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A trip to the doctor
It’s early May, and I am seated in a room in Sydney with a man called Marc. Marc – not his real name for reasons that will become apparent – is a mental health professional, a slim, casually dressed man in his fifties who might easily be mistaken for a designer or an architect. Although this is the first time we have met in person, I warm to him quickly, reassured by his mixture of intelligence and alert but genuine empathy. At first we make small talk, chatting about his background, my work, books we have both enjoyed. But then, gradually, we turn to the less easy topic of what has been going on in my life and why I am there, the fact I have been suffering from one of the worst episodes of depression I have ever experienced.
Depression is not a new presence in my life; it’s something I’ve grappled with since I was a teenager. I suspect its origins are at least partly biological: there’s a lot of depression in my family, along with more than our fair share of anxiety disorders and alcoholism. And while there sometimes seem to be triggers for the episodes, more often they just arrive, seemingly out of nowhere, their approach heralded by very particular sleep disturbances, and the unsettling knowledge that the beast is out there somewhere, circling.
This time I hadn’t had the sleep disturbances. Instead the darkness had overwhelmed me slowly, and then all at once. Perhaps that isn’t surprising, as the year leading up to that meeting with Marc hadn’t been easy: the pandemic and the stresses of lockdown and homeschooling amplified by the death of my mother, complex family dynamics, anxieties about work and money, and, finally, a serious assault upon one of my daughters, which had left my partner and me grappling with an alarmingly depressed and traumatised teenager. At some point it had all become too much, and I had begun to spiral down into uncontrollable cycles of self-recrimination and negativity. For large parts of the day I was so anxious it was difficult to breathe, a seething, focus-less agitation filling my chest and hands and throat. When I wasn’t gripped by anxiety I was breaking down in tears multiple times a day, weeping in the car or waking up crying in the small hours of the morning. Most of all, I just wanted not to be here anymore, to somehow delete myself. One afternoon at the station I almost stepped under a train; the only thing that held me back was knowing I couldn’t inflict that on the driver.
My story will be familiar to many. According to the Australian Institute of Health and Welfare, one in seven Australians will experience depression at some point in their lives, one in four will experience an anxiety disorder, and at any given moment one in six are experiencing one or the other, or both. Over the 12 months to June 2020 alone, a staggering 4.4 million Australians filled a prescription for a mental health–related prescription.
The cost in human suffering behind these figures is difficult to comprehend. But to take just one metric, every day in Australia an average of nine people die by suicide, making it the 13th leading cause of death. And its incidence is rising: in 2010 11.2 people per 100,000 died by their own hand; by 2019 the figure had risen to 12.9. Every one of these deaths impacts upon the lives of family, friends and workmates, with enduring and often irreparable consequences. The economic cost of depression and mental illness is also colossal: in 2020 the Productivity Commission calculated Australian governments spend $15.5 billion on mental health–related services annually, while estimates of the indirect cost to social security, housing, the criminal justice system and lost productivity run even higher.
Conventional therapies are surprisingly ineffective at dealing with these conditions. Only 40 to 60 per cent of people prescribed antidepressants report an improvement in their symptoms, a figure made even less encouraging by the fact 20 to 40 per cent of people given placebos report similar improvements. And, as many who have taken them can attest, antidepressants often have serious side effects, causing agitation, nausea and weight gain or weight loss, as well as suppressing libido and interfering with sexual function.
Psychotherapy can be even less effective, at least if one’s measure is alleviating symptoms. And many conditions associated with depression and anxiety are also highly resistant to conventional treatments: almost half of those suffering alcoholism or other addictions who seek treatment relapse, and less than half of people diagnosed with post-traumatic stress disorder recover. As British psychologist Rosalind Watts has observed, “in mental health you just have to go into an inpatient ward anywhere to realize that we need something new”.
Over the past decade or so, a surprising candidate has emerged as this “something new”. Researchers around the world have been trialling high doses of powerful psychedelic substances such as LSD, psilocybin and ayahuasca on patients with a range of psychological ailments, with often startling results. For now these therapies remain illegal in Australia, the substances used in them banned alongside addictive and dangerous drugs such as cocaine and heroin. Yet while legal access to these medicines is still impossible, a thriving underground scene already exists for people who are curious, or in need of what they may offer. And that is why I am here with Marc. Because before I go back on antidepressants I want to try illegal psychedelic therapy for myself, to find out whether it can help me crawl out of the hole I have been in for the past five months.
The notion that psychedelics could have a positive role to play in the treatment of mental illness might seem radical, especially in a culture in which they have been treated with suspicion and fear for more than half a century, yet the idea is not new. Cultures around the world have used naturally occurring psychedelics for thousands of years. In the Amazon many indigenous groups possess complex cultural practices centring on the consumption of ayahuasca, a brew made from the ayahuasca vine and the leaves of the chacruna bush. Likewise Native American peoples in Mexico and the United States have developed many rituals around the use of the mescaline found in certain cactuses. But all recognise the power of these substances to unlock visions, transfigure reality and, perhaps most importantly, heal.
