Dr. Craig Heacock, M.D., psychiatrist and ketamine treatment provider, offers a counterpoint to a previous guest’s view on mental illness and psychiatric medications. While his goal is always to have patients on as few medications as possible, Craig stresses the importance of correctly understanding the nuances of mental health and mental health treatments instead of painting with a broad brush. He and Paul also discuss the current state and near-future of psychedelic treatments for mental health, as well as the reception of psychedelics among the psychiatric community.
Dr. Craig Heacock, M.D., is an adolescent and adult psychiatrist and addiction specialist practicing in Fort Collins, Colorado. He’s had a decades-long interest in psychedelics since taking part in a DMT study in the 1990s, and was co-therapist in the Phase 3 trial of MDMA-assisted Psychotherapy for Severe PTSD. Craig is particularly interested in ketamine and MDMA as treatments for mood disorders, and has completed over 1,000 ketamine treatments for patients in the last few years.
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This episode is brought to you by Mindbloom, a mental health and wellbeing company on a mission to help people expand their human potential by increasing access to effective science-backed treatments for anxiety and depression, starting with guided ketamine therapy. Mindbloom partners with licensed psychiatric clinicians to help their clients get the most out of treatment through technology, content, and hospitality-inspired client experiences. Third Wave's viewers can get $50 off with the code "thirdwave is here."
0:00:00.5 Paul Austin: In today's episode, we have Dr. Craig Heacock, a psychiatrist out of Fort Collins, Colorado, who's also a co-therapist in the Phase 3 trial of MDMA-assisted Psychotherapy, and was recently featured on CNN in Lisa Ling's feature on psychedelic substances.
0:00:19.5 PA: Welcome to the Third Wave Podcast. I'm your host, Paul Austin, here to bring you cutting-edge interviews with leading scientists, entrepreneurs and medical professionals who are exploring how we can integrate psychedelics in an intentional and responsible way for both healing and transformation. It is my honor and privilege to bring you these episodes as you get deeper and deeper into why these medicines are so critical to the future of humanity. So let's go, and let's see what we can explore and learn together in this incredibly important time.
0:01:00.1 PA: Listeners, do we have such an interesting sponsor for you this week: It is Kraken Kratom or Kraken Kratom or Kraken Kratom, or whatever and however you wanna pronounce it. This sponsor is quite a bit different from some of the other ones that we've had on the show before. We've never actually had a specific substance which we have a guide about, because all of the substances we talk about on Third Wave are, for the most part, illegal, which is why we're providing education to shift that.
0:01:25.8 PA: But Kratom is legal, it's something you can purchase, and it's something that I've personally used here and there. I've probably done Kratom maybe four or five times, very, very on occasion, usually in the evening with a couple friends as more of a social thing, or go to a kava bar, try kava and Kratom together.
0:01:46.0 PA: And this week's sponsor is Kraken Kratom, who strives to deliver the highest quality, most thoroughly tested Kratom products available. From powders to extracts, to capsules and tablets, Kraken has what you're looking for. They're GMP-compliant and meet extensive quality control standards. And Kratom, in particular, is great for a number of things: Energy, mood, general aliveness.
0:02:08.8 PA: But it also has a dark side. Kratom is slightly more addictive than things like Ketamine, much more addictive than things like the classical psychedelics. So it's good to use in an intentional way with some sort of ritual. And to do that in a way that helps with the both the healing and the transformational process. So if you want to learn more about Kraken Kratom, go to krakenKratom.com and you can find out more information there. Use the coupon code 'THIRDWAVE', that's one word, for 20% off your Kraken Kratom order. Thanks so much.
0:02:47.2 PA: And this podcast is sponsored by Mindbloom. Legal psychedelic medicine is here, and it's available through Mindbloom. Mindbloom helps you transform your life with safe, science-backed psychedelic therapy. If you're looking for your depression or anxiety breakthrough, Mindbloom provides a fully guided and clinician-monitored experience tailored just for you. Some clients see results as soon as 24 hours after their first session.
0:03:14.8 PA: Mindbloom is in fact our first official partner here at Third Wave, and a company and organization that we support. In fact, I'm going to start my own Mindbloom experience in the coming weeks, and will write about my experience going through Ketamine therapy to address both Cannabis addiction and general anxiety. The Cannabis was to cover up the anxiety, and I can't wait to share my own transformation with you.
0:03:48.5 PA: Hey, listeners. Welcome back to the podcast. As always, I am your host, Paul Austin, here with an episode on treating significant mood disorders, with Dr. Craig Heacock. I heard from Craig just after we published the Erick Godsey episode, which I think was episode 102, it was a couple months ago.
0:04:10.0 PA: Craig had reached out sort of rebutting a few of Erick's points as it relates to our mental health care system and our pharmaceutical system, essentially saying that a lot of what Godsey had talked about in relation to mental health was too wide of a paintbrush, so to say, that there were more particulars that we had to pay attention to around the efficacy of certain antidepressants and conventional psychiatric drugs, and how that relates to healing people who are really quite sick.
0:04:44.3 PA: And so I reached back out to Craig, I said, "Hey, thank you so much for writing this thorough email. Would you like to come on the show and talk more about this?" Only later did I realize that Craig had also been featured in Lisa Ling's CNN special on psychedelic substances, talking about his work with Ketamine and what he was doing in Fort Collins.
0:05:03.5 PA: And then I sort of started to do some little research around Craig, and turns out that he was a participant in Dr. Rick Strassman's groundbreaking DMT study at the University of New Mexico in the mid to late 90s, which is all chronicled in Rick Strassman's book, The Spirit Molecule. So I invited Craig on the show and we got into sort of a balanced perspective about, "Hey, this is where we're at currently with mental health care."
0:05:33.4 PA: "This is why certain conventional psychiatric medications are useful for what situations and scenarios they are useful where maybe they're not so helpful. And why psychedelics, both MDMA and Psilocybin, will help to eventually help us to evolve more and more out of conventional psychiatric treatments into a whole new way of approaching these things."
0:05:54.5 PA: It was a very grounded approach, a very important approach about, "This is where we're at right now, and this is what we can do in the next six months to a year to five years to help shift and change this system." So I learned a lot in this episode. I've had my own hesitations about the current mental health care system, which I've expressed numerous times on this podcast. I read a book called the Anatomy of an Epidemic by Robert Whitaker several years ago, which helped to help me to better understand what was going on with our current psychiatric system.
0:06:27.5 PA: What I love about Craig is Craig is pro-psychedelic, pro-Ketamine, pro-MDMA, pro all that healing, and he also still works with clients who are very sick and has to prescribe, and prescribe things like Wellbutrin and other conventional psychiatric medications, which a lot of us in the psychedelic space see as being not ideal. So anyway, this is a really balanced conversation, and I won't take up any more of your time. Without further ado, I bring you Dr. Craig Heacock.
