Harm Reduction

Transcript: Shaping Your Own Reality with Ketamine – Will Van Derveer, M.D.

The Third Wave · November 12th, 2020

Please enjoy this transcript of our interview with Will Van Derveer.

Just a few years into his psychiatry practice, Dr. Will Van Derveer grew frustrated with the limitations of the psychopharmacology model, which focused too much on medication and not enough on a holistic approach. In this episode, he discusses his journey from conventional psychiatry to integrative psychiatry, his research on psychedelic therapy, and the role of ketamine as a catalyst for long-term, whole-body health.

Highlights include:

  • The limitations of the psychopharmacology model.
  • Will’s journey from “traditional” doctor to advocate of psychedelic therapy.
  • Ketamine infusions versus ketamine-assisted psychotherapy.
  • The difference between a state change and a trait change.
  • Ketamine’s impact on the default mode network and other areas of the brain.
  • The difference between neuroplasticity and dendritic sprouting.
  • Psychedelics and the gut-brain connection.
  • Bodywork, ketamine, and trauma release.

0:00:00 Paul Austin: In today’s episode, we have Dr. Will Van Derveer, a psychiatrist and psychotherapist who emphasizes an integrative model of well-being. Will is a study physician and psychotherapist on multiple MAPS clinical trials, evaluating MDMA psychotherapy for PTSD, and he has practiced integrative psychiatry in Boulder, Colorado since 2002.

0:00:22 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.

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0:03:31 PA: Hey, listeners, and welcome back to Third Wave’s Podcast. I am your host, Paul Austin. And just like last week, we had Marcela Ot’alora on the show. This week, we have another person who was slated to speak at our Becoming Whole Conference in Boulder this past May. Unfortunately, we had to cancel that. And our next guest, Will Van Derveer, is also someone who’s been a friend of mine for the past couple of years. We had our first phone call in mid-2018, I interviewed him as an expert interview for our microdosing course, and we’ve continued to stay in touch. We met for the first time at Horizons in 2019. And what I love about Will’s approach is his ability to look at the integrated perspective. So, like in our expert interview that we did for the microdosing course, we talked a lot about the role of personalized and precision medicine, how, for example, psychedelic healing affects telomere length or how it affects inflammation in the body, and basically, what that means for healing psychosomatic issues.

0:04:37 PA: And so, in today’s episode, we just got a chance to dive even deeper into Will’s background, how he came around in psychedelic medicine, his experience in being involved in the MAPS clinical trials, how he’s training psychiatrists and medical doctors in providing integrative Ketamine treatment, a little bit about what he’s currently doing in Boulder with patients, and just weaving all those pieces together to really explore what does an integrative healthcare model look like and how will psychedelic medicine help that come to the forefront of our mainstream healthcare model, right?

0:05:13 PA: With psychedelic medicine, we’re undergoing a fantastic, incredible transformation of the way that we approach health, from being something that is biological, being something that is chronic, that we are stuck in, to actually understanding that we can change chronic disease, that we can heal chronic disease, that we can heal chronic trauma by getting to the root cause of these issues, which is, so often, early adverse childhood experiences. So Will and I dive deep into that. And, I mean, it’s just sort of two homies who are getting a chance to connect over the podcast, and we get to share this with all of you. So I really hope you enjoy the conversation between Will and I. And without further ado, we bring you Dr. Will Van Derveer.

0:06:00 PA: Let’s just start with a little bit of background about you. So how did you get involved in the space? Just kind of give the basic overview, and then that will sort of lead into the rest of the conversation.

0:06:09 Will Van Derveer: Great. Thanks, Paul. It’s great to be here again with you. And so, I’m a psychiatrist by training, and I have been doing that for almost 20 years. I estimated I probably have about 20,000 hours of that in my system. And after getting traditional training, I started to see the limitations of the psychopharmacology model because I had patients in my practice who were not responding to medication after medication after medication. And even though I was giving them, I think, pretty decent psychotherapy and sometimes teaching them to meditate, and things like that, I wasn’t getting the results I wanted to see. So just a couple of years into my practice, I quit out of despair and frustration, and I went looking for other ways to help people get well. And it was around that time that I had a patient who didn’t progress well in my practice, not well enough, anyway, who had severe anxiety and couldn’t travel, very limited in his ability to live his life, and he went outside of my practice. And when he got tested for Celiac disease and came back positive, stopped eating wheat, and pretty soon, his symptoms were gone over a period of weeks. And then he went off the medications that I had him on and he still had no anxiety.

0:07:44 WD: So that was in 2004. That was a huge turning point for me, where I realized that there was a lot more to the story of psychiatry than I was taught in my training. So I got into more of this psychedelic space, and I think it was 2011 or 2012 when a friend of mine here in Boulder, Colorado, who’s an oncologist, told me that an MDMA study was getting organized in Boulder and that they needed a physician for the study to move forward. And at that time, I was one of those brainwashed physicians who had been taught that MDMA causes holes in the brain and it’s always bad, it’s never good, it can’t do any benefit to anybody, something the kids in raves use, and so forth. And he said, “Well, why don’t you read this paper by Michael Mithoefer?” And so this is the 2011 paper that Michael put out, where 83% of the people who got MDMA psychotherapy for chronic PTSD stayed well for a long period of time after the three exposures to MDMA therapy. So I thought to myself, “Well, okay. I’ve been humbled already by not knowing that the brain was connected to the gut.”

[laughter]

0:09:05 WD: That warmed me up to another humbling, which is that all of my ideas about MDMA were wrong, and I needed to sort of open my mind to these possibilities. So I was never one of those… I didn’t grow up in the psychedelic community. I wasn’t a kid who did that in college, it wasn’t my thing. So it was a bit of a hurdle to get over, but when I started… So I got involved in that study. We published the paper a couple of years ago, similar findings to what Michael had put out a few years earlier. And it’s just a really incredible, powerful tool to have available for people who have just suffered for decades, often. So that’s a longer answer, maybe, than what you are asking me, but that’s how I entered this space.

