Anxiety, depression and the new science of psychedelics part two – ABC News

Norman Swan: Hello, and welcome to the Health Report with me, Norman Swan. Today, part two, a really special conversation with American writer and journalist Michael Pollan on his journey with psychedelics and the promise they might hold for treating addiction, depression, the distress of terminal illness and maybe even creative block.

Last week we covered a part of the brain called the default mode network. Effectively the traffic manager in our brain, our narrative self, our ego, which goes quiet when you take psychedelic drugs. And that's key to understanding the entire psychedelic experience and how it is that some people can report having mystical, life changing experiences with drugs like LSD or magic mushrooms.

But there are risks in taking psychedelics as well, especially when they are done recreationally and without a guide. These include precipitating the onset of psychosis and maybe even schizophrenia. Now Michael Pollan shares his own experiences with these drugs and the changes they wrought in his life, plus future directions for psychedelic medical research.

And a few warnings, this program does have some frank discussion of drug use and some explicit language. The drugs we are discussing are illegal in Australia and in many other countries.

The conversation was recorded in front of a live audience at the Sydney Opera House in July.

Michael Pollan: Most of my experiences were really good, better than I expected them to be. I just didn't know what was going to come up. I was really afraid of discovering, I don't know, childhood trauma or something. I needed to do this to understand and write about it. It's the journalism I do, I like to do participatory journalism. When I wrote about the cattle industry I bought a cow. When I wrote about architecture I built a house. So my readers expect it, so I did it for them. But I also did it because I had started interviewing these volunteers. And the first group I interviewed were these people who had cancer, many of them terminal, who were being given the drug, not to treat their cancer obviously, it doesn't do anything for your cancer, but to help them deal with their anxiety, depression, fear. And their stories were so amazing, the kinds of spiritual breakthroughs they were having, the kind of reset of their minds made me incredibly interested to try it. I had never had a spiritual experience, I don't think I had ever had one, and I was kind of jealous of these people.

Norman Swan: And with the people with terminal cancer, it apparently only worked if you did get some ego dissolution and a mystical experience and you needed that.

Michael Pollan: Yes. There was a real one-to-one correspondence. So they were measuring something called mystical experience. The psychologists have a survey for everything and a score for everything, so they've actually quantified the mystical experience, and it has thesethere are eight characteristics, one is ego transcendence, another is unitive consciousness, that you are joining with something else, another is transcendence of space and time, you know, they have this list. And the people who had had what's called a complete mystical experience were the ones that had substantial reductions in their fear and depression around death.

I'll give one example of a woman who had a remarkable story. She had ovarian cancer, she was about 60, she was a figure skating instructor in Manhattan named DinaBazer. Her cancer had been treated, it was in remission, but she was paralysed by the fear it was going to recur at any time, that the other shoe was going to drop, and she couldn't do very much. And she entered this trial, had the careful preparation session with the two guides, and then the guides were with her during the whole journey, which lasted about five or six hours.

And like a lot of the cancer patients, her experience took her inside her body. She had this experience of travelling inside her body. Many of the cancer patients had a confrontation with their cancer. In her case though she sees a black mass under her rib cage. So she knows it's not her cancer, it's in the wrong place, but she recognises it immediately and she knows it's her fear. And she's spontaneously screams at it. Now, imagine these two guides, they don't know what's going on in her head, and suddenly she says, 'Get the fuck out of my body!' And with that, it vanished, the fear vanished.

And I wrote this in a piece I wrote for the New Yorker about this particular trial, and in the measly way of journalists trying to thread the gauntlet of fact checkers I said her fear was substantially diminished. And they called her and they read it to her and she said, 'No, he got it wrong, it's totally wrong, my fear was extinguished, completely eliminated,' which is the most remarkable thing.

Norman Swan: Is this the woman who was an atheist?

Michael Pollan: Yes. She also had told me before that she was an atheist. I said, 'What happened after you got rid of your fear during the trip?' She said, oh, it was the most amazing thing and this happened and this happened, and I kissed the face of God. And I said, 'But you told me you were an atheist. Are you no longer an atheist?' And she said 'No, I'm still an atheist.' And I said, 'Well, how can you kiss the face of God?' And she said, 'We don't have a word big enough for what happened. God is the biggest word we have for this kind of experience, so I have to use it, but I'm still an atheist.'

Norman Swan: So brieflyI mean, we haven't got time to go through everything, but where did you rate on the mystical scale and did it change according to setting and drug?

