Why Microdosing Requires A Cautious Approach

Podcast Highlights

• How global attitudes towards psychedelics are changing for the better.
• Why we need to educate people about microdosing, even if it’s not the best option for everyone.
• Why the difference between psychedelic and psycholytic therapy matters.

Show Links

1. Ingmar's website
2. The Psychedelic Education & Continuing Care Program
3. Upcoming Psychedelic Event in NY
4. Michael Pollan's article in The New Yorker, 'The Trip Treatment'
5. Ingmar's article on microdosing at Chacruna.net

Podcast Transcript

0:00:25 Paul Austin: Welcome back to The Third Wave Podcast, I'm your host, Paul Austin, and really excited about this episode today, I was able to do this in person with Ingmar Gorman, who is a clinical psychologist. I should say Dr. Ingmar Gorman, a clinical psychologist and principal investigator in MAPS' research into MDMA-assisted psychotherapy. The reason that we organized this conversation was, about six months ago around the Horizons Conference in New York, Ingmar and I sat down and had a discussion about microdosing. And a few months ago he published a piece on Chacruna, was run by Bia Labate, about the controversy surrounding microdosing. So I wanted to set up this podcast so that we could kinda go back and forth about our understandings of the microdosing phenomena, and what was legitimate, and what maybe there are reasons to be skeptical of. And so that's really what we dug into in this episode, is the rise of microdosing and why Ingmar believes that we should be cautious about its benefits. We recorded this in his office space at the Center for Optimal Living. So it was great to meet in person and do this, and I really do think that you all will enjoy this podcast.

0:01:38 PA: Hey, listeners, just a quick interruption, a quick add-in before the start of the podcast. We're now offering a special discount code for any podcast listeners who want to access our microdosing course. The discount code is thirdwavepodcast, all lower cases, no spaces, thirdwavepodcast, all lower cases, no spaces, and that will get you 15, one-five, percent off Third Wave's microdosing course. This is a special little thing for only our podcast listeners. Again, thirdwavepodcast, all lower case, no spaces for 15% off our microdosing course.

0:02:16 PA: So without further ado, I bring you Dr. Ingmar Gorman.

[music]

0:02:24 PA: Yeah, let's just go ahead and let's jump in and just some background for the listeners who are turning in. I'm sitting across from... Is it doctor? Dr. Ingmar Gorman?

0:02:34 Ingmar Gorman: Yes. Yes, it is.

0:02:35 PA: Dr. Ingmar Gorman, you just recently finished your PhD?

0:02:37 IG: That's right, summer of 2017.

0:02:40 PA: Cool, and let's talk a little bit then about the process of how you got involved in... I mean, we can generally start with psychedelics or if you just wanna orient towards psychedelic therapy, I know you're leading the phase three trials for MAPS here in New York, so I'd love to just get a little into your story.

0:02:55 IG: Yeah. Sure, I'll be happy to share a little bit of my back story. So one place to maybe start would be Prague, the Czech Republic in the early mid-2000s. I was living there and there was a wonderful expatriate scene, I'm half Czech, I was partly raised in the Czech Republic. And I had just dropped out of college, out of the University of Chicago, and I was figuring myself out in a way and I bumped into this really cool expatriate scene. And Americans, people from all over the world, but also a good number of people from the US living in Prague. This was the Bush era, second Bush era of politics, so there are people who are very politically-minded. And I became more aware of the role of psychedelics, particularly LSD, in what is the former Czechoslovakia. So as some of our listeners may know, Stan Grof is from Prague, and... But there were also many other people who stayed in the Czech Republic, they didn't have the opportunity to leave the country during communism.

0:04:16 IG: And there was this rich history of psychedelic therapy, psychedelic research that took place from... I mean, it really goes before even the '40s, because there was a lot of work with interest in mescaline, but that history was there. And so it was this really neat kind of lining up of learning about that history, and also hearing from these new expatriate friends that I had made there, who were interested in sort of psychedelics, and from both like a kinda cultural perspective, as well as a therapeutic perspective. And I thought, "Well, you know what? If I'm gonna go back to school and dedicate my life or career to something, it would be very cool to dedicate it to something like psychedelic psychotherapy, or psychedelic research." It represented to me something that was an underdog, in a sense, something that seemed to be really unlikely [chuckle] but if there really was some validity to the potential for these substances to be transformative and healing, then it'd be, wow, what a great opportunity to look into something that has been overlooked, due to the restrictions around the research.

0:05:30 IG: The other aspect of this was that having grown up, on a more personal note, having been raised both in the Czech Republic and the US, I kind of occupied, I felt that I always occupied these two different worlds, and was sort of trans... Like I existed between these two very different cultures, I mean, the pinnacle of capitalism in the US, and then a post, literally two years after the fall of communism, so like a... Yes, Czech Republic, Prague in the early '90s was technically transitioning into a capitalistic society, but it had and still, to some degree, still has certain... It's not your typical capitalistic culture.

0:06:27 PA: I'm sure.

0:06:27 IG: It inherited some things from their experience of being under Nazi control and then communist control. And so, of course, I was very young at that age, but throughout my life, going back and forth between these two countries, there was something about psychedelics, and what people had spoken about psychedelics, and about psychedelic experiences, that really connected with me on a personal level, with this idea of living between two worlds and seeing how the world can be different in different ways. If we think about psychedelics as something that sometimes helps people call into question their fundamental beliefs, the way that they live and operate in the world. If you move to a different country, and I don't mean like visit Europe for two weeks, but really live in a different place, and you begin to really pick up on how people are different. That to me is a psychedelic experience. You begin to question certain fundamental beliefs that you thought were true.

0:07:33 IG: Maybe to bring it up till today, I was looking to have a career and study something that I actually really cared about and was passionate about. In this case, it was the potential for psychedelics to help people, to really to pursue that question. So, well, I went to college, I went to the New College of Florida, which is where Rick Doblin went, and a lot of people who are now kind of actively involved in this world came from that school. And then I went to the New School for Social Research here in New York City to get a clinical degree, a PhD. And, so really from the year 2005-ish to today, my fiancee, she reminded me of this, sometimes I forget. She's like, "You know, you've pretty much single-mindedly pursued this goal for like 13 years or so." And so today, and I do many different things, but one of them is as the co-principal investigator, or co-clinical investigator of a phase two, phase three study, two studies of MDMA-assisted psychotherapy for post traumatic stress disorder. And that's one site here in New York City. There will be another site in New York that's at NYU and I'm helping, I'm running the, what we call the private practice site. So, it's independent of an institution, but both sites, the NYU and ours, will be or is sponsored by MAPS, the Multidisciplinary Association for Psychedelic Studies.