0:07:01.1 Craig Heacock: Anxiety is normal, we know what that it. Most of us have been, at least grieved, if not, had some measure of depression. But that's not what comes in a psychiatrist's office. What comes into our office is really severe, people who cannot function, people who cannot parent their kids, cannot go to work, or thinking about when and how should they kill themselves. So I think... And I think Erick probably means well, but he's just, he's completely missing the boat. [chuckle]
0:07:30.7 CH: As I talked about in Psychedelics Today, it's almost like he and Will Hall's argument is, "Hey, if the psychiatric soccer team just played better defense and passed better, we wouldn't need the fucking goalie." That's a nice thought, but the thing is, yeah, I'm all about we should have passion and art and meaning and connection and love and excellent therapy. And we should exercise and we should find peace and meditate.
0:08:00.9 CH: And sometimes, bad mental illness breaks through and it's horrifying, and we have to treat it, aggressively sometimes. And sadly, those are some of the people who we struggle most to get them onboard with treatment 'cause they're just so full of shame and, "I'm broken, and now you wanna zombify me with meds and... " So I hope that...
0:08:22.6 PA: It's complex.
0:08:24.1 CH: Yeah, it's super complex, right. And I think one of the reasons, too, that I love Third Wave 'cause I'm all about psychedelics. I do probably 15 high-dose Ketamine sessions with patients a week. I just stepped out of a MAPS study that I'd worked with that for three years, I'm super interested in Psilocybin. And I prescribe meds, and I'm a psychotherapist, and I'm a compulsive runner, and I'm a true believer in exercising, and I'm all about, I love psychotherapy.
0:08:53.5 CH: And so I think that the view that Erick and some of the anti-psychiatry people put out is just so black, white. Like, "Let's just dump psychiatric treatment and replace it." But with what? With art? With literature? Again, for about... People are having an existential crisis, yeah, for sure. But for people who are readily gouging themselves with knives, and burning themselves, and trying to find a reason not to drink poison, which, that's who I see. [chuckle]
0:09:28.7 CH: So I just... Yeah, so anyway, I so appreciate that you let me come on and... I'm not a combative guy, I'm actually super friendly, easygoing guy. I am. I don't wanna fight. Erick seems like a cool guy, I think I'd probably really like him.
0:09:42.9 PA: Yeah, no, he's a great guy.
0:09:44.7 CH: It's nothing about him. Yeah, so I'm not... I'm gonna try to barely even mention his name. I'll mention in terms of how you and I connected, but it's really a bigger thing of how people who don't work with serious mental illness often just don't get it and...
0:10:01.3 PA: Well, and this is... This is sort of my... I don't know how much I went into this in the Godsey podcast, but I mentioned a little bit about my background. I don't have a background in mental illness, never been on pharmaceutical medications. I definitely have struggled with depression for most of my teens and early 20s, and then as that was healed, I became more aware of how anxious I was. So over the last few years, it's been more anxiety.
0:10:25.9 PA: But now, I've sort of found a point of balance, and psychedelics have helped tremendously with that process. I've probably done six months of psychotherapy in my life. Both of my sisters are on medications, neither of my parents. And so it's mild to moderate, I would say, but I would also say that's probably the case for tens of millions, if not hundreds of millions of people.
0:10:48.0 CH: Oh, for sure, for sure. And not to diminish mild to moderate. Moderate depression is horrible, and moderate anxiety can be debilitating. So yeah, I'm not...
0:11:00.3 PA: Absolutely.
0:11:01.0 CH: Yeah.
0:11:01.1 PA: So this is all on a scale. And sort of to go deeper into this point, in 2015 or 2016, I was living in Oaxaca in Mexico, and was talking with a friend there and telling her about... This is 2016, early 2016. So this was about five months into starting Third Wave and before, obviously, a lot of the momentum around psychedelics had started to emerge. And so she recommended that I read a book called Anatomy of an Epidemic by Robert Whitaker.
0:11:31.1 PA: And so I read it a couple times. So he talks a lot about ADHD medication and prescribing ADHD medication at a young age, talks a lot about antidepressants, talks about antipsychotics, talks about sort of alternative treatments. He's sort of exploring what the mental health epidemic is about, what role psychiatric medications have played in that, how they're helpful, and also how they're not helpful. And so ever since I had read that book, I've been more on a track of the more we can get away from psychiatric medications and towards more sort of holistic treatments, the better.
0:12:03.9 PA: At the same time, I've interviewed enough psychiatrists and medical doctors through the podcast, and other formats, where I understand that that's not a one... We can't do a one-size-fits-all holistic health treatment for everyone. For some folks, especially, I would imagine with the folks that you're seeing, that the issue is so debilitating that you first need to look at what are things that can immediately help, and potentially to keep the Band-Aid on, so to say, or to moderate the condition.
0:12:33.1 PA: And then growing and potentially looking at the downstream like, "Do they wanna do psychotherapy? Do they wanna do Ketamine-assisted psychotherapy? Maybe they'll be, when MDMA or Psilocybin becomes medically available, that might be a choice." But the fact is here in January of 2021, your legal options as a psychiatrist are still not as comprehensive as you would like them to be, I imagine.
0:12:56.0 CH: Absolutely, yeah.
0:12:57.0 PA: Especially with your background in psychedelics and understanding how useful they can be. So just for our audience who's just stepping in and listening, Craig, I'd love if you could provide a little bit of context about your background, because it's fascinating in itself as it relates to psychedelics and DMT and some of these early things from the early '90s, how that led to your current role. And then just providing a little bit of context about how we connected and why we're having this conversation now.
0:13:24.1 CH: Yeah, happy to do that. So psychiatry is my third career. I was a high school teacher, and then I started down the road to get a PhD, and then saw that seemed hopeless and hard to get a job. [chuckle] And then I worked in the environmental field for a few years. And then I went to med school to be a psychiatrist. Part of the reason I was wanting to do that is I wanted to work with psychedelics, this was back in the mid-90s, and it was just sort of, seemed like it might become a possibility.
0:13:51.8 CH: I was a member of MAPS, and I read in a MAPS journal about this DMT study that was happening at University of New Mexico. And I was living in New Mexico, and so I thought, "Oh, I should enter that." So I went down and screened in, met Rick Strassman and got in the study, and I remember telling him at one point, I said, "I wanna do what you do. I wanna be a psychiatrist, I wanna work with psychedelics." And he said, "Well, that's gonna be a long ways away."
0:14:19.9 CH: He told me a little bit about how hard it was for him to get that study going. I said, "Well, someday this is what I wanna do." And it's really thrilling to think that would have been, let's see, '96, so it was 25 years ago. And that's happening now. I'm doing a lot of work with Ketamine and was working on the MAPS MDMA study, and this is just about the most exciting time ever to work in psychiatry.
0:14:46.3 CH: I've been doing Ketamine work for about three and a half years, and I just stepped out of the MAPS PTSD study, 'cause I just have so much going on. I also have a psychiatric storytelling podcast called Back From The Abyss, and it's the place where people come on and describe their plunge into psychiatric psychological hell and how they got out. Some of those healing stories involve psychedelics, some involve therapy or meds or MDR or all sorts of things.
