Tag Archives: Michael Pollan

Mary and the Mushroom: Psilocybin, Chronic Depression and Me (10)

Posted on July 11, 2022 | 6 comments

Why You Might Want to Read Pollan’s Book Before You Dose. A Rather-Long Book Review.

How to change your mind: What the new science of psychedelics teaches us about consciousness, dying, addiction, depression, and transcendence, by Michael Pollan (Penguin Press, May, 2018. Also available on Audible)

Anyone who has read Michael Pollan’s writing knows that he not only brings an inimitable perspective to subjects that range across the environment, nature, and food, he does so with a virtuosic literary flair. While his approach is authoritative and science-based, his books are as much aesthetic pleasures as they are troves of compelling information. These attributes are part of the appeal of his most recent work, How to Change your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.

The book opens with a line from Emily Dickinson – “The soul should always stand ajar” – and Pollan invites us to put that advice to use by exploring a world with which most of us (even most “acid heads,” I would guess) are unfamiliar. His opening paragraph is as much a hook as an introduction.

“Midway through the twentieth century,” he begins, “two unusual new molecules, organic compounds with a striking family resemblance, exploded upon the West. In time, they would change the course of social, political and cultural history, as well as the personal histories of the millions of people who would eventually introduce them to their brains. As it happened, the arrival of these disruptive chemistries coincided with another world historical explosion – that of the atomic bomb. There were people who compared the two events and made much of the cosmic synchronicity. Extraordinary new energies had been loosed upon the world; things would never be quite the same” (p. 1).

It’s a paragraph that may strike the reader as hyperbolic, but thanks to Pollan’s fine blend of compelling writing, intriguing facts and riveting anecdotes, his exploration of the world of psychedelics consistently lives up to this initial promise.

How to Change your Mind unfolds in six chapters that cover, among other subjects: the social history of psychedelic use (from the time of the Aztecs to the present); the natural history of “magic mushrooms” and other true psychedelics; a review of the scientific literature relating to these substances; a discussion of the chemical makeup of psychedelics and current research into what effects they may have on the brain; the drugs’ philosophical and mystical dimensions; the political issues that have plagued the entire field of psychedelic use and study and may threaten them again in future; and, perhaps most importantly in this bat-shit crazy era of human history, the promise offered by these drugs to address depression and addiction and to expand our knowledge about the nature of human consciousness.

Pollan personalizes his story by explaining what drew him to write a book about psychedelics and what happened when he (a “healthy normal,” as he calls himself) tried them out for the first time. And for the second time. And the third. He also offers anecdotes relayed to him by others who have taken psychedelic trips.

Perhaps most relevant to my own decision to participate in a clinical study of psilocybin is the material in Pollan’s book relating to the treatment of depression and anxiety. He details the massive clinical evidence that has accrued to date showing the beneficial effects, which can last for months or years or even longer, of one or two psychedelic treatment sessions on those experiencing chronic and/or serious existential depression, addiction and certain other (non-psychotic) forms of mental-health disturbance.

The protracted effects of a well-managed single dose suggest that these benefits cannot be attributed to the chemical itself, and some of the most fascinating content in this book is the discussion of current research into what effect these substances may be having on the brain. Scientists now believe that psychedelics must cause a “temporary dissolution of the ego,” allowing the wiping away of certain debilitating thinking patterns and allowing new, more positive patterns to be built.

The mind-boggling range of interrelated topics that are covered in this book (I can’t begin to convey the vastness of its scope) to my mind makes this essential reading for anyone with any serious interest in the subject of psychedelics. In this post, I talk about some some of the many issues Pollan raises – not in an attempt to offer a condensed version of the book (which would be impossible anyway), but rather out of a hope that the reader’s interest will be piqued enough that they will find a copy of the book and read it for themselves.

The Context

As many of us know, in the early 1960s Harvard professors Timothy Leary, Richard Alpert (who later renamed himself Ram Dass) and others became so enthusiastic about the potential of LSD to save the world that they decided to try to turn on everybody, or at least an entire generation. The effort had several disastrous outcomes – not because of the drug itself but because of the way it was distributed, mostly underground, and used. The fallout put psychedelics out of legal reach for research or individual use for decades.

Although many who tried LSD at the time had wonderfully transformative experiences or just garden-variety amazing trips, others had more negative and newsworthy outcomes. These ranged from disastrous judgement calls (there were incidences of accidental deaths, suicides and cases of long-term psychosis), through accounts of hallucinations that terrified the trippers, to events that mostly horrified disapproving onlookers and the media – such as kids running naked through the streets. The love of humanity and nature engendered by these substances also led to a widespread disinclination among users to march off to fight a war in Viet Nam. Within a few years, alarm about psychedelic drugs had risen to such a level that President Richard Nixon declared war on them, Harvard fired Leary and Alpert, and all research into this intriguing substance was made illegal. It would be thirty years before clinical investigations into the positive aspects of psychedelics could be resumed – legally, at least.

Disabusing Myths

As it turns out, the actual research from the 1950s and 60s and the extensive clinical investigation since the late 1990s clearly indicate that psychedelics are physically safe. “It is virtually impossible to die from an overdose of LSD or psilocybin… and neither is addictive” (p. 11). Tryptamine, the organic compound that causes the psychedelic effect, is not only not toxic, but it works differently on the brain from substances that do lead to addiction. “What is striking about this whole line of clinical research,” Pollan writes, “is the premise that it is not the pharmacological effect of the drug itself but the kind of mental experience it occasions involving the temporary dissolution of one’s ego that may be the key to changing one’s mind.” (Pollan points out that other drugs that are not true psychedelics, some of which are now being used in clinical settings to relieve depression, and all of which are available on the street – such as MDMA [aka “molly” or “ecstasy”] and ketamine [Special K, KitKat] – can be addictive.)

