In this episode, Joe interviews Portland, OR-based licensed marriage and family therapist, ketamine-assisted therapist at Rainfall Medicine, lead educator at InnerTrek, and speaker at our upcoming Convergence conference: Gina Gratza, MS, LMFT.
She talks about how she decided she wanted to become a therapist and when she knew psychedelics were the next step; meeting Rick Doblin at Burning Man; the efficacy of MDMA being used in conjunction with traditional therapy; how the self-compassion of MDMA gives her tremendous hope for its use in treating eating disorders; how non-ordinary states of consciousness teach us the wiseness (and uniqueness) of our inner healer; and her healthy concerns for how Oregon handles psilocybin legality: InnerTrek will be graduating some of the first licensed facilitators in Oregon and they should be certified by summer, but with OHA-approved service centers and manufacturers still up in the air, what happens next?
She and Joe also discuss how non-ordinary states of consciousness teach us the wiseness (and uniqueness) of our inner healers; the need for therapists to continuously do their own work; the idea of a psilocybin-licensed facility doubling as a music venue; David Nutt’s drug harm scale; Kylea Taylor; “The Trialogues”; archetypes of Burning Man; and how in psilocybin-assisted therapy, we can only do so much before the spirit of the mushroom ultimately takes over.
“There’s a strength in the empathic attunement that’s happening in the heart space that’s coming forward, so it’s not just talk therapy. There’s a connection happening. And we are creatures of love and belonging and connection, and when we feel that with another human being [and it’s] authentic – that is a very powerful force. We don’t have to compare it, but it’s just as powerful as medicine.”
“I hope to never be a master of any domain. I know that the juiciness of this life and this existence is continuing to stay open to learning and growing and evolving, and for me, that’s coming back to humility: I’ll never know everything, especially when it comes to the realm of altered states of consciousness. We’re trying to understand life in this state of consciousness, let alone bringing in altered states and the many different dimensions at which things can come through to you, and the uniqueness of everyone’s experience.”
“This is what we humans are able to do: Here are the measures, here are the ways in which we’re training. And then there’s the spirit of the mushroom. There’s what we are going to bring and then there is going to be what the mushroom brings: …the mycelium network, the earth, the nature; like a total other force that is beyond our ability to really know or read what will move through that.”
In this episode, David interviews two people from different sides of Vital: clinical psychologist, adjunct professor, Co-Founder of the Psychedelics R2R nonprofit, and Vital instructor, Dr. Dominique Morisano, CPsych (the teacher); and writer, psychedelic-assisted medicine facilitator, integration coach, and Women On Psychedelics Co-Founder, Jessika Lagarde (the student).
With the 2023-24 edition of Vital set to begin in April and applications closing at the end of February, we thought it would be interesting to relaunch Vital Psychedelic Conversations, but with the spin of speaking to both instructors and students to hear their different perspectives on retreats, facilitation, psychedelic education, the quickly advancing psychedelic space, and of course, Vital itself.
Morisano and Lagarde mostly discuss experience: how it’s gained, how it changes perspectives and methodologies, how one decides they’ve experienced enough to be able to know the terrain enough to help others, the importance of knowing when a patient needs a facilitator/therapist who has had the same life experience, and knowing when one’s own skills and limitations means a patient would be better off seeing someone else. And they discuss safety, the importance of being trauma-informed (and what does that mean, really?), and the puzzling cases when facilitators haven’t had their own psychedelic experience but feel the need to use psychedelics to help others.
And of course, they talk about Vital: the joy in joining together in community with people they’ve only known virtually; how interesting these retreats are compared to others due to the level of the participants’ experience; how partnering up and taking turns as the sitter and experiencer shows how little of a difference there is between student and teacher; and how many people have reported the most impactful part of the retreats was not their own experience, but being there for someone else.
“Do you know the terrain? Let’s say you’ve taken ketamine once, and you’re doing six sessions of ketamine with a client. Do you really know what they’re going to be experiencing, and can you have had the full range of experience? …How do we define this? I can tell you: You have a hundred psychedelic experiences; most likely you’re going to have a different experience each time, and a different connection to inner/outer terrain or different realms or different ways of thinking and being. So when is enough enough? When did you learn your lesson? When did you gain the experience necessary to navigate someone [else’s experience]?” -Dominique “You learn a lot about yourself as well, I find at the end of a day. Every journey is also a journey for the facilitator, and we are constantly mirrors to each other, so it’s very interesting work to do in that sense as well, because your own inner work is continuously being done.” -Jessika “It’s never the same. Two sessions are never the same, and even how you show up on that day for that session, or set and setting; all of that influences [the experience], so we have to constantly be placing ourselves between being a student [and being] a teacher sometimes, but never put ourselves in the spot that we think, ‘Okay, now I know everything. Yeah, I’m done.’” -Jessika
“How do you develop wisdom? The way to develop wisdom is through experience, and often, pain.” -Dominique
In this episode, Kyle interviews researcher, speaker, writer, competitive freediver, and one of the world’s leading experts on 5-MeO-DMT: Dr. Malin Vedøy Uthaug.
