psychedelic therapy, a talk with robin carhart-harris [video]

So that's been my party mushroom experience. I've dabbled in psychedelics, but I really don't know a lot. And I think it's becoming an increasingly more relevant topic as it's being revealed that it can help with mental health issues. It has therapeutic qualities. And so I'm curious about this. I don't know a lot about it.

So I'm going to be interrogating Robin Carhart-Harris today. A pioneer and leading researcher in human neuroscience in psychopharmacology. And he's best known for his groundbreaking work on how psychedelics affect the brain and how they can be used to treat mental health issues. In 2019, he founded the world's first Center for Psychedelic Research at Imperial College London, and there he oversaw human brain imaging studies. With LSD, psilocybin, MDMA and DMT, Robin has also overseen several clinical trials of psilocybin therapy for disorders including depression, anorexia, and fibromyalgia. Basically, he is all about using psychedelics to help human suffering, improve the quality of people's lives through psychedelics. And you know, I think a lot of us think of psychedelics. And we think of, I don't know, doing shrooms with friends and painting and painting, or doing shrooms at a music festival, or doing LSD at a rave or whatever.

We think of psychedelics as being something that is very much recreational and also illegal. It's just it's sort of hard to comprehend in a way. Because I feel like we all have such a clear view of what psychedelics are. But today, we're going to learn a new definition of psychedelics with the king, the king of psychedelics. He might not like me, calling him that Robin Carhart-Harris, here he is.

I think my first question for you is to like fully, I'm just throwing it on you. My first question has to be, what was your first psychedelic experience? If you even have one, maybe you've never even tried them, tell me everything.

I was the summer of 1995.

I'm 43 now, so I was 14..

That's where I turned on for the first time.

You know, it sort of develops, it gets weird and then gets weirder and weirder and weirder. And then I thought I died, and I thought I was in hell.

And so, yeah, that was probably the peak, uh, sort of, you know uh, negativity of the trip. It got better, but.

My first experience was with mushrooms, and it was at a party and it was just a little bit, and that's the only psychedelic experiences I've ever had. Is just a little microdose, like, not even a microdose? It's like, a little more, maybe, than a microdose at a party. That's all I've done.

People sometimes lump MDMA, uh, molly, uh, ecstasy, and with psychedelics, and I think you can kind of get away with that. It's kind of soul revealing in a sense. Um, it has different properties. I'm not sure I'd put that one right at its core, and then maybe ketamine, but not really in my book, but kind of a pit. So yeah, there are some that are sort of fringe edge case psychedelics.

So when I realized that and the penny dropped and I thought about, you know, my trips, it all made sense. And I was like, Ah, yes, of course.

Did you have that with psychedelics at all, you know? Was it like, maybe you're anxious, or maybe you're? You know, you've struggled with depression? Have you struggled with those things? And has that made you more interested in psychedelics as sort of a form of therapy? In a way?

This shouldn't be happening. It's like it's annoying as well. So I, yeah, I guess in that sense I was looking for some answers, I really was, yeah.

And so that was the pull into psychology, and it was very strong. It was really like, only that, you know, I wasn't going to be a professional footballer that way, by the way, soccer player, but so that was the pull. And then it wasn't obvious to me that psychedelics were helpful for mental health.

Interesting, until, like, I was in the job researching it in a sense, when I wanted to first research psychedelics, which is in my early 20s. And I'd done my psychoanalysis masters. And I was looking for a P.h.D. And I wanted to do a brain imaging study with LSD. And I took that to someone in the UK and said, you know, this is what I really want to do. But it wasn't because I thought they could be useful in treating mental illness.

It was just that I thought that they were really, you know, amazing tools to see into the mind, and that we would get amazing insights into the nature of the mind and the brain. If we did something like this, gave someone LSD and a brain scanner. In fact, I couldn't believe that no one had ever done that before. You know, it was some way along, probably once we started giving people psilocybin magic mushrooms in a brain scanner. And then they said they felt really good afterwards.