0:09:23 PA: Right. Yeah. And so one really interesting thing about this that I just wanna dig a little bit deeper on is, as you said, you started to go to school in 2005, I believe? For this?

0:09:30 IG: That's when I went back to college, yeah.

0:09:32 PA: Right, and so we know that Roland Griffiths' kind of ground-breaking paper on the relationship between psilocybin and mystical experience was published in 2006, I believe. So you've pretty much been along this journey, when you made that commitment, you've seen how this has developed from a small sort of seed to what it is now. What, what... I'd just be curious, just a few minutes, about like what's that experience been like for you?

0:10:00 IG: Oh, wow.

0:10:00 PA: Seeing that developmental process?

0:10:02 IG: That's a fantastic question. Well, I can definitely remember the turning point, which was, for me, from my perspective was, I was at grad school here. It was pre-Michael Pollan's article and post-Michael Pollan's article in The New Yorker about psychedelics. Prior to that, I would go... So part of my training is to go on what are called externships, which are like miniature versions of internships. Basically trying to get, we do get clinical hours, so we get exposure to psychotherapy. And in different states in the US, there are different processes in New York City, since there are so many, many students and so many sites where a person could get that kind of clinical experience. It's super competitive.

0:10:53 IG: And so you go on these interviews and you're trying to be your best, and you're there with other people who are basically competing against you, other students, and often you'll get a mix of people, interviewers, who are either they're trying to make you feel okay, but some of them are really trying to see what, if you're gonna crack under the pressure. And for me, a big piece of that was often like, "Okay, well, how much do I talk about my interest in psychedelic therapy or research?" Because some people will have a really negative response to that, and some people will, you know, anything from neutral to supportive. And I remember one year prior to the article coming out, talking about my interest and the response would usually be something like, "Huh, like that's... That's weird," or, "Never thought of that." And then after the article came out, it was... People like knew, like they heard of MDMA-assisted psychotherapy for PTSD or the psilocybin treatment. So that, to me, was like, "Okay, something changed. Something really changed in the culture." And so that to me, there are other things that I could maybe comment on, but that is what comes to mind.

0:12:08 PA: So this one article, which is The Trip Treatment that was published, I think, in February 2015, in The New Yorker, so about three years ago. And it's interesting that you bring that up, because I was, about a year ago, I went to the psilocybin retreat in Jamaica, that I believe Katherine MacLean is at right now in Treasure Beach, and I remember probably there were maybe 10 to 12 participants there. I don't remember the exact number, and more than half of them, the way that they had heard of psychedelics was because of that article. And it was just one single article in The New Yorker, and I think this kind of, again, speaks to then the present moment and bringing it back today, because Michael Pollan's new book is coming out in a little under two months. And I think that's gonna continue to signify like this tide shift from a cultural perspective in how our world is perceiving these substances.

0:13:03 IG: Yeah, yeah. Definitely. You know, something just popped into my mind. I think we're kinda going in a free-wheeling way with this interview, and maybe, I think that maybe the best things come out maybe in a non-linear way.

0:13:16 PA: Absolutely.

[chuckle]

0:13:18 IG: So let's follow through with it. I had a... So and it actually also relates to my history. In 2008 it was the... I always get confused, it was the World Psychedelic Conference in Basel, Switzerland. 2006 was the LSD Symposium, but they're the same place. 2008, I presented a poster with a friend of mine, Petr Winkler, and we worked together. It was a kind of qualitative, semi-quantitative study looking at mental health professionals who worked with psychedelics, particularly LSD, under the former Czechoslovakia, under communism. So we spoke to these people, and I could talk a little bit about that, but that study was made possible in part to a journalist named Ross Crockford, who's from Canada. This is all gonna come back together, but the reason why I mention him is because I saw him in Prague a year ago or two, and we were talking about the media coverage of what some people have dubbed the psychedelic renaissance. And he said something that was very poignant and still sticks with me today, which was that, "Right now we are in... " What would, how did he say it? Not the limelight, "But we're in sort of the good graces of the media."

0:14:45 PA: Right.

0:14:46 IG: Right. And that wasn't the case, you could definitely think back to 20, 30, 40 years ago, and he was sort of warning, like that could, that can shift. Because, well, we know very well from the news coverage today, if you turn on any channel or the click bait, that it's the tension that that media industry sort of wants from us. It doesn't necessarily matter what the content is. And so there could be this possible future, if... And I think a lot of researchers are afraid of something negative happening, and then that narrative of psychedelics, fill in the blank, something negative, makes you go crazy or whatever, then returns. So, we're kinda celebrating right now on the precipice of this book coming out, which I think is gonna be very... I think it's gonna be a positive thing, but I think we always have to be wary of how things can change.

0:15:49 PA: And have you explored that possibility or that question at all, like either internally? So for example, Horizons, which I know you're on the board of...

0:16:00 IG: The board, yes, yeah.

0:16:00 PA: The first Horizons that I went to was the one in 2016, where Bob Jesse spoke. And he spoke specifically about this topic in terms of what could go wrong, and he listed out a number of things that could go wrong with this, some of which I thought were legitimate. So one of them was like if something goes wrong in a clinical trial. There haven't been really any issues, so to say, in any clinical trials yet, but even if it's completely unrelated to the psychedelics, so for example, someone has a heart attack or something like that, who knows?

0:16:30 IG: Yeah.

0:16:31 PA: Then, could that be tacked on to the experience itself? Or, like what I can see developing, for example, now that we're talking about this and it came to mind is, there was a pretty strong connection between someone like Charles Manson in the '60s and psychedelic use as well. So what if that narrative pops back up again about...

0:16:50 IG: Brainwashing and...

0:16:52 PA: Cults, and that sort of stuff. So have you given any thought to that in terms of, what are possible scenarios?

0:16:58 IG: I have a anxious neurotic predisposition. [laughter] So I'm always imagining scenarios of how things could go wrong, but also I think that's also adaptive and what I'm trying to do is be prepared for what may happen. But that being said, and I've spoken to Rick Doblin on this topic a few times, he feels fairly secure and I feel also pretty secure that, in terms of the clinical work and the research, it would take a lot to... I don't know, actually, I can't imagine what it would take for that to be derailed.

