Are psychedelics the future for mental health? Research on the use of psychedelics for depression, PTSD and addiction is being carried out in respectable academic institutions such as Johns Hopkins with impressive results that dramatically outweigh the kind of change we would see with typical psychotherapy and pharmacotherapy. It is still very early days and we do not know the extent of risks, but it seems clear that the “third wave” of psychedelics is upon us and those of us who work in the field of mental health should be informed about what it all means.
I recently finished two excellent books on the topic of psychedelics and mental health: How to Change your Mind, by Michael Pollan, and A Really Good Day, by Ayelet Waldman. Michael Pollan, a journalist whose books include the Omnivore’s Dilemma, explores the history of psychedelics in Western culture, his own journey as an reluctant psychonaut, and then looks at the neuroscience of psychedelics and how they help change our mind for therapeutic purposes. Ayalet Waldman’s book is a personal narrative on her experience with microdosing LSD for her longstanding problems with mood dysregulation (with excellent results). Both books are written by two people who are not your typical psychonauts – Michael Pollan describes himself as a rational atheist/skeptic, and Ayalet Waldman is a middle aged, mother of 4 children, ex-lawyer/public defender, married to the novelist Michael Chabon.
What I took away from reading both books is that the days of Timothy Leary and history of misuse of psychedelics has set us back from truly understanding therapeutic benefits of these substances. While traditionally psychedelics have been used by indigenous cultures for spiritual purposes, the western narrative has been more one of healing of specific conditions, particularly mental health issues but became co-opted by the counter culture movement and associated with recreational use/misuse. There is now a counter movement of a third wave of folks, like Pollan, Waldman, and many entrepreneurial/creative types who coming out of the “psychedelic closet” to disclose their own personal experiences for personal growth, creativity, and mental wellness.
We may be a long way off from being able to access psychedelics legally for therapeutic purposes, especially because of the stigma that continues as a result of the dark side of illegal use. Despite the current situation, we can certainly be informed about what supports therapeutic change – as it is not the substances alone that facilitate healing. It is the “set and setting” that makes the difference.
“Set and setting” are also essential to change in psychotherapy (and mindfulness practice). People come to therapy with the mindset that they seek some kind of positive change in their lives, through effort of creating new habits/thoughts/behaviours and/or letting go of dysfunctional patterns. This can only happen if the setting is appropriate in therapy, meaning that there is a good therapeutic rapport with the therapist and the time and space are safe enough.
Psychedelics facilitate change by increasing the neuroplasticity of the brain and quieting the “default mode network”, a network of pathways in the brain that are active when we are doing nothing. The DMN is particularly active in people who are suffering from depression and anxiety, and quiets down when we are able to be in a mindful/present state and not ruminating about the past or future. This different state and orientation to self can be disorienting for many people and for this reason, they need a guide/therapist who can help guide them through the process.
I see the quieting of the default mode network especially with people I work with in my practice through EEG neurofeedback training which quiets the brain and body to feel more calm by regulating brain wave patterns. People who have suffered their whole lives with anxiety have to learn to relate to themselves in a new way. If they aren’t their anxiety, who are they?
Maybe the therapeutic use of psychedelics is not too far off the future given the legalization of cannabis. There is likely a more immediate possibility for the evolution of cannabis informed psychotherapy to support people to relieve anxiety, overcome trauma, and gain insight into their lives. This will require education and training for therapists, and an open dialogue about cannabis use with clients and prescribing professionals.
Now that the third wave is upon us, and these conversations are more out in the open (at least for some, and in the confidential therapy room), as mental health clinicians we should be exploring some of these basic questions to understand the safe and effective use of therapeutic psychedelics:
There are many more questions that this new direction in therapy will bring up. My prediction is that in years to come we will move beyond the stigma of psychedelics and it will be a viable option for those suffering from intractable mental health problems such as treatment resistant depression and PTSD.
For more info on the research into psychedelics for mental health, check out the following links:
Multidisciplinary Association for Psychedelic Studies
The Big Trip: A CBC Documentary
Rachael Frankford, MSW, RSW is a clinical social worker in private practice. This blog is to share musings on mental health and about the intersection of mindfulness, neuroscience, and psychotherapy.