I agree with the basic point of the article entirely.
However he shows the same kind of bias that he is speaking out again by not discussing the best known branch of such research. And that is MDMA for PTSD.
It is best known simply because it is, in fact, demonstrating that it works. The FDA has been repeatedly calling it a "breakthrough therapy" since 2017. It is in multiple phase 3 trials around the world that are going well, and full approval is expected this year. Research papers on it, like https://www.nature.com/articles/s41591-021-01336-3, are appearing in the top science journal in the world and are no less enthusiastic than a press release. Let me quote, "These data indicate that, compared with manualized therapy with inactive placebo, MDMA-assisted therapy is highly efficacious in individuals with severe PTSD, and treatment is safe and well-tolerated, even in those with comorbidities. We conclude that MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation."
So no matter how much questionable research there may be - and I'm sure it is a lot - let's not throw out the baby with the bathwater. There is also good research, and these drugs have the potential to make a huge difference.
> While we’re here, it’s worth talking about the MAPS MDMA-therapy trial itself. In May 2021, to much media fanfare, they published their Phase III clinical trial in Nature Medicine. The trial reported enormous, nearly unbelievable effect sizes: 0.91 of a standard deviation difference in score on a PTSD questionnaire between an MDMA and a placebo group (both groups got therapy). That’s the kind of effect medical researchers fantasise about.
> Are these effect sizes plausible? Nature Medicine also published two critical commentaries on the paper. The first one points out the issue we discussed above: that the blinding was almost certainly compromised in the study, since the control group got a completely inert placebo and the treatment group surely could tell whether they’d been given ecstasy. Expectations could have played a major role, and might explain at least some of the huge difference between groups (the commentary also makes the interesting point that researchers used to be required to collect data on which condition patients thought they were in, but since 2010 this is no longer the case. It might be time to bring back this rule). The second commentary asked for studies with more relevant control groups and longer follow-up periods to check the safety of the treatment. The MAPS researchers also responded, somewhat limply.
> The journal also published an entirely uncritical commentary co-authored by Imperial College London’s David Nutt. Remember him? He was Fired4Truth as a drugs adviser by the UK Labour government in 2009 for criticising government policy on drug classification; he’s now a major psychedelics researcher who co-authored the psilocybin trial we encountered above. The commentary calls MDMA “remarkable” three separate times in about 1,000 words (it’s true the effect sizes in the study are remarkable, but what if they’re due to expectancy bias?). It also says it’s likely that MDMA “will be an approved medication within a few years”.
> So there’s a final potential harm that stems from the breathless hyping and cheerleading of psychedelic treatments way beyond the evidence: it could mean that therapies—which come with their own rare but real dangers—are approved and rolled out to large numbers of patients when we need a lot more evidence that they really are beneficial in the long term.
It feels like they actually mostly overlook this study in favor of their thesis that psychedelic research is bogus. The Nature critiques are less than convincing, either way they are doing another phase 3 trial so we will know.
My guess is if this scientist did psychedelics he wouldn't have written this article.
> My guess is if this scientist did psychedelics he wouldn't have written this article.
That was my thought too, though that also runs into the author's argument that psychedelic research is heavily biased by people who have tried it. On the other hand, I think people who have not tried psychedelics have never experienced how much of what they think of as objective, rational mind is actually fairly fluid, and how much the referential frame of experience informs and influences what we'd consider objectivity.
I don’t know if someone who has never taken psychedelics can adequately understand what it is like, unless they have experienced something similar without taking psychedelic substances. (That is, spontaneous, visionary experiences). There’s an intellectualization of what the person thinks this experience is about, as a substitute for direct experience.
A physicist might study physical phenomena, but what they work with are models about those physical phenomena, and then call that “reality”. That isn’t reality. Those are models of physical phenomena with high degree of predictive ability.
Rather, if you want to use an example of someone who attempt to directly experience reality, we’re talking about Zen practitioners or one of those non-dual teachers. If you hear them talk, they spend a lot of time saying very plainly, you don’t really experience reality directly. But people hearing it pretty much nod their head and think that they do.
As far as oncology research goes, you are right. It is biased towards study participants with cancer. Not only do the _researchers_ themselves are not experiencing cancer themselves (unless they got cancer), but what is _not_ being studied is what health and wholeness looks like and contextualizing cancer that way. Instead, we’re getting to know a lot about the mechanisms of cancer, and the various causal chains of cancer, and this limits our view to that of the body as a machine. That by somehow understanding all the fiddly bits, we would understand the whole, and we won’t.
The author, Stuart, dismisses the entire study based on: expectancy bias, and participants being able to tell whether they are in the treatment group or the control group.
What if this were applied to everything? "95% of participants preferred the meal of pizza to the one that was hard tack and water. However, participants might have just had pre-existing bias that pizza was tasty, and they were able to identify whether they were eating pizza. No conclusions can be drawn whether pizza is actually tasty or this is simply a placebo effect caused by the participants' expectations."
Out of curiosity, is there anything specific about them that you think make them weaker critiques?
> either way they are doing another phase 3 trial so we will know.
As long as (potential?) weaknesses are not repeated; for example, if loss of blinding is indeed a significant issue and the second trial also suffers from the same flaw, then I think it's not unreasonable to call into question the utility of that second trial.
I think these get a lot of traction because of the interesting proposal that, should this go through, the possibility of a future where when one is feeling a little down or a little bored they might pop into their local Walgreens and get a one-night dose of OTC MDMA to liven up the boredom and sadness of their life.
It's an interesting consideration that I think is part of the excitement and buzz these articles generate. I think many people would experiment with psychedelics and other harder drugs if they knew the safety was very high and that it might correlate to other benefits such as overcoming past emotional blockages or looking forward to tomorrow with brighter eyes.
I said all of that to say that I take these articles with a grain of salt. Some of these well-known drugs may very well have amazing positive benefits for a select group of people experiencing a correlated negative existence, but I strongly doubt that any of them will be a panacea for any of the more universal ills, that is to say, I doubt casual sadness or unhappiness will ever have a treatment in pill form. These treatments will most likely be best reserved for the people who have deep and abiding emotional and psychological scars that traditional holistic approaches ("whole-body", not new age woo woo) would be entirely unable to treat.
If you do a simple ctrl+f on the article for "MDMA", the second result directly addresses MDMA used for PTSD[0], and the big issues surrounding clinical trials for it. Based on the treatment of participants in MAPS trials, conducted under Health Canada, I would treat anything the FDA says about psychedelics with a large amount of skepticism too.
Just to point out: I always find it shady when a paper uses an inert placebo / therapy as the control group rather than the current state of practice.
We'd ordinarily use at least - at least - an alpha-2 agonist like prazosin. Even going with just that would be malpractice-bordering conservative for severe PTSD.
I like the article. With psychedelics, it's clear that much of the excitement comes from people (including scientists) who have used them and found their experiences helpful. That's not science but that doesn't mean it's wrong. Not everything is amenable to clinical study and this doesn't mean we should disregard it.
And the issue isn't just psychedelics being hard to study. Mental health is hard to study. An overweight man with no friends who plays computer games all day is not depressed unless he feels bad about it. Mental health depends on subjective feelings. Hard to study that!
My view is that we should continue to think about psychedelics from a religious or spiritual perspective. Even if that's literally incorrect, it's the correct metaphor. I'm also very skeptical of people who think widespread use of psychedelics can make society better. Lots of people used LSD in the 60s and 70s and as far as I can tell they didn't usher in a new age of love, peace, and tolerance.
> as I can tell they didn't usher in a new age of love, peace, and tolerance.
Things did improve, but of course how would you attribute it to that, and of course, how would you account for the effectiveness of the counter forces? Just because something didn't succeed completely doesn't mean we can conclude it has no effect, especially if it wasn't actually tried at the suggested scale. We have this problem in Vancouver with opioid addiction and there are some services in place but they are mostly shit and the government's overall plan is direly incomplete. Then people say "Wow, we spent money on harm reduction and still have addicts".
> There was madness in any direction, at any hour. If not across the Bay, then up the Golden Gate or down 101 to Los Altos or La Honda. . . . You could strike sparks anywhere. There was a fantastic universal sense that whatever we were doing was right, that we were winning. . . .
> And that, I think, was the handle—that sense of inevitable victory over the forces of Old and Evil. Not in any mean or military sense; we didn’t need that. Our energy would simply prevail. There was no point in fighting—on our side or theirs. We had all the momentum; we were riding the crest of a high and beautiful wave. . . .
> So now, less than five years later, you can go up on a steep hill in Las Vegas and look West, and with the right kind of eyes you can almost see the high-water mark—that place where the wave finally broke and rolled back.
That's Hunter S. Thompson on the 60s drug movement. I'm not saying it led to nothing but it certainly didn't lead where its members expected and its legacy is far from clear.
I think we should continue to study these drugs. I just think there's a lot of unwarranted optimism.
I don't think that vibe was unique to drugs or the 60's, perhaps every generation gets that.
For example, I feel the same way about the 90's Internet...
It's hard to explain the optimism a lot of people felt at the time.
It seemed like it could fix the world, what if everyone could just talk to each other? Couldn't we fix the misunderstandings?
We were gonna route around the censorship and cryptography (not crypto...) was going to free us from The Man. State control of "the message" through TV and newspapers was over.
I look at what we got and there it is, human nature staring right back at me.
> Lots of people used LSD in the 60s and 70s and as far as I can tell they didn't usher in a new age of love, peace, and tolerance.
I would argue that LSD helped end the war in Vietnam. It's also not a fair criticism because governments around the world demonized LSD and made it a crime to partake, so you took it in an atmosphere of fear and paranoia. Hallucinogenics are only now given a fair test. There's already lots of anecdotal evidence that hallucinogens changed lives for the better (Steve Job, Richard Alpert.) A lot more has to change before a new age of love, peace and tolerance comes about, things like human greed and selfishness. No one is claiming that LSD turns people into angels.
> Lots of people used LSD in the 60s and 70s and as far as I can tell they didn't
usher in a new age of love, peace, and tolerance
There's a documentary on UK late 90's rave culture that noted that perhaps 60-100,000 people in the USA indulged in LSD during the period you mention. By contrast, somewhere on the order of 10-20 MILLION people dropped MDMA/ecstasy during the heyday of UK rave culture.
The documentary went on to note that there are a lot of professional, retail and public spaces in the UK that have been built in the last 15 years that show particularly strong connections to the "chill out room" vibe that became significant during the ecstasy+rave period. Even real estate agent office (realtors in the US) design is claimed to show many elements of chill out aesthetics.
This isn’t correct in a lot of places. There is a number of diagnostic criteria. The most important being how much it affects your quality of life.
This can be directly measured by looking at how the individual functions day to day. An example is “Was the person able to shower regularly?” (This assumes the person wishes to shower if they have the ability and opportunity.)
It’s pretty easy to record the number of panic attacks or how often the person has suicidal ideation.
ADHD can be measured by asking the individual to preform tests under specific conditions.
Significant changes in psychosis and paranoia can readily be determined with structured interviews.
The problem is most of these things are not easily and correctly measured by a questionnaire. You need more expertise to get this information out of a patient.
I really hate the mental health questionnaires. They did a poor job of assessing my difficulties when I was in the thick of it (I’m doing much better now). I also found them quite stressful to fill out.
I remember getting scores of “mild anxiety” or “mild depression” and just kind of sitting there confused and somewhat dismayed, thinking… “Why am I having such a hard time? What is actually wrong with me?”
Turns out some of my core issues were difficulty knowing and connecting with my emotional state, constantly trying to meet intense expectations that I believed were necessary regardless of how I was feeling, putting (what I imagined to be) the needs of others above my own needs, and having deep fractures in my sense of self-worth.
Five years ago, I was largely oblivious to all of that. All though some pieces of the puzzle had been slowly coming together for some time.
Some potentially more informative labels for what I’ve been dealing with: C-PTSD, emotional neglect, and / or highly sensitive person.
C-PTSD isn’t even in the frickin DSM! I had taken online questionnaires (the anxiety and depression ones mentioned earlier were from medical professionals) for PTSD. It didn’t really match up, which makes sense. There is less material for C-PTSD compared to PTSD. I did try one or two assessments I found online for c-ptsd and I think I got a score that was very close to the “clinical threshold”. Which was a little helpful. But it took me quite a while to get to that point and I was still confused and uncertain.
All that to say… The ”best in class” assessments, as well as our general ability to classify and understand the mental health difficulties that people experience, are not very good.
We can do much, much better. And doing so would alleviate an immense amount of suffering.
P.S. My advice for anyone who relates to this is to find a good somatic therapist who knows how to work with complex trauma / emotional neglect. It’s very difficult to work through this on your own. I was pretty skeptical about therapy… It took me 4 tries to find a good therapist. The first 3 were not that helpful. The somatic approach is important. If you haven’t found a good therapist, keep looking!
Exactly, the reality of the mental health field is they know very little and their methodologies are largely flawed. I've been diagnosed with so many different things based on their "scientific methods" when at the end of the day they are just making rough guesses.
I get really turned off by any article that acts like we have a clear understanding of these things. Most things are actually just reactions to trauma.
I definitely agree that scientific understanding mental health is pretty low, but I don't believe the methodologies are flawed. They are the best we have at the moment and they work well enough for the common cases. (Drugs vs therapy is a different problem.)
Anyone with a non-trivial case ends up in informed (or poorly-informed) guesses territory.
> Most things are actually just reactions to trauma.
I don't think this is quite correct. Mental illnesses have a lot of overlapping and contradictory criteria because all of the categories are rough patterns.
Many share the same symptoms of trauma and people with mental illness are more likely to have trauma.
This does not mean the majority of mental illness is caused by traumatic events.
They work okay for some basic cases. My experience and the experience of folks I've talked to they just seem like a charade mostly.
Again anecdotal, but every person I know (including myself) with some sort of mental illness has ultimately just been due to trauma. I'm sure there are other things that happen, but too many therapists jump over that toward some other diagnosis that's just a symptom, then have some specific treament/medication for that DSM-5 diagnosis.
I finally found a therapist that explained this to me and really dug in on what had happened in my life and I finally began processing it and I'm now better. This is after seeing ~7 different therapists and having ~10 diagnosis.
> The most important being how much it affects your quality of life.
This is unique among illnesses. Whether or not I have a cold does not depend on how much it affects my quality of life. Why is mental illness different?
The symptoms of a mental illness can overlap with normal variations of personality. It is very important to note this is overlap, *not* a spectrum!
A person’s baseline can be altered by mental illness but not severely enough to be indistinguishable from a personality difference. Telling the two apart is damn near impossible.
Since we don’t have blood tests, we cannot tell the difference. So we need to fall back on want little objective criteria can be found.
Behavioral criteria can be skewed due to environment. An active kid who wants to run around isn’t going to do well being stuck in a classroom for six hours. A curious kid with ADHD, who would otherwise be a good student also won’t do well because they can’t stay on task. These look identical. (This is why ADHD is both over and under diagnosed.)