Research is also showing that with screening and supervision, psychedelics are almost always psychologically safe. The incidences of “bad trips” (which can indeed be terrifying from all reports, and are one of my big worries about my impending dose), can almost always be averted or at least mitigated by attention to set and setting. The “psychotic breaks” that emergency doctors unfamiliar with the drugs identified in those (few) people who were admitted to their care after taking LSD back in the 1960s are now believed to have been primarily panic attacks – which are also less likely to happen when dosing takes place in a safe setting in the presence of a knowledgeable guide. Again there are usage warnings: people with psychosis in their family history and young people who are predisposed to schizophrenia may not be good candidates for psychedelic use.

“Set and setting” are so crucial to the successful therapeutic use of psychedelics that early on, Johns Hopkins developed a set of “flight instructions” that are given to research participants in advance of their treatment doses in order to help them avoid bad trips – or to transform bad trips into good ones. These instructions basically involve trusting that you’re going to be okay, letting go, and remaining open to the experience, and they have become part of the standard protocols of clinical studies into psychedelics everywhere – as has the mixed tape of music that Johns Hopkins researchers developed for participants to listen to while they are tripping.

Psychedelics are highly “suggestible,” which means that setting expectations for a psychedelic experience ahead of time is an extremely important step. (This is the “mindset,” or “set,” part of “set and setting.”) It seems, for example, that those who anticipate a mystical experience in which they feel as though they have made contact with a divine being or a deceased loved one are far more likely to have these kinds of experiences than are people whose intentions are (again, by way of example) to learn more about the self or about the nature of consciousness.

Clinical Evidence

The evidence that psychedelics have a dramatic role to play in the treatment of mental-health issues including chronic depression, end-of-life despair and PTSD includes a 2016 publication from New York and Johns Hopkins universities showing clinically significant reductions in measurable incidences of depression and anxiety in 80% of cancer patients. When researchers applied for funding from the FDA in 2017 to extend a study into the effects of these substances on cancer patients, the results they had already amassed were so impressive that FDA staff asked them to expand the next phase to include depressed patients who did not have cancer. As Pollan points out, they made this request “seemingly undeterred by the unique challenges posed by psychedelic research, such as the problem of blinding, the combining of therapy and medicine, and the fact that the drug in question is still illegal” (p. 375). Similar initiatives have occurred in Europe, where there is also serious concern about the pervasiveness of depression in the general population and the inadequacy of current resources and medications to adequately address the situation.

Way back in the 1950s, before psychedelics became illegal, there was already growing evidence that these substances could help people with addictions. Pollan takes an interesting detour in his historical account to report on a highly successful program in Weyburn, Saskatchewan in the early to mid- 1950s – involving Aldous Huxley among others – that made LSD standard treatment for alcoholism in that province. Even before that, indigenous people in North America were using peyote to treat the rampant alcoholism that had accompanied the European invasion of the “New World.” Since the 1990s, research in the addictions field has resumed both underground and above ground, and is showing promising results, with up to 50% of participants in one Johns Hopkins study having quit smoking following a psychedelic session compared to 10% to 35% who used other treatment options.

Even “healthy normals” who have taken standard therapeutic doses of psilocybin or LSD in settings that approximate the ones being used in clinical studies have reported such benefits as increased focus and greater creativity. In small doses, psychedelics have shown a benefit to the fitness of animals, and the implications for humans in this context are also being investigated.

The Spiritual Element

As well as temporarily dissolving the ego (or “shaking the snow globe” as one scientist quoted by Pollan put it), psychedelics have occasioned what many have described as “mystical experiences.” Science is exploring theories about what makes this happen. This is in itself quite an amazing turn of events: we now have researchers focusing their traditional methods of investigation on efforts to discover what causes phenomena that have zero anchors in reality – such as convictions of the existence of higher powers in which people may have faith, but can show no concrete proof. Obviously, the only way to approach this topic in a way that has scientific resonance is to explore the physical side of it. What effect does tryptamine (which is, as explained above, the psychoactive component of psilocybin, LSD, ayahuasca and other true psychedelics) have on the brain that might lead to hallucinations and mystical experiences?

Many studies in England, the U.S., Canada and other countries are now focussed on the effect of tryptamine on the brain’s default mode network (DMN), which “forms a critically and centrally located hub of brain activity that links parts of the cerebral cortex to to deeper and older structures involved in memory and emotion” (p. 301). Wikipedia describes the DMN, which scientists who study the brain did not even know existed until about 2001, as “being active when a person is not focused on the outside world and the brain is at wakeful rest, such as during daydreaming and mind-wandering. It can also be active during detailed thoughts related to external task performance. Other times that the DMN is active include when the individual is thinking about others, thinking about themselves, remembering the past, and planning for the future.” Scientists are able to get the DMN to “light up” during functional magnetic resonance imaging (fMRI) when subjects are asked certain questions about their selves or given feedback about something they have done (such as receiving “likes” on social media), and with other prompts that involve identification of the sense of self. For this reason, neuroscientists sometimes refer to the DMN as “the Me network.”

The positive effects of the DMN on human thinking and behaviour are multifold. The network essentially acts as a conductor of the orchestra in our brain, whose instruments carry out functions such as smelling, seeing, adding, subtracting, etc. It organizes the instruments in a way that prevents all their necessary activity from leading to cacophonous collisions that would send us into madness. However, the DMN can also create patterns of repetitive thinking that are unproductive, causing our minds to wander around and around dark alleyways (wearing deeper and deeper ruts in our mind) that can lead some of us into cycles of depression and addictive behaviours that we seem unable to escape.

Pollan provides a comprehensive report on the recent history and current thinking related to the DMN, all of which – thanks to his strong writing – is truly interesting. The long and the short of it is that some neuroscientists now think that during psychedelic trips, the DMN or “me network” is knocked out of commission, leading to the dissolution of the ego. This allows the brain to stop processing input as it traditionally does, on the basis of memories and learned emotions, and instead to respond in a way that some have compared to how babies and young children see the world: with amazement and pleasure. Because the DMN is not doing its usual job of telling us “this is impossible,” perhaps tryptamine also lets us encounter visions that we interpret as gods and monsters.