As a society, we mostly live in our minds, emotionally constipated while surprisingly disconnected from our bodies, with basic human needs that are all too often not met. Uthaug and Kyle talk about what manifests when those needs aren’t fulfilled, the strength of one’s inner mind state to change perspective, and how powerful true catharsis and embracing grief can be. And they talk about somatics: why we don’t focus on the body more, and how we could embody experiences with non-ordinary states of consciousness to better connect to our inner world.
She discusses the impact (or non-impact) of following a strict dieta before a big experience; preparing for an experience with physical exercise (even right before the ceremony); freediving; the challenge of therapists/facilitators sitting with someone through strong catharsis; the popcorn theory; the guilt people feel from experiencing love and bliss; and the paralysis-by-analysis problem of not making the connection between insight and action.
“What I’ve seen throughout all these years working in the field is that there is at least very commonly this notion that the psychedelic is going to heal them; they don’t have to do any other work – just popping that tab of psilocybin or smoking that pipe of 5-MeO is going to result in change. And that expectation is a bit dangerous, I think. They might not get the help that they are seeking because they’re placing that help externally to them. …Healing is actually hard work. It’s not something that happens overnight. It’s the tiny little steps of change accumulated that creates a bigger change. It’s changing your tiny, tiny habits until it changes your life.” “You can realize a bunch of things, but if you’re not doing anything, nothing is actually going to change. It might feel like it changes because you have felt it in your brain or you’ve seen it or have this insight, but that needs to be translated actively into your life.” “I think putting the body back into the equation is the way forward, however that might look.”
In this episode, Kyle interviews C.J. Spotswood, PMHNP-BC: author and board-certified psychiatric-mental health nurse practitioner currently enrolled in CIIS’ Psychedelic-Assisted Therapies and Research certificate program.
He talks about his introduction to psychedelics and his first patient immediately asking him about microdosing; why he changed his mind on microdosing and why he wrote his book; microdosing studies he’s most excited about; the terms: treatment-resistant depression, risk reduction, and flight nurses; Irving Kirsch’s work uncovering the bad science of research studies; the need for physicians to know enough about psychedelics to be able to meet their patients where they are; the importance of group work; and how, while they’re already so well-versed in caring for patients, using nurses to their full licensure could be the answer to the quickly growing psychedelics and scalability problem.
“When you look at the early research into the 50s in the 60s; they were doing microdosing research, they just didn’t have a title for it. They thought they were using placebo levels but they were actually looking for threshold levels; things like that. Really, it was what by today’s standards [would be an] amount that we would consider as a microdose.”
“I don’t like the term [treatment-resistant depression] when we use that because if you’re using [it] when you’re looking at the standard medications like SSRIs [or] SNRIs, they’re basically all the same. …So when you say that someone’s ‘treatment-resistant’ for three medications, four medications that are all basically working the same pathways and in the same amount; is that truly treatment-resistant, or are we just trying the same thing with just different medications, whereas doing microdosing is a different pathway [and] is a different approach?”
“My first patient I ever saw as a new clinician, like, literally my first patient: I come in and I’m starting to talk to them for the first interview and I got to the point and I’m asking them: ‘Where are we going, what do you need?’ and they said to me, ‘Do you know anything about microdosing?’ …I said to them, I go, ‘Yeah, I know a little bit.’ …So I asked her what she knew, and she knew quite a bit. And she goes, ‘What do you know?’ and I kind of just said to her: ‘I don’t really know how to put this, [but I] wrote a book on it and it’s going to be coming out next year.’ …It reinforced my feeling [that] I’m doing the right thing: this career suicide I’ve thought of, going into working with psychedelics and being open and talking about it, hearing my first patients talking about it – it’s got to be serendipity.”
In this week’s episode, Kyle is back on the podcast, joining Joe to discuss three recent articles; two of which pose a lot of questions.
They first look at Colorado’s Proposition 122, which, now that it has passed, enters into the long and arduous process of being figured out – all while existing in the complicated paradigm of state vs. federal legality. One of the biggest concerns revolves around data collection and privacy: Is the collected data truly anonymous? Since psychedelics will still be federally illegal, how can we trust that the DEA isn’t going to abuse their power?
Next, they discuss Attorney General Merrick Garland making moves to end the sentencing disparity between offenses involving powder cocaine and crack cocaine: while essentially the same substance, being caught with 28 grams of crack cocaine currently carries the same sentencing as having 500 grams of powder!
And lastly, they touch on a very interesting article from Lucid News about the value of psychedelic therapy, which gives some staggering data points showing why the black market will always exist: MDMA-assisted therapy sessions likely costing $11,500 (with the MDMA itself costing between $480 and $9,600), Esketamine treatments costing as much as $32,400 a year, and more – all with results that don’t seem to be as long-lasting as many believed they would be. This one deserves more analysis, but Joe and Kyle had limited time for recording this week, so stay tuned for more. For now, enjoy this episode, and Happy Holidays from the Psychedelics Today team!