0:17:35 PA: I mean, the only thing that I can think of is like the dissolution of the United States.

[laughter]

0:17:39 PA: Literally something happens where we enter a post-nation-state world, and then all these infrastructures that have been created, the FDA, the whatever, they don't support that anymore, but I don't see that happening in the next three years.

0:17:51 IG: Right. [laughter]

0:17:52 PA: Or in the next 20 years.

0:17:53 IG: Right, right. So it's like something... Right, so the thing to be mindful of is that, in any kind of clinical trial there are side effects, so there are unpredictable effects, and there are what are called adverse events, right? And the FDA is prepared. That data, that event is examined like any other and so it's not like we... We do everything that we can, at least I can speak on behalf of the trial that I'm co-managing and co-directing. We have people go through a cardiologist, they go get an EKG, they... Depending on the results, they can even get a nuclear stress test. So there's a lot of preparation and screening to make sure that a person will not have a really significant adverse event. And if something unpredictable happens, that can happen, and does happen in studies. And so, you just can take that as to be part of research, part of clinical work.

0:19:10 IG: Outside of that, something like Manson-like, cult-like, I don't... I don't know. I guess these things are hard to predict and hard to imagine. I guess I'm hoping that our dialogue around substance use generally, and this goes beyond psychedelic research and really applies broadly to some of the other work that I do as a clinician, helping people with substance use disorders, or substance misuse, I think we're becoming more nuanced in terms of our conversation around that, and that may be partly driven by rates of the current opioid use. Current conversations around trauma and how that manifests and how that leads to people going down certain routes in terms of their mental health. I'm hoping that we've come to a place where we can have a more nuanced conversation and not go into hysterics about these kinds of things.

0:20:17 PA: Well, I think... And this is where something like cannabis is so interesting, right? Because I refer to the work of Ken Topper. You know Ken?

0:20:25 IG: Yes, yeah.

0:20:26 PA: Ken's a great guy. Had him on the podcast before, we're pretty good friends, and a lot of the work that he's done is talking about these normative state-sanctioned altered states that we have, which have been integrated because of colonialism, tobacco from the new world, [unclear speech] beverages, coffee and tea from the new world, and also elsewhere. And then alcohol, not beer and wine, but like gin in particular. And so we have these three that have been built up because of industrialism, by and large. And so I think this is what then is so interesting that cannabis represents is it's this other substance that was previously illegal that's now legal. And so now all of a sudden people are turned on their head. And then going along with that, like you said, we have the opioid crisis, which is all these things that have been prescribed illegally.

0:21:16 IG: Right.

0:21:16 PA: And then we have also the pharmaceutical I would say crisis of sorts, where a lot of people are realizing that the typical pharmaceutical medications are not as effective as we had once thought or hoped, which of course, ties back into the psychedelics and what not.

0:21:33 IG: Right, right and this is... I get a little bit cautious in this territory because I'm not a psychiatrist, and I certainly don't want to... I want to preface this by saying that certainly not anti-psychiatry or anti-psychopharmacology or anything like that, but somebody recently who I've been talking to. Some people may know Ethan Goldwater. He was telling me about his observation that many people, particularly in their 20s, young people who are approaching psychedelics either through ayahuasca ceremony or however, maybe through microdosing. His observation is that they're feeling like the typical prescription medication that they had been on often from a really young age. I mean, that's another...

0:22:32 PA: Adderall, for example.

0:22:33 IG: That is a really good observation that, yeah, we're now having people who are now becoming independent, they're in their 20s, early 30s, they can be making now decisions about their own mental health and some of them are questioning the medication that they've been on, and they are turning to psychedelics and microdosing as an alternative. And I just wanna be clear that I'm not condoning that. I think there's a lot of risk involved there, but that doesn't mean... We can't turn our backs to reality, if that's happening, then we need to... As a clinician, I feel like I know I have to provide some sort of safety support around whatever decision a person decides to make.

0:23:22 PA: Right.

0:23:22 IG: And I wanna say one more thing before we continue, because it's not clear. Currently, where this interview is happening at the Center For Optimal Living which is where I direct the Psychedelic Education and Continuing Care Program, where we basically do what I had just mentioned. So we don't provide any psychedelics to anybody, but what we do is work with individuals who come in, who have... Well, we say that have any kind of relationship to psychedelics, that means that they may have never even done psychedelics, but they've heard about it in the news. And what we do is we provide, not just harm reduction in a sense of identifying the risks and working with them in that sense, but also to clarify what the clients or patients what their goal is, what are they looking for, how has it been working for them? Can that be fine-tuned? And that's sort of another aspect of who I am and what my work is, it's not just as a PI on a clinical trial but also... And working with people who have a relationship with some sort of substance.

0:24:31 PA: Right. Which I think brings us to the crux of the conversation which we really wanna talk quite a lot about today, which is microdosing.

0:24:39 IG: Yeah, that's right.

0:24:39 PA: And I think we had spoken at Horizons five or six months ago, about microdosing, and you just had mentioned to me that because of the rise of interest in microdosing, you've had a lot of people who have now come to the Centre for Optimal Living, asking about it and what not. So I just would be curious to hear, yeah, when did you first become exposed to microdosing, and then what was that process in terms of your understanding of it and your hesitations or concerns about it?

0:25:09 IG: So I heard about microdosing for the first time. I think I know that I was at the New School, I was a graduate student there. I was working with... Well, a friend of mine, Russell, was... I'm blanking on his last name, but Russell was... He expressed interest in this question of microdosing and he was collaborating to some degree with Jim Fadiman around the collection of experiences that Jim Fadiman was receiving from people about their microdosing experiences. So that was... I think around that time was when it first came on my radar. I think I've had... I think most humans, I've had my opinion about microdosing, like any kind of thing, like shift over time. I think it's really important to acknowledge that our opinions change, and that's a healthy thing and I can't... I don't think I could even tell you when I thought what, but I can still access the different reactions that I have to it, which is one is, that's interesting, in the sense of it's not like how I can typically conceptualize psychedelic use to be like, either recreationally or clinically or otherwise.

0:26:36 IG: I think there's definitely a little bit of defensiveness to some degree, because... Well, what is... You raised the question of what is the optimal way to use this substance? And again, that can be both in the question, in the realm of outside of clinical research or clinical work, and also within, right?