Psychedelics can make even the most cynical of us into fervent evangelists of the obvious. (Pollan, p. 251)

Pollan explains it all much better than I do here, but in short, psychedelics may wipe out the ruts we have created in our thinking, allowing us to see trees and flowers as if for the first time, to love those we love as though experiencing love for the first time, and just generally to become much more open and creative in our ways of interpreting the world. And they may do this simply by taking the default mode network out of commission for a few hours. Herein lies a scientific interpretation that may also explain some magic.

The Psychonauts

There is no doubt that the spiritual component of psychedelics is what is attractive and notable to many who are exploring altered states of consciousness through the use of psychedelics. Indeed, it was for their mystical properties – not to get “high” as one does with alcohol or cannabis – that almost every aboriginal group in the world made use of psychoactive drugs from early times. And it was their mystical effect on users that made LSD seem so dangerous to governments in the 1960s – people who had experienced an explosive love for humanity and the world around them as a result of using psychedelic drugs were no more interested in becoming cogs in the capitalist machine than they were in going off to war. (I imagine that this is not a selling point for psychedelics within the industrial complex.)

Interestingly, it was thanks to a paper published in the journal Psychopharmacology addressing the whole mystical side of psychedelics that revived research interest in the use of psychedelics in therapeutic settings fifteen years ago. Entitled “Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance,” it was the result of a study by a highly regarded neuroscientist named Roland Griffiths, a researcher who had grown bored with his previous work after having had a spiritual experience himself on psychedelics.

This aspect of psychedelic use is still of major interest to many, and groups have been established to foster and explore the spiritual experience. Unlike most religious experiences, the contact with higher powers precipitated by LSD and other psychedelics is direct – you don’t need an intercessor (religious leader, shaman, etc.) to tell you about the immutable revelations; you experience them yourself. (I imagine that this is not a selling point for psychedelics among would-be cult leaders – including not only religious leaders, but also some politicians.)

Pollan writes about a whole range of figures from both within and outside of the world of science who are interested in and knowledgeable about the mystical facets of psychedelics – including the aforementioned Roland Griffiths, as well as Bob Jesse (another of the authors on the Psychopharmacology paper and founder of the Council on Spiritual Practices), Rick Doblin (founder and executive director of the Multi-Disciplinary Association for Psychedelic Studies, [MAPS]), Terrance McKenna (creator of the “Stoned Ape Theory” of the evolution of human cognition, including language), and Paul Stamets, a self-taught mycologist who is central to the movement to increase human awareness of the power, ubiquitousness and benefits to the planet of the range of mushroom species (not just those containing psilocybin).

Back to the Neuroscience

“If, as Freud said, dreams are the royal road to the unconscious, is it possible that psychedelic drugs are a superhighway to the unconscious?” (M. Holden, 1980, as quoted in “The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs,” by Robin Carhart-Harris, Robert Leech, et al.)

I personally found it reassuring that despite all of his research and personal “travels” using psychoactive drugs, Michael Pollan has not turned into a mystic, or completely relinquished his atheism (although he does confess to having “communed directly with a plant for the first time” on his first, unguided trip), but those who are interested in the spiritual aspects of these drugs will find lots of non-judgemental and interesting material in his book.

However, I am at this point more interested in living in the world than lifting off from it on any kind of permanent basis. In fact, one of my big worries about my upcoming trip has been that I will lose my groundedness and sense of purpose, both of which I value highly. So it is reassuring to know that the direct effect of psychedelics on the default mode network is temporary, lasting only as long as the drug is having its most intense effects, which is typically between 6 and 8 hours. Psychedelics do not make people permanently delusional.

The lack of permanent physical change to the brain as a result of psychedelic use is of great interest to scientists. Since the nature of the psychedelic journey does not make people want to have trips on a regular basis (or even more than once, in many cases), and since the effects may wear off within months or years, clinical trials such as the one I am involved with now are working to figure out how to extend the benefits of these trips by means of follow-up integration sessions, meditation, and other non-pharmacological means. (I imagine the fact that only one dose is typically administered is not a big selling point for Big Pharma.)

In Conclusion

This review is so long that I am tempted to just throw the whole thing in the trash despite the hours it has taken me to write it, because I doubt others will be bothered to read the whole thing. Even if they did, their time would be better spent in opening Pollan’s actual book and digging in. But I read How to Change Your Mind far more closely than I would have otherwise because I wanted to to write about it, and that was of great benefit to me. Writing this review, or dissertation, or whatever it is, was also beneficial. It would be a better a literary artifact, and become a more appropriate length for readers of this blog, if I now embarked on a great deal of trimming and restructuring, but I have other things to do.

There are unfinished threads I still want to write about that have arisen from my ingestion of so much material on matters psychedelic – I am concerned abut the future role of these drugs in therapeutics and other consciousness-expanding settings, and specifically about how their potential benefits may be eroded yet again by the machinations of Big Pharma, governments and even therapists themselves who may see little benefit to themselves in the relief experienced thanks to psychedelics by ordinary humans, but I’ll write about that next time.

In the meantime, people who are asking other people and/or the Internet to tell them more about psychedelics, as well as people like me who are contemplating a one-off full-dose psychedelic tour of the inside of their brains, will benefit from reading Pollan. How to Change Your Mind is an extraordinarily rich and interesting resource.

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Mary and the Mushroom: Psilocybin, Chronic Depression and Me (9)

Posted on June 19, 2022 | 5 comments

Sobbing at the Symphony, an Amazing Film, and Other Trip Preparations

As the date of my first (only?) psilocybin dose moves closer, I find myself suspended between the relative certainty of what is happening now and the mystery of what will happen afterwards. This feeling of suspension (or should I say “suspense”?) is no doubt attributable in part to the aura of unreality that accompanies antidepressant withdrawal, and in part to my efforts to learn everything I can about psychedelic experiences in advance of actually having one.