This results in family history and quality of life being more objective than self-reported feelings.
Mostly because we know very little about mental illness, so we are just guessing.
Previously, we had a terrible habit of identifying "mental illness" by external factors, such as meeting social and moral norms (so being gay was considered a mental illness, as was being troublesome).
To avoid this, and given that our understanding of the fundamentals has barely improved, if at all, we have chosen to take an approach that is much less likely to cause extraordinary distress to people who are perfectly well.
Remember that being labeled mentally ill can durectly rob you of your most basic human rights, so this is not a diagnostic that should be easily applied.
> The problem is most of these things are not easily and correctly measured by a questionnaire. You need more expertise to get this information out of a patient.
It sounds like you're agreeing. Mental health is subjective feelings. When we want to study it, we reduce it to an objective measure of a few dimensions, like those diagnostic questionnaires. This removes its complexities, but also allows some level of standardisation across studies.
It's worth it to study these things from a behavoral or functional perspective but that is also very hard. If only because, ultimately, people seek treatment or don't based on subjective feelings.
I think there's unavoidably an element of subjectivity here. You can attempt to minimize it but it's always there.
> An overweight man with no friends who plays computer games all day is not depressed unless he feels bad about it.
This is entirely wrong. You can suffer from depression (and anxiety) and attribute it to other things, such as personality traits. Many people think "that's just me" with those that know them thinking the same. For less acute forms of depression such as dysthymia, that's common. People can think they're entirely normal and they're just not good at certain things.
If you talk to sufferers of serious and disruptive mental illnesses such as schizophrenia and bipolar with psychotic features, most of them will deny they're ill at all and rationalise their behavior. They'll generally talk about it by saying "well my doctors say..." and suggest that their doctors have been mislead or have misdiagnosed them.
It's much more complicated than it seems. It's all part of the perniciousness of mental illness.
> This is entirely wrong. You can suffer from depression (and anxiety) and attribute it to other things, such as personality traits. Many people think "that's just me" with those that know them thinking the same. For less acute forms of depression such as dysthymia, that's common. People can think they're entirely normal and they're just not good at certain things.
My post explicitly says the hypothetical man is happy, not that he thinks "that's just me".
If you want to argue against that, you have to define mental illness from a behavoral or functional perspective which I don't think you've done.
What if the subject doesn't realise they're unhappy because they've never been happy and have nothing to compare against? Your statements seem to assume everyone has the same perspective to measure against, but in reality people's perspective can be radically different
Like I said, you can make that argument, but then you need to provide a criterion for saying someone is unhappy. That's where behavioralism or functionalism or something similar comes in.
> Your statements seem to assume everyone has the same perspective to measure against, but in reality people's perspective can be radically different
On the contrary, I think people have different perspectives. Two people can be in the exact same situation and their subjective feelings can be radically different.
The grand-parent comment was arguing that this distress can be objectively catalogued by someone other than the patient, and that the patient may themselves be unaware.
This does seem to be true for some forms of mental illness, depending on exactly how you define distress. For example, someone going through an episode of mania (such as in bipolard disorder) is typically subjectively extremely happy with their state.
"I'm also very skeptical of people who think widespread use of psychedelics can make society better. Lots of people used LSD in the 60s and 70s and as far as I can tell they didn't usher in a new age of love, peace, and tolerance."
Why can't it be? Why can't we just start doing studies on people who have already had positive experiences with these drugs? Why is there an assumption that one size has to fit all? The data collected from them would useful as a control group regardless.
I know a lot of cannabis fans (and count myself as one). Very, very few of them acknowledge that cannabis affects people inconsistently; one person's reaction to it can be very different than others. This is inconvenient for calling it a "medicine" so let's just ignore it.
Psychedelics are even worse. The same dose of the same drug can produce wildly vary effects in the same person depending on factors we have trouble nailing down. "Set and setting" and the Erowid wisdom are all very well, but they are barely enough to describe the area and edges of the therapeutic window in a general way. Your trip, today, is still going to be an experiment.
Psychedelic enthusiasts can be even worse in this regard. When someone does have a bad trip, they tend to reach for every possible excuse to avoid blaming the drug. This ranges from criticizing their "set and setting" to blaming "triggering an underlying mental health issue". The latter is particularly concerning in the context of treating mental health issues, because by definition everyone in that category has some level of underlying mental health issues.
Research is particularly difficult in this area because the study volunteers are self-selecting for psychedelic research. Basically, anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out. This creates a huge risk of placebo effect when your patients are arriving with huge enthusiasm and preconceived notions of efficacy. Combine that with the weirdness of a psychedelic trip and it's a recipe for a sort of super-placebo.
However, that's doubly interesting in that maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo. Put someone through a weird, confusing psychedelic experience and tell them that it their life will be radically different afterward and maybe they'll believe it so much that it becomes their new reality. Weirdly enough, we have the opposite problem with SSRIs right now because so many patients will start googling side effects and become convinced that they're not going to work before they even take the first dose.
It's an interesting area of research, but I think right now there's too much crossover between the research and the pop-culture phenomenon of "psychedelics cure everything". It's also strange that so few people are questioning why all of the previous psychedelic users didn't notice that the drugs were treating depression. In fact, the common wisdom among psychedelic enthusiasts years ago was that psychedelics were to be avoided if someone was not in a good mental state, largely due to all of the negative reactions they noticed. It seems that telling someone "this will cure your depression" provides a different set and setting than just giving them the psychedelics without context.
Listen, your comments on all these threads make it clear you’re seriously pessimistic about psychedelic medicine, and that’s perfectly ok.
What bothers me is the incessant pushing of this agenda:
> anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out
> maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo
This amounts to uninformed armchair dismissal that is inconsistent with a growing body of scientific evidence, and easily refuted by a cursory survey of recent literature and clinical trial results.
Surely you’re familiar with double blind randomized placebo controlled studies? I’ve linked you to recent ones in other comments.
These methods aren’t perfect and your concerns certainly have merit in general - I just don’t understand why you continue to make these broad and suggestive claims without any supporting evidence.
I am curious: is it actually possible, even in principle, to have a blind placebo controlled psychedelics study?
How can you not be aware of whether you have consumed a psychedelic substance or a sugar pill, assuming we are not discussing something like micro-dosing?
It’s a valid concern and many folks have raised it here on threads concerning this topic.
The short answer is yes: beyond mannitol, niacin, and even bespoke substances designed to mimic the organoleptic properties of ayahuasca have been used effectively as placebos.
At modest dosages (above the threshold of perception but within the therapeutic window) the side effects can be surprisingly similar in the general population, and thus difficult to distinguish for the average joe.
Of course studies vary widely in quality and rigor, so one must critique experimental design on a case by case basis.
> Psychedelic enthusiasts can be even worse in this regard.
Oh yes, I've had a run in with a "psychedelic enthusiast", and this is so accurate. It was my girlfriend during my late 20s, a woman who was 12 years older, very into psychedelics, and pretty obnoxious about how beneficial they were. Of course, at the time I ate it up because I was kinda lost in life, and let her overcome my better judgement with her guru bullshit.
I'd previously only ever used marijuana, and had mostly negative experiences resulting in anxiety, so had mostly sworn off the idea of trying psychedelics until she came into my life. Long story short, I tried mushrooms once with her, fun for a bit, but then led into a crazy making spiral leading me to be convinced I'd never be the same.
I guess I was a glutton for punishment back then, because I also tried LSD with her twice, and it had pretty similar results. In fact the second trip shook me up in such a bad way that I think it took nearly a year to get the negative bits still remaining out of my head.
