The Blindboy Podcast - Psychedelic drugs as mental health treatment

Episode Date: February 11, 2020

 A chat with Dr Paul Liknaitzky, who is an expert on ground-breaking medical research into the use of drugs like psilocybin, LSD, and MDMA to treat depression and addiction, and an investigator on Australia’s first clinical psychedelic trial. Hosted on Acast. See acast.com/privacy for more information.

Oh yart! Hello and what is the crack? Welcome to the Blind Buy Podcast. I'm recording this from a hotel room in Sydney in Australia and it has required a considerable amount of effort for me to get the audio fidelity right because the table in the room is glass and when you record a podcast on a glass table it sounds disgusting so the glass table is has currently got a mattress on it and then my laptop is on a mattress if someone was to walk into the room i'd look incredibly strange i've basically deconstructed the entire bed and placed it on the fucking table in the corner so yeah that's the crack I'm in Australia on an incredibly intensive tour um it's it's good crack it's good fun but it's that type of fun where you're just non-stop busy so basically I'm here a week and I've done nearly five gigs already

so I'm gigging getting to bed waking up the next morning getting onto a flight flying to a different part of Australia gigging going to bed getting onto a flight so it's it's non-stop uh work work work um but i have been meeting some absolutely fucking incredible people and seeing some beautiful things the weather here is nice and mild which is nice because it's the summer here so i was expecting it to be fucking unfeasibly hot but it's not it's quite mild the bushfires seem to literally get they got quenched the second i landed in australia because the torrents of rain came down so that's about it i have for you this week um i've had access to some pretty fucking incredible guests here in australia um i had a lot of trouble getting guests because no

one knows who the fuck I am over here um although I'm being pleasantly surprised like I thought my live podcasts would like just be fucking Irish people my fear was is that the live podcast would be full of Irish people who moved here in 2011 because of the recession, who would come to the live podcast because of my previous work with the Rubber Bandits. And that's a completely different audience. And I was afraid that they'd arrive at my podcast show expecting me to sing songs. But that's not the case um it's a there's no fucking rubber bandits people it's all podcast listeners absolutely amazing fucking audiences and about between 50 and 40 percent Australian too which I'm shocked I'm really shocked I didn't know there was that many Australian people coming

to my listening to my podcast so that's been amazing to get it's I suppose what it is is my first proper podcast where I'm playing to a non-Irish audience so it's been absolutely incredible so I have a conversation that I recorded with... This is a really interesting one. He's like a doctor of neuroscience and psychology, right? But his research, he's doing groundbreaking research, which is being funded here in Australia. And as far as I know, it's the only place in the world doing it he his name is Dr Paul Licknightsky okay I'm not going to attempt to spell it but what

I'll do is I'm going to write the spelling of his name in the description of this podcast because the research that he's doing is so interesting. That I think if you're listening to this and you're part of a university in England or in Ireland. You'd want to get in contact with him. And I know that he would like to see trials of this stuff being done around the world. the clinical use of magic mushrooms, ecstasy, psychedelic drugs, things that we consider to be illegal recreational drugs. Dr. Liknitsky is studying these things in helping to cure people's depression and cure PTSD and prepare you know patients that are in palliative care and have severe depression because they're facing death he's doing some

incredible stuff and it's groundbreaking and it's happening right now so I have an incredibly engaging and an interesting chat for you around that before I play it for you just kind of a little disclaimer like I don't want anyone listening to this podcast someone who's you know suffering from depression or anxiety or someone who has mental health issues who feels that the therapies you know going to therapists or the drugs that you might be on aren't working from I don't want you to listen to this podcast and think that you can now go away and start doing magic mushrooms or doing ecstasy as a form of self-treatment i really don't want that because it's it's irresponsible what uh paul ignitsky is researching specifically. It's not like how we think of antidepressants,

but it's like a medicine that you take and it changes how your brain chemistry works. It's much different. He's looking into how the psychedelic experience in conjunction with supervision and specific long-term therapy can help things so it's not just it it's it's not like take a mushroom and it helps your depression it's like it's it's almost shamanic i know that it's ritualistic study of how psychedelic drugs can change a person's perception of themselves and of the world and how that through therapy in a controlled environment is leading to success. success so i'll let i'll let uh paul ignitsky tell you so before i get into this um just a quick one because i don't want to interrupt you halfway through the podcast

this podcast is about sponsored by you the listener via the patreon page if you're enjoying the podcast and you're liking it and you're listening to it every week please consider supporting the podcast financially through the Patreon patreon.com forward slash the blind boy podcast this is this is what fucking

allows me to have it as a full time job this is why I'm in Australia right now doing the podcast it's fucking fantastic I have a life where I am earning a right now doing the podcast it's fucking fantastic I have a life where I am earning a living from doing something I love and that's made possible because of the Patreon

so if you can afford it please consider giving me the price of a pint or a cup of coffee once a month and if you can't afford it you know you can listen for free that's how it works it's a model based on kindness and suggestion and it seems to be doing fine also

recommend the podcast to a friend that's the reason I'm able to fucking sell out a venue in Sydney and have half of the audience

that are Australians who didn't know about the rubber bandits it's because of word of mouth it's because someone on social media or in real life said i'm listening to this podcast and i really like it and i think you'd like it too more than anything that's really standing to me in terms of the podcast growing and getting to where it is right now so please consider doing that too um because i put it out for free and it takes a lot of work

and that's just that's the crack that's the nature of it fully independent podcast so without further ado i don't have the ocarina with me i didn't bring the fucking do you know why did i not bring the ocarina to Australia in case it would have gotten taken off me at customs? They're very, very peculiar here in Australia with protecting their biodiversity. So if you, if you even bring over a pair of running shoes and those running shoes have Irish soil on them, you might end up like three hours in in border security so I didn't bring the ocarina because I don't know it looks like the type of thing that that'd be flagged it's it's an it's an instrument that uh is from South America and it's it's handmade

from clay and I just felt I'd get asked a bunch of questions about it. So, what can we have instead? I bought a Melbourne mug. Shit, we don't need the fucking ocarina, Paz. I got a mug in Melbourne that I drink horrible hotel tea out of. Very difficult to get a good cup of tea here, lads.

The weather's hot. They don't enjoy their tea. They have me drinking English breakfast. Which is a. A strange perversion of what we call tea. So without further ado. Here is a chat with Dr. Paul Litnitsky. About.

The psychotherapeutic use of ecstasy and magic mushrooms to treat a full gamut of mental illnesses and emotional disorders and it's highly interesting. I'll talk to you next week. I've got a class. I've got a very, very good guest for you tonight. I've got an incredibly interesting guest and a very very good guest for you tonight I've got an incredibly interesting guest and this is going to be unbelievable crack and his name is Dr Jonathan

Litnitsky and he's a doctor of psychology and neuroscience who's specializing right in the use of psychedelic substances that means means acid and yorks. But he's an expert specialising in the use of acid and yorks to treat depression, addiction and mental illness. Jonathan, come out. First up, blind boy, should I call you Mr. Boat Club? No, blind boys are alright. Mr. Boat Club.

That's the type of thing that would get the tax man interested in you. Why are they calling him Mr. Boat Club? That sounds like the name you'd have if you accrued a lot of boat clubs. That's right. So I just have to tell you, you got my first name wrong, even though I've got your last name wrong.

Did I call you Jonathan? Yeah. Where the fuck did I get that from? I have no idea. Is it Paul? You're the only person who's ever pronounced my last name right. Okay, very good.

I've practiced that one. What's your first name? Paul. Paul! Okay. Do you know what... No. Do you know what... No. Do you know what happened?

One too many shows. There was a Jonathan floating about backstage when I was typing that. I'll get him. So apologies, Paul. I'm going to just rip off the bit where it says Jonathan because... I'm going to continue calling you Jonathan if it's there. I'm going to call you Mr. Boat Club then. Oh, there you go. Oh, chewing paper. I haven't done that in a while. Next time you see Jonathan will be when you go to the toilet speaking of chewing paper

you are working in an area that is I'm gonna it controversial, even though it shouldn't be, but it is controversial. It is. You're a proper fucking doctor, proper, all of this carry on, and you're studying LSD, mushrooms, psychedelic substances in the treatment of mental illnesses. That's right. Yeah. It's a, it's an interesting time in history, that's for sure. Yeah, so my background is in neuroscience and psychology, and I work in mental health research, and one of my areas of interest is psychedelic medicine, and it's becoming my main area of interest. And we're just at a fascinating moment in time now where um the tide is is clearly turning and and in australia i can place that over the last 12 months even things are really changing quite rapidly because it's one of these subjects i've noticed that's on the internet it's actually lots of people have

opinions on it and i know people personally who are micro-dosing with mushrooms, mainly mushrooms, not LSD, but Irish mushrooms, as a way to treat their own depression. Yeah. Which, it's encouraging, but when I hear that, it also makes me sad, because I want to hear about someone treating their depression in a regulated, safe way, rather than them growing a lot of mushrooms in their hot press.