As the psychedelic movement expands, with surmounting research serving to change the tide of public opinion, more people are seeking out psychedelics as modalities for healing and self-exploration. Whether in the context of psychedelic-assisted therapy, plant medicine ceremonies, or recreational use, the modern Western psychedelic discourse has long been interwoven with the concept of “set and setting.”
But in contemporary psychedelic culture, the term is no longer sufficient as a harm reduction mantra. How can it be updated to better serve today’s journeyers?
A Brief History of Set and Setting
“Set and setting” refer to many factors which extend beyond the psychoactive effects of a given substance, playing a vital role in shaping psychedelic experiences. Typically, “set” refers to the mindset of a psychedelic explorer and “setting” refers to the context in which a substance is taken.
However, there has been little development of which variables fall under the umbrella of set and setting since its conception in the 1960s. There are significant factors that shape a psychedelic experience – both acutely and in the long term – which aren’t fully captured by set and setting alone.
The concept of set and setting has become something of a harm reduction mantra interwoven with the emergent field of psychedelic-assisted therapy and psychedelic research at large, used to describe the ways in which factors that extend beyond the substance itself can impact and shape its effects. Accordingly, it’s been an impactful linguistic tool that therapists, researchers and explorers have looked to for guidance on curating a container for an experience with medicine.
“Set” commonly refers to an individual’s mindset, including both immediate and long-range states of mind. A person’s immediate set is related to their state of mind before a psychedelic session, including everything from intentions, fears, hopes, and expectations about the session. However, their long-range set might include enduring personality traits, personal history and formative life experiences, social identities, and mental health history.
“Setting” commonly refers to the container of the experience, which includes the physical and social environment within which a substance is ingested, factoring into account when and where it will take place. Thus, setting may include aspects such as music, whether it takes place outdoors or indoors, the decor/props in the session room, as well as the relationships between others present.
The concept of set and setting does not exist independently of culture, with the sociocultural context of set including, but not limited to, race, economic status, strength of relationships with others, and the individual’s access to and relationship with nature.
Timothy Leary, 1960s counterculture icon and ex-Harvard lecturer in clinical psychology, is generally given credit for popularizing the concept of set and setting through his emphasis on the importance of both in shaping psychedelic experiences.
In the cult classic, The Psychedelic Experience, Leary together with his colleagues Ralph Metzner and Richard Alpert reflected, “Of course, the drug dose does not produce the transcendent experience. It merely acts as a chemical key – it opens the mind, frees the nervous system of its ordinary patterns and structures. The nature of the experience depends almost entirely on set and setting.”
To a large extent, the notion of set and setting within Western culture has been shaped and inspired by the ways in which Indigenous cultures around the world ingest psychoactive plant medicines in contexts bound by ritual, ceremonial objects, music, relationship with the land, and cosmological interpretive frameworks.
Compared with Indigenous cultures, Western culture has a bias against the use of psychoactive substances, and despite evidence that the peoples of Europe once used psychoactive plants ritualistically, such traditions have been long forgotten. Cultural frameworks determine the lens through which psychedelic experience is interpreted, and the lack of a cultural context, beyond that of prohibition, within which to make sense of psychedelics in the global North has produced a need for the ongoing formulation of set and setting.
More recently, Ido Hartogsohn, assistant professor at the program for Science, Technology & Society at Bar-llan University, has been conducting research on set and setting, exploring the ways in which psychedelic experiences are shaped by society and culture. In 2017, Hartogsohn published a paper outlining the history of set and setting, pointing out that although the term is often credited to Leary, its roots extend further back.
He explains how members of the Club des Hashischins, translated as “Club of the Hashish Eaters,” a Parisian group dedicated to exploring psychoactive-induced experiences in the 1840s, gave emphasis to what he calls factors beyond the substance itself. When Timothy Leary began his research with psilocybin in 1960, he exchanged letters with English author Aldous Huxley, who shared an excerpt written by one of the club’s members, Théophile Gautier, in which Gautier explores the necessity of preparation and going into a hashish experience with a “tranquil frame of mind and body.”
In addition, Hartogsohn suggests that having a better understanding of set and setting could serve as a form of harm reduction as well as benefit enhancement, highlighting that “the discourse on set and setting had remained largely underdeveloped over the years.”
An Expanded Vision: Set, Setting, and Support
Considering the growing mainstream emergence of psychedelics, set and setting alone is no longer sufficient as a harm reduction mantra, nor is it sufficient as a guidepost for the benefit maximization of psychedelic therapy and research. We argue that as a matter of public health, this mantra must evolve into “set, setting and support.”
Despite the undeniable healing benefits of psychedelics, media discourse around them is sometimes dressed in sensationalist language, serving to construct psychedelics as miracle cures for all mental health problems. This premise is misleading and does not highlight the innumerable challenges that present themselves around the psychedelic experience.
One evident challenge that may emerge, is that of the psychedelic experience itself. Even when set and setting are controlled, there is no guarantee that challenging content and situations will not present themselves.
