Studying psychedelic assisted therapy

It is not what you're picturing

Kill the beanbag and the crystal fantasy now. Here's what it actually looks like. Screening and clinical assessment, usually by an authorised prescriber (a psychiatrist) and the primary therapist. Then preparation, a minimum of three sessions. Then a medicine day. Then integration, another minimum of three sessions. That loop repeats across typically three medicine days. You're looking at north of twenty five sessions for a full course.

The medicine day itself is eight hours, with two therapists in the room the entire time, plus a psychiatrist overseeing from outside. Someone asked whether they'd ever relax the two therapist requirement. The answer: "The only reason the dyad exists is because the primary therapist can't always be present. We do need loo breaks." No mystique, just the plain truth that nobody can hold that kind of space alone for eight hours. That groundedness is a running theme with this faculty, and it's a big part of why I trust them.

The ethics question that stopped the room

Early on we were asked: if it were you, or your child, what would the therapist need to be for you to go into that experience? The answers came from psychiatrists, psychologists, nurses, GPs, an energy worker and an actual shaman, and almost none of them were clinical. Someone who's not a robot giving prescribed answers. Someone who's done their own work. Radical honesty. Not one person said "excellent formulation skills."

Then a psychiatrist from New Zealand compared the current hype around psychedelics to the EMDR boom. I'm an EMDR practitioner, so that one landed. Her point was that EMDR got hot, everyone did a weekend course, and some people got hurt, not because the protocol failed but because the gap between the protocol and the practitioner's competence did. Exactly the same risk is building here, at much higher stakes. A powerful tool doesn't make you a safe practitioner. It just raises the cost of you not being one.

Nutt's greatest hits

The second half of the session was a lecture from Professor David Nutt, twenty years into psychedelic neuroscience at Imperial College London, formerly chair of the UK's Advisory Council on the Misuse of Drugs until he was sacked for saying, correctly, that LSD was less harmful than alcohol. He later flew to Australia and presented directly to the regulator when their first rescheduling decision was a rejection. People in the room say without his voice, it doesn't happen.

His history lecture was genuinely absurd, in the best way. A few highlights:

A biochemist named Kary Mullis was on LSD when he watched a strand of DNA unzip and copy itself in his mind, which is how he invented PCR, the test the entire world took during Covid. He said on the record he'd never have got there without it. It won him the Nobel Prize.

Ayahuasca requires combining two specific plants out of the entire Amazon basin, one of which does nothing to DMT on its own and the other of which is only useful for blocking the enzyme that destroys it. Indigenous peoples worked this out thousands of years before anyone knew what an enzyme was. That's not trial and error. That's the most patient trial and error in human history.

There's a case, careful to say it's arguable rather than proven, that the ancient Greeks brewed a drink from ergot infused wine, held weeks long ceremonies called the Eleusinian Mysteries every autumn, then went home and invented geometry, philosophy and democracy. Albert Hofmann later took that same ergot molecule and turned it into LSD while trying to invent a migraine drug.

Francis Crick, who co-discovered the structure of DNA, took LSD and concluded that discovering the double helix had been "relatively trivial." He spent the rest of his life on consciousness instead, which he decided was the actually hard problem.

And there's an eleventh century mystery involving the Amanita muscaria mushroom, church art depicting it in the Garden of Eden, and a systematic destruction of those images once the experience it pointed to started looking like a threat to power in Rome.

The part that actually made me angry

Between the 1950s and 1971, researchers published over a thousand clinical papers on psychedelics, involving forty thousand patients. When the data was pulled together, it described a safe and effective treatment. One re-analysis of LSD trials for alcoholism found an effect size roughly three times better than our current best treatments.

Then it was all banned. Not because of the data. Nutt's account is that LSD had become politically entangled with the anti Vietnam War movement, and since you couldn't ban the protest, you banned the drug you blamed for it. The scheduling that followed asserts three things: no medical value, extremely dangerous, addictive. All three are false. Nutt calls it the worst case of research censorship in history, worse even than the Catholic Church banning Copernicus, because this one silenced hundreds of thousands of scientists and clinicians worldwide for fifty five years and counting.

He closed with a line from Huxley, who wasn't even talking about drugs: "Great is truth, but still greater, from a practical point of view, is silence about truth."

Loose ends from the Q&A

A few things worth knowing on their own. Psychedelics can't force change on someone who doesn't want it, which is exactly what MKUltra proved when the CIA tried to use LSD for brainwashing and failed completely. The default mode network, where entrenched negative thinking tends to live, has the highest density of the relevant serotonin receptors of any network in the brain, which is part of why psychedelics can loosen it. And Paul Stamets, the world's foremost mushroom expert, took magic mushrooms as a young man and it cured his stammer. He then devoted his life to studying mushrooms.

Why it costs so much

In Australia, a full three dose protocol currently runs around twenty five to thirty thousand dollars, because none of it attracts a Medicare rebate. Two practitioners for a full day, twenty five plus therapy sessions, a supervising psychiatrist, and a hospital or authorised clinic setting; all of it out of pocket and all of it visible, unlike the theatre and staff costs bundled invisibly into something like a hip replacement. One insurer is now running a funded pilot, largely because treatment resistant depression is estimated to cost around a million dollars per person over a lifetime in repeated psychiatric admissions. If that pilot holds, the projected cost could fall from thirty thousand dollars to about three thousand. That's the difference between a boutique treatment and an actual mental health intervention.

Where I'm at

I'm one week into a training I'll be unpacking for years. New Zealand isn't Australia, but the pathway here is quiet and under used rather than absent. When it opens properly, I want there to be practitioners on the ground who are actually trained, actually supervised, and actually humble about it. That's the whole reason I'm doing this in public.

I'll leave you with the quote Nutt used to close his own lecture, from George Bernard Shaw: "Those who cannot change their minds cannot change anything."

See you next week.