Yeah. You know? Which isn't fair, you know? We shouldn't have to do that. Firstly, what's the reaction that you... You're in an area whereby people would be sceptical

and people would doubt your credentials. They would think that you're either a snake oil salesman or they might think that you're just using this as a way to legalise it so we can all do acid and go mad. But these are some of the perceptions right now of this area. A lot of people aren't taking it seriously. Can you speak a bit about that first? Yeah. Well, it's true that we still are in, you know, this long shadow of Nixon's war on drugs

today, and the stigmas and the prejudices are there. But as I said, the sentiment is shifting, and it's shifting on account of the last 15 years of research from the most reputable research institutes in the world doing the work in a high-quality way. But I am also among those who have a healthy degree of skepticism about this. I'm very interested in the applications and how it works and why it works. interested in the applications and how it works and why it works. But, you know, we're not at the point where it's time now to, you know, set up mushroom shops on every corner and psychedelic assisted therapy centers everywhere. There's a, you know, process to doing this through the scientific method. And we're very near to the point where we will be able to see psychedelics registered as legal medicines, but we're not there yet.

And so we need to not get ahead of ourselves and stay close to the data, is my view. One thing you mentioned there, which was interesting, you specifically said the damage that Richard Nixon has done. Can you speak about that, the history of that, and what you mean by that? Yeah, absolutely. Well, Nixon's war on drugs was a war like any other. You know, the same mechanisms that are used in any other line of warfare were used for drugs. Decades after Nixon's administration,

there was an interesting set of admissions from John Ehrlichman, who was one of his top advisors. After he had come out of prison, he had some candid interviews, and he basically... After who came out of prison? John Ehrlichman.

Okay. Yeah. What was he in prison for? Some government stoogeery, yeah. Okay. What was he in prison for? Some government stoogey, yeah. Okay. Just slipping that in. After Nixon's top advisor came out of prison. That's right.

And Nixon didn't. What? So John Ehrlichman, who was, you know, ostensibly the architect of the war on drugs, really said quite candidly that the Nixon administration had two key enemies. They were black people and the anti-war left, the people that were against the Vietnam War. And they devised a plan to associate those two groups with drugs,

to reschedule those drugs in the most prohibitive way, and then basically to use that to target those groups and to vilify them night after night on the evening news and put the leaders in prison and prevent what they were doing and John Ehrlichman says and I quote he says in this interview in the 90s did we know we were lying about the drugs of course we did and another thing as well from that area that I heard about was conservatism so like Nixon was a Republican, so conservatives didn't have an appeal to emotion, right? So if you think of the late 60s in America with the, I don't want to say the left, we say the Democrats, so that means John F. Kennedy. John F. Kennedy was, like, some people say John F. Kennedy was elected because the debate between Kennedy and Nixon was the first ever televised debate between presidents. Kennedy was a young, good-looking man, and Nixon,

who hadn't done much television, had a five o'clock shadow and looked like he drank a lot of whiskey. And they say that he lost it on aesthetic grounds. People just, it was the celebrity thing but also the movement you had the hippie movement you had uh the cultural revolution of the 60s and people on the left really had something to believe in they had a feeling of what we are doing feels good and conservatism was left with nothing we are just conservatives who want to keep things the way they are. And from that, that's when conservatism began to be associated with Christian fundamentalism for the first time because it's like, well, these people are on the side of peace and love. Well, guess what? We are on the side of fucking

God. Yeah. Started in the late 70s with Nixon and them. Yeah. And also then the drugs came into that too. So are you saying then so that, because the first anti-drugs campaigns in America around the late 70s and early 80s, were they openly lying about the dangers of smoking marijuana, the dangers of smoke and marijuana?

Absolutely. Yeah, and those campaigns started earlier than that. So, you know, Nixon's war on drugs was in 70, and then there were a whole set of international treaties that the vast majority of countries in the world signed up to. So America started that shit? Yeah. So the Psychotropic Substance Act was ratified by the UN, but it was written by Nixon's administration

and signed on to by almost every country. And to give a sense of the situation we're in at the moment and the turning tide, we still have this shadow of a propaganda campaign that didn't only involve a kind of cultural war where they were spreading lies and showing these adverts about how marijuana will take your children away from you and whatever.

But actually, these drugs were classified in America, classical psychedelics are classified in what's called Schedule 1. It's equivalent to Schedule 9 here. I don't know what it is in Ireland. And that's the most prohibitive scheduling. That's where you find… Class A. We call them Class A. Class A. Okay.

So that's where you find heroin and crack cocaine and ice. And it's a scheduling reserve for compounds that have high abuse potential and no known medical value. And that was clearly a lie when that happened in 1970, because prior to 1970, you had 15 years of some pretty intensive research in psychedelic psychotherapy. It was really... That's what I want to talk about. Yeah. So it was the next big thing in psychiatry. In America and in Europe, it was taking psychiatry by storm. And you have, there were about over 40,000 people were administered with LSD legally prior to prohibition. You had six international conferences dedicated to LSD alone.

You know, many books, thousands of journal articles. It was a burgeoning field. And there's nothing like it in science. It's completely unprecedented where you have a political move that leads to policy change that should be determined by science and medicine. You know, what's the abuse potential of a drug? You know, what's the medical value of the drug? These are scientific questions. And there was clearly evidence to show that there was a lot of medical value to be had there. There are risks, and we can get into them soon, but the abuse potential is negligible for psychedelics. Classical psychedelics, you don't see dependence, you don't see physical addictions. You know, you get these studies where you have a little mouse in a cage, and it can administer some drug

to itself, and you know, you give it, you know, cocaine or a cage and it can administer some drug to itself and, you know, you give it, you know, cocaine or something and it will just tap the cocaine lever until it dies, it starves, you know. You put LSD in one of those, it taps it once and it never taps it again. So, it's, yeah, so it's really like, the last thing people think when they've come out of a big hero's dose psychedelic journey is, where can I get some more of that? It's like, I need a few months to process this. So the abuse potential is very low. Yeah, certainly there are risks and we do need to get into the risks.

But basically, there were lies that made it into legislature. that made it into legislature. And, you know, I don't spend my time bemoaning the fact that that's the situation we operate in, and it affects, you know, what we do dramatically. Like, these are illegal compounds. To run one of these psychedelic trials costs about five times what it would if the scheduling was different.

Yeah, because it's worth mentioning, you're allowed, you're someone who is legally allowed to work with LSD, to work with MDMA, yeah? Well, it's complicated. Yes, the study that I work on, so I'm an investigator on Australia's first psychedelic trial at St. Vincent's Hospital and also involved in establishing a number of others. It's just kicking off now. Yes, it's just happening right now. And yes, the study is is authorized to import these substances and store them and dispense them, you know, to the study.

So you can't make your own LSD, you have to, who are you buying it from? There's a couple of great guys on a corner in England. They're actually in England. Do you have to get dark web LSD for your trials? No, no, no. It is something that's made in a laboratory by people who are allowed to do it. This is one of the costs. In order to produce these compounds in a way that is considered clinically okay, it's called GMP. It's a

kind of clinical practice, a clinical grade. It costs so much more to produce the same substance in that kind of environment. And so there are very few producers on the planet who produce psilocybin. And a lot of pay for work as well, I'm guessing. Yeah, absolutely. And so there are only a few producers

that manufacture psilocybin, MDMA, LSD, DMT at that level. And we actually get it through these organizations overseas that have spent costs upwards of half a million dollars just to get your first milligram. Oh, my God. But then it costs a lot less to get your next kilogram. But then it costs a lot less to get your next kilogram. So these organizations that have got labs to produce this GMP, psilocybin, and MDMA in this case, they give us these compounds for free.

Okay. Because we give safety data back to them. It's a working relationship. Just a quick one there. You mentioned psilocybin. That's the active chemical in magic mushrooms. Correct, yeah. Do they have to give you psilocybin, the chemical, or do they just grow mushrooms and give you mushrooms?

Yeah, so far, the last 15 years of research, and that's what it's been. So we've had 15 years prior to prohibition, prior to 1970, and then the better part of four decades in sleeping beauty land. And then we've had another 15 years of a gradual uptick that's accelerated dramatically over the last five years. And all the trials that have been conducted over the last 15 years, the modern era, use synthetic psilocybin. But in the future, I imagine there will be some organic psilocybin used. It's interesting.

This is an interesting question that a lot of the, you know... Just a quick one. Is that because of stigma? Is it like seen as you can't have someone chewing on a mushroom? No. It must look like a drug. I don't think so. I think it mainly comes down to the pragmatic constraints

of producing GMP psilocybin. It's purity. You need it to be pure. Exact. Exact, and it needs to have nothing else in it. And that's just easier to do if you synthesize it. But, yeah, what's interesting is that there are folk in the psychonautic community

that we sometimes might disparagingly refer to as plant heads who have raised concerns about, you know, using synthetic psilocybin as though it was somehow not the real medicine. And, you know, who knows? There may be some interesting other components in organic psilocybin that are important and therapeutically relevant. But an interesting story about that is the old Mazatec Indian woman, Maria Sabina, who is famous for being the person who gave the first Westerner, Gordon Wasson, a psychedelic. And she became heralded as an important figure in the kind of early wave of psychedelic use. Gordon Wasson, Aldous Huxley, those guys. And she, many years later, she was a curandera, like a shaman.