0:15:13.9 CH: And that's been a... That's been my real love lately, is trying to bring stories of hope and healing and let people know that there is a way out. The way out is often very difficult and can be long, but there's always hope. I think sometimes in psychiatry, we work with such difficult and often lethal people that it's important for me and for others to remind ourselves that actually a lot of good things are happening.
0:15:41.0 CH: So I've tried to feature on my podcast stories of healing with psychedelics, and there's been some amazing ones, including the most recent episode that we released a week ago.
0:15:52.5 PA: And then that leads us to this point in time in terms of even how we connected, how we connected with this podcast. And I would love if you provide the context and story on that, because it also speaks to your involvement with Third Wave's community and listening to the podcast and your background as a psychiatrist in psychedelics but also these other things, I think that'll put a nice sort of...
0:16:10.0 CH: Yeah. Thank you for the prompt. [chuckle] So, yeah, I'm an avid podcast listener, I have probably 10 or 12 podcasts I subscribe to and listen to, a lot, and Third Wave is one of them. And definitely some of the more fascinating people in interviews I've heard have been on Third Wave.
0:16:27.7 CH: So in November, I was listening to the Erick Godsey episode. And the first part of that story's super interesting, although I was wondering, I'd heard him on maybe one or two podcasts before, and he's kinda fallen into his whole anti-psychiatry thing. And I wondered if that, "Oh, is he gonna go there?" and then you prompted him to ask... Talk about his book. So then the podcast evolved into this, I don't know, 30 minutes of not just untruths about psychiatry and meds and mental illness, but what was most upsetting to me, it was so shaming.
0:17:03.3 CH: Because I just spend so much time with people trying to help them work through this not feeling guilt and shame about whatever they're struggling with psychiatrically, and the main messages seemed, that Erick had, was that your mental illness isn't really actually real, it's more of a sociological, psychological construct.
0:17:23.8 CH: And that, at one point he said, "Art will heal almost any mental disorder," and, "Psychiatric meds break the brain, exacerbate the illness." And so I frantically took a bunch of notes, and then got home, and then wrote to you, Paul, wrote the podcast, and said, "Hey, I really love what you guys do, but we have to be intellectually honest."
0:17:46.1 CH: I think in the psychedelic sphere... And we're gonna be high... We are being highly scrutinized, because these substances are coming back online, and we need to speak intelligently and honestly, not just about psychedelics, but about psychiatry and mental health and healing in general, and I think we need to hold ourselves to a high standard.
0:18:05.5 CH: So Erick's misunderstandings and black-white generalizations, and just outright, just rejection of so much of what we do, was really disturbing. And so when I wrote you and asked if you would allow a counter-balance, you graciously said I could come on and talk about this, so I really appreciate that. And my goal...
0:18:32.3 PA: And then...
0:18:32.3 CH: Okay.
0:18:32.3 PA: No, keep going, keep going. Sorry about that.
0:18:32.5 CH: Yeah, my goal's not to have a big fight with the anti-psychiatry people, my goal is to help your listeners and other realize that this stuff is very complicated, very complicated. Even if we... We talked about depression, and I did a podcast episode on this called, What's The Deal With Depression? Well, depression is not a disease, it's not like a multiple myeloma or scleroderma, depression is a syndrome, and there's a thousand roads to the well of depression.
0:19:01.0 CH: It really matters how you got there, whether it's grief or some kind of genetic susceptibility or hormonal or existential or bipolar or substance-induced, and on and on and on and on. And so one of the things I think that a lot of people don't understand who don't work in psychiatry is that to even study essential questions in psychiatry is incredibly complicated. So this question...
0:19:25.0 CH: So for example, Erick said that psychiatric... Or that antidepressants don't beat placebo, which is what Irving Kirsch claims and some of the other folks, and Whitaker. But what... That is such a complicated statement, 'cause first of all, what is depression? Are they talking unipolar depression? 'Cause unipolar depression, vast majority of psychiatrists agree, is not even a thing, it's sort of a wastebasket diagnosis for non-bipolar, non-hormonal, non-existential, non-grief, non-metabolic depression. So it's not even probably even a real, a real entity.
0:20:00.3 CH: And then even if you use the term "antidepressants." So it turns out in psychiatry, the meds that most people think of as antidepressants, like the SSRIs, those are not antidepressants. The antidepressants, SSRIs, for example, those are anti-obsessional, anti-neurotic, anti-rumination, that's their anxiety meds, and if they help for depression at all, it's usually through the pathway of decreasing anxiety.
0:20:26.6 CH: The best antidepressants in psychiatry are actually the atypical antipsychotics, lamotrigine, MAO inhibitors, not things that we call, or lithium, not things that we call antidepressants. Even to try to study this question, "Do antidepressants treat depression? Do they beat placebo?" That is an unfathomably complicated question, which is actually pretty meaningless. And so I think the general public sees some of these books and they think like, "Wow, prozac doesn't beat placebo, it's a fake, it's a big conspiracy with the psychiatrist and the drug companies."
0:20:57.5 CH: No, prozac is not an antidepressant, and any psychiatrist knows that. It does work for a few subtypes of depression, it's an anxiety med. So it turns out that you're right, the SSRIs do not beat placebo for mild to moderate depression, all psychiatrists know that, that's day one of residency, that's not news. And so I think we just confuse the public when we throw out these really general and meaningless statements that suggest that antidepressants don't work.
0:21:34.0 CH: Actually, the truth is that the bonafide antidepressants like the atypical antipsychotics and lamotrigine and MAO inhibitors, work very well for moderate to severe depression, they tend to have a lot of unpleasant side effects. What we see in psychiatry is, efficacy is not the problem as much as side effects, which is one of the reasons that psychedelics coming online is so exciting, because...
0:21:56.4 CH: Ketamine is a good example, I have a whole crew of people with really severe treatment-resistant depression, who are doing Ketamine maintenance, they come in usually once a month, and that keeps their depression at bay, they come and do one high-dose fully-dissociative IV treatment and it resets the brain, if you will, and they're good.
0:22:13.4 CH: And prior to... And what side effects are they giving? Almost nothing. Some people get nausea with Ketamine and we can deal with that, some people get blood pressure elevation, we can manage that. Ketamine is really safe, much safer than the atypical antipsychotics.
0:22:33.3 CH: So looping back to the statement, psychiatric meds are complicated. When Erick said that psychiatric meds break your brain, I just thought, "Are you kidding me?" So first of all, it reminded me of that old '70s... I guess about '80s, "This is your brain on drugs." I thought Erick is totally flipping back into drug war mentality, like "Psychiatric meds break your brain."
0:22:55.9 CH: Because first of all, which meds are we talking? Klonopin or Adderall or Prozac or Aripiprazole? Because psychiatric meds is a huge category, and they do very different things in the brain, and some of them can have some really, very unfortunate consequences, particularly the stimulants and the benzos. But do they break the brain? No. Crystal meth breaks the brain, alcohol can break your brain, the hydrocarbon inhalants can break your brain.