Modern scientific interest in the effects of psychedelics really began in 1943, when the Swiss chemist Albert Hofmann accidentally ingested a minute amount of a recently synthesised substance known as LSD-25. Restless and dizzy, Hofmann left the lab and went home, where he fell into a dreamlike state in which he “perceived an uninterrupted stream of fantastic pictures, extraordinary shapes with intense, kaleidoscopic play of colours”. A week later, Hofmann took another dose of the compound. This time the effects were far stronger. Escorted home on his bicycle by his lab assistant, Hofmann found himself lost in a bewildering storm of sensation, and later experienced an extraordinary transformation of his inner being:
Every exertion of my will, every attempt to put an end to the disintegration of the outer world and the dissolution of my ego, seemed to be wasted effort. A demon had invaded me, had taken possession of my body, mind, and soul. I jumped up and screamed, trying to free myself from him, but then sank down again and lay helpless on the sofa … My body seemed to be without sensation, lifeless, strange. Was I dying? Was this the transition?
Although both Hofmann and his employer, the Swiss pharmaceutical company Sandoz, quickly intuited the young chemist had stumbled upon something profound, the exact nature of his discovery was less easy to define. Because of the hallucinations and feelings of dissociation the drug induced, it was initially treated as a psychotomimetic, a drug that mimics the experience of psychosis. But gradually it became clear LSD was not a psychotomimetic in any simple sense, but something far stranger. People taking it didn’t just experience bizarre visions and ego death; instead many described feelings of joy, transcendence and spiritual awakening. Psychiatrists and psychoanalysts found LSD aided in psychotherapy, opening patients up to new possibilities and unlocking hidden memories; others found it helped stimulate creativity; still others reported startling results in the treatment of depression and anxiety. Even more striking was the drug’s effect on alcoholics: in one early study almost half those treated with LSD reported they no longer wanted to drink after a single high dose. By the early 1960s tens of thousands of people in the US and elsewhere had undergone treatment with LSD, with many hailing it as a wonder drug. The actor Cary Grant, who underwent LSD therapy in 1959 famously said he had been “born again”. And, perhaps even more significantly, it was also beginning to be used outside psychiatric circles, leading to figures such as Aldous Huxley and Timothy Leary arguing that LSD had the potential to transform not just individual consciousness but society as a whole.
Dr Robert Gordon is a Sydney psychiatrist and an expert in the treatment of trauma. Now 87, he still practises two days a week, as well as acting as an adviser to the Mental Health Tribunal. But in 1964 he was working at Broughton Hall, in what was then Callan Park Mental Hospital, when he encountered a Canadian psychiatrist who was running LSD sessions for young patients.
Intrigued, Gordon began administering LSD to some of his own patients, with very positive results, so in 1965 when he joined the practice of John Ellard, then one of the most senior psychiatrists in Sydney, Gordon suggested he and Ellard set up a more organised study with the assistance of David Maddison, then the professor of psychiatry at the University of Sydney.
The study Gordon devised involved patients suffering from severe depression, anxiety or obsessive-compulsive disorder. Initially the patients met as a small group, a process intended to help them get to know one another and explore their issues. Then, at the conclusion of five group sessions, each patient attended a solo session where they were injected with 100 micrograms of LSD.
Gordon and a nurse sat with the patients during the LSD sessions, partly to observe, partly to share the experience, a process Gordon found “quite startling”. But the results were even more so: in the weeks after their LSD experience “the depression disappeared, the patient who had very severe OCD lost his symptoms entirely, and the degree of anxiety amongst the other patients had so diminished that they no longer said they were anxious at all”.
Curious to understand the drug’s effects, Gordon decided to try LSD for himself. Under its influence he experienced something remarkable.
“My parents and I escaped from Hungary in April 1939 when I was five. Prior to that my aunt, who was a singer, and quite famous in the Vienna operetta scene, had a chalet on the lakes in Austria, and we used to visit her at Easter time. In the LSD session I was suddenly four and a half again and seated on the platform at Salzburg railway station. I was alone: my parents had gone to get a coffee and given me the job of guarding the luggage. But they’d left me with a vanilla ice cream, which I’d somehow dropped, and I could see it spread in front of me on the ground. Suddenly a little old man came running down the platform pursued by two Nazi brownshirts, and as he reached me he slipped and fell and hit his head, and I saw the blood from his head mingle with my ice cream.”
The release of this traumatic event, until then locked away in Gordon’s psyche, explained his longstanding and previously inexplicable hatred of strawberry ice cream, an aversion that completely disappeared in the aftermath of the LSD treatment. But more importantly, it allowed the experience, long dissociated from his conscious memory, to be recovered and reintegrated, a process Gordon found deeply cathartic. “It was like a breath of fresh air. You suddenly realise other elements of your experience are linked to these unconscious connections that the LSD releases.”
Gordon and his colleagues were understandably excited by their initial results, and hoped to expand the study. But overseas, LSD had become a flashpoint in the rapidly escalating conflict between the establishment and the counterculture, triggering Senate hearings in the US and growing political condemnation. Under pressure on multiple fronts, Sandoz shut down production of LSD, effectively ending research into the use of it around the world.
Even today Gordon regrets Sandoz’s decision, believing it prevented “a very constructive step for psychiatry”. But it was only the beginning. By the time president Richard Nixon declared the War on Drugs in 1971, LSD and other psychoactive substances had been made illegal not just in the US but in many countries around the world, and excitement about their potential had been replaced by moral panic about their risks.
