The Trip Fix
Psychedelics are having a major renaissance. After being exiled to the underground for decades, they've gone mainstream via Michael Pollan’s #1 NYT bestselling book How to Change Your Mind, which made “psychedelic therapy” a household name. And now they’re poised to transform the way we treat mental illness.
Psychedelic therapy (aka “psychedelic-assisted therapy”) is simply therapy in which patients ingest psychedelics, typically while wearing eye shades and headphones to encourage them to “go inward”. Therapists prepare patients for the trip experience, support them through it, and then help them to “integrate” any insights that it sparks afterwards.
A new wave of research is assessing the ability of psychedelic therapies to treat a wide variety of mental health issues and the results so far have been stunning. These therapies are helping desperate people with treatment-resistant symptoms (e.g., depression, PTSD) finally get some relief. And, in stark contrast to their conventional pharmaceutical counterparts (e.g., SSRIs, opioids), psychedelics are non-addictive, have a very low risk of overdose, and can produce lasting effects (e.g., up to a year) after just 1-3 doses.
The health issues that psychedelic therapies appear to be remedying in these studies include many quintessential MBS symptoms, like PTSD (Elsouri, 2022), anxiety (Feulner, 2023), depression (Raison, 2023), eating disorders (Calder, 2023), OCD (Buot, 2023), chronic pain (Kooijman, 2023), and even fibromyalgia (Bornemann, 2024). “Classic psychedelics” (e.g., psilocybin, LSD, DMT, 5-MeO-DMT, mescaline) all induce their effects by activating a particular serotonin receptor (i.e., 5-HT2A) in the brain. Thus, the diverse outcomes achieved with these therapies are all the result of a single molecular mechanism, a fact that nicely supports the notion that all the aforementioned health issues share a common root cause in the brain.
Psychedelics work their magic by infusing some much needed chaos into overly rigid minds. They break down the brain’s high-level networks that are responsible for organizing brain activity (e.g, the default mode network) and, as a result, they increase the communication between specialized neural networks that are typically siloed (Carhart-Harris, 2014). They also stimulate neuroplasticity (Calder, 2023), i.e., the ability of the brain to rewire itself in response to learning. The result is a brain that is more flexible, creative, and open. Recent work suggests that this “looser” brain state reduces experiential avoidance, i.e., the tendency to avoid distressing thoughts/feelings (Zeifman, 2023), and allows us to revise deeply held beliefs that underpin mental illness (Carhart-Harris, 2019). In other words, psychedelics provide a mental reboot that can allow us to feel our suppressed feelings and to snap out of unhealthy thought patterns that we’re trapped in.
When the brain’s high-level networks are down, people commonly experience a phenomenon known as “ego dissolution” or “ego death,” i.e., a disintegration of the sense of self or a blurring of the boundaries between the self and the rest of the world. With the ego out of the way, people feel connected to or one with all life forms/nature/the universe/a deity, and this sense of connectedness has been shown to reduce death anxiety and ease existential crises, including in people who’ve received a terminal medical diagnosis (Ross, 2022). Research suggests that ego dissolution is more than just a bizarro side effect of tripping; it appears to underlie the diverse therapeutic effects of psychedelic therapy (Stoliker, 2022; Kałużna, 2022). In other words, killing the ego may be key for getting better. This suggests that much of human suffering is a consequence of having an overbearing ego, i.e., an ego that imprisons us in loops of self-focused rumination and makes us feel isolated.
While this conclusion feels profound, it’s not a new idea. In fact, it’s comically old. Buddhists have been teaching that the self is an illusion and a cause of suffering for thousands of years. One of the ultimate goals of Buddhist meditation is to “transcend the self” and fMRI data has shown that experienced meditators achieve this goal by quieting at least some of the same high-level brain networks that are unhinged by psychedelics (Garrison, 2015).
Speaking of meditation: While we all can (and almost certainly should) work to squash our egos via meditation, doing so is a hard slog. It can take years of going at it in silent retreat, and there is no guarantee of success. (Not a great option for someone that’s teetering on the edge of a mental breakdown!) Psychedelics are a much faster and more reliable means to get there. A cheat code of sorts. And after experiencing a looser, self-less mental state on psychedelics, people report that they tap back into and work to cultivate that state via meditation.
Before I hype these therapies up any further, it’s time for a reality check. Unfortunately, psychedelic therapies are still pretty inaccessible. Psychedelics are classified as Schedule I drugs by the DEA. So, if you live in the U.S. and want to try these therapies yourself, your options are basically to (1) become a criminal, or (2) travel to another country. And with zero help from health insurance, these therapies are expensive. It’s a frustrating situation, especially for the study participants who experienced relief from a disabling mental illness after taking psychedelics but have no way to access them again.
The good news is that all the shiny new data appears to be slowly winning people over. Oregon and Colorado have passed ballot measures to legalize psychedelic therapy, and California is trying to follow suit (LA Times). Psychedelic research is booming as a result of fat donations from zealous philanthropists who have witnessed the power of these drugs to transform and save lives.
We’re in the midst of a mental health crisis (thanks SARS-CoV-2!), and it’s clear that the tools that our healthcare providers are currently wielding are not cutting it. It seems possible that we, as a society, may finally be desperate enough to try something different. I certainly am.
If you want to learn more about psychedelics, I highly recommend that you check out the book How to Change Your Mind and/or the awesome Netflix documentary based on it. You can also check out the work of leading psychedelic researcher Robin Carhart-Harris, a charming, mild-mannered Brit who has recently been interviewed on several popular podcasts (e.g., Making Sense, Huberman Lab).
DISCLAIMER: This blog post is in no way meant to encourage engagement in illegal activities, including the purchase and consumption of illegal substances.