Of course her reaction after all this was that I was being too resistant and that I simply needed to have a "corrective experience". Fuck that! She seriously couldn't comprehend the fact that everyone reacts to psychedelics differently and that they might be quite dangerous for some people. Which seemed kinda crazy because she was actually highly intelligent, but possibly too arrogant to look outside her world. I seriously could have ended up in an institution if I had stayed with that woman (can you tell I'm venting a tad :) ).
I've later come to learn that I have a genetic mutation that reduces my ability to degrade dopamine in the prefrontal cortex by 75% (COMT met/met), leading to much higher baseline dopamine levels. After learning about this, it makes a ton of sense why I have such bad experiences with dopaminergic drugs like caffeine and Adderall (euphoria followed hours later by intense anxiety). Now I don't know how LSD and mushrooms impact the domaine system, but it does make me wonder if this genetic SNP, partially explains my propensity to anxiety/psychosis on these drugs. High baseline dopamine leads to hyperfocus, which is great for coding or other technical work, but terrible when you're stuck in a spiral of thinking you're going crazy and will never be the same.
It's fun to send this "MAYBE YOU JUST HAVENT TRIED THE RIGHT STRAIN" [1] image to friends who don't like weed because it's a pretty hilarious embodiment of the downright anxiety the stuff engenders in a lot of people. I'm pretty sure it's like a genetic thing. I think I remember hearing something about the COMT gene being potentially affected if you smoke too much too early in life as a teenage stoner or whatever, and how this can lead to mental illness down the line... There's a lot we really don't understand yet fully about these things.
I'm convinced that the "normal" way Americans consume weed is basically an overdose for most people. Heavy users drive the market and the 30% THC and higher strains are targeted at those high-spending, high-tolerance users. I started to enjoy weed again when recreational stores opened up and I could find 10-15% THC weed that gets me pleasantly high, not paranoid and incapacitated.
I find that CBD-rich hemp still gets me "high", but the effect is extremely therapeutic. I hope low-THC cannabis is more widely studied.
High-THC cannabis has a very negative effect on my mind, mood, and motivation. But CBD-rich strains with low THC are perfect for handling my anxiety and autoimmune symptoms.
For most of my life, whenever I say that I hate beer, the stock response is "you just haven't tried the right one" (and no, the actual root cause is that bitter things are much more bitter for me). Humans are hardcoded to project.
I'm not in the anxiety camp or in the fun camp. The general experience of marijuana products is something like the sleepy lethargy of having eaten an excessively large meal. Not wholly unpleasant but neither is it something I'm really excited about seeking out. Low doses do mostly nothing. I've tried plenty of strains. To be fair I still do it sometimes.
And we lack actual shamanic centers where we can do this stuff safely, where the dose is exact and you know what you're getting, and you can have guides to help you through the trip if things start feeling sketchy. And we could even have people on standby to administer anti-psychotic medicine in-case you have adverse reactions and need to calm down quickly before you do something stupid. The illegality of these substances is illegal in itself!
Well, I would rather say there are probably way too many people, who would totally trust such a place with their whole health, just because of the name and some other esoteric buzzwords like indigenous, ancient wisdom.
I do have great respect for "real" shamans. But I met way too many fake ones, handing out horrible and dangerous advice, while glowing in their self declared illuminative state of higher consciousness.
Yeah its interesting because I've had absolutely game changing experiences with real shamans, and then bad experiences with phony ones. If you find a good one, stick with them
Most are quite harmless and you still can have interesting conversations with them. Some are more weird and even dangerous, like this individual, which I have not met personally, but people like him.
I agree. And I also think that for the same reasons, the psychiatry system, at least the parts that I was exposed to, is abysmal. They prescribe according to whatever scriptbook is en vogue at the jurisdiction and the substances themselves are very far from proven - and also the part where you're guided on the trip you're having can be almost completely missing. There's a huge room for improvement in this area.
Check out the Cover Story podcast mentioned in the article. It's pretty eye opening. They mention a few centers that historically you can categorize as unsafe. The key would be to find professionals that have your best interests in mind but the podcast and this article reveal how surprisingly difficult that is.
IMO the tolerance factor is huge with cannabis. Even for experienced daily smokers if you were to take a few days off, the effects are very noticeably more powerful. When you have zero tolerance, the drug feels like on another planet compared to something more familiar like alcohol. When you have a lot of tolerance, its a comfortable buzz you can be productive on, like a workingman's whisky drunk but without the slop.
This is an anecdotal and slightly off topic response to your note on cannabis tolerance. I am a frequent cannabis user and have been for a long time. While I no longer use psychoactive cannabis regularly (not in a fully legal state anymore) but I do use CBD, which purports to be non-psychoactive and, by law, has THC delta-9 levels of below 0.3%.
What I find fascinating is that CBD absolutely has a psychoactive effect on me. I suspect that this is because of my prolific use of typical cannabis. The components of CBD must tickle the same pathways that are so accustomed to psychoactive cannabis.
The result is that I often get reasonably high from CBD hemp and CBD tinctures.
A high tolerance for cannabis seems to create a stronger response to CBD, at least in my case!
I think the opposite is what is happening, the regulated CBD products aren't regulated in a way that keeps them free of psychoactive components and nobody noticed yet or aren't too excited to try to change it, legalization being on the menu all over the place.
CBN, CBG, and terpenes, are all responsible for medical and recreational things that regulators don't have a single clue on, and medical folks are only beginning to.
As they say: everyone’s endocannabinoid system is different. They also say everyone’s brain is wired differently. Completely agree that every first use whether it is THC or psilocybin is at the end personal experimentation with non zero risk.
Some psychedelics are more unpredictable than others, and incidentally these seem to be the ones that are hyped the most. LSD is much more predictable than mushrooms for instance, and is well researched partially because of that. The seems generally true for synthetic vs naturally occurring substances across the board, though there are plenty of horrible synthetic drugs like bath salts, synthetic weed. Advocates seem favor this as it allows them a no true Scotsman defense. “You didn’t get real ayauasca”, or with cannabis the hand wavey talk of the “entourage effect.” The biggest problem facing psychedelic research are the researchers involved. They have little credibility, almost like that’s their intention.
I agree LSD may be more predictable than mushrooms, but it is also a crazy intense 12 hour voyage that leaves one with at least two days of recovery time after. Vs 4 hours for mushrooms.
Both are extremely "set and setting" sensitive. Take either on a bad mood day with bad weather, a dirty house, and stuff on your mind... and you won't have a good time.
> Take either on a bad mood day with bad weather, a dirty house, and stuff on your mind... and you won't have a good time.
That doesnt sound like the start of an apparently very promising candidate for treating depression and PTSD. Just goes to show how different experiences are, I guess...
Sure, I imagined as much. My point was that your experience (and others like yours) seems to differ significantly from the experience of, for example, the people penning these studies.
I personally have no experience with psychedelics (and no desire to get any), so I am just looking with a bit of wonder at the differences from the sidelines.
Yup, from experience, you can give the same dose from the same batch of a hallucinogenic drug to people who are broadly similar in terms of age and overall mental health, and you can get a real wild range of results.
(Except maybe ketamine. Ketamine seems pretty consistent, in my anecdotal experience.)
Yes, but talking about that makes one a "science denier" etc.
My wife has a good one: she burns opiates different, so they don't really benefit her. she just gets nausea from them. They've got her down as a "drug seeker" now cuz she refuses them.