She was given synthetic psilocybin and asked her opinion on it, and she said, it's the same. The spirit of psilocybin is there. So she couldn't tell the difference. So I've got friends who will smoke DMT through a pipe, but then they claim that it's not the same as an ayahuasca ceremony. And then they will now see the ayahuasca ceremonies in Ireland are weird. It is possible to do ayahuasca ceremonies in Ireland,

but it's usually by people who are a little bit too much into Christ. ayahuasca ceremonies in Ireland, but it's usually by people who are, they're a little bit too much into Christ. So then these people will travel to Brazil and do an ayahuasca ceremony there as it's intended. And they said, that's the best one, the full eight hour puke your ring up business. I don't want to get onto DMT yet. What I would like you to talk about is, What I would like you to talk about is, we'll say, let's just take MDMA as an example, ecstasy. The history of ecstasy in the 50s and 60s and its use in psychotherapy before it was ever used recreationally. Tell us about that, what was happening and what was it for? Yeah, absolutely. MDMA was, again, one of these, along with LSD, MDMA was heavily

used, particularly in America, in psychiatric environments. It was, you know, there were all kinds of experiments that happened, and some of them, you know, not very smart. I was just reading the other day about an experiment in, I think, the late 50s where they gave LSD to autistic children, which made me grateful that I'm in this era doing the work now. But MDMA was used as a marriage counseling adjunct. Yeah, couples therapy, it was. Yeah, that was, and to great effect. And actually, it's interesting, you see the echoes of this happening now. I was just on a call last week with a woman who's running a trial using MDMA to treat post-traumatic stress disorder, which is

its main indication, its main use currently. And she has a trial where she has the person with PTSD and their partner, their romantic partner, in the room. They both take MDMA. And then they do a form of therapy called conjoined therapy, a kind of couples therapy. And it seems to great effect. And is the issue there that the person with PTSD is having issues with connecting with their partner? Is that it? It's complex the issue is that PTSD is also born out

in the relationship and the person who is not diagnosed with PTSD often has a kind of trauma on account of who they're with but also there's a lot of research that suggests that we get much better sustained outcomes when the therapy can be transmitted and

carried on in some way by the close people in a person's life. Wow. Yeah, so if there is... They're doing this with eating disorders now quite a bit where the caregivers, the parent or the sibling or the partner of a person with eating disorders is also brought into the therapeutic room, taught these skills, and then continues to somehow support their close one

in a particular way. So there's a way in which it's about sustaining the outcomes by bringing the relationship into the therapeutic environment and that relationship becoming therapeutic in the longer term rather than just the session. And one of the big, I don't want to say problems, right? But one of the big walls that I've always seen that's faced psychotherapy is it's so hard to measure results and prove them in a psychotherapy as opposed to just drugs.

Do you know? How do you go about proving, not proving, but showing data that this therapy is better when the person's sister is present or the person's brother is present? Yeah, it's not simple, but there are ways to do it. I mean, you know, the gold standard in medical science is the randomized controlled double-blind placebo trial, you know, where you have a number of groups and you give what you think are active ingredients to one group and, and, and not to the other group. Um, it's, it's hard to work these things out. And then you, you know, you,

you give surveys and we, you know, we psychologists, we have a survey for everything. We'll get into the, the psychedelic experience soon, which is an interesting one to try and put surveys to. Yeah. Um, but, um, yeah, but, uh, but, but we've done it, um, done it, and we're doing it. But it's, you know, it's not straightforward to do this work well, and it's imperative that we do do it well. The placebo is just one of a number of key issues that the psychedelic science field is dealing with. Because if you think about it... How do you do

placebo acid though? Exactly. Oh shit, yeah. It's very hard to placebo blind. You can't give someone a placebo and say this is acid. Well, no, you can. Because then you start to think that reality is hallucination. It is.

No, no, the issue is that you only get about one hour of the placebo effect when, you know, after you give an MDMA. So are you literally doing trials where you give one person ecstasy and one person not ecstasy, but you say that it is? Like a bad dealer. No, no, everybody... Exactly. No, everybody knows everybody... Exactly.

Everybody knows it's a placebo-controlled trial. They know they could get one or the other. They don't know what it is. But everybody knows he's had the active dose one hour in. Do you know what, though? We've all been in the situation when we were kids where someone

either tries to buy hash and you're sold a piece of turf and you don't know the difference and what happens is no one wants to admit that it's not real and you don't know what being stoned is like you play along yeah so you end up going oh man the music sounds so great and you're pretend like everyone's been pretend stoned when they were younger because someone sold you shit. Is that stuff happening? Because if you have a group of people and you hand

three people real ecstasy and another three people not real ecstasy, fake ecstasy, the fake ecstasy people are going to start taking their tops off as well. Yeah, not so much in the treatment room, because it's just you and the psychotherapists, and there's no points for guessing who's had it and who hasn't.

But it's interesting that a lot of people derive substantial kind of benefit from these placebo sessions. This happened just recently in Melbourne. So on the first psychedelic trial in Australia, this is a placebo-assisted... This is a psilocybin-assisted psychotherapy trial to treat depression and anxiety in people who have a terminal diagnosis. A terminal diagnosis, as in these people are dying?

Correct. Yeah. And so the trial is sponsored by St. Vincent's Hospital and headed up by a wonderful colleague, Dr. Marg Ross. And she just had a placebo session, and it's an interesting one because the dosing session is eight hours long. You're in a room with two psychotherapists, so in this case it's a psychiatrist and a psychologist,

and the dosing session's eight hours long, but after about four hours of the placebo session, she couldn't find any good way to keep the patient in the room any longer. You know, this is four hours, they're lying there, they're a little bit bored of the playlist, and they've had their their conversations and it's four hours and nothing's happening. So she went home. But with the person who's taken psilocybin, they will happily stay there for eight hours. You betcha. Yeah, no, they're in no hurry to leave. And are these problems that are unique to this type of research then? Yeah, absolutely.

There is no other treatment that entails an eight-hour session. You know, how are you going to bill for that? Think about scaling this in the future. That's a big day for the person, for the psychiatrist. It is. Totally. This is one of the reasons it's so expensive. And that therapist has to stay within,

grounded and professional for that amount of time. They can't start scratching their feet. That's right. It's intensive. You've got two therapists in the room, so there is an opportunity for one person to leave momentarily. But it's an intensive treatment session. But having said that, Paul, right,

would you not shamans for years have done just that? Who's shamans? Not shamans. Is that your man? I'm Jonathan. Were you joking? I wasn't joking.

Not a guy called Seamus. Shamans. Shamans. Sorry. Limerickian. Shamans. Shamans do this. Shamans will...

A shaman's job is not just to bring the substance to the person, but it's to guide them through a session for a long period of time and to sit with them. So is there any element of your research? Are you looking at, we'll say, communities that have been doing this for a long time? It's just not called medicine. It's called spiritualism.

Certainly the researchers that are in the field are well aware of you know the the history of these compounds and how they've been used um and and in many ways you know there's a whole neo-shamanic movement as well and ayahuasca circles that you reference are a very common thing probably the most uh common way that australians consume psychedelics uh non-recreationally is an ayahuasca circle. And you don't consider that recreational? Well, the term recreational is a complex one. What do you mean? Let me put it this way.

There's no clinical use so far. We don't have legal clinical use of psychedelics. of legal clinical use of psychedelics. And so what we typically see are two broad camps of use. And this is just a way of thinking about it. It's not necessarily how it plays out in the world. But you see what we call recreational use, which is usually in a party environment without a specific set of intentions.

A festival. Yeah, and not guided or, exactly, not facilitated. Whereas, so the closest we have to a clinical setting is the neo-shamanic ayahuasca-type circle. There's an intention, there's an organisation to it, there's a facilitator, there's a trajectory, and there's a degree of support. So that's reasonably common.

You know, there are ways in which the shamanic and the neo-shamanic practices have had some influence on modern clinical trial protocols using psychedelics, but also minimally. you see some overlap are elements of the clinical protocols that look like, you know, aesthetic considerations and attempts to engender a sense of sacredness and reverence. And there might be various, you know, tools and accessories that are used to that end. Yeah, because that's the thing. Taking a psychedelic which affects your mood, like a doctor's, I'm not having a good trip in a doctor's office.

Even if I was to smoke a joint in a doctor's office, I'm going to get a whitener. Yeah, yeah. Do you know what I mean? I need to be in a room with lights like that and a bit of Bob Marley playing, you know? Yeah, that's right. And this enhances what I'm looking for.

Yeah, this is one of the ways in which the clinical environment for psychedelic trials doesn't resemble other trials. And there are many ways it doesn't resemble other trials. But one of the ways is just in the physical appearance of the room.'s a lot of care taken to set it up in in an aesthetically pleasing beautiful way with often you know candles or flowers or even a buddha or something like that depending on who the participant is and what works for them and um and we know very much that these compounds the classical psychedelics in particular, are compounds that dramatically

exacerbate your inner state and your response to your outer environment. You know, Stan Grof called them non-specific amplifiers. I don't think that's exactly true. I think there's something that's very specific about what happens with psychedelics. But there's a component of it that is a nonspecific amplifier. And if you are in an environment that is likely to make you feel anxious to some small degree when you're sober, that's likely to inflate dramatically when you're tripping on acid. So there's a lot of care taken in setting up the environment to be conducive to the therapeutic process.

I'm going to be caught on an interval shortly if you have itchy feet for pints. So just to let you know, that will be shortly, that the bar will be open. I love how they've moderated with another perfectly legal drug that they're all itching for. Which, incidentally, Australia just did a study that replicated a couple of big studies overseas. Alcohol is by far and away the most harmful drug we've got.

