"To a scientist, that’s just incredible.”
February 5, 2015 5:46 PM   Subscribe

Michael Pollan in the latest New Yorker about the mainstreaming of research on psychedelic treatment for depression, anxiety, and addiction. "The fact that a drug given once can have such an effect for so long is an unprecedented finding. We have never had anything like it in the psychiatric field.”
posted by vecchio (36 comments total) 55 users marked this as a favorite
I'm going to have to bring this up with my counselor tomorrow.
posted by Thorzdad at 6:03 PM on February 5, 2015 [3 favorites]

"We have never had anything like it in the psychiatric field. Except that other time we had it in the psychiatric field."
posted by tapesonthefloor at 6:21 PM on February 5, 2015 [14 favorites]

There aren't currently any psych meds that you take once and they're still working a year later.

I am very interested in this, but as usual, all the cool new psych treatments are contraindicated for Bipolar.
posted by Biblio at 6:25 PM on February 5, 2015 [1 favorite]

Patrick had never taken a psychedelic drug, but he immediately wanted to volunteer. Lisa was against the idea. “I didn’t want there to be an easy way out,” she recently told me. “I wanted him to fight.”

I don't understand this sentiment at all. At least when some people criticize suboxone for heroin addicts, or rehabilitation for convicts, they're using the principle that addiction or crime is a moral failure and should be atoned for with suffering. (I disagree.) But cancer? That's is no way Patrick's fault, why should he have to "fight" it?

It reminds me of The Onion's "Loved Ones Recall Local Man's Cowardly Battle With Cancer." Sure, it's great that some people fight back when they get cancer and struggle to live their life regardless. But not everybody can, not everybody wants to, and nobody should have to.
posted by Rangi at 6:28 PM on February 5, 2015 [37 favorites]

"Mettes was told, would take place in a room decorated to look more like a living room than like a medical office, with a comfortable couch, landscape paintings on the wall, and, on the shelves, books of art and mythology, along with various aboriginal and spiritual tchotchkes, including a Buddha and a glazed ceramic mushroom. During each session, which would last the better part of a day, Mettes would lie on the couch wearing an eye mask and listening through headphones to a carefully curated playlist—Brian Eno, Philip Glass, Pat Metheny, Ravi Shankar. "

Ah. My, what a coincidence. Ahem.
posted by Devonian at 6:29 PM on February 5, 2015 [8 favorites]

I do love Pollan's brief asides into combating war-on-drugs hysteria, far and few between as they may be. His 1997 Harper's piece on opium is another great read.

One particular detail stuck out to me here:

The effects of psilocybin resemble those of LSD, but, as one researcher explained, “it carries none of the political and cultural baggage of those three letters.” LSD is also stronger and longer-lasting in its effects, and is considered more likely to produce adverse reactions.

Cultural baggage indeed. Such is the way it's commonly described, but my personal anecdata and that of many others doesn't quite match up. Longer-lasting, yes, but I've known people who have had much worse experiences with psilocybin, with lingering negative effects lasting for months from just a single dose. Acid casualties are a real thing, but the ones I've come across were highly habitual users. Shrooms tend to be a lot harder on the body as well. As ever, YMMV...

(I'm 32, so my experiences are mainly post-silo bust. May or may not play into this...)
posted by sphexish at 6:47 PM on February 5, 2015 [5 favorites]

Better put down some plastic tarps.

I thought you were supposed to constrict anus for depression
posted by thelonius at 6:50 PM on February 5, 2015 [1 favorite]

As against this, the dataset of people not remembering the content of their LSD insights
posted by batfish at 6:55 PM on February 5, 2015

If the trial was successful, the government would be under pressure to reschedule psilocybin under the Controlled Substances Act, having recognized a medical use for the drug.