0:10:05 PA: But I think it leads us into a really good starting off point, which is the work that you’re currently doing in Boulder with the Ketamine integrative clinics that you’ve opened, and that you’re going to open more of. And currently, as we’re recording this conversation, MDMA is still a Schedule I substance, it’s federally-illegal. And although MAPS is now in phase three trials to treat PTSD with MDMA, you can’t yet go to a center and get MDMA treatment, but you can do this with Ketamine. And I’d love if you could just explain to our listeners and go a little bit into how Ketamine treatment has rolled out, so maybe the difference between Ketamine infusions versus Ketamine-assisted psychotherapy. And in particular, the approach that you take to Ketamine treatment, in terms of looking at the person as a whole, the holistic self.

0:10:58 WD: Great. Yeah, right, so what ended up happening was we finished this MDMA clinical trial, and I knew it was gonna be a number of years before MDMA could be reviewed by FDA for the phase three results we’re in. So I found out about Ketamine. I actually had a patient who asked me for Ketamine, again, very similar kind of scenario forof me, for saying, “Wait a second. This is a horse tranquilizer, that’s a drug of abuse, and I’ve never heard it being prescribed in psychiatry.” And then I came around to, “Wow, look at these studies from Carlos Zarate and NIMH, and 80%… 70% to 80% treatment response.” And I opened once again and thought, “Well, let’s give this a shot.”

0:11:50 WD: So I went and I got training and ended up starting my Ketamine work with people, I think it was three years ago now. And we first started treating people with intramuscular Ketamine and doing the two-hour psychotherapy sessions. So it was kind of a model that was based on the MDMA psychotherapy model that I learned through my involvement with MAPS, much shorter, obviously, than an MDMA session. But the idea was to take people through an experience and open… I learned later, as I started learning about the effects of Ketamine in the brain, opening the default mode network, getting into unconscious material that’s hard to access without a facilitator like that. And we did IM Ketamine for a couple of years. And I was reluctant, at first, to build out an intravenous Ketamine approach in the clinic for a number of reasons, some more psychological or kind of philosophical, and some more practical. It’s just… It’s a lot more to put people through IV treatments in a psychiatry clinic.

0:13:07 WD: But eventually, we added IV Ketamine as part of what we do, and we provide psychotherapy with IV Ketamine and also with intramuscular Ketamine. So that’s what we’re doing now, and our outcomes are pretty similar to the 70-80% that we see in the clinical trials in the phase… They’re basically phase two trials with racemic Ketamine. I call them phase two because they’re small, randomized placebo-control trials, but they’re definitely not phase three trials. But we’re really pleased to have a tool that, for people who haven’t responded to more traditional approaches, can have a massive change in their symptoms in three or four weeks.

0:13:58 PA: Let’s get a little bit deeper into that because there’s a new company that’s popped up called Mindbloom, which is essentially a company that prescribes you a Ketamine lozenge, which you can take at home now and use telehealth services to help guide you through it if you need it. They also have an app. And that is a way of doing treatment in Ketamine therapy that can be done through telehealth because the lozenge is less intense, we could say, than IV or IM. So I’d love if you could just bring our listeners a little bit deeper into like… Let’s say someone is interested in going to your clinic for treatment, right?

0:14:38 WD: Right.

0:14:39 PA: What’s that process like? What are you screening for? How do you then lead the client into that session? How do you prepare them? How do you help them integrate? Just bring us a little bit deeper into that, the story of someone who’s coming to your clinic.

0:14:49 WD: Sure. So I would say that most of the people coming to our clinic for Ketamine are actually not looking for a psychedelic experience, which I think is important to say upfront. Most of them are people who have struggled with long-term depression, who are… They’re studying the Internet for what’s the cutting-edge treatment, what’s the latest thing that I haven’t tried yet. If I don’t want to do Transcranial Magnetic Stimulation ’cause it’s too expensive, or I don’t wanna go through ECT because the side effects are horrific, what else can I do? What options do I have?

0:15:33 WD: So, typically, we’re seeing people with chronic depression who have tried three, eight, 15, 20 different types of medications to try to get their depression under control. Boy, there’s so many directions we could go in this conversation, follow with… Like talking about just even like the psychopharmacology model of depression, which is pretty limited, I think, in terms of how we’re defining the treatment goals. Are we looking at symptom reduction as the outcome that matters, or are we looking for a deeper result along the lines of what you were just talking about, of integration? And getting to the bottom of what’s the hidden, unconscious thought structures that are driving the chronic depression or the suppressed memory of the trauma that happened that, if excavated and integrated, could lead to lasting wellness without the need for continued support or continued psychiatric intervention.

0:16:43 PA: And it’s both, a little bit, right?

0:16:45 WD: It’s kind of both. Yeah, it’s both.

0:16:46 PA: It’s both heal the wound so it stops festering…

0:16:51 WD: Right.

0:16:52 PA: And understand that life sometimes is suffering, and difficult stuff happens, and challenging stuff happens. We have to deal with grief, and we have to deal with loss, we have to deal with depressive states and states of anxiety. And so it’s almost like you gotta do the work to excavate, like you were saying, to get into the unconscious. And it’s always a consistent practice to stay balanced and centered and grounded.

0:17:20 WD: Absolutely, yeah. There’s so many different kinds of fantasies that we can get into of kind of cross the finish line and you’re done. You don’t need to keep working into a healthier diet, you don’t need to keep exercising, you don’t need to do these everyday maintenance… Health maintenance issues that are critical for us to maintain wellness throughout the lifespan. And so, coming back to Ketamine and how to work these different methodologies, we’re really strong in our wish to serve people at the deepest level and not promise people a chemical cure, because I don’t think that is, at the end of the day, an honest way to look at what the tool is. We want to mitigate symptoms because, obviously, people need to have enough space to do the deeper work, but we also want to really encourage people to do the deeper work. Having said that, not everybody’s ready to do the deeper work. And so what happens to those people is an interesting question as well. And I think there’s moral and ethical considerations to take into account there.