Yeah, despite having magic mushrooms in a brain scanner. And so I started putting things together in terms of the history of magic mushroom use by certain cultures. For, you know, visionary medicinal reasons. And then the history with the psychotherapy stuff in the 60s, 50s and 60s. And then we looked at the brain imaging data and saw things that made sense in the context of other treatments for depression.

And so, yeah, we put kind of two and two together. And wrote a grant application to do a trial with psilocybin therapy and depression, which ended up being the first trial. And now we might be a couple of years away from psilocybin being a licensed medicine. Wow, yeah, across the Western world.

You know, it's all like little stepping stones forward, different studies, but that was a pretty important milestone. One was doing that first depression trial with psilocybin, yeah.

They're the ones that might open the psyche and reveal maybe things that you've repressed or overlooked. For sure, they're really perceptually, visually, perceptually disturbing, like if we were tripping right now. Depending on dose, the walls might be moving and swaying. And there's like a fractal kind of quality to things, surfaces and everything's more animated and things can distort. And then you close your eyes and you can have these very vivid, elaborate visions that sort of morph and change, have a kind of dreamlike quality in a sense.

So those are the classic psychedelics historically, some people like to call them hallucinogens. A little bit misleading because you don't typically see like a little green man just, you know, run through the wall, into the room and start dancing or something.

Yep, so I would say, like, revealing things of the mind is really the quintessence of classic psychedelics, and that is what the term is saying, and I think that's true. That, and the visual side of it, so near neighbor psychedelics like MDMA, is more about sensation, positive emotion, like a sense of social, deep social connection.

So it's more reliably positive in a sense, MDMA.

It's rarer that it would get dark and scary, like classic psychedelics, can you know? That's why it's often combined with, you know, music listening and stuff and dancing. But in a psychotherapeutic context, it can allow you to go to dark places without being overwhelmed necessarily. So, for example, in post-traumatic stress disorder, people have been developing MDMA therapy for treating that. So, you know, combat veterans or victims of many types of trauma, severe trauma that cripples them psychologically.

They can talk about those experiences under the MDMA, where usually they just really couldn't talk about it. They would have overwhelming flashbacks, or they might dissociate. So it's an incredible tool to facilitate psychotherapy in that sense, and with MDMA, people generally can talk, you know, maybe with the classic psychedelics, like a big dose of magic mushroom psilocybin. It's so intense and weird that, like, talking is left till later on.

Generally, you know, in the psychotherapy, that happens later on, yeah, and then there's others. Like, ketamine is more of a. It's more of a dissociative, I mean, it's defined that way as a dissociative anesthetic. If you give too much, it becomes an anesthetic and knocks you out.

Yeah, it's dangerous that way, and it is used as an anesthetic in certain contexts, but it's less emotional in a sense. And I don't think it's so reliably revealing of the psyche, like the classic psychedelics, with the classic psychedelics in psychedelic therapy. There's often a lot of tears, and actually it's a funny thing to say. But when people are crying in the trials, we generally know it's working, which is weird.

But there's a kind of catharsis, there's a release of this pent up emotion, and we think that's, you know, part of the healing. Absolutely, yeah.

What's the difference?

So drugs like LSD and psilocybin are actually quite similar, and they look a lot like a brain chemical called serotonin, which is swimming around our brains right now, and mostly it's actually in our guts, but in the brain, it does some important things. It's involved in a lot of different things, sleep, mood, and we think, especially mood, probably. And so there are certain sort of signaling proteins in the brain that serotonin would bind to and stimulate.

And these drugs do that LSD, psilocybin, because they look like serotonin, they're sort of like serotonin imposters, and they'll stick to these. They're called serotonin receptors, these proteins that will kind of tune brain function in different ways. And there's one in particular, it's called the serotonin 2A receptor that the classic psychedelics stick to. And then they do their thing there.

And to cut a technical, very technical story short to the gist of it. By stimulating these serotonin 2A receptors, they cause brain activity to become, in a sense, more chaotic, dysregulated. So the usual kind of regulated function of our brains and our minds. Like right now, being able to talk and stitch things together, have some sense of like assuredness about what's what. That depends on the regularity in a sense of our functioning brains right now, and when they get funky and dysregulated. So does our experience of the world, and that's kind of the gist of it, there's more to it.

