044 - The Big Three

Program Notes

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Guest speaker: Casey Paleos

https://drpaleos.com/Date this lecture was recorded: 2018

Dr. Casey Paleos is one of the few psychiatrists to have worked with the Big Three: MDMA, ketamine and the psilocybin of magic mushrooms. In this interview, a day after his MDMA experience in Boulder, he shares what he’s learned from his years of psychedelic research.
Casey A. Paleos, MD
“Ketamine: A Light in the Darkness” by Dr. Casey Paleos

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Transcript

00:00:00 ►

Greetings from cyberdelic space.

00:00:19 ►

This is Lorenzo and I’m your host here in Psychedelic Salon 2.0.

00:00:24 ►

And I’m looking forward to listening to this podcast with you today, but before I turn the mic over to Lex,

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I want to be sure that you know about one of Joe Rogan’s recent podcasts.

00:00:35 ►

Now I have to admit that I haven’t listened to every one of Joe’s programs,

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but then again, I suspect that he hasn’t listened to all of these programs from the salon either.

00:00:44 ►

Then again, I suspect that he hasn’t listened to all of these programs from the salon either.

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But what I do with Joe’s podcast is to pick out the conversations that I think I would be most interested in,

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and I listen to them while I’m in the gym.

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Actually, now that I think about it, I would probably be in triathlete condition if I listened to all of Joe’s podcasts and worked out while I did it.

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Anyway, the program that I want to point

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out is his interview with Michael Pollan, whose books I’ve talked about several times here in the

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salon. In particular, I was taken with his book titled A Botany of Desire, and if you haven’t

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read that yet, you probably should. It’s a short, easy-to-read book that tells the story of how

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plants may actually be manipulating us more than

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we humans are messing with them. For sure, it’ll probably change your view about the history of an

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American folk hero called Johnny Appleseed. It turns out that old Johnny may have been one of

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America’s first major drug dealers. But it’s Poland’s latest book that I’m now looking forward

00:01:43 ►

to reading. I admit to not having read it yet because it only came out two weeks ago, but it’s Poland’s latest book that I’m now looking forward to reading. I admit to not having read it yet because it only came out two weeks ago.

00:01:49 ►

But it’s titled How to Change Your Mind.

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And the subtitle of this book is

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What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.

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After listening to his conversation with Joe Rogan, I’m even more anxious to read this new book.

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Now, I would have told you all of this anyway,

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particularly because Paulin and Rogan get into a discussion

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not only about psychedelics,

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but also about Terence McKenna’s stone-dape theory.

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And by the way, we’ll be hearing from Terence once again next week.

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But you can only imagine my surprise when,

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during their discussion of Terrence McKenna’s work,

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Joe gave the salon a shout-out, which I really appreciate.

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So, after you finish listening to this podcast from the salon right now,

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I suggest that you surf over to Joe Rogan’s podcast number 1121,

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where you’ll hear some new ideas about psychedelics

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that should give you some fun

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things to think about.

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And now I’m going to turn the mic over to Lex Pelger, who will introduce today’s program.

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A place like Rivendell, Lord of the Rings, inhabited by enlightened, spiritual, loving

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beings.

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I’m Lex Pelger, and this is the Psychedelic Salon 2.0.

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Today we have a real treat. Our guest is Dr. Casey Palios, and he’s one of the rare psychiatrists

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on the planet to have worked with the big three. He’s done research with MDMA, ketamine,

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and the psilocybin of magic mushrooms.

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He’s also an old friend from the psychedelic world, and we got to catch up with him at a

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beautiful Airbnb in Boulder, Colorado, right underneath the mountains of the Front Range.

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It’s not easy to find scientists with poetry in their soul,

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and I’m glad we got to find Casey in such an expansive mood.

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Hello, everybody. I’m here with my friend Casey Palios, and he’s going to talk about his life as a scientist and a researcher and a physician.

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Howdy.

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Hi. So I guess maybe the first question would be, what did you want to do when

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you were young? What was the first thing that appealed to you? I remember actually wanting to

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be a doctor early on. And I remember really loving biology. That was sort of the first thing that

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kind of gripped me.

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I mean, I think like every seven-year-old,

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I was totally fascinated by like dinosaurs and, you know, things like that.

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And then just like biology in general.

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I used to love watching nature documentaries as a kid.

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And, you know, just science always captivated me.

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And, you know, just science always captivated me.

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And then, you know, becoming a would have been too pleasing to my parents.

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And so I thought that I didn’t want to do that anymore.

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I thought it maybe was, you know, I don’t know, being too conformist to go down that path.

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And in college, I wasn’t actually pre-med.

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Um, in college, I, uh, wasn’t actually pre-med.

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I was a film major, studied filmmaking and, um, realized after I graduated or soon before I graduated that I didn’t have the self-discipline to make any kind of living as an artist.

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Um, in my opinion, it’s a lot easier to make a living as a doctor than it is as an artist. So, I mean, at least for me,

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I’m like very ADHD. And, you know, at that point, I really missed studying science. And,

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you know, the thought of medical school came back to me.

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And I entered it with sort of a different, a little bit different of an agenda.

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Even back then, I had the vague notion that I wanted to go into medicine to do something to, like, change things,

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change the status quo, change how things were done.

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At that point, I didn’t know how that would take shape.

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It was a very sort of kind of inchoate, embryonic idea in my mind, but, you know, I still retain that kind of inchoate embryonic idea in my mind but um you know i still retain that kind of

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and to this day i retain a sort of adolescent rebelliousness which i think is um a fire that

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a lot of people let go out and i never ever wanted that to happen to me and um so but you know i just

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followed my instincts a lot of times, like just kind

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of going in the direction that my intuition made me feel was felt like the most right.

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Um, and so anyway, went back to school after I graduated college, did my pre-med classes

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at Stony Brook, uh, lived at home for a a couple years in Long Island while I was doing that,

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and then went down, worked at a research lab at Duke in North Carolina for a few years

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in a lab that was trying to develop an HIV vaccine, which I think is probably still working

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on it.

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This was almost, I guess this is back around 2000, so almost 20 years ago now, but, um, uh, doing a lot of molecular biology and

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immunology and, um, really getting into, uh, kind of the, the sort of the weeds of,

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you know, how things happen, uh, physiologically on a molecular level. And, you know, in,

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of all my pre-med stuff immunology was the most fascinating

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to me just the way um the body’s immune system is uh how it develops over time how it operates

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the way we develop you know cellular and auto you know like antibody mediated immunity and and just that whole mechanism which is so beautifully sort of uh

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complex um fascinated me but so for a little while i thought maybe i wanted to be an immunologist or

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something wasn’t sure um anyway when i’m going to med school uh at University of Pittsburgh. At that point, still didn’t really know what

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I wanted to specialize in. And during my third year of medical school, we do our each year

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clinical rotation. So you go through kind of every sort of specialty and get a taste

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of what everything’s like and find out where you kind of fit in the best.

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And sort of to my own surprise, psychiatry was kind of the thing that really resonated with me the most.

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And it was sort of a combination of realizing, A, that you can actually help people.

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I did my rotation on an inpatient unit and had patients who came in like really profoundly

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psychotic and you know by the end of a week or two they were actually doing much better and

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functioning and able to leave and live out in the world and that was very um instructive and kind of

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profound to see that to see you know that there was actually something you could do to help people who were struggling that hard with something like that.

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And also, I kind of found my tribe of people.

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I mean, I think psychiatry, of all fields within medicine,

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attracts the people who are most kind of still…

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What’s the word?

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what’s the word?

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You know, it’s this,

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psychiatrists tend to have the biggest affinity towards the humanities.

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Like, they retain, you know,

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I had lots of people,

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like, people who were,

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like, the residents I worked with as a medical student and also you

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know going into residency i mean a lot of people were people who are also like reformed kind of

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liberal arts majors or whatever um english majors people who were uh

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you know didn’t hadn’t lost touch with that sort of side of things or what have you.

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But, you know, for me, the other thing I really have always sort of aspired towards growing up was,

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was being a writer.

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And so what drew me to filmmaking was this idea of telling stories.

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And, you know, psychiatry also very much preserves the humanity of the patients,

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I think, when it’s practiced properly does that, you know, you’re constantly dealing with people’s narratives and just the narrative of a human life in all its sort of complexity and meaning

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to have that be sort of the focus of your work was very compelling to me too

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and by that time also I had you know in college I’d become acquainted with

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the writing of Carl Jung and I realized that he’s actually, you know, was a psychiatrist and, um, you know, his theories

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definitely, um, spoke to me a lot. And, um, I think, and I’m kind of skipping out of chronological order here,

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but early in college I had my own pretty powerful experiences with psychedelics.