The two times I got SSRIs prescribed both psychistrists underlined that fact. We are trying to find something which worked for me, and the first choice might not work out. For example, Fluoxetine (Prozac) got the adverse side effect that I got severe muscle fatigue. Basically, it makes me more sensitive to pain. But it also makes me less edgy. I find it counts for all drugs and even food (sugar makes thirsty, requires good dental hygiene; salt makes thirsty, pee less; yet we crave both in our food).
All of medicine has a lot of possible side effects depending on the person taking them. Current anti depressants can have severe side effects, whether just until they're properly dosed or not. No one says we should start handing out shrooms to everyone over lunch. But either we allow illegal, unhealthy, corruption-causing criminal markets to flourish with a lot of negative effects on society or we legalize and control it.
> Just as you’d feel extra-sceptical if all the research showing that pork is unhealthy was written by Muslims who’d already decided for religious reasons not to eat pork, you should be worried about the sheer number of studies by psychedelic researchers who are themselves aficionados of the drugs.
Perhaps a better analogy would be: just as you'd feel extra-skeptical if all the research showing that exercise is beneficial was written by exercisers who'd already decided for experiential reasons to exercise, ...
It's not like people are born into the religion of psychedelia and have strong cultural reasons to conform. If something truly is good, of course the people researching it are going to be "aficionados" of it. And this doesn't save it:
> (You might wonder if they’re into psychedelics precisely because the research shows such impressive benefits, switching around cause and effect. But as we’ll see below, that evidence doesn’t exist yet. That particular horse is coming way after the cart).
Why can't they be into it simply because it worked for them?
There's nothing about the fact that psychedelic researchers are excited about psychedelics that by itself is suspicious, as we are strongly being led to believe.
Personally I think it's valid to consider selection-bias effects in authorship -- in general, things are written by the people who are the most excited about the topic, which leads to there being a bias towards excitement. I don't think it invalidates the research but it feels like a valid point.
I think an interesting observation is that this anti-psychedelics post is written by someone who doesn't even want to try them, so this argument of his also says to treat this blog post with skepticism.
My qualm isn't about whether it introduces bias, but why it does. The example he gave implies that the only possible reason is a _religious_ one, and that's not fair.
>There's nothing about the fact that psychedelic researchers are excited about psychedelics that by itself is suspicious, as we are strongly being led to believe.
It's also quite possible that they are excited about the potential to try a different method of reducing the suffering of patients with mental illness with more efficacy, or fewer side effects, or some other positive change. Anybody can be excited about something while doing another thing. Presumably at least some of these people wish to provide aid, um, when they are not reeling from acid, and grooving on E's, or apparently, assaulting patients, based on the article.
By the way, how does he know they use the drugs? He said some guy said he knew a lot of people who did. A valid concern with mental health is the difficulty of evaluating statements people make about their, or other peoples internal states, and for what reason they make such statements. Basically he's saying, "They're addicts! Some dude told me!"
That's literally hearsay, although this is not a court environment, I suppose. Still, I, for one, would prefer a bit more rigorous statement about this endemic drug use among researchers.
As for his example, lots of people don't eat pork, for a variety of reasons. If someone follows their procedure and replicates their results, then does it matter if they were Muslims? Skeptical? Have some bacon and do the experiment, see if you get what they got. Of course you wouldn't just take it on faith, my goodness! Not all, certainly, but some people don't allow their desires to supersede their professionalism. I don't know, are Muslims even that invested in not eating pork as to fake a bunch of studies to fool the masses into not eating back bacon?
Actually, given what we know about the replication crisis.. hmm.
But surely people who take psychedelics have their own subculture, right? Dr. Alice and Dr. Bob might spend long weekends listening to Cream and obviously Black Sabbath, and definitely some jazz, staggering high because they are trying acid to wean them off of the Oxy's they were into 3 years ago, or the boozing they did under quarantine ... but what if they got results that are worth looking into? Anybody who's known someone using psychoactive drugs surely... well the drugs available now sure seem sub-optimal.
( What about their kids? They're trippin with the kids? Really? REALLY? )
You know, I'm quite unsure about this assumption that the researchers need to spread their drug of choice to people claiming ( skepticism about the afflicted seems to be a theme in the comments? I guess they should just snap out of it? ) mental defect to a third party, which is a life changing decision.
I'm not saying that these things are impossible, or inconceivable. Unfortunately. I question the number of people who act like this, while maintaining well enough to author research papers and do Guardian interviews, vs the number of people who are enthusiastic about reducing suffering and are pursuing a surprising and somewhat promising avenue to do so. They would be in a great position if this work led to a better way of treating mental illness. Seems exciting.
The article makes a lot of good points. I'm a lover of psychedelics, I've apparently managed to be wired in a way that has made every single experience one that I don't regret (whether joyous, superficial, or intricate, unexpected), but I would never make the mistake of assuming my experience directly translates to other people's. Hype, cultists and people thinking in absolute only do a disservice to what we could extract from those experiences.
Serious research with people who are detached from the drugs is something we should all want, especially because we've only had a short time for detailed records of psychedelics experiences to exist at all and most experiences to this day aren't really observed scientifically at all. I believe that science is the best thing we've got to approach the unknown, psychedelics aren't a "godly exception".
I also remain aware that science doesn't always offer answers right away and we just keep on going anyway. It's been true for most technologies, for a lot of what goes in our food every day, for how we've structured society, etc. We accept that there's unknown risks, we try to mitigate what comes our way and prepare for what we can estimate, and we learn to live through what we didn't see. But we still eat the food, use the technologies, try social systems, and so on.
I think that attitude is also one to have with psychedelic experiences. That happens through testing what you have, guided experiences if and when there's a need or uncertainty, "set & setting" and discussing them beforehand, being gentle with dosage, making a sincere attempt at an inventory of the self before deciding on taking the psychs, and so on and so forth. And some people try some of it, some people don't, and that's OK as long as everyone strives to have an experience they can handle with what they know. Just like with everything else.
Is it true what they say about psychedelics helping people to come to terms with their own mortality and death?
Occasionally I'll get crippling anxiety when I think about how one day I'm going to stop existing and there's absolutely nothing I can do to stop that.
I've heard people say that [some drug] has shown them how to no longer fear death and always wondered about that.
I don't think it's possible to make a broad statement like that about psychedelics. You'll always just hear one take from a person with their experience and the experience of the people they might have tried it with or even guided, but the spectrum of experiences is too vast to qualify and quantify it without the actual research.
My personal standpoint is fairly different from yours because my anxiety is permanent and a measure of the "agitation" of my existence, to which death is almost a relief really. From that standpoint I've never quite had to confront much of anything about mortality or death. In fact I've almost always felt more alive during trips, at peace with whatever flowing model of the self and existence experienced in the moment. Psychedelic effects can make our senses feel more 'salient' too (for me musical experiences can be very profound), which I've used to contemplate extremes (like noise-cancellation silence after a roaring musical piece).
The main regularly noticeable thing I experience after just about every trip (of various kinds of psychedelics) is severe depression being alleviated for anywhere between a couple days to a few weeks.
Ultimately though, most of what I would say is just likely to be whatever personal theory I've built up this unique stream of experiences. That's why we really need people to get in there and do the difficult work.
edit: also the "some drug" in question is most likely DMT, and I've had extensive experiences with it (on its own or not) and absolutely appreciate that others would have religious experiences, near-death experiences, etc.. but I don't think anybody with any experience of DMT that goes beyond a one-shot would testify to the reliability of trips of such nature. It can be a very volatile experience, as well as being much less predictable from person to person than the more mild stuff like low doses of mushrooms etc. Again, science might eventually come to the rescue :)
I would be very interested to know where Stuart Ritchie's funding is coming from these days also. I am rather surprised that he did not list all his sources of income in a show of transparency.