“Sometimes active journeyers can find themselves in unsound decision-making states. Having the support of a peer, trip sitter, or facilitator, during an experience can help the explorer navigate their inner state and make adjustments to the setting for maximum comfort and safety,” says Hanifa Nayo Washington, co-founder and Chief of Strategy at Fireside Project, a psychedelic peer support line that provides free, live phone support to individuals actively tripping or looking to process past experiences.
As psychedelic researcher and transpersonal psychologist Stanislav Grof says, psychedelics can be “non-specific amplifiers of mental or psychic processes.” That is, they have the ability to amplify content which is latent in the psyche, bringing up thoughts, emotions, and sense impressions that we were previously unconscious of.
Another challenge that may emerge after the experience relates to the fact that healing is often a messy, non-linear process in which things sometimes get worse before they get better. Anecdotally, there appears a common point of contention around individuals’ expectations going into an experience versus the actual outcome. No doubt, having forms of support already integrated into the process can make such moments of difficulty easier.
Beyond this, the aftermath of a psychedelic experience can also be destabilizing, as the non-ordinary states of consciousness they elicit serve to catapult us beyond the bounds of our everyday perceptions. In part, it is this very disruption in our normative flow of consciousness that enables psychedelics to be so healing, however, it can also be a simultaneously scary process as we find the foundations of our worldviews and belief systems turned on their heads.
“Psychedelic experiences can invite tremendous dysregulation in the body, mind, and spirit system,” Washington says. “Enlisting post-journey support in the immediate days, weeks, and months that follow a psychedelic experience can significantly ease the process of self-regulating to a ‘new normal’.”
What Can You Do To Seek Support?
Seeking avenues of support is a way to enhance psychedelic preparation, journeys, and integration, with support taking many different forms. One type of support, which may seem more self-evident, is that of socially-based, community support at the interpersonal level.
Despite the fact that psychedelics can elicit feelings of connection and oneness, some who use psychedelics may find themselves feeling alienated and misunderstood. For years, prohibitionist, zero-tolerance policies served to demonize psychedelic substances and those who used them, resulting in a lingering stigma and sense of shame associated with their use. This is especially true for individuals from communities of color who have long faced the impact of the discriminatory enforcement of drug laws, with the war on drugs producing profoundly unequal outcomes across racial groups.
Additionally, spiritual and mystical-type experiences have long been ridiculed and pathologized in Western culture, as they often include elements that are not culturally accepted as objectively real, sometimes resulting in those who have profound transpersonal experiences being dismissed or labeled as “crazy.”
Following a deep spiritual or transpersonal experience in which an individual disconnects from their ego, once they begin folding back into themselves there are layers of their identity or their lives that they may leave behind. This letting go of behaviors and parts of the psyche that are no longer of service can be conceived of as a type of “psychedelic shedding.” Omar Thomas, Founder of Jamaica’s Diaspora Psychedelic Society, CEO of Jamaican Organics and Psychedelics Today Advisory Board member, first formulated the notion of “shedding” in the context of psychedelic integration.
This might relate to one’s job, relationship, identification with a certain religion, sexual identity, or even their gender. When one goes through this shedding process without adequate support, there’s the risk that rather than finding relief from their mental and psychospiritual afflictions, they deepen, due to the many associated implications and consequences of the shedding process.
For example, what happens when someone realizes that the reason for their stress is rooted in their work, but they can’t quit because they won’t be able to support their family otherwise? Or what happens when someone sheds a cis-gendered identity but they’re in a marriage that would fall apart, opening a flurry of difficult, albeit potentially necessary effects?
This shedding process isn’t necessarily a bad one, but it certainly can be without having adequate support present to facilitate and ease the process. Like a butterfly going through its metamorphosis, it needs to be held in a safe container while fragile to emerge on the other side as its fullest and most beautiful expression.
Even today, as psychedelics become increasingly accepted in the mainstream, there is still a residue of stigma that remains. Thus, it is important, when looking for someone to support your journey, to find a non-judgemental, trustworthy person to share the experiences with. For some, this person may materialize in the form of a therapist, counselor, coach, or shamanic guide, while for others it may be a trusted friend or family member.
If support in an individual’s immediate circle is scarce, finding community support could come from connection online or in person with a psychedelic community, many of which offer courses and integration circles. One benefit of finding community online is around connecting with people from a particular social identity group that may not be accessible otherwise. For example, there are now integration circles that cater to individuals who identify as BIPOC, neurodivergent, or queer.
“In preparation for a psychedelic journey, support can look like gathering with a trusted friend, psychedelic facilitator, or support circle, to explore intentions, apprehensions, impressions, and beyond,” Washington says. “This support can increase awareness of one’s inner weather or set. With greater awareness comes the possibility for increased understanding of one’s own needs and knowing.”
Other forms of support include tools and techniques that a psychedelic voyager can draw upon as resources for grounding before, during, and after psychedelic experiences.
No matter the quality of the experience, beyond an intention to reduce the risk of harm, certain practices can be adopted as a way of supporting oneself through moments of discomfort or difficulty, to add a deepened sense of meaning and lasting benefit to the experience. For example, a 2019 study that observed the effects of psychedelics on long-term meditators suggested that the effects of a mindfulness practice may help patients sustain treatment outcomes in the long-term.