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And some difficult ones, mostly positive ones,

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but things that definitely left me sort of questioning the nature of reality and um the nature of

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what it is what it means to be a human being and what it is that we’re doing here like what the

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point of all this is um there just seems to be so much uh again you know from a biological

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standpoint so much immense beauty and complexity in the

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living world everywhere around us and it’s it’s just it’s mind modeling to think about

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the existence of all these things and also to be as a living creature ourselves to arise out of that

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with and develop this capacity to actually study it and

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understand it and you know draw meaning from it comprehend it you know albert einstein said

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the most incomprehensible thing about the universe is its comprehensibility and it’s that uh that is what really draws me to this work.

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That and its capacity for

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sort of stoking the crucible of transformation.

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The medicine, the drugs that we use in this work aren’t sufficient alone,

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but they’re a necessary ingredient, I believe,

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in sort of catalyzing that whatever sort of alchemical reaction is happening

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on a psycho-spiritual level to enable transformation

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and to enable people to break through the blockages that sort of crop up

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in their lives and um that keep them from from growing and progressing and evolving i think you

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know we’re all born with this innate inborn capacity to grow and evolve and uh depending

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on life circumstances especially you traumatic circumstances, that progression, that evolution, growth can become arrested, can become frozen.

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People can get sort of the process and up the kind of scar, psychological scar tissue that forms around that to give space for things to breathe and start moving again.

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For blood, so to speak, to start flowing through it to permit people to put down new roots and start growing in new directions again

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it’s a pretty difficult path especially these days to be both a researcher and a doctor trying

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to help people um how did that evolve for you and then how did being able to study these

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formerly demonized drugs come about for you yeah that was that was very serendipitous. Um, so, uh,

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you know, I started out, um, you know, when you go to medical school and you figure out what you

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want to do, you apply to a bunch of programs for residency. And, um, you know, I based my decisions

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largely on, uh, geography. I mean, obviously the reputation of school, but you know, I applied to a lot of

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mostly residency programs that were in the Northeast because I’m from New York originally

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and kind of wanted to go back home or near home to do my training. Cause that’s kind of where I

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wanted to end up practicing. So, so NYU was among those programs and I, you know, I interviewed

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there and was really impressed by sort of the clinical training.

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I mean, it’s affiliated with Bellevue Hospital, which is like one of the oldest, most famous hospitals and psychiatric hospitals in the country.

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And, you know, speaking to the residents when I was interviewing there, just got a sense how, you know, they really felt like they were getting excellent training.

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how, you know, they really felt, um, like they were getting excellent training. And, um,

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so wound up matching there for residency. Um, again, with sort of vague notions of where my career was headed. I mean, at that point, obviously I knew I wanted to be a psychiatrist. I didn’t know

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exactly what kind of psychiatrist I wanted to be, but I knew that I wanted to, you know, I didn’t

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want to be one of these guys who just sees four or five patients an hour and just dispenses pills and

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like onto the next one. I mean, that type of practice never, ever appealed to me. And another

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reason why psychiatry really appealed to me in general is that it’s one of the few professions

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that has, I think of necessity resisted this, the this, the impetus towards eroding the doctor-patient

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relationship. You know, I think increasingly in other fields of medicine, the relationship is

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sort of boiled down to what’s quantifiable. And, you know, you go in to see a doctor and he does

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a bunch of, or she does a bunch of lab tests and gets some imaging done. And, you know, everything sort of boiled down to

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the kind of the least subjective components of the presentation. And that’s what the decisions

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are based on in a lot of medicine. And to me, the doctor patient relationship is what was important.

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I mean, you could be a scientist and work in a lab and that’s, I would rather do that if it was all going to be about,

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you know, numbers and quantification. But the point for becoming a doctor to me was so that

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you can actually interact with other human beings and help them, um, in a way that, you know, is

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tangible and meaningful and sort of immediate. Um, you know, obviously, you know, basic science

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research is obviously

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very important and necessary, but you’re not dealing with like real life human beings in,

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in, in real time. Um, so, you know, I didn’t want to go and go through the whole trouble of medicine

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of training and medicine and going through medical school and all that stuff just to, um,

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find myself interfacing with, you know, mainly just a bunch of lab values

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and numbers. It just wasn’t, didn’t really do it for me. So, you know, with psychiatry, you,

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you know, for better, for worse, we don’t have, we can’t boil people’s problems down in psychiatry

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to like a bunch of lab values. We don’t have, you know, those tools. And I don’t know that we’ll ever really have those tools. Um,

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but it requires that you base your, you know, your clinical decision-making on getting to know

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the person that’s in front of you and getting to know their, their life story and their narrative

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and understanding how, you know, everything that sort of has transpired in their life,

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their life has brought them to the moment that, uh, has them sitting in

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front of you and telling you their story. Um, so, I mean, I knew I wanted that to be a part of what

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I did. Um, so, you know, with, um, psychiatry, especially in, in, in New York, you know,

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there’s still the tradition of the psychiatrist as a psychotherapist remains a thing.

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That’s kind of been preserved.

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In a lot of other places in the country, sort of economics and health insurance industry and that kind of thing has made it increasingly difficult for psychiatrists to practice that way.

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But New York at least can continue to sustain, make that a viable sort of career path.

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can continue to sustain, make that a viable sort of career path. Um, so, you know, I knew I wanted to be a doctor, a psychiatrist that actually spoke to my patients, got to know them. I got to NYU,

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started my training there. And during my third year of, uh, training, this must’ve been like 2009.

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uh, training, this must’ve been like 2009. I, uh, attended a grand rounds lecture that was given by Steve Ross, who is, um, or was the primary investigator of the MIU psilocybin cancer

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anxiety study. And he, this was like very early on during that, uh, that study. Um,

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I think they had maybe treated six or seven participants at that point um and i sat

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through this lecture and was just dumbfounded because i had no idea i mean i had no i knew

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a bit about the research that had gone on you know in the 50s and 60s and i knew that there

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was sort of a moratorium placed on it when all those basically prohibition was uh enacted and those as you said those

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substances were demonized and banned um i had no idea a that that research had resumed again

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and b that it was happening like literally in my backyard right where i was doing training so

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it to me it just seemed too, too serendipitous to not be like

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something I needed to follow up on. Um, because as I mentioned, I had had my own sort of personal

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experience of psychedelics that had affected me in a personal and, you know, pretty powerful way.

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Um, and had kind of maintained a sort of interest in subject matter that was kind of where my

00:21:12 ►

curiosity was kind of fueled by those experiences.

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So like a little bit more esoteric, um, stuff, um, kind of like, you know, having to do with Jung and alchemy and, um, uh, you know, psychospiritual,

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spiritual things, um, things that are kind of, I think, uh, trivialized by a lot of,

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by the majority of the sort of scientific community. Um, you know, sort of the reductionist

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camp of, of the scientific community tends to kind of trivialize that stuff

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or pathologize it. So I never, you know, and yet my interest in that was sort of very still sort

00:21:55 ►

of independently strong, kind of in parallel to the sort of scientific track that I was on in

00:22:02 ►

this conventional sort of medical training.

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And all of a sudden when I was at that talk, it dawned on me like this was a path where these two things could actually kind of start to become braided together instead of running

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in parallel lines.

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And it just kind of really clicked for me that this is what I was actually, this is

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what all of this work has been leading up to is this, you know, this is where I’m meant to be working.

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This is what my life’s work needs to consist of in large part.

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So I approached Steve after that talk, asked him how I could get involved as a resident.

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He was totally open and just said, yes, I made an email.

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We’ll have a

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meeting we did and then i was like within a few months i was uh the first resident in like 50

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years to be treating a psychedelic psychotherapy patient it was really really cool um so i got to

00:22:58 ►

be a study therapist in the psilocybin cancer study um with steve as my co-therapist.

00:23:07 ►

And from there, I started making contacts within the sort of larger psychedelic community,

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met a lot of the people at Johns Hopkins,

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started meeting a lot of the folks at MAPS.

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And as time went on,

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I finished my residency training,

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stayed on at NYU for a few years, working in the emergency department there as a consulting psychiatrist.

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Did a ketamine study with Steve as co-PI with him.

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And then eventually got connected to MAPS, starting, just starting to get the phase three

00:23:46 ►

study underway. They were recruiting therapists. Um, and I, uh, contacted a friend of mine,

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Ingmar Gorman, who I think you’ve interviewed on this show before, um, asked him, this was a

00:23:59 ►

couple of years ago now, like what opportunities there were with MAPS. Cause I was, you know,

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becoming very

00:24:05 ►

interested in the MDMA PTSD work that they have been doing and continue to do. And he said, well,

00:24:11 ►

as it happens, they’re interviewing for therapists right now. And he just connected me with the right

00:24:15 ►

person. And I interviewed with Marcella Otolara, who practices here. I’m sure I just butchered her

00:24:23 ►

last name. Sorry, Marcella. But I think it’s

00:24:26 ►

Otolara. I think she corrected me the other day. But anyway, Marcella, lovely, lovely woman,

00:24:32 ►

who’s been doing this work for 20 years now. She interviewed me and I was offered an opportunity

00:24:41 ►

to become a study therapist in the MDMA study, which I very happily accepted

00:24:46 ►

and went through that training with her and Michael and Annie Mithoffer and eventually

00:24:56 ►

became one of the co-PIs along with Ingmar at the private practice site at NYU. So we’re one of the 14 phase three clinical trial sites

00:25:08 ►

for the NDMA for PTSD study.