0:23:26.5 CH: But that kind of statement, it's just, it scares people, it puts mental health treatment back a decade or two, it's wrong, it's not nuanced. It's just kind of fear-mongering, and it comes out of this, I don't know, like through belief, black-white thinking. 'Cause it turns out that psychiatry is incredibly complicated, and actually, that's what I love about it.
0:23:52.0 CH: But any time we try to make these broad-based statements. Here's one for example. I would argue the best medicine that we have in mental health, is aerobic exercise, and the best thing if you want... Other than having someone that you love and care about, that's the best mental health treatment, if you will, and to have a purpose. But probably... Along with that would be to work out aerobically.
0:24:18.3 CH: But there's probably 4%-6% of the population that seems to get no emotional or mental benefit from aerobic exercise, and that's been well documented. So even if we say, "Oh, everyone should exercise because that's good for your mental and emotional health." Well, that's true for 94%-95% of people, it's not true for everyone.
0:24:37.7 CH: So these... I just think we need to be careful of absolutes, we need more nuance. It's tempting to try to break down these concepts and these ideas into black-white, but that's just not accurate and it's not helpful, and I trust that people actually can understand the nuance if we're willing to share it with them. And that's a lot of what I do, is try to help people understand that, "Hey, meds are complicated and they have benefits and risks, and here are some reasons it might help you or not."
0:25:07.7 CH: Or Ketamine. Or I tell people like, "Look, Ketamine can be scary as hell, at fully dissociative doses that I use, for some people, it's the scariest thing they've ever been through," and so we have to have a big discussion about that, "Let's talk about how we can make it less scary. What can we do to help you through that?"
0:25:29.5 CH: But being honest about it, and I just think we need honest assessment of how hard it is to treat what we're treating, and honest assessment of how little we actually really understand our treatments. I think we're... I'm willing to admit that.
0:25:44.8 PA: So then, how... This is great, by the way. So talking about the nuance of the different psychiatric medications that could be prescribed for mild to moderate to severe depression, for potential schizophrenia, anxiety. There's obviously, there's a wide range of conditions that are prescribed for that. You didn't mention all of them necessarily, so there's a lot more within that itself.
0:26:10.8 PA: And so I'm curious, as someone who both has a strong background in psychedelics and also obviously a strong psychiatric background, how do you see the space then, evolving in the next five to seven to 10 years? So in other words, as psychedelic-assisted psychotherapy becomes more prevalent, do you think that will reduce the amount of pharmaceuticals that are prescribed?
0:26:38.1 PA: And if so, how will it reduce it? For which populations or groups of people might it be reduced? Because my, maybe idealistic and non-medical perspective is, the more we can work with plant medicines within a therapeutic context, the more that we can work with these natural substances, the more that we can bring people back into community, the more that we can surround people with love and support and something very, very integrated, the less need we have for psychiatric medications.
0:27:14.0 PA: And genuinely, I think, the less need we have for needing to do an Ayahuasca ceremony every month. There's also, obviously, an upside to consistent psychedelic use. So I'm just curious about your perspective on how the psychiatric profession will evolve as a result of psychedelic-assisted psychotherapy, and what conventional things will likely be let go of to create space for this alternative treatment?
0:27:42.4 CH: Yeah, that's a great question. And I think that's a very complicated nuanced question, which I love these, I'm not gonna make any black or white statements. But let's just start with Ketamine. So there's controversy, is Ketamine a psychedelic or not? But let's say this: Ketamine is, I would argue, the best treatment that's come along for severe depression in the last 27 years. Lamotrigine came on the market, '94, that's an awesome, awesome med, but there's been nothing really good and safe in the last 27 years.
0:28:09.0 CH: So Ketamine... But Ketamine's not a fix. My people with severe treatment-resistant depression under PTSD, a lot of them do maintenance Ketamine, it's super helpful, it's a game-changer. But they have to keep doing it, it's not a fix. I think we're seeing that, again, when we're talking in this severe disabling range of different depressive syndromes and PTSD, Ketamine is not a fix, but it's amazing treatment.
0:28:31.4 CH: MDMA is gonna be a fix. We're already seeing that in the MAPS study that, not for everybody, especially with people with complex PTSD and a lot of attachment in the zero to three. Parental trauma, it's probably not gonna be a fix, it will be extremely helpful. But I think MDMA is going to...
0:28:48.9 CH: It is and it will continue to actually fix PTSD, and it turns out that, I've argued before, both in writing and speech, is that there are two areas of psychiatry that we are just woefully aren't able to help people, we have been. And one is with PTSD. Psychiatry has had essentially nothing. We have tried meds and talk therapy, none of it really makes any difference. PTSD is its own horrific beast.
0:29:22.7 CH: The second area is the negative symptoms of schizophrenia, which is, I think, less relevant to the talk we're having now. But in any case, those were the two biggest needs. Well, MDMA, I think, is going to, it's going to meet the biggest missing need in mental health in the US and the world, which is trauma. Because we... You can't talk your way out of trauma, talk therapy does not work. Propranolol helps a little bit, was an adrenaline blocker, but in general, meds don't really work.
0:29:47.5 CH: Ketamine, which is an awesome, awesome treatment, does not fix PTSD. It helps it, but doesn't fix it. Whereas, MDMA seems to be getting actually to the core, if you will, spiritual wound. I didn't used to believe that, but I do think that there is actually, at the core, not just a primary consciousness, but a spiritual wound with serious trauma. And that's why we haven't been able to talk our way into it or medicate our way into it.
0:30:16.9 CH: So I could see, for example, a clinic five years from now, where someone shows up and they get a couple Ketamine treatments to dial down their depression, and as they're coming off meds, getting ready for their one or two MDMA sessions. 'Cause it can be a little rough coming off meds. I think, surprise, surprise, most people with severe PTSD are on a bunch of meds, which are usually not doing much of anything, but even just trying to get people to sleep.
0:30:40.7 CH: Some people come to a clinic like this where they do a med taper, they do a couple Ketamine sessions, and then they do their MDMA session with integration afterwards. I think, I really think we're very few years away from that. And that's not even talking about Psilocybin, that's a whole other exciting possibility. So...
0:31:05.3 PA: Let's stick with the MDMA for a little bit because I think there's a few more nuggets there that are really yummy. One nugget is there was a research study published maybe four to six weeks ago that went into detail on how MDMA-assisted psychotherapy, the effects are blunted with those who are tapering off certain PTSD medications.
0:31:26.0 PA: And I might be explaining that wrong, but essentially, those who are on medications going into a PTSD treatment with MDMA are less likely to show the same significant results as if someone hasn't... As someone who hasn't been on medications or someone who hasn't as long. So I think that goes to your point about, let's assume for a minute that a lot of those who are on medications for their PTSD.
0:31:56.0 PA: When MDMA-assisted psychotherapy becomes medically available, will obviously choose that as a treatment because of the efficacy. Can you talk us through that process from a psychiatric perspective, and even maybe from client perspective?
0:32:09.9 CH: So...
0:32:10.9 PA: Yeah, just tapering off of meds and deciding to go forward with that, and that's a lot of... Those are a lot of big decisions. And I would imagine there's a lot of things that you would... The psychiatrist have to be aware of in that tapering off process, and sort of going into, potentially, a psychedelic-assisted psychotherapy journey.
0:32:29.7 CH: Yeah. So it's turned out in the MAPS study that's been a really complicated thing, because you basically can't be on meds going through the experimental days, the MDMA versus placebo. So people have to get off, essentially, all psychiatric meds and definitely anything with any serotonergic activity. And that's proven to be a painful process for people and... But arguably, the most painful part of it is PTSD wrecks your body, mind and spirit. But arguably, what it most wrecks is your sleep.
0:33:02.7 CH: So many people with PTSD get put on sleep meds, which, the thing about sleep meds, they work at first, and then you build up a tolerance, then they don't work. But still, so many people both coming to the MAPS study and for sure, coming to these clinics in the near future for, say MDMA-assisted psychotherapy, many of them are gonna be on serotonergic meds like mirtazapine Remeron or trazodone or SSRIs. And as you taper people off meds, insomnia often gets worse.
0:33:30.5 CH: So that is a really tricky thing; that might be the biggest hurdle. And I wonder, too, I saw that same study that you were talking about, that people don't respond as well when they've tapered off meds. My theory on that was that sleep disruption, I thought, "I wonder if people doing various med tapers before MDMA-assisted psychotherapy, that if you were to actually look back at their sleep architecture, REM versus non-REM and total sleep, you would see that they actually, before and after the MDMA sessions, were getting pretty poor sleep? And so they went into the session not in a good place."
0:34:08.2 CH: 'Cause for example, REM sleep restores emotional resilience. It seems to be the most psychiatrically, psychologically important stage of sleep. REM sleep tends to get wrecked when people come off different meds. So that's been my theory. And so there are ways around that, the MAPS study, there's differed things that we use to help people sleep in the days and weeks as they're coming off meds, getting ready for their first all-day medication sessions.
0:34:34.0 CH: But yeah, it's a challenge, for sure. Again, I think because the nature of PTSD with such severe sleep disruption for so many people, it's rare that you're gonna get someone coming to MDMA clinic of the future who will not be taking at least probably heavy-duty sleep meds, which often have some serotonin activity, which means they're probably gonna have to come off those for the study, or for the treatment process.
0:35:03.9 PA: And that's super fascinating 'cause this goes back to what you were even talking about before, is aerobic exercise is critical to mental health and well-being. And sleep, I would say, is probably even... Potentially even more critical in some ways. And that just shows how sort of multifaceted the healing response is.
0:35:23.2 PA: And it also brings up the question, and this is something we've considered at Third Wave as well, because we have so many people who are interested in microdosing who are looking to sort of taper off psychiatric medications with the help of a psychiatrist so they can begin the microdosing process or they can go do Ayahuasca or they can whatever, new transition, a new journey that they're going into.
0:35:45.1 PA: And it's sort of that what we'll call the "liminal space", the space between, "Okay, I've been in this old treatment modality into the new treatment modality," and it's that chasm that's so difficult to cross for so many people. So it's likely we haven't seen this yet, I haven't seen a lot of coverage or companies that are focusing on this yet, but I almost wonder what is the solution for that? What's gonna help, potentially, if psychedelics grow to the level of popularity that we think they're gonna grow to, what's gonna potentially help millions and millions of people taper off meds and sort of get into this new way of healing?
0:36:27.3 PA: I don't know the answer to that question, it's just there were ideas that were popping up as you were talking about that, like maybe we set out... You have to set up inpatient clinics or outpatient clinics, or clinics where people stay for a week to taper off meds, that have optimized sleeping facilities or float tanks or anything else that can help them with that process.
0:36:45.9 PA: Because it just feels like to do that in a normal environment, to go home to your bedroom, to go home to your wife, to go home to that same set and setting and try to wean off the medications when it's affecting sleep, just would make it way more difficult than just taking someone out of that context, providing a new context for them for a week or two to taper off, and then having them go into the psychedelic experience. So this is, it's a complex topic, it's a very difficult thing to get our head around, so to speak.
0:37:11.8 CH: Yeah, yeah. But I do think that when MDMA comes online and it's becoming more and more widely used for PTSD, I think those folks are gonna end up on way less medication. Because again, psychiatric medication just doesn't do much for PTSD, and really, it's people try to dial down the adrenaline system or help sleep, but those meds lose efficacy and build tolerance over a while.
0:37:37.1 CH: So yeah, I know that people, so far, the people that I've worked with in this study that we know got MDMA, they're on essentially no meds now, and they were on a number of meds, the ones I'm thinking of. So again, that's a small group of people. But it makes intuitive sense that if you get to the root of the trauma and you exorcise the trauma, that people are not gonna need a bunch of meds to keep them from having panic attacks and be able to sleep.
0:38:06.3 CH: Although then we've also seen people in the MAPS study who have PTSD and concomitant bipolar disorder or other primary psychiatric disorders, that when we try to get them off their meds, it goes very badly. So yeah, it's gonna be complicated. It'd be a really cool challenge. I hope to have a clinic like this soon where I'll just add on MDMA-assisted psychotherapy to what I'm doing now.
0:38:29.7 CH: And yet, one of the big challenges will be try to transition people off their more problematic psychiatric meds and really minimize what they're taking. 'Cause that's my goal and I want people taking as few medications as possible, and I want people to thrive.
0:38:46.5 PA: Absolutely. And so how is that different for maybe... We're obviously, MDMA is slotted to treat PTSD. And then we have Psilocybin, which is so often talked about, to treat major depressive disorder and treatment-resistant depression. What are the, maybe some of the distinctions between Psilocybin and MDMA, in particular, Psilocybin for depression?
0:39:08.9 PA: 'Cause even with some of the early research we've seen out of Imperial College, people will go in, will have a Psilocybin experience, will heal their depression for a month or two months or three months, and then nine months later, the depression has come back and a lot of the same symptoms have come back, maybe they had to go back on some sort of psychiatric medication. What are some of those distinctions between MDMA-assisted psychotherapy and Psilocybin-assisted psychotherapy from a psychiatric perspective?
0:39:38.0 CH: Well, first of all, I think dose absolutely matters, it matters with everything, and it matters with Psilocybin. And so with Ketamine, I think, low-dose, for example, sublingual Ketamine-assisted therapy is a completely different beast from high-dose IV dissociative sessions like I do. They're both really useful, but for different things. So I could see where... You're the expert on microdosing, not me, but I have a lot of patients who are doing it.
0:40:05.0 CH: And from what I hear is that microdosing is, yeah, is a helpful strategy for many people to manage depression and it's an ongoing thing. I think about of it sort of like psychiatric meds that grow out of the ground, that you don't have to take every day and are, essentially don't have side effects.
0:40:23.1 CH: But then, there's that whole other more deep-dive Psilocybin-assisted therapy where people are doing a substantial amount of Psilocybin. And I, my sense of that is that the mechanism where higher-dose Psilocybin can really change people is that it wakes them up to the beauty and wonder of the world.