One might consider adopting a type of embodiment practice, engaging different aspects of the body in creating deeper self-awareness, balance, and connection. Whether it be a practice rooted somatics or mindfulness, or a more dynamic movement-based practice like yoga or dance, finding ways to become embodied helps to cultivate a deeper relationship with oneself and inner support to fortify your whole being.
Exploring the value of somatic practice, Lauren Taus, therapist practicing Ketamine-assisted Psychotherapy and Founder of Inbodied Psychedelic-Assisted Therapy and Integration Training shares, “Every emotion has a somatic counterpart, a felt sense in the body, which means that developing a daily practice of being in your body and listening to somatic wisdom is essential for healing.”
Support can also manifest by tending to your connection with nature. It can be easy to feel isolated after the depth and intensity of a psychedelic experience, however, the earth and the manifold beings that permeate it can serve as a source of community, providing consistent support through the embodied, knowing you were never alone to begin with.
In our vernacular, we tend to say that we are using psychedelics, but it’s certainly possible that psychedelics are actually using us. When one considers the predictable shift in values developed out of their use, expanding them to the global scale, we can see that not only are psychedelics healing us at the individual level, but are collectively helping to change the course of humanity’s place on earth by allowing us to care more about ourselves, one another, and the earth itself.
As this continues, there will be a never-ending need to increase layers of support for the broader community. Where might you be able to add that missing piece in your community, in your work, or in your personal life? What does it mean for you to evolve beyond set and setting?
In this week’s episode, Joe and David team up again to discuss what news interested them the most this week: the DA dropping a felony drug charge against a mushroom rabbi in Denver due to the passing of Proposition 122; Numinus Submitting a Clinical Trial Application to Health Canada that would give in-training practitioners the ability to experience psychedelics with their psilocybe-containing EnfiniTea; and a University of Exeter-led trial moving forward with the next step in a study using ketamine for alcohol use disorder (with 2/3 of the money coming from the National Institute for Health and Care Research).
They also review a paper that analyzed the economics of psychedelic-assisted therapies and how insurers come into play; as well as The Journal of the American Medical Association stating that, based on current trajectories compared to cannabis legalization, they believe the majority of states will legalize psychedelics by 2037. So nice to see these continued steps in the right direction!
And if you missed it, we just announced that applications are open for the next edition of Vital. There are incentives to paying in-full by certain dates, so if you missed out on last year’s edition or have been curious, attend one of our upcoming Q+As!
In this episode, David interviews Sherry Rais: Executive Director of the Boston Psychedelic Research Group, Grants Manager for CIIS, and CEO/Co-Founder of Enthea.
Enthea is a benefit plan administrator that provides health plan benefit riders and single case agreement services for psychedelic healthcare with a provider network including certified and credentialed Ketamine-Assisted Therapy (KAT) and Psychedelic-Assisted Therapy (PAT) practitioners. In other words, if a company wants to offer psychedelic-assisted therapy as a benefit for their employees, Enthea makes this possible (and affordable). Their first client was the very psychedelically-minded Dr. Bronner’s Magic Soaps, and they’ve just announced the signings of three new clients that you may not expect to provide KAP to their employees: Daybreaker, Tushy, and Guinn Partners. Their goal is to have 100,000 covered lives in 40 cities by the end of 2023, and, alongside the guidance of MAPS, hopefully roll out MDMA-assisted therapy in Q2 of 2024.
Rais talks about Enthea’s process, costs, and goals; her Ismaili religion; her nomadic, marathon-running life; her experience sleeping on the streets of Toronto at 16 and her need to help the less-fortunate; how her most powerful psychedelic experience was watching someone else transform; and why companies are suddenly interested in these emerging therapies.
“For me, the most powerful psychedelic experience I had was actually in a situation where I was sitting with someone else and saw this person transform in front of me. That was two years ago and that person; I still see the effects of that experience on that person’s life and how much he’s changed from this one experience, and I’ve never seen anything like it. It was the most beautiful thing I’ve ever witnessed.”
“I think you and I know that these medicines work, and we also know that they cost way more than $500, and immediately, that tells me there’s an equity crisis in the ecosystem; that we’ve finally found medicines that may be able to help millions of people that are suffering from a variety of issues, and there’s this huge barrier and its cost. So the goal of Enthea is to solve that problem by making these medicines affordable.”
“The fact that you have a plan that doesn’t cover mental health is very telling of the landscape and the culture in America today and why you’ve made the case for me on why Enthea is needed. Because if this doesn’t happen, when will people get access? They’ll continue waiting and waiting and waiting that their primary insurance provider covers this.”
In this episode, Kyle interviews psychologist, psychotherapist, author, and certified Holotropic Breathwork® facilitator: Marc Aixalà.
Aixalà is part of the International Center for Ethnobotanical Education, Research and Service (ICEERS), offering integration psychotherapy sessions, developing theoretical models of intervention, and training and supervising therapists. He is also the writer of the recently released, Psychedelic Integration: Psychotherapy for Non-Ordinary States of Consciousness, of which you can win a copy by entering our giveaway here!