Yeah. And you see this curve where you have harm to self and harm to others on this rating scale, and where do you see mushrooms and MDMA and LSD? It's far down the least harmful of the substances. Would you view, though, the consumption of... Like, alcohol can be consumed in a way that's safe, right? Would you view the consumption of alcohol in a social setting? I mean, okay, for me for me one thing i speak about

alcohol a lot on my podcast right and i speak about consistently i evaluate my relationship with it right so i'm my problem isn't it's it's never the substance it's how am i relating with the substance and how am i using it so one thing I'm always cautious about is I have a history of social anxiety so when I go to a pub if I have to go out and hang around with my friends and be in a crowded pub that's not my comfort zone my comfort zone is being on my own so I have to watch then am I drinking pints to make myself feel at ease with an environment that makes me uncomfortable or am I drinking because I want to do it? And it's something I always have to keep a watch over.

But do you think there is a... I don't want to use therapeutic as the word, but our value. But does our society Irish society, Australian society use alcohol in a kind of a bonding way

a social bonding way is it something that you think could be trialed no but seriously if you had we kind of do it people want to get along together, let's have a pint together. No, there's definitely, there's a lot of merit in what you're saying.

And I think this is, this speaks to this issue that I deal with a lot where people have lost the ability to think about things in the drug context with any kind of clarity. So there are clearly drugs that are bad for you out there. You know, there's not a whole lot of, you know, crack cocaine that you can smoke that'll end up being good for you. It's really, it's likely to be a bad thing. And then down the other end of the spectrum,

really the way you use these substances matters a lot. And we've drawn an interesting boundary, not the line that we draw in the sand typically is not between misuse and positive use. We draw a line in the sand between illegal and legal. And so I encounter the circular argument often, you know, psychedelics are dangerous. Why are they dangerous? Because they're illegal. Why are they illegal? Because they're dangerous. And so this happens a lot. And we need to find ways to distinguish between misuse, and there is misuse even of psychedelics.

I feel like that's in some ways potentially maybe a minor fallout of the scientific renaissance in psychedelic research, but you do see a bit of this kind of, you know, hashtag because science justification of psychedelic misuse, because now it's becoming a thing. But really, I think we need to think about how we use these substances, and alcohol is no different, absolutely. I don't think alcohol is all bad by any means. It can be wonderful, and a trial like you're suggesting could be a good thing to do or as well it could be used as like i said there the idea of meeting your friends and having a little bit of alcohol to enhance the situation to increase bonding to relax is utterly normalized. Yeah. And that could help with... That's normal, but the idea of

I'm going to hospital in the afternoon with my wife to take acid seems mad. Do you get me? Right. Well, it is a little mad in a hospital setting, but that's a temporary situation, yeah. Yeah. Yeah, absolutely.

You know, we still have these stigmas associated with it and these prejudices. But bear in mind, of course, the psychedelic experience is mad. It is not like getting a little tipsy with your buddy. And this is one of the things that I'm most interested in is how it works. What does the heavy lifting for mental illness when we think about psychedelics? Because there's a reciprocal loop between understanding how things work and making the treatment better. And there are all kinds of interesting ideas

and all kinds of interesting research that's coming in on a weekly basis that further shows us what it is that could be important here. But key to understanding the beneficial effects of psychedelics is understanding something of the psychedelic

experience itself. A lot of people ask me questions about, like, reductive brain mechanisms, and they're interesting, and they're important, and we do need to understand brain mechanisms better. Does that mean literally looking at brainwave patterns and things while someone is taking a psychedelic yeah so these experiments are being done and and looking at long-term changes in in you know brain functionality over time um and that's important that gives us some uh information about how it

works and we can talk about that a bit. But what I think is more informative at this point in our understanding of how the brain and the mind work with respect to psychedelic medicine is looking at the subjective experience, the phenomenological experience of psychedelics. And it is an experience like no other. And there are key elements of the experience that seem to be incredibly important in delivering these therapeutic outcomes. So this has been borne out in quite a few large psychedelic trials now.

Certain kinds of subjective reports that people make after the psychedelic experience, about the psychedelic experience, predict beneficial clinical outcomes better than the dose, better than the intensity of the experience. There's certain kinds of experiences, and in some way I think about this treatment approach as delivering a certain kind of experience. You need a serotonergic agonist, called a psychedelic. You need the right kind of setting, the right environment. You need the right mindset goingic, you need the right kind of setting, the right environment,

you need the right mindset going in, you need the right cast of characters, you need a whole set of ingredients. And if you get that right, which the vast majority of clinical trials in the modern era have gotten right, the safety profile is excellent. And it can be incredibly effective. I mean, what we see... But then the thing is, my idea of a calm environment that would be good for me to take LSD could be very different to someone else's. So what do you do

to find out what is this person's optimal safe space? Yeah, so, you know, we will move over time into better and better optimization and tailoring, but for now, it seems good enough to have, based on the data, to have a nicely decorated clinical setting with two therapists who you've gotten to know for a number of psychotherapy sessions prior.

So the typical protocol is you have about three psychotherapy sessions without the drug beforehand, and you learn some important things to prepare you for the dosing session. So you learn about how to not avoid your experience, because it can be incredibly challenging. The vast majority of participants that go through these clinical trials rate the psychedelic experience as among the most challenging of their lives, and a similar proportion rate rated as among the most valuable and important in their lives. So it's a big, big experience, and you need some preparation going in, and you need to develop trust and an alliance with those therapists. And then there are protocols around how we do the

dosing session, and then there are integration therapy sessions afterwards. You meet your psychotherapists multiple times after each dosing session. So the typical protocol involves one or two or three dosing sessions. And before and after every one of those, you'll have about three psychotherapy sessions. So there's a lot of support. And yeah, absolutely, it's not perfect for everybody. You have things like playlists where, you know, people don't vibe with the tunes and want to change it or take it off. That's fine. You have these options. You work around it.

Does the person bring their own playlist? They can in some trials and not in others. So is this a real doctory way of saying this person likes Pink Floyd? That's right. Wow. That's right. But given what the psychedelic experience is like,

because people are so sensitive to their context and so influenced by their context, the music plays an important part and can be disruptive or facilitatory. In the dosing sessions, there's typically what's called a non-directive approach. So it's led by the patient. And the psychotherapist is not doing active psychotherapy a lot of the time, or at least it's very responsive. It's not interventionist. Because patients in the 50s and 60s complained that they were clearly making a beeline for the most important material in their psyche with their eyes closed, and the therapist was interrupting them.

So there's a non-directive approach, but then you have things like music, which can help people, can facilitate, you know, emotional release and going into deeper states. And so it's important to have something like that there, but then it can also be disruptive if it doesn't align well. So you have to get the balance right. Okay. Paul, one thing you asked me backstage to ask you about was to explain the nature of a psychedelic trip. Yeah. Yeah, I did think it would be good to touch on that because no conversation about psychedelics that doesn't go into something about what the encounter is like

does justice to, you know, the conversation. And in many ways, I think this is where a lot of the money's at if we're trying to understand why these psychedelic substances in the context of psychotherapy seem to be so effective in helping people with mental distress, you need to understand some of what the experience is like. And so the reports that come out of these trip sessions are interesting. They're diverse and varied in all kinds of ways, but there's some strong, striking commonalities across them. And some studies, quite a few studies now, have measured this interesting thing.

I was saying before that psychologists have a way of measuring everything. There's this concept called mystical experience that there's a survey for. And this particular kind of experience, which has some qualities to it, some attributes to it, predicts clinical outcomes in a lot of these trials better than the dose and better than the intensity of the experience. Wow.

And the mystical experience has various parts to it. One part of it is this intense, basically they call it ego dissolution, this breakdown in your sense of boundary between self and non-self, which is a phenomenal thing to understand. That's one of those ones, like, what does that even mean? Like, I mean, no, but seriously, like, it's so abstract. Totally. Can you put that in, for someone who's never done drugs, what does that, what's that mean?

Yeah, well, we're getting beyond, like, technical jargon into, like, ineffable, yeah? But we are attempting to F the ineffable. You know, we can make some headway. But does ego mean my sense of I am blind by I am here, I'm doing a podcast? It's even more pervasive than that. So you've got these stories about who you are

and what your gender is and what your identity is and what's happened in your life. But then there is a far more fundamental aspect of your selfhood that is so pervasive that it's invisible. I mean, most things that are consistently there are invisible. And when you have a psychedelic experience, that pervasive and invisible element of your selfhood starts to shatter and can even fall apart.

So, for example, when you wake up in the morning, you know, you might have to take a moment to realize which city you're in, because you're traveling in the morning, you might have to take a moment to realize which city you're in, because you're traveling around the world, but you don't have to take a moment to realize that you're a human being. You don't kind of wake up and think, am I a dog? Or what is... Oh no, I'm a human. Oh, and I'm a man.