00:25:11 ►

So that’s a very long-winded version

00:25:14 ►

of how I got involved in this work.

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A lot of it is honestly just happenstance

00:25:18 ►

and being in the right place at the right time

00:25:20 ►

without any conscious intention to be there, really. I mean, really, it’s like that is how a

00:25:28 ►

lot of, I don’t know, for me anyway, that’s a lot of, some of the most important moments of my life

00:25:33 ►

have happened in a very synchronistic way. And that’s kind of how I know that I’m on the right

00:25:39 ►

path, you know, when the universe kind of winks at you and is like, here you go, stupid, pay attention.

00:25:49 ►

That’s true, but so much of luck that gets called luck

00:25:52 ►

is hard work by someone who’s really paying attention.

00:25:55 ►

Well, yes.

00:25:56 ►

You made sure to show up at Steve Ross’ thing.

00:25:59 ►

You had the fortitude to go up and talk to him afterwards.

00:26:01 ►

That’s true, although in fairness to me,

00:26:04 ►

to my deflecting any ownership over this,

00:26:07 ►

I didn’t know what his talk was going to be about that day.

00:26:11 ►

I didn’t know what Steve Ross’ work was about,

00:26:13 ►

but he had given us a couple of lectures

00:26:15 ►

in the addiction psychiatry part of our teaching curriculum,

00:26:23 ►

but I didn’t know he was doing this psychedelic stuff.

00:26:25 ►

Anyhow, but yes, I think, who was it?

00:26:27 ►

Pasteur that said, chance favors a prepared mind.

00:26:31 ►

That’s true.

00:26:32 ►

That’s definitely true.

00:26:34 ►

It is this weird combination of, like, keeping the ground fertile and just, but being open

00:26:41 ►

to new experiences.

00:26:43 ►

I don’t know. It’s like there is an element of,

00:26:46 ►

at the risk of sounding totally pretentious,

00:26:49 ►

you know, wu-wei, kind of this effortless action

00:26:55 ►

or actionless doing Taoist principle.

00:27:03 ►

Taoist philosophy really hit me hard in the wake of my early psychedelic experiences.

00:27:08 ►

It just very much resonated with me. I do really think that Taoists had a pretty good grasp on how

00:27:14 ►

the universe works. So anyhow, yeah, I mean, I used to say I was lucky.

00:27:25 ►

Lately I’ve had people correct me to use the word blessed rather than lucky.

00:27:31 ►

So I guess I have been blessed with a lot of just fortunate circumstances.

00:27:39 ►

It is a remarkable journey.

00:27:40 ►

And actually maybe we can go back a little bit and just focus on some of those parts that you mentioned on the path. The first one being to be a resident giving mushrooms to

00:27:50 ►

someone dying of cancer at a NYU facility. What was it like? And what did those actually look

00:27:58 ►

like to someone who might not have seen what these peer-reviewed psychedelic sessions look like?

00:28:05 ►

So it’s interesting because the protocol used at NYU and Hopkins,

00:28:13 ►

all this renaissance second wave or third wave of psychedelic therapy,

00:28:19 ►

are very much steeped in the tradition that was, I think,

00:28:22 ►

initially put into place by Stan Grof back at Spring Grove in Maryland in the late 60s, early 70s.

00:28:31 ►

And there they came up with this model where obviously it’s all about set and setting, right?

00:28:36 ►

The mindset of the participant and the other people in the room,

00:28:40 ►

which in this case would be the other therapists.

00:28:43 ►

The fact that there is a dyad rather

00:28:45 ►

than a single therapist, usually male and female. Though in my case, it was two males with me and

00:28:51 ►

Steve, but most of the time it’s male and female. The room, the setting itself is deliberately

00:28:58 ►

designed to be non-clinical. So it’s not like one of these terrifying CIA experiments where you’re

00:29:06 ►

like strapped to a stretcher and they’re dosing you through your eyeballs with LSD or something.

00:29:12 ►

It’s meant to evoke a kind of a comfortable living room type of atmosphere. So a person is

00:29:19 ►

made to feel at home. And there’s a lot of time spent in that physical space before the dosing

00:29:28 ►

session, doing what we, I guess we’d call a prep session, prep sessions consisting of several hours

00:29:36 ►

over a period of a couple of weeks, getting to know the person’s life story. And in this

00:29:41 ►

particular study, it was, it’s cancer anxiety. So, you know, consisted of early history, but then also a lot of like what their life was like

00:29:51 ►

around the time of the cancer diagnosis there. Uh, a lot of them had already gone finished

00:29:56 ►

through treatment, what that was like, um, just the whole, uh, process around confronting death and mortality. Um, and this is what a lot of

00:30:08 ►

these people understandably had a lot of anxiety about. And, um, you’re doing all of that stuff

00:30:13 ►

and developing the rapport, uh, between, you know, the therapeutic diet and the participant,

00:30:19 ►

um, you know, cultivating, uh, an atmosphere of trust and safety and safety um so that by the time that you’re actually

00:30:28 ►

there on you know weekday morning giving them psilocybin um it’s in an environment that they

00:30:36 ►

already have kind of gotten used to and they feel safe in and with two people that they have gotten to know and trust a bit.

00:30:50 ►

So on the actual dosing day, in this study,

00:30:53 ►

in the Hopkins studies, we’re not giving mushrooms, but actually synthesized pure psilocybin.

00:30:57 ►

So it comes in like a little capsule form.

00:30:59 ►

It looks like a white pill.

00:31:02 ►

And we try to maintain or preserve a sort of ceremonial aspect to it.

00:31:07 ►

So there is a moment in the beginning where we kind of set intentions for the session, for the

00:31:13 ►

day, what’s going to happen. We, you know, obviously the participant is sort of driving that.

00:31:17 ►

And we offer the medicine to them in a little bowl and they take it and at that point it’s just kind of

00:31:27 ►

you know we have a setup where there are headphones that are playing a sort of a

00:31:34 ►

predetermined playlist of music the participant is also an eye mask and they’re encouraged once they start feeling the medicine take its effect

00:31:48 ►

to kind of go inward, listen to the music and at that point there begins this kind of

00:31:55 ►

this sort of back and forth where you know we’re asking them to sort of go inward and let whatever spontaneously comes up to come up.

00:32:07 ►

And then intermittently we’ll be checking in with them,

00:32:12 ►

and they might have things that they want to say to us,

00:32:15 ►

or they might just want us sort of to be physically nearby to be a source of support.

00:32:22 ►

And really during the most intense phase of the dosing session,

00:32:27 ►

mainly what we’re doing is really just holding the space for them.

00:32:31 ►

A lot of the talking tends to happen in the latter stages

00:32:35 ►

when they’re sort of coming down off the acute effects,

00:32:38 ►

the peak effects of the medicine

00:32:40 ►

and are less directly engaged with the often very powerful material that’s coming up from inner sources for them.

00:32:54 ►

And at that point, our role is to kind of help them make sense of the material.

00:33:00 ►

And that process continues in the days and weeks that follow through integration sessions.

00:33:07 ►

And in that study, we did two dosing sessions.

00:33:12 ►

One was an active placebo.

00:33:13 ►

The other one was psilocybin.

00:33:16 ►

So the process kind of repeats itself again.

00:33:20 ►

And then they are obviously along the way, because it’s a research study,

00:33:24 ►

they’re doing all kinds of scales and questionnaires and that kind of thing.

00:33:31 ►

So obviously we’re there to make sure that, to hold the space, as I said, but also to maintain safety, make sure that nothing really goes awry during the session.

00:33:38 ►

We’re also monitoring their vital signs.

00:33:40 ►

So there’s kind of that aspect sort of preserves this sort of the

00:33:47 ►

medicalized part of it. But I think that also helps people feel a little bit safe too, just

00:33:51 ►

to know that there’s physician there and we’re monitoring their blood pressure and heart

00:33:55 ►

rate and this kind of stuff there, you know, we’re not going to let anything horrible happen

00:33:58 ►

to them while they’re under the influence. Um, so yeah, that’s kind of what it’s like,

00:34:02 ►

but it’s, uh, obviously the content of what’s

00:34:06 ►

coming up is highly individual for each person.