0:40:46.1 CH: I had a woman on my podcast last week who talked about, actually this very topic, sort of how she... Her healing path with both MDMA and Psilocybin. She's actually a therapist and it was interesting to have her speak from that perspective, too. But she described how high-dose Psilocybin literally woke her up. It filled... She was just dead from trauma, she was just numb and dissociative. It brought her back to life. It's like, she said it filled up her chakras, it charged her up.
0:41:14.2 CH: She said, "I had felt dead for as long as I can remember, and I felt alive, and I could see the world, and I could see the beauty and the wonder." She said it just, "It turned the lights on. It just woke me up," and I just, I love that description. But then she went on to describe how, even though Psilocybin profoundly woke her up and just allowed her to get out of her sort of numb dissociative self and see the world, she still was so haunted by the demons of her abuse. And then it was her MDMA sessions which finally sort of purged the demons.
0:41:47.7 CH: But the Psilocybin, but they had a really nice one-two punch. And I think that makes a lot of sense, that they'll be used in conjunction, that again, the clinic of the future, people come in and get an assessment, with med taper, if need be. And then we're looking like, "Okay, do we need to sort of wake you up to the world, either with Ketamine or high-dose Psilocybin, sort of yeah, bring you back online, if you will? Do we need to exorcise your demons with one or two or three MDMA treatments and processing around that?"
0:42:21.0 CH: It's super exciting to think about just designing those treatment plans of what, where the pain lies and how to get there. I think with trauma, it's so much in the primary consciousness in those early phylogenetic parts of consciousness. And Ketamine gets there, but not in a very controllable way, but Psilocybin and MDMA draw right down to that. Again, with very different utilities and phenomenologically really different, but potentially, a really amazing complement together.
0:42:58.3 PA: Has there been any clinical research about that, that combination of Psilocybin and MDMA that you know of?
0:43:04.9 CH: No, I've had, actually three people in my podcast talk about their own healing journey using those two in combination, and not at the same time, but back and forth in therapy. So that would be difficult studies to do, but I do sense that high-dose Psilocybin versus microdosing are both potentially really helpful strategies, but they're completely different in terms of what they might do for someone.
0:43:33.6 CH: And someone who is just completely deadened with some sort of depression and/or traumatic dissociation, that Psilocybin might just help wake them up to the beauty of life. But again, not necessarily heal their demons, but give them the strength and the will to move forward and wanna do that.
0:43:57.3 PA: One metaphor that I love or analogy of, I always confuse the two words, is that of a lotus flower. And there's a woman whose name is Anne, who wrote this book about MDMA-assisted psychotherapy called Trust Surrender Receive. And she'll talk about this analogy of the lotus flower where essentially, for healing, we first take... And this is her recommendation.
0:44:26.1 PA: For a lotus flower, you need to till the soil and make sure the soil is very fertile. And the representation of that in the psychedelic space is using MDMA to heal trauma. And we all have trauma, some of us have a lot more trauma than others, but we all have trauma. And so going in and going in with something like MDMA to heal that, to feel totally safe, to feel like that part of yourself can be integrated or it can be let go of, whatever needs to happen, is sort of that first step in growing the lotus flower of enlightenment.
0:44:53.8 PA: And then the second step, she says, is to plant the seed. Once the soil is fertile, plant the seed of the new self, and that's what the Psilocybin or LSD... Psilocybin or LSD sort of wake you up to the potential of what you could become. And then once you're sort of woken up to that new sense of self through wonder and awe and this awakening, then the opening of the flower, so to say, is the Ayahuasca or the 5-MeO-DMT, or the things that open up the crown chakra and connect you with God and transcendence.
0:45:25.9 PA: And I love that analogy because A, it speaks to the fact that this is an ever-unfolding process, and that there's no need to rush it. And I think B, it also speaks to something that helps to... It really helps to ensure that the healing experience is not controlled, necessarily, but there's a rhythm to it, and that you're not sort of skipping steps because as...
0:45:56.2 PA: Yeah, yeah, as I've observed in the space, especially as psychedelics grew more popular, especially as psychedelics like 5-MeO-DMT grow more popular, people have a tendency to wanna sort of skip the hard work, if you will. Skip healing the early childhood trauma or that and just jump right into unity consciousness.
0:46:15.5 PA: And that although it can be impactful maybe for a week, once people have that opening, a month later or two months later, they're often still back to the same place that they were before, not having healed the things that are underneath that.
0:46:31.6 CH: Yeah, I think especially if there's attachment trauma, those early years where the trust versus mistrust, the little baby and toddler, is the world can be a safe, warm protective place; whereas, it could've be a chaotic or cold or lonely or abandoning. And that kind of wiring, I really think, requires something like MDMA. You could touch it with Psilocybin and maybe explore it, but to really start to rewire from mistrust to trust, that might be MDMA's biggest utility.
0:47:03.5 CH: Again, you think about people, not just with attachment trauma, but trauma trauma, trust is broken. Yet, if you're gonna do any kind of meaningful healing with someone, it has to start with trust. And a lot of trauma therapists, and I've experienced this, will say sometimes it takes years, years, hundreds of sessions working with someone before they really start to trust you when they have that kind of trauma. With the MDMA, you could potentially get there in an hour.
0:47:33.4 PA: Wow. And that's what's so innovative or breakthrough or whatever, however, whatever word you wanna use to describe it, it's just all about that, that treatment.
0:47:41.0 CH: Yeah, yeah. And cost-saving. A couple of the episodes in my podcast, people were talking about their multi-year trauma journey and all their therapy. And I got some emails from people saying, "Hey, these are great stories, but who can afford 700 sessions of therapy? Who can afford six years of EMDR? Who can afford... "
0:48:00.1 CH: They make a great point that to heal trauma, traditionally, has been not just a long, painful slog, it's expensive. All those sessions and trying to figure out who you can work with and trust and... It can be tens of thousands of dollars or more. Most people don't have that. But if we had trauma centers where we could relatively quickly assess people and move them into these powerful healing modalities that could move people to healing quickly, that's gonna be much more affordable to the masses because most of the people can't afford to do the kind of therapy that PTSD has demanded up to this point.
0:48:45.2 PA: So to sort of put a loop on this and put a bow on this, we've talked about... We started the podcast and the conversation sort of talking about the rebuttal to the Erick Godsey episode, and how psychiatric care is much more nuanced than what was explained in there. And then we've transitioned into tapering off of meds, sort of the future of psychiatry, MDMA-assisted psychotherapy, Psilocybin-assisted psychotherapy.
0:49:11.9 PA: One thing that we haven't yet touched on is the role of education within all of this. I'd love your perspective on that, in terms of what you're observing and noticing just from a professional perspective in the psychiatric space, in the mental healthcare space, and how this is... How psychedelic-assisted psychotherapy is being talked about in comparison to or in comparison to traditional psychiatric medications.