You don't go through that. You're always something. You're always a perspective that has got very particular constraints to it. And we can dance around and attempt to describe it, but this very fundamental aspect of identity and selfhood starts to fall away, and that can be frightening. But if you can go through the frightening experiences, you can get to an experience that is often referred to as non-dual, where there is no distinction between

this experience and everything else and this is also an experience that's reported with other induction methods forms of meditation yeah because i once i meditate and i said this before and it sounds like a mad thing but so I was meditating regularly like every single day and after about a month of it I used to meditate by a riverbank and I woke up from the meditation and I saw a nettle and I felt empathy for the nettle yeah and I literally felt it was only fleeting but I felt a deep sense of me and that nettle are some type of oneness. Totally. So what's interesting that you're describing there is a common kind of report in psychedelics. And one of the ways in which this may be relevant to clinical outcomes is that

the way I think about it is we have a kind of closed, narrow aperture, kind of constraint on our perception of reality that is born out of our need for self-preservation. And in the context of the modern human being, that typically happens at a level of status preservation rather than basic survival. Survive and leave, yeah. And under psychedelics, as that self-preservation principle

loosens and you start to see something that you weren't aware of, you start to see that actually you're anxious about your self-preservation all the time. I mean, I remember this when I first started university, one of these old gray-haired academics spoke to me. On April 5th, you must be very careful, Margaret. It's a girl. Witness the birth.

Bad things will start to happen. Evil things of evil. It's all for you. No, no, don't. The first omen, I believe, girl, is to be the mother. Mother of what? Is the most terrifying.

Six, six, six. It's the mark of the devil. Hey! Movie of the year. It's not real. It's not real. It's not real. Who said that?

The first omen, only in theaters April 5th. Rock City, you're the best fans in the league, bar none. Tickets are on sale now for Fan Appreciation Night on Saturday, April 13th when the Toronto Rock hosts the Rochester Nighthawks at First Ontario Centre in Hamilton at 7.30pm. You can also lock in your playoff pack right now to guarantee the same seats for every postseason game and you'll only pay as we play. Come along for the ride and punch your ticket to Rock City

at torontorock.com. In the first week of my university course, one of these, you know, the last of the dying breed of academics before, you know, the whole thing got corporate, and he said in this big lecture theater, raise your hand if you think all of life is suffering. And nobody pretty much raised their hand. There were 18, 19-year-olds, you know,

I didn't raise my hand. And he said, well, that's, you know, the first tenet of Buddhism. All life is suffering. And when you feel your, you know, the sense of your self-identity preservation principles start to come undone, and you feel you can see what that is, you realize, ah, there's anxiety there all the time and and that constrains your perception of everything around so are you saying that some of the psychedelic experiences within clinical trials are tying up almost with buddhist tenets because another one is uh that we're in a continual state of ignoring the fact that we're going to die and that anxiety is is because we know we're

going to die but we don't acknowledge it at any point during our days i mean a part of buddhism is to truly accept and know that your physical life is finished yeah it's it's a great point and it's actually totally relevant to psychedelics some people think about the psychedelic encounter as a dress rehearsal of death and that's one of the reasons why it may be very helpful for people who are dying, because they break on through to the other side and it's all right. But there is this... A dress rehearsal for death? Yeah. That sounds like if Jim Morrison didn't die, that would be the name of the Doors next album. That's right. But, you know, this is...

What you're speaking about is relevant to another core feature of the psychedelic experience that I think makes a lot of sense for clinical outcomes, and that is that... ..we know that ideas and thoughts, certain kinds of information, don't really change a lot of our behavior and our attitudes. It's very, you know, we all know we're going to die, but it doesn't, you don't live your life as though that were true. But if you were to walk out here tonight and get hit by a tram and be in a coma for the next six months and then miraculously survive and you had

your near-death experience, there's every chance your life would be irrevocably changed on account of having that genuine encounter. And psychedelics provide you with knowledge that isn't just cognitive linguistic. A lot of people feel like they learn something, but they can't articulate a new bit of information. They just got that knowledge by acquaintance. It's what philosophers call knowledge by acquaintance. You actually felt it. You were there.

It was embodied. It was experience. And that produces a lot of change in people's lives. So, you know, all the smokers on, there was a recent trial where people that had attempted to quit smoking for many, many years and had failed went on a psilocybin trial, and 80% of them were quit by six months, which is phenomenal.

I mean, the next best treatment gets you about 25% quit rates at six months. And those people, every one of them always knew that they were going to die from smoking at the rate they were. It wasn't new information. It wasn't like, ah, oh, yeah, it's bad for me. It's a sense of proximity to your values in life and a different way of living.

So they had the cognitive information that if you smoke, you will die. What's the name for what you're describing? Is it empathy with the experience? Is it more than that? We're going to have to work on this together and F the ineffable. Words don't really exist for this shit. It's emotional, it's bodily,

and it's just this encounter that is hard to push aside. Why mystical? Why was mystical chosen as the word? Yeah, it's probably the wrong word, you know, in the current context. But it was chosen because it comes out of an old tradition that William James, the kind of grandfather of modern psychology, formulated where he was interested in religious experience, and he found out that there were these six components to religious experience wherever you find them. There's noetic quality where there's information imparted and there's knowledge by acquaintance.

There's ineffability, the non-dual experience. There were all these components and so they were tapping something that was in the literature tradition. But one of the things that is interesting about these experiences where you have this encounter, and even if you don't have an intense informational download, the psychedelic experience has a lot of what we call verisimilitude.

I know you like your technical terms. So verisimilitude is just a jargonistic word for something that resembles reality. And so the interesting thing about psychedelics is... Is a dream like that? No, well, a dream is dreamy. But a dream resembles reality. In some way.

No, but what I'm referring to is that with psychedelics, a lot of people report something that feels like they've woken up out of the dream of their lives. So their normal sober state is more dreamlike, and the psychedelic state is a better representation of reality. They're more sober than they ever were, and it's more reliable. And what's interesting is, unlike with many drug experiences where after the fact, you just put that down to, oh, that was a drug experience. You know, you get stoned, you write a great poem, you think it's the best thing you've ever done, and then the next day, nah.

Nah. So with psychedelics, it's not like that. You have this different orientation to your life or your family or your principles or yourself or some new embodied encounter with something important, and it has an enduring authority over time. You know, a year later, it has weight in your life. And from a recreational perspective, it's true. Like, I mean, a buddy of mine did ayahuasca and moved to Brazil and started teaching children.

Right. But seriously, like, it's, psychedelics are the only ones whereby people change their lives afterwards and they don't speak about it as if I had a mad night. It's like, no, this heightened my senses. It woke me up to certain things. Yeah. Which, I don't know, I've always had a skepticism around it. I always felt that the person knew it anyway and needed this.

But it's your research and information then is going to stop people being skeptic skeptics about it to some degree and then also there are things we need to be somewhat skeptical of and and we'll see what comes out in in the wash but absolutely there there are these ways in which that psychedelic experience as i say doesn't necessarily impart new information in the typical sense of the word but it imparts the kind of embodied felt sense that is everything for living a life differently in a simple way could you try and explain like how does psilocybin benefit a person with depression like what is depression and how would psilocybin, which is the chemical and magic mushrooms,

why is that working for people? There are so many ways to answer that. One of the simple ways that I think about it is that our diagnostic categories, these terms like depression, are of course arbitrary in many, and they're symptomatically defined by definition. Mental health is a bizarre branch of medicine. I mean, it's kind of out of place. And when you hold it up against other branches of medicine over the last 50 years, it's made very little progress.

And my sense is that's in large part on account of some false assumptions. And one instantiation of that is the diagnostic criteria around these things, why we call them what they are, and that we focus on symptoms. My sense is that depression is not primarily a mood issue. It's an issue primarily to do with extreme isolation. And I mean that in like a fundamental way that the term doesn't lend itself to. That people who are deeply depressed are disconnected not only from, obviously,

the world around them and their friends and whatever, but they're disconnected from themselves and from time and from experience. And they're disconnected from the possibility of anything else, and that's what predicts suicide, this hopelessness, that actually this is forever. There's no way out of this. And one of the things that psychedelics do,

one of the many things that they do, is that they increase a sense of connection with yourself, with your experience, with time, with the world around you, with other people. There is a way in which you feel drawn to everything as though it were new. There's a sense of newness. People often describe a childlike awareness where, you know, once you looked at that as just a water bottle and all that really happened in your head was I ticked the concept water bottle. And now I'm actually looking at a water bottle for the first time. And like a child, and it's kind of engaging and phenomenal

and you're full of curiosity. And when you engage with your experience in that way, it's meaningful. That's kind of like the definition of meaningfulness. And depression is the definition of meaninglessness. So I'm trying to, another question I asked you backstage, right, was, and I think I'm kind of getting my head around it now. So I asked you, are pharmaceutical companies looking at this? And you said, not necessarily necessarily it doesn't fit within what we understand drugs to be yeah as in so the person with depression so let's just say you take

one person with depression and you give them antidepressants that's a person who's taking a drug every single day to change their mood but the person who's taking psittocybin is not necessarily taking the drug continually rather they're having an experience and from that experience the change within themselves comes from that's right and that's one of the reasons why it doesn't fit the big pharma model i mean we were talking about this before you don't take psychedelics regularly it's not a take two and call me in the morning you know it's not that kind of thing. You have to come into a clinical setting with a lot of psychotherapeutic support, and that costs money. You know, it's very cheap to dole out drugs. It's expensive to have that kind of facility and service. But also, it's a short program. You don't just keep doing it.