0:18:49 PA: I was interviewing Julie Allan for the podcast a couple of weeks ago, and we had a similar conversation about when she has people come in, some of them just simply aren’t ready to get off their pharmaceutical medications. And if you took them off the pharmaceutical medications, it would be a disaster, right?

0:19:04 WD: Right.

0:19:05 PA: Whereas, other people are sort of… They’re ready for that. So, when it comes to your position, from a psychiatrist’s perspective, how do you evaluate that? What’s the process to understand this person is ready for this, this person is ready for that? What are you doing from an intuition perspective? What are you doing from a screening and data perspective? What’s that process like?

0:19:25 WD: I think it starts with taking a stand that anyone can achieve well-being with the right level of effort and the right level of support. And then really assessing the patient… Part of it is intuition, but part of it is questions and really interacting with someone around what they believe is possible for their lives. And one of the problems with chronic PTSD or chronic depression is that people get so beaten down by it that they oftentimes lose… They’re so discouraged in their lives that they lose this bigger vision of what’s possible for their healing process because they’ve been so discouraged by what hasn’t worked so far, right? So, having said that, I don’t find it helpful to turn people away, who are not ready for the deeper healing. I think what often needs to happen is people need to have a dramatic symptom reduction in order to be able to find the wherewithal and the strength and the commitment and the effort that it does take to get the deeper result, if that makes sense.

0:20:37 PA: Yeah, ’cause we talked about this in our last interview that we did a couple of years ago, where it’s difficult to get to emotional trauma if your physical organism is still so unhealthy, right?

0:20:48 WD: Yes.

0:20:49 PA: And sometimes, what psychedelics can do is they’ll just blast through all the way to spirit, but then if you blast through all of that, you’re gonna leave a lot of chaos in your wake. So it’s definitely a… It’s… Again, it’s the balancing of the knife-like precision with the understanding that, as a human, we are interconnected to everything around us.

0:21:13 WD: Well said. Absolutely, yeah. And so the process of psychotherapy and integration around any psychedelic, and we’re talking about Ketamine right now, I think it’s applicable anywhere. I think it’s so critical, it’s so important. And I have concerns about people who are getting access to that surgical knife that you’re talking about without getting the frame of reference of, “Okay, this is something that can blast you to oneness or to divinity or to a non-dual experience.” But I think we need to be sober about what the effort is that it takes to make a state change turn into a trait change.

0:22:03 PA: Can you explain that more? What is a state change versus a trait change?

0:22:08 WD: So I’m quoting Huston Smith, who was just a brilliant religious scholar, he was out of UCLA, who said, “True change is not just a state change.” It’s not just, “Okay, I’m on LSD or MDMA or Psilocybin or Ketamine, and I have a direct experience of myself as an infinite being, and no boundary between self and other.” And that beautiful ego death kind of experience that can be so transformative and so catalytic for people, I would call that a state change. And then a trait change is establishing a stable new normal for that person, going forward in their life, that doesn’t require ongoing… Well, that can happen… Well, first of all, that can happen outside of the Ketamine experience, that’s critical, that we’re using the Ketamine as a catalyst that can show people what’s possible, but having the view that the human experience or the human physiology, the human mind can actually, with practice, whether it’s mindfulness or brain training or neurofeedback or any number of incredible…

0:23:27 PA: …

0:23:29 WD: Yeah, any number of different tools. As one spiritual teacher I had said, “Keep refreshing the umbilical cord.” There has to be a way to keep plugging into that bigger mind, that bigger perspective.

0:23:41 PA: The analogy that I like to use, which is a bit grounded, I would say, is like going to the dentist, right? Every six months, we go to the dentist, we get a deep clean. It’s like we’re fully… Everything is good. And then every day, we gotta brush our teeth, we gotta floss.

0:24:02 WD: Right.

0:24:02 PA: There’s that sense of, “You gotta keep the ritual.” ‘Cause the ritual, the consistency is where the actual transformation happens. And this is, I think… This goes into an issue which is just only going to become more prevalent as psychedelics gain popularity, which is spiritual bypassing.

0:24:18 WD: Right.

0:24:19 PA: And how there is a tendency for a lot of people, when they have that state change, to place so much emphasis on that state change without recognizing that, as malleable beings, what is actually much more is to utilize that state change to adapt yourself to these new circumstances that you need to step into for continued nourishment and well-being.

0:24:40 WD: Great analogy, I like it, brushing teeth.

0:24:43 PA: Alright.

0:24:43 WD: And flossing. [chuckle]

0:24:44 PA: It’s so important, right? It’s so important. And imagine if we never learned to brush our teeth and floss, but just every six months we just went and got a deep clean, we’d be fucked. It would not matter. And so, again, you have to have both. You have to have both the deep cleanse and you have to have the consistent hygienic practice to… In this case, like you said, to stay connected to the umbilical cord, to stay connected to source, to stay connected to the nourishment that comes from that.

0:25:13 WD: Right. Beautiful, yeah.

0:25:16 PA: So let’s talk about some of that science, right? So let’s talk about some of the science of what’s actually going on physiologically when we have these state changes. How are things like Ketamine and MDMA and Psilocybin… What’s physiologically going on in the body and how is that leading to, A, I think better lifestyle choices and better lifestyle decisions, and then, B, as a result of that, how is that leading to better overall health for the individual?

0:25:45 WD: Well, I guess, the honest researcher answer to that is we don’t know. So I just wanna say that first, we don’t know what the… We know some of the science. We know some of the things that are happening, and we can certainly get into that. I love talking about that stuff, but…

0:26:05 PA: What do we know, Will?

0:26:06 WD: Yeah, what we do know.

[laughter]

0:26:08 PA: Let’s not talk about what we don’t know. Let’s talk about what we do know.

0:26:11 WD: But I think sometimes, in the popular press, there’s a jump that happens from association to cause, and I think that’s a problem for people, because, again, it creates a fantasy that’s unrealistic. So why don’t we start with Ketamine as what we know about that, and then happy to share what I know about other things, but the Ketamine is interesting because we have, I think, three or four really interesting things that we know are happening. Some of these things are happening in rodents, some of it hasn’t been researched in humans, but there is plenty of human research on Ketamine. So, first of all, I think what’s most interesting about Ketamine is the impact on the default mode network. I’m sure your listeners are familiar with that construct. You probably talk about it a lot with your guests, am I right?

0:27:00 PA: So the default mode network is essentially the network that… It’s your default mode, but when it becomes too tight, too high-strung, then that can lead to depression and too much rumination, essentially.

0:27:11 WD: Right, exactly. So this is the kind of free-wandering attention that happens when you… I like the analogy of when you get to the gate at the airport, and you are not aware that your flight is delayed, and you get there and you find out it’s delayed by an hour. And then the first series of thoughts that you have, right at that moment, is your default mode network kicking in. It’s like, “Okay, I don’t have anything to do. What do I do? Oh, I go in my phone. Oh, there’s that email. Oh, I forgot to make that phone call. Oh, blah, blah, blah.” So, when we’re on task and we’re focused, and famously, in these books and researches about flow states, is when the default mode network turns… Like it’s very quiet, and we’re on task, and we’re doing our thing, but it’s the free form kind of, I don’t know… A meditator might call it sort of like the monkey mind or the garbage that comes through our minds when we’re not on task, is really what we’re talking about with the default mode network.

0:28:15 WD: So I think you said it really well when you said rumination, obsession, circular thinking, hamster wheel-type thinking. This is when the default mode network has gone awry. And what’s interesting is… So there’s a healthy version of the default mode network. Once again, we don’t wanna get reductionistic or oversimplified, and say that there’s good things in… The default mode network is bad, or it’s good not to have one, or something like that. It’s more like what you were saying, is it can get too tight.

0:28:47 PA: Right.

0:28:48 WD: And tight…

0:28:50 PA: Imbalance, right? It can just get out of balance, essentially.

0:28:52 WD: Yeah, out of balance, and can recruit brain areas into the connectome of the default mode network, that don’t actually belong… In health, do not show up as members of the brain areas associated with the default mode network. So what we know about Ketamine is… Well, we have research on the default mode network in very depressed people, which has a certain pattern to it that’s recognizable in this way that you were just describing. And then we have plenty of research on what the default mode network of a healthy person looks like. And the interesting thing about Ketamine is we now have research showing that Ketamine, for a period of time, it looks like it’s maybe about a week, will impact the default mode network of depressed people to make the EEG signature of the default mode network in those people look more like a normal… A person without depression for about a week. So, it looks like… And it’s really interesting when you look at these images of what happens, how the different… These nodes in the default mode network that are recruited in in chronic depression, especially rumination and this obsessive stuff, fall away.

0:30:10 WD: And so you have this really cool opening with the, I would say, ego defenses down, for a period of time, where you can actually access deeper, more painful, aversive memories that people don’t remember because they’re not fun to remember, and it feels better not to consciously remember them. And so we’re talking about one of about three or four different things that are happening with Ketamine right now, and I’m starting with the one that I think is the most interesting and the most important, is taking down our unconscious defenses, our walls, that prevent us from getting back into the safe where we’ve stored the things that drive our depression.

0:31:00 WD: So that is a huge asset, and Ketamine is not the only way to do that, obviously. Hypnosis trance, shamanic ritual without psychedelics or with psychedelics, LSD, Ayahuasca, DMT, Psilocybin, have all been shown to have a big impact on the default mode network. So that’s sort of the… To me, that’s the entrée of, if we’re looking at a plate of what Ketamine offers us, is the opportunity that that involves. And then, after that, there is this interesting spike in the hormone, brain-derived neurotrophic factor, BDNF, which is a hormone that turns on dendritic sprouting. So one of the hallmarks of chronic mental illness, in general, and specifically chronic depression and chronic PTSD, is you have dendritic pruning, which is the pulling back of connectivity between neurons. It’s almost like you have fewer options in terms of… If you think about roads, like getting from Colorado to Florida, for the chronic depressed person, there’s maybe only a few roads that they can take because the connectivity in the brain is reduced between neurons. For the person without chronic mental illness, they could wander all over the country on their way down to Florida, ’cause they’ve got more connectivity, there’s more options. And what that means, neurologically, is that it’s harder to learn new tasks, it’s harder to learn new ways of thinking about your life, it’s harder to break out of your construct of who you are if you have fewer connections. Makes sense, right?

0:32:49 PA: Yes.

0:32:49 WD: So turning on the connectivity actually makes learning more feasible, and psychotherapy is basically learning or unlearning. So it’s creating new neural networks that you’re gonna then reinforce through integration sessions or ongoing self-care and self-investigation. So turning on dendritic sprouting, I think is a really important thing for people who have very long-term depression and PTSD, because those people often are really behind the eight ball in terms of getting results from ordinary therapies, where it’s just harder for them to actually take away the value of therapy in ordinary consciousness.

0:33:40 PA: So, to get a little deeper into that, another common word that we hear tossed around a lot when it comes to psychedelic use, and generally mindfulness, is neuroplasticity. Can you explain a little bit what’s the difference between neuroplasticity and dendritic sprouting?

0:33:54 WD: So I would say dendritic sprouting is a component of neuroplasticity. Whenever something new happens… I mean, this is a really different perspective from what we thought in the 90s, where nobody talked about synaptogenesis, or dendritic sprouting was kind of like a new concept in the late 90s. People used to think that the connectivity you got was what you got, and then, in your 20s, you sort of peaked, and then, from then on, it was all about degeneration of the brain. It was a pretty bleak perspective until it was in the early 2000s people started to realize, no, there’s actually not just synaptogenesis, but there’s also new growth of new neurons. So neuroplasticity involves a lot of different processes that include synaptogenesis, but it’s basically a term that, to me, refers to remodeling the brain to adapt to what your new normal is or to create the new normal in your life.

0:34:58 PA: And not only the brain, I should emphasize, and this is what I wanna get into next, but also the entire self. In other words, we’re not just a mind or a brain walking around with a meat suit, but what we’ve learned, especially from more recent research, is the importance of the gut in overall health as well. So if we’re to go one step deeper into integrated psychotherapy and Ketamine treatment, we have the default mode network, we have how psychedelics can help with dendritic sprouting and neuroplasticity, but we also know that when inflammation lowers in the gut that we also see lower inflammation in the brain as well. So I would love for you, at least as a starting point, just tell us a little bit about what is that gut-brain connection, and why are things like Ketamine and general psychedelics so helpful at helping to heal the gut and inflammation in the body?

0:35:52 WD: Yeah, it’s a great, great question. So that brings in this antiinflammatory component of what we see in a lot of rodent studies in Ketamine. We have some evidence in humans of Psilocybin decreasing inflammation. I think we’re gonna see a lot more of that as we go along down the road into more and more… Hopefully, more and more expansive research with all of these psychedelic tools. So, to answer your question, let’s start with health. So, in health, we are what we eat, right? So our entire body is built off of nutrition that we absorb through the gut. So, from there, it’s easy to see that the mechanisms that are used in the body, physiologic pathways for building proteins, for building cells, for maintaining healthy balance in the body require us to be able to absorb effectively in the gut, right? I mean, that’s kind of basic. So we also know that, in the United States today, even, there are massive amounts of people who are deficient in micronutrients, okay. So that’s just like we’re talking high-level here, like very common in some minerals, more common than not. For example, zinc deficiency is a huge problem in this country. Essential fatty acid deficiency, huge problem.

0:37:25 WD: So we could just start at a level of looking at the American diet and see what’s wrong with that. There’s a whole rabbit hole that we could go down into the soil, and how farming practices in this country have depleted the soil of essential micronutrients which are critical for the body to work well, not just the brain, not just in the psychiatric world, but also in how we build bones, how we maintain red blood cells and white blood… I mean, the whole body is dependent on this all functioning well. So then, going into more of a what I see commonly in my practice perspective, when people come in with chronic symptoms, oftentimes… I would say, more often than not, people are dealing with severe symptoms, we call them psychiatric symptoms, but oftentimes, they’re linked to having a gut that’s a absolute mess, candida overgrowth, consumption of a lot of Roundup from eating sandwiches. I don’t think you and I talked about this before, but it’s not well-known that American wheat is… Wheat berries, in America, because they’re genetically-modified have I think it’s something like 30-fold more gluten in them than heirloom wheat, which is still grown in Europe.

0:38:56 WD: So the gluten makes the wheat berries really sticky, which harms the combines that harvest the wheat. And so it was found out a few years ago that spraying wheat berries with roundup, not for the purpose of weed control but for the purpose of desiccating the wheat berries, helps the machines harvest the wheat. So…

0:39:17 PA: Oh my God.

0:39:19 WD: So I don’t eat American wheat. I mean, I actually have a gluten sensitivity as well, but eating American wheat means you’re poisoning yourself with Roundup.

0:39:27 PA: Glycophosphate, is that the technical name for it?

0:39:30 WD: Yeah, Glyphosate, Glyphosate.

0:39:31 PA: Yeah.

0:39:31 WD: Yeah. The website for Monsanto explains that the mechanism that Glyphosate works to eliminate weeds is by blocking this pathway… Well, it’s called the Shikimate pathway that weeds use to grow. Well, the Shikimate pathway is a conserved pathway that’s present in bacteria, that are important in the gut for building amino acids that we need for us to function well, particularly Tryptophan. So Tryptophan is… For your audience, probably most of them have heard of Tryptophan, it’s a precursor to Serotonin. So if your bacteria in your gut are struggling to deal with their Shikimate pathway being disrupted, and they’re not able to make Tryptophan efficiently because of that, and then you’re trying to absorb Tryptophan and all the other essential amino acids that you need, and your Tryptophan supply is kind of messed up because of that, then you might be more prone to chronic anxiety, or chronic depression, or other psychiatric issues.

0:40:40 WD: And the other thing is you may also be contributing to a thing we see a lot called leaky gut, where the lining of the gut is being disrupted and pro… What that means is that the tight control of what’s allowed to get into the body is ungoverned. So proteins that normally your body would say, “No, I’m gonna leave that in the lumen of the bowel, I don’t want that inside the body.” Those kinds of larger proteins are able to cross the mucosa of the gut and get inside the body, and then this is associated with autoimmune reactions. So, for example, take Celiac disease, where you have proteins that are causing inflammation in the gut lining, which leads to disruption in the integrity of the mucosa, which allows these proteins inside your body, which then allows your immune system to interact with these proteins in a way that your immune system shouldn’t be actually having access to these proteins in the first place, and now developing an immune reaction to those proteins. And then there’s cross-reactivity, where those same antibodies are reacting to parts of your thyroid gland, for example, which is why hypothyroidism and Celiac disease run together in people. Does that make sense?

0:42:05 PA: Makes sense. Oh yeah, yeah.

0:42:07 WD: There’s also a problem in the gut-brain access, when the blood-brain barrier that protects the brain from the arrival of inflammatory proteins is made of the same kind of structure as the gut mucosa. So, when you start having leaky gut, it’s not uncommon for people to also have symptoms of brain inflammation that theoretically is because the blood-brain barrier is also being disrupted in a similar way.

0:42:40 PA: So they’re mirrors of each other to some degree?

0:42:42 WD: Yeah, exactly, exactly.

0:42:44 PA: And so where I wanna bring this now, Will, is, going outside of your clinic, where you treat individual patients, you’ve also, over the past few years, started to develop professional-level education for Ketamine facilitators. So the question that I have is… It’s really around a number of things that we’ve touched on in this conversation, which is essentially that the mainstream medical educational system teaches a much more sort of biologically-driven model, that, in particular, emphasizes psychopharmacology.

0:43:17 WD: Right.