It has been nearly three weeks now since I took my last dose of the SSRIs I’ve been on for several decades. The side effects of withdrawal, which I also described in my last post, continue, including the unwelcome feeling every few minutes that a series of little electrical-like pulses are shooting through my brain (aka “brain zaps”), a tendency to burst into tears at the slightest provocation, anxiety, and a more-easily-triggered impatience than is typical for me. I feel as though these side effects are diminishing (I hope so), but it’s also possible that I’m just getting used to them.

Tired of Thinking about my Self

Concurrently, I have been reading and listening to and viewing so much material that relates to psychedelic trips, mushrooms in general, and states and conditions of consciousness, that I am growing tired of the whole subject. I tell myself versions of the following: “This is ridiculous! People drop acid all the time without totally immersing themselves in the science, philosophy and history of it all and perusing narratives that chronicle the experiences of other people. Sure, maybe all they get is a little break from reality, but that is all they’ve asked for: they do not expect to emerge with dramatic alterations to their world views. These are just fungi, after all.”

Of course, there’s a fear of disappointment woven into all of this: after all of the preparation, what if mine is a one-day trip that takes me nowhere? Michael Pollan, whose latest book has become a core reference for those who are interested in how psychedelics can “change [their] mind,” emerged from his first two trips – one on LSD, one on psilocybin – feeling somewhat disappointed, and fairly certain that what had happened to him was not likely to have any permanent effect.

On top of everything else, my anxiety often presents itself as a form of self-castigation that I’m sure is familiar to most people who are dealing with mental health issues: What if I am just blowing everything out of proportion? (To which I answer, Of course I am. That’s part of what I am trying to stop doing.) (<– Circular thinking is another symptom of depression, but it also often seems to be a logical and compelling form of discourse.)

On the other hand….

I’m probably just experiencing information overload. The behaviour that’s led to this is typical of me: when I’m going on a real-life journey, I study as much as I can about the destination before I go, and even attempt to acquire a little of the language in advance. I admit that what I’m learning about psychedelics in general and mushrooms in particular has been interesting and useful no matter what the outcome, and writing about it has been helpful. And I’m happy to hear that it’s also helping others who are in similar circumstances.

The psychiatrist who is supervising “my” research study has suggested that, for a couple of weeks before the dose and at least a week after, I avoid engaging too much with the world on this subject (or most others), as I will want to think about my own expectations, and then about the effect the experience has had on me. To that end, I envision two more pre-dose blog posts – one a review of Pollan’s book, and the other an account of what I am looking forward to and concerned about as the dosing date approaches.

The Study

A few people have asked me what it’s like to be in this research study. Up to this point, the experience has primarily consisted of administrative steps (a blood test, a referral from my family physician, etc.) and completing a whole lot of questionnaires about my state of mind, and about the medications I am on and have been on. The same questions keep appearing on new surveys and seem to be designed for easy processing by computer: most of the questions are Yes/No or number-based (e.g., “For how many years have you been [xyz]?”). I expect the same questions will form a significant part of the follow-up as well: that’s how research works.

I get emails about once a week from the study coordinators asking how I’m doing, and I had a good conversation with the psychiatrist about the withdrawal symptoms. This week I received a list of appointments I am expected to attend before and after the dosing. There are about twenty appointments on the list, extending right through December – about half virtual and the rest in person.

A few appointments before the dose will involve discussing my expectations with the two-person team to which I’ve been assigned, and afterwards we’ll talk about how the experience has affected me. There will also be more surveys, and more blood tests.

Fantastic Fungi: A Fabulous Film

Thanks to several enthusiastic recommendations, including from a couple of biologists in the family, this week I watched a film called Fantastic Fungi. I recommend it to you with equal enthusiasm. (Check out the preview here; you can watch the film for “free” if you have Netflix.)

Fantastic Fungi does talk about psilocybin trips, but its primary focus is on the many other “magical” properties of mycelium and the mushrooms that emerge from it. Along with an explanation voiced by Brie Larson (Go, Captain Marvel!) of what fungi are and how they operate (“There is a world under the earth, full of magic and mystery…” she begins), the film features lay and scientific experts in the field of mycology, including Paul Stamets, Roland Griffith, Andrew Weil, Pollan, and nature and food journalist Eugenia Bone.

The film shows us how fungi already fulfil roles in nature that we are only beginning to understand (they serve as networks of communication among plants and trees in very similar ways to those in which humans use the internet), how they can be used to solve immediate problems (termites in your house? Stamets has cultivated a fungus that will destroy them without harming the environment), and how they can help us to address long-term issues affecting the future of the planet (check out the segment that compares traditional ways of cleaning up oil spills and what happens when fungi are introduced to do the same: not only do they clean up the mess, they start whole new colonies of growth and life). There is convincing evidence that after we humans finish destroying ourselves and the environment, the mushrooms will be here to clean up and rejuvenate our planet – a mycelium staff preparing for the hotel’s next set of visitors, a staff that is fully equipped to survive and thrive on their own if new guests don’t show up.)

Fantastic Fungi is entertaining and educational, and watching it might well change your view of the world.

Fears of Tears

This past week I attended a truly magnificent production of Beethoven’s Symphony Number 9 that featured not only the entire Toronto Symphony Orchestra but also the superlative Toronto Mendelssohn Choir and four outstanding soloists flown in for the occasion from around the world. As the concluding movement approached, I felt a growing sense of apprehension: I was watching the hundred-or-so members of the choir sitting quietly above and behind the orchestra, clad in dramatic black-and-white, ecclesiastical-looking robes and black masks, awaiting the moment when they would stand and sing. As almost everyone in the building knew, this was going to happen in the fourth movement of the symphony, which includes the powerful and uplifting anthem to peace, “Ode to Joy.”

I knew that when they rose, my wobbly illusion of emotional stability was going to take a direct hit. I feared I would be so overwhelmed by emotion that I would be unable to avoid contributing loud tuneless sobbing and hiccoughing noises to the soundscape, seriously diminishing the pleasure of those around me.