Nixon’s motivations for pursuing the users of psychedelics and other drugs were crudely political, and principally concerned with discrediting black activists and the anti-war left. Yet his administration’s rhetoric continues to shape perceptions of psychedelic drugs to this day, feeding into public fears about their dangers, despite decades of research clearly demonstrating they pose almost no risk of permanent physical or psychological harm. A bad trip might be terrifying, but it is extremely unlikely to cause lasting damage, and while they pose risks for people with a predisposition to psychosis or schizophrenia, urban legends about people being permanently committed to mental wards after a single dose of LSD or so-called magic mushrooms are mostly just that.
With psychedelics illegal, research into their effects came to be seen as fringe science at best. That is until 2006, when a team at Johns Hopkins University led by psychopharmacologist Roland Griffiths published a study in which subjects were given 30 milligrams of psilocybin, the active ingredient in magic mushrooms. Griffiths’ team found that the dose induced a “mystical experience” characterised by intense feelings of transcendence, oceanic boundlessness and the dissolution of the ego, in the majority of subjects. This might have been interesting enough in itself, but the real meat of the study lay in the results of this mystical experience. Two thirds of the subjects described the psilocybin experience as one of the five most meaningful experiences of their lives, ranking it alongside events such as being present at the death of a parent or the birth of their child, while a third ranked it as the most meaningful experience of their life. Even more remarkably nearly 80 per cent of the subjects said the experience had improved their sense of personal wellbeing and satisfaction. And these effects seemed to persist: at a follow-up a year later, the results were almost identical.
The Griffiths paper provoked a wave of new studies exploring the effects of psychedelics such as psilocybin and ayahuasca on conditions ranging from depression and anxiety to alcoholism and nicotine addiction. Time and again, these studies have shown psychedelic therapy to be remarkably effective. In one study at New York University in 2016, patients suffering from terminal cancer were given a high dose of psilocybin. In the aftermath of their treatment almost four fifths of the subjects reported “rapid, robust and sustained” reductions in depression and anxiety associated with their impending death; more than a few said they had lost their fear of death entirely. Another 2016 study, headed by Imperial College London psychologist and neuroscientist Robin Carhart-Harris, found a single dose of psilocybin reduced symptoms in almost two thirds of patients suffering treatment-resistant depression, with 58 per cent meeting the criteria for remission at three months and 42 per cent remaining in remission long-term. More recently, the Imperial College London team found two doses of psilocybin caused the remission of moderate to severe depression in twice as many subjects as one of the most widely prescribed antidepressants, the SSRI escitalopram, more commonly known as Lexapro. These studies have led to a growing push for psychedelic treatments to be made available for medical use, and increasing interest in their commercial potential. In the US psilocybin is in the final stages of Food and Drug Administration approval, and was recently granted breakthrough therapy status, a classification designed to speed up the approval process in cases where a drug seems to offer a substantial improvement over existing therapies. Meanwhile investors are piling in, with one analyst predicting the global market for psychedelic medications may be worth as much as US$7.6 billion by 2028.
Despite the level of excitement overseas, interest in psychedelic therapies in Australia has been relatively subdued. Yet that is changing. In the past 18 months a number of institutions have announced trials of psychedelic therapies. At St Vincent’s Hospital Melbourne, researchers are testing the effectiveness of psilocybin in treating end-of-life distress among patients in palliative care. Scientists at Monash University have started work on a trial to test the effects of psilocybin on severe anxiety, and another to test the use of MDMA – better known as ecstasy – in treating PTSD. (Although MDMA is not strictly a psychedelic, similarities in its legal status and effects mean it is frequently studied and used alongside drugs such as LSD and psilocybin.) Researchers at St Vincent’s Hospital Sydney are testing the use of psilocybin in the treatment of methamphetamine addiction, while other, smaller trials at Swinburne University of Technology and Edith Cowan University are exploring the use of psilocybin for treatment-resistant depression, and MDMA therapy, and not one but two organisations have set up programs designed to train mental health practitioners in the use of psychedelic therapies. As one researcher said to me, “Things have gone bananas.”
At least part of the growth in public interest stems from the efforts of Mind Medicine Australia. Founded by Melbourne social entrepreneur and philanthropist Tania de Jong and her husband, investment banker Peter Hunt, and boasting a board that includes former Defence Force chief Chris Barrie, former Liberal minister Andrew Robb and ethicist Simon Longstaff, the organisation has hosted multiple public events and lobbied politicians and regulators to speed up the availability of psychedelic therapies. De Jong, who set up Mind Medicine Australia after her own transformative experience with psychedelic therapy in the Netherlands several years ago, says the use of psychedelic therapies in Australia has been held back by “prejudice, stigma and fear of change”, but she thinks that is changing. “We’ve had support from federal and state government ministers, the vast majority of the medical profession, and indeed the general public. We probably receive 15 to 20 letters, emails, messages every day, all from people just desperate for these medicines.”
Dr Martin Williams is a medicinal chemist and a pioneer of psychedelic research in Australia. The co-founder of both Entheogenesis Australis (an organisation that supports the scientific understanding of medicinal plants and chemicals) and Psychedelic Research in Science and Medicine (which helps coordinate Australian psychedelic research), Williams agrees that after lagging behind there’s now “a real groundswell, a much greater appetite for research and receptivity in the public space”.