Also, it seems unlikely that the government would ever fund such a study. “The N.I.M.H. is not opposed to work with psychedelics, but I doubt we would make a major investment,” Tom Insel, the institute’s director, told me. He said that the N.I.M.H would need to see “a path to development” and suspects that “it would be very difficult to get a pharmaceutical company interested in developing this drug, since it cannot be patented.” It’s also unlikely that Big Pharma would have any interest in a drug that is administered only once or twice in the course of treatment. “There’s not a lot of money here when you can be cured with one session,” Bossis pointed out.

I feel like Insel's statement is supposed to make me feel like there's no point, but instead it makes me feel like the structure he's in charge of needs to be burned to the ground and rebuilt.
posted by Pope Guilty at 6:56 PM on February 5, 2015 [45 favorites]

“There’s not a lot of money here when you can be cured with one session,” Bossis pointed out.

The banality of evil.
posted by clockzero at 7:02 PM on February 5, 2015 [52 favorites]

Patrick had never taken a psychedelic drug, but he immediately wanted to volunteer. Lisa was against the idea. “I didn’t want there to be an easy way out,” she recently told me. “I wanted him to fight.”

Well, that's.... well. Fuck. Mental illness is not a moral failing. At times it is not even a question of fighting but simply surviving.

I guess the only way I could put it is that that is a horrible perspective to take. People struggling with mental illness don't have to 'fight' to fulfill someones bizarre view of the world, they need support not this ridiculous kind of judgement. Fucking Calvinists.
posted by Hello, I'm David McGahan at 7:07 PM on February 5, 2015 [22 favorites]

Patrick had cancer, not a mental illness. I guess she was afraid that if he didn't "fight", she'd lose him faster. But you can she how much she embraced his experience by the end of the article.

I wonder how well this would work with people who were more pragmatic/ concrete / skeptical / cynical.
posted by maudlin at 7:19 PM on February 5, 2015

Sorry. This is a message I've been hearing a lot the last year or so. It's maddening. There is nothing to fight, but please disregard.
posted by Hello, I'm David McGahan at 7:24 PM on February 5, 2015 [2 favorites]

The Intima published a very well-written essay, titled "Psychedelics in Psychotherapy," on this topic a few years ago.

Many substances, treatments, diseases carry some sort of cultural baggage. HIV/AIDS, marijuana, obesity. ... This is why people don't show up on your front porch with casserole when your daughter is suffering from schizophrenia the way they might if you suffered from something less off-putting.
posted by gemutlichkeit at 7:36 PM on February 5, 2015 [4 favorites]

Lisa was against the idea. “I didn’t want there to be an easy way out,” she recently told me. “I wanted him to fight.”

posted by schmod at 8:02 PM on February 5, 2015 [12 favorites]

“There’s not a lot of money here when you can be cured with one session,” Bossis pointed out.

And there is a lot more money in the "lifetime treatment" than in any actual "cure". Which is an important reason why there is a rational reason to distrust Commercial Pharma (and so much irrational distrust).
posted by oneswellfoop at 8:09 PM on February 5, 2015

It's not the drug but the change of perspective it elicits - the effect of perceiving the world and oneself differently, even just once, is what lasts.

This is what the medical-interventionalist crowd doesn't get, despite it being the mechanism, via the placebo effect, of their most popular prescriptions.
posted by unmake at 8:18 PM on February 5, 2015 [6 favorites]

Our government, on behalf of Big Pharma, will never get behind this in any truly significant way.
posted by Quasimike at 8:26 PM on February 5, 2015

Is anything about the subjective experience described in this article news to anyone who's ever taken mushrooms in a good set and setting? I'm all for "new" therapies, but I find it depressing that there is so much inertia toward propagating the Puritanism inherent in the idea that I need a doctor to eat a fungus, and it takes a paternalistic medical establishment to validate my personal experiences. I don't think I'll see psychedelics made available to informed adults without exceedingly exceptional circumstances in my lifetime, as much as I'd like to.
posted by TheNewWazoo at 8:27 PM on February 5, 2015 [7 favorites]

“Progress has been made in decreasing use of hallucinogens, particularly in young people. We would not want to see that trend altered.”