That's the sort of breakdown side of things, but maybe in, well, we think, in the breakdown side of things, there's also a release side of things. So stuff that before was constrained can come up more easily. Like emotional circuitry can be let off the leash a little bit, you know. And that can account for the crying and so on. And maybe the insight as well, because memories that were being constrained are now unconstrained and can come up.

It's actually a very low dose of psilocybin that shouldn't have any action. We scan their brains before all that, we scan their brains after the placebo, and then we give them a whopping dose of psilocybin. Their first ever psychedelic experience, and we look in their brains a month after, and we did see some enduring changes. And actually, it was in the anatomy of the brain, which is kind of weird and maybe at first a bit scary.

And it is a question mark now is that, you know, what, if we looked a year later or even longer, would we still see it? Like, is it a permanent change, right? What does the change mean?

All these questions, that's kind of classic science, really. It sort of teases you, gives you a little bit, you know, and you've got a bunch of other questions. So we have seen this change. What is it?

So we look at the cabling of the brain and we look at how that changes, whether it changes at all. We saw that it changed, and it changed in a direction which is the opposite direction to what happens in aging, and pathologies of aging like Alzheimer's. On that level, it's a good thing, maybe a good thing, we don't know. And it's a consistent direction to what happens in the brain when you go from being a baby into being an adult.

So the fibers are becoming sort of more packed, we think, maybe, but we don't really know. The cables are sort of truer in the direction that they're going in, they're less, sort of diffuse. In fact, that's what it is. It's a diffusivity measure along a long cable that goes from the front of the brain into the middle of the brain.

Because it is to me, like, you know, with other drugs, like, you know, you can very easily od just die. Yeah, I don't hear about that ever with psychedelics.

Can you do that? can you overdo it? and, if so, what happens? Or do we not even know that either?

You wouldn't really know that you're a human, you certainly wouldn't be able to talk or walk, you know, you probably wouldn't. I don't know of OD through the direct toxicity. I know of a vague case of a heart attack in someone who was elderly and had cardiac-like issues, had a vulnerable heart in the first place.

So it's not like, say, fentanyl, where it's far too easy to OD and kill so many people. You know, even alcohol has this small window of where you can be a bit tipsy or drunk to. It's pretty dangerous now and can be fatal. Thankfully, it's quite rare that you're going to OD. Because of, like, some organ failure, because of psilocybin, or some other, you know, toxin, say, probably be more likely to be some other ingredient in the mushrooms than psilocybin.

So, but you know, nevertheless, if you eat that big plate of mushrooms, like, it's not good news.

Psychologically, it's going to be a wild ride. You might not remember much of it that, too. And if you are conscious and online, so to speak. It's going to be just so outlandishly weird that it's probably unpleasant as well.

That's probably bad news. And that, you know, the lasting impact of that is probably going to be more likely to be negative than positive. Or at least not so obviously positive. But many trips have the challenge, and often that challenge happens early on. When things start getting weird and you know, your sense of self starts breaking down. And there's something sort of instinctive that wants to push back on that, like, I don't like this, I don't want this, maybe attempts to stop it, and they're kind of futile.

And so that resistance can sort of define the struggle, but what often happens is that there's a sort of almost like a surrender to the struggle. It's like, Okay, I'm tripping, you know, let's sort of sink into this and drop into it. And and then it very subtly and quickly can change into something that you're like surfing rather than just battling against. And that that's the kind of way we sort of tutor people, in a sense, supervise people when we do. The psychedelic therapy for the mental people is to you.

Know, we don't dress it up. It can be challenging, and especially early on. But when you feel that, know that your body's safe, that you're being looked after, know that we've seen this before many, many times. Um, we're confident in, you know, medicine, and and um, try, try and go with the flow of that.

You know, is it even clear? Sort of what makes an experience bad? Um, is it maybe somebody who has a lot of demons in particular, or can it kind of just happen to anyone? It's sort of whatever your subconscious decides to do, like, what, what do we know?

