The Blindboy Podcast - The Psychologist who uses MDMA to treat mental illness

Episode Date: January 12, 2022

Dr. Paul Liknaitsky is the head of clinical psychedelic research at Monash University Australia. He is conducting world-first clinical trials into the use of magic mushrooms and ecstasy to treat depression, anxiety, and PTSD. This is his second time on this podcast to chat about this exciting and important field. Hosted on Acast. See acast.com/privacy for more information.

Greetings you fleeting ephahs. Welcome to the Blind By Podcast. I hope everyone's having a wonderful, a wonderful January. Fuck January. Fuck February. Fuck March. I'm not a fan of all three of those months. They're like the people at a house party at 7am who are still downstairs in the living room. Kind of going to sleep. With the music playing real low. And it's like just get a taxi.

Just get a fucking taxi. Nothing's going to happen. The party was over too. What are you doing? Get into a taxi and go home to bed. It's 7am. Everyone else is in bed. That's January, February and March

for me like with with like December November there's a kind of a purpose to those months and they're cold January, February, March it's just

deceptively cold it's just deceptively cold it's dark and the cold doesn't come in the form of frost it comes in the form of aggressive sideways wind and rain that smells like untanned leather I'm usually optimistic

I'm usually striving to find meaning in whatever particular bit of weather or seasons we get but my issue with January, February and March they really put me to my limits it's hard to find beauty within them because I suppose you're just waiting for them to end give me a nice refreshing dose of April

that's what I want, I like April because April's cold but it's doing it's best impression of summer. So this this podcast has nothing to do with months. This this podcast is about psychedelic drugs.

It's about MDMA and about magic mushrooms otherwise known as psilocybin I have a guest who's returning to the podcast this week Dr. Paul Liknitsky who's a clinical psychologist

and a neuroscientist and he's the head of clinical psychedelic research at Monash University over in Melbourne in Australia. And Paul is leading the world's first clinical study of psilocybin as a treatment for generalized anxiety disorder. So Dr. Paul Diknitsky is, he's a scientist, he's an expert, and he's a scientist he's an expert and he's studying and testing out on humans drugs that we've been told are illegal and dangerous psilocybin psilocybin is magic mushrooms

mdma is the active ingredient in ecstasy we know these things as recreational drugs that are completely illegal and we've been told they're dangerous which is quite a backwards attitude towards these substances which can also be used as medicines so that's what dr paul nitsky is doing testing these things out and seeing what is their benefit as a medicine for multiple mental illness and mental health issues. Such as MDMA being used as a treatment for PTSD. We also talk a bit about DMT, ayahuasca, things like that. When I announced this interview, someone said to me, you're just doing what Joe Rogan is doing now. No, I'm not. Because I'll tell you why.

Joe Rogan brings on some comedian and they talk about their dmt trip what i'm doing is i'm having a conversation with a mental health expert about the field of mental health and psychedelics and this expert is conducting this research under the highest ethical standards in a university peer-reviewed using the scientific method, with safety in mind. So when I do that on this podcast, that means I also have the safety of the listener in mind, and I know that everything about this conversation is ethical and not in any way irresponsible or misleading,

because that's always something I try to do when I speak about mental health. In particular, when I bring an expert on and we speak about something like trauma, you always have to be very ethical around something like trauma and keep the listener's safety in mind. Whereas Joe Rogan will bring on an actual dog and then the dog will tell everybody why it's a good idea to inject dog food into the top of our dicks and then people will do it and there's an outbreak of dogs biting the top of everyone's delicious dog food dicks. But yeah, look I'm talking to a fucking expert

in their field, in their particular field of mental health and yes we're talking about drugs that are illegal in Ireland so this isn't espousing I'm not telling everybody go out now and do a lot of magic mushrooms or go out and do a lot of MDMA these are clinical trials and the end goal of this is for substance like psilocybin or MDMA to become legitimate therapeutic practices that can heal people's pain. That's the goal of this and that's the work that Dr. Paul Litnitsky is doing. We had a nice long in-depth interview. We covered a lot of stuff. And before I get into it, I just want to thank everybody for... There was magnificent feedback to last week's podcast.

I got so much lovely feedback. And if you sent me a DM, apologies if I didn't get around to answering it. I got quite a few. But there was just a lot of people, because it was the first week of January, who really needed a bit of a mental health podcast last week. really needed a bit of a mental health podcast last week and I was so thankful to get all that feedback and to see that some people got some help from it so thank you for listening last week and if you're a brand new listener you can listen to this episode but I also recommend going back and listening to some earlier episodes of this podcast if you enjoy it so without further ado here is the chat that I had with Dr paul litnitsky of monash university

in australia paul uh thank you so much um for coming on the podcast um the last time we spoke was literally two years ago this month that's right that was on stage in melbourne yeah and the response i got to that podcast was phenomenal people were so interested in what you're doing and the research that you're conducting what what has happened since that time well it's been a very interesting time. On the one hand, the research has been slowed down by COVID. We've had difficulties getting approval to commence in human research due to the pandemic. On the other hand, we've been preparing a large number of projects. And so over the last couple of years, I've established Australia's first clinical psychedelic lab and have also a number of research trials that are very soon to commence this year in 2022. So Paul, just for anyone who hasn't listened to the last podcast um like so you're a neuroscientist and you're also training in psychology that's correct isn't it

and what is it exactly that you do what's this area of research that you're doing so my specialization is in clinical psychedelic research i've also been involved in other fields of research in psychological sciences, always with a clinical focus. And really, I've been involved in establishing a number of Australia's first psychedelic trials. So basically, I run clinical psychedelic research, but that's, you know, rather a narrow description of the job. You know, it involves all kinds of things like recruiting and training psychedelic therapists, communicating with regulators around how these drugs will eventually make it to market approval if the evidence comes in and so on.

So there are many aspects to the job. And what, so when I hear the word psychedelic, I think of a drug that you take that makes you hallucinate. Is that what a psychedelic is or is it more than that? Yeah, it's more than that. In fact, it's interesting that the term hallucinogen was commonly used to describe what we now call psychedelics more commonly. Yet hallucination is actually not always there. When people consume high-dose psychedelics, people don't always hallucinate.