That's because you raided the guy making all the good clean acid in that missile silo in Kansas. (or at least this is my understanding)
posted by RobotVoodooPower at 9:01 PM on February 5, 2015 [4 favorites]

[tl;dr] [eponysterical] The existing treatments for anxiety, depression, and PTSD are for the most part ineffective. These conditions are so disabling that it's worth trying almost anything reasonable (and psychedelics are reasonable). But we need sufficiently-large, well-designed, randomized controlled trials before we can meaningfully state their effectiveness and safety.
posted by neuron at 10:16 PM on February 5, 2015

Patrick had never taken a psychedelic drug, but he immediately wanted to volunteer. Lisa was against the idea. “I didn’t want there to be an easy way out,” she recently told me. “I wanted him to fight.”
I don't understand this sentiment at all.

To the extent that a patient is clearly terminal, your perspective makes a lot of sense, just like hospice and other quality of life treatments do.

At the same time, though, people can and do use drugs (among other things) to retreat from situations rather than trying to address them. And when the situation is a life-threatening illness that would take your spouse, if there is any way of addressing that, it doesn't seem too hard to see why one might want them to focus on marshaling all their resources to eliminating or controlling the illness rather than coming to terms with it.

And there's a sense in which Lisa's initial judgment was partly correct: Patrick's new drug-induced perspective did in fact lead to him choosing to give up on chemo, though the piece also shows us a Lisa who eventually comes to understand the gifts that perspective gave them and an ending perhaps as happy as a mortal could hope for.

Certainly something to think about, but I'm not sure it's a basis on which to pronounce a decision to rage against the dying of the light as incomprehensible.
posted by weston at 10:42 PM on February 5, 2015 [4 favorites]

Raging against the inevitable is kind of incomprehensible. Maybe especially to those that formerly held that position.
posted by unmake at 12:01 AM on February 6, 2015

I know someone who, a couple of winters ago, had phoned a suicide hotline. He was that low and for a few weeks I had to keep an eye on him (at his request). Spring came and he was alright.

Next Autumn I saw some magic mushrooms out his back. Pointed it out to him (as kids we had dabbled) and he picked them. Not much of a quantity but maybe a few dozen. He took them in a couple of doses.

Totally changed him and pulled him out of his spiralling despair. Completely anecdotal of course, but there you have it. I would suggest those little mushrooms saved a life.
posted by twistedonion at 2:30 AM on February 6, 2015 [1 favorite]

The problem of psychedelic therapy not being economical because no pharmaceutical company would want to steer the compounds through approval when they're not patentable, or single-session therapy not paying the therapist enough, doesn't hold much water. The first - well, we got past medicinal cannabis. Not the same thing, but the regulatory environment is not a one-size-fits-all system. The second - by the time you've done the pre-screening, the counselling the all-day session, and the follow-ups you're at much the same process length as short courses of CBT. Certainly, the therapists I know would weep for joy if given the chance to make as much difference to people's lives as this promises, even if it paid them thruppence-ha'penny and a currant bun.

Likewise, the worry that this therapy is in some way unethical because it allows the therapist to too-closely control the patient's mental state is doubly daft. First, because this is precisely the desired effect of therapy - you assume that professionals will work to an ethical code when administering any thing effective. Second, as MK-ULTRA showed, the use of psychedelics to force or coerce people into arbitrary behaviours or mental positions is profoundly ineffective (unless you want to bludgeon them into madness, and even then...).

Let's say that the slow re-acceptance in Western culture of psychedelics as a sober, moral and beneficial part of human experience continues, and we achieve the life-long dream of many of us that they become safely accessible to responsible people for responsible purposes in responsible ways. There's a long way to go in even starting to imagine how that will work across the social spectrum from ghetto to palace. from tabernacle to the state pen. But if you don't feel touched by the evangelical, the need to make this part of anyone's life who needs it, then you haven't quite got it. Leary and his pals had it, and we know how that panned out. The people in the FPP have it too: it does seem to be part of the package, and perhaps that's not so surprising, and any thinking about how these therapies will develop in society can't pretend otherwise.