> A few years ago, John Ioannidis (RIP) published an article on conflicts of interest in nutrition research. The conflicts you get in this field, he said, are different from those in, say, Big Pharma-funded trials of new drugs. Not only are there those usual kinds of financial conflicts—some research is paid for by the food industry; nutrition scientists have diet books to sell—but there are “nonfinancial” conflicts, too. If you’re a strong adherent to the particular kind of diet you’re researching (vegan, Atkins, gluten-free, etc.), Ioannidis argued, you should disclose this at the end of the paper, so readers can be fully informed about how the research was produced.
I find it's common to see forum comments like "we know this researcher is a big advocate of X so this study is bias". I find this critique is usually very shallow and sets an impossible standard.
Where are you you going to find researchers pouring years of their life into researching a subject they have no interest in or opinions of?
If you were studying vegan or Atkins diets for example, it's an ongoing personal choice in your day-to-day life if you're going to switch to/from that diet or not, where either choice could be used to imply bias in your future studies. And after a few years of research, how could the evidence you collect not impact your personal choice? And if it doesn't, what would that say about your belief in your own research?
Researchers are trained to be aware of their biases, to devise experiments that reduce these biases, and peer review helps identify problems here also. Another part of peer review where the media jumps the gun is that other researchers should be able to replicate the studies themselves to check the results - if you become known for producing highly biased research that can't be replicated this is surely going to impact your career (e.g. less citations, less funding, distrust from peers) so there's a very strong incentive to keep this in check?
I think in general, the real problem here is the dysfunctional click-bait approach the media has with scientific reporting (exaggerated, sensationalist, premature, lacking any nuance/caveats/details) and the public's understanding of the scientific method is very broken e.g. the notion that scientists are always changing their minds, little understanding of how to evaluate how strong evidence is before accepting it as true, which includes dismissing everything about a study because they can create a story about one researcher being bias.
> If you become known for producing highly biased research that can't be replicated this is surely going to impact your career so there's a strong incentive to keep this in check?
I would strongly say no.
If the vast majority of studies in the “soft” sciences are already not reproducible, the risk to a person’s career is minimal.
This is before accounting for the pattern of prioritizing short term gains over mitigating long-term risk, especially if that risk is considered to be low.
> If the vast majority of studies in the “soft” sciences are already not reproducible, the risk to a person’s career is minimal.
Let’s not be so arrogant as to say this is isolated to the soft sciences. Soft science is only the most obvious because it’s much harder to run science experiments in the real world. Let’s not forget the fact a computer science PhD student committed suicide because of the degree of academic fakery he was being forced to participate in at an elite institution. That we still have nonsense like unreproduceable ML papers, and physics has multiple examples of older models being wrong and only being held up by the political power of the academics who built their careers off them.
Yeah I visited some of their sacrificial sites out there, weird vibe. They believed the person being sacrificed would be reborn as royalty basically. Parents viewed it as a great honor to have a child sacrificed
I concur with the core message -- that the current research on psychedelics is not strong. Some of the problem is that the research itself was not designed with an eye on earning FDA approval. This was hard to do because we'll never have a true double-blind psychedelic trial for psychedelics like we can have for SSRIs. Spravato recently showed a path for FDA approval, because ketamine treatment for depression closely mirrors protocols for psychedelics.
How is it different than trying to double blind talk therapy. Obviously someone knows that they are getting talk therapy, likewise, people obviously know they are getting psychedelics.
Yet we are still able to get experimental results supporting talk therapy and no one complains, right?
Also don't get this, how would you ever possibly isolate that? Give them a drug which kinda feels like MDMA? But what about the individualized effects of that drug?
It feels more like they are just looking for a critique. All in all it looks eons better than most SSRIs we prescribe willy nilly every day.
Give non-alcoholic beer to 100 people who don't drink beer. I don't know the number, but I would be surprised if there weren't at least 10% who reported feeling tipsy and acting in stereotypically drunk ways.
I know that some psychedelic researchers use a suitable dose of niacin as the control arm. The person will experience some flushing and a faster heart rate. If they are new to psychedelics, they don't what psychedelics are supposed to feel like, and so they assume it is the real thing.
Yeah I don't really get this either. The author suggests asking a lot of detailed questions about which arm participants thought they were in. What happens if participants (as you would expect) make very accurate guesses?
"This is just an anecdotal account, but there’s an interview with the psychedelics researcher Manoj Doss, who says that he “only know[s] one psychedelic researcher who’s never done psychedelics”, and notes (in an encouragingly self-critical way) that this is a conflict of interest." - Yeah that's a good point to be honest
I think that some of the most interesting applications for psychedelics as medicine target treatments that aren't strictly mental health related. Ketamine is already approved for ischemic brain damage or stroke, like you better hope that's the first thing you get in the ambulance to prevent glutamate excitotoxicity from getting really nasty if you fall of a motorcycle or whatever - But DMT actually shows a lot of promise for recovery too, and I'm actually getting involved in a project tangent to that research right now. We're talking sub-psychedelic micordoses to build people's neurons back from brain damage, one of those things in modern medicine we're still generally hopeless about. Pretty interesting stuff! [1]
It’s easier to market “psychedelics” than meditation, prayer or something like DBT. We should learn from that and try to make more things as popular as psychedelics. “Put this little square of paper on your tongue” is much less of an ask than “sit in chair for 30 minutes everyday and be mindful of your breathing.” It’s like the McDonald’s approach to mental health, and who doesn’t love McDonald’s! Over a billion served. Psychedelics scale similarly.
Psychs are absolutely not comparable to "sober" activities. While things like meditation have benefits, you are still largely operating in the same regimes within the neural network in the brain.
The main idea behind psychs is that they allow you to operate in a vastly different regimes. And, unlike McDonalds, and compared to other drugs, they are INCREDIBLY safe. It should be a no brainer for anyone needing them to use them.
If it works, and that's all it takes, that's fantastic! But you have an incredible solution too it seems?
“sit in chair for 30 minutes everyday and be mindful of your breathing.”
Now this is great advice for everybody. Unless during these quiet times the weight of the world lays upon you, or your grasp over your inhibitory system is not sufficient to find stillness, never mind finding discipline of the breath.
What about the people who's affliction is not due to some implied lack of industry or effort? What if the problem is not ... sloth?* ... but actually a flaw in the brain, or imbalance?
I guarantee you that there are not a billion people who are gagging for psychedelics as a solution to their mental problems. The question is: Are they in fact a solution?
Prayer: Unless you are praying to some entity who publishes regularly, I feel this avenue has been tried and found to be lacking.
[*] I do not endorse this concept. I don't think you can just "apply yourself" and heal your mind, any more than you can do could with your lung cancer. Sure it helps, but we'd like to minimize the suffering, not endure as much as possible.
I liked the article and tend to agree there is a lot of pressure to rush psychedleics to the mainstream.
This is from a person who used MDMA to heal bipolar / schizophrenia in an underground setting; ran an underground clinic for 3 years; took funding from Dr. Bronner to found a non-profit to decriminalize plant medicine; and was featured in a PBS documentary administering MDMA in an underground setting.
Also, the author obviously hasn't done psychedelics ;) and he states as such.
"I’d think about taking them if I had a relevant condition and the evidence they worked was convincing." You could argue that the relevant condition is that you are a living human, and we've evolved to be in relationship to altered states of consciousness.