00:34:10 ►

What did it feel like the percentage was where people had a really beautiful opening trip

00:34:14 ►

versus someone who had a trip that was probably overall positive, but definitely had some

00:34:19 ►

hard spots versus the number really just had very difficult experiences that you really

00:34:23 ►

had to be there the whole time?

00:34:25 ►

Percentage-wise, it’s hard to say.

00:34:26 ►

I only had like a handful of, so it’s a pretty small sample size for me.

00:34:31 ►

But I mean, I can tell you just from speaking to the group at large,

00:34:38 ►

I mean, numbers-wise,

00:34:42 ►

I would say the majority of people, at least at one point or another during the experience, encountered some significant difficulty or anxiety.

00:34:53 ►

I think psilocybin has that tendency more so than with MDMA.

00:34:57 ►

I mean, I haven’t done – I’ve observed a lot of dosing sessions.

00:35:00 ►

I haven’t actually done a dosing session myself yet with MDMA, but I think with psilocybin,

00:35:08 ►

it does have a tendency to be somewhat confrontational in a way that still preserves this kind of

00:35:19 ►

… There’s a gentle sort of wisdom to it. It’s not, you know, there are…

00:35:27 ►

It seems like nobody’s ever encountered an experience

00:35:30 ►

that was so harrowing that the, you know,

00:35:33 ►

like the only choice was to terminate it.

00:35:35 ►

Nobody’s ever…

00:35:36 ►

I mean, we actually do keep emergency…

00:35:38 ►

or an emergency stock of an antipsychotic

00:35:40 ►

and a benzodiazepine in the session room with us,

00:35:44 ►

but to my knowledge it’s never

00:35:45 ►

actually ever been used in any of the psilocybin studies but i mean that escape valve is kind of

00:35:50 ►

there um but you know to my knowledge nobody’s ever gotten to the point where that’s had to be

00:35:57 ►

used like every time it gets difficult it’s um ends up being an opportunity for them to really confront kind of the dark heart of what’s really torturing them,

00:36:13 ►

you know, what’s driving their suffering.

00:36:15 ►

And instead of, you know, run away from it or hide from it, actually get through it in a way that enables them to kind of integrate

00:36:27 ►

something from the experience and achieve a state of healing around it.

00:36:37 ►

And I know I’m describing that vaguely, but there’s something about the experience of confronting some very powerful forces that seem to be threatening and exogenous, like coming from some outward sort of malevolent place and learning through the

00:37:10 ►

experience that that’s not something that actually has any power over you, that it is all kind of

00:37:16 ►

coming from internal places. And there is a sort of a path through the labyrinth and you can find safe passage through it

00:37:31 ►

that you know discovering that you do have the inner resources to kind of

00:37:36 ►

confront something like that and get to the other side and remain intact and whole and alive

00:37:42 ►

there’s something that’s very profoundly empowering about that for people.

00:37:48 ►

And also, there’s something about being in a psychedelic session, having that

00:37:56 ►

psychedelic experience that is, I think you’re kind of dipping into the waters of death a little bit.

00:38:09 ►

There’s something, to me at least,

00:38:11 ►

it’s always felt like you’re kind of piercing the veil a little bit and peeking behind the curtain

00:38:14 ►

and walking for a little while in, you know,

00:38:20 ►

on the paths that we take when we die

00:38:23 ►

and then coming back to the waking, living world.

00:38:27 ►

And that changes you.

00:38:30 ►

Having that experience changes you.

00:38:32 ►

And so many of the people in the psilocybin study

00:38:34 ►

came out saying how they realized that death is not an ending.

00:38:40 ►

It’s a transition.

00:38:41 ►

And the various individual ways in which people came to that sort of epiphany differs a little

00:38:50 ►

bit from person to person, but that came up time and time again.

00:38:57 ►

Just this idea that we are more than, you know, we’re more than just our physical bodies, that, you know, the universe is, everything’s interconnected.

00:39:12 ►

You know, there’s this sort of eternal oneness that every living thing is a part of.

00:39:21 ►

People had a direct experience of that somehow by I think transcending the limitations that

00:39:30 ►

are necessary to have a sort of this boundary ego that you need to get through the world

00:39:37 ►

on a day-to-day level you need to have these sort of you know this kind of casing around you that, you know, you need to be able to

00:39:46 ►

use to navigate through the world. But, you know, over time, that those boundaries can become very

00:39:55 ►

sort of ossified and have a tendency to close people off from the immediacy of their experience.

00:40:03 ►

I mean, you look in the eyes like a little kid, like every single experience a little

00:40:06 ►

child is having is immediate and unmediated by this rubric of like judgments and labels

00:40:12 ►

and, and, um, really just like classification and language that we, uh, gather over the

00:40:20 ►

years through just living life and our education and, you know, just in the world

00:40:27 ►

and in school and whatever. I mean, we start to live life through increasing degrees of separation

00:40:33 ►

from the actual world. Um, and you can get trapped in that space pretty easily. Um, if you don’t

00:40:42 ►

make a practice of doing things

00:40:45 ►

that can reconnect you to the immediacy of the world.

00:40:49 ►

And that to me is what makes psychedelic experiences so powerful

00:40:53 ►

is that it just, that’s kind of what it’s doing.

00:40:56 ►

It’s bringing you in touch with a level of reality

00:41:02 ►

that’s deeper than the level that we have words for and so you have no choice

00:41:07 ►

but to interface with it in an immediate way with an immediacy that we lose past a certain age

00:41:14 ►

and that’s i think by doing that you’re kind of bringing your consciousness back closer to the source of all being.

00:41:32 ►

Because this stuff, the structures, the cognitive maps that we carry around in our heads are very useful, but they’re not reality.

00:41:37 ►

And so what we do so much of the time is confuse our map of the world with the territory we confuse you know our sort of

00:41:48 ►

really imagined reality with what’s actually real and it colors your whole experience and if you’re

00:41:54 ►

somebody who’s had a lot of traumatic experiences especially at a formative stage really but any

00:42:00 ►

stage of your life but you know when you have that sort of you when you’re placing that pattern over your interactions with the world,

00:42:08 ►

things tend to look threatening, even when they’re not.

00:42:14 ►

And what happens with mental illness is it’s, I think in a lot of of cases you’re dealing with a distorted lens you’re seeing

00:42:29 ►

the world through a screen that colors everything a certain way and

00:42:36 ►

the mind is very good at picking up patterns but that capacity can be twisted when you’re entering a situation with a certain

00:42:49 ►

expectation and you’re placing all of your emphasis on the things that support your sort

00:42:55 ►

of preconceived notion let’s say the preconceived notion is the world is dangerous you’re going to

00:42:59 ►

pick up on cues that support that notion and really kind of ignore the cues that refute it

00:43:05 ►

and in that way your experience kind of builds and builds and builds on itself and so you know

00:43:12 ►

when you have lived that way long enough it becomes very difficult to see or experience

00:43:17 ►

the world and outside of that it just becomes a really sort of habitual again like sort of ossified way of interfacing with the world

00:43:27 ►

and on a psychedelic when you’re thrust into the sphere where you have to face reality

00:43:34 ►

on reality’s terms not the terms that you’re bringing to it um it can really shake that up. And if it’s done properly in sort of a kind of a loving, safe vessel or container,

00:43:52 ►

you know, what can, you know, you sort of boil everything up and soften it up,

00:43:57 ►

and what can harden, re-harden on the other side of that process

00:44:00 ►

is something that is more in line with, you know, the benevolent aspects of reality,

00:44:06 ►

because there’s both, you know, there’s light and shadow, and there’s, you know, you can’t walk

00:44:12 ►

around the world, you know, with rose-colored glasses and think everything’s peachy and great,

00:44:15 ►

because that’s not real either, but, you know, it’s about finding or regaining one’s,

00:44:24 ►

finding or regaining one’s,

00:44:25 ►

uh,

00:44:29 ►

the balance of one’s perception of the world.

00:44:31 ►

If that makes sense.

00:44:36 ►

Especially with what you were saying about psilocybin being more challenging. Cause I think it’s what the whole old heads often say is that with LSD,

00:44:40 ►

you get to be a little bit more in the driver’s seat,

00:44:43 ►

but with mushrooms,

00:44:44 ►

the fungi is in the driver’s seat, but with mushrooms, the fungi

00:44:45 ►

is in the driver’s seat and they, she makes it go where, uh, where it might be best, even

00:44:51 ►

if that’s uncomfortable.

00:44:52 ►

Right.

00:44:53 ►

Well, yeah.

00:44:53 ►

And I’ve always thought, I mean, psilocybin is always fascinating to me because it does

00:44:58 ►

come from mushrooms and, you know, in the natural world, I mean, the, the function of,

00:45:02 ►

of fungi in the ecosystem is to break things down it’s to

00:45:05 ►

take it’s to transform uh death into new life in a way um but you know it without the fungi

00:45:15 ►

we wouldn’t we wouldn’t have like the forest ecosystem would be impossible you need that

00:45:20 ►

element of breaking things down um and softening things up from the forms that they retained before so that they can then take on new forms.