As it turned out, I was right about the first part: given everything that is happening in the news, no power on earth or anywhere else could have stopped the tears from pouring down my face and into my mask as the movement began and the choir rose to sing. This waterfall continued beyond the final note and through the standing ovation, both extended and passionate, that seemed to launch itself unbidden on cries of “Bravo!!” from the audience. But to my relief, I did not make a scene.

Afterwards, I told my friend Ksenija – my TSO companion and a woman who has enjoyed superbly performed classical music since she was a child in Europe – that I had never been so viscerally moved by a concert, so unable to stop the tears. She said, “But Mary! Tears are perfectly natural when you hear great music.”

She’s right, of course. They are. And in retrospect I think that to have been able to listen to that monumental work in these hard times, and to have been able feel it all – my emotions unobstructed and undulled by antidepressants – was a gift that was both absolute agony and absolutely glorious.

I really hope that my guides choose less staggering music to play when I am launched into the psychedelic universe (music and eye masks are traditional components of a guided psilocybin experience), and that is one of the things that I now intend to ask about ahead of time. But in the meantime, no matter what happens to me as a result of ingesting psilocybin – and even if nothing does – I will have gained one unforgettable experience that I would never have had if I hadn’t become involved in this study.

So there’s that.

TSO and Mendelssohn Choir assembling before Beethoven’s Ninth.

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Mary and the Mushroom: Psilocybin, Chronic Depression and Me (4)

Posted on February 13, 2022 | 7 comments

A note to new readers: I have recently applied to be included in a Health-Canada-approved study into the use of psilocybin in the management of treatment-resistant depression (TRD). I have survived the first few stages of the screening process and I hope to join the study in a couple of months. I will share the experience with interested readers here. In the meantime, how I got to this point is the subject of this series of blog posts.

I apologize in advance for the clinical terminology and references I have included in this post, but I wanted to get the wording right for those who like to follow the science. You can skip over any terms, definitions or references that aren’t of interest to you – I hope I’ve written the post in such a way that the citations, links, etc. don’t interfere with your understanding of what I am trying to say.

What I Know About Psychedelics So Far

There has been an explosion of news and media attention relating to psychedelics since I started this blog series. As of January 5, 2022, Health Canada has expanded its Special Access Program to include the psychotherapeutic use of psychedelics and MDMA in the treatment of severe or life-threatening conditions. At the end of January, the Canadian Psychedelic Association announced that the University of Ottawa will soon start offering a master’s degree program in psychedelic research. Numerous clinical trials are now underway or are being planned in various locations across the country and in the USA.

Outside of clinical studies like the one to which I have applied, the Special Access Program in Canada allows psilocybin treatments only for those “with a serious or life-threatening condition on a case-by-case basis when other therapies have failed and where there is sufficient evidence of safety and efficacy for the treatment of the patient’s condition.” Despite the restrictions, psychedelics are poised to become big business – as was the case with cannabis when it was approved for medical use in Canada several years ago. So it is no surprise that since this announcement, dozens of business groups, clinics, psilocybin manufacturers and organizations are fighting for attention in their efforts to attract investors and future customers. (Try Googling “psychedelics mental health” for a sample of what I mean.)

Although most articles relating to recent advances in the therapeutic use of psychedelics do talk about the almost immediate relief they’ve offered many patients with chronic depression, PTSD and end-of-life distress, they don’t talk too much about how and why the treatments work. In the past year or so, I have read and heard quite a bit about these drugs in general, and psilocybin in particular, but as is the case with any complex subject, I still feel as though I don’t know very much. Perhaps I won’t know much more until I’ve actually had a psychedelic experience, but I’m sharing what I know so far and hoping that others who have additional information or perspectives will share them with the rest of us in the comments.

What Is Psilocybin?

You can get a crash course in the chemical composition, sources, nature, history and uses of psilocybin on Wikipedia. Basically, it is a “tryptamine alkaloid” that affects certain serotonin receptor sites in the brain. It occurs in a variety of genera of fungi located in various parts of the world

These mushrooms have been used by Indigenous cultures since the beginning of time, primarily for spiritual or religious purposes.[1] It wasn’t until the middle of the last century, however, that a Swiss chemist named Albert Hofmann became the first person on record to synthesize and ingest lysergic acid diethylamide (LSD), a substance that is extracted from a fungus found in grain – to startling and somewhat terrifying (to him) effect. (After his brain started tripping, he took a bicycle home from work to lie down. The anniversary of the day he did that, April 19, 1943, continues to be celebrated as “Bicycle Day” by psychedelic enthusiasts.) Hofmann also later identified the compound, psilocybin, that produces psychedelic effects in “magic” mushrooms.

The use of LSD and psilocybin in both controlled studies and non-therapeutic (“recreational”) settings “mushroomed” (sorry) in the 1960s, primarily due to the efforts of Timothy Leary and Richard Alpert. These two psychologists were at Harvard until their experiments with psychedelics, and their subsequent enthusiastic promotion of LSD for use by young people, started attracting a lot of negative attention. It was largely due to the misguided efforts of these two and others that the drugs became banned or controlled substances in many countries.

Despite their illegal status, mushrooms (often called “shrooms” in recreational settings, although scientists avoid this term) ­­­are not hard to come by and are pretty widely available on the street. (I do not know which street, so don’t ask.)

What Happens When You Ingest Psilocybin?

The effects of psilocybin, which turns into psilocin when ingested, typically set in approximately 30 to 60 minutes after the drug is ingested, and they peak at between 90 and 180 minutes. The onset of symptoms can be measured externally by monitoring heart rate and blood pressure (which increase), and by watching participants’ behaviour. Over the next five or six hours, the effects gradually recede.