In fact, real paradigmatic hallucinations are rare. Psychedelic, the term means literally mind manifesting. And so the basic idea around psychedelics is that these drugs produce experiences that appear to the person undergoing these experiences to reveal their minds to themselves. So it somehow is opening up the portal of insight into their own inner process. Okay, so I've never taken psychedelics, but I've had mental health issues i've struggled with uh pretty

severe anxiety depression and what i've done is attended therapy for many years and use things like emotional intelligence uh meditation is a huge thing for me to observe and be still with parts of my mind that are that in my day-to-day that my mind wants to hide from me you know uh hidden pain insecurities all these things i use cbt therapy meditation to access these things is psychedelic therapy is that is that the? Yes, in some respects that is in common with psychedelic therapies. There are perhaps a few other goals or aspects of psychedelic therapy. I guess one of the key affordances of psychedelics is that when people attempt to address the sources of their pain and suffering, they're often doing so with the same basic hardware

that instantiates the suffering in the first place. And so it's very difficult to kind of work your way out of a problem using the same machinery, if you like, that builds the problem. And many psychotherapists will say that a huge amount of their job, the vast majority of their job is helping participants to lower their psychological defenses so that they can have access to, you know, deeper levels of themselves and deeper sources of their pain. It's no trivial task to lower those psychological defenses, the processes that kind of have allowed you to survive. In a sense, we often use the term defenses. It's a Freudian term. But really, that term is somewhat

disparaging, because these so called defences have been, in many cases, a person's key ally through their lives, they've had, they have memories or certain kinds of experiences that are overwhelming, that are too hard to bear, they're painful. And the defense mechanism is there to allow you to survive and allow you to kind of get on with your life in some way. And often, that just spirals into something, you know, extreme and pathological. And so in a sense, one of the things that psychedelics do, at least initially, is lower the defense barrier quite dramatically. A lot of people will say, I've been working with these kinds of patterns in my life, these ways of thinking, these beliefs about myself or the world or others. And it's an ongoing battle to kind of shift your perspective on things,

and then within the first hour or two of a psychedelic experience, the defense barrier just comes down, and you have access to a whole lot of material that is just under the surface, but perhaps over many, many years of psychotherapy, you've not been able to access. So in a way, when you said there okay i've got thought patterns that i repeat about my opinion thoughts about myself other people and the world and like i know that language from cognitive behavioral therapy so like i was speaking to a neuroscientist called dr ian robertson on this podcast a few months back and i've used cbt will say to re-pattern my brain i've used i've i will challenge myself when i have a negative thought pattern whatever and when i do

this over and over again i can re-pattern the neural pathways in my brain so that i autonomously think in a way that's more helpful for me so psychedelics could allow someone to get to this in a quicker way yes and also you know what you're describing is useful for some people and it's been useful for you it takes a lot of motivation because you're having to rehearse and practice again and again. You're kind of swimming upstream. And I'm also, I'm not dealing with any heavy trauma. Right, exactly. And so, you know, in a sense, it depends what the sources of your suffering are. If you have a set of negative and maladaptive beliefs about yourself that may be set in when you're an adolescent uh you know there are ways in which something like cbt can be very useful if you put in the time and the practice and you're motivated to keep at it and ultimately as well paul like for me

i knew that that exploration was a safe place whereas if I had been someone who had experienced severe abuse or something as a child, which I didn't, I would not feel safe. It would just be too terrifying to go to where I needed to go. Right. And it may be the case that the sources of suffering in a person who's had early trauma are pre-verbal. in a person who's had early trauma are pre-verbal. And so cognitive behavioral therapy is built on a cognitive linguistic framework. It's thoughts and words and beliefs. And if you haven't even the ability to articulate your belief because it's so deep, it's in your body,

your body responds to the world in a certain way you don't even know for example that uh you're riddled with guilt and that that guilt is turned inward and now you loathe yourself if you can't even identify that behind your self loathing is guilt um and perhaps behind your guilt is uh love You know, often that's the case. You know, we grow up with this interesting situation that almost nobody escapes, which is that the people in our early lives who provide us care and who are essential for our survival will often disappoint us or upset us, sometimes in extreme ways.

And yet we cannot um leave them you know our our program is such that we need to find a way to stay close to them and you know we it's interesting we often talk about uh you know parents unconditional love for their children well it's amazing i'm a parent of three kids, and I've never seen unconditional love like the kind of love I receive from my children. You know, I can make a misstep as a parent, and within no time at all my children are loving me again. And so what do you do when your parent has upset you

or hurt you or disappointed you, and you feel anger towards them, rage, even murderous rage to your parents. But, of course, your parents are the only people that are between you and the great void. So you have to find a way to love them. And if you love them and you have murderous rage, well, that often feels like guilt. And then the guilt can often turn inward.

So this is just one example of a kind of common, deep psychological process that is usually not within somebody's awareness. And so one of the things that psychedelics do is they drop these defensive barriers. You kind of are opening up what I call the aperture on perception. Aldous Huxley famously spoke about something called a reducing valve,

and modern neuroscience corroborates his early intuition, which is that the kind of central role of your neurobiological hardware is to constrain your perception of the world in a way that is relevant to your survival, either your bodily survival or your status survival. And so you're perceiving the world in a highly constrained way. You're looking through a tiny pinprick that is framed by your survival. and psychedelics just open that up dramatically and there's neurobiology that corroborates that as well you're now perceiving the world not constrained solely by your survival and you get more information that's probably part of why psychedelic experience feels so reliable a lot of people will report that

that their psychedelic experience felt like they were waking up out of the dream of their lives. Or it feels more real than real. A lot of people would say it feels more real than real, and they can't explain it when they're out of that experience. Right. And so, you know, my sense is that part of that is because you are genuinely getting more information from more perspectives. brain like our brains just process the environment so our awareness of the environment around us it's limited by what our brains are processing at that time so it's often the question is is what is reality like like i always think of the metaphor renee descartes that's probably not how you pronounce his name

Descartes had this thought experiment about a bat where he was thinking a bat doesn't see but a bat can navigate a room better than a human can so what is the inside of that bat's mind when it can't see but yet it can navigate a room better than a human

and what is that bat's perception of reality? And why is my reality better than a bat's? Right. Yeah. No, exactly. I mean, you know, our perception of the world and the way we think about the world, the way we make sense of the world is highly species-specific. It's really specific to having a human brain. And then it's also quite idiosyncratic to you as an individual.

I think, you know, psychedelics open up that frame of reference quite dramatically. Some people think that psychedelic experience represents ground truth. I think that's rather far-fetched because you're still processing psychedelic experience through a human brain, through a cultural lens, processing psychedelic experience through a human brain, through a cultural lens, through, you know, your story making, that is very idiosyncratic. But it is a wider view, it seems to be a wider view on reality, you are getting new perspectives. And critically, you know, and perhaps different than a lot of people's experience of CBT is that the new kinds of experiences you might have about yourself or the world or others are not just cognitive they're not just in your head they tend to come with a lot of emotion and often it's

quite somatic it's bodily and the feeling is something like a direct encounter so people will talk not just about having a new idea they'll talk often it's quite somatic, it's bodily. And the feeling is something like a direct encounter. So people will talk not just about having a new idea, they'll talk about a revelation. And they'll talk about insights. I mean, my sense is that the insight, the thing that you can actually articulate the next day, you know, where you say, you realize, for example, that your angry mother had her own struggles and you understand her much better now. You had a real, you know, radical empathic sense of what your mother was going through when she was angry with you.