Aixalà wrote the book after receiving more and more emails from people asking for guidance on how they were supposed to process a recent experience, and he realized that so much was unknown around the concept of integration: What exactly does it entail? Has the psychedelic space created a narrative that you need integration when maybe you don’t? When is the work considered integration and when is it psychotherapy?
He talks about some of the metaphors he uses to explain integration; the seven scenarios he typically sees in people seeking integration (and how to respond to each); philosophical constructivism and the importance of working with someone within their preferred cosmology; how the psychedelic hype has created a marketplace full of competition (and why that could be bad); and why he thinks being trained in Holotropic Breathwork is perhaps more important than being trained in facilitating a psychedelic experience.
“One of the things that psychedelics show us (or for me, the main thing) is that somehow, healing is inside of us and growth is inside of us, and they teach us accountability, they teach responsibility, and they teach us that we are the expert of ourselves – that our journey does not depend on an external person. So in my way of practicing integration, I also want to honor that, and do integration when it’s needed, but not create an additional need for people that don’t have it.”
“I think that that’s the richness and the beauty of psychedelics and the psychedelic experience, is that it cannot be understood from just one prism. No, it’s a trans-disciplinary approach that will give us a more subtle understanding of different dimensions included. I don’t think that there’s one way that is better than the other of using psychedelics, [just] as I don’t think that there’s one Shamanic tradition that is better than another Shamanic tradition. Things are there for a reason and we find what resonates more with us.”
“I believe that breathwork can be more effective than psychedelics to deal with certain emotions; things like anger, rage. The body and the somatic part of a traumatic event; that has worked very well with breathwork in my opinion – better than with other substances because it provides some sort of mental clarity that is not distorted by the archetypal aspects of psychedelics.”
An NYU psilocybin depression study participant discovers an unforeseen application for psychedelics: the treatment of chronic pain. Part 1 of the series: Psychedelics and Chronic Pain.
Everything Worked, but Nothing Lasted
In the fall of 2020, I was living a pretty successful and happy life – on paper. I had co-founded a very popular, leading-edge CrossFit gym in NYC; one of the first in the world. I held multiple advanced certifications in applied neurophysiology through Z-Health, helping clients with challenging pain and performance issues. As an early adopter of kettlebell training, I became a nationally top-reviewed instructor and trained Team 6 Navy SEALs, astronauts, pro athletes, wounded veterans, and members of the FBI, NYPD, NYFD, and ROTC. I was featured in Men’s Fitness, the NY Times Sunday Routine, and USA Today. I had 30 years in the pain & performance field, training and teaching at a high level, and was becoming widely known for helping people with difficult mobility problems or chronic pain, using unique methods from the leading edge of neurological rehabilitation. On top of all of that, I was 17 years sober.
However, not all that glitters is gold. A now ex-business partner was committing a Ponzi scheme to the tune of millions, and his case followed him like a shadow, turning my life’s passion into an emotionally and financially toxic nightmare that economically devastated my family. My best friend, Kirk MacLeod, who I had completely rehabbed from chemo & cancer surgery, died six months after being declared in remission. My first son had developed undiagnosed GERD and couldn’t sleep more than an hour and half at a time, which meant my wife and I slept even less.
Unsurprisingly, my episodic depression returned after more than a decade and a half, and I was now increasingly treatment-resistant; unresponsive to psychiatric drugs that had previously worked. All my pain neuromodulation interventions that worked on my clients no longer worked for me, and I had developed chronic pain myself.
I share all my background here to demonstrate that I was not under-resourced in either knowledge, networks, or diversity of approaches, practice, or experiences. I poured over all my certification materials looking for anything I had missed, but had fallen into an increasingly deeper recovery hole; everything worked, but nothing lasted. I was hitting a new bottom in my life, deeply sinking into the midst of an increasingly treatment-resistant depression episode that had likely been ongoing for five years.
But then I became aware of ongoing studies on psilocybin for depression happening locally in NYC. I had experienced a few high-dose psychedelic sessions nearly a quarter century ago and had been an avid Terence McKenna fan (even speaking with him directly after a lecture in Seattle), but I had never taken psychedelics therapeutically, and my recreational interest had effectively vanished once I became sober from alcohol. Intrigued, I connected with the local clinical research coordinator, Leila Ghazhal, at the NYU for the clinical trial of Psilocybin for Major Depressive Disorder study (sponsored by the Usona Institute), and took all the online and over-the-phone assessments, passing them easily. The primary investigator (PI) on my study was Dr. Stephen Ross, who had been leading psychedelic research at NYU for more than a decade. Amazingly, I made it into the trial within a month and a half, learning that I’d actually beat out 8500 other applicants for just 100 spots nationwide.
Trying Not to Hope
When I first entered the trial, I was in a state of denial about how severe my depression was, but once I took the MADRS assessment, there was no avoiding that I had moderate to severe depression with suicidal ideation.