00:45:28 ►

And I think that’s what’s happening in some pretty real way when you’re ingesting this substance from the fungus, the psilocybin.

00:45:47 ►

ingesting this substance from, from the fungus, the psilocybin, it is working the kind of the same,

00:45:54 ►

doing the same sort of task that the fungi do in the natural world, you know, on the forest floor, it’s breaking things down and helping them, you know, breaking things down into its constituent

00:45:59 ►

parts and helping it reassemble into new forms. And, you know, obviously those new forms

00:46:07 ►

are going to be influenced by the environment,

00:46:13 ►

the conditions that prevail at the time of that forming.

00:46:17 ►

So that’s why the set and setting are so important

00:46:20 ►

because it’s not enough just to break things down.

00:46:22 ►

I mean, you need to be able to foster new growth in a way that in a form that’s positive and, and helpful and, um, you know,

00:46:32 ►

supportive of new growth and, and equilibrium, um, achieving a healthier state of equilibrium.

00:46:50 ►

So these tools can’t be just applied willy-nilly without paying very close attention to what are the conditions that you’re creating

00:46:56 ►

when you bring a person into that state of kind of renewed fecundity.

00:47:03 ►

And it’s one of the big pushbacks, it feels like,

00:47:05 ►

against the medicalization of these psychedelics

00:47:09 ►

from anarchists like Dimitri Mugianis,

00:47:11 ►

who just the last thing he wants to see

00:47:13 ►

is anyone in the medical profession

00:47:14 ►

being the gatekeepers for psychedelics.

00:47:17 ►

And I’m sure you know about the dark sides

00:47:18 ►

of how this could go with certain people.

00:47:22 ►

I’d like to have someone like you, Dos Mics.

00:47:24 ►

I know you know how to make a good

00:47:25 ►

space. But as these start getting rolled out, what about psychiatrists who have never experienced

00:47:32 ►

these trying to create a space for something where they really don’t understand? How are

00:47:36 ►

there ways to make that better? Well, I think that it’s really hard

00:47:40 ►

to know how to help somebody navigate that space when you’ve never navigated it yourself.

00:47:45 ►

And so that’s the whole rationale behind the MT1 study, which is the protocol that MAPS

00:47:52 ►

has in place to allow study therapists that are working to provide the treatment in the

00:47:59 ►

MDMA for PTSD protocol to themselves have their own MDMA-assisted therapy experience, which is what

00:48:07 ►

actually brings me to Boulder today. I’m here this week for that. So just yesterday, I’m really right

00:48:13 ►

in the middle of that process right now. Yesterday, I had the first of two dosing sessions, which

00:48:18 ►

may or may not have been MDMA or placebo, and tomorrow I’m going to have the other one, which

00:48:22 ►

will be the opposite. Pretty sure that what I got yesterday was MDMA, but not 100%.

00:48:27 ►

Marcella and Bruce, who are the therapy diet that are administering the protocol to me while I’m here,

00:48:36 ►

say that they’ve observed this interesting phenomenon where the psychiatrists they get in session,

00:48:46 ►

on where the psychiatrists they get in session as opposed to like therapists or social workers all kinds of clinicians that are uh recruited as study therapists but there’s a subset of us who

00:48:51 ►

are you know md psychiatrists for some reason um they’ve had they’ve observed in a couple of

00:48:59 ►

them so far that they’ve had an experience where they were convinced that it was mdma

00:49:03 ►

everybody there was convinced and then they found out actually the next session was the MDMA. So something weird

00:49:09 ►

is happening. Some kind of crazy placebo effect is happening with psychiatrists and they call that

00:49:12 ►

the psychiatrist effect. So I don’t know because of that, I’m reserving a hundred percent judgment

00:49:17 ►

on what happened yesterday, but I know that what happened was very powerful and, um, mind altering.

00:49:23 ►

So, Hey, if that’s placebo, then I guess start making more of those sugar pills.

00:49:29 ►

I don’t know.

00:49:29 ►

But I think it’s part of the beauty of this is that the intention with any of these drugs

00:49:34 ►

can often be – I tell you, I often explain to my father, it’s great to have all your

00:49:38 ►

friends say, we’re going to go out in the woods and take mushrooms together.

00:49:41 ►

Sometimes you don’t even – you don’t need the mushrooms for it to turn into a psychedelic

00:49:44 ►

experience just because you’re going to spend time

00:49:46 ►

with your people doing this.

00:49:48 ►

Totally, out in the woods or something.

00:49:49 ►

Yeah, the set and setting are so powerful.

00:49:54 ►

And, you know, I have a friend

00:49:58 ►

who calls psychedelics like placebo on rocket fuel.

00:50:02 ►

I mean, you know, that makes a little bit of sense because it’s it is so much

00:50:08 ►

contingent on what your expectations are um but yeah i mean the fact that you can have

00:50:13 ►

an experience that feels that profoundly mind-altering just because also the ceremony

00:50:19 ►

too right so it’s like the therapy team in the room the person there everyone has this expectation

00:50:23 ►

and then like there’s some like magical transaction that happens when you take a pill and put into your body.

00:50:30 ►

Like you’re priming your whole psyche for something to happen.

00:50:33 ►

And sometimes unusual things can happen.

00:50:36 ►

Even if it’s there’s, you know, the substance that you’ve ingested is technically inert.

00:50:42 ►

You know, the act of taking it itself has a power or can have a power. So, um, anyway, I did take something yesterday and, um, you

00:50:54 ►

know, had, uh, a very profound sort of session with them. Um, lasted about, I don’t know, five or six hours from start

00:51:11 ►

to finish. Um, and, you know, confronted, got, just got some new perspectives and new angles

00:51:21 ►

on things that I’ve been, you know, had kind of had a certain level

00:51:26 ►

of awareness over the years, just sort of, um, some of my own internal dynamics around,

00:51:34 ►

you know, things that happened in my upbringing and my own trauma during childhood,

00:51:38 ►

the way that’s informed, um, the way I am in the world today and, you know,

00:51:43 ►

the relationships that I have now with my you know

00:51:45 ►

my close the close people close to me in my life and how that um

00:51:51 ►

really gaining some insight into how

00:51:56 ►

um so i michael and any myth of ran marcellacella, and Bruce put a lot of stock into this kind of theoretical framework, psych fact that each of us kind of,

00:52:33 ►

that each of our psychologies kind of comprises a number of different parts, right?

00:52:39 ►

And each part takes on a sort of a different role within the person’s psyche.

00:52:47 ►

And so there’s, you know, there are protectors.

00:52:52 ►

There’s like the inner child.

00:52:54 ►

There’s parts of us that are there to protect the inner child.

00:52:59 ►

There are dynamics that happen between those parts within us.

00:53:06 ►

So, you know, I think we all sort of can, it’s a very sort of intuitively appealing

00:53:15 ►

framework.

00:53:15 ►

I think we all sort of kind of get that, that that exists.

00:53:20 ►

Like, you know, we are sort of a multiplicity. You know, we’re each an individual person,

00:53:25 ►

but our individuality is made up of this sort of multiplicity of constituent parts

00:53:30 ►

that sometimes are working in tandem and in unison with each other

00:53:36 ►

and sometimes are working at odds with each other.

00:53:38 ►

I mean, the idea of being in inner conflict, right?

00:53:41 ►

Everyone’s had the experience of being internally conflicted about something.

00:53:43 ►

Well, who’s, where’s that conflict, who is that conflict happening right? Everyone’s had the experience of being internally conflicted about something. Well, who’s, where’s that conflict? Who is that conflict happening between? It’s these parts of

00:53:51 ►

us. And, um, the MDMA can sort of permit you to, uh, take a step back away from those parts in a way,

00:54:05 ►

but at the same time empathize with what each of those parts needs

00:54:09 ►

and can, through that, enhance understanding.

00:54:18 ►

You can understand a little bit more about the dynamics

00:54:20 ►

of what’s really going on internally

00:54:22 ►

when you do encounter inner conflict or behaviors that run counter to, um, you know, your highest good or your

00:54:32 ►

greatest health. Um, cause we all engage in self-sabotage in various ways and ways in which

00:54:40 ►

we kind of limit ourselves and limit our potential.

00:54:48 ►

And I know I definitely have done that.

00:54:50 ►

And so a lot of what came up yesterday was trying to understand, like, well, what’s going

00:54:54 ►

on in these moments when, you know, I find that I am sabotaging myself or, you know,

00:55:02 ►

you know I find that I am sabotaging myself or you know lots of us have this sort of

00:55:05 ►

very critical voice

00:55:06 ►

in our heads that

00:55:08 ►

finds it’s

00:55:10 ►

you know thinks it’s job is to sort of cut

00:55:12 ►

everything down or to you know

00:55:14 ►

make you

00:55:16 ►

feel

00:55:18 ►

really bad

00:55:24 ►

about things in certain ways.