It's not just that, you know, you have that thought, it's that you actually felt like your mother, you transfigurated into her, that people will often report things like this. And in your body and in your emotional life, you have this deep sense of who she is and what she was going through. And that really, really leads to compassion and it's the kind of it's the kind of compassion that lasts it's not just an idea that you have to kind of practice and maintain in your mind like you were there and and that sounds like a supernatural empathy that sounds like like a level of empathy that's i can't articulate yeah it is. It often is like that. And whether it's empathy or some other kind of perspective on life, it is distinctly psychedelic when it comes with this deep embodied felt sense. And that is, you know, we know in psychotherapy that words and ideas don't tend to drive change in behavior and attitude and

affect very well. You know, they do for some people. And you may be, you know, an example of somebody who's been able to use some words and ideas and with a lot of motivation and practice, you drive change incrementally. But for most people, those words kind of land flat, you know, your doctor tells you, you're gonna die of smoking, you should stop. And you've been smoking, you know, 30 cigarettes for 30 years. And yes, you know, you're going to leave your young, beautiful daughter without a father in the next, you know, 10 or 20 years or whatever it is, you know, that there may be some widespread ramifications. But the idea that it's unhealthy to smoke just doesn't land. But then when you have these deep psychedelic experiences,

what you'll tend to have is it's often a really surprising kind of view on yourself or your life, often a really surprising kind of view on yourself or your life, which makes sense as well. You know, if you've been attempting to kind of grapple with some struggle in your life for a period of time and then you have a psychedelic experience and this immediate change, then, you know, what you'd expect is that something happened that was a bit surprising. It was not what you could have predicted.

And so you'll often get a perspective or an experience that comes from somewhere in your life or your memory. It can often be even quite visionary. It can be metaphoric, but it lands in your body. You really feel it. You feel, for example, the real pain of losing a father or a father that's somehow absent because of an addiction or something like that. And that pain sits in your body. And that is the kind of thing that drives motivation to change. One thing as well with the way that you're speaking, Paul, and I can imagine it presents a lot of difficulty for you in your field, is that you're speaking in a way that like our Western society and esoteric almost spiritual as a way which in our society we tend to go that stuff doesn't really have value they're evidence-based here like there's no way for you to have these conversations without you stepping outside the language of rationality and and what is observable objectively. Like, how does that, surely that creates problems in your,

like you're working in a university, you're a scientist. How the fuck, and you're bringing up Aldous Huxley, like an occultist. How does this work for you? It's a great insight, Blind Boy. That's true. You know, I guess what I would say is that for me personally it's really important to speak about and resist this rather lazy and false dichotomy between uh hyper

materialist uh and and rational uh views of the world on the one hand, and esoterica or spirituality or religiosity on the other hand. I don't fall into either of those camps. And my sense is that we need to begin to articulate a new kind of framework and a new kind of language that can hold what seems to matter under psychedelics and what seems to drive change under psychedelics. A lot of people will have these experiences that are very profound. The vast majority of people that have supported psychedelic experiences in these clinical trials will rate the psychedelic experience as among the most personally meaningful experience of their lives. And often the experience is hard to rationalize, hard to understand or comprehend.

It can seem like it has a lot of wisdom, for example. It seems like, you know, for some people, it seems like it was too perfect a lesson with a narrative arc that, you know, it had to have been designed by something. My intuitions and my feelings are not aligned with that. I mean, I really feel like there's plurality of experience here and I let everybody have their own language and interpretation of this. But personally, I don't have a spiritual or religious frame on this at all. I think there is a way to naturalize the most profound experiences that seem to, you know, go outside the domain of ordinary experience. Psychedelic experience is non-ordinary.

And we can get into the details of what that might be. But yeah, I don't fall into the camp of saying these are spiritual experiences or they come with some higher powers, intentionality or anything like that, there is a huge amount of information right below the surface of usual ordinary awareness. And psychedelics are allowing you access to that information in an unprecedented way. And that information is not just cognitive, it's broad it's it's broad information it's it's bodily it's affective and uh its usefulness is not uh you know by design i also don't feel by the way in a related topic i don't feel that psychedelic experience uh or psychedelics themselves like psilocybin or LSD or whatever,

hold any innate wisdom or any innate usefulness of their own. There's this kind of interesting unwitting alliance between traditional psychiatrists, on the one hand, who say that the therapeutics are within the molecule, and on the other hand, you have, you know, neo-shamanic psychonauts who say the healing is within Mother Aya or, you know, or the mycelium intelligence or whatever, you know, whatever frame it is. I feel like there's an unwitting alliance there, you know, and it's problematic because actually our own path out of suffering and distress is, in my view, dependent on our own efforts, our own capacities, our own path, our own trajectory. our own trajectory. And, you know, while we can have all kinds of assistance, you can have assistance from a psychotherapist or a friend or a drug. It's really just that it's assistance, it's possible assistance. But you have to do the work. It's not a one and done, it doesn't,

it doesn't solve your problems, it doesn't heal you. In the case of psychedelics where you often see rapid therapeutic benefits, you also see a lot of pain and encountering distressing material. Like it's not for free. I don't think there is a free lunch. You have to do the work, and the faster you go, the more it hurts. lunch you have to do the work and the faster you go the more it hurts um what would you say um so something like psilocybin that you mentioned there like that that's like magic mushrooms mushrooms that you can pick up off the ground contain psilocybin do you ever think that there's an evolutionary reason or an evolutionary symbiotic relationship between

human beings and these mushrooms the fact that that's a human 10 000 years ago could walk into a forest pick up this one mushroom and they could have had an experience that helped them through to understand themselves do you think that's evolutionary evolutionary? Yeah, I've always had something of a sympathy for what Terence McKenna called the stoned ape hypothesis, but I don't think we'll ever know the answer to that. Basically, you know... What is the stoned ape hypothesis for people who don't know? is basically that we have an explanatory gap in the evolutionary data whereby our monkey ancestors seem to make a dramatic and rapid leap in their ability to think and use tools and negotiate complex social environments with very little development in their neurobiology. Like their brains changed very little over the period of time in which cultural and intellectual evolution seemed to be, you know, dramatic.

And so one idea, and Terence McKenna wasn't the first to name it up, but he certainly popularised the idea that, you know, that it's likely, given magic mushrooms grow in about 100 species and, sorry, psilocybin is in about 100 species of mushroom and grows all over the world almost, it's very likely that some primate would have eaten a mushroom. And if they did eat a mushroom, the kinds of experiences they had given the potential for psychedelics to produce dramatic insight and new creative perspectives on things and problem solving and all sorts, that that may have played a substantial part in the kind of intellectual, cognitive,

and social evolution of our species. I don't think we'll ever be able to prove that one way or the other, but I think it's an interesting idea. And also, you know, possibly these mushrooms may have played a large part in the evolution of proto-religions and early religious. So we're just going to take a tiny little break from the interview there now. That last word that Paul said there was early religious thinking. It got cut off.