I remember a specific moment very well during this process, when I was finally cleared to enter the study and the study coordinator was speaking with me about the results of my assessment and my upcoming participation. I asked what would happen if I didn’t receive psilocybin during my session, and he reassured me that they would not just drop me off in the middle of the ocean to dog paddle – that there were other interventions and studies available and they would be sure to find me something, but there was a good chance I would receive psilocybin and hopefully get some good results. At this point, my mask cracked a little bit and some protective cynicism came out, and I quipped with a bit of a shrug: “Well, we’ll see.” I hadn’t meant it to be dismissive or sarcastic but it came out that way, and the conversational atmosphere rapidly shifted. He looked right at me and suddenly he wasn’t the primary investigator anymore, lost in the myriad details and logistics of a very involved study. Now he was the deeply experienced clinician and therapist, and, having heard something within the tone of my voice, dropped all the way in and asked softly: “What’s going on behind that, Court?” Suddenly, all the masking dropped and there was no more place to hide because I was so, so tired at this point, and had been waiting for this moment. In and out of therapy for years, dozens if not 100 self-help books, so many modalities, so many somatic systems, and here I was with a chance for something new to help me. When I realized why there was cynicism behind my statement, my voice cracked, I started crying, and I answered him: “Trying not to hope.”
The one glimmer of hope I did have was reading a 2018 paper by lead author Calvin Ly describing psychedelics’ neuroplastic activity in the prefrontal cortex. As someone who had studied the neurology of pain for years, this was revelatory. Many pain conditions are, in fact, nociplastic or noxious conditions arising out of the central nervous system (CNS); there’s no more injury or damage if there ever was, but your CNS is still continuing to put out a maladaptive alarm signal that is perceived as pain. So learning that psilocybin was creating actual structural change within my cortex – not “just” psychological change – was completely astonishing.
My dosing date was on March 5, 2020, and I remember looking down at the capsule sitting in the cup, saying to it: “I really hope that’s you.” I was terrified inwardly that I would receive the placebo, that I wouldn’t respond to the psilocybin, or that it would only work just a little bit, only for its effects to slowly fade. But within half an hour, there was no denying that I had received psilocybin, and I earnestly pursued all the procedures everyone on my care team at NYU had worked with me on for weeks in preparation for this day.
I was genuinely shocked at the sheer volume of psychological material from my childhood and early adulthood that came up. I had profound transpersonal experiences and healing, revisiting instances that were pivotal in my childhood. I had an encounter with the first woman I had ever loved, who had committed suicide three years after we had broken up. Her death had caused a profound grief in me that drove my drinking for a decade after. I thought I had released the majority of my grief around her once I got sober, but clearly, there was so much more to heal that had been deeply suppressed as I tried to move forward with my life.
Reset, Renewed, and Reborn
The biggest shock of all, though, was waiting for me at the end of the day when one of my facilitators casually pitched a seemingly routine question while closely watching me out of the corner of his eye: “So, how do you feel?” Without thinking, I reflexively replied, “Good,” but then, just as reflexively, scanned more deeply inward, and in a sudden rush, realized my depression was completely gone – not just better, but vanquished, exclaiming: “Good! That fast? Are you fucking kidding me, that fast? Is it gone already?”
It felt as if a huge mass had been surgically removed from me or as if an entire continent within my interior was now suddenly revealed. No matter how many times you read the word “remission” and the percentages behind it in scientific studies, very little will prepare you for the shocking reality of it. The contrast between before and after was profound. All of the iterative rumination was gone, and it took no effort for that to happen. And it only seemed to strengthen as the days passed. Miraculously, all suicidal thoughts ceased on that day and never returned.
Shockingly, only ten days after my dosing session, NYC went into a complete pandemic lockdown, my entire industry closed, and my two young boys were now at home with me 24/7, tele-learning. I cannot imagine what 2020 would have been like for me if I had received the placebo. It’s almost unimaginable.
But here is where the story takes an even more profound and impactful turn. During the session, my leg started intensely tremoring/spasming. I had been evaluated for musculoskeletal pain and dysfunction that I had acquired through a host of injuries over the years of my performance career, and in fact, had just been in the doctor’s office a few months earlier trying to determine if I had arthritis or something worse. But right there in the session room, I started having a neurological revision, with my muscles and nerves in my right inner thigh firing in an effort to recalibrate the sensory and motor inputs and outputs in that part of my kinetic chain. It was almost like a self-generated TENS unit (Transdermal Electromagnetic Nerve Stimulation, used to generate muscle contractions and neuromodulate pain signals with micro-electric pulses) getting my leg back online by creating intense motor activity in the muscles of my thigh.
While I partially understood what had happened, I was understandably beyond eager to learn more, and to see where else this realization could take me: Why did this work so well? Has our understanding of chronic pain been wrong? And if psychedelics are the answer, what does treating chronic pain with psychedelics actually look like?
This is part 1 of a 2-part piece and part of a larger series on chronic pain and psychedelics. In part 2, I will dive into the research around remapping and mirror box therapy, and why my psychedelic experience seemed to be so effective.