Interest is also growing in the wider community. Although it is difficult to obtain solid figures, one person I speak to estimates that in Sydney alone there are probably up to 20 underground practitioners working illegally with various forms of psychedelic therapy, as well as a host of less formal groups experimenting with psychedelics. Another estimated the number was closer to 50. These include local chapters of the ayahuasca churches that exist overseas, and several groups that regularly run ayahuasca retreats for groups of 40 or more at locations outside the city, as well as a range of more informal and temporary groupings. And alongside these, large numbers of individuals are exploring practices such as microdosing, which involves taking sub-perceptual doses of LSD or psilocybin.
Marc’s interest in psychedelic therapy began several years ago, when he came across an article about the success of psychedelic therapy trials overseas. It took him back to a day in his twenties when he and two friends went into the forest and drank mushroom tea. He laughs as he recalls the experience. “I can’t tell you exactly what happened next. All I know is that half an hour later there were three young guys running around naked amongst the trees. But there is one thing I do remember, very clearly, and that is that all of a sudden I felt something I had never felt before, this sense of oneness and belonging, and that I was a part of everything around me. That was incredible. Growing up it wasn’t easy for me: there was a lot of shit, and I was very lonely and excluded. But somehow feeling that connection helped me see just how isolated, how not connected I was.”
Curious, Marc began to consider how he might incorporate psychedelic substances into his work. His first attempts were informal, and mostly involved trying mushrooms with friends. But within a year or two he was running groups for four or five people at once. “Eventually I hit a sort of critical mass, where I could actually hire space and begin inviting people who were interested or would benefit from what I was doing.”
These days Marc conducts group retreats every couple of months, as well as working one on one with people who aren’t comfortable with a group situation. He relies upon word of mouth, taking the view psychedelic treatments shouldn’t be undertaken lightly, and that the process of seeking him out is a way of ensuring prospective clients are serious.
As his work has expanded he has developed a process, informed partly by the framework employed in many scientific studies, and partly by the practices of other, more experienced underground practitioners. With individual patients like me, that means three sessions: a preparatory session during which he explores why the patient is there and screens them for potential risk factors, a full-day session involving a high dose of psilocybin, and finally a reintegration session a week or two after the psychedelic session. By contrast, group retreats take place over two days. On the first evening participants take a low dose of psilocybin so they become acquainted with its effects, and on the second they take a high dose. He also works on an ongoing basis with clients who see value in further sessions.
Marc says the real reward of what he does lies in helping people. Yet his new career has not been without personal cost. Two years ago his wife and two daughters staged what was effectively an intervention, demanding he explain what he was doing, and although all are more understanding these days, they remain concerned that Marc’s work may be exposed, and about the likely legal consequences of that.
When I ask Marc about the possibility he might face serious criminal charges, he shrugs. “I take the view the government already knows pretty much everything about all of us. But they also have limited resources, so they have to choose who they go after. I think that’s why they leave underground facilitators like me alone even though we’re working with substances that are classified in the same category as heroin and ice. They know we’re not hurting people, we’re helping people get better.” He laughs. “Perhaps that’s idealistic, and perhaps I’m completely wrong, but it’s how I have to rationalise it to myself; otherwise I’d just be anxious every day.”
On the day of my treatment I am nervous, worried about what lies ahead, how I will handle it. My appointment is for midday, and when I arrive the room has been arranged in preparation: a mattress on the floor, candles on the shelves. We chat for a little while, then Marc dims the lights and disappears to the kitchen.
He returns with a cup of a tea containing 5 grams of dried mushroom powder and lemon juice. Although accurate dosages are difficult to calculate when using a natural substance like mushrooms, 5 grams is what the psychedelic community dubs a “heroic” dose, and probably contains around 50 milligrams of psilocybin, more than enough to induce an overwhelming and transformative journey. As I drink, Marc apologises for the taste of the brew, telling me he mixes it with lemon because many people find the flavour of the mushrooms unpleasant. I’m not bothered by it: the taste of lemon is so strong it overwhelms all but a slightly earthy funk. He tells me to be sure I’ve drunk all of it, waiting while I swirl the last few drops of liquid around to gather up the remaining mushroom powder. He then hands me a single dried mushroom and tells me to place it on my tongue, but not to bite or chew it. Instead I should focus on it while it dissolves, allowing myself to feel its structure: the head and gills, the slightly woody stem. This is important, he says – an act of respect for the mushrooms and the experience. Once I have the mushroom in my mouth he puts on music, a special playlist designed to help ease me into the journey.
For 10 minutes or so I feel nothing besides the jitters of my own edgy anticipation. And then, quite suddenly, the flames of the candles have auras, dancing shadows that shimmer and swirl, and within what seems a matter of moments I am swept away, and the world around me is gone. What follows is extraordinary, intense. I am moving as if in a river, but discorporated, my body gone, the world transformed into a field of pure sensation. For a time I float, adrift, then I am flying, moving through a series of futuristic cities where lines of smooth-shelled capsules flow between the buildings like traffic in the sky or streams of blood cells. After that I am in a field, then somewhere else again, each new vision accompanied by the sense I am moving inwards, deeper into something, by the feeling that some meaning I cannot quite name hums in the fabric of these worlds. Periodically I am aware of the music – shifting patterns of bells and synthesisers and trumpet that move through me and around me like currents or clouds, and later Bach’s cello suites – and in the deepest stages of the experience the moving pattern of the instruments, and the trumpet in particular, becomes a lifebuoy I can cling to, helping keep me afloat as I am borne from one part of the experience to the next.