We're going to take a little break so that we can hear some digitally inserted adverts. So let's have the ocarina pause. I don't have the ocarina with me this week. What I do have is a very interesting lighter. Now, because of the pandemic, I haven't smoked a cigarette in nearly two and a half years

because I haven't been, like, I don't smoke cigarettes. But if I'm out having a pint and someone has a cigarette, I'll probably smoke one. But I think that's gone out of my system now forever. I don't think I ever want a cigarette again. probably smoke one but I think that's gone out of my system now forever I don't think I ever want a cigarette again so I'm left with this really beautiful

lighter that I bought it doesn't use a flame it uses plasma which is a superheated gas this is the coolest lighter I've ever had in my life like you press the button to light your cigarette, and it's like a laser or something. It's absolutely bizarre, but it makes quite a nice little electric noise. So we'll have the plasma lighter pause. I'm going to click the plasma lighter a couple of times, and then you might hear a digitally inserted advert that's algorithmically tailored towards you and your needs. Let's go.

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pause I hope you enjoyed that if you're a first time listener you having a fucking clue what's going on fuck it sit with that anxiety sit with the anxiety

of not knowing what that just was so support for this podcast comes from you, the listener, via the Patreon page. Patreon.com forward slash The Blind Boy Podcast. If you listen to this podcast, if you enjoy it, if it's given you solace, a bit of fun, just please consider paying me for the work that I'm doing. This podcast is my full-time job. It's how I earn a living.

Consider paying me for the work that I'm doing. This podcast is my full-time job. It's how I earn a living. And because of the Patreon page, I'm able to make the podcast and do it as my full-time job and put it out each and every week. And I adore doing this work. But if you're consuming it and enjoying it, just please consider paying me for it.

But if you can't afford it, you're out of work, whatever the fuck, don't worry about it. You can listen for free. And the person who's paying is paying it. You can listen for free. And the person who's paying is paying so that you can listen for free. So everybody gets a podcast, I get to earn a living. The Patreon also keeps the podcast independent.

No advertiser can come in here and tell me what to talk about. Like there's loads of advertisers who'd be like, you're not doing a podcast about magic mushrooms. I don't give a shit if they're clinical trials. That doesn't fit with like, you're not doing a podcast about magic mushrooms. I don't give a shit if they're clinical trials. That doesn't fit with our brand. Don't do a podcast about magic mushrooms.

Well, piss off is what I can say to them. So the Patreon keeps this podcast independent and it means that I can make the content that I want to make and put out the podcast that I want to put out. And support all independent podcasts not just mine the podcast space over COVID has become flooded with quite a lot of corporate money and a huge amount of quite low quality but big budget podcasts are being released all the time and what this does is it drowns and silences small independent creators that are passionate about what they're

making because that's what podcasts should be so whatever podcast you're listening to if it has a small team of people or maybe one person support it any way you can monetarily or just tell people about it and share it follow me on instagram blind by boat, and catch me on Twitch once a week, Thursdays, half eight, twitch.tv forward slash The Blind By Podcast. And the Patreon, once again, is patreon.com forward slash The Blind By Podcast. Please consider giving me the price of a pint or a cup of coffee once a month. That's it. That's what keeps this podcast going. Now back to the talk with Dr. Paul Litnitsky from Monash University. So a question for you as a neuroscientist.

What happens to the human brain? What's going on inside the human brain when someone takes a psychedelic? And also if you could speak about when people say that they get ego death, that they lose sense of who they are and there's no sense of self, what's going on in the brain when that happens? Basically, the term psychedelic is used currently to refer to the classic psychedelics, which are LSD and psilocybin and magic mushrooms and DMT and those kinds of substances. and psilocybin and magic mushrooms and DMT and those kinds of substances. And then also a set of psychedelic-like substances like MDMA and ibogaine and some people even use it to refer to ketamine. How you do the psychedelic is part of the definition

because if we're going to define the term in terms of mind manifesting capabilities, then, you know, if you take MDMA and you bounce up and down at a party with your friends, it may be the case that none of your mind was really manifest to yourself over that time. Whereas if you lie down with eye shades and a soundtrack and some therapeutic intentions and support uh and you lie there for eight hours then often mdma is psychedelic so uh cannabis as well can be psychedelic it really depends how you use it um so when we talk about uh just kind of constraining this

uh particular neurobiological question to the classic psychedelics like psilocybin and LSD, there are a number of key neurobiological changes under psychedelics that we know something about. It's still reasonably early in the field. The neurobiology of psychedelics has only begun to... It's only been a field for a small number of years. And it's also worth just saying as another tangent that my view is that neurobiology is not, at this point in time, the most powerful level of explanation for psychedelic effects in a therapeutic. Wow.

So a lot of people will kind of say, well... And neurobiology there means that the internal workings of just the brain. Well, our understanding of that, I mean, my view is that for every experience, there is a neurological correlate. But we are, I think, a long way, hundreds, maybe even thousands of years from having an understanding of the neural correlates of what matters under psychedelics. I think we can get far more granular and get far more insight into how these substances work for therapeutic ends if we talk about subjective experience.

But nonetheless, I think there is something interesting happening in contemporary neurobiological studies of psychedelics. So I'll tell you just two broad findings that have been replicated in a couple of studies. under psychedelics would just become hyperactive. You know, given the nature of psychedelic experience being so intense and multifaceted and wild in so many ways, people expected that the most consistent neurobiological change would just be that the brain lights up in different ways to a greater degree. Actually, the most consistent finding is that one large hub of neural networks quietens down. And that hub is referred to as the default mode network. It's kind of like your background

idle. It's what is most active when you're not attempting any task. It was discovered, the default mode network was discovered by accident when people were lying in fMRI scanners waiting for their next instructions or just in a rest phase. And people over many studies and many different groups realized that the same basic structure was lighting up when people were not asked to do anything. And so that's like our background idol. That's why we refer to it as default. And it tends to instantiate capacities like self-reference. So when you're thinking about how something matters to you or you're thinking about yourself in a particular way, default mode network lights up when you're thinking about the past or the future mental time travel default mode network is at play um and and right there you can see the building blocks of psychopathology yeah um we're thinking about the past thinking about the future thinking about how it matters to you those are yeah right there you're describing like when i experience mental health issues or i get a flare-up of anxiety I'm focusing on the past or the future and not spending a hell of a lot of time being present in my body in the here and now.

Right. Which requires effort. Right. And which is why, you know, you practice mindfulness and why it's useful. Part of what's useful for you is because it brings you back into the present moment, which is. And my entire body. That's a huge thing for me with mindfulness is when I practice it, I'm aware of my feet, I'm aware of my hands,

I'm aware of my experience of time, my emotions. There's a whole lot going on, and this leads to mental health and a better quality of life. But when I'm not, and I'm pacing around the place, and I'm losing time, and I'm thinking of the past and the future, then I'm suffering exactly exactly and you know what you can see there is and we see this consistently across different capacities of the human brain is that there's a shadow aside to our greatest strengths you know like as an animal one of our greatest strengths is our ability to become abstract in our thinking, to plan far into the future, to work in a way that is highly detached from perceptual awareness, to plan, to think, to philosophize.

To be creative. To be creative, to strategize. All these things are kind of key to our strength as a species, but also the shadow side, in my view, is basically mental illness. So one of the things that happens under psychedelics is the default mode network quietens down, and that allows for other parts of your brain to light up because the one of the things that the default mode network does and indeed almost all networks in the brain do is they inhibit other networks there's a kind of competition in the brain that happens so um you know know, some people will say, you know, what a shame that we only use, say, 10% of our brains. Wouldn't it be great if we could use all

of it? Well, actually, no, it would be a total mess and chaos if every part of your brain was lit up at the same time. The only way you get specificity, the only way you get any capacity is if only certain parts of your brain are activated at a given time. And that is achieved in your brain through competition between different structures. And the majority of neurons in your brain are actually inhibitory neurons. The majority of your neurons are inhibiting other neurons um so um so what happens when the default mode network quietens down is that a whole lot of typically inhibited structures light up and that's part of this kind of expanding on on aldous huxley's reducing valve where information that you're not normally aware of is now flooding in and is this the information that's in your unconscious mind?

Yes, you could say so, yeah. It's information that's in your unconscious mind or even just memories that you don't have access to. It's fascinating. A group of us trained up with MAPS, the Multidisciplinary Association for Psychedelic Studies, in MDMA therapy for PTSD. And part of the training was watching a huge memory stores whereby people who had been seeking therapy for over a decade for some um index trauma that might have happened say you know in a war situation um suddenly you know so they're kind of processing what happened in the war 10 or 15 years ago, you know, weekly for years and years and years.

And then under MDMA, they suddenly find themselves remembering the events of their index trauma in super slow-mo, high definition, the most granular details you could imagine that they had no access to previously. details you could imagine that they had no access to previously and they were counting it you know all the the details uh that that happened in those 25 seconds before the bomb went off wow i've never had any any major trauma but obviously i have had instances where you know when you cross the road and you almost get hit by a truck you know little things like that that are very very frightening and for a second you feel like i'm gonna die and i've had a couple of those moments and it fucks with your perception of time right you know i'm a little bit rattled for the rest

of the day now i can only amplify that by a thousand for someone who's experienced severe trauma. So are you saying that something like MDMA would allow a person to safely revisit the memories that their brain has locked away so that they can relive that moment with a bit of safety? Yeah, that's one key aspect to MDMA treatment, which is exposure therapy. Is that the anxiety therapy exposure, like where if someone's afraid of spiders, you gradually introduce them to a spider in the room? Right, exactly. And with something like PTSD, it's often like imaginal exposure. So you go back to the traumatic events in your memory and you attempt to kind of grade up your imaginal exposure to that over time. But as you said, without psychedelics, you're using the mechanics that are already not working

for you. Exactly. Well, so there's kind of two problems. One is that people will often find it overwhelming to return to traumatic events and they'll simply not do it. They'll walk away or feel re-traumatized. But also, even if you've created a degree of safety and they're willing to go back as best they can, their brains don't allow full access typically. And so, yeah, exactly. So what MDMA allows for, one of the effects of MDMA, which is different than the classic psychedelics like psilocybin,

is that it dramatically reduces distress or increases tolerance for distress. So things that are typically overwhelming or too painful to bear become far more tolerable and safe. And so people will go back to memories and relive them in a far more detailed way. And it's not only the reliving, it's not only the kind of return in memory that matters, it's that there's this capacity to reappraise those memories.

So you're now going back to the memory but your body is not flooded with adrenaline and you're not feeling, you know, shit scared while you're dragging yourself through the memories. You're actually in a different state. while you're dragging yourself through the memories, you're actually in a different state. You might be feeling philosophical or curious or you might be feeling a lot of love for yourself in that memory or for some perpetrator of a crime even,

some sort of forgiveness or compassion or a very different kind of emotional context is playing up while you're revisiting. And that's key to exposure working. Exposure works when people can reappraise, when they can go back and they can find a new way of encountering that memory so that your system, your brain and your bodily system that's associated doesn't feel like it is under threat currently just because you've heard a chopper in the sky. So just to use a little metaphor to help me understand this better. When I was a little kid, I used to be very afraid of religious statues.

There was a lot of religious statues in Ireland. And I used to be terrified of like, I'm like four and Christ is crucified and it's in my school and I don't really understand it, but I see it as a very violent image and I started to get very frightened of it and I would run past the statue of Christ. I couldn't look at it. And then one day my mother just took me to the statue and she was there. Now, it wasn't a religious thing. She was she didn't give a fuck about christ she's just like i don't want my kid being afraid of a statue but i i was able to stand by the statue of christ to look at it because my mother was there with me

and i felt safe now and then i stopped being afraid of the statue of christ because the safety that my mother being there with me was like it's still frightening but this loving person is here with me to describe it to me and explain it and then lo and behold i'm not scared of statues anymore right what you're describing sounds a little bit similar to that it's like the mdma yeah whatever feelings i was feeling the love from my mother the safety the confidence of nothing that's going to go wrong. I was able to process that little fear I had of statues. And so this is doing it as an adult and you're your own love.

That's right. Exactly. Well said. That's really what is doing a lot of the work with MDMA therapy. Yeah. And MDMA, of course, that's otherwise known as ecstasy for people who aren't aware isn't it that's right although you know street ecstasy given we have this unfortunate war on drugs and prohibition street ecstasy often uh contains very little mdma okay yeah that's what we tend to refer

to that um what what's your opinion on like immediately when you say lsd i get terrified like i would never do lsd because i just grew up with horrendous stories of like sid barrett in pink flied who took too much and destroyed his mind or they'd say similar things about brian wilson who was in the beach boys he took too much lsd and never came back. What's your opinion on that? Is that a thing that can, and that was a quite a lot of questions I got, people being terrified of, I like the sound of this psychedelic therapy, but what happens if I become someone who never comes back? Right. Yeah. I understand that fear and it's quite widespread. Psychedelic spread, you know, psychedelic experiences are not without risks. But I would say, as important as what drug you take, and what dose you take is the extra pharmacological factors,

the stuff that is not the drug. So how much preparation you've had, how well supported you are, what is the physical context in which this happens so in our trials we are not delivering drugs we are delivering a form of facilitated psychotherapy you're not just talking about here's a pill go away and take this you're speaking about we're gonna you're gonna take some psilocybin but also there's therapy the mood the color in the room the sounds that are used it's a full sensory experience yeah what would someone who's doing one of your trials first off who is the type of person that you'd like to do this trial and what does it look like from day one to begin this what's the whole process yeah good question so um you know before describing the treatment protocol, it's worth just saying that if you have psychedelic experiences in a way that is well supported and with adequate preparation, it tends to be really safe.