0:49:43.2 PA: Because a lot of psychiatrists are coming at this, from what I can see, with a similar perspective as you, which is, "Hey, we're really excited for when these medicines become more available and yet, they're not available right now, so we have to work with the tools that are currently available to us."
0:50:05.5 PA: What's been sort of the uptick of interest in psychedelics over the last year, let's say, in the psychiatric space? And what's the core shift that psychiatrists have to go through to understand the potential of psychedelics compared to conventional psychiatric medications?
0:50:24.3 CH: It's ironic you asked that. This week, I got my monthly issue of Current Psychiatry, and the lead cover story was psychedelics in psychiatry. And I just thought, "Wow." 'Cause this is a fairly conservative thing that a lot of psychiatrists get, and this is the big lead story of that, "Okay, it's definitely moving in the mainstream of psychiatry."
0:50:46.9 CH: And my experience with other psychiatrists is they're fascinated. I've told many of my colleagues, for example, Ketamine. I said, "You have to start doing Ketamine, it's a total game changer." And most of them haven't just 'cause they're so busy and overwhelmed just trying to keep their head above water right now, but I haven't heard of anyone say to me, "That's weird," or, "Why are you doing that?" The other psychiatrists I know who, when I talked about the MDMA work, were totally fascinated, completely fascinated.
0:51:13.5 CH: So I think it's sort of like the way social change happens, it's change is not happening, not happening, not happening, boom! You're like, "There'll never be gay marriage. Never, never, never, never, never." Boom! Or, "Weed will never be legal." Whoa! It's suddenly legal in all these states. And I think there's this tipping point, and Malcolm Gladwell wrote about that, and I think it's here. What's already here socially with people thinking about psychedelics, but I think it's happening in psychiatry.
0:51:41.7 CH: Literally not had one psychiatric colleague say anything other than, "This is so interesting and I wanna learn more. Wow. How will this develop?" Because I think psychiatrists see, we need help. [chuckle] We have some good tools, but there's so many people, particularly people with bad trauma that we are not helping. So if we could have more tools to reach people with deep trauma, oh my gosh. That would be lovely. And who doesn't... Again, we all went into this 'cause we wanna try to help people, and where there's so much pain out there.
0:52:21.6 CH: Even when I was on the, recently, in CNN thing a few weeks ago, people asked me, "Oh, did you get any emails about that?" I got so many, hundreds of emails from all over the country, and they all said the same thing. Some version of, "Hi, I'm Craig, I'm in Fort Collins. Here's my trauma. Here's what I've tried. I don't know what to do. I'm so suffering. Do you have any thoughts for me?" And they were all trauma, just trauma, trauma, trauma, trauma.
0:52:47.9 CH: That's just the people who actually wrote me, figured out where my website was and wrote me their painful stories. So there's just an endless well of need out there. So to bring on these tools to try to help more people and quickly get to the root of things, what's more exciting than that?
0:53:10.6 PA: And sort of what's, what do you... What needs to be the perspective shift for psychiatry and psychiatrists to be to be fully behind this? Or in other words, to accept psychedelics as a really great treatment modality? The initial response is of course, "Oh, research," and research helps.
0:53:30.2 PA: But I feel like it's a fundamental shift in perspective in how we view the self and how we view the human. Can you just talk a little bit about what that fundamental shift is? Either what it was for you, what you're noticing with other psychiatrists who are starting to get into this? What's sort of the philosophical framework that then allows the psychiatrist to say, "Oh, yeah, psychedelics definitely can be a great option for X, Y and Z reasons."
0:53:56.7 CH: Well, I wonder, for one, if it's also just an age cohort thing, because as they say, science changes one gravestone at a time. And now, we're getting to the age where people who are working... I'm 54 and I think so many people my age and younger in psychiatry, for example, have had psychedelic experiences, and oftentimes had really positive ones. Whereas, a generation ago, that wasn't necessarily the case.
0:54:23.3 CH: I also think psychiatrists are different than most medical doctors. I think, actually, there will be more suspicion and hesitancy in just medicine in general than there will be in psychiatry, because psychiatry is already so gray and nuanced and confusing and mysterious. That's what I love most about how mysterious it is. But most doctors are not like that. Most docs are very A to B to C connects to E.
0:54:49.6 CH: And so I really think that there'll be a little more pushback in other specialties in medicine. People coming in and like, "Oh, and microdosing, Psilocybin. What? Is that safe? And why didn't you tell me?" Whereas, I think my colleagues in psychiatry, we, A, we realize it's very mysterious, and B, "Wow. There's so much suffering, so people are finding help through unusual modality A, B, or C. Great, awesome."
0:55:19.4 CH: But I think psychiatry is coming onboard quickly, and it's not a territory issue. It's like we feel like we're drowning. It's particularly, this last year, I saw an article recently about how many psychiatrists are just struggling with terrible burnout, and I've definitely been feeling that. It's just there's never been so much anxiety and fear, at least in my lifetime, as the last nine, 10 months. So yeah, I think psychiatrists are saying, "Help! Help! [chuckle] Is there anything on the horizon, please?" That's what I hear from people.
0:55:57.6 PA: And this, I think, perspective of turning inwards, of healing emotional trauma, of healing attachment trauma, of healing whatever it is, you're going in and saying, "Hey, like this is more than... Like, yeah, there are these symptoms that you're feeling, but in order to get to the core of this, we have to sort of peel back the self. We have to unwind and we have to go into traumatic memories. We have to understand how you're holding those traumatic memories, we have to understand how to heal them."
0:56:23.5 PA: I feel like that appears to be the the bigger promise of psychedelics, is I often think about sort of the difference between regular talk therapy and maybe something like depth therapy, like a somatic approach, or depth therapy accepts the conscious, the unconscious, the fact that we're all connected, the interconnectedness to everything.
0:56:44.4 PA: And that's why, that's just sort of why I'm veering more and more into that, because the medical establishment, obviously pays a lot of attention to research and science. And there has been a fairly, I would say, reductionist framework in how both physical and mental issues have been addressed and developed.
0:57:02.2 PA: I think that the big sort of opening that we're seeing with psychedelics, as well as meditation and other sort of modalities that opened us up to interconnectedness is, "Oh, the mind, the body, the spirit, this is all intertwined." And you had briefly touched on this earlier in terms of the role of even healing existential disconnection, so to say, and what role that might play. And we've seen that with psychedelics, as well.
0:57:29.1 PA: So I think all of these point towards a more optimistic future, certainly, for addressing patient trauma and helping with depression and anxiety. At the same time, we're still here in January 2021. And so sort of for the final question for you to dive into, for any people who are listening to this who maybe come from a more anti-psychiatry perspective, anti-pharmaceutical perspective, anti... What do you recommend as resources? What do you recommend in terms of perspectives?
0:58:08.0 PA: How can we hold the complexity of the fact that psychedelics eventually will be here, and a lot of these are not yet available for people to get into? So you had mentioned the CNN special and how you had all these folks reaching out to you about needing help. How do you respond to them, knowing that the potential of psychedelics is on the horizon, but it's not here yet?