Michael Pollan: You know, for me I did fill out the mystical experience questionnaire because I wanted to see if I scored

Norman Swan: 'How well did I do?'

Michael Pollan: And on two of my trips I did I had complete mystical experiences. Interestingly enough, one was incredibly positive and one was incredibly negative, but in both cases I had transcendence of space and time and unit of consciousness, all this kind of stuff. And the bad one was really horrifying.

Norman Swan: So that was DMT, the toad.

Michael Pollan: Yes, so this was a pretty obscure psychedelic that wasn't on my agenda, and it's not being researched in a serious way, and it's called 5-MeO-DMTnobody is clapping for it, okaythis is the smoked venom of the Sonora Desert toad. A species that figures that out has got something going for it. So I had this opportunity, one of my sources said that this person who was coming up from Mexico who collects the venomand by the way, no toads are harmed in the making of this psychedelic, you just gently squeeze these glands and it shoots this liquid onto a piece of glass

Norman Swan: We're taking notes and now, are we

Michael Pollan: Well, you've got to find the toads, you're not going to find them in Australia. And then it crystallises and then you smoke that crystal. So I had the opportunity to do this and I really was afraid of it. I had interviewed somebody who had used it, an acquaintance of mine, and we were having lunch together and she reaches across and she puts her hand on my forearm like this and she said, 'It's the Everest of psychedelics.' And I was really scared about using it. All my experiences I had a sleepless night before as my ego essentially tried to convince me not to assault it with a chemical, and this one I did too, but I did it. And if you'd like I can read a passage about it, about this trip, which illustrates how bad things can get but also some of the challenges of writing about this.

So you take one long puff from this pipe andwell, I'll begin with this:

I have no memory of ever having exhaled, or of being lowered onto the mattress and covered with a blanket. All at once I felt a tremendous rush of energy fill my head accompanied by a punishing roar. I managed, barely, to squeeze out the words I had prepared, 'trust' and 'surrender'. These words became my mantra, but they seemed utterly pathetic, wishful scraps of paper in the face of this category 5 mental storm.

Terror seized meand then, like one of those flimsy wooden houses erected on Bikini Atoll to be blown up in the nuclear tests, 'I' was no more, blasted to a confetti cloud by an explosive force I could no longer locate in my head, because it had exploded that too, expanding to become all that there was. Whatever this was, it was not a hallucination. A hallucination implies a reality and a point of reference and an entity to have it. None of those things remained.

Unfortunately, the terror didn't disappear with the extinction of my 'I'. Whatever allowed me to register this experience, the post-egoic awareness I'd first experienced on mushrooms, was now consumed in the flames of terror too. In fact every touchstone that tells us 'I exist' was annihilated, and yet I remained conscious. 'Is this what death feels like? Could this be it?' That was the thought, though there was no longer a thinker to have it.

Here words fail. In truth, there were no flames, no blast, no thermonuclear storm; I'm grasping at metaphor in the hope of forming some stable and shareable concept of what was unfolding in my mind. In the event, there was no coherent thought, just pure and terrible sensation. Only afterward did I wonder if this was what the mystics call the mysterium tremendum, the blinding unendurable mystery (whether of God or some other Ultimate or Absolute) before which humans tremble in awe. Aldous Huxley described it as the fear 'of being overwhelmed, of disintegrating under a pressure of reality greater than a mind, accustomed to living most of the time in a cosy world of symbols, could possibly bear.' Oh, to be back in the cosy world of symbols!

After the fact I kept returning to one of two metaphors, and while they inevitably deform the experience, as any words or metaphors or symbols must, they at least allow me to grasp hold of a shadow of it and, perhaps, share it. The first is the image of being on the outside of a rocket after launch. I'm holding on with both hands, legs clenched around it, while the rapidly mounting g-forces clutch at my flesh, pulling my face down into a taut grimace, as the great cylinder rises through successive layers of clouds, exponentially gaining speed and altitude, the fuselage shuddering on the brink of self-destruction as it strains to break free from Earth's grip, while the friction it generates as it crashes through the thinning air issues in a deafening roar.

It was a little like that.

The other metaphor was the Big Bang, but the Big Bang run in reverse, from our familiar world all the way back to a point before there was anything, no time or space or matter, only the pure unbounded energy that was all there was then, before an imperfection, a ripple in its waveform, caused the universe of energy to fall into time, space, and matter. Rushing backward through 14 billion years, I watched the dimensions of reality collapse one by one until there was nothing left, not even being. Only the all-consuming roar.