And it seems to work, which is also not in the interest of a big pharma. Fucking hell. So do you, like, it's so new. In five years, if you had a vision of, in five years' time, where this is now, legislation comes in, and this is now accepted, normal and publicly available. Would this be called psychotherapy? Is it like

what does that look like in an ideal world? Yeah, I mean nobody knows what it will really look like. My sense is a lot of people in the field think about it as an adjunct to psychotherapy so we never separate the two. You don't get

reliable clinical outcomes just by consuming these compounds. It's not the case. And the safety profile in a clinical context is excellent, whereas in the wild, it's not. There are risks, and they happen. So, it's a psychotherapy adjunct that, in my mind, that's the way it'll happen. it's a psychotherapy adjunct, in my mind, that's the way it'll happen. And initially it'll happen probably in, unfortunately, probably quite expensive clinical environments. Yeah. Until government come on board to fund it, it's going to be, you know, one for the rich people.

Yeah. Which is a real shame, but hopefully government comes on board. Elon Musk. It'll be fucking Elon Musk. Yeah, exactly. On his own. Yeah. Getting loads of free mushrooms.

Right. That's right. So if the evidence shows us, you know, if the phase three data comes through and it looks like this stuff is really effective and safe enough and it's rolled out and the drugs are registered, then you'll have probably these short-term programs. And nobody knows, you know, you've got these kind of 12-week or 15-week clinical programs

in the experimental setting. That'll probably just be translated into service provision. But nobody knows how to sustain the change. You know, you get some great sustained outcomes in some individuals, and then you get relapse in others. Yeah. And this is, to my mind the key challenge is how do you move into the rest of your life so one thing i'd like to ask as well is so within

psychotherapy uh the therapist will find uh an approach that suit that uniquely suits the client okay so that means the therapist would be using an integrative approach so a bit of cbt a bit of transaction analysis whatever are you looking at psychedelics and how they react to specific pre-existing forms of talk therapy like are you going how does psilocybin work alongside cbt today is that something you're looking into yeah so. So that's a great question. That's exactly where I think we need to be at right now. This is starting to happen. So far it's been a bit, the field has been a bit hodgepodge. You know, it's all starting in organic ways and every group is kind of separate and doing their own thing.

We know that there are some key important things to hit when you do the psychotherapeutic support around psychedelics. You know, there are some key things to get right that are psychedelic specific. And then different groups have got different schools of psychotherapy that they bring into the mix that align in various ways. They take some of it, they leave some of it. So different groups are using different kinds of psychotherapies. And this is exactly, I think, where we're at now, where we need to take psychotherapies and this is exactly I think where we're at now where we need to take evidence-based psychotherapies for certain mental indications and see what we can use in combination with psychedelics and and and test them out but it's so early days now and and in in many ways we provide quite a minimal psychedelic container compared to what you could do in the future and

also as well so if we take something like cognitive behavioral therapy as an example right that requires so if for cognitive behavioral therapy to work a person will say would their anxiety or depression is because they have rational or faulty beliefs about themselves or the world right that means the person needs to be able to know what rationality is how do you do that when the walls are melting but you know what i mean yeah and and a lot of psychotherapy is based on western empiricism of evidence-based stuff and what is evidence when you're tripping balls? Really? Honest question. Yeah, well, again, there is this interesting report that comes out often of

verisimilitude, the sense that while the walls might be bending, actually what you're experiencing is something more reliable than your sobriety. So in some ways, there's a reality check that is happening, analogous to CBT, but I would suggest at a different level of processing. So CBT addresses some maladaptive thinking styles, you know, if you're black and white thinking, or you catastrophize, or whatever, you can talk yourself out of some of those thinking styles. But, you know, for some people, that is all you need and maybe that's all the issue was. You just had a way in which you got wound up in your thoughts but underneath that you were all right and maybe that was your case. You seem to have

used CBT to a very good end. But you've also been highly motivated to use it. You were telling me you use CBT every day. That's incredible. That tells me something else is happening too. Yeah. But in the case of a psychedelic experience, it's often to do with more shifts in what you value in life and in your perspective on things and your ability to see things from other angles. Your empathy goes up. Your empathy goes up. Compassion goes up. Self-compassion is really a very common report as well. And your priorities change. And I think that's often what can drive the change.

You know, depression is a high – people often think about it as being incredibly passive. It's a highly active, exhausting state to be in. You are highly motivated typically to ruminate about all the ways in which you are inadequate or all the ways in which the world is inadequate. And you constantly are involved in that. With psychedelics, you can, people report just having a very different perspective and a very different set of priorities on life, such that all the things that they were focused on and ruminating about are just not so relevant anymore. Can you tell me about how you're using these treatments for people with addiction? How does that work?

Again, in some ways we don't know how it works, and in other ways, there are these interesting ideas here. Ultimately, my sense is that, you know, one of the ways in which people are sceptical about this is it looks like this new jujus that seems to work for your everything, you know, and, hey, that doesn't sound very plausible. They used to prescribe people heroin to get them off cocaine. Right. Right. Exactly.

But, you know, people raise an eyebrow, you know, when I'm giving a talk and I've gone on to my, like, fourth indication. Okay, there's depression, there's anxiety. Now it's working for you. Is it a wonder drug? Snake eye? Yeah, come on. This doesn't sound right.

Well, you know, we'll see in time what it really is good for and it won't be good for everything. But to my mind, this just points a very clear spotlight on the fallacy of the diagnostic boundaries, that there are more fundamental ways in which we suffer, and they're borne out in different ways on the surface. And ultimately, you know, the human condition is not easily parceled out into 305 different mental illnesses. We suffer in very similar ways and express it in different ways. To keep it really simple in case people don't know,

can you explain to people what the Diagnostic Statistics Manual is and why it's so important? Right. So the DSM, the Diagnostic Statistics Manual, is in some ways the Bible of mental health research and treatment. But within the field, there is a huge amount of scepticism and caution around its use. It was originally devised to standardise communication between doctors.

I can say that my client who is experiencing a particular thing is kind of similar to your client. We need a language and a rating scale to say, we've got the same thing I can learn from your treatment. It's a checklist. Exactly. Exactly. But we've taken these invented terms and the invented kind of criteria

that make them up. So this idea of depression consists in these various criteria, and we've now converted that into, we now think of that as something that is real and in the world and always was here. Of course, the experience is real. It's like treating the mind like physical symptoms. Right. If, you know, if I have the symptoms of a cold, chances are I have a cold. Yeah. But it's not the same when it comes to emotional things. Yeah, and even if you do have the symptoms of a cold, you may not have a cold. I mean, you've got this, if you have red cheeks, you know, you could have a cold.

You could have been slapped in the face. You could be puffed out. You know, there are lots of causes. And medicine works by searching for the causes and attempting to address them. In mental illness, not at all. We don't even have a manual of causes. There's not been a single reliable biological marker of these mental illnesses that can distinguish between any other mental illness. So they're artificially constructed, and to be clear, the experience of depression, whatever that is,

is very real. It's not to say that we've invented the experience. That kind of distress has existed and continues to exist. The categories that we overlay and the names that we overlay have been invented. And that's problematic in many ways. Because in our research trials, for example, you know, I recruit depressed people. But actually, I might have a whole range of different issues in that room. Whereas there may be more in common between one depressed patient and an addicted patient than two depressed patients. Their underlying issues may be more in common. And I think ultimately, if you drill deeper, you do find very common fundamental causes of human distress.

And possibly psychedelics are working at a more fundamental level. And that's why you see all these blips on the radar across different indications. So when it comes to something like psychosis, so a person is hearing and seeing things that aren't physically present. Are you looking at the use of psychedelics? Because that's for me is like, when you take a psychedelic, is it fair to call that a form of psychosis? So you're on the money. And so firstly, you know, psychosis is not something that we would use psychedelics for. It's really strongly contraindicated.

So anyone who's got psychosis or a first-degree relative with psychosis, or even in some studies a second-degree relative with psychosis, they're not allowed into this. They're not allowed into it. Wow. You know, there were all these reports that came out of Nixon's propaganda campaign about, you know, crazy stuff that would happen if you take LSD. And some crazy stuff did happen, you know, people staring into the sun until they go blind or thinking they can fly. But in all the cases that were actually investigated where people did these kinds of things, they could trace it to risk factors

for psychosis. So there was a history there or a family connection, and psychosis is quite heritable among all the mental illnesses. It's one of the most heritable, runs in families. So you wouldn't use psychedelics to treat psychosis. Psychedelics, in fact, were used to study psychosis. They were considered a way of artificially inducing psychosis in the lab, because there is a lot in common between a psychedelic trip in some situations and psychosis, absolutely lab, because there is a lot in common between a psychedelic trip in some situations and psychosis. Absolutely. And it was used to train mental health workers who worked with psychotic patients to give them more empathy to see what it was like to redesign buildings because some of these old psychosis hospitals freaked out the patients. And when you

take an acid trip and you walk down the corridor, you realise why, you know, it never ends or something's happening. So, yeah, they called them psychotomimetics. They mimicked psychosis and that was one of their original uses in research. But in many ways, you know, they're quite distinct. One of the questions I was asked online, and I don't know if this is too conspiracy theory-ish, have you heard of the MKUltra program?

Yeah. Is it real, and did anything of benefit kind of come from it? And what is the MKUltra program for anyone who doesn't know? Yeah, so the MKUltra program was definitely real, absolutely. So, you know, as is always the case, when something exciting and powerful enters, you powerful enters the zeitgeist, the CIA have a crack at it. And so psychedelics came on the scene through the 40s. They were really used a lot through the 50s, and in the 50s the CIA attempted to use psychedelics to

arrange different ends and they experimented in all kinds of ways. At first they thought they could use it as a truth serum but the people under LSD just seemed to speak gobbledygook and nothing came of it and then they thought they could use it

actually to make their soldiers perform better on the battlefield but the soldiers didn't want to fight anymore. They were climbing trees. So that didn't work. And then actually the only thing that really came of it was they used it as a torture device, and that worked. Wow. So high-dose psychedelics. Do we have evidence of the people that were tortured by the CIA with LSD, or did they disappear?