What creates a bad trip?

There's more, more dark stuff in there, and it can come up also the intentions. If you're sort of trying to take a psychedelic for escapist reasons, it doesn't work that way. And it's going to slap you in the face and and cause a confrontation rather than an escape. So it's like the inverse of what you were hoping for, you know, yeah.

Actually, younger people do seem to be more vulnerable to challenging experiences. That I think that's true. Even if you take into account experience with the drugs. I mean, it's there's this sort of logic to. People who are less experienced are more likely to have challenging experiences.

Because those who are more experienced, well, they've learned a lot, but they're also just simply gone back. You know? Yep, and that would be unlikely if you know you had a really challenging experience and and you closed the door on it, yeah.

Into into relational things, relationship stuff, um, can can be a trigger, life stress, yeah, and like situational things big time, you know, tripping in the wrong place. And and sometimes that that's hard to predict. Because you could even be in nature thinking, Oh, nature and psychedelics really go well together.

And then, like, the cops show up, or, um, or what looked like, the cops, you know, yeah, and so it takes a turn that way. So, you know, that formula isn't always that reliable.

That's really the idea and some people really swear by it. You know, big names, Paul Stamets, at least in my field, yeah, Jim Fadiman, and like Amanda Fielding the Bechtle Foundation, they're all really passionate believers in microdosing. And it's tricky because we've done a bit of science there and and it hasn't always come through as compelling.

Yeah, that it's really doing something. Um, it's hard, actually for microdosing to beat placebo in trials.

Like, is the benefit from the trip itself? like, does it have to feel like a trip in order for it to do all the things that it does? You know, I guess that's sort of in. My question is like, is that trip and that experience the thing that changes the brain?

And actually, the evidence supports that. So we can measure the trip in a few different ways, we can look at different aspects of its quality, we can look at how strong the emotional breakthrough is. That kind of crying stuff I was talking about earlier, the catharsis, the mystical type.

Experience is a popular one. What's that sort of a sense of transcendence and being at one with things, you know, nature, other people, the world? Psychological insight Having insight into yourself and your past that you feel then feel is helpful. So these are all things of the trip of the psychedelic psyche, revealing, you know, property, core property of the drug. And so to try and cheat that by taking a tiny little dose, I'm not sure it really works. Or there's even ideas that you can cheat it. By playing with the molecules and the pharmacology to get an action that isn't a trip, but is therapeutic.

And I just think that that's sort of missing the point and also isn't really that logical because the trip in the human data seems to be carrying the response. So, you know, I think microdosing is a bit like trying to bypass some of the psychotherapy aspects of psychedelic therapy through just relying on the drug. And that's the other thing with microdosing is that it's a more regular use of the drug. It might be a tiny dose, but the idea is to, like, have a course of taking a psychedelic. Maybe three or four times a week for six weeks, you know? And that starts to sound a little bit more like a course of an antidepressant like Prozac or something, to be honest, for people like me.

Having seen what psychedelic therapy can be and in depression and other psychiatric disorders with just one or two dosing sessions, but the doses are high. But people are very well looked after and there is that psychotherapeutic support before and after seeing the life transformations with that approach. I wonder why you would, you know, favor that old model of relying more on a drug rather than just one or two doses of a drug? And the rest is really the psychotherapy.

Yeah, I think it's a bit of an attempt to sort of cheat the model, maybe because the model is a little hard to fit into the system.

Although the anorexia can be like a slow suicide in a sense, and then, you know, psychedelic therapy for severe drug and alcohol abuse, again, the intervention could be life-saving. So, yeah, the turnaround is pretty remarkable, and when it's so fast, I mean, I'm talking about the best cases. But there's a lot of very, very good transformations.

And so people understand what, you know, kind of proportions am I talking about? In the depression trials, it's about two-thirds of people. 60-70 will show a significant response. Wow, that's better by roughly about 20 on current treatments, so it's potentially a pretty significant improvement, I would say, on current treatments, by efficacy alone. How well it works.