It was just horrible.

But there's sort of a happy ending

Norman Swan: Sort of? Well, you're here.

Michael Pollan: The best thing about 5-MeO-DMT is it only lasts about eight minutes

Norman Swan: But the longest eight minutes of your life.

Michael Pollan: It was the longest eight minutes of my life, but suddenly and very quickly the world starts reconstituting. I suddenly can feel I have a body and there's a floor, there's matter and I can tell time is passing. And so all the coordinates of reality came back, and I had this incredible rush of gratitude. But it was a new kind of gratitude. It wasn't the gratitude most of us have felt, the gratitude of being alive, it was the gratitude that there is anything, because there could just as easily be nothing. We could be before the Big Bang. So that kind of fundamental gratitude was a new experience for me. So I won't say it made it worth it, but close.

Norman Swan: How did people around you respond, your wife, your son, the people who know you, how did they respond? Did they see anything new, were you nicer to live with?

Michael Pollan: My wife Judith was nervous about the whole thing, for a couple of reasons. I think the big one was we've been together a very long time, we met in college, and all the big experiences of our adult lives we've shared, you know, having a kid, moving here or there, work experiences. And here I was going to have a big experience potentially and she wasn't part of it. And so she felt like it was going to put a certain distance between us. And she also confessed to being worried that I'd change in some way. It didn't occur to her I may change for the better.

Norman Swan: And if I were to interview her today here?

Michael Pollan: Well, if you were she would tell you a few things because I have asked her, you know, so do you think this changed me and in what ways? And she felt that it did. She felt it made me more open and more patient than I was and somewhat less defensive, which has to do with the kind of getting a little perspective on your ego. I think the value of having temporary ego dissolution is that you realise you're not as identical to your ego as you previously thought and that it is a character in the drama of your inner life, but it's not the only one and you don't always have to listen to it, and it has these moves and tricks that you can see for what they are.

Norman Swan: But you did take psilocybin with her before you started all this.

Michael Pollan: Yes, we did, so she ended up taking part in one of my experiences, and then subsequently a couple of others. So she found it interesting and useful, only her mother kept appearing in all these trips and

Norman Swan: The Jewish mother gets everywhere, I can tell you.

Michael Pollan: The Jewish motherwell, it didn't happen to me but it happened to her and it wasn't always happy.

Norman Swan: It's one of the reasons I had stay off it I think.

Michael Pollan: But the other thing she said that I thought was really interesting and telling was she thought that Imy father died a year ago in January, and she thought that I handled that very differently than I would have before these experiences. And what she meant was that I was very present for the last 10 days of his life, I kind of moved into the apartment. He was 88 and he died of lung cancer. And I was just with him, like hours and hours and hours and wanted to be there and lying with him in the bed and talking to him and saying what needed to be said. I'm a busy person who could have concocted excuses not to be there all the time, but I wanted to be, and that presence, that openness to his death I think had to do with the fact that I'd been interviewing all these cancer patients and had gotten very comfortable talking about death with them. Although he never talked about dying at all, he processed it to the extent he did very internally. And so I think there have been changes. It's not a night and day thing but I do think there has been some changes.

Norman Swan: There's one thing I noticed in the book, you talk about having interviewed 15 guides to end up with five you say in the book, but you only describe four experiences. What's the one you didn't put in the book?

Michael Pollan: Let's see, well, I'm not sure your maths is right.

Norman Swan: I'm a doctor, I can only add up to four or five.

Michael Pollan: I had a guided LSD trip, I had a guided psylocibin than trip, I had two ayahuasca and fiveyes, there were two ayahuasca trips.

Norman Swan: Any difference between the drugs or are they all pretty much the same?

Michael Pollan: I think it they are more unlike than not. I mean, leaving aside 5-MeO-DMT, I think psilocybin and LSD in my experience, the main difference is LSD lasts longer.

Norman Swan: Why are the researchers focusing on psilocybin rather than LSD?

Michael Pollan: It's a good question. Two reasons, one political and one practical. The practical reason is an LSD trip can last 10 hours, and the researchers want to get home for dinner. It's very hard to fit in to the work day. You'd have two pay a lot of overtime and it would make the research very expensive. And the other is that it's so notorious

Norman Swan: So it's the one the moral panic was over.

Michael Pollan: The moral panic was around LSD, not psilocybin. And frankly, politicians don't know what psilocybin is, most of them, and so you're not going to have some know-nothing politician screaming about the government funding psilocybin research, although they're not. So I think it's safer politically.