0:43:17 PA: Whereas, what we’re talking about is a much more holistic perspective and integration of both Eastern philosophy and Western medicine, and really getting into more cutting-edge sort of health and well-being stuff, which is about the gut-brain connection. So I’d love to just hear you talk a little bit about like, as you’re training psychiatrists and medical doctors, what path or journey are you bringing them on? Where do they come in, from an educational perspective? And where do you bring them through the training that you put them through?

0:43:49 WD: Thanks for asking that. So I’m really excited about our institute because the problem with this medical model that you’re talking about, the psycho-pharmacological-based model, is that it just leaves too many people behind. I would say it’s great when the medication prescription works really well for a person, and that does happen, so I don’t wanna present a perspective that I’m anti-medication, but I think that it’s an incomplete model to have one bullet in the gun or one tool in your toolbag. And I also think that the pharmacology model teaches a kind of dependency on medication to function. And as I’ve said before, I want people to get their functioning back, but I also want them to get a deeper result where they can step into sovereignty and not depend on medical intervention to continue to live their life and flourish. I wanna get them out of survival and into thrival. So most of the people coming into our institute are prescribers who are frustrated and disillusioned, like I was 15 years ago, who know that there’s a lot of research being done on these topics, like what we were just talking about, the gut-brain connection is a big one, but they were never taught, like I wasn’t, in their traditional training, that the gut mattered in psychiatry, for example. They never learned about how to deal with inflammation as a root cause of chronic depression, or how to reduce brain inflammation, for example, using natural interventions.

0:45:41 WD: So these are beautiful souls who have committed themselves into the practice of medicine and really want to get people well, and who want to practice in a way that comes out of medical evidence, but they need to expand their horizons to get better results for their patients. And so we take them through a year-long training that is very comprehensive, it’s broad and deep. We cover three main areas in our curriculum, which is… We call it the lifestyle of the person, which includes how to work with sleep, how to optimize that, how to work with exercise recommendations for specific problems, how to help people with mindfulness training. And then we go into the psychology of the person, which involves this deep trauma work, some of what we’ve been talking about today, and involves spirituality and spiritual connection.

0:46:42 WD: It involves dealing with maladaptive thinking that develops over the course of a lifetime for patients. And then we have a heavy emphasis in functional medicine, which is this… We call it the body area of our curriculum, looking at physiologic pathways, looking at very nuanced, specific gut health tests that we can do, organic acid test, stool test, looking at ratios of micronutrients and pouring over the data and the research on how to treat people with vitamins and minerals as either in combination with medication or as an alternative to medication, to really support people to make the full journey to wellness and well-being rather than just what I was taught to do, which is to look at… To define the destination. In psychiatry, the goal is to get to symptom reduction. I think symptom reduction is a critical early result, but it’s not the end of the journey for people. So I think we’ve got more chapters to add to the book, is how I would say it.

0:47:53 PA: And you’ve started with several of those chapters, the spiritual element. Again, the sort of seeing the individual as part of something greater, the lifestyle changes. And one of the things that I wanted to go deeper into was the physical element. That’s something that I’ve been very interested in lately, is how we store everything in our physical organism. So, about two months ago, I did a Ketamine and bodywork session. It wasn’t IV or IM or a lozenge. It was, I would say, a fairly peculiar and unique way of taking Ketamine. After that session, it was like going through a week of plant medicine in an hour and a half.

0:48:29 WD: Wow.

0:48:30 PA: It felt incredible. It felt like I was fully in my power right after that. And for the month after, I was literally able to be in touch with the deepest part of my intuition. It was like my mind wasn’t there anymore and I could just flow with things as they came up. It’s the best healing that I’ve ever experienced. So a lot of people will say that your body keeps a score, right?

0:48:54 WD: Right.

0:48:54 PA: There’s this book by Bessel van der Kolk that we store a lot of our subconscious and unconscious trauma in our body. Why is it that Ketamine then is such a useful tool to help specifically with bodywork and dealing with trauma that is stored in the physical organism?

0:49:11 WD: That’s a great question. I think that the way that we hold our body, the posture, that we reinforce the unconscious pattern of the way that we physically exist in the world, in our body. And the tension and the contraction, the changes in the connective tissue, the fascia, are basically just a reflection of our biography and how we interpreted the things that happened to us in our lives. So I agree 100% with you that the body holds… The body bears the burden, as Bob Scaer wrote. And I think that we see this often in people who have body… We don’t provide bodywork in our clinic, but in terms of having releases in bodywork, I think anybody who does bodywork, whether with or without a psychedelic, would vouch for the fact that people have releases. People cry on the table getting a massage. I had a bodywork session about 15 years ago in the middle of a meditation retreat where a bodyworker was working on a scar on my abdomen. And I could literally smell the ether from the anesthetic that was given to me when I was 3 years old and the operation that the scar was associated with. So I think it’s true that… I think that people underestimate the power of bodywork in terms of releasing trauma and getting us free of our perspective.

0:51:07 WD: In terms of Ketamine, specifically in bodywork, I know there are people out there who really think about our personality, which is kinda what we’re talking about when we talk about the default mode network, is who we think ourselves to be, that our personality is carried as. Wilhelm Reich was famous for talking about body tension as character armor, personality armor. So, to the extent that the Ketamine is interacting to open up the default mode network and open up our perspective about what we are and who we are, it would make sense to me that that could be a really powerful combination to open up an opportunity for these unconscious patterns to release in the body.

0:52:01 PA: I’ve had bodywork in the past, and when you’re in a fully-sober state, so to say, all your character armor is on.

0:52:07 WD: Right.