00:55:29 ►

And, you know, through the skill of Marcella and Bruce

00:55:36 ►

in combination with sort of the enhanced awareness

00:55:43 ►

that the medicine brought to me.

00:55:47 ►

And this kind of dialectic that was happening between my internal process and which, you know,

00:55:55 ►

would happen, they would encourage me to sort of go inward.

00:55:58 ►

There were headphones and an eye mask involved in this process, too,

00:56:01 ►

very similar to the psilocybin protocol.

00:56:04 ►

Go in, listen to the musicilocybin protocol, go in, listen

00:56:05 ►

to music, sort of let things come up, and then come out of that, sort of hash that material

00:56:16 ►

with Bruce and Marcella and have them help me kind of sort of flesh out the understanding a little bit.

00:56:30 ►

And it was a lot of that sort of process going back and forth

00:56:34 ►

that over the course of the day got me to a place of kind of realizing

00:56:45 ►

ways in which I can be sort of

00:56:52 ►

limiting myself

00:56:53 ►

and how to

00:56:54 ►

accomplish what

00:56:58 ►

the parts of me that are sort of imposing that limitation

00:57:02 ►

accomplishing what they want in a way that circumvents the limitation

00:57:07 ►

or doesn’t make the limitation not necessary.

00:57:11 ►

Getting to a place of sort of harmonious agreement amongst those parts

00:57:16 ►

such that the block is sort of lifted and taken out of my way

00:57:21 ►

and I can sort of grow, continue to grow and move forward and progress

00:57:24 ►

and become a more effective person.

00:57:27 ►

And now that you got to sit on the couch like that and have an experience,

00:57:32 ►

in your opinion, what do you think are some of the most important traits of a good sitter?

00:57:37 ►

What do they bring to the table that you think matters the most?

00:57:43 ►

I think openness and receptivity are probably the most important traits,

00:57:47 ►

just being attuned to what’s going on in the person’s process. And, you know,

00:57:53 ►

in the MAPS training for therapy, we talk a lot about what we call the inner healing intelligence.

00:57:59 ►

So this idea that within each of us, there is this sort of reside, like this kind of intrinsic wisdom that resides in each of us.

00:58:11 ►

And which I believe very strongly in.

00:58:14 ►

And you see it, you know, even I think it’s something that lives in our bodies, in our cells.

00:58:19 ►

It exists on a cellular level in each of us.

00:58:21 ►

I mean, if you get a scratch on your arm or something, you something, there’s nothing that you can do consciously to make that heal.

00:58:27 ►

Your body’s inner healing intelligence is what knits the tissue back together

00:58:30 ►

so that you can have an intact organism again.

00:58:34 ►

And I think this very same process is happening on a psychological level

00:58:38 ►

when there’s wounds and trauma.

00:58:40 ►

So being, as a therapist, as a study, as a, you know, in supporting that process,

00:58:48 ►

it requires that you, first of all, have an understanding and a respect for, for the

00:58:57 ►

existence of that capacity within the person, the participant themselves who are undergoing the session, and knowing how to kind of get out of its way, so to speak,

00:59:08 ►

and also to recognize when the participant is kind of resisting,

00:59:16 ►

at times, the incursion of that process,

00:59:18 ►

because sometimes it can be frightening.

00:59:19 ►

It can be leading people into a direction that rushes up against some defense

00:59:24 ►

that has been in place for

00:59:27 ►

a long time to keep them from feeling anxious feelings or painful feelings. But sometimes to

00:59:33 ►

get to a place of healing, you need to get through that uncomfortable space. So, you know, knowing how

00:59:40 ►

to support that without having an agenda,

00:59:50 ►

but being able to recognize when the inner healing intelligence has been activated and essentially helping to create the space

00:59:58 ►

and hold the space for that process to happen.

01:00:03 ►

And it requires that the person as a whole has

01:00:07 ►

to go through this place of vulnerability. Like you can’t change things on that deep of a level

01:00:13 ►

without opening yourself up to change, which means becoming vulnerable and becoming open

01:00:19 ►

to potentially harm, right? I mean, people shut down and they create these shells,

01:00:23 ►

which keep them in places of fear and anxiety, but it’s for a survival function? I mean, people shut down and they create these shells, which keep them in places of

01:00:25 ►

fear and anxiety, but it’s for a survival function. I mean, it’s there so that no further harm will

01:00:31 ►

come to the organism. The only way to undo the harm that’s been done is to open it back up.

01:00:37 ►

And when you’re in that place of being opened up, it can be really, really threatening,

01:00:41 ►

especially if you’re somebody who suffered a lot of trauma. You don’t ever want to be opened up again like that, because last time that was

01:00:47 ►

the case, it really didn’t end well. So, you know, being able to create a space where that

01:00:54 ►

can actually happen, and the medicine facilitates that opening up. But then what happens after it

01:01:01 ►

opens up is, you know, if the conditions are right, the inner healing intelligence, it just will spontaneously, you know, we have a tendency towards wholeness.

01:01:10 ►

There’s a reason why, you know, if you break your bone, if you put the cast on and put the, you know, the bones in the right place together, they’re just going to spontaneously knit back together.

01:01:20 ►

Our bodies, our organism has a tendency towards wholeness.

01:01:24 ►

And I mean, that’s what like Stan Groff used the word holotropic instead of psychedelic this this tendency back

01:01:31 ►

towards wholeness um and so you know these substances can easily be described as holotropic

01:01:37 ►

or these processes can be described as holotropic it’s a process that supports the body’s, the organism’s natural tendency to regain a state of wholeness.

01:01:47 ►

So, you know, you have somebody who’s been injured and closed off,

01:01:57 ►

and they have regained a state of wholeness, but it’s a closed off type of wholeness.

01:02:01 ►

And it’s wholeness in a way, you know, you can think of it as like a bone that’s kind of set in the wrong way.

01:02:07 ►

You know, it’s not it’s not ideal and it’s it’s still contributing to loss of functioning and further pain.

01:02:15 ►

And sometimes you got to break a bone again to get it to set properly.

01:02:19 ►

That’s kind of what we’re doing here in a way.

01:02:28 ►

And that’s very scary for a lot of people, understandably, but, um, you know, when the process goes right, what you have at the end is, is a new state of

01:02:37 ►

wholeness that is healthier and more functional and more conducive towards having a joyous life.

01:02:46 ►

And there’s no really higher purpose to my mind

01:02:50 ►

than to be in a position to help people overcome their suffering

01:02:56 ►

and instead of be enchained by it and imprisoned by it,

01:03:12 ►

and enchained by it and imprisoned by it, use it as a pathway to a greater being, to growth.

01:03:16 ►

So we went over something about two of your tools with psilocybin and MDMA.

01:03:24 ►

I wanted to ask some more about ketamine, mostly because that’s, I think, one of those fascinating drugs we have in the last couple of decades. I always see it as a double-edged sword of our generation.

01:03:27 ►

It’s such a vital anesthetic that gets used all over the world.

01:03:31 ►

We’ll talk about your work with depression and ketamine, but it’s also very psychologically addictive and you won’t get addicted, but psychologically you just keep on taking because it’s very easy to create a cloud between yourself and your emotions and the world, things like that.

01:03:53 ►

It’s a very slippery slope.

01:03:55 ►

And so it’s so fascinating because it can be so good for some people’s chronic depression, and then it can also just exacerbate that into much worse spots.

01:04:04 ►

So I wanted to just ask what was it like for you to start getting involved in ketamine work?

01:04:08 ►

Yeah, so ketamine has been really an exciting development in the field of psychiatry.

01:04:15 ►

I think it’s important to make a distinction between ketamine as it’s used in anesthesia versus ketamine as it’s used in antidepressant protocols versus ketamine,

01:04:25 ►

as it’s used recreationally,

01:04:27 ►

because those are three pretty different things.

01:04:30 ►

You know, in anesthesia, and I think a lot of it is a function of dosing and frequency.

01:04:38 ►

So, you know, in anesthesia, you’re using relatively high doses.

01:04:42 ►

We’re talking maybe like four to eight milligrams per kilogram

01:04:45 ►

to essentially put a person into a state of complete dissociation where

01:04:52 ►

you know like an invasive surgery can happen and they’re not going to feel it and they’re

01:04:57 ►

not going to remember it and they’re not going to be traumatized by it psychologically

01:04:59 ►

and it’s a very useful tool and it’s been in use since the early 1970s for that purpose

01:05:07 ►

it’s also very safe anesthetic it’s one of the only if not the only anesthetic that doesn’t

01:05:13 ►

suppress you know heart rate and the respiratory centers of the brain so they actually to this day

01:05:22 ►

still use it as like a battlefield anesthetic so So you have somebody who you can’t afford to lower their blood pressure

01:05:30 ►

because they’re bleeding out from a wound or something, you use ketamine.