Yeah I have the same impression. The author wouldn't have even written the article if he had tried psychedelics, which are often reported as the most significant experience in peoples lives.
This is just reductionist thinking, which can be good to temper things and reduce harm, but the authors bias is pretty readable
I have to wonder how many of our strongly held beliefs can be rendered irrelevant to our own minds by something as mundane as a few micrograms of a chemical.
I also have to wonder how many of those beliefs can only be corrected by something as drastic as a foreign substance acting on it against our will.
In some other universe, the world might become a very different place if the people in power chose to take LSD with an open mind. If so, there would be no "meaning" we could attribute to that radical change except that it was the result of a chemical formula.
It feels like there is something profound about that related to the meaningfulness of all things, but since I haven't taken psychedelics, I guess I am still blind to what it is.
It does stimulate empathy among other things, which is something that's very lacking in politics (meaning genuine empathy, not the virtue signalling performance variety).
This article is interesting but a major issue is that the vast majority of the points (and the linked articles!) are not about psychedelics. They are about pharmacology, psychology, statistical significance, and science in general. The majority of the author's critiques can and are applied to a lot of other fields (he even takes a meta-review critical of nutrition and applies the logic to psychedelics).
His main three themes (author bias, statistical significance, double-blinding/scientific rigour/confounding) are not at all unique to research with psychedelics. If the author's point is that we should take all studies with a grain of salt then why focus on psychedelics? If psychedelics is really such a problem field then I would expect more evidence than a couple bad actors (the MAPS stuff sounds terrible!) and light issues in a few studies that were brought up in reviews before publication.
It seems the main point isn't research as much as the public's perception and hype (partially fueled by researchers to be fair). That's a good point and I'm totally against the psychedelics version of "weed cures cancer" bros. But, as the author points out, this isn't unique to psychedelics either! Ironically, I found the intro and most of the article to sound much more critical of the research than the conclusion really is.
Why are these articles so popular with HN? Any article about treating mental illnesses (including depression) with LSD/shrooms/cannabis/[drug] immediately shoots to the top, and I see articles like this every other day at the top of HN. Is it just people wishing for a silver bullet that will cure their mental problems? At any rate, the number of mentally ill people on the internet must be much larger than I am estimating.
To your first point, I suspect that hacking your own brain and pituitary gland fits with the ethos of hacker culture. What’s cooler than going to the doctor and getting the same SSRIs as every other chump when you can hack together your own medication?
In reality this is why we need serious research into these drugs. I am sure there are therapeutic benefits and also yet unknown risks. Would be nice to study them formally.
To your second point: I know very few people without mental illness. GAD and generalized depression account for a large part of it, but so do neurodivergenicies like autism. Chances are much higher than you think that you yourself have one or more condition like this. That’s not to say I wish for you to have one, just that statistically speaking lots of people have them, so much so that the current advice is to establish mental healthcare same as you do with a primary care physician and have at least yearly checkups.
>> Overall, it is difficult to see how prohibition of psychedelics can be justified as a public health measure”
> This is activism, not science. As I said above, I actually support drug legalisation – but it’s far from appropriate to include this kind of thing so prominently in what’s supposed to be a neutral, factual scientific analysis.
Scientific studies that ingesting chemicals like THC are one of the reasons we have things like the Rockefeller drug laws. Activism from some in the scientific community is one reason people are rotting in jail for selling marijuana (while tobacco companies donate to politicians and in return get trade deals where it is illegal to have a law requiring warnings on cigarette packs.
People can be arrested for ingesting mescaline from peyote plants like Native Americans used to, scientific studies and activism is one reason for this, but scientists asking for people not to be imprisoned for getting mescaline from a cactus is not "appropriate".
(I have never tried mescaline but don't want to be imprisoned if I ever do)
Anecdotal but I did LSD when I was 19 and have been a been a huge consumer of mental health services, antidepressants and anxiety meds ever since. Prior to that horrific incident, I had no issues to speak of.
So we can't say that they can cure it, but they most certainly can cause it. Perhaps the sword needs to cut both ways to be effective?
The author points out a bunch of problems that are present in basically all research involving human behavior. He implies that it is particular to research involving psychedelics (except for I think a single example involving diet), and that is false. He should take a look at the dumpster fire that is Social Psychology...
The article mentions Cover Story: Power Trip podcast which I finished last night and enjoyed so much. It’s by New York Magazine and the folks at Psymposia. Highly recommend as a balancing counterpoint to all the positive hype about psychedelics.
For the record, I have been both helped and harmed by psychedelics and in net believe their return is positive. I’ve seen enough oddities in the Bay Area psychedelics and mental health scenes to warrant some serious caution about the current path we’re taking.
I’m reminded of something the PhD Pharmacologist Psychiatrist told us during med school - effect size of new depression meds decreases over time (probably because you have an early positive result and then it’s pushed in and then later better quality studies show smaller difference) so the joke is ‘every time a new depression medication comes out there’s a race to use it before it stops working!’
The best description that I have heard that most users that I have spoke to agree on is that psychedelics have an aspect of "flattening" emotional significance of things by making any thought that you have just as "prominent" as another experience. The reduction of blood flow to the area of the brain that is responsible for parsing reality means that your thoughts become more prominent, making any thought of change or improvement just as impactful mentally as what you believe your reality is.
This in turn gives lasting perspectives in the form of "hey, I am able to think and feel about things differently and not locked into this pattern of thought", which could be the necessary catalyst for change.
My strong-man description of your (I think correct!) feeling is that we all have a very specific lens through with we look at the world. Because all of us have very very limited lenses, but the world is actually quite large and complicated, we each end up with our own neurotic worries that are in a way over-blown when compared with the chaotic complexity of actual reality. Just think of that friend you have that always brings up the cost of something, or that person in your life who seems to always bring the conversation to how their political viewpoint would alleviate the problem, or the person who seems to always have a new and exciting reason to not have a kid yet.
Psychedelics just allow us to step out of our rigid framework for a few hours. For people with flexible/creative minds it might not be such a big deal as they are used to looking at reality and asking "but what if it were this way...", but lots of us have rather rigid conceptions of reality. Taking mushrooms and realizing that most of our worries are 'made up' in the sense that they don't relate to our basic needs can be eye opening.
Yeah this seems intuitively correct. Psychedelics are largely playing with your beliefs of the world, which is why it can go a lot of ways and is hard to study.
In a good setting with good guides it can be wildly transformative in a positive direction.
One of the effects of psychedelics is that they allow you to perceive, for a while, just how incoherent many of the things we take for granted really are, both about ourselves and about the society around us.
This can be hugely beneficial to figure out the root cause of some mental health issue one suffers, because they often lie in those two areas - mistreatment of oneself, and/or traumas caused by other people's behavior that we're conditioned to treat as normal. But that knowledge is also something that'll nag you ever after, and might make you more politically active, which is its own can of worms in terms of mental health.
If it is true that the mind is "anti-fragile", in that, appropriately dosed stressors make it stronger, then perhaps its not "or", but "and".
Psychedelics treat mental illness and cause mental illness. They treat it by causing it.
Regardless, mental illness seems highly relative to societal norms. And psychedelics have a way of minimizing the importance of societal norms, so maybe thats a factor too.
One challenge around studying these drugs is efficacy is often linked to expectation. Some speculate 1 key mechanism at work is an amplification of the placebo effect. If this is the case then clearly testing of these drugs using traditional techniques to eliminate the placebo effect will be problematic
The argument ”all but one psychedelics researchers have taken psychedelics” is not particularly convincing; many other researchers have taken psychedelics, too. Certainly one wouldn’t expect e.g. liberal arts, sociology or organic chem majors and their cohorts to be completely naive to them.
