psychedelic-assisted psychotherapy

 

 

Last summer while I was attending a writing workshop at Omega Institute, a MAPS (Multidisciplinary Association for Psychedelic Studies) group was also on campus for the week, so I had the opportunity to speak to a number of psychiatrists and therapists who are beginning to integrate the use of psychedelics into their practices. 

"With psychedelics, 

if you’re fortunate and break through, 

you understand what is truly of value in life.

 Material, power, dominance, and territory 

have no value. 

People wouldn’t fight wars, 

and the whole system we have currently 

would fall apart. 

People would become peaceful, loving citizens, 

not robots marching around in the dark 

with all their lights off.”

~Gary Fisher~

I especially like the part about no more wars.

The therapeutic use of psychedelic substances, including LSD, psilocybin, and MDMA ("ecstasy") to modulate certain aspects of consciousness has attracted renewed interest and enthusiasm in recent years. Clinical investigations have targeted depression and anxiety, alcoholism and other addictive disorders, and PTSD, among others, with unprecedented success. LSD has demonstrated palliative effects on the anxiety, fear, and dread experienced by patients with terminal illness as they approach death. Many people experience a mystical or spiritual awakening that leaves them calmer, gentler, and more loving. And it sticks. As long as it's done correctly.

"Patients reported that their psychedelic sessions

 were an invaluable experiential training for dying.”

~Stanislav Grof~

The problem is that research into the use of psychedelics has a stormy history. Research protocols are notoriously difficult to design and to control when the end-point is subjective. Because these drugs are illegal, they are difficult to procure. And there are reports of adverse experiences. Entire departments have been shut down out of fear that their work may be more harmful than helpful. This has forced dedicated scientists and doctors to continue their research underground, jeopardizing their reputations and the results of their studies. 

"By banning psychedelic research 

we have not only given up the study 

of an interesting drug or group of substances, 

but also abandoned 

one of the most promising approaches 

to the understanding 

of the human mind and consciousness.”

~Stanislav Grof~

From those clandestine efforts, however, there eventually emerged a systematic plan and therapeutic process that addressed some of the concerns raised by the naysayers. A code of ethics emerged, and a charter was established. Questionnaires were developed, and guidelines for therapists were published. With this new sense of order and accountability, psychedelic-assisted psychotherapy is finding its way into mainstream practice...although it has a long way to go.

The history of psychedelic use in psychotherapy is fascinating, and it spans many decades. If you read up on it, you'll encounter names you may recognize but not associate with psychology or scientific studies: Aldous Huxley, Andrew Weil, Allen Ginsberg, Walt Whitman, Ken Kesey, and of course, Ram Dass and Timothy Leary...names we associate with literature, art, and the search for enlightenment, all of them curious about consciousness and creativity. 

Experts in the field and proponents of the practice suggest that it provides a new perspective on consciousness and the role of the ego in accessing memory, emotional response, and learning. Its potential is literally mind-boggling. If you'd like to know more, I recommend you start with this book:

Or, you can attend the largest gathering of psychedelic researchers and practitioners ever assembled next summer in Denver at the 2023 Psychedelic Science Conference: https://maps.org/

Seriously...I'm thinking about it.

jan

everything we need to know

 

Where there's a will, there's a way.

It seems as though everything we need to know is right at our fingertips. How to change a flat tire. How to set a beautiful table. How to potty train a toddler. All available with a click on a keyboard.

This week alone, the following titles popped up on my social media feed:

• How to master a life transition
• How to make the best of life
• How to be perfect
• How to reprogram your subconscious mind
• How to access superhuman abilities

And my favorite:

• How to finish your book.

Although some of these sound like impossibilities, this is not a joke. The authors and presenters are all serious. Among them are authors, life coaches, researchers, spiritual leaders, and world famous teachers and gurus. 

They did, however, miss a few topics of interest to me. I'd also like to know:

• how to convince people to take care of their health
• how to get people to complete their Covid vaccinations and get their flu shots
• how to make it safe to vote
• how to eliminate child neglect and abuse
• how to rescue every animal on the planet that is sick, injured, hungry, or lost

 And my favorite:

• how to do away with conspiracy theorists and their followers and believers

Maybe something will come up for me next week.

What impossibilities interest you? If you could do anything at all to help humanity, what would you do? How would you explain the process? How would you change people's minds?

"People who think they know everything

are a great annoyance to those of us 

who do."

~Isaac Asimov~

jan

how telling your story can help you heal

It doesn't take a stretch of the imagination to understand how hearing or reading just the right story at just the right time can help with healing. For example, you might gain a new perspective on an issue that has been troubling you. Perhaps you've been struggling with guilt after a friend committed suicide. You pick up a book like "The Ticking Is the Bomb" by Nick Flynn whose mother took her own life. His story looks at suicide differently. He considers the inevitability of it given the course of his mother's life. After reading it, you might see things a little differently. Maybe it wasn't your fault your friend found life unbearable. Perhaps you didn't miss the clues because there were none. A layer of guilt falls away.

Healing.

"The book I read after my mother died,

the how-to-deal-with-trauma book,

had failed to say when change could resume,

when one could go on."

~Nick Flynn~

~"The Ticking Is the Bomb"~

 

Or maybe your friend has been diagnosed with cancer, and it doesn't look good for her. You have no idea what to say or do for her, no clue how to help. Then you pick up a book like "Talk Before Sleep" by Elizabeth Berg, and you learn all the ways you can comfort and encourage her, and even bring a touch of humor to the situation. 

 

Healing. 

 

It may be a bit harder to grasp the idea that telling or writing your own story can also be a healing practice. But it is.

 

Maybe for you, anger sometimes erupts without provocation. Perhaps you feel anxious even when life is going well. Maybe despair blankets everything you do for reasons you don't understand. Or a particular song always brings you to tears. You can't help it. Why?

 

"We don't write what we know.

We write what we wonder about."

~Richard Peck~

 

Intrusive thoughts and feelings are the shadows of traumatic memories. Remember the time your father hit your mother in a fit of rage? You were so angry you wanted to hit him back, so scared you didn't dare move, and you couldn't run away. You felt helpless as a child, and now you feel worthless as an adult.

 

Perhaps, in your family, you never knew when the front door would open and your father would come home drunk, and even if you were already in bed, he'd find you there...

 

Maybe that was the song you listened to so you didn't have to hear your parents argue.  

 

Your anger, or sadness, or fear needs to find a time, or a place, or a name to explain it. You need to know its identity, its source, and its setting in order to renegotiate your relationship with it.

 

Telling your story puts you in control. It helps you think about what happened. It helps you understand why. You get to decide how it ends. And that can help you heal.

 

 "At any given moment

you have the power to say,
'This is not how my story is going to end.'"
~Christine Mason Miller~

 jan

 





 





the concussion conundrum

Concussion care made big news this week when the NFL called for new guidelines for the management of players who sustain a head injury during the course of play. The NFL has agreed to make changes to its concussion protocol mandating that concussed players be removed from the game whