I was nervous about this. But the reactions I get are more curious than judgmental, even from my mother and son. In general I expect much more pushback—both personal and professional—than I actually received. I’ve come to the conclusion this is one of those issues—like gay rights—where it is vitally important for people to come out of the closet, discuss their experiences in an unsensational way, and when they do the public will listen and shift its views. This is how anything gets normalized—by ordinary people telling their true stories.
Michael Pollan
Karma: 97
Scaling psychedelic therapy is an enormous challenge—it’s so different from either the current models of pharmaceutical therapy—a pill a day forever—or talking psychotherapy—a weekly session more or less forever or until the insurance runs out—that it will take some genuine innovation to fit this square beg into these round holes. Yes, psychedelic therapy takes intensive preparation and integrations but only over a short period and with a small number of sessions. It actually cures many problems, so shouldn’t need to be repeated constantly . But when people say it’s potentially revolutionary, they’re thinking of these existing models. It needs to be said, however, that these existing models don’t work very well for many, if not most, patients. If psychedelic therapy is proven to be superior, corporations and national health agencies (and potentially some public benefit corps like MAPS’) will figure out the necessary new models. The success of the research is the key.
I’m a bit of worrywart. Some of these retreat centers are well-run and legit, but others are sketchy, and when people start having bad experiences it will have consequences. The public is just learning about psychedelics, and negative stories are bound to shape their perceptions.
I’d be curious to know what Matt Johnson thinks, but don’t think it’s necessary for the researchers to have the experience. However I do think it’s useful and informative, and especially useful for the facilitators. This is one of the limitations of most current training programs—the trainees can’t legally have the experience they are administering. The Berkeley Center for the Science of Psychedelics (full discloser: I am a co-founder) has an opportunity to offer the psilocybin experience to its trainees, since the Center will be working with “healthy normals” rather than volunteers with a clinical diagnosis. MAPS has gotten permission to do give MDMA to a limited number of trainees.
We haven’t seen rigorous well-controlled trials of microdosing of psychedelic vs a placebo. One recent study, in which citizen scientists blinded themselves, strongly suggest a placebo effect. There is so much “magic” associated with psychedelics that that taking a tiny dose is likely to have an unusually strong placebo effect. But more research needs to be done.
It’s important to understand that ALL the research done on psychedelics—research that has already produced potentially revolutionary treatments for PTSD, depression, existential distress and addiction—has been privately funded by philanthropists. This area is still too controversial for government funding. I can’t think of another case where philanthropy has achieved so much in twenty years.
I share Hamilton’s concerns that psychedelic therapy can be over-hyped. Many of the researchers are sounding a more cautious note, but there’s so much capital chasing so few good ideas right now, and the media is so positively disposed to psychedelics that a correct is bound to happen, and should. Some of these over-valued new companies will crash; there will be adverse events in the drug trials: if you trial hundreds of depressed patients, some of them are likely to commit suicide, and because the pre-existing narratives about psychedelics, this will be a big media story, even though suicides happen getting on and off SSRI’s all the time.
But in the end, it is the research that will determine whether psychedelic therapy earns a place in mental health treatment or not. I don’t think we’ll see a disabling backlash as we did in the 1960s. The need for new therapeutic tools is so desperate that the mental health establishment will embrace psychedelic therapy if the phase II trials are anywhere near as good as the phase II.
There’s a lot of good work being done on this important question. Several new training programs have been started, but there is also research to see if there are other, more efficient models of therapy besides the traditional two facilitator model—group therapy is one; designing treatment suites where one therapist can guide several patients at once, etc. But the Psychedelic Science Funding Collaborative estimates that 100,000 facilitators will be needed in the next decade, so this is a potential bottleneck to scaling psychedelic therapy. It’s also an opportunity for philanthropy.
I can’t overestimate the value of public education as a way to inoculate the public against the inevitable negative stories—business collapses, sexual abuse in the treatment room, suicides, scandal. The press, having treated psychedelics so positively in the last few years, will eventually turn, as the press always does sooner or later. But the more solid information and true stories in the information ecosystem, the less of an effect this will have.