Norman Swan: You're listening to RN's Health Report with me Norman Swan, and a special conversation with writer and journalist Michael Pollan on the new science of psychedelics.

So you had the '50s where you had people like Cary Grant taking this, you had a lot of research, 40,000 subjects. And then it starts to go south, and Timothy Leary is often blamed for this. Fairly?

Michael Pollan: Yes and no. He definitelyso he begins as a very serious researcher, he's hired by Harvard, he has a psychedelic experience on psilocybin the summer before he goes to start at Harvard. He said he learned more about the human mind in four hours by the pool in the Cuernavaca then he had in 15 years of being a psychologist. And so he starts this project, but he very quickly gets bored with science and he starts turning on poets and musicians. His idea of research was to have a lot of people over to his house and give them all psilocybin. And the papers were like 'Psilocybin in a Naturalistic Setting'. He transcended science instead of his ego.

And so he began, when he got firedhe got fired from Harvard for his partner, Richard Alpert, who became Ram Dass, was giving the drugs to undergraduates. They were only allowed to give it to graduate students, so they had violated their relationship with Harvard. And after he is fired he becomes an evangelist. This is an occupational hazard. I mean, people get involved with LSD and they think it really can solve the world's problems. And I get that kind of thinking. There is a certain logic to it. But we don't have a model for administering a drug to a whole culture except for fluoride, and it's not like fluoride. So he starts proselytising. And the researchers think he's screwing it up for everybody and they try to stop him.

Norman Swan: Because it's still legal at this point.

Michael Pollan: It's still legal at this point, it's legal up until '66 and it's not really nationally illegal until 1970. But it becomesit's taken up by the counterculture. President Nixon thinks it's fuelling the reluctance of American boys to go to Vietnam, which may have been true. It did helpit wasn't the only factor creating the counterculture but it certainly gave it a lot of its character. It was an unprecedented moment, if you think about it, where since this was a new drug, the young were having a rite of passage, the acid trip, that their elders did not understand and found really frightening and scary. Normally rites of passage in a culture are designed to knit the culture together. So you have the vision quest and the Native Americans or the bar mitzvah for Jews, it's a trial set up by the adults and the adolescents do certain things and cross the river and join the adult community. Here you had this weird rite of passage that the kids had organised themselves essentially

Norman Swan: The acid test.

Michael Pollan: Acid tests. And it was landing them in a country of the mind that adults didn't understand, and it was frightening to the government. So there was a backlash. The media turned against it, the government turned against it, and pretty soon the researchers were out of business.

Norman Swan: So we're into the second wave, you've been asked this question before, could another Leary come along and spoil it now?

Michael Pollan: That's a good question. I think everybody is so mindful of that example, every researcher I talk to alludes to the example of Leary and they are being very careful not to over-hype what they've got.

Norman Swan: They've got a whole group of people who believe this is for the betterment of the well, to use the words that you use

Michael Pollan: Yes, and there are researchers who will say that off the record. It's very hard to get them to say that on the record, that this is not only useful for people who are sick, the kinds of people who are being treated for addiction and depression, but that it has potential to treat all of us. I wouldn't say they are all off the record, some of them are on the record but very careful about saying that. And they are right.

Norman Swan: These drugs rely on the testimonies of individuals. There's no randomised placebo-controlled trial here. We've tried but essentially it reliesit's like studying pain, you've just got to believe somebody when they say I am scoring 10 of pain.

Michael Pollan: Right, the phenomenologywhat else are you going to go on? You're talking about mental experience, yes.

Norman Swan: Will there ever be the scientific methodology to allow the regulators to say, 'yes, we will allow psilocybin on the market'?

Michael Pollan: Oh yes, and we are not very far from that, believe it or not. So there have been placebo-controlled randomised trials. It's very hard to do a placebo for a psychedelic. You can imagine. And they tried different things. They give people niacin, which gives you a tingling sensation, or methylphenidate, Ritalin, but peopleyou can fool them sometimes if you have a naivesomeone who has never used psychedelics, but basically it's a problem. Nevertheless, they see dramatic differences in the two groups. And on the cancer anxiety studies they got a very strong signal, stronger than we have seen in any other psychiatric intervention, by the way.

Norman Swan: And where do you sit on the decriminalisation, legalisation?