0:52:08 PA: So any places that are overly-tender or where there’s a lot of resistance, the bodyworker isn’t gonna be able to get quite as deep into that, just because there’s that physical resistance from the pain. And what I noticed, with Ketamine being a disassociative, is it basically allowed me or myself, my mind, whatever it is, to disassociate from the pain which enabled the bodyworker to go deeper and deeper with his touch. And then he did some fascinating things when it came to the healing process itself, where as… He called it like my software, my hardware, that the software was, I think, that some of that, like the arm and maybe the hip and a few other physical places in the body, and that the hardware was my neck and my face, so to say. And I just remember that the analogy that he made was like, basically, what we’re doing is we’re popping bubble wrap, and every time you scream or cry or yell or do something, you need to get energy out, that’s just another bubble that’s being popped in that character armor, so to say. The process that he took me through where he was… He’s clearly a very trained psychotherapist as well, because while I was on the table, in a very disassociated state, like a very, very disassociated state, he essentially would talk to me in a baby voice to get almost what it felt like into my inner child, so to say, to start to bring things out and work with me and, you know, he was able to do that.

0:53:42 PA: A lot of times when we do IV or IM Ketamine, or I’ve insufflated high levels of Ketamine before on a friend’s couch and just sort of went into a K-hole, so to say, which is that deep, deep, dissociative state. What he did, was really interesting with the bodywork, is instead of it doing IV or IM, which would sort of send me, what he called, into a transcendent state, I actually inserted it anally because he said it worked on the lower root chakras. And that allows for transformation. It allowed me to stay present with things as they were coming up, so I could talk through them live on the table with him, rather than sort of fully-disassociate into another world, which would have made me still present and available, but… Well, still there but not present and available, so to say.

0:54:31 WD: Right. That’s interesting. Yeah. I have heard of…

0:54:39 PA: What’s the technical term for that, taking Ketamine up the ass? Is there a technical term for that?

0:54:42 WD: I think that’s the technical term, Ketamine up the ass [laughter] No, it’s… So we would say that a suppository is given PR, per rectum, in medicine. So, by mouth is PO, by rectum would be PR. Wow, I can’t say that we’ve considered doing that here.

[laughter]

0:55:12 PA: It was incredibly useful and impactful. And this guy’s website, which we’ll link to, is somaticagency.com.

0:55:24 WD: Very interesting.

0:55:25 PA: And he calls himself the dragon because when he comes in and works on you, he basically, with his tool, with his toolkit, he breathes away all the stuff that isn’t you, by working with you on the table.

0:55:43 WD: Wow. I mean, one of the things that I’m taking away from this conversation about your experiences is really just a reinforcement of my perspective that there’s so many different ways to work with this tool, and we need so much more dialogue about what people are doing, what they’re discovering. We’re gonna have victories like what it sounds like you had on the table there, we’re gonna have defeats, we’re gonna have things that didn’t work, but I think we need to have an open mind about exploring all the different applications and different ways that we can help people get well.

0:56:28 PA: Which, I think, speaks to exactly what you’re teaching at your institute, which is this is a multi-faceted approach. We have to think about this from several different angles.

0:56:39 WD: Absolutely, when you think about… Let’s take just depression. I could think of 20 different possible explanations for why that person has chronic depression, and it bothers me a lot that people are being told, “Well, here’s the medication for your condition,” without mapping out the territory of, “Well, maybe we actually need to take a look at your gut, maybe we need to offer you Ketamine, maybe we need to actually look at your hormones, maybe you’ve got an inflammation issue, maybe you’ve got trauma that you haven’t acknowledged, maybe you’ve got really maladaptive thoughts, maybe you’re completely cut off, spiritually, maybe you don’t sleep at all, maybe you’ve got genetic SNPs that are interfering with your physiologic pathways.

0:57:37 WD: There’s so many different possibilities that need to be thought about before we jump into treatment. And so that’s my concern, and really, I think, the impetus behind this institute is to give people the tools to develop a broad differential diagnosis for what they’re seeing in front of them, and to not get stuck in a silo as a kind of hyper-specialist. And I think there’s a danger with psychedelics of these kind of hyper-specialty clinics where you go in and you get, let’s say, Ketamine. And you’re not even having a psychiatric evaluation, or like nobody’s even thinking, “Well, I wonder what would happen if I helped this person get moving with physical movement?” Or I wonder if they need yoga as a part of their treatment plan? Or I wonder if we need to look at their gut? So it can get reductionistic, and then I think it’s disappointing because the fantasy of the chemical cure isn’t going to produce the result in any kind of long-lasting sense.

0:58:43 PA: What’s your ideal intake scenario? Like if someone comes to you… And obviously, there are so many different issues or challenges, everyone is unique in terms of the issues and challenges that they’re facing. But from a more generalized perspective, what’s a logical way to do an intake, balancing both the understanding that this person has agency, this person has responsibility for their health, that this individual can make lifestyle changes, and with an understanding that there is obviously some level of healing that is catalyzed by the molecule or the drug or the substance itself?

0:59:20 WD: Yeah, I think the answer is, for me, wanting to take this broad perspective and really invite our patients into this bigger point of view about, first of all, what’s possible for their lives, and second, to… I mean, we show them the map of this territory of different places where the root causes can be found for their human suffering. And then we try to invite them to look deeper into these different areas. And we can look at the psychospiritual areas with the Ketamine psychotherapy, we can support, to a limited degree, the physiology of the body with Ketamine, but to really go into deeper healing, I really think more of… And I talk to my patients about this, that the Ketamine is like a tow truck that’ll get you out of a ditch of chronic symptoms and chronic impact on the brain, but then we’ve gotta… It’s not gonna get you home. Or the deep cleaning analogy that you used is another way, maybe, to talk about it. So we gotta figure out how to support you to develop these rituals that you need to maintain your health, regardless of what the challenges are that you face later. I’m always thinking in the long-term of not where this person is gonna be a year from now, but where they’re gonna be 10 years from now, 50 years from now, and what can we do to get them on the right track to really, like you said, take hold of that self-responsibility and that sovereignty. So…

1:01:08 PA: It’s a tricky thing because a lot of people are just not used to it.

1:01:11 WD: They’re not used to it. Our culture doesn’t really teach people that level of radical responsibility. There’s a lot against the process, but sure does feel good to have your sovereignty, even when you face devastating challenges, to be in that mindset of, “Yeah, and I get to learn from this too.”

