Psychedelic Medicine 101
“This is your brain on drugs.” Those of us who grew up in the 80’s had that TV ad burned into our minds. Those eggs in the frying pan…the sound of sizzling grease…the ominous warning coming from the announcer…the message couldn’t be any more clear. Add to that, Nancy Reagan had her own ads imploring the youth of America to “Don’t Do Drugs.”
I was convinced that there could be no benefit to altering a person’s mind.
Well the whole idea of the therapeutic alteration of one’s mental status is being turned upside down. “Psychedelic medicine” is getting a lot of attention as more and more people recognize that it has the potential to radically transform how we look at mental health treatment. Our collective understanding of the role that a therapeutic psychedelic experience can play has radically changed over the last 60 years. In 1962, Harvard University fired psychologist Timothy Leary who was an early pioneer in the field of psychedelics. Granted some (well perhaps several) of his research methods were fairly unorthodox (e.g. taking psilocybin himself) but he and others such as Richard Alpert (Ram Das) were clearly on to something.
Very few people would have predicted in 1962 that in 2021, Harvard would stand up The Center for the Neuroscience of Psychedelics. Not many in 2015 (when I got into the field) would have predicted the former Texas (Republican) Governor Rick Perry would be giving one of the opening speeches at the 2023 MAPS psychedelic convention in Denver…in support of psychedelic therapies.
Psychedelic medicine is very much a real thing. Time Magazine, NPR, Rolling Stone and well known authors such as Michael Pollan, Joe Rogan, and Tim Ferriss are all talking about it. Psychedelic medicine is revolutionizing the treatment of depression, PTSD, and severe anxiety. It is also showing some promise in the treatment of alcohol and other substance abuse conditions. The disconnect for many people however is understanding how an alteration in one’s consciousness can actually lead to a therapeutic benefit.
Let me describe the concept from a 30,000 foot level. I will focus on ketamine for now as it is the only legal mind-altering medication currently but the concept applies to other substances like psilocybin, ayahuasca and ibogaine etc. Purists reading this may say that ketamine is not a “classic psychedelic” as it does not primarily target the 5HT2A receptor. If you ask anyone who has experienced a heroic dose of ketamine however, they are almost sure to report something along the lines of “well it was pretty darn psychedelic.” So for the purpose of this discussion, I will use the term “psychedelic” to refer to any substance that leverages a non-ordinary state of consciousness for a defined therapeutic goal.
When you use these medications to treat a mental health condition, there is both a biochemical and an experiential component involved. Ketamine and other substances do bind with various receptors and cause changes in the brain’s chemistry and structure. What really differentiates ketamine and similar medications from traditional oral antidepressant medications (Prozac, Zoloft etc.) however is that, in addition to this biochemical component, there is an equal…and possibly more important…experiential component. I will leave the biochemical lecture for another time as my goal here is to help you understand the role of the psychedelic experience.
The foundation of psychedelic medicine is to reframe your mental paradigm. The mental paradigm is the way in which you see the world and the way you see yourself in that world.
“I’m not a morning person”
“I have anger issues”
“I can’t finish what I start”
“I’m attracted to bad men who never respect me”
“Women don’t like me”
“I’m bad with money”
Those are paradigms…they are an operating system that has been created…and that can be changed. They are things that you’ve come to believe about yourself over the years. Our paradigms have been largely imposed upon us from the moment we were born through the constant barrage of external stimuli on our subconscious minds. Additionally, if we suffer a psychological trauma of some sort, that can solidify a self-destructive paradigm as well. The good thing is that these paradigms however is that they can be changed. This where the term “neuroplasticity” comes in. This refers to the brain’s ability to change and create new neural pathways.
Dr. Shad Helmstetter in his book The Power of Neuroplasticity said “everything we think, feel, or do, imprints or rewires our brain. Our rewired brain, in turn, affects everything we think, feel, or do…which again, in turn, imprints or rewires our brain.” Dr. Helmstetter, in many of his writings talks about the power of self-talk and other strategies to rewire the brain. In my experience, the addition of a guided psychedelic experience however takes these strategies to a whole new level.
With psychedelic medicine, we’re ultimately trying to leverage a non-ordinary state of consciousness to help us reprogram our subconscious mind and change our paradigm. The alteration in consciousness can be a powerful tool to help see things differently…to see the world differently… and, most importantly, to see yourself differently. Now I get it…this concept can be a little bit difficult to wrap one’s arms around because it’s hard to put into words. In fact, if you could put it into words, then I would submit that talk therapy would’ve already worked. That’s why this is such a game changer in mental health.
I have been administering ketamine at our Klarisana centers since 2015. One major observaton that I have made is that it is important to understand psychological trauma from a big picture perspective. I’m a simple ER doc and I like broad brush strokes and primary colors. I won’t get all freudian on you here. The way I think of psychological trauma is that it leaves a person with two existential questions…
Number 1: “Why did that happen?”
Number 2: “How can I possibly move on?”
What do you say to someone to answer these questions? Will a simple change in brain chemistry answer these questions?