Michael Pollan: So let me just go a little further with this though about satisfying the FDA. The FDA is the Food and Drug Administration in the United States, or the EMA in Europe. They've set out the benchmarks they need to see, and if they can see essentially if it performs better than placebo or better than a current SSRI in depression, they will approve it. We don't know the brain mechanisms of lots of psychiatric drugs. We still don't know how SSRIs work. So they are not waiting for that kind of information, although it would be very interesting to get it, and there are people working on it.

Norman Swan: Getting to the end of it, you quote William James a lot, the Harvard physician and psychologist who wrote about the religious experience, and he talked about mind cures, interestingly. Is the religious experience just a physiological phenomenon?

Michael Pollan: Well, it's a very good question. We are learning the neural correlates of spiritual experience. The fact that you can use a chemical to induce or occasion a mystical experience is quite a remarkable finding. What does that tell us? I mean, it may be that there is a physiological basis for religious experience. And some people think that diminishes it, to have a spiritual experience caused by a molecule, but that's an assumption worth examining. It seems to me it's kind of more mystical and wonderful that a mushroom that grows in the world that you take into your body can give you a religious experience. That doesn't diminish this at all.

We tend to assumethere's a whole lot of interesting assumptions about human nature that happen, that it's cheating to use a chemical, for example, to have a spiritual experience, that's a very common belief. And maybeI mean, I'm kind of agnostic on it, you know, it's that idea that if you climb to the top of the mountain, you have earned it in a way that if you take a helicopter, you haven't, yet you have the same view. And is it just our puritan nature that says, no, you've got to work for it for it to mean anything? I mean, all mental experiences are mediated by chemicals, so why the fact that it comes from outside you is cheating rather than it coming from inside? I mean, I just think we need to have an open mind about all this. I don't know the answer.

Norman Swan: And your advice is to take a guide and put on the eye mask and put on the headphones and listen to music?

Michael Pollan: Well, I don't want to advise anybody to do this unless they really feel motivated to do it, but if they are going to do it I think you mitigate a lot of the risk by having a guide. You have the potential of having a much deeper and thorough experience because of the environment that an experienced guide creates. A guide can be just someone who has a lot more experience than you do who is not going to be taking the drug with you. But I think there are enormous advantages, I found, to working with a guide. I also had a very good experience without one, but at a high dose, don't travel solo, I really think that's risky.

Norman Swan: Please join me in thanking the fabulous Michael Pollan.

Michael Pollan: Thank you.

Norman Swan: Michael Pollan. And his book is called How to Change your Mind: The new science of psychedelics. That conversation was recorded at the Sydney Opera House in July.

But before you go I want to recommend another show from the ABC science unit which many of you would be already familiar with, All in the Mind with Lynne Malcolm has done a series of programs looking at this second wave of psychedelic research for mental health issues. Here's a snippet:

David Erritzoe: The experience is so odd and strange and sort of mystical, so it's more about actually encouraging and supporting them in going into that experience and let the drug experience guide them through it. Our role and interaction during the actual trip is for some of the participants quite minimal. If people found it really challenging and really felt like sharing some of it we let that happen as well, but we encourage people to go inside.

Lynne Malcolm: Is the idea that you are hoping that they get some sort of personal insight that they didn't have before that might help them with their depression?

David Erritzoe: Yes, and that goes hand in hand with what we have been seeing during the acute state with the psychedelic in healthy people, what happens in the brain, that the networks of the brain, the functional networks that we can measure with MRI, they seem to fuse into each other. So, suddenly a lot of functional connections of brain areas and brain networks, they are broken down, so suddenly other perspectives are possible, and that is some of what people are experiencing, that they get a new angle, a new insight, new meanings and new understandings and a sense of coming to terms with some things. People often feel some sort of reconnection, that people can have felt estranged in their depression from their own emotions, from other people around them, from the world in general, even from nature, and those connections seem to be re-strengthened by the experience.

Lynne Malcolm: The results from this pilot study were quite positive.

David Erritzoe: We saw that people's depression scores significantly dropped, in particular after one week, that was the first proper measure. And then the depression score stayed low overall, almost half, I think nine out of the 20, they were in remission after five weeks, and six of these had not relapsed, even after six months of follow-up. In that sense quite impressive results, it really had a significantly positive impact on most of the participants, even some people found it really, really challenging, it helped their depression, it helped their suicidality, their anhedonia, this sense of not being able to feel anything, which is classic for depression, anxiety dropped in parallel. So very promising results. I would probably use the word 'promising' because remember it's a small trial, it's an open-label trial.

Norman Swan: And we've posted links to these All in the Mind episodes on our website. I'm Norman Swan, this has been the Health Report, I'll see you next week.