01:05:35 ►

So it’s a very useful anesthetic in a lot of situations.

01:05:38 ►

It’s also very brief and short-acting.

01:05:40 ►

So for interventions like in emergency rooms, for example, especially

01:05:50 ►

in like pediatric emergency rooms, they’ll use ketamine slightly, maybe like two to four

01:05:55 ►

milligrams per kilogram for what we would call procedural sedation. So again, you’re

01:06:00 ►

inducing a pretty short-lived state of dissociation.

01:06:07 ►

You know, say a kid comes in with like a separated shoulder,

01:06:12 ►

and they need to put the joint back into the socket, and that’s obviously very painful.

01:06:17 ►

Frequently they’ll give a kid ketamine so that they can do the procedure,

01:06:20 ►

and it’s painless to the child, and, you know, within 20 minutes,

01:06:23 ►

they’re sort of back to their baseline, and everything’s good.

01:06:26 ►

So it’s a highly useful medicine for that, for those purposes. Its use as an antidepressant went undiscovered for 40 years,

01:06:33 ►

I think largely because of the fact that at that dose, you’re not really causing much of an

01:06:39 ►

antidepressant effect. So nobody ever noticed that there was an antidepressant effect until by accident there was a group at Yale using low-dose ketamine to study as a model for schizophrenia.

01:07:07 ►

because there is some hypothesizing that the biochemical mechanism of ketamine might sort of mimic some of what’s going on in a brain that’s undergoing a psychotic episode.

01:07:13 ►

So they discovered as part of those studies that very low-dose ketamine,

01:07:19 ►

we’re talking like a half milligram per kilogram, administered intravenously.

01:07:27 ►

Aside from whatever they were looking for in terms of the psychotic side of things, they saw that people who were taking it at that dose were

01:07:32 ►

becoming, who had severe depression were finding their depression to sort of lift

01:07:40 ►

kind of miraculously within a few hours and, you know, for days or weeks in some cases.

01:07:48 ►

And so that was initially observed and was obviously an intriguing finding,

01:07:53 ►

enough for them to sort of try and repeat it with a placebo control

01:07:58 ►

in a cohort of, I think, 12 or 14 patients.

01:08:01 ►

These are treatment-resistant patients with either depression or bipolar disorder.

01:08:07 ►

That was done at Yale and the results were published in 2000 and showed versus placebo

01:08:14 ►

this what seemed like a very real and robust antidepressant effect that that does.

01:08:20 ►

The finding was so kind of out beyond the pale of any understanding or any of what conventional psychiatry had to say about depression and how to treat it that those findings were kind of essentially ignored for a good five or six years until it was repeated in a slightly larger sample of treatment-resistant depression patients at the NIMH.

01:08:47 ►

And that’s when the field sort of sat up and paid very much closer attention to it.

01:08:50 ►

And many more studies were done.

01:08:53 ►

Hundreds of patients at this point have gone through that protocol, and the findings have been very consistent.

01:09:05 ►

70% to 80% of patients will have a pretty robust and relatively persistent antidepressant effect, again, at this dose of half milligram per kilogram. And there’s some animal studies that show that there’s kind of sort of a sweet spot for ketamine for it to have that antidepressant effect.

01:09:15 ►

Looking at both sort of animal models, like behavioral models of depression,

01:09:20 ►

and then also what’s happening on a neuronal level in terms of

01:09:25 ►

synaptic connections.

01:09:26 ►

You know, there are very characteristic changes that happen in animal models of depression

01:09:31 ►

or in human brains of people who are clinically depressed, taken, for example, from like post-mortem

01:09:36 ►

brains of people who committed suicide.

01:09:39 ►

You’ll see essentially a shriveling up of the connections between neurons at the synaptic

01:09:44 ►

level in those brains.

01:09:47 ►

And that effect on a physiological neuronal level can be reversed by ketamine, but only within a certain dosing range.

01:09:56 ►

So if it’s too low, it’s not going to happen, and if it’s too high, it’s not going to happen.

01:10:00 ►

So at the doses where we’re using it for anesthesia or also that people kids are using it

01:10:07 ►

recreationally this two to four milligram per kilogram or higher you’re not getting the

01:10:12 ►

antidepressant effect so that’s very interesting and i think might speak to why you can see such a wide variety of, you know, sort of phenomena, depending on

01:10:27 ►

the context that’s being used and the purpose that’s being used for and the doses that are

01:10:32 ►

being used. And so experientially, at that, or that level for people you would have been seen,

01:10:39 ►

what would it feel like if it was a recreational user? Is this something like kind of floating

01:10:44 ►

around the edge of the K-hole loopy kind of level?

01:10:47 ►

Or is psychiatric effects more at you get pretty deep into the K-hole and maybe dissociated all the way from reality?

01:10:54 ►

Or is that not consistent?

01:10:56 ►

Well, I don’t know.

01:10:57 ►

I mean maybe it would help to define the K-hole a little bit more.

01:11:02 ►

That’s about the toughest thing there is to do.

01:11:05 ►

define the k-hole a little bit more whoo that’s about the toughest thing there is to do um i’d say i would maybe if you wanted to find the k-hole as completely ego dissociation from reality where

01:11:12 ►

you don’t know who you are anymore okay and then circling around it is you’re pretty loopy but you

01:11:16 ►

know that you’re still on a drug it’s just kind of you are you know maybe the top levels of your

01:11:21 ►

brain are are lowered if it really is does work by the

01:11:25 ►

glutamate action of lowering general sure electricity sure i’d see i see what you’re

01:11:29 ►

saying yeah um yeah i don’t think you quite get to the point of complete ego dissolution so i think

01:11:34 ►

throughout the experience even though you’re in a very altered space um and definitely dissociated

01:11:39 ►

from your normal waking reality you can get to a place where you don’t know where the hell you are.

01:11:45 ►

It’s like, but there still is an I to be somewhere.

01:11:49 ►

There is still somebody there who can say, where the hell am I?

01:11:52 ►

Versus, you know, the K-hole, which as I’m understanding it,

01:11:56 ►

is like you’re basically that I,

01:12:00 ►

the distinction between I and the world kind of disappears.

01:12:03 ►

So you’re definitely not quite to that place.

01:12:08 ►

And yet you are very much removed from ordinary waking states.

01:12:14 ►

So it is sort of an in-between.

01:12:16 ►

And I think maybe calling it circling the periphery is probably a good metaphor.

01:12:22 ►

And so because it’s a schedule three, I believe. Um, so there are

01:12:27 ►

clinics in a lot of the major cities in the country now where you can just go and get this stuff.

01:12:31 ►

What are your thoughts on the wide availability now with what you know of how well it works for

01:12:35 ►

various people and how important set and setting is and where some of the places that this is being

01:12:40 ►

administered? Yeah. I mean, my understanding is that the majority of clinics that are in operation now uh where ketamine is being given for depression are run by like

01:12:49 ►

anesthesiologists so these aren’t psychiatrists these aren’t people who have been trained

01:12:52 ►

as psychotherapists um and the settings tend to be kind of clinical um i’ve had people who’ve

01:13:00 ►

gone through them describe them as almost like factories or, you know, very impersonal in a way.

01:13:09 ►

Like you’re kind of there for like chemotherapy almost, like if you were a cancer patient or something, something similar to that.

01:13:17 ►

And in my own practice, I do administer ketamine for depression.

01:13:22 ►

I don’t do it in that way.

01:13:23 ►

I do it in an outpatient psychotherapy

01:13:27 ►

office. So this is definitely much more akin to kind of like the setting of, you know,

01:13:34 ►

like the psilocybin or the MDMA studies where it’s kind of like more of like a living room

01:13:39 ►

type environment. It’s not clinical in the way that going to an outpatient chemotherapy clinic or an anesthesiologist’s pre-op room would be.

01:13:55 ►

It’s interesting, though, because I should say that there is ketamine the way it’s administered according to like sort of the NIMH protocol for depression, which is an infusion usually through an intravenous

01:14:11 ►

drip that lasts 40 minutes.

01:14:12 ►

I do it a little bit differently in keeping with the protocol that we use at NYU in the

01:14:18 ►

emergency department.

01:14:20 ►

So I mentioned before that, you know, it’s, ketamine has been used in anesthesia for many

01:14:23 ►

years, but it’s also been used in the emergency department.

01:14:25 ►

And when they give it in the emergency department, it’s not a long drip.

01:14:29 ►

It’s really just kind of a short-term bolus.