0:27:06 PA: Right.

0:27:06 IG: And so there's a reaction to that. And I think that reaction comes from... In part from this idea, that somebody is using a psychedelic on multiple occasions. If you're following the protocol is it, every three or four...

0:27:25 PA: Two times per week usually, yeah.

0:27:25 IG: Two times per week. Four... It's like what, like four months or something like that.

0:27:30 PA: I did it for seven months, initially. Jim I think recommends five weeks. But even then, you had someone like Paul Stamets who was on the Joe Rogan podcast in the past couple of months, and mentioned five times a week, which seems... Which then you're taking it from... I think a lot of the conversation around microdosing has still been as a quote unquote "drug," meaning that although the effects might be sub-perceptible from a visual perspective, you might notice a slightly enhanced sense of touch or feel, which gets into another thing about microdosing, the definition. And the way that Paul spoke about it was more as like a supplement. In other words, you're taking this like fish oil.

0:28:06 IG: Right, right.

0:28:06 PA: Or something on an ongoing basis because it might have a potential impact. But yeah, so it's...

0:28:13 IG: Well, see, and that's like the... That is... I have a certain response to that because it's like, "Well, what are talking... Can we agree on what we're talking about?" And not that's a bad thing, but if we're talking about something, we should know what we're talking about, 'cause people use it... It sounds like people use it in different ways. People disagree about what sub-perceptual means, people disagree about dosing, and that could potentially have... Maybe that's a significant thing. Those differences maybe are important. So another aspect of it, that I have a thought about is, you had mentioned people coming in to the Center for the psychedelic program, asking about microdosing. The thing that's different is that there have been people who have absolutely no experience with psychedelics at all. Not just never having taken them, but never really even... Not being really familiar with what they are.

0:29:14 IG: So you read something that's more of an accessible media piece in the newspaper and, "Oh, psychedelics, microdosing helps with attention or creativity," and people come in with... They think they have ADD or anxiety, depression, and they may do, right? And so what's microdosing? And that's... Well, man, that's like from A to Z. That's a big leap from somebody who's had, say, an experience with a psychedelic and having a conversation with them around microdosing. Who are we attracting to this topic? Not that there would be anything wrong with them, but we're... This is a shift in who is approaching us.

0:30:03 PA: Sure. And I think this ties in both to the conversation that we were having about Michael Pollan earlier, in terms of a tide shift. And we've started to see the beginnings of this with microdosing, because it has been covered by every... Pretty much every major media publication you can think of, not only because of Jim Fadiman's work, but also specifically because of Ayelet Waldman, who published the book that was published by Knopf. And so then, she got all this media for it.

0:30:29 IG: And she's mentioned often when people see... Just a sidebar, when people come here, I hear her name, and her book, a lot.

0:30:37 PA: Yeah, exactly. And so I think that... But then that also speaks to, I guess the reason why I'm so interested in microdosing is the same reason why I'm so interested in the work that Michael Pollan is doing with his book publishing, is from my perspective, it's two things: One, we've had the research on psychedelics since the '50s and '60s. And while the research that was done then wasn't necessarily up to today's "standards" quote unquote, it was still research at the time. It is still showed that obviously psychedelics were useful. And then of course, we've had all this research that has been developing which has been phenomenal over the past 12 to 15, to 20 years. Yet still in our culture, there's a complete lack of psychedelic literacy. In other words, no one really is educated about this topic.

0:31:27 IG: Right.

0:31:28 PA: Outside of the very small subculture of people who maybe have had experiences with them before. So I get excited at that notion. That you're having all these people who have never yet been exposed to psychedelics. The first time they hear about it is through microdosing, and to me, that represents a healthy ship because now they're approaching professionals who can then provide them with educational information, so that they can make a decision about what they're doing.

0:31:56 IG: Right. Yeah, absolutely. So no, I definitely agree with the idea of education and access to information. I think that's extremely valuable. It needs to be available for people to make right decisions, decisions for themselves. My perspective is one of caution because being a mental health professional, I have encountered people whose ment... I wanna say mental stability, that sounds really derogatory, but like people who... It is what it is. Some people have a very difficult time kind of just functioning in the world, to people who we're like super highly functional. I've seen everybody from the severely mentally ill to very, very profesional people, highly performing individuals, right?

0:33:03 IG: And the feeling of caution comes from... Again, we don't have the science, the research, but I don't think this is for everybody, I really don't think it's for everybody, and that's when... My role and where we're educating, I think we need to be careful about how we go about educating people. That doesn't mean that we should be withholding information from anybody, I don't think that's useful. But I think we need to be also clear about, "Okay, what are the risks, what are the potential harms, is this something that is for everybody?"

0:33:42 PA: Right.

0:33:43 IG: So, the point that a psychedelic experience can be like 10 years of therapy.

0:33:48 PA: Sure.

0:33:50 IG: We've all heard that quite a bit.

0:33:51 PA: And I just recently heard it from Gabor Maté on the Tim Ferriss podcast, which is why I was like, "Okay, this is recent and this is the... "

0:34:00 IG: And Art, the director of the center, Andrew Tatarski, is gonna be doing a talk with Gabor at the end of May for anybody who's interested here in New York to check it out. It's gonna focus on largely about substance abuse or addict... We tend to not use the word addiction here because that's a whole another conversation. But that we have I think, issues with that word, but essentially it's gonna be about... It's gonna be a little bit less about psychedelics and more about that topic.

0:34:26 PA: Okay.

0:34:27 IG: But yeah, that phrase, right? So the phrase "ten years of psychotherapy in one night." I think that creates a certain kind of expectation in people and I don't want to say that that phrase is completely invalid, but I don't know if it's a... I don't think it's 100% valid. [chuckle] So, I'm like qualifying this a lot. But what I think it does is for some people... And this is one thing I think a lot about in the work that I do at the Psychedelic Education Continuing Care Program. What are people's expectations when they approach... And this could apply to microdosing as well. That experience, what are they hoping for, what change or thing is going to happen and then how does that change then come about?