As I move deeper I feel everything slip away from me: at one point I realise I no longer know my name, cannot understand how language works, until at last my self seems to dissolve entirely. And in that place I realise I feel the weight of what I have been carrying, feel the sadness, so much sadness. But also love.
Part of what makes psychedelics so confounding is the way they seem to demand we operate in two epistemic frameworks simultaneously. On the one hand there are the neurological effects and their impacts on brain chemistry and function. But on the other there is the way they produce visions and experiences that seem meaningful, unlocking memories and traumas from deep in our minds and offering insights that alter our outlook on life in profound and lasting ways.
“Give it time to settle,” Marc tells me, as I sit with him waiting for my partner to pick me up, but in the car on the way home I find myself worrying away at this apparent contradiction. The rational, slightly cynical side of me wants to insist what has happened is entirely chemical, the equivalent of a hard reset of my brain. But the part of me that was there, in the journey, wants to hold on to the things I experienced while under the influence of the mushrooms, to give myself time to come to terms with one of the most intense experiences of my life.
For the day or two after my journey I find myself struggling to make sense of what I have learnt. I think I already knew the sadness I encountered while in the journey was inside me, but now I understand it in a profoundly different way: bodily, perhaps, rather than just intellectually. And there is something else as well, something more difficult to put into words, not just a newfound appreciation of the bonds of love that hold us in the world, but an awareness of the way love and loss are written into us, two aspects of the same thing. Psychiatrists such as Bessel van der Kolk argue trauma is something lodged in our bodies that we learn to repress; perhaps it is not coincidental van der Kolk also writes about trust, reciprocity and connection as routes to healing. As I feel my way through these understandings my confusion slips away, transformed into something more like gratitude, the sadness not gone but tempered by a kind of acceptance, a desire to reconnect with the world, until on the second morning I wake up and, to my astonishment, realise I have found my way back to myself, and the depression is gone.
This tension between the scientific and the shamanic is not just imagined. Studies show many people enjoy lasting benefits from a single psychedelic session, and that these effects persist long after the drug has left the patient’s system. And, even more remarkably, one of the most powerful predictors of success in psychedelic therapy is not the dose or nature of the drug administered, but whether or not the patient undergoes a mystical experience while under its influence.
Howard – again not his real name – is a Sydney addiction psychiatrist with several decades of experience in psychotherapy. He became interested in psychedelics and their therapeutic potential several years ago, and has since explored a wide range of psychedelic drugs and communities. Howard has also conducted psychotherapy with the assistance of psychedelics, and has participated in various forms of therapy while he is under their influence. He believes psychedelics act as “amplifiers … so whatever mental state you’re in is intensified, and you get to see it”. Howard describes this as “a gift”, because it allows you to “step back and see your mind in operation, to understand your own psyche more clearly”.
Dr Paul Liknaitzky heads Monash University’s Clinical Psychedelic Research Lab. The son of anti-apartheid activists, he became fascinated by altered states as a child in South Africa: “Buddhist friends of my parents had pictures in their house of monks meditating in the ancient Tibetan city of Lhasa. I’d stare at them, mesmerised, in the same way other kids might stare at pictures of Superman.”
Liknaitzky believes psychedelic medicines are best understood as an “experiential medicine”. In other words it is not the drug that does the work, but the things experienced while under its influence that allow us to reach new understandings and break out of old patterns and behaviours. As Liknaitzky observes, “the psychotherapeutic changes are the most useful level by which to understand how psychedelic treatment works … this is quite different from psychmeds like SSRIs, which drive gradual changes in your neurochemistry that have downstream subjective correlates.”
Marc also emphasises the centrality of the subjective experience, which he says “feels true, true to the point where it changes your perception of the world. You’re more conscious, more connected to everything.”
Yet how do psychedelics make such experiences possible? From a neurobiological perspective, at least part of the answer seems to lie in their effect on the default mode network, the part of the brain that is responsible for introspection and autobiographical memory, which comes into play whenever we are not engaged with a task or the outside world. Under normal conditions the default mode network exerts a top-down control over other networks in the brain, but psychedelics suppress its activity, unlocking memories and feelings buried deep in our psyches, and allowing for startling new insights and perspectives. “The brain is less constrained on psychedelics,” says Liknaitzky. “That means its repertoire of activity is more diverse, and it’s able to do things it wouldn’t normally do. One aspect of this is that parts of the brain that wouldn’t normally talk to each other are now in conversation with each other.” The suppression of the default mode network also seems to play a part in the sense of ego dissolution often experienced with psychedelics, as well the powerful feelings of interconnection.
Liknaitzky argues psychedelics also break down the psychological defences that tend to prevent effective psychotherapy. “In most psychotherapy, the key challenge is getting through that initial line of defence, those psychological mechanisms that serve to protect you from difficult feelings … With psychedelics, that line of defence can come down substantially, and the patient suddenly has remarkable access to material that would not normally be available, from repressed memories to painful but useful insights. The process can be incredibly confronting and challenging, yet often transforms into something liberating. And the scientific literature bears that out … [showing] strong correlations between psychedelic experiences that are challenging, experiences that are personally meaningful, and experiences that are therapeutically beneficial.”
Howard agrees. “Some of my experiences have been very, very, difficult, very painful, and I’ve had to confront really intense feelings I’ve packed away, possibly from childhood, possibly transgenerational traumas. But even when it’s difficult I always feel better for it.” He has also seen the same effect in people he has worked with while they’re under the influence of psychedelics such as ayahuasca. “One woman re-experienced a very intense trauma from her childhood. It happened when she was very young, and she’d been going in circles about it her entire life. But after she relived it she found she had a very different sense of it and of herself, and that really altered her. One of the ways you know psychotherapy is having an effect is that the muscle tone in people’s face changes. That happened dramatically with her in just that single session.”
Yet while most discussion of psychedelic therapy focuses on its benefits, Liknaitzky is curious about “small signals of harm” in trials to date. Some of these concern the nature of the psychedelic experience itself. “A key element in the efficacy of psychedelic therapy is the way the insights and perspectives it creates seem not just true and reliable but more true and reliable than normal experience. In many cases, these are helpful and healthy insights about one’s self, one’s relationships or the world, and their reliability can have a lasting impact on attitudes, feelings and behaviour. But what happens if that strong and lasting sense of truth gets misapplied? What if what emerges from the patient’s mind isn’t real, for example a false memory or a distorted one? That could have massive repercussions.”
Liknaitzky points to the experience of one of the subjects in the Imperial College London trial, who, while under the influence of psilocybin, recovered a horrifying and deeply traumatic childhood memory of his father attempting to smother him. “Maybe that was real, maybe it wasn’t. But there are massive implications for that person’s life if they just accept that memory as true. So it’s vital we help inoculate participants against overly concrete interpretations by helping them recognise the difficulty of distinguishing the real and the metaphoric while under the influence of psychedelics.”
Liknaitzky is also exploring the potential for psychedelics to cause what he dubs “epistemic harms”: shifting people’s world views in ways that might increase their tendency towards delusion, conspiratorial thinking, or even various forms of environmental despair. “People who take psychedelics often say they feel more connected to nature. Great. But what happens if you feel more connected to nature in a very emotional way in the current context of environmental destruction and an individual’s relative helplessness? Similarly, people often report feeling more interpersonally connected and empathic. But are those feelings projected onto people generally, or might there instead be an exacerbation of in-group bias and tribalism?”And, finally, there’s the tendency of those involved with psychedelics to become narcissistic or evangelical, to feel they have gained some insight that needs to be shared with the world, something almost everyone I speak to mentions, and a reminder psychedelics are capable of sending people’s lives veering off on startling new trajectories. As medicinal chemist Martin Williams says, “anybody who undertakes this sort of therapy needs to be forewarned their world might be turned upside down, that nothing will be the same.”
On a cold, wet afternoon in June, I join a group of 15 or 20 people waiting outside an old church in a back street in Newtown, in Sydney’s inner west. We are here for a film screening and meet-up organised by the Australian Psychedelic Society.
As we scan in at the front desk, somebody is selling tickets for a raffle. The prizes – three cuttings of psychoactive cactus – are arranged in a row on the counter by the QR code, their pale green interiors still damp, the spines on their warty skin alarmingly long. As more people file in we take our seats, and after some messing around with computers and projectors, the society’s Sydney chapter lead, Jef Baker, stands up to address the group. He speaks briefly, working his way through various practical details, reminding us to respect the space because it’s a place of worship, and to be cognisant of the fact there’s a meditation class in progress in the loft overhead. With that out of the way Baker moves on to details of the society’s next event, which will include a talk on safe mushroom foraging techniques, a presentation by a PhD student working on the phenomenology of psilocybin experiences, and another by scientists engaged in sequencing the DNA of different psychoactive mushrooms.
After the film – British documentarian Monty Wates’ intensely moving portrait of the Imperial College London psilocybin trial, Magic Medicine – people mill about, talking. They are a diverse group. Several have the look of serious psychonauts or spiritual seekers, the lean physiques and gaunt features that speak of a lifetime of yoga and vegetarian food; a couple look like stoners from central casting. But most are notable by how ordinary they seem: a few students, a number of middle-aged people kitted out for the weather in jeans and puffer jackets, a group of women in their sixties who look like they have stopped in on the way to their book club.
The mood is friendly, and it’s obvious many of them know each other. There’s talk of a party that people have or haven’t been invited to, conversations about an elderly acquaintance of several of those present who is about to move into a facility because their partner is not coping with caring for them. For a while I chat to a handsome young guy in his twenties who is here because he wants to find somebody who will give him some mushrooms. “I’ve tried finding them myself, but I’m worried I’ll pick the wrong ones and poison myself,” he confides in me. When I run into him later he is disappointed to report he has been unsuccessful.
Later I talk to Steve, a big, voluble man in his fifties who seems to be one of the regulars here. Until a few years ago Steve was an emergency nurse, often working as a first responder with police in situations involving highly distressed or psychotic individuals. But he gradually became disillusioned with the way the health system approached mental illness, its tendency to try to manage symptoms rather than addressing core problems.
Steve’s frustration led him to the research on psychedelics. Although sceptical at first – “you have to understand, I was Mr Straighty 180” – he began planning a trip to South America to investigate ayahuasca, but after he discovered the same compounds that are present in ayahuasca are also present in a number of species of Australian acacia (including, as Steve notes with some amusement, the wattle on the $10 note), he realised he could get what he was looking for much closer to home.
Steve’s first psychedelic experience was completely unstructured. With no sense of how much he should use or what it would do to him he took bark and leaves and brewed up some tea, which he drank at home, alone. He describes what followed as “the most profound, moving, mystical experience of my life”, a trip in which he realised the tree he had ingested was speaking to him, and his old reality was stripped away and replaced with a sense of dizzying freedom. The next day he brewed more tea and tried again: once again the tree was there, waiting for him.
Steve’s experiences with acacia have changed his life. “The thing I realised was that I had to let go of the past, and begin to change.” At first that meant giving up his job, then his nursing licence; more recently it has meant the end of his nearly 20-year marriage. These changes were hard, but Steve also feels like they’d been a long time coming. “I hadn’t wanted to be a nurse for a long while,” he says. Likewise, he thinks he and his wife only stayed together for so long because it was easier than embracing the unknown.
Although sceptical of what he calls the “whole plant spirit thing”, Steve thinks psychedelics allow you to become “very different in a hurry”. But he also admits he’s not so sure that’s always good. “So much of the way we think about the world is totally rigid. Acacia has given me a way to step outside all of that. But that’s also risky – you’re vulnerable and that can be terrifying and confronting.”
Steve’s experiences have also crystallised his longstanding frustrations with the mental health system. For while it might be simplistic to say it’s our society that makes people sick, it’s also at least partially true. Depression, anxiety and other forms of mental illness are strongly associated with various forms of economic and social disadvantage. At any given moment almost a third of Australian Aboriginal and Torres Strait Islander peoples suffer from high to very high levels of psychological distress, a key indicator of depression and anxiety, which is triple the percentage in the population at large. Rates of suicide among Indigenous people are almost double those of other Australians. Psychological distress is also strongly associated with economic disadvantage, with one in four of the poorest 20 per cent of the population suffering high to very high distress at any given time, compared with just one in 20 among the richest 20 per cent. And groups that are the focus of various forms of discrimination and violence are also susceptible: younger LGBTIQ people are three times more likely to experience psychological distress than their peers in the general population, and almost five times as likely to attempt suicide; rates are similarly elevated among groups that regularly experience racism.
These statistics are a reminder of why it might be premature to treat psychedelics as a panacea capable of single-handedly resolving our mental health crisis. But they also point to the tendency of the underground community to see psychedelics as about more than just healing, and instead part of a broader philosophy.
Jef Baker first encountered psychedelics as a teenager when he was given some mescaline by an older acquaintance. Two decades later, while studying philosophy at university, he became intrigued by the resonances between that first experience and a range of metaphysical questions, a fascination that led to him completing an honours degree exploring the idea that ayahuasca might embody a form of deep ecology by offering an experiential understanding of our intrinsic connection to the natural world. In his view, the emphasis upon the medical applications of psychedelics risks overshadowing their broader importance. He argues that “there’s absolutely nothing wrong with taking a psychedelic out of curiosity, perhaps to get a better understanding of how your mind works, or to work out how you can connect to other people or nature better, or to stimulate your creativity”.
This idea psychedelics might have a role to play in what American researcher Bob Jesse has described as “the betterment of well people” has been eagerly embraced by prominent figures in the tech and wellness industries, many of whom advocate the use of techniques such as microdosing, arguing it can unlock new vistas of happiness and creativity.
Not everybody in the underground community is comfortable with the co-option of psychedelics as a form of Silicon Valley self-optimisation – a cartoon posted on the Psychedelic Society’s Facebook page a few weeks ago featured a spivved-up entrepreneur in dark glasses declaring, “only 10 grams of psilocybin in the clinic helps me conquer the world!”, while a cross-legged guru behind him whispers, “7 grams of mushrooms in the woods and you wouldn’t need to”. Yet it is difficult not to wonder whether the medical applications of psychedelics could open the door to wider acceptance of their other possibilities, and where that might lead.
For now, the legal barriers to the use of psychedelic therapies remain. In February, Australia’s Therapeutic Goods Administration rejected an application by Mind Medicine Australia that sought to have MDMA and psilocybin rescheduled to make them available for use by medical professionals. While the TGA left the door open to revisiting its decision, it took the view that despite the promise of a number of the trials, rescheduling was premature and more research was required to establish the efficacy and safety of psychedelic therapies, and to establish adequate frameworks and training for their use.
Mind Medicine Australia’s Tania de Jong is highly critical of the TGA decision: “If there are treatments that can get people well and help them feel more connected to themselves, to others, to the planet, then we must do everything we possibly can to make those treatments available … it’s a question of human rights, really.”
Others disagree. “I don’t think it’s any secret that the two main directors of Mind Medicine Australia are in a very great hurry to have these medicines available in Australia,” Martin Williams says. “Because of that they’ve argued that the research overseas is conclusive, and there’s no need to replicate any of it here.” Williams is wary of the rush. “It’s demonstrable that psychedelics have very low toxicity, and a very high therapeutic index, and that they’re very safe in a physiological and medical sense when used in a controlled psychological or psychiatric context. But there are still unknowns that need to be explored.”
