to make a buck off of this hype and excitement and so i think it's really important to really emphasize the science and advancing the science and getting more of an understanding of what's going on

01:56:12 but also not allowing medicine to be the only way that people can access these experiences all sorts of you know creativity was mentioned before creativity and connection and community building that are not necessarily like medicalized subjects that psychedelics can really lend themselves well to so i would caution against a purely medical paradigm but i would also caution against you know trusting any kind of group or expert that's popping up without a background of evidence and kind of offering suggestions to meet this this

01:56:44 current need for its current desire to to access psychedelic healing outside of the limited options that are currently available also we're not really in a position to be making those kinds of demands anyway people are using these substances you know they're even if they're medicalized people aren't going to restrict um how they're engaging with them to the clinic eco tourism drug tourism was mentioned there are

01:57:15 hundreds of ceremonies happening daily um just in the tri-state area and the the you know the underground psychedelic work continues to to grow rapidly so um you know i i think it's foolish to even think that we have any capacity to pronounce on what the right um use of these substances is that you know the they're they're being used and and i think what we should do is acknowledge

01:57:46 that that's the case and start thinking deeply collectively how we might engage with them in a way that [Music] it doesn't fall into old tropes [Music] that's willing to challenge some some really fossilized systems fossilized predictive patterns let's say in our culture

01:58:18 okay i think that probably you for questions given the time uh limit um but i just wanted to just add one one comment from my end because someone did ask about funding and just for their sex they know something that hasn't been mentioned is that i think research shows that currently for a new drug to come to market going through all the requirements that the fda puts forth it's about a billion dollars and hence as was said here a lot of the research into secondary comes from the fact that they're already made and the psychopharma kinetics already rather well known so there's less investment needed to sort

01:58:49 of breach the market as with a completely new pharmaceutical compared to these drugs so that was for smurfy d just to get that out of the way and i guess add a little extra context so that's it for my end you're a mute beverly beverly you're mute still still on mute

01:59:21 here all right all right thank you i appreciate very much as i'm sure we all do your participation today and what mostly comes forth is we're on a true cusp in terms of the directions and the projections and the possible vectors of what all the incredible work and research you're doing might take us so with most appreciation for giving us these insights and knowledge and

01:59:52 perspectives wish you well i hope you don't have the storm where you are that we have here in new york but go forth into cyclone bomb safely thank you everybody thank you everybody

02:00:39 you