And that's OK. But it will be a trip.
posted by Devonian at 2:31 AM on February 6, 2015 [2 favorites]

Oh, and another thing (sorry, but the article was just about the last thing I read before going to sleep and clearly it's been churning away overnight) - the neuroscience in the article is particularly interesting. The idea of the default-mode management system defining the experience of adult consciousness is compelling, not just because of the structural and developmental sense it makes or the neural activity evidence, but because the psychedelic experience does so often reactivate the sensations, thoughts and memories of early childhood. Perhaps it's safer to say that this appears to be the case, perhaps that's a necessary caveat for all of this.

By itself, that aspect is woefully under-explored even by the nascent state of the art in mapping and understanding psychedelics. The 'kid in the candy store' metaphor mentioned in the FPP is apt: once you start to realise quite how much there is to learn once you decide to start - god, I wish I was twenty again and a life in research was once again an option.
posted by Devonian at 2:54 AM on February 6, 2015 [4 favorites]

I wonder how well this would work with people who were more pragmatic/ concrete / skeptical / cynical.

If they cling to their cynicism to protect themselves, they might discover it wasn't just about being realistic.
posted by Obscure Reference at 4:25 AM on February 6, 2015

Lisa was against the idea. “I didn’t want there to be an easy way out,” she recently told me. “I wanted him to fight.”


Yeah, shame on that lady for being afraid of her dying husband participating in an experimental therapy without any solid science behind it in the last months of his life and then later embracing it when she learned more about it. What an uptight square, man.
posted by ultraviolet catastrophe at 6:41 AM on February 6, 2015

So when these people were in the rooms being dosed, did they just lay there listening to Eno for 8 hours with a blindfold on, or were they allowed to interact with the therapists? I find that my most rewarding psychedelic experiences came from listening to music and hanging out with my friends, whether they were tripping or not. I would almost prefer to have a psychiatrist that I trusted sit there and watch me trip hard for 8 hours and have conversations with me in that time span and take notes.
posted by gucci mane at 7:12 AM on February 6, 2015

no pharmaceutical company would want to steer the compounds through approval when they're not patentable

Slow-release psilocybin analogue formulated to reduce adverse effects. Purified psilocin combined with a SSRI. LSD PM. Children's mescaline.

To say that these compounds do no have marketable qualities or are not patentable is ludicrous. Taxanes are naturally occurring, but that didn't mean a couple drug companies couldn't refine, tweak, and synthesize the compounds for megabucks. Penicillin has been around for decades and has spawned numerous patented variants and combinations. Even cannabis has a synthetic analogue, Marinol, that has been on the market for years.

There is the one person cited in the article talking about drug companies not being interested, but only a few sentences before the article talks about how FDA approval may not be forthcoming for future phases due to concerns over drug policy. The problem isn't some vague hand-wringing over patents, but that these are Schedule I drugs. Big Pharma hasn't touched them because there's little incentive to do research into a compound that is currently highly illegal; has limited availability for research; has numerous hurdles to get even that limited access; and may not result in a legally marketable product.
posted by Panjandrum at 7:54 AM on February 6, 2015 [2 favorites]

In the early 1970s, Dinur traveled to Holland to undergo a new and controversial treatment for post-traumatic stress disorder. The treatment involved receiving injections of LSD that caused him to enter a trance, during which he would describe his Auschwitz experiences and the attendant psychiatrist would videotape them.

this remarkable author, with PTSD from the camps, was sent by his wife for treatment with a man specializing in camp survivors. It worked! His book tells the complete story.

This treatment, he later said, revealed to him "the greatest horror of all": that by virtue of being human, he too bore part of the guilt. This led him to become active in efforts to prevent a nuclear holocaust. Ten years after his return from Holland, he described his treatment in the book "Shivitti: A Vision."