And this idea that you have one psychedelic experience and you go mad is a dramatically inflated fear. But it really matters how you do it. However, I would just say there are a number of issues that people suffer with that lead them to be excluded from participation in these trials. in these trials and so it may be the case that certain vulnerabilities that people that struggle with certain kinds of issues may not be um best place to have safe psychedelic experiences so like do you mean somebody who is already uh experiencing difficulty with psychosis right so we exclude psychosis schizophrenia etc and we also exclude um a number of issues of pathological liability like bipolar disorder and borderline personality disorder and other personality disorders. You know, the evidence is not yet in on the safety profile for these cohorts of people. But, you know, we did see in

the first wave of psychedelic psychiatry through the 50s and 60s that people with schizophrenia who were given high-dose LSD tended, on average, to get worse. We have also seen a few cases of psychedelic-induced psychosis, but, you know, psychedelic-induced psychosis, but, you know, it's not clear whether all those individuals had an underlying vulnerability for psychosis already. And, you know, psychosis vulnerability can lead to a psychotic break through all kinds of traumatic experiences. You can have, you know, if your parents get divorced, that can trigger a psychotic break. So something like a psychedelic experience may just simply be overwhelming in the moment, and that can trigger a psychotic break.

But it tends to be very, very rare. It looks like it is all related to psychotic vulnerability. And so, you know, I would just say we have to hold these two in hand. One is that psychedelics are not safe for everybody, and two, if done really well, psychedelics are really safe for the vast majority of people. Are really safe. Yes, are really safe.

So to go to your question around what it looks like from the participant perspective so um we recruit participants uh in a highly rigorous way so people are screened multiple times for safety and um and so while it's not the case for all trials that this happens we in our trials at Monash University that will be kicking off in the next couple of months, we are recruiting people who are physically well and have a psychiatric diagnosis. It depends on the trial, you know, what psychiatric diagnosis we're dealing with. diagnosis we're dealing with. They can have some comorbidity, so some degree of other issues, but there are all kinds of psychiatric diagnoses that exclude people, like, as we just described, psychosis. And so they go through this rigorous screening process, and then they're screened in,

and they will be taken through the entire protocol, which is usually two to three months of treatment, by two trained and experienced psychotherapists who are there with them every step of the way. And they will undergo a number of preparatory sessions. These are non-drug psychotherapy sessions that involve establishing rapport and therapeutic alliance and working to basically get that launch. This is even before psychedelics are taken. Right. The therapeutic alliance is established and a safe environment is established.

Right. And you're also doing kind of psychedelic education. So, you know, understanding what psychedelic experience is about and how to navigate that terrain. So you kind of are preparing a launch pad and the therapist of ground control participant is the astronaut. And you're going to fire them off, you know, through the stratosphere onto an alien planet. you know, through the stratosphere onto an alien planet.

And so you want to do as much as you can to get that launch pad well prepared. And one of the key elements of the preparatory phase is allowing people to find as much trust as they can. A key mantra in psychedelic therapy is trust, let go, be open, because fundamentally psychedelic experience is impossible to predict, is surprising in all kinds of ways, and is often profound and meaningful and also challenging. Many people describe their clinical psychedelic experiences as among the most challenging experiences of their lives as well so you do these preparatory sessions and then when the participant is ready we have in one trial in our psilocybin for generalized anxiety disorder trial we have two high dose psilocybin sessions these are eight hour long sessions are you giving people a mushroom are you giving someone a dried mushroom or no we don't and nor do any of the contemporary trials using psilocybin. It's all pure medical grade synthetic psilocybin. So you're not even getting this from mushrooms, you're synthesizing the chemicals that are present in the mushrooms. Right, exactly. um and so so these participants will have a psychedelic

experience alongside the support of of these two therapists who are there with them and there's a very particular way of of you know best practice psychedelic support it doesn't look like standard psychotherapy at all and are these people like i have depression i have anxiety or is it or is it i have complex ptsd like does someone have to be very extreme or could it be someone who's simply i keep getting anxiety attacks i'd kind of like to not have them anymore yeah so it depends on the trial and depends on the research question so in our psilocybin for generalized anxiety disorder trial, they need to have a diagnosis of GAD and it needs to be quite severe. We are also establishing an MDMA for post-traumatic stress disorder trial and they also have to have a PTSD diagnosis and it also needs to be quite severe. But my view is that while psychedelics have been investigated over the last 25 years, primarily in the context of what we refer to as treatment resistance,

which is people who have not found adequate relief from their mental distress with a whole range of other interventions that are available, with palliative patients, people that are dying, my view is that that has been primarily a kind of cultural rationale around the acceptance of these drugs and the understanding of their safety. I think that actually psychedelics, psychedelic-assisted therapy are, therapies are potentially an appropriate first-line treatment, so not just for the most severe and not just for those who haven't responded to other treatments. But depending on the trial, we may have some of those constraints around treatment resistance, so you may have had to have had,

you know, a number of failed drug treatments previously or similar. failed drug treatments previously or similar. And so then after the high-dose session, which lasts the full day, people are generally spending a lot of their time lying down on a comfortable couch in a room that looks much more like a retreat spa than it does like a hospital room. There's a lot of attention paid to the physical setting. What's the role of music, the role of smells, the role of colors, the role of lighting? Yeah, so we don't go for like a super multi-sensory intervention per se.

I mean, we've created an environment that is comfortable and conducive, comfortable and conducive but we're not using these tools in a systematic deliberate way as part of the intervention they're optional tools and people can use them or not they have music and the playlist is there and is often very supportive who picks that i mean what if this person who picks that music if like if the person particularly enjoys Coldplay, are they allowed to do that or do you guys choose the music? No, in our case, we choose the music. We have a couple, we have three options. One is the playlist, which has a trajectory that's built in that maps to psychedelic experience in some way. Like how do you decide that? Like, that's amazing. It's an art and it won't work for everybody. And some of

the early evidence shows that some participants will say that the music seemed to be getting in the way of their experience. And so we have these other options. One option is that you can switch over to just nature sounds, you know, birds tweeting and, you know, waves crashing, or you can just take it off and have silence but the approach to the music that we foster in the participants is a little bit like the approach to all the experiences that come up it's not about curating an ideal and comfortable experience it's about an attitude of curiosity and openness with whatever comes up. So, yes, if you really think the music is getting in the way of your process, you switch or you take it off.