Central to this debate about the pace of change is the question of training. Because psychedelic therapy remains effectively illegal in Australia, there has been no need for training in its use. Yet in the past six months three pilot schemes have been established for mental health professionals interested in working with psychedelics if – or when – they become available for wider use. The first of these, Mind Medicine Australia’s Certificate in Psychedelic-Assisted Therapies, produced its first crop of graduates in May. Meanwhile, Monash University’s Clinical Psychedelic Research Lab has two programs in place, one for practitioners interested in working with MDMA, and another, in conjunction with St Vincent’s, for therapists keen to develop experience working with psilocybin.
Yet who should be able to undertake such training? Psychiatrist Robert Gordon believes the use of psychedelic therapy should be limited to psychiatrists, at least at first. “That might sound narrow-minded, but psychiatrists have had some basic experience of the human mind and how to deal with it, and that puts them one step ahead of psychologists and social workers.”
Liknaitzky takes a rather different view, arguing that a collaborative care model is more appropriate for a treatment where the medical and psychotherapeutical elements are so closely interwoven. “While the law mandates the involvement of a medical doctor for good reasons … the trials I’m establishing also mandate for psychotherapeutic qualifications and experiences … Being a psychiatrist or medical doctor doesn’t automatically qualify you to provide the clinical care and support needed for safe and effective psychedelic treatment.”
Liknaitzky also points to the need for extremely robust ethical and supervisory structures. “In psychedelic therapy you see a shift from the authoritative, directive approach where the doctor is the professional and provides directive counselling, to an approach that’s much more patient-led, where the therapist’s role is more like that of ground control to an astronaut. There’s certainly a lot of expertise involved, but your job is to keep the patient safe and support them as the process runs its course. That means you’re not in charge, instead you’re bearing witness, often to something that can seem miraculous.”
This shift, in both the nature of the relationship and the psychedelic experience, often requires more intimacy, and may involve setting aside long-held prohibitions on providing therapeutic touch to patients; indeed, many psychedelic therapists consider it unethical to withhold therapeutic touch in certain circumstances. It can also involve an expectation that practitioners have personal experience with the medication: Gordon and Howard both argue any form of psychedelic therapy accreditation should include a requirement the therapist has taken psychedelics themselves. And it can mean allowing patients to suffer fear and discomfort as they engage with repressed memories and feelings. Successful psychedelic therapy is at least partly dependent upon a patient’s preparedness to give themselves over to the experience, no matter how difficult it is. Like bad trips in less structured environments, negative psychedelic experiences are usually a result of the subject’s panicking or resisting the effects of the drug. “Normally we’d regard distress in patients as an adverse effect, and therefore something we want to reduce,” says Liknaitzky. “But in psychedelic therapy there are many so-called adverse effects that are actually target states … what is needed is the ability to tell when people need you to intervene and when they need your encouragement to go deeper.”
Yet what all agree upon is the importance of having well-structured training programs in place prior to any wider rollout of psychedelic therapy. “We only get one shot at this,” says Williams. “We don’t want to get it wrong.”
Exactly what the reintroduction of psychedelic therapies will mean is an open question. Gordon argues, “It would be a very constructive step, as significant as chlorpromazine was for schizophrenia, and would bring about a major change in the way we go about understanding and treating people’s trauma.” De Jong also believes it could transform the treatment of mental illness. “We’ve had so many psychiatrists approach us saying this is the first time in years they’ve felt hopeful about their profession and actually getting patients well and out of the mental health system.” But others, like Howard, counsel against irrational exuberance. “These medicines have a powerful place in helping us, but they’re not a silver bullet.” Instead, he believes psychedelic therapies are likely to be useful to a subset of patients who are able to make use of what the medicines reveal. “The problem is people want the relief, but not everybody is prepared to do the work.”
It is also difficult not to wonder whether the wider use of psychedelics might change more than just our approach to aspects of mental health, and whether their ability to create feelings of connectedness and openness may prompt an alternative to the disconnection and alienation of contemporary life. “These medicines come from plants and fungi that are tens of millions of years older than us, which have evolved neurotransmitters that fit with the human mind like lock and key,” says Baker. “They help bring us back to a healthier relationship with our own minds by showing us where we’re out of balance. But that applies equally to the external world, to the way we relate to other people and the environment, and that means they have the potential to help us find a more harmonious relationship with the planet.” Or, in the words of Roland Griffiths: “if you direct your attention inward … an indisputable and profound inner knowing arises … This inner knowing is at the core of our humanity … [and] may ultimately prove to be crucial to the very survival of our species.” Martin Williams agrees the medical use of psychedelics may well be just the first stage in a larger process of change. “We have to find the right way to turn the world on,” he says with a laugh. “Just one step at a time.”
And me? How do I feel? Two months after my psychedelic experience the occluding darkness of my depression has not returned, and my anxiety has almost entirely disappeared. I’m happier, more open, more aware of my own behaviour and the habits of mind that led me to spiral downwards. I feel more robust as well, less reactive: things that would have sent me into a tailspin a few weeks ago now seem perfectly manageable, and more often than not the world seems full of possibility. Could all that have happened without the mushrooms? I don’t know, but I doubt it. Will it continue? Again, I don’t know, although I suspect I may need to return, try the therapy again at some point. What I do know is that I feel like myself again, but a happier and more connected version of me.
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