0:58:35.0 CH: So yeah, there's a lot of thoughts in that. First is that in my mind, healing starts with connection, any kind of healing. And so when I'm sending out all these emails to people after the CNN special, I was saying, "Okay, it starts with a connection with a therapist, someone that you really trust." That's job one.
0:59:00.8 CH: And two is, I'm a big fan of considering... Even though Ketamine, I think, does not have the same properties as Psilocybin and MDMA, it's off some very different molecule, but it is a very powerful, interesting substance, which you can do some deeply meaningful work at different doses in different contexts with people.
0:59:23.1 CH: So I also suggested to a bunch of people who wrote me that to look into Ketamine-assisted psychotherapy in their area, which is becoming much easier to find. I think that is a legal and more widely-available route now to begin to plumb your unconscious and start to get a sense of what your body and spirit holds.
0:59:46.8 CH: And then I'm getting really interested in the work that Saj Razvi is doing with the Psychedelic Somatic Institute and this idea that reaching trauma through the body. He's doing some interesting work with THC and Ketamine, but doing somatic therapy, not talk therapy, but somatic therapy where people are really going into primary consciousness and trying to do bottom-up healing using those two substances. Again, Cannabis is not legal everywhere, but it's legal in a lot of places.
1:00:21.3 CH: I think we have some good legal options, and I didn't at first really believe Saj when he said that THC Cannabis could be a psychedelic, but for sure, I have experienced that when used in the right context at the right dose. It is a mind-blowingly powerful psychedelic and brings you to, yeah, this deep primary consciousness more rapidly. Maybe only Ketamine gets you there that rapidly.
1:00:54.0 CH: So there are some cool legal options now, and we can hold on just a little longer, I think we're gonna have others on the horizon today. Were there other things, Paul, that you asked as part of the question? I was trying to list all the...
1:01:09.8 PA: No, I think that just about does it. The only thing was the nuance with...
1:01:16.5 CH: Oh, yeah, yeah.
1:01:17.2 PA: You touched on extensively, just... And psychiatry differences, what...
1:01:20.8 CH: Yeah, yeah, yeah.
1:01:21.8 PA: Right now, and the...
1:01:24.2 CH: Well, one thing it's... That is a big theme of my podcast. [chuckle] I have a lot of... Probably every fourth episode, I do educational just sort of mini-talk on some of these things. And psychiatrists realized, in contrast with what Erick said, that we realize that medications are not a fix. We know that, that's not news. We know that people need meaning, we know that people need connection, we know that people need to move their bodies, and they need REM sleep, and they need love. We know all that.
1:01:55.0 CH: And for some people, in 2021, psychiatric meds are a total lifesaver. We just talked about one med, lamotrigine Lamictal. It's changed the lives of millions of people around the world, it's saved countless lives. I can't imagine a world without lamotrigine. Whoever invented that, I hope, got a really nice bonus and gets a Nobel prize because it literally has changed the world.
1:02:21.8 CH: Interestingly, it's not called an antidepressant, it's called a mood stabilizer, which is inaccurate. It's actually an antidepressant. But we in psychiatry have a huge naming problem, we have a nosology problem, we have a DSM problem, which Erick was right about, although I think he category... He called the DSM a philosophy book. I would call it a coding manual for insurance companies, but still, it's got problems.
1:02:43.1 CH: Yeah, psychiatry has problems, but we... And, not but, and we're helping a lot of people, we're gonna help a lot more. And medications are one part of it, and none of us think that's a panacea. I personally think that the main panaceas are love, sleep and exercise, if we could do that. But again, that's not gonna heal the most severe things, but it's gonna help.
1:03:10.6 PA: I love that. Love, sleep, exercise. Maybe good food as well, nature. We're learning more and more about the role of nature and Psilocybin-assisted therapy, and how healing that can be. And I think this speaks to something that we've talked about on the podcast time and time again, is psychedelics are the opener, they're the opener for both the individual and the collective. I think what a lot of us are excited for is what happens in a world where these substances become medical and legal, and what new sort of infrastructure are we creating to live in?
1:03:45.7 PA: I read a really good piece a few weeks ago that talked about how a lot of the reasons that we, in modernity, feels such a malaise about everything is because literally of the physical environments within, and they're these financial buildings, or they're downtowns, or they're just not that inspiring. And compared to a place like Paris, or a place like Lisbon, or other places in Europe where they have these beautiful cathedrals and beautiful architecture and environments that inspire wonder. They inspire awe, they inspire mystery.
1:04:19.1 PA: And I think the big question that we have to sort of reckon with as a species is, what are those new integrative living spaces that we're living in? And how do we make every element of our life, every element of our environment inspire curiosity and wonder and awe and love?
1:04:38.9 PA: And that way, it's not just going into a clinic, doing MDMA or Psilocybin and coming back into our sort of depressing lives, but we're actually creating new structures and new systems that embody the psychedelic experience itself. And I feel like that's sort of the longer vision, but that it feels relevant to where we seem to be happy.
1:05:02.9 CH: Yeah, I think I like that. Speaking of that, the word I use to describe that is "depressogenic". So I often tell people, "Look, you have a depressogenic life, meaning a depression-fostering life. And if you don't change your fish bowl, there's nothing we're gonna do that's gonna help you." And I think COVID and the pandemic has really revealed that, that Americans really live so strangely because we are a social tribal species.
1:05:26.6 CH: But a huge percentage of Americans live like cats. They're alone, they're mostly inside, they sleep odd hours, they don't have much interaction. I think the whole pandemic isolation has made people more of their cat selves and less their dog selves. In my mind, healthy humans are like dogs. We're outside, we're connecting, we're playing, we're exploring, we're moving, we're curious. We're maybe not sniffing as much as dogs do, but...
1:05:55.5 CH: And I think of unhealthy humans as cats. And I think this has been a 10-month episode of pushing people more towards isolative, feline, erratic sleeping behavior and it's not good. I have to say I love cats, I'm not being anti-cat, but I'm often encouraging my patients or write it on their form, "Okay, you need to bring out your inner dog, because you're falling back into your cat ways."
1:06:23.2 PA: I like that, I really like that, depressogenic, and then the cat versus dog, and how that's a strong way to end the podcast, Craig. So I appreciate you popping on and sharing the rebuttal from the Godsey episode, but obviously, we went into some really other interesting topics about...
1:06:41.3 CH: Yeah, it was fun, I'm glad we did, yeah.
1:06:43.1 PA: MDMA attachment, and Psilocybin, and cats and dogs. I love to be, move to one of those. So just for our listeners, if they wanna find out more about you, website, anything else that you think would be relevant to their healing path specific to what we've spoken about on today's episode.
1:07:00.5 CH: Yeah, thank you. Yeah, my podcast is called Back From The Abyss, and it's on all the podcast platforms. It's a psychiatric storytelling podcast. And then I'm at craigheacockmd.com. I live in Fort Collins. And yeah, I think anybody who was interested at all in this discussion would probably really dig Back from the Abyss because there's some, even just psychedelic-wise, there's some fascinating stories of healing on there, so invite you to check that out.