What happens on the inside (i.e., from the perspective of the ingester)? According to Health Canada, “Taking magic mushrooms may cause you to see, hear or feel things that are not there, or to experience anxiety, fear, nausea and muscle twitches accompanied by increased heart rate and blood pressure. In some cases, the consumption of magic mushrooms can lead to ‘bad trips’ or ‘flashbacks’.”

The possible physical manifestations of taking psilocybin as set out by Health Canada may make the experience sound highly unappealing, but keep in mind that the agency is also obliged to remind its readers that “The production, sale and possession of magic mushrooms are illegal in Canada.” However, the site is of value for its scientific summaries and for its link to Health Canada approved studies that are currently underway.

It is the hallucinogen part of psychedelics (“see[ing], hear[ing] or feel[ing] things that are not there”) that is of interest to psychologists, psychiatrists and their patients. The hallucinogens are undoubtedly why these substances gained traction in the religious rites of early Indigenous cultures. (Michael Pollan points out in his book, How to Change your Mind (p. 13), that the Inuit were the only early Indigenous culture not to have used plant-based hallucinogens of one kind or another – most likely, he points out, because magic mushrooms and other mind-altering plants didn’t grow in the regions where they lived .)

Psilocybin is generally said to cause a feeling that the individual ego has disappeared, allowing those who take it to feel more connected with others and with the world as a whole. The psychedelic experience has been said to lead users to observe phenomena as children do, in a fresh way, unimpeded by the intervening repetitive experiences that, to adults, may make them seem routine, ordinary and uninteresting.

In an article in Quartz entitled “Scientists Studying Psychoactive Drugs Accidentally Prove that the Self is an Illusion” (I love this title), Ephrat Livni reports that in a study published in 2017, “Participants showed significant positive changes on longitudinal measures of interpersonal closeness, gratitude, life meaning/purpose, forgiveness, death transcendence, daily spiritual experiences, religious faith and coping.”

In addition to the feeling that consciousness has fallen away, hallucinogenic experiences induced by psychedelics seem to contribute to a sense that the mind is creating new connections to the mystical/spiritual. I am beginning to understand the “falling away of consciousness” part of that statement thanks to my investigation of meditation and my ongoing efforts to attain a meditative state for minutes rather than seconds at a time (sigh. See my next post for more on this), but the second part is beyond my ability to conceive at the moment. However, others have gone where I have not, yet, and they warn that the experience can be great or terrible. Or both.

Sam Harris writes, “If [ …] a person ingests 100 micrograms of LSD, what happens next will depend on a variety of factors, but there is no question that something will happen. And boredom is definitely not in the cards. Within the hour the significance of his existence will bear down upon him like an avalanche” (p. 193, Waking Up). In his own experience, he says, a psychedelic trip can be ”More sublime than I could have imagined or can now faithfully recall,” but it can also be “so painful and confusing as to be indistinguishable from psychosis” (p. 194).

“Ingesting a powerful dose of a psychedelic drug is like strapping oneself to a rocket without a guidance system.”

Sam Harris, Waking Up

Using a similar metaphor to Harris’s “rocket,” Michael Pollan compares his first experience with psilocybin to other psychedelics he has tried as “more like being strapped into the front car of a cosmic roller coaster, its heedless headlong trajectory determining moment by moment what would appear in my field of consciousness” (How to Change Your Mind, p. 261). He goes on to point out, however, that when he took off the eye mask he’d been given to wear during the “trip,” he had a better feeling of connection to the real world, and also experienced the commonly reported amazement at the beauty of the physical world around him.

John Hopkins Study

In a ground-breaking article that appeared in Psychopharmacology in 2006 (“ground-breaking” primarily because it was one of the first reports on a study of spiritual experience to appear in a peer-reviewed, scientific journal), R.R. Griffiths, W.A. Richards et al. reported that two months after receiving doses of psilocybin in a controlled situation, participants in their study reported “mystical-type experiences having substantial and sustained personal meaning and spiritual significance.” These individuals attributed “sustained positive changes in attitudes and behavior” to the psilocybin, and the behavioural changes were confirmed by family and friends.

The article is fascinating and well worth reading. To summarize, 36 well educated, healthy individuals who reported “regular participation in religious or spiritual activities” and who had never before used hallucinogens were recruited for the study. Most said they’d agreed to participate out of “curiosity about the effects of psilocybin and the opportunity for extensive self-reflection…” (p. 2). Each participant had either two or three 8-hour monitored drug sessions, during one of which they were administered a dose of psilocybin. For comparison, during the other session they received another drug, methylphenidate hydrochloride, which has effects similar to psilocybin but without the hallucinogenic component.

In advantage of the drug-treatment session, each participants spent eight hours with their monitor(s) to build trust, which is “believed to minimize the risk of adverse reactions to psilocybin (Metzner et al. 1965)”(Griffiths et al., p. 3) and to manage expectations (“It is widely believed that expectancy plays a large role in the qualitative effects of hallucinogens [Metzner]”). Participants also completed questionnaires intended to measure “psychiatric symptoms, personality measures, quality of life, and lifetime mystical experiences” (p. 3). Some of these and other questionnaires were also administered immediately after the drug sessions and/or two months later, and volunteers met with monitors for four sessions of one hour each following the treatments. The drug-session monitors as well as pre-selected family and friends of the participants were also surveyed on various topics before, during and/or after the drug sessions. (For precise details on the various questionnaires and how the double-blind study was conducted, please refer to the actual paper.)

For many, the road to “substantial and sustained” positive outcomes was not smooth: “Psilocybin produced a range of acute perceptual changes, subjective experiences, and labile moods including anxiety” (Griffiths et al., p. 1). “Eleven of the 36 volunteers after psilocybin and none after methylphenidate rated …. Their experience of fear sometime during the study to be ‘strong’ or ‘extreme’,” and four said that “the entire session was dominated by anxiety or unpleasant psychological struggle” (p. 11). However, “These effects were readily managed with reassurance,” and “no volunteer rated the experience as having decreased their sense of well-being or life satisfaction” (p. 12).