Like, I know of Philip K. Dick, who wrote Blade Runner and A Scanner Darkly and loads of massive science fiction. He claims that he is somebody who was kidnapped by the CIA and put through that program, and it left him with a paranoia and psychosis for the rest of his life. and put through that program and it left him with a paranoia and psychosis for the rest of his life. Wow. Yeah, I wouldn't be surprised. But maybe a bit of, you know, the byproduct there was some creativity

because he did some good stuff. Ridiculously creative, yeah. But, yeah, I don't know of any reports from people that were abused in that program, but there were definitely people abused. There's certainly dossiers and documents on that. They used to use... They used to get sex workers,

and what they would do is use sex workers to compromise businessmen particularly and basically catch the businessman who would have a family and something to lose, and then this is the person who would be put on a psychedelic trial or torture oh wow that's what i heard yeah interesting who knows i don't know i wouldn't put it past them but uh yeah it was it was a program that went on for a while and then they kind of gave it up um uh ultimately it didn't do it didn't do much of

what they wanted to do and in the end it really it spilled out of the lab and out of mk ultra into the public and became you know public enemy number one with the anti-war movement um what are your views on on micro dosing versus the larger doses and and micro dosing mushrooms for depression is something that i've been hearing about a lot recently as well what's your opinions on it this one's interesting interesting. So microdosing is completely unlike macrodosing. You know, a microdose is usually about one-twentieth or one-tenth of a normal recreational dose and the kind of dose that is used in these clinical trials. Typically, you barely perceive any effects. If you do, it's very subtle. There's no impairment to functionality in any way. And what's fascinating is that microdosing has just grown in popularity to an astronomical level with almost no science. So Jim Fadiman published his Psychedelic Explorer's Guide in 2011.

That was the first time really that microdosing entered the psyche of the Western world. And then really not many people read that book, but in 2015, a Rolling Stones article really brought it into the world. And from the last five years, it's only five years, it's just boomed. And yet the very first placebo-controlled microdosing study just happened last year. And yet the very first placebo-controlled microdosing study just happened last year. So we're writing a review on microdosing studies right now, and I'm looking at all this research. There are only about 10 reasonable scientific studies that have been done on microdosing, one of them by my colleague who I'm working with now at Macquarie, Vince Pulido.

And yeah, the science is trying to catch up with this phenomenon, but people are microdosing a lot and claiming all kinds of things. And you can go to the subreddits with 40,000 members and the claims are wild. But the plural of anecdote is not data. So there's a distinction there that we have to make, and we have to run these through proper trials. But if it works for somebody, regardless of how it's working, even if it's a placebo, then great. But we don't know yet. Because you said an interesting thing to me backstage about placebo.

You said that Prozac was more effective at the start. Yeah. So the placebo effect is sensitive to the novelty of the start. Yeah, so the placebo effect is sensitive to the novelty of the compound. So in 86 when Prozac was released, the late 80s Prozac was more effective than it is today because of that. And so with psychedelics as well, it's important to say there is an enormous amount of hype about psychedelics. Yeah, and people would, it's the type of thing someone wants to believe will work. Totally, yeah. And it's the type of thing someone wants to believe will work.

Totally, yeah. And there's all kinds of biases as well, like there are things that are hard to scale, like the therapists and clinicians working on the trials dedicate their lives to this in a way that you're not going to scale easily. People self-select and travel across the world to be a participant in these trials. And there's an enormous expectancy effect, which will come out in the wash, I suspect. But I think there's enough of a signal there to survive, you know, whatever decrement we see over the next five or 10 years, which I'm sure

we'll see. I'm going to open things up to the audience now for some questions. Who has a question? It doesn't have to be about acid. It can be about anything or mushrooms. Can we bring the house lights up slightly, actually? Is that possible? There we go. Pulseman. This gentleman. We've got Brendan.

Brendan the usher. I have a question for Jonathan. Thanks. Are you looking for volunteers? No, a genuine question. Is it a prerequisite for one of the psychotherapists to have a psychedelic experience? Rock City, you're the best fans in the league, bar none.

Tickets are on sale now for Fan Appreciation Night on Saturday, April 13th, when the Toronto Rock hosts the Rochester Nighthawks at First Ontario Centre in Hamilton at 7.30pm. You can also lock in your playoff pack right now to guarantee the same seats for every postseason game and you'll only pay

as we play. Come along for the ride and punch your ticket to Rock City at torontorock.com. ...before entering your studies. Did you ask if a therapist needs to have a psychedelic experience? Great question. So there is the leading organization in the world who's running psychedelic studies, MAPS,

the Multidisciplinary Association of Psychedelic Studies, has exactly that. They've got an open-label, healthy-control trial for their therapists to go go into an MDMA experience and experience it themselves. I actually just got the data from those therapists about two weeks ago showing that it was an incredibly beneficial experience for them.

And also, you know, anxiety is something that needs to be managed, you know, in a very important way when you go into these psychedelic experiences. And these therapists who went through this MDMA experience themselves reported in the data that I was looking at that so many of their clients asked them before they went into the trip session, have you done it? And that was important for them to know that they were with a therapist who knew the terrain and could hold their hand and knew what they were going through. And so being able to have a legal psychedelic experience and also within that kind of clinical context was incredibly important for the safety and effectiveness of the trial. So I think that is an excellent idea. There are certain

subjective components to the experience that, as we've tried to describe, are hard to describe. And I think it's an incredibly useful process for a therapist to go through, but as yet we don't have a trial like that up in Australia. Hopefully we can get one up. A quick one for you. So one of the kind of tenets of psychotalk therapy is that a therapist would have what Carl Rogers called the core conditions, right? Empathy, congruence, unconditional

positive regard. How does that tie in with the therapist taking the drug themselves? That it has to be truthful and to have true empathy for the person who's taken psilocybin. They must know what their

experience is like rather than guessing. What would Karen Rogers say about it? Yeah, I think that's right. I think it is very important in terms of empathy, but also the psychedelic encounter often entails a kind of vulnerability that you can't explain and you can't transmit in any other way than experience. And so empathy will be limited. You'll still be attempting to be empathetic if you've never been there before,

but it'll be limited in its quality and your ability to kind of hold that space if you've never been there yourself. So I think it relates to all the core tenets of good psychotherapy. It's just a slightly special condition. Any other

questions? It's not the fucking late, late show, man. This woman there on the edge. Hello, how are you doing? How are you? What's the crack? Blind Boy, just like to say thank you. I had my first solo saving experience when I was listening to your CBD podcast.

It was on episode two and absolutely changed my life. So thank you very much for that. Thank you very much. Jonathan, I have a question for you. You see what you've done? You're going to have to tweet out my real hand. I will, man. Don't worry. Have you done much research into ketamine psychotherapy

and the use of ketamine? Oh, yeah. You. Ketamine. Ketamine. Ketamine's been used for PTSD, isn't it? No. Ketamine's mainly used for depression.

So ketamine is interesting. It's not a classical psychedelic. It is in the class hallucinogen. It's called a dissociative. It's got some very different characteristics to the classical psychedelics. It seems to be most effective as an anti-suicide drug in the short term, and it's used to treat depression in the short term. Its abuse potential is much higher than the classical psychedelics.

It's much more dangerous for your body. And the research is coming in now. You know, it's had a very different historic trajectory. Ketamine is a general anesthetic. And in some countries, it's the general anesthetic of choice. In other countries, it's used where the normal drugs are contraindicated. And so ketamine has sat in hospital fridges over the last 40 years of prohibition of psychedelics. It's a legal compound. And so the use of ketamine to treat depression has run well ahead of the research. It's used, as they call, off-label, where psychiatrists who have ketamine in their fridge are now dispensing it for depressed people without the research to back it up.

But the research is trying to catch up now and get in there. How is that allowed? You can use... Yeah, exactly. This is an issue where you have these legal, illegal boundaries between things that we think of as right and wrong and we lose the ability to think about things more clearly in terms of how it's used.

Well, if you think about it, if I have a bad enough pain in my back, a doctor can give me heroin. Yeah, that's right. That's right. And in most cases, ketamine has been dispensed off-label in pretty safe ways and to good effect. You know, the trials, unfortunately, and I talk with some of the people that are doing

the trials here in Australia on ketamine. There's a couple up. They unfortunately haven't looked into the psychedelic literature well enough and taken a leaf out of that book. Because, you know, 30 years of psychedelic work has shown us a lot of how to get this technology right in terms of set and setting and cast and the whole approach. And yet ketamine is dispensed in these trials and in hospital settings without any regard for preparation, set, setting. So, you know, they just mainline the stuff into somebody in a neon lit room with two research assistants taking notes and watching them. And they have the most monumental experience of their life. And the adverse reactions are much higher than they need to be. But that's an aside. So the treatment research isn't being done properly?