Dinur continued to write every day until two weeks before his death, and according to his son, he left much unpublished material behind. He is survived by his son and a daughter, publisher Daniella Dinur, and grandchildren. "
I have re4ad the book and I have met the author's wife. Odd that this early use of LSD, which worked for PTSD, is not noted in the otherwise fine article
posted by Postroad at 8:08 AM on February 6, 2015 [3 favorites]

I permanently got over my wasp phobia after some strong mushroom tea in the 90s. Before then, I was terrified of wasps, bees, hornets, anything with a stinger. To the point that I would have to leave my apartment if one got in. I remember once waking up to the sound of a wasp in my bedroom at 5 a.m.; I frantically grabbed whatever clothes were at hand and left the apartment 'til dinner time. When I was a kid I would run in terror. I still have a really vivid image of dropping a glass bottle of orange Fanta on the asphalt and it detonating into shards and orange mist as I ran for the screen door.

And then one morning after taking mushrooms with friends, awakened again at dawn by buzzing wings (we later discovered there was a wasp nest under the eaves outside my window), I just wasn't afraid. Super calm and lucid. Got a drinking glass and a piece of cardboard, trapped it and let it out the window, like it was nothing. It was like a switch had been flipped.

Not that the mushroom taking was for the purpose of curing phobias. It was just a pleasant side effect, no Ravi Shankar required.
posted by looli at 1:01 PM on February 6, 2015 [1 favorite]

looli I know next to nothing about CBT or psychoactives, however one thing I do recall quite clearly from taking a course on mindful thinking is the current neurostudies theory of "mental maps"; i.e. the well-worn pathways our brain keeps going back to in re-hashing familiar thoughts, anxieties and actions, that become more well-entrenched as you become older and your neural net "fills in" - this would be your default-mode management becoming mature.

The course counselor likened the well-worn thought pathways to "mental ruts" that we get into by going through the same familiar old stresses, fears, anxieties and banal or trivial day-to-day thought processes... and especially for those of us familiar with negative internal dialogues, anxiety, compulsion / addiction, this sounds all too familiar. The premise is that after awhile the trivial becomes a deep "rut" you cannot escape from. Mindfulness, sometimes aided by pharmacological help (meditation, yoga, CBT, some stimulants, etc...) can help (when done with enough consistency) to "smooth out" the edges of these "mind ruts" so that we can peek over the side and ultimately shift our thoughts out of them.

After reading this article, and others like it, especially hearing of positive changes in personality and a "sense of childlike wonder" or "ineffability" that are very common to the themes, the best analogy I can think of is that certain strong psychotropics are acting kind of like a mental zamboni; rather than slowly filing away at the edges of the ruts, they just wipe the whole thing smooth and fill in the ruts and gouges in one pass.

probably waaaaaaay too simplistic, but that's my take anyhow.
posted by lonefrontranger at 1:44 PM on February 6, 2015 [3 favorites]

A shutdown and reboot for the ego.
However, we're not computers. The divinity students in earlier studies were already predisposed to see God (thus "entheogen"), and the cancer patients in the main study were carefully guided during the "trip." What if you don't believe in God and you don't much like being guided by a guru or even an expert psychotherapist? What happens then?
posted by bad grammar at 7:02 PM on February 6, 2015 [1 favorite]

Okay, I'm convinced. Where do I sign up for this? Sure sounds like it beats six weeks of side effects before *maybe* it works...

Oh, wait.
posted by jenfullmoon at 9:13 PM on February 6, 2015

Patrick had never taken a psychedelic drug, but he immediately wanted to volunteer. Lisa was against the idea. “I didn’t want there to be an easy way out,” she recently told me. “I wanted him to fight.”

Fuck you, Lisa. Fuck you.

I bet you look down on all those lazy cowardly diabetics who take the easy way out by injecting insulin, too.
posted by feckless fecal fear mongering at 1:13 PM on February 7, 2015

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