The Discussion section of the Griffiths paper includes an interesting exploration of the issue of “empirical analysis of mystical experience,” but the relevant finding can be found in the first paragraph of that section. “The […] study shows that psilocybin, when administered under comfortable, structured, interpersonally supported conditions […] occasioned experiences which had marked similarities to classical mystical experiences and which were rated by volunteers as having substantial personal meaning and spiritual significance. Furthermore, the volunteers attributed to the experience sustained positive changes in attitudes and behavior that were consistent with changes rated by friends and family” (p. 12).

How Do Psychedelics Work on Depression?

Some reports (see this PubMed paper, for example) indicate that psilocybin may have an antidepressant effect through its action on the serotonin system, serotonin being a neurotransmitter whose “biological function is complex and multifaceted, modulating mood, cognition, reward, learning, memory, and numerous physiological processes such as vomiting and vasoconstriction” (Wikipedia). But this can’t be all of it: the antidepressants I’ve been taking for many years also work with the serotonin system, and they don’t produce out-of-body experiences or induce “sustained positive changes in attitude and behavior.”

Writing in Psychology Today, Scott Aaronson M.D. opines that “The use of psychedelics — in particular psilocybin, which is among the therapies [Aaronson is] investigating — seems to make patients more amenable to changing the thought patterns that underlie depression; these treatments work as, and with, therapy, not instead of it.”

The “suggestibility” occasioned by psychedelics is repeated often in the literature, primarily in relation to the importance of individuals considering their expectations and goals before the drug is taken. However, the fact that one becomes suggestible under the influence of these drugs leads to other issues. Like Pollan at the beginning of his investigation of psychedelics, one of my many questions is whether the “mystical experiences” reported by so many people who have consumed psychedelics are themselves hallucinations. (Then again, maybe life itself is a hallucination, but I’m not going there. At least not yet.)

Set and Setting

It is believed that “set” (being a shortened form of the word “mindset”) and “setting” have an important influence on the outcome of a psychedelic experience.

“Set” is the mental state that a person brings to the experience, such as thoughts, mood and expectations (Wikipedia). This relates to the “suggestibility” component of hallucinogenic drugs and seems to be why there is so much interest in studying the therapeutic uses of these substances in combination with “talk therapy,” rather than just offering patients psilocybin or LSD to trip with, context-free. As mentioned above, volunteers in the study by Griffiths et al. met with a monitor for eight hours before their drug treatment session, and for four hours afterwards.

 “Setting” is the physical and social environment in which the psychedelic experience occurs (Wikipedia). The psilocybin treatments in the Griffiths study were conducted in a peaceful setting, with the patient reclining and using a facemask and headphones to reduce outside distractions.

Negative Outcomes (Bad Trips and Other Stuff)

The paper by W..W. Griffiths et al. contrasted their generally extremely positive results from administering psilocybin to a study known as “The Good Friday Experiment” (Pahnke, 1963), in which ten theological students were given a dose of psilocybin and another ten were given nicotinic acid in a group setting during a religious service. While the participants who received psilocybin did show “significant elevations on the Pahnke Mystical Experiences Questionnaire [link added by me], and reported positive changes in attitudes and behavior at 6 months and at a 25-year follow up,” (Griffiths et al., p. 13) things got a bit weird (and the study’s double-blind component was broken) when some of the participants who’d received the psilocybin began to act “bizarrely,” affecting the experience of the others in the group.

Most of us have all heard reports of people tripping on psychedelics who have been found running around in traffic or throwing themselves off high buildings. We have also heard of people who had trips that were almost entirely horrifying, and led to all kinds of mental distress even when the drugs had left their systems. And then there are the “flashbacks” (officially known as hallucinogen persisting perception disorder, or HPPD) which causes a small percentage of people who have used psychedelics to have occasional or even (rarely) persistent psychedelic symptoms. According to an article published on BigThink, there is no known cure for HPPD.

All of these outcomes and side-effects sound terrible.

Concerns about effects like these on the masses of young people who were using psychedelics at the urging of Timothy Leary and Richard Alpert in the 1960s (“Turn on, tune in, drop out”) was what got the two men fired from Harvard, and eventually contributed to the banning or at least restricted use of psychedelics in many countries, including Canada and the U.S.

However, the risks of using psychedelics seem to be greatly diminished by close attention to “set and setting” in comparison to their being used in uncontrolled situations. Michael Pollan reports that “Many of the most notorious perils are either exaggerated or mythical” (How to Change your Mind, p. 14). In addition, overdosing on LSD or psilocybin is almost impossible, and these substances do not lead to addiction: most people decide early on that one or two doses is enough, and the effects of these substances are reduced with repeated use. (In fact, they show promise in the treatment of other addictions, including to tobacco and alcohol.)

Since the revival of sanctioned psychedelic research beginning in the 1990s, more than a thousand volunteers have been dosed, and not a single serious adverse event has been reported.

Michael Pollan

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So there you have it: all I know, and then some.

In the next post, I’m going to try to put into words what I have been thinking about meditation as it relates to therapeutic treatment with psychedelics, but if that kind of meandering thought doesn’t stir your interest, you can skip that one and wait for the one after that. If you want to subscribe to this blog, which is free of course, you can put your email address into the little “Sign me up!” box on the upper right of this webpage. Then you will get a notice whenever I get around to posting something here.

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[1] “These mushrooms] may be depicted in Stone Age rock art in Africa and Europe, but are most famously represented in the Pre-Columbian sculptures and glyphs seen throughout North, Central and South America.” (https://en.wikipedia.org/wiki/Psilocybin_mushroom#History )

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Mary and the Mushroom: Psilocybin, Chronic Depression and Me (2)

Posted on January 17, 2022 | 4 comments

A note to new readers: I have recently applied to be included in a Health-Canada-approved study into the use of psilocybin in the management of treatment-resistant depression (TRD). I have survived the first few stages of the screening process and I really hope to be admitted to the study. How I got to this point will be the subject of this series of blog posts. By the time I’ve written a few of them, I should have learned whether or not I am admitted to the study. If I am, I intend to share the experience with interested readers here.