I think in some cases it's not done as well as it could be, because part of what it carries with it is the psychiatric model or the chemotherapeutic model, which is that all that we're doing here is providing a molecule to the brain. We're unlocking something in the brain. It's just a lock and key system, disregarding the fact that certain kinds of experiences matter a lot for mental health outcomes. And some of these experiences can be genuinely traumatic. I mean, if you take high dose psychedelics or high dose

ketamine, you can have a genuinely traumatic experience that you will spend the rest of your life trying to recover from. But it's yeah i said backstage i know somebody who took do you know that stuff salvia so salvia used to use to be able to buy it in shops and you smoke it and it will make you very high for 15 minutes and it specifically fucks with your perception of time and i know someone who did a salvia trip it lasted 10 minutes they perceived that 10 minutes to be an actual year and to this day they feel like a fucking year of their life was gone yeah there's a missing year yeah and that's you were speaking to me about the we'll say DMT and salvia they act very rapidly and very quickly and for a very short amount of time. And why is

that not good? Well, you know, it could work. And the research, you know, is just beginning with these more fast-acting substances. There is a motivation to use a more fast-acting substance and not have the eight-hour session. I prefer the eight-hour session, to be honest, because it's therapeutically dense and efficient, and you get a lot of bang for buck. It's an intensive workload for everybody involved, but I think it'll bear out in the longer term. But people are looking into these shorter-acting compounds

like DMT and 5-MeO, DMT, you know, the smoked venom of the Sonorian toad. Yes. A friend of mine got the toad venom when they asked for DMT and they had a deeply bad experience. That's whopping, yeah. But so one of the tricky things is that it's very hard to provide the same psychotherapeutic container around a trip that has an onset duration of 10 seconds and takes you into the stratosphere where, you know, you're not even a human entity or anything like it

and you can't process any of the things you've learned in your preparation and then drops you down half an hour later also in about 10 seconds. It's very hard to find ways to prepare people for that being a positive trip and to then bring them back into the rest of their lives and integrate. And contrast that now with an ayahuasca

experience which is the same drug it's still DMT. What's the difference there? Yes, ayahuasca experience, which is the same drug, it's still DMT. What's the difference there? Yes, ayahuasca is DMT combined with another substance called monoamines oxidase inhibitor that you consume into your gut, and it's metabolized much more slowly, and it's not, the onset is, it's similar to psilocybin, onset is half an hour to an hour. Peak after two hours. Peak of the trip is about four hours long. And you're sober again maybe eight hours later. So it's a much slower trajectory.

But how did they know? So this is happening in the rainforest. It's thousands and thousands of years old. You chew the DMT leaf and it does nothing. It does nothing. Your gut metabolizes it. So this is the phenomenal thing that in an Amazon basin with many thousands of different plant species, you have to consume exactly two and exactly the right two in order for

you to have a psychedelic effect. You need the DMT and you need a monoamines oxidase inhibitor. And that's what they've done in the Amazon. They combine these two plants into a brew, drink it, and God knows how... Someone figured that out a long time ago. It's like when you get stung by a nettle, and then you find a dock leaf.

Yeah. But they grow alongside each other. That's right. Any other questions? I'm trying to judge people's heads and go, who's got an interesting question? Not him picking his nose, anyway. This gentleman here who's wearing the wristband.

I guess a man with a leather wristband has got something to say. And glasses. That's a lot of pressure. Yeah, my question's for Jonathan. Mr. Bo Ball Club. Although I was a bigger Paul fan, but that's okay. Could you talk a little bit about your research with psychedelics and how that sort of fits in, I guess, with current,

for want of a better word, legal pharmaceutical treatment for depression. So things like what we call antidepressants or SSRIs. How does that sort of fit in with your research? Do you see psychedelics potentially replacing these or working together? I'll just speak a bit more about that, I guess. Yeah, thanks. So to be clear, SSRIs and other antidepressants are very helpful for some people. They seem to work quite well for about half of people who stick at them for a while. So, half of people don't respond well. And, of course, it doesn't address anything like a cause. Relapse rates are up at about 80% when people come off their antidepressants. So there is a

place for SSRIs. And in many cases, the case that is being made for psychedelics, I think it's wider than this, but the case so far that's been made for psychedelics are those 50% of people who don't find adequate response in any other treatment. And so it may be the case that antidepressants work for some people and psychedelics work for other, and the populations are a bit distinct or the indications are a bit distinct. I imagine there will be a lot of overlap. But they work at such different levels, and in some ways they work in opposition to each other. So if you want to be on a trial, a psychedelic trial for depression, you will have to come off your antidepressants first, because it's not a safety contraindication, it's an effectiveness contraindication.

It'll actually reduce the effects. Antidepressants in many ways seem to do something that looks about the opposite to what psychedelics do. And there's an interesting study that has been published on exactly this. Antidepressants obviously clip the lows of mood, but they also clip the highs of mood. And they also clip the highs of mood, and they often save people's lives and bring them into just some sort of functionality that allows them to move on. My sense of antidepressants are that they are a temporary treatment and a wonderful one for many people, but they're considered permanent. There's no getting off them in the treatment plan, typically.

So antidepressants typically kind of dull people in some way, and not everybody's like this, but they can really make life tolerable, but still not necessarily exciting or engaging, whereas psychedelics seem to just take you right into the belly of the beast. It's not about clipping the low end of your mood and struggling to a less degree. It's about taking you right into the heart of where that low mood comes from. And psychedelic experiences are incredibly challenging in a lot of these trials,

as I mentioned before. But what happens when you go through the other side is that it isn't just about modifying your mood, it's about shifting your perspective on reality and your priorities and your values. So I don't see a very good way for those two things to cohabit a single body, but I think there are ways in which antidepressants might get somebody into a situation where they can now face psychotherapy and psychedelics. Paul, would a person need psychedelic treatment if an entire room tried to convince them that their name was Jonathan? I'm beginning to think so.

I'm going to take one last question now. These three ladies in the middle, which one are you, though? The one with the middle. Which one are you though? The one with the glasses. Hi, thank you. Sorry, Jonathan, I'm not actually going to talk to you. Just because of the nature of the question that I'm going to ask, and because this was something that wasn't done at the start, I'd just like to say that we are on Wurundjeri land, and I'd like to acknowledge that. This always was and always will be Aboriginal land, and sovereignty was never ceded. I wanted to ask you, Blind Boy, how... Hold on two seconds. Are you talking about the indigenous ritual? Yeah. Okay. So something that often, even if people aren't necessarily in a place

to welcome someone to their country, they acknowledge the land that they're on. Okay. And it's something that, I don't know, it's often a thing that's done at the start of ceremonies as a white sort of way to say, oh, I'm a bit sorry, but action doesn't necessarily come from that.

I didn't know what that was sort of way to say, oh, I'm a bit sorry, but action doesn't necessarily come from that. I didn't know what that was because apparently it was supposed to happen on this tour, but I didn't know about it. So where was it? In Perth? No, no, no. In Brisbane, an indigenous person came up at the start and did that. And I didn't know what it was. I wasn't sure what was going on. It was the first time I'd seen it, but welcome to country. Yes. Yes. Yes. That's what someone who's of the land does. And then if someone who isn't of the land, they often acknowledge the country. Okay. Acknowledge the country. That is okay. I'm just learning about that this tour, but thank you for that. What's your question? My my question was and i suppose you've sort of half answered it already is how you're finding being on um or in a place that is a colonized place and how you're finding that weird as fuck really fucking weird really honestly really really

weird because um today i visited the melbourne Museum and I was there I went into the first people's section of it and I was just trying to process it and it just it felt weird as fuck and what it really felt was so I was in this exhibition

and it's all about learning about the indigenous people and it's trying to show respect for the indigenous people and it's all about learning about the indigenous people and it's trying to show respect for the indigenous people and it's curated by indigenous people but in my heart I was just going it's just performative do you know I mean it's lovely and all of this but in my heart I'm going that's not reparations like having a that says, it used to be like this, and trying, that didn't feel like reparations to me.

So I don't know, it feels fucking weird, and it felt dark, and it felt sad. That's all I can say. And it's a new complex thing. I don't know, because I'm fucking Irish.

But one thing I will say is, I've learned recently, only on this tour about the problem that's happening in Australia with police brutality towards indigenous people I had no fucking clue I had to learn that here talking to a guest of mine who works with indigenous people and I was shocked that in 2020 where i have the fucking internet that i'm not learning about a huge problem with police brutality towards indigenous people and what i said to my audience was like first off the the irish history in australia is it's fractured and strange irish were mostly brought here as penal colony, then there was immigration,

but there's also, like in America, we discovered white privilege and were very violent and horrible towards the indigenous people here. So Irish people have to take ownership of that. But the thing about being Irish is while our ancestors discovered white privilege, we don't have that history of colonization.

We have a history also of knowing what it's like to be colonized, to be the victim, to have our culture eradicated. And I would like to see Irish people living in Australia use your position of privilege to share the fucking videos online, share the information, share the injustices that are happening now against indigenous people.

And let people know. I'm conscious of time here, lads, because it's quarter to 11. So, Paul Liknitsky, doctor, that was incredible, man. That was so fucking interesting, and it was a pleasure

and to all of you lads thank you so much this was one of those podcasts where there's like there's fucking 800 people here and it felt like a tiny room of a few people

at an interesting gaff party where someone interesting starts talking. Genuinely, it was a lovely, intimate experience and thank you so much for doing it, alright? Thanks. Yart, have a good night.