1:01:33 PA: Yeah, there’s real deep meaning and fulfillment that comes from that…

1:01:35 WD: Yeah.

1:01:36 PA: In knowing that you can shape your own reality, that you have control in that way…

1:01:41 WD: Exactly.

1:01:42 PA: To grow and develop and heal.

1:01:44 WD: Exactly. That’s what we’re trying to change, essentially, is what you just said, is the perspective that I’m a victim of my brain or I’m a victim of my depression or my bipolar, or my whatever, to gain that agency and that empowerment to overcome what the challenges are. We all need tools to face the challenges, and there’s massive opportunity for growth in the challenge. And so I think the difference between a traumatic experience and a growthful experience is what tools do you have to face the challenge.

1:02:24 PA: Yeah, especially like… We all deal with trauma, and there’s, of course… There’s adverse childhood experiences, which I think are, categorically, something else. They’re traumatizing, and we obviously had no choice at that point. That’s part of them being adverse childhood experiences. But as adults, we’re all subject to trauma, right? And COVID has been traumatic, job loss is traumatic, break-ups are traumatic. There’s a bunch of things that are traumatic. And I like what you’re saying, is it’s somewhat of a perspective shift. And there’s this sort of cliché that floats around in a lot of new-agey circles, which is this is either happening to you or it’s happening for you.

[chuckle]

1:03:15 PA: Which essentially means either you can be a victim to your situation or you can have the perspective that I can adapt and grow from this as well, I just need to understand what tools are available to help me do that.

1:03:29 WD: Exactly. Exactly. I was recently in a seminar with John Demartini, and he’s a kind of a human development, kind of personal growth guy, and he uses the phrase, “Is it on the way or is it in the way?” And that if the challenge in front of us we perceive is part of our learning path and part of our growth, then it’s on the way, right? And if we perceive a big boulder in the way as being in the way and, “I’m fucked now because this boulder is here,” it’s a totally different perspective. And so I think this is another piece of the pie in terms of healing, is acknowledging the incredible potency of perspective. And being able to see the balance of challenge and opportunity in everything that we go through. And I think, to me, it’s really interesting how one event that, from the outside, might sound like or look like a minor event, can cause rippering PTSD.

1:04:39 WD: And I think oftentimes, when we examine that and we work through it, we find out that powerlessness in that moment was present. The perception that I didn’t have alternatives or that I didn’t… Like I was gonna die if I fought back against the rape, for example, is what drives the PTSD. It’s the helplessness. It’s not the thing… It’s not the event itself, it’s not what the outside circumstances were that were happening. That’s relevant, but the more relevant piece is what our perspective is. The person who believes that they have a fighting chance to get away from the rape or the one who hasn’t been beaten down in the past and doesn’t perceive the opportunity that maybe is there to fight back, who goes into a freeze response in a kind of learned helplessness type of thing is the one who’s gonna have PTSD. It’s not… Do you know what I mean?

1:05:41 PA: Yeah. So, it’s interesting that you mentioned this. I’ve been getting into movement and body stuff, and a friend of mine showed me this video of a leopard that had an antelope in its jaws, an impala in its jaws, and I will link to this video in the show notes. And essentially, the impala was playing dead and playing dead and playing dead, and then the leopard had the impala in its jaws. And then the leopard got distracted by something else. So it went to go do whatever it was, and the impala waited a little bit, opened its eyes, sort of breathing really, really heavily, got up, did a really intense shake, like a physical shake to get all of the traumatic injury out, and then boom, was off.

1:06:21 WD: Yeah.

1:06:21 PA: Right? So it’s almost like this is the downside of living in an industrial civilization, is we abstract so far away from the hurt and the trauma and the pain by getting stuck in the mind, where a lot of the healing is just to go into that, to basically relive it or to just shake it off, however that looks, and to allow that emotion to move through you so that you can integrate it and move on with your life.

1:06:47 WD: Yes. That’s the beauty of, I would say, body-centered PTSD recovery. Peter Levine, what a genius to figure that out, that we need to complete our sequencing in our body of acknowledging the threat in our environment, maybe freezing a little bit, figuring it out. And then, in the course of the therapy session, activating the self-defense or the running-away responses that help the body to catch up to the knowledge that you’ve survived, and that you’ve entered a… You’ve exited from the dangerous situation and you’ve entered a secure environment. And the body often doesn’t know that in trauma. It’s fascinating.

1:07:40 PA: It is. Well, we could keep talking [chuckle] for days.

1:07:45 WD: Yeah.

[chuckle]

1:07:46 PA: I would love to, but I know I have a call in about six minutes and you probably…

1:07:50 WD: I do, too.

1:07:51 PA: You probably got one as well. So, to wrap up, Will, if you could just provide our listeners with a few more details, specifically about the… Whether you have a personal website or whether it’s specifically the educational institute that you’re doing. Anything that you think would be relevant and helpful, please… Please, now is the time.

1:08:08 WD: Thanks, Paul. So the institute is a pretty simple website. The URL is simple. It’s psychiatryinstitute.com, and that’s where we put on our year-long fellowship training, and it’s pretty much entirely online at this point, with COVID. But usually, under normal circumstances, it takes place as a weekend in Colorado, and then 10 months of online learning, and then another weekend in Colorado. So that’s psychiatryinstitute.com. And we provide our Ketamine services and our integrative psychiatry services at Integrative Psychiatry Centers, and that website is psychiatrycenters.com.

1:09:03 PA: Fantastic. Well, Will, it’s always an honor and a pleasure to talk with you about this. I love how much of an interdisciplinary approach you take to these topics and how it’s so well-grounded in both, again, Eastern philosophy and Western medicine. Really appreciate the work that you do and that you continue to do. And I can’t wait for us to have another conversation, whether that’s for the conference that’s upcoming or on the podcast again, or whatever it is. I always really enjoy it when we get a chance to speak. So thank you so much for your time.

[music]

1:09:39 WD: Well, thanks, Paul, and I really appreciate your effort to bring a depth of really genuine inquiry into these emerging fascinating areas of medicine and well-being.

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