From There to Here

Despite my normally adventurous (some would call it “foolhardy”) spirit (e.g., I’ve skydived… once. Never again… and travelled to India on my own), if I had seen an invitation to join a study into the use of psychedelics in the treatment of depression even five years ago, I might not have submitted an application. Then, I probably would have been worried that: 1) the treatment would do nothing, and I’d be further demoralized, and/or 2) (at the other end of the spectrum) my mind would change so much that I wouldn’t be “me” any more (specifically, that I wouldn’t feel the need to write any more), and/or 3) that my friends and family would disapprove.

It is not that my fears have gone away – in fact I’ve acquired some new ones since I first contacted the study administrators, and I intend to write a whole post about them when I get closer to the actual experience. But my knowledge about mind-altering substances has increased considerably in the past five years. This learning journey started in an effort to find a meditation program that was suited to my needs and I’m recounting that experience here not because I think other people should learn to meditate, but only to explain how for me, that investigation led me from where I was in regard to psychedelics to where I am now.

Several years ago, a person who is close to me said that he was giving serious attention to the practice of meditation, and he’d found it was giving him some relief from the uproar of the world in general and daily life in particular. He was telling me about it because he thought I might be interested. Even though many people I know have found meditation helpful – most notably my sister, who is actually a meditation guide – I have always resisted it. I used to say, “I’ll have time to sit and do nothing when I’m dead” (totally ignoring how much time I spend sitting and doing nothing even without meditation). But since I was deep in my blue ocean at the time, I decided to give it a shot. He’d been reading Dan Harris’s Ten Percent Happier so I started there as well: first with the book and then with the app, and I used the app fairly consistently for several months.

I loved a lot about Dan Harris’s wildly popular program (which thousands if not millions have found helpful) but I had some issues with it: the spiritual dimensions and something about the tone just weren’t right for me. I was grateful for the introduction to Joseph Goldstein and a few other leaders in the field, and I admired the “heart” and generosity at the foundation of Dan Harris’s meditation program. But I was not interested in becoming a buddhist or a saint, and I decided to investigate what else was out there. I tried Headspace for a while, then Calm.

In the meantime, I had become a regular listener to Sam Harris’s Making Sense podcasts. (Sam Harris is totally unrelated to Dan Harris, by the way.) I know there are people who love Sam Harris’s outlook and some who absolutely do not, but I have always appreciated his (usually) rational approach to issues, his intelligence, and his wide range of interests. I don’t always agree with him, but in recent years particularly, I have found him a reasonable and interesting voice in this increasingly distressing – and often downright frightening – world.

Sam Harris had often talked about meditation on his podcasts, but I’d mainly skimmed or skipped those until now. I went back and started listening to his interviews with others in the field (including Dan Harris and Joseph Goldstein), and I learned that Sam now had his own meditation app. Entitled Waking Up, it was pricey compared to other meditation apps, but it offered a lot of other resources I was interested in as well (more talks by interesting people on psychology, philosophy, etc.). I decided to give it a shot.

In the immortal words of Goldilocks, for me Waking Up turned out to be “just right.” It was not too mystical and “oogie-boogie” on the one hand; nor, on the other, was it too bare bones, intended only to relieve my daily stresses and help me learn how to fall asleep. It went deep and made demands of me. I now meditate several times a week and after quite a bit of practice, I’m finally getting the hang of it to the extent that I do feel better when I do it. I’m seeing the world in a new way, and the possibilities continue to intrigue me.

In the meantime, I continued listening to the Making Sense podcast. I realized that several of the guests Sam Harris interviewed, as well as Sam himself, had begun talking seriously about psychedelic experiences they’d had in the past and, as time went on, ones they’d had more recently. They frequently talked about these experiences in terms of what they had learned from meditating. By now I had a high degree of trust in Harris, and I found the guests he was talking to (Tim Ferriss and Michael Pollan, for example) equally sincere, intelligent and rational. I knew they were respected in their fields, and so my ears perked up when they started talking about recent findings regarding the use of psychedelics in the treatment of addiction, depression, and PTSD. They also reported that psychedelics were showing great promise in alleviating end-of-life fears among those with terminal illnesses, freeing them to more fully engage with the world in the time that they had left.

Of course, psychedelics are not available for therapeutic use in Canada, and many of Sam Harris’s guests had cautioned against using them without a knowledgeable and honest guide on hand (there are sleezeballs out there. More about that in another post). So, even though I found several places online where I could apparently order “magic” mushrooms or the spores to grow my own, I was not about to try something that could actually cause me damage.

Late last year – increasingly frustrated to know that they might help but that I could not access them – I began to look more seriously for someone in my geographic area who might be using psilocybin or other psychedelic substances for therapeutic purposes. When a close friend of ours was dying, someone suggested he check out a CTV W5 program on psychedelic healing. As it turned out, our friend didn’t need it (he was not afraid of dying), but I watched it carefully. Twice. I was amazed to learn that treatments using ketamine to treat depression are available in Canada and the U.S., and that clinics that combine ketamine dosing with psychotherapy are opening in many cities. Soon after that, with the support of my family, I registered to attend a ketamine clinic in Toronto.

Ketamine has been showing astonishing, almost overnight, results for people with depression – estimates of those finding relief after using it have been as high as 70%. As you may have noticed, suddenly this approach to treating PTSD and depression is being written about and broadcast everywhere. However, it wasn’t until after I had been accepted into the program that I started reading the scientific literature about ketamine, and a few weeks ago, before my treatment program had begun, I decided to withdraw.

I’ll write about ketamine next time.

P.S. I welcome your comments on this blog! Please note that I have settings that permit me to approve comments before they are posted (I went viral on another blog once, and I don’t really want to re-experience the downsides of that kind of attention again!) so your comments may not appear until the day after you have posted them.

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