0:35:21 IG: The thing is, that even in the clinical trials with MDMA, and the therapy that comes with it, people then have to do a lot of work. What I like to say is that... And I may have said this before. [chuckle] But that maybe psychedelics and MDMA, maybe what they do when combined with therapy, maybe they make change easier, maybe it's easier to change, but you still have to change, you still have to do the work. Microdosing, I don't know, that exists in an interesting middle ground, presumably, you would know more than me, here. And I wrote the Chacruna article and maybe we'll talk a little bit about that, but one of the kind of things I wanted people to think about was, was your intent... Not just your intention, "What is your expectation?" Is this something where you engage in microdosing and then "What's the mechanism of change?" Is it that... For example, "Are your symptoms just sort of relieved while you're taking it as a supplement?" Or is it that then it's more than just a supplement, it's a way to engage with your present moment more or differently. So then you could have certain observations about how you function in the world and then say, "Huh, I think I need to change that about my life." And then you can do that without the microdosing. Or what?

0:36:49 PA: But this brings up a really interesting relationship that Imperial College just published a paper on. Which is this relationship between 5-HT1A activists or agonists, whatever. Which is largely like antidepressants, which is a passive coping model. In other words, when you take an antidepressant, it blunts you to dealing with stimuli in the external world. Whereas the 5-HT2A activists or whatever the ones that activate that receptor, they deal with active coping, which is what... Kinda getting back into your question about microdosing.

0:37:21 PA: So, are we utilizing that in a way then where it makes us better able to actually cope with our external circumstances. So that it's not just something that we're taking, for example, to cover up the symptoms, but it's actually something that we're doing on a consistent basis, to provide maybe a little bit of fuel to integrate new habits and new ways of being. And so that made me think of that relationship, that in terms of "What are people getting out of this?" Because the last... I think one of the downsides that I think you... Well, let's do this, let's outline that article that you wrote in Chacruna, because I don't wanna put any words in your mouth, in terms of what you did and didn't include.

0:38:08 PA: So it would be great just to briefly go through that in terms of what were some of those hesitations that you presented, and then we could just provide a back link so people can get more and then dig in a little bit more from there.

0:38:17 IG: Yeah. I was inspired by something that James Kent mentioned in one of his podcasts, which of course, Brian had recommended to me, so he turned me on to that. Which was this idea of psychedelic legitimacy, which I think is a whole podcast topic unto itself, which I think is totally awesome. But the idea is, could you apply that to microdosing? That was the thing I was playing around with. What would be the legitimacy of microdosing? What are the assumptions that underlie microdosing? And...

0:38:53 PA: What is... Can you just define "psychedelic legitimacy"? Just so people have a context for that.

0:38:58 IG: Yeah. Well, no, we are in... In our current world, society, we have to talk about whether psychedelics or psychedelic experiences are... Or maybe psychedelic use is legitimate. I'm using that really in the broadest sense. In some cultures, in some countries, this is not even like a discussion. Just sorta taken as a given that that's somehow integrated into their culture. So, so, because of, primarily because psychedelics are illegal, when somebody, whoever says that they are using psychedelics, they have to somehow legitimize that, right? And that can be gained through... Now, so these are different categories, right? There is... So the psychiatric medical model. We're investigating these things as potential medicines, therefore that's how they are going to get legitimacy, and that's potentially then how they could be integrated into the culture or society.

0:40:00 IG: There is the cognitive liberty, libertarian kind of perspective which is, "I have the right to do whatever I want with my consciousness, and so why shouldn't I be able to do this?" There is the historical model, which is saying, "Well, Kykeon, or Soma, or whatever sort of ancient rite, or psychoactive compound was used so long ago, therefore it's right for us to do it now." It's sort of a little bit a leap, but that's a way of giving legitimacy to these substances. And there are others, I'm blanking on them right now. Well, there's the one that James Kent presented was just a recreational, like, "What's wrong with engaging in some sort of some celebratory... " You know, I was... It actually made me look up the etymology of "recreation," which is to recreate, to make, to renew, so like a process of renewal. We can think about... I think that's kind of profound, right?

0:41:15 PA: It is.

0:41:17 IG: So that's the legitimacy. And so I began to think about microdosing and thinking about, "Well, how is that presented?" It can help you with your symptoms, it can make you more efficient at work, which I thought was an interesting one, because many people in the psychedelic community are critical of capitalism in its current form or just capitalism generally. And so I think people have taken issue with this idea of using psychedelics to become more proficient at work. But the funny thing is there was an article not so long ago about psychotherapy like, "Are psychotherapists making people more... Is the psychotherapy process and capitalism just about making people more okay with how they're being exploited?"

0:42:05 PA: Yeah, and this is also like a criticism of some of MAPS' work, which I've heard before from certain individuals, were basically like, "Is MDMA for PTSD therapy just a way to make better warmongers? So we'll just, they'll just send them back in the war after [unclear speech]."

0:42:23 IG: Right, right. More efficient soldiers that could then... Right. Now, of course, I don't think that's true, but there are... Certainly, you can raise that question, right? And so that's where that... And then of course, my harm reduction psychotherapy work perspective comes into play, which is like, "Okay, you as an individual, what are you... If you're interested in microdosing, what's the motivation there? What are you expecting to come out of it?" And you've spoken... I'm gonna wrap this around to something that you had said, which is that, you know about the... You speak of the potential for microdosing to be a way to not numb or suppress symptoms, but a way to positively, actively engage with issues, or what's coming up for a person.

0:43:16 PA: Right.

0:43:17 IG: And I really think you have to contextualize that into who you're talking about. So people present with different diagnoses and, of course, those aren't perfect and there's all sorts of problems with categories, but for somebody who's depressed, for whom that activation may be useful, for somebody who maybe is... And I'm just kind of guessing here, but somebody who maybe has a psychotic disorder, maybe the way that their brain functions they have a difficulty, well, this is true, they have a difficulty filtering out information already. And so what happens if they... Potentially somebody's microdosing, and then they even have a harder time to filter out, 'cause maybe that's one of the mechanisms in psychedelics, in microdosing, right? Maybe that's not right for that person.

0:44:12 IG: So we can't, we have to be really careful about how we talk about things, because for somebody who this is contraindicated for, could hear this and be like, "Oh, my gosh, I've been taking all these antipsychotics, they make me feel blunted and terrible," which they sometimes do. And then they would... I guess my fear or caution would be, "Well, I think this is a great alternative," and then it kind of leads to a negative outcome, right?

0:44:40 PA: Right.

0:44:40 IG: It's really important, basically, like whose brain are we talking about? Also, in what cultural... With what kind of psychology we're talking about, and what kind of cultural context are we talking about? Is it in a country where they're gonna be put into jail for life, if they are found to have a psychedelic on them?