You can do talk therapy…but it is going to take a long, long time for it and other strategies (journaling, meditation, etc.) to work. Don’t get me wrong, those strategies and tools are important. Ketamine in no way replaces them…it just makes them much more effective. Like I said, it is hard to put this into words so let’s look at some analogies to understand what it means to “leverage a non-ordinary state of consciousness.”
#1: “The Magic Show”
You may have seen the old trick where a magician puts a woman in a box and is presumably going to cut her in half (it’s a historical analogy so please bear with the pronouns and gender roles for the sake of this illustration). Let’s say for a moment that the “woman in the box” represents your trauma. It represents the paradigm you have after a psychological trauma (or repeated traumas). If you truly believe that the magician is going to take a saw and cut this poor lady in half, you would understandably be very disturbed.
Now, let’s say I take you aside and try to perform talk therapy. I say to you “no he’s not gonna cut her in half don’t worry about it” your first reaction will be something like “dude what are you talking about? He’s gonna cut her in half, this is not cool!” If we try to proceed with talking about your feelings and your childhood or whatever, we will get nowhere. You will be preoccupied with her impending demise. How about I change my strategy and give you an oral antidepressant? Let’s say I modulate your serotonin reuptake…that might make it a little less intense when he cuts her and a half…but it’s not going to change the fact that he’s cutting a woman in half. Either way you are not ok with the situation that is unfolding and we are not going to make much progress.
With a psychedelic experience however…I guide you through a profound mind-altering journey. It’s hard to put in words but you see the whole situation differently. To keep going with this particular analogy, this would be equivalent to the magician taking you backstage, and showing you how the trick is done. He shows you that she pulls her legs up and a trap door falls down. He taps in the box a couple times, spins it around etc. etc. and shows you that she’s not actually being cut in half. At that point everything changes. Now, I have no idea how that particular magic trick is actually performed but my point is that if you could see how it is done, then your whole perception of the situation changes…your paradigm is changed. In fact, to take this analogy one step further, after you learn the trick, it wouldn’t make any sense for you to “buy a ticket to the show” again.
#2: The Radio Controlled Boat
Imagine there is a kid with a radio controlled boat. Assume for a moment that you grew up in an area where you knew nothing about the concept of radio controlled toys. You had no idea that something could be controlled by radio waves from a distance. Now assume for a moment, the young girl puts a radio controlled boat into a pond and then she goes and hides behind a bush. You walk up on this pond and you see this boat zipping all around the water and doing different things. You may assume that the boat has a mind of its own, and it is somehow capable of its own actions. You have a paradigm where you think the boat is operating on its own accord. If I go ask the girl to step out from behind the bush and I show you that it is actually her controlling the boat with a radio controller, then you will have a radical change in how you perceive this whole situation. Once you understand it, you will never go back to believing the boat controls itself.
#3: The Room and the Radio
Imagine being locked in a room with a radio. Imagine that that radio is tuned into a station that you absolutely hate. Now imagine that the radio represents your trauma and the music it is playing represents the ongoing effects of that trauma . You are being forced to listen to it and you can’t stand it. Now imagine I give you an antidepressant medication. Let’s bump it up a notch actually…let’s do some talk therapy as well. I’m going to give you a few strategies to help work on making that music less annoying. Maybe you can throw in some journaling and meditation as well just for good measure. Guess what though? The music is still playing…it’s just a little softer.
The net result of what we did may be that the volume on the radio gets turned down…perhaps not as bad as it was…but that music is still playing. The problem here is that a life stressor can come along and “the volume gets turned back up.” That scenario is a set up for a bad decompensation or something much more serious like thoughts of self harm.
Now imagine a different scenario. I walk in the room and I change the station on the radio. I ask you what kind of music you like and we find that station. The whole situation changed. At that point you don’t mind if the volume gets turned up…it is music that you like.
Hopefully this begins to give you some clarity on how a psychedelic experience can change your mental paradigm and transform your life. Remember that the experience can’t be put into words. Some of you reading this may have had psychedelic experiences yourselves and might be thinking…”well it’s actually more like this or that.” That’s cool…but remember what I said…”if you could put it into words then talk therapy would have already worked.” What I have presented here is one way to think about it…but it is certainly not the only way. The reality is that trying to describe this experience is similar to trying to describe the concept of “love.” Taylor Swift and Metallica may both sing a song about “love” but those two songs will sound very different.
The key thing to take away is that we are not having a party. We are using mind-altering substances in a very intentional and thought out way in order to leverage a non-ordinary state of consciousness to help people reframe their mental paradigms and transform their lives.
All photographs were licensed and downloaded from Shutterstock.com
Photo 1: “Woman looking at the Ocean” by IZF
Photo 2: “Woman in the Box” Photo by Zastolskiy Victor
Photo 3: “Girl and radio controlled boat” Photo by Sherbinator
Photo 4: “Old Radio” Photo by Gearstd
Photo 5: “Man and Dog” by Marcin Jucha