The author says
> Quite a few psychedelic drugs are naturally-occurring, and have been used for hundreds of years (this doesn’t include synthetic ones like LSD, obviously).
LSD occurs naturally in the Ergot mushroom:
> The ergot fungus contains a number of highly poisonous and psychoactive alkaloids, including lysergic acid (LSD), which was synthesized from the ergot fungus in 1938 by chemist, Albert Hoffmann [1]
What the author means is that it's synthetically made these days. Psilocybin can also be synthetically made these days.
psychedelics are the best hope humanity treating refractory mental illness. I know at least 5 people personally that have embarked on psychedelic voyages to treat their demons. Some of them are renowned psychiatrists.
The US Forest Service is just wrong on this. Ergot does not contain LSD, although it contains very similar psychoactive alkaloids. Ergot cannot be called a mushroom, it is a fungus that grows on wheat, rye or other grains/grasses.
Parent used the term mushroom, but the article does not.
It's correct that the fungus does not contain LSD the chemical, but it does contain lysergic acid which is colloquially LSD the drug. For a short, layman-targeted article I'm inclined to give the US Forest Service a pass on this one.
>but it does contain lysergic acid which is colloquially LSD the drug
The chemical differences between "lysergic acid" and LSD areas significant as the differences between morphine and heroin, if not more so. Pure lysergic acid is closer to LSA, which is still categorically not the same thing as LSD - to the point that many people will refuse to take the former when a test kit reveals they got that as opposed to the latter. They are not colloquially equivalent.
As a counterpoint, I'd read Michael Pollan. Also, a fundamental problem with this article is the lumping of 'psychedelics' into a neat category so it can be critiqued. In the real world, the story of what's happening is diverse.
TL;DR: This is a dangerously biased dismissal of actual science and historical progress in understanding of various 'psychedelics', and it's exactly the kind of cherry-picking dismissal that's been fought against for decades.
As someone who quit drinking alcohol quite a long time ago ( which I am quite sure is why I am alive today) I agree that one of the "side affects" of LSD is that it helps one to come to the realization that they are killing themselves from a bad habit. I cannot say that it killed my desire to drink, and I did drink for a while after an experience with what might have been LSD. An interesting historic tidbit is that the founder of Alcoholics Anonymous was introduced to LSD and thought it was a tremendous tool to fight Alcoholism. By that time a foundation had sprung up around AA, and the board members urged Bill Wilson not to proselytize on the subject less it incur bad publicity for the organization( one of their traditions is to avoid controversy on outside subjects) Since the name of Bill Wilson was synonymous with AA he agreed to quit talking on the subject.
Months after dosing with LSD drinking alcohol has the appeal of drinking department store paint thinner. It works. It's sad that people are scared to associate with it due to its demonization.
From knowing a whole bunch of people with ranges of issues, my personal opinion is that it seems that certain people are just simply not "tuned" to their lifestyle/environment, and the mental health issues stem from a certain part of that psyche not wanting to change their environment.
Not that this would get past any ethics board, but it would be an interesting experiment if you took someone suffering from severe depression, fed them 10 grams of shrooms to reset their brain, and then put them in a remote village in South America with no phone or internet where basically their entire day has PURPOSE - i.e wake up, do work with fishing/farming/hunting construction, socialize in the evening, all as a group activity.
People with severe depression probably have things they don't get around to here. No phone or internet means no family or friends, but I guess if you are planning to feed them 10g of shrooms and dump them back into a hunter gatherer lifestyle in South America you won't want them contacting anybody.
I personally would very much like to use my phone after somebody fed me TEN GRAMS of shrooms. I strongly feel that I would want to do them on the plane, and not in a remote village where I don't even speak the language, and I've got to occupy myself in the darkness with strangers who are going to make me stagger into the jungle and fish, or farm, or hunt. Something I was not severely depressed about would be my very low parasite load, or the lack of arthropods in close proximity. In fact, there are virtually none here.
Somewhere in South America there are very large spiders. We don't have them here. I would certainly not be depressed about this. In fact, I am jubilant and appreciative of my good fortune.
In fact, were I to have this condition, it would stem from an imbalance in my head. Because of it I would become depressed. This would be different than me not being "tuned" to my lifestyle, it's not clinical depression if I just need to paint my walls orange or just stop being such a mopey downer, it's a real drag, pitter patter, let's get at er! WEW! PROBLEM SOLVED!
It's like going bald, or having asthma, or being washed away by a tsunami while you are on a date. Sometimes things happen, which are not ideal and also not because of any defect or sin on your part. Sometimes things just happen, sometimes they happen to you.
For example, the poor person who's mind you reset with TEN GRAMS of shrooms and fired off thousands of miles from home and back in time thousands of years to do backbreaking manual labor among strangers. Seems unusually coercive, no? Punitive. Would you do that to your dog? A dog? For being sad too long?
Depressed is not stupid, after the monumental shroom trip, you'd have to force them to stay there, surely? This is probably the part where the ethics board might ask more questions, I reckon. We agree on that at least. Anyway, what if they in fact are not shamming and succumb to despair? Or simply tip the canoe or whatever over learning how to fish? TEN DAMN GRAMS of shrooms is going to make skills acquisition difficult, for quite some time after they eat them.
Socialization might be a lot to ask, do we share a language? What's the purpose of this anyway? Shouldn't this PURPOSE be something defined by me? Lack of agency was not a problem I had before, why is it part of your experiment? I mean, you don't even give me a choice, can't I volunteer or something? My friends probably are not sick, can I socialize with them? Instead of the strangers? In the village? How about you send me to work in Milan? Ok, Wales? Scotland? Missis... hmm. Scotland?
I mean really, you think phone and internet need to go, but instead want to force group interactions with strangers instead?
By the way, about your "personal opinion." If you know a whole bunch of people with ranges of issues, how did you achieve the deep insight into las depresionistas? Or are you saying that slacking is the root cause of mental illness? Force them into paleolithic lifestyle and they'll snap out of it? Would you say you've read 10 books on the subject? How many more than 10? Lots? I'm just trying to properly value your opinion here. How's your results?
Finally, I have to say that your experiment kind of seems similar to pray away the gay camp or whatever name was used for it. Isolation, coercion, duress and reconditioning. Plus TEN GRAMS OF SHROOMS.
Not OP but if I read between lines it might mean that it is way cheaper to give people some soma than addressing the actual root problems certain societies have.
The reality is that people are open to anything that promises alleviation of suffering from what os diagnosed as "mental illness" because the mental health industry has proven to be a complete scam designed to keep people sick and provide them lifelong "treatments" that don't work.
However he shows the same kind of bias that he is speaking out again by not discussing the best known branch of such research. And that is MDMA for PTSD.
It is best known simply because it is, in fact, demonstrating that it works. The FDA has been repeatedly calling it a "breakthrough therapy" since 2017. It is in multiple phase 3 trials around the world that are going well, and full approval is expected this year. Research papers on it, like https://www.nature.com/articles/s41591-021-01336-3, are appearing in the top science journal in the world and are no less enthusiastic than a press release. Let me quote, "These data indicate that, compared with manualized therapy with inactive placebo, MDMA-assisted therapy is highly efficacious in individuals with severe PTSD, and treatment is safe and well-tolerated, even in those with comorbidities. We conclude that MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation."
So no matter how much questionable research there may be - and I'm sure it is a lot - let's not throw out the baby with the bathwater. There is also good research, and these drugs have the potential to make a huge difference.