There's a bunch of other stuff to worry about in a sense, but that's a big one. It's got to work, it's got to work well. Yes, so yeah, we have done those trials in depression.

Personally, I designed a couple of trials, helped design a third trial that a company has now developed on. And they're doing what's called a phase three trial, which could lead to a license for psilocybin therapy for depression. Federally, this isn't some state-level ballot initiative or anything that's happened as well. But now this is through the medical system, getting psilocybin approved, so doctors can give it basically, wow.

And that could be a couple of years away. MDMA could even get a license like that for treating PTSD this year. It's been filed already and is being looked at by the medical regulators. Here in the U.S. You know, we're on the cusp of major infrastructure-level changes. With psychedelics. We won't necessarily notice it overnight, which is a good thing, I think.

Yeah, it needs to be a sort of incremental change, but like, key sort of milestones are about to be reached this year.

Let's take the average person who has the average ups and downs, but maybe doesn't need to be treated for anything. Would they still benefit from psychedelics in some way? Or do you think that it's not something that should ever be used for everyone, and rather it's more useful when attacking a specific problem?

There's no should here. It's just more like, could, could, totally. Yeah, and you don't have to be suffering from depression where now it's really obvious that it could benefit you. Yeah, sure, the transformation there could be really dramatic, could be life-saving.

But that doesn't mean that healthy people can't improve in their life satisfaction and well-being. And they do, like we've done those studies, and quite reliably and markedly, people improve. And there's, you know, often a nice long tail to it as well, like it lasts.

Yeah, it's a very weird walk in the park, yeah, and there's a lot of drugs that are hedonic that just make you feel good. You know, people talk about, oh, let's not be too exceptionalist, about psychedelics.

I hear that. But I also think they're quite distinct from a lot of drugs in how sort of fundamentally they alter consciousness. And then not being like most drugs. Being like, obviously fun and sort of recreational, I'm sure they can be fun, and maybe in lower doses.

But it can easily, you know, not be fun.

What does that mean? Like, you know, once a year or a couple of times? Yeah, just more. Like in medicine, you call it PRN. I think it means like it stands for pro Renata, and I think it means you take the medicine when you need it.

So not like a regular course, but when a symptom emerges, maybe take the medicine and that's PRN. So yeah, I've done that and it has been helpful.

It's difficult to know how things would have been having not done it. But I think, you know, I didn't do a trial on myself. But I could tell you, as a human, in a sort of qualitative way, I think it was beneficial. Yeah, yeah, a couple of times in my life at least.

Or do you find them to be separate completely? I'm curious your opinion on their connection.

People use for them spiritual experience, mystical type experience, peak experience, which is a bit more humanistic, a little less kind of supernatural in a sense, or potentially supernatural. Unitive experience is one I like because it does get to the core of it, I think, and also mechanistically. I'll lay my cards on the table. I'm not a supernaturalist, it's often the case when you're a scientist.

And if ever you were or had that in you, it gets kind of beaten out of you.

Revealing psyche is soul. And you know, there's that side of psychology that talks about insight into yourself and your past and your traumas, and but then there's another side of psychology. You know, Carl Jung, who would talk about insight into what it is to be a being, you know, a human being, and sort of a deeper, sort of human shared inheritance. In a sense that, for me and for him, was a spiritual place. How we interrelate and how we relate to the rest of nature, very transcendent, and I think it's that transcendence that is at the core of spirituality, interconnectedness and oneness.

And you know, when you sort of explain it out, you realize it's not a woo woo thing as a disparaging phrase, but it's not a supernatural thing. It's very beautiful thing of this, you know, universe. So, yeah, in a curious way, I think psychedelics could help validate spirituality if it needs that. Many people might be challenged by that and say it doesn't need validating. You don't need to validate my religion or anything like that.

In the cultural domain of science, you certainly do. I mean, I'm not proposing we validate religion, but maybe the core of religion, that is the spiritual experience we could validate actually and explain what it is. You know why those experiences happen, yeah, and then think about what the insights mean.