Why Psychedelics? A doctor’s journey through a transformative space

I came from a world of tradition and science. Some of this came from my Asian upbringing, which encouraged caution over risk and security over opportunity. Then there was my medical training, which was steeped in tradition around the art of medicine. Not to mention the scientific rigor I held myself to as I grew up in the academic world.

It was, in fact, this attention to research that made clear the possibilities of psychedelics.

This is representative of what my mind felt like, reading results from psychedelic research studies. Photo by Distinct Mind on Unsplash

Chapter 1: The Research

I originally brushed off the excitement around psychedelics as mere hype. The friends and founders around me who were “into psychedelics” seemed off-the-wall or really “woo.” I prided myself in the most rigorous of sciences (you’ll often find me doubting nutrition studies or even most psychology studies for this reason). I had come from a world of randomized controlled trials, some of which were still not scientific enough because they weren’t properly double blinded or didn’t have a proper control arm.

Yet, as a mental health practitioner, I was constantly prescribing what felt like and looked like (according to research) incredibly mediocre medications (1, 2). I’ve seen thousands of patients with depression, anxiety, and other mental health conditions. Time and again, I’ve seen that SSRIs and other traditional antidepressants kinda work, but not really.

But I also completely understand why we still prescribe these mediocre antidepressants. The bottom line is, we want to encourage people to accept medical help. No longer are the days when we deny that mental health is a real thing. So when a patient comes to us we want to help in whatever way they will accept it. But when they do come to us doctors, they *expect* us to prescribe something. I get a lot of stink eye for suggesting lifestyle modifications or therapy. Then once a patient is on medication and feels satisfied that they’re “doing something,” they want to keep trying medication after medication, even if they aren’t really helping much.

“You know that maybe you should first work on your sleep, diet, exercise, friends, and marriage. When that’s all fixed up let’s talk about if you still want to start medications for your mood.”

-No doctor ever.

Then I finally started looking at psychedelic research. What I found was fascinating. First of all, these research studies were not necessarily on illicit psychedelics (which would be unusable to a clinician like myself right now), but also on ketamine, a fully legalized medication in the U.S. Second of all, the results were ground-breaking. For example, one ketamine study demonstrated that a single dose of the drug led to near-immediate antidepressant effects which persisted for a week or longer (3). I’ve included links to where you can dig into it yourself, but basically the more I read the more I felt the skeptic within myself getting uncomfortable.

Chapter 2: The Experience

Despite the research, it takes a lot to convince a die-hard rationalist like myself. “So maybe this class of medication works on very specific populations in very specific research studies.” What does that mean for me and my patients?

I decided to embark on my own psychedelics journey. Like Michael Pollan, the writer of the fantastic How to Change Your Mind (about his own journey discovering the potential of psychedelics), I wasn’t satisfied by others’ testimonies or even pretty good research. I wanted to understand just how people got to being such rabid fans of a class of drugs.

So like any other good academically-trained doctor, I turned to training and study. I dove into all the most intensive programs I could find for licensed professionals, ending up with Polaris and the Integrative Psychiatry Institute. I joined *all* the messaging and email threads I could find. Then during one of my trainings, I went through my first personal experience of ketamine-assisted psychotherapy.

This 5-day training retreat, which I will elaborate on in a separate piece, was mind-bogglingly…amazing. It wasn’t sleek in any way — we were a group of about 20 therapists and doctors in a modest wooden building near UC Berkeley. It was filled with what I’d normally call “woo things” like spirit cards and feathers. We started off by writing on dissolving paper the things we wanted to let go of during the next few days. We practiced art therapy, underwent a sound bath, and wrote letters to our “pain.” This would normally have been way too out there for me (I regularly write letters instead to the skeptic who lives in my head), but somehow the experience of it all swept me up and plopped me on a different plane of emotion.

Kinda what I saw, except it was in my head and much lower resolution. Photo by FLY:D on Unsplash

I returned to my home in NYC with a sense of presence (as I’m writing that, I’m literally screaming in my head “I can’t believe you just used the word presence!”). But truly, I felt like nothing could pressure me or feel anxious. Even when I arrived at the airport incredibly late because I had been reluctant to leave the training, I found myself walking on clouds all through the interminable security line and to my gate. I was the last person to board, five min before doors closing, but I had calmly calculated the time and even gotten a bottle of water before boarding. I knew that I would be alright.

Chapter 3: The Action

After the retreat, it took me a moment to get back up to NYC speed. A large part of me wanted to stay in that cloud of peace, love, and happiness. But a growing part of me recognized that sitting there would allow human civilization to continue falling apart (generally what it looks like it’s doing if you read the news).

As part of my integration, or processing of all the thoughts that came up through my psychedelic therapy, I had a long, hard think about my place in the world. It would be easy to turn to practicing with psychedelics at a small scale, helping one person at a time achieve personal peace. What would be harder is interweaving the hopeful and transformational nature of this novel therapy with the machinations of capitalism.

My vision board from art therapy in post-ketamine integration

I have long been frustrated with our healthcare system, which was why I had originally entered the startup world from academic medicine. But I have stayed close to it, and am now re-entering it, because I have recognized the need to transform a system rather than ignore it (a much easier but fruitless option). The same goes for much of our consumerist society, which relies on the manipulation of people’s emotions to drive often personally and globally detrimental purchasing behaviors.

That being said, my ketamine sessions also have helped me realize that I would prefer this world than one without humans in it, dirty systems and all. There is a beauty to our systems, even then broken ones. We achieved what we have today through centuries of human behavior and action. It would be a waste to disintegrate everything we’ve achieved just because it’s grown sick.

So now I am back at my desk, working on Curio — the company bringing psychedelic medicines to the mainstream in a way it will be understood. Those from traditional plant medicine practices dislike our approach because it’s too clinical-seeming. Those from the traditional medical system are scared of it because it isn’t a familiar fee-for-service pill mill. But my hope and belief is that we can do this with the thoughtfulness and daring it takes to bring something this transformative to life.

References

1. Kwon, D. (2016, February 3). The hidden harm of antidepressants. Scientific American. Retrieved May 5, 2022, from https://www.scientificamerican.com/article/the-hidden-harm-of-antidepressants/
2. Ioannidis, J. P. A. (2008). Effectiveness of antidepressants: An evidence myth constructed from a thousand randomized trials? Philosophy, Ethics, and Humanities in Medicine, 3(1), 14. https://doi.org/10.1186/1747-5341-3-14
3. Zarate, C. A., Singh, J. B., Carlson, P. J., Brutsche, N. E., Ameli, R., Luckenbaugh, D. A., Charney, D. S., & Manji, H. K. (2006). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Archives of General Psychiatry, 63(8), 856. https://doi.org/10.1001/archpsyc.63.8.856

A searchable psychedelics research database by MAPS: https://bibliography.maps.org/

A beginner’s resource compendium to learn about psychedelics: https://medium.com/a-primer-on-psychedelic-medicine/psychedelic-medicine-resources-7da05821ff45