0:45:00 PA: Right, right. This is one of the challenges in terms of when you do take a larger vision picture, which is more what our focus and my focus is bound on. It is more the larger thing, you lose out on some of the nuance that, for example, you might take from a clinical perspective, because these are pertinent questions that you deal with on a day-to-day basis.

0:45:22 IG: Right, right.

0:45:23 PA: And so this is one of the most fruitful things from the conversation that we had in October, I believe, was: What are ways that you can hedge that risk, even in just from an educational perspective, in publicly speaking about these topics? Because while I am more oriented towards what's the upside of these, and I think part of that is just it's a common reaction to the larger narrative, which is "It's so bad," and so it's almost like, "Well, how do we balance this out?

0:45:26 IG: And also, like the perspective of... Caution, not, and this is not just me, I'm really talking about, I think, more broadly amongst researchers is, well, the fear of returning to the past where these substances were banned from being studied, right? Well, it's two pieces. One, as scientists we are, and you may listen to this podcast and think that I'm very enthusiastic and I am enthusiastic about this research, but I always hold out the possibility that this might not work, that psychedelics may not be helpful. Psychedelic-assisted therapy may not be helpful because, ultimately, what are we doing, what am I doing, what I think we hope we're all doing is we're trying to make the world and people, like life better for people. So why would we prescribe something that could harm somebody, right?

0:46:46 IG: So ultimately that's what it comes down to. So, but at the same time, I think for some researchers there is this fear of, "We can't talk about the positives too much." A, because of the science piece of being unbiased, which I think is good. I think that's true. But also, well, if we talk about the benefits, then there is, and something goes wrong, there's gonna be this huge backlash, or we're not gonna be legitimate scientists. And so I'm saying that because of your perspective, which is you've heard all the negative, so you're emphasizing the positive. There's a lot of people who are like working within the realm of the positive and they don't want to over-inflate it or they want to also pay attention to the possible negative as a... You're both operating from these perspectives of, well, revealing some sort of truth or getting at, getting at truth, right?

0:47:29 PA: Right.

0:47:30 IG: But from two different angles.

0:47:31 PA: Which I think is why it's so important to engage in conversations like this, because then...

0:47:35 IG: I agree.

0:47:36 PA: With that process of engagement, then you find a middle ground that then works...

0:47:38 IG: Absolutely.

0:47:40 PA: From a cultural and scientific way...

0:47:41 IG: Yeah, or if at the very least, the people who are listening can kind of hear the other, whatever side that they're approaching this from, they can hear the other side. And I mean, I'm also pushing this, because I think we need to be doing this in areas outside of, outside of psychedelics. [chuckle] I think like globally, well, globally, as a culture in the United States, we're not having enough conversations with people who we don't agree with.

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0:48:09 PA: Hello, listeners. Just a quick announcement and a few pieces of news before we get back to the interview. Albuquerque has voted to decriminalize marijuana possession following the example of other US cities and highlighting the power of state and city autonomy when it comes to drug policy.

0:48:25 PA: The LSD 75 Festival in Basel, Switzerland, will be marking 75 years since the discovery of LSD with talks from influential speakers, and artistic workshops and events. This will be running from the 19th to the 22nd of April. And MAPS is inviting people to record a two-minute long video explaining why LSD is important to you, to celebrate the 75th anniversary of its discovery. If you're interested in doing this, we'll provide more details in the written up summary of this podcast on our website.

0:48:57 PA: Last but not least, we still have spots available in the Synthesis Retreat that is coming up in July and August. If you want to take psilocybin truffles in a legal, structured, responsible setting and do it with professionals, then reach out to us for more details on that program. That will be at the end of July and early August in Amsterdam. Thanks so much for all of your help and support. And now back to the interview.

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0:49:35 PA: So, let's get back to the article.

0:49:36 IG: Yeah, sure.

0:49:36 PA: So you were talking about, we were talking about psychedelic legitimacy, we were talking about...

0:49:40 IG: Motivations for use...

0:49:40 PA: Motivations for use.

0:49:42 IG: We were talking about like kind of using it at work, and I think that was one thing that we haven't touched on yet that I think is a concern to me a little bit, which is somebody who's totally psychedelic naive, who begins to maybe experiment with something that's very potent, like LSD, in an environment where... Well, there are two pieces of it. One is, and I joke around with like being careful using heavy machinery, right? [chuckle] Like, don't operate, don't be doing that kind of thing while you're under the influence, potentially, because of the potential effect of it being stronger than you anticipate.

0:50:16 IG: But the other one, which I don't know if this is entirely valid. I remember reading it... I forgot, I don't know if it was Vice, it was some... One of those publications where somebody was talking, like they decided to microdose with a colleague and compare their experiences. People, I think can... I would... I wonder if people might have an adverse reaction that's more in the realm of anxiety, and trauma, where they either have a past history of trauma or they begin to feel they're not familiar with the psychedelic territory. They take a low dose, they're in an environment where they have to perform, and hopefully it's kind of a place that, a work environment that's flexible where a person can go home or whatever, but what if that person has to really do something stressful? That's not a good set and setting. So, I don't know. What do you... What are your thoughts about that?

0:51:11 PA: Well, I think, so the approach that I like to take about this is, this for me, like when you're looking at doing it within a work environment. And then, speaking from personal experience, I've never worked in a corporate workspace. Whenever I've microdosed, it's been at cafes, it's been in my apartment, it's been in places that I am very familiar with, that I've been to lots of times, because I've never worked in any sort of corporate workspace. So that, so a big part, then, from an educational perspective, what we say about microdosing, and I think this is the important part, then, about like some of the risks that people take on when microdosing is, again, from my perspective, most of those can be mitigated with some basic common sense. Which is, one, the first time you microdose, don't do it in a public space. You should not be putting yourself in any sort of vulnerable situation the first day or probably even the first few days that you microdose.

0:52:06 PA: When I started microdosing, I did it after many years of regular psychedelic use. So I started microdosing in mid-2015, I had my first psychedelic experience about five years before that, and probably had done psychedelics maybe 20 to 30 times before that. So I had a lot of experience and I could easily calibrate my dose level, meaning that I knew if I took this, I would have about this effect, if I took this amount, maybe a little bit more would be a bit... Blah blah blah. A lot of people who are coming to this don't have that. So I think that's one, is don't be in a vulnerable space. But I think two then, again, from a work perspective, it's like microdosing for me, and this is sort of the larger narrative that I've been working to develop in... Not in opposition, but because of some of the backlash against, "Well, are we just microdosing to meet the end purposes of capitalism, so to say. Are we just, are people just microdosing to be better, more productive workers?"