Future articles will focus on:What is pain and what causes chronic pain, old assumptions vs. new science, the suspected mechanisms of action behind the interaction between psychedelics and pain, and best practices and safety concerns for working with psychedelics to alleviate chronic pain.
In this episode, David interviews Dr. Ben Medrano: Co-Medical Director with Nue Life, board-certified psychiatrist specializing in integrative psychiatry, and former Senior Vice President and US Medical Director of Field Trip Health.
He discusses his path to Nue Life; from growing up around mental illness, to the rave scene, to Buddhism, to his years working for the underserved in an East Harlem Assertive Community Treatment, and his biggest takeaway from that time: that the healthcare system he knew was not truly helping people. He talks about stigmatization (of some modalities like electro-shock treatment, of psychedelics, and of ketamine – which seems to be stigmatized even within the psychedelic space); his concerns that the at-home ketamine model is at risk as we make our way out of the pandemic; and how at-home ketamine can drastically reduce the cost of treatment.
Medrano tells a great story of a patient who saw incredible improvements through ketamine, and discusses some Nue Life highlights: their just-released 664 participant-study in Frontiers Psychiatry showing the safety of at-home ketamine (and that at-home is just as effective as other routes of administration); Nue Care, their model for aftercare using digital phenotyping, goals, and a scoring system (which he believes could be the new model for integrative psychiatry); and their Nue Network, which could be a solution for better education on ketamine and for granting access for patients through prescribers who typically don’t understand much about its efficacy.
“All the different interests, personalities, visions, [and] goals that are in this sort of circus of psychedelic commercialism is very necessary to understand. And for me, I think the biggest takeaway is that there is one thing that binds everybody who’s involved, and that is hope, really. I think there’s a lot of hope in this sphere.”
“The hazards of a benzodiazepine are well known, and to some extent, one might even argue that with some of these DEA-regulated substances that we do ship at home; that if we’re going to say that we need to subject ketamine to a higher standard, then we need to do it for the rest of these DEA-regulated substances, because they have very hazardous risk profiles. …I can’t help but think that there’s a little bit of …stigma [around] what it is that we’re doing.” [On an at-home ketamine patient’s success]: “He is able to get out of the house every day and enjoy the sunshine, and the way he views his trauma is at a level that I think all of us would aspire to: really, as something that has sort of made him into the man that he is today, with something really unique and powerful to offer as a human to others – rather than as a wound.”
In this Veteran’s Day episode, Joe checks in with two members of the Heroic Hearts Project: Founder and President, Jesse Gould, and Chief of Operations, Zach Riggle.
Heroic Hearts’ mission is to create a healing community that helps veterans suffering from military trauma recover and thrive through helping them gain access to psychedelic treatments, professional coaching, and ongoing peer support – and we’re always happy to have them on the podcast to remind listeners about the extremely important work they do.
Among other projects, they are currently running several studies: psilocybin for gold star wives (spouses of fallen soldiers), ayahuasca for combat veterans, and ibogaine for special operations veterans through the University of Texas at Austin Dell Medical School’s Center for Psychedelic Research & Therapy; a study with the University of Georgia on personality change through psychedelics; a gut microbiome study with University of Colorado Boulder; and a psilocybin for head trauma study through Imperial College London. And today, they released the short film, “It’s Time – A Documentary of Veterans and Pro Athletes Seeking Healing Through Psychedelics.”
Gould and Riggle discuss the growth in interest and acceptance in psychedelics they’ve seen over the last few years; the importance of people telling their stories; relative trauma and how people too often wait to seek help; how trauma isn’t always due to a single event; Colorado’s Proposition 122 (which passed!); the need to have standard measurements in psychedelic studies; and how people who go through trauma together can heal together.
“At what point do we ask for help? I think, just as a society, we feel like things have to be in full-on crisis before we need to seek some sort of assistance. And we want to put [it] out there that that doesn’t have to be the case – that if you’re able to look at your life and realize that there may be some areas where things could improve and you might need some help in improving them, then don’t be afraid to reach out, because we’re not going to turn you away.” -Zach
“In the standard medical world, the physicians [or] the psychologists are looking at that qualifying incident and trying to heal that, trying to address that. And there’s some things that are pretty effective …but they’re working largely on that single incident, and ignoring all the other things that may have happened over time. And that’s where psychedelics can be so beneficial, is that they address that whole issue with a full system reset.” -Zach
“You take a population that largely (due to their illness) has been isolating, pushing everyone away, and just sitting back and looking at how amazing everyone else’s life is while theirs continues to deteriorate. Well, we plug them back into a community, bring them in, and help them to heal together. That’s a powerful thing to realize: that communities that were traumatized together; they heal better together.” -Zach
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MAR 30 - APR 2, 2023
Don't miss this trailblazing event
Immerse yourself in the many facets of psychedelics, from advocacy, education, industry, arts, and community. We’ll hear from thought leaders, healers, musicians, and more in this one-of-a-kind venue. Check out the line-up and learn more >
HAMILTON MORRIS • SUTTON KING MYSTIC GRIZZLY • RAFEEKI DR. CARL HART • STEVE DEANGELO