But if the music is just upsetting, we will encourage people to lean into what is upsetting for them. So there's continual dialogue. How is the music working for you? Is this there's continual dialogue throughout? working for you? Is this, there's continual dialogue throughout? Well, you know,

often with psilocybin experiences, people are not speaking for a lot of the peak phase. They're not able to speak and speaking tends to be, you know,

a defence and also disruptive. With MDMA, there is much more conversation. But no, we're not having, you know, a lot of conversation

about tweaking things. It's really about leaning about leaning into you know the deeper processes that are happening for the person um but in the preparatory phase we kind of gear people up for the music as one example and um and yes there's no there's no perfect playlist for everybody but uh but really that doesn't matter. You know, the music has its function. You know, it can be facilitatory. It can kind of open people's hearts up in the early phase. It can provide some sort of grounding and comfort in the later phase. We tend to, in our work, follow the non-directive principle

as best we can with the music. So non-directive approach is key to psychedelic psychotherapy during the dosing sessions, which is that you are really, as a therapist, not attempting interventions. You're there for support. And this process was really developed through the early wave of psychedelic psychiatry where psychotherapeutic interventions is often just, you know, getting in the way of a participant who's making a beeline for the most, you know, useful or painful

information. And the music can also be directive in ways. And we tend to, for the peak phase, have that music be a little bit more in the background so it's just like a golden thread or a hand held out and open if you need it it's there if you don't need it you you forget about it now i'm going to ask your opinion on something which which you're not working with but i'm a lot of the questions i got and one thing i'm really fascinated with is things like dmt 5meo dmt which is particularly powerful or even salvia divinorum like i know people who have taken these substances recreationally and they literally describe they visit what they describe as heaven they leave all objective reality and they're in fucking heaven or like what's going on in the brain of someone who takes something like DMT or 5-MeO-DMT?

Yeah, these are, you know, fascinating molecules, these rapid onset psychedelics. And it's really not yet clear what's happening in the brain. You know, there are just the beginnings of therapeutic applications of drugs like DMT and 5-MeO-DMT happening now. So the jury's still out on their therapeutic utility. There's a lot of interest in these substances, in part because they're much shorter acting. So an MPA or a psilocybin treatment session is a long day, whereas something like DMT, you can do a two-hour session, and that is more billable and more practically appropriate in the medical context.

But, you know, I guess I would say these are fascinating substances with fascinating experiences that are associated with them. It's also interesting to consider their ability to provide the kinds of shifts in perspective and the kinds of shifts in attitude and behavior that matter for people who are trying to get their lives back on track. Because in this case, you're kind of rocketed out onto a completely unrecognizable planet over the course of 10 seconds. You're not able to take your biography and your memories and yourself along for the ride and then you drop back almost as quickly and while you're there in this other realm um very little of your yourself is there and that

you know may provide a whole lot of benefit. My hunch, but it'll play out in the data over the next five years, my hunch is that we may see that these fast acting psychedelics like DMT are useful in, more useful in a chemotherapeutic way than a psychotherapeutic way. And I'll try and explain that. So with psychedelics, what we, what we see with something like psilocybin is for a period of one to three weeks after the high dose psilocybin, we have something called an afterglow phenomenon where people feel noticeably and spontaneously in a different state. And they're doing things differently. They're walking by the river listening to music or they're having honest conversations

or they're crying when they wouldn't normally. You know, things are different for them. And then that afterglow wanes and what you're left with is, you know, potentially nothing or some shift in your beliefs or some shift in your style of relating to yourself or the world. And so in a sense, you know, one of the ways I think about it is that you've got chemical therapeutics that are directly related to this molecule in your brain, obviously, chemotherapeutic effects drive the acute psychedelic experience. That eight hours of dripping is chemotherapeutically driven. And then my guess is that…

When I hear chemotherapy, I think of cancer. What context are you using it in here? So I'm using it to refer to a process that is driven fundamentally or better understood fundamentally as molecular activity in the brain. Okay. That it really doesn't, you know, that it's not about your psychotherapeutic or psychological processes as much as it is about molecules causing the change. It's like inebriation.

Right, yeah. So it's clear that the fundamental cause of a psychedelic experience is that you've got a psychedelic drug docking in receptors in your brain. It's not about your state it's not about your attitude or what you're thinking about as much as it is that the molecule is in your brain driving the change you think this is why like so many people have so when people take dmt a lot of people have a very very similar experiences they visit a place that they describe as heaven and then they meet these beings that they refer to as the elves in the machine.

And these beings are like bejeweled basketballs that are fun. And they make fun of you. And everyone has this experience. Yeah. And it's that particular quality that makes people believe that DMT is like supernatural or that you literally do visit the same place. Right. Yeah. Look, you know know a lot of

people have common experiences with dmt it's worth saying that you know a lot of people that have dmt are also swimming in the same cultural soup and the same expectations and ideas um i'm not sure so if you if you want to meet the elves you're going to meet the elves because you've been told the elves exist right and you know that's that because you've been told the elves exist. Right. And, you know, that would be my sense that maybe there are some species specific and human brain specific kinds of alterations that lead to seeing certain kinds of things. But, you know, when people, you know, when a devout Christian takes psilocybin or LSD, they tend to have Christ encounters. or LSD, they tend to have Christ encounters. And when, you know, a Amazonian shaman will take ayahuasca, they'll tend to have mother ayah encounters and jaguar encounters. And, you know, so it's very hard to separate out cultural and expectancy, you know, overlays from, you know, innate effects of a drug. Do you think our western way of thinking and

culture is a barrier to this therapy because if we're being honest a lot of the stuff we're describing in our culture is rubbished it's not taken seriously and it's it's it's it's rubbished it really is if you if you say to somebody uh i took mushrooms yesterday and i had a profound experience and i can't describe it. Most people will go, that person's crazy. I don't get that. Yeah. And this is a flaw of our culture.

I mean, I say that because I'm an artist. And when I create art, I experience a thing called creative flow or I lose sense of self. And I just stop. I've stopped saying it to people because they think I'm mad. Sure. But I know it's real and I know it's very helpful. And to be honest, it's it's it's my favorite part of being alive. Yeah. Stop telling people. Yeah. Well, I think, you know, it's possible that the distance between our cultural norms in the West and psychedelic experience is the size of the opportunity of psychedelic experiences for us. You know, maybe there is something more useful for a contemporary Western person to undergo psychedelic experience and bring them more, you know, in contact with other aspects of their

lives and their priorities that matter. But, you know, I think what you're describing is potentially less relevant to psychedelic experience and more relevant to how you unpack that in your life thereafter. I think we have a big job in the West to kind of build the kind of the cultural norms and the language that will be an appropriate place to land psychedelic experience. That hasn't happened to any substantial degree. And also, too, like something that has done quite a, I don't want to use the word damage, but like I love science, I adore science science and you're working in the field of science

but the western love of science since the enlightenment is what has created this extreme rationalism that rubbish is anything that we would perceive as a spiritual do you know what i mean yeah and and you're like it's almost like how the fuck do you make this research work within the western scientific method well again i feel like yes the challenge is great but the opportunity is similarly great because my view is that there is something incredibly special about the sharp, bright spotlight of post-enlightenment intellect. There's something incredibly impressive in the evolution of our species that is manifest now as incredibly precise and deep and thorough thought.