0:53:09 PA: For me, the big step ideally that people can take when microdosing is, again ideally, microdosing because of its effects, I think also lends itself to a deeper sense of self-awareness and self-reflection, right? And so then, there are two transitions people can go through. One is I've started microdosing and I've come to realize that I really actually, I've always known I hated my job, but I never really had the courage to quit and really pursue what I wanted to, and potentially microdosing can facilitate that process. So I think that's option number one, I think. I think number two then is, again, from my perspective, like, I love what I do, and I think the work that I'm doing, that we're doing is important, it's valuable, it's contributing to a future that's going to be healthier, more sustainable, etcetera, etcetera.

0:54:00 PA: And from my perspective, although this isn't true like on a wide scale, again from the conversations that I have, from the trends that I pick up on, I notice that there are more and more people who are opting to pursue work that's meaningful and has purpose, where the end goal isn't financial wealth and stability. The end goal is purpose, meaning, experiential wealth, really doing something you love with the idea of, well, as long as I can like make, I think the figure is like $70,000 a year or something like that, then I know that even if I go way above that my quality of life won't improve that much. So I see, again from my perspective, it seems like a lot of people who are microdosing are not doing it to find their corporate jobs more palatable, it seems to be a lot of creative entrepreneurs, freelancers, who are already doing things that they love, and they're microdosing to facilitate the process.

0:54:57 IG: Well, don't, don't, please don't take this as a criticism, but that may also be, and maybe it is a criticism, but maybe that's also the people who you're speaking to, you know? When we think about, this is gonna be sort of a social critique. Right, but it also comes from my own experience at my work here and speaking to people who... Well, I'll leave it at that. I have known people who are struggling at their job and don't necessarily have such an opportunity to move jobs, or, I mean there's always that... You just have to take the risk. But the other piece of it is that a lot of people don't make $70,000 a year, and as the... And with your own interest in reaching out to more people... I don't know, it's... If you can work in a cafe or you have the luxury to work in a certain kind of environment, I think that's great, but a lot of people don't, right? And they're working under different circumstances, and I guess we just have to be mindful of that.

0:56:05 PA: Yeah. No.

0:56:07 IG: I just wanna bring that up.

0:56:07 PA: And that's a really good point is, for example, I sometimes don't think about that in terms of my lifestyle or even the lifestyle of people who I know who are microdosing, it's not necessarily representative of everyone who is microdosing. And that's, I think, an important thing to keep in mind, and this, of course, gets into the larger social critique question of then, what are we doing on an active basis to facilitate changes in our economic structure? So that it is more equitable, and so that people do have a chance to pursue meaningful work, and that they're not just stuck in jobs that they prefer not to be in.

0:56:49 IG: Right. And this also comes back to the... And this is for a conversation, I think that we don't have enough time for it, but just to put a little bookmark on it, maybe, is the availability of psychedelic-assisted psychotherapy or MDMA-assisted psychotherapy if it proceeds beyond the FDA and gets approved, how can that become affordable to people who need access to it? That's a big question. So these questions of affordability of income economics, insurance society, they are like, they're connected.

0:57:26 PA: So one other thing that I wanted to hit on as well was, and I know maybe we already dug into this enough, but I kinda wanted to open it back up.

0:57:35 IG: Sure, please.

0:57:35 PA: Was this idea of psychedelic legitimacy in terms of microdosing being this completely new paradigm, in terms of how people are approaching psychedelic use. So in other words, the underlying assumption that obviously, since the '50s and '60s, since psychedelics have been reintroduced into Western culture, they've largely been used in high transformative doses. And so what does that say about microdosing when instead of it being this, I think this paradigm-shifting dose where you go from day zero to day one and you pull the doors open and all of a sudden you're higher on the openness scale and all this stuff, microdosing is more like a health tonic, so to say.

0:58:19 PA: And the reason I mention that word is because one thing that I've found to be really interesting from this microdosing event that we did in Bushwick around Horizons the same day, Hamilton Morris spoke on the panel, he was first to speak. And he brought something up which I found to be really interesting, that a lot of the indigenous cultures that he spends time around or has spent time around, that in fact their exposure to psychedelics is most often not in higher doses but at a lower dose level, again, as this sort of health tonic. And so, that's also something I wanna dig into with you a little bit in terms of what's your understanding of that relationship between this high-dose, paradigm-shifting experience and microdosing which, again, to tie into our conversation about work, seems to be this modality that just kind of concretes or continues to validate some of the assumptions that we already have.

0:59:22 IG: I'm just going to riff off of that, which is that one thing that comes to my mind is the distinction between psycholytic and psychedelic. And psychedelic being kind of the full dose, often connected to mystical experiences, now we kind of talk about it, versus psycholytic, which was the use of lower doses of psychedelics, particularly LSD, to enhance really what was psychoanalysis or psychotherapy. The idea that maybe that exists a little bit more within the biographic domain, and then the psychedelic, full dose, mystical being in maybe this sort of transpersonal domain.

1:00:01 IG: And of course, what some people have observed anecdotally, is that when somebody engages in the full dose experience, they kind of go through a biograph. Like there's a trajectory where the effect of the psychedelic is still coming on, and maybe they're in more of sort of a biographic place, then they have this experience and then as they're coming down, they're maybe re-entering in a kind of biographic way, so maybe there's a psycholytic and psychedelic therapy happening at the same time. And so you're talking about microdosing. Well, one thing is that we don't really have any studies of psycholytic therapy nowadays. So that's something that's...

1:00:36 PA: Is the MAPS? MAPS isn't a psycholytic then, the MDMA-assisted psychotherapy?

1:00:38 IG: Well, it is in the sense that MDMA... Well, it's because we're now talking... If you consider MDMA not a psychedelic, right?

1:00:45 PA: I just want to clarify.