01:14:32 ►

You give it over one to two minutes, you deliver the amount that you’re going to give over

01:14:35 ►

one to two minutes, and then the drug has its effect for about 20 or 30 minutes, and

01:14:38 ►

then the people sort of come back to normal.

01:14:42 ►

That’s how I give it in office. And so, you know, the way I set up a session,

01:14:49 ►

it’ll be 20 or 30 minutes in the beginning to sort of talk with the person, see how they’re,

01:14:54 ►

if it’s a followup session, um, you know, which more often than not it is, um, I will see how

01:15:01 ►

they’re the previous days, you know, week has been since the last infusion.

01:15:10 ►

And then just talk to them a little bit about just how things in life are going in general.

01:15:12 ►

Then we’ll proceed to the infusion.

01:15:20 ►

And when they’re in the acute phase of the effect of the drug, they’re pretty dissociated for 20 or 30 minutes. Again, they’re in that place where there’s still an eye there, but the eye is not in the same room that they sat in when they started um or if it is the same room it’s not

01:15:30 ►

really recognizable as such until they get back um and uh and then when they’re back then we can

01:15:37 ►

talk i will ask them how the experience went what came up um sometimes there will be useful

01:15:41 ►

insights psychological insights that we can talk about but more often than not it’s kind of very difficult for them to put into words where they just were.

01:15:51 ►

And so there’s not a whole lot that can be worked with in a traditional psychotherapeutic sense.

01:15:59 ►

And yet it’s clear to me that something has shifted and they feel that something has shifted

01:16:08 ►

even if it’s very difficult for them to put into words

01:16:11 ►

and then three out of four times

01:16:14 ►

the next day, couple of days

01:16:16 ►

depression, which can be really severe in some cases

01:16:20 ►

just starts to lift somehow

01:16:22 ►

and they’re able to be motivated and interested

01:16:26 ►

in things again and their ability to like laugh and derive pleasure from their life you know sort

01:16:32 ►

of returns out of nowhere and it really does happen that quickly and then when that does occur

01:16:38 ►

you know that the challenge at that point is to how to it, how to maintain the effect, because it is a time limited effect. It’ll fade on the order of anywhere from a couple of days to a couple

01:16:50 ►

of weeks, depending on the person. And sometimes it takes a little bit of tweaking of the dose

01:16:56 ►

too. Sometimes I’ll maybe go up from a half milligram per kilogram up to like 0.6 milligrams per kilogram.

01:17:10 ►

But, you know, with what happens with ketamine with repeated infusions,

01:17:19 ►

so if the time to resurgence of the depression after a single treatment in a given person was a week, say,

01:17:26 ►

if you give three or four or five treatments in a row, you know, separated by days or a week in between after that final infusion, you might put them in total remission, you know,

01:17:34 ►

indefinitely more often it’s like remission that can last for a few months. A lot of these patients

01:17:39 ►

are coming to me from other psychiatrists who are also at the same time treating them with

01:17:43 ►

conventional antidepressants, which can happen. Sometimes at that point, the conventional antidepressants can

01:17:48 ►

take over and, um, you know, they can be in a state of remission, you know, using that as kind

01:17:55 ►

of a maintenance strategy, but, um, you know, it, so it varies. Um, ideally what’s happening in,

01:18:00 ►

So it varies.

01:18:06 ►

Ideally, what’s happening for people is that, you know,

01:18:12 ►

they get unstuck from a place of depression where, you know,

01:18:17 ►

depression has this way of sustaining itself where the symptoms are such that you’re withdrawing from the things in life that can sustain you

01:18:22 ►

and bring you joy and meaning in your life.

01:18:24 ►

And once it gets to that

01:18:26 ►

point where you’re cut off from those things it becomes a very vicious cycle because the

01:18:31 ►

you know if you’re in a severe depression you’re cutting yourself off from the things that can

01:18:36 ►

counteract it you’re becoming increasingly sort of isolated and you know it it can be really hard to to come out of that place without a direct

01:18:47 ►

intervention such as you know a drug a ketamine infusion something like that um but once you’re

01:18:54 ►

out of there hopefully you know you can make the changes in your life that can then really sustain

01:19:01 ►

long-term health which should you know can be anything depending on who you’re talking about.

01:19:07 ►

But people can make decisions.

01:19:11 ►

Maybe they’re not in the right line of work.

01:19:12 ►

Maybe they’re not with the right partner.

01:19:14 ►

Maybe they need to make some major changes in their life.

01:19:30 ►

And, you know, that can be as big a piece of sustaining an antidepressant effect as any other sort of treatment intervention.

01:19:35 ►

It’s fascinating what ketamine can do, and I’m really glad you’re there doing the research and moving that one forward.

01:19:39 ►

So I’d like to be checking in more and more as you keep doing all these different works.

01:19:44 ►

So before I let you get back to enjoying Boulder and getting ready for your session tomorrow, the golden question is if you could be outside the drug scheduling system of this country and we could land you a very big grant to do just the kind of work you want to be doing using the whole palette of psychoactives out there as well as the space creating, what kind of center would you like to run?

01:20:03 ►

What kind of center would you like to run?

01:20:55 ►

I’ve given this a lot of thought because ultimately the goal with all of this work is to get these substances rescheduled so they can then become a part of the legitimized clinical toolbox at our disposal. If that didn’t exist, I mean, what I imagine is one of, you know, a restoration to peace and wholeness

01:20:59 ►

for people.

01:21:00 ►

I mean, I think that environment could be really conducive to that.

01:21:04 ►

I mean, I think that environment could be really conducive to that.

01:21:18 ►

A place that almost like kind of like an ashram or like a meditation retreat, like an environment like that, like that’s where people are sort of ideally like living and working.

01:21:23 ►

And people who are coming, whether it’s for healing or for just like spiritual, I mean, I would want these things to also be available, just not just for the treatment of, of, you know, quote unquote,

01:21:29 ►

mental illness, but, um, to help people who are, uh, not diagnosable with anything, but who are

01:21:36 ►

trying to use these substances as a way of promoting their own spiritual growth and

01:21:40 ►

development. I think they’re very important tools for that purpose as well which is way outside the medical model but um i think that that ultimately might be their most

01:21:51 ►

important function um in terms of what they can contribute to the evolution of our species but

01:21:58 ►

um something you know so for people who are seeking that type of transformation, they can come and stay and live in the space with the people who are there more sort of long term for a week, two weeks, however long it needs, the process will need, or they can return.

01:22:30 ►

Return, almost like a place like Rivendell in Lord of the Rings is kind of what I imagine.

01:22:33 ►

The last homely house.

01:22:51 ►

Some place like that where there’s sort of human being at his or her highest self.

01:22:55 ►

I think we’re all sort of, I don’t know.

01:23:02 ►

My goal in life is to evolve to the point of a token elf.

01:23:06 ►

That’s where I hope all this is headed for me.

01:23:08 ►

I want to become Elrond’s nephew.

01:23:15 ►

And with that, I lose my position in maps.

01:23:19 ►

But, I don’t know.

01:23:21 ►

No, you’ll be chief elf one of these days. Yeah, maybe.

01:23:22 ►

Don’t you worry.

01:23:24 ►

Heading up Elrond’s council.

01:23:25 ►

Sure, why not?

01:23:27 ►

No, but seriously, like a place like that,

01:23:29 ►

a place that is itself has breathes the magic of transformation and growth.

01:23:35 ►

I mean, there’s something already magical about like a forest anyway.

01:23:38 ►

So just like a place where like the architecture sort of, uh, is harmonious with nature, you know? And, um, in fact,

01:23:51 ►

um,

01:23:52 ►

maybe even like up the geek level one step further,

01:24:00 ►

not even Rivendell, but, um,

01:24:04 ►

the forest where Galadriel lives in Lord of the Rings which I’m

01:24:07 ►

god I’m spacing on the name of it oh Lothlorien that’s what it is

01:24:15 ►

Lothlorien where the elves actually have their homes are built up in the trees like that I don’t

01:24:21 ►

know if initially we need to be in the trees but something where it’s like the architecture is very sort of biologically almost like mimicking the the biology uh of the structure

01:24:31 ►

of the biology around it um something that’s very like symbiotic with the environment um

01:24:38 ►

that’s kind of what i imagine so if i had a billion dollars and can do that, I’d build Lothlorien. I’d hire Cate Blanchett to be there in her full regalia at all times.

01:24:48 ►

And we’d do it up straight up Lothlorien style.

01:24:52 ►

That’s what it would be.

01:24:54 ►

I wish you luck, and I hope that we can all see your vision accomplished someday not too far away.

01:24:59 ►

Me too.

01:25:01 ►

Casey, thanks so much for sharing, and thanks for all your work pushing these psychoactives out there

01:25:05 ►

in different directions to do the help

01:25:07 ►

my pleasure thanks Lex

⚗️ alembic

Explorer

044 - The Big Three

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Program Notes

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