And yes, that may have come at a cost to other kinds of experiences, other modes of being, other priorities in our lives. But perhaps if we can avoid just having two buckets where you're either a rational materialist that won't entertain any new kinds of experiences, or you're a kind of esoteric spiritualist who has a whole alternative view on the physical world and everything else, the metaphysical world. Yeah, we don't have an in-between right now.

Right, and I think there's an opportunity there that psychedelics potentially afford, which is that for people who have the capacity for kind of clear, rational intellect and deep thought to then expand the kind of the range of experience and incorporate that wider range in a better understanding of themselves of the world but yes it is a challenge for sure i'm gonna ask one last question part of that's okay so when i went to instagram and said to people i was going to have you on i was shocked by how many people are actually microdosing themselves? But how do you feel about that?

How do you feel about people microdosing by themselves with no supervision? You're doing it illegally in a way that if they were caught, they'd get arrested. Yeah, no, this is a tough situation a lot of people are in, of course. And, yeah, well, I mean, firstly, I would say in terms of, you know, the criminality aspects, you know my view is that um that the criminalization of substances uh is a bad thing and has been a bad thing for decades yeah and and um we really do

need to move away from uh from a legal perspective on drug use entirely in my view and that that doesn't just include psychedelics by any means. In fact, I would say that we need to do this most urgently for drugs with greater harm, like heroin. But that's a separate issue to therapeutic administration and regulation. And I guess I would say it's a difficult situation because on the one hand, we've got people who have a lot of need, are desperate for treatments, and with the right context and support are likely to benefit from these treatment approaches. On the other hand, psychedelic-assisted therapies have not satisfied the basic standards by which we apply that we apply to any intervention

or drug that becomes approved and regulated and so um there is scope for compassionate use and there are compassionate use programs around the world where people can get access uh prior to regulatory approval i would say say, however, that psychedelics are not without risks. And in order to adequately provide compassionate use, psychedelics, you need a workforce of adequately trained professionals, and you need proper oversight, and you need, you know, something like a peak body that can assess and understand what best practice in psychedelics is. And, you know, we really need to ensure that we don't have a wild west situation where people can do it any way they like. And

there's no recourse to kind of resolving issues that might emerge. But, you know, the issue is that we are still a number of years away from approval and we need to get it right because approval is tied in with access and access is in part an economic question. You know, it's really important that we don't just develop a set of interventions that very few of the elites can afford. We need to get the evidence base and the approvals that stand us in the best chance of getting either government Medicare cover or insurance cover so that

it can be these can be accessible treatments and so far like what you described sounds quite expensive paul to be honest i mean like even like i i i hate seeing when when like cbt sometimes is rolled out publicly in a way that you'll get a group of people doing cbt together and and it's you know it's there to save money and people aren't finding it as effective and and when it comes to pinching pennies around stuff like this like psychotherapy is expensive psychotherapy is time consuming the journey for healing is is requires a lot of people and a lot of money to do it and simply packaging into us into a pill for the least amount of money that's not that's not going to heal human beings yeah too right i mean you know my my sense is what

we need to do is an is economic evaluations of these treatment approaches that go much further out than most economic evaluations go. So often when you're trying to understand whether an intervention is cost-effective, studies will look over the course of 12 or 18 months. If these interventions are very expensive in the short term, which they are likely to be, but actually lead to lasting changes in people's lives, where people who are in and out of a medical system can exit that system

and that's for good or for 10 years, then that becomes actually cost effective. Really, the most expensive option is to provide inadequate care that leads to people going in and out of the revolving door situation and landing up, for example, in inpatient psychiatric care, which costs, you know, thousands and thousands of dollars a day in some cases, or tens of thousands of dollars a week, you can offset that one visit with adequate psychotherapy and adequate interventions and care. And so my sense is, yes, it will be expensive, but it may still be cost-effective, and we just need to look at a longer period of time.

On a long-term basis. Yes. Wow. So thank you so much for all that, Paul. Is there anything that I didn't cover effective and we just need to look at a longer period of time. On a long-term base. Yes. Wow. So thank you so much for all that, Paul. Is there anything that I didn't cover that you really want to get across? Look, there's always an infinite number of topics we could discuss and we could carry on forever. But no, it's been a total pleasure to chat with you again, Blind Boy. Really great. I appreciate your interest in the topic and just appreciate your voice in in the space of uh mental health care and awareness and and um thank you so much for for chatting with me so that was dr paul litnitsky of monash university um a wonderful conversation and i'm really excited to

see where his research goes where his research goes and and it sounds like something that personally me i would actually like to do i would like to like i mentioned i'm cautious and afraid of psychedelics but under a clinical psychotherapeutic process like that i would feel safe with something like psilocybin and I'd be interested in doing it so that was quite a long interview um but we had a lot to cover we had a lot to cover and it's an important area so I'm gonna sign off now and I'll catch you next week I'll come back with a hot take I reckon next week and'm going to sign off and say goodbye. But after the little break, I'm going to come back on for about five minutes and play one of my Twitch songs.

So if you're not into that, you can just say goodbye right now. And if you are into it, you can stick around a few minutes. 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 okay this is the bit at the end of the podcast where i play a song from my Twitch stream. So what I do on Twitch is, and I've been doing this for all of the pandemic,

Twitch is a live streaming platform. Once a week, I go onto Twitch completely live and I play a video game called Red Dead Redemption. But while I'm doing it, I have recording equipment and live instruments with me. So what I do is I write songs to the events of a video game in the moment. So quite a lot of people use Twitch and what they do is they'll play a video game and then talk about what's happening. What I do is use instruments to write songs about what's happening. So it's a new way to create music

in the moment so all the music i make is completely improvised on the spot and i don't know what the song is going to be about i don't even know what it's going to sound like i just try and enter the state of creative flow and let it happen so this song that i'm going to play ye i think i made it about a year ago on twitch and the song is called jerry adams has 32 peanuts in his beard and i was quite happy with it for something i pulled out of my arse i was quite happy with it the title is self-explanatory here's jerry Jerry Adams has 32 peanuts in his beard. God bless. And by the way, my Twitch address is twitch.tv forward slash the blind boy podcast.

And I'm on on Thursday nights at 830. Jerry Adams. Jerry Adams. Jerry Adams. Jerry Adams. Jerry Adams. How many peanuts have you got in your beard? Oh, Jerry Adams, how many peanuts have you got in your beard? Jerry Adams, how many peanuts have you got in your beard?

He's got 32, 32, 32 peanuts in his beer Because Jerry Adams Jerry Adams Has heart-pitch-o-peanuts In his beer Jerry Adams Has heart-pitch-o-peanuts In his beer I'm gonna Pick them up One by one

Until we've got A nation once again I'm gonna pick on all One by one With my teeth My Republican teeth Cause Jerry Adams has Cocktails or payouts in his payout Jerry Adams has carpental pain once in his beard.

Jerry Adams has carpental pain once in his beard. Jerry Adams has carpental pain once in his beard. Jerry Adams has carpental pain once in his beard. is