1:00:46 IG: Yeah, so that's a good clarification. Yeah, so certainly MDMA-assisted psychotherapy for PTSD is not pursuing a mystical experience as the one that's operative in the healing, and so it is very much biographic. There's a little bit of mix of both, but sometimes people have a spiritual experience. So if we put that aside for a moment, the work with, say, psilocybin, there's not a lot around a kind of lower dose. Again, it's not a microdose, it's not a sub-perceptual dose. So that would be, that's kinda... So why is that neglected? I think that's an interesting question. And then microdosing is just... I know that Beckley is looking for funding for a study looking at microdosing and creativity. So there are these studies that are coming about, but it's not the same place as the other research is.

1:01:45 IG: Other cultures, I did look into whether, what was it, the Bwiti tribe used ibogaine, and I think there was a reference that I saw somewhere, but I had trouble finding... And maybe this is not because it's not accurate, or that Hamilton is not right. I would trust his first-hand experience 'cause he's had a lot of them, but I had trouble finding academic references, whatever that's worth. I mean, it's worth a lot, but it doesn't mean that it doesn't exist.

1:02:16 PA: Sure.

1:02:19 IG: Well, I don't know what... Well, from an armchair anthropology, evolutionary perspective, if somebody had access to, if you think about people who had access to these plants, it would make sense that they would start off small. And from a practical perspective, who can have their... You can't really have your mind blown on a full dose psychedelic experience on a regular basis in I would imagine most cultures, whether it be ours or elsewhere. You need to kind of operate in the world with whatever you're doing, whether it be hunting or working in a cubical. So it would make sense that a microdose... Well, people would kind of go that that route before...

1:03:16 PA: Right. And I think that's what's then for me, it's so interesting about now, how this is re-emerging as a practice was... Because we just had that very in the past, binary, black and white, it's either you take psychedelic at a high-dose level or you don't do any psychedelics at all. And I think this is why it's kind of entering from a controversial perspective is because of things that we've hit on in this conversation already. Obviously, there's a distinct lack of clinical research, there's a distinct lack of vernacular terminology around it so that we can actually have an accurate understanding of what is a microdose.

1:03:53 IG: Right.

1:03:54 PA: And then there's just the fact that it's taking place within a late stage capitalistic economy that might facilitate endgames that many people in the psychedelic space fundamentally disagree with. But I just would be curious, in a conclusion. When it comes to microdosing, in your ideal world or even from a very much April 2018 perspective, what would you like to see done in the larger conversation around microdosing so that it does gain more legitimacy within... Particularly what I'm interested in is within the clinical, academic and institutional side.

1:04:38 IG: No, I think we definitely need the clinical research, and we need the science. And the other thing is also the question of the placebo effect, and that's not just a criticism of microdosing, it's a criticism that people make of the psychedelic and MDMA-assisted psychotherapy, because you can't blind, people know if they've gotten the active dose or not. But I think it's even more so when you're calling something sub-perceptual, then you really need to have a controlled study. But, yeah, let's do it, why not, it could be really profound. But then the other thing is you also have to think about, "Well, what's the design of the study, what is the protocol around taking the other substance and also the duration, for how long and then, what is your hypothesis around how long the effect lasts?" Are you're saying that it's... These are just questions, are you gonna say that it's forever, or that it has a certain period that is beneficial after you stop the microdosing? But there is no reason... Well, it's hard to get funding, that's the reason here.

1:05:53 PA: That's the main reason this is like... I spoke to... I was speaking to a scientist at Imperial who was trying to submit a grant to do a microdosing study, but his main challenge was how do I pitch the outline of the study, because if people come in more than five times to microdose, then the study just becomes prohibitively expensive, and I would need grant money to support it.

1:06:20 IG: Oh, yeah, and also you can't give them the substance, 'cause it's schedule one.

1:06:26 PA: Exactly.

1:06:26 IG: They can't go out... They can't take it on their own.

1:06:27 PA: Exactly, so this is like... And so this is what I keep coming back to is the primary issue is, even with the LSD microdosing for creativity and problem-solving experiment that the Beckley Foundation is doing, it's just a single microdose, and what we're noticing is the impact of microdosing is not just the day that you take it, but it's day zero to day 90 because of that eventual unraveling process, so even... It's hard to wrap around how are we gonna find and discover the efficacy of these things until we have... So for example, until we have a more mature approach to personalized medicine potentially.

1:07:09 IG: Well, here's another alternative, which is doing naturalistic studies, doing qualitative studies, and of course they're I think inappropriately looked down upon within certain circles of academia, but... And I guess that's what James Fadiman in part was doing, he was trying to gather data from people's experiences. But now, through your network and your experiences, there must be many people... Of course, you can't do that double blind part...

1:07:43 PA: Right.

1:07:43 IG: Right. But you could at least...

1:07:45 PA: And this is what we're starting to roll out, and I know someone is... I'm working with someone from Imperial who's doing a survey-based study with placebo control, and they set it up for people to do at home. So there is that coming out. We're also starting to... We just got our first... At Third Wave our first IRB-approved research study that we're going to facilitate as well with our audience about microdosing. So that's exciting. But, yeah, that is I think the primary challenge right now is how do we properly study this to understand the impacts?

1:08:16 IG: And what you can do with that data is you can also then present it, too. It can help with getting the grants instead of just starting from scratch you can say, "Well, look, we've gathered all this naturalistic qualitative data, look at that, does that give this any more merit?" But the scheduling piece is also, yeah, that is still [unclear speech] good, yeah, agreed.

1:08:37 PA: Well, I just wanna thank you, Ingmar, for sitting down and chatting.

1:08:41 IG: Thank you.

1:08:42 PA: If people wanna find out more about your work, or what you're doing here also, what is the best place to do that?

1:08:48 IG: Yeah, psychedelicprogram.com is how you can access our work where we both provide psychotherapy around psychedelics, again we don't give the psychedelic substances, but we do everything around that, and we also do education, so we teach clinicians and the public about the workshops. Actually, we have a workshop coming up at the April 21st and 22nd at the New School, Psychedelics 101 and 102 for clinicians, but it's open to the public as well. So we do that and we feel very passionate about that, because we want to educate the mental health field around what it means when their clients are using. It's a multi-pronged kind of approach to change.

1:09:33 IG: And then, well, there really isn't any way to access the psychedelic... The MDMA-assisted psychotherapy research. However, if individuals are interested in participating, they can email [email protected]. However, this is a treatment for post-traumatic stress disorder, and there is no kind of... That's what it's for, so that's one way to access that.

1:10:06 PA: Great, great. Well, thank you so much.

1:10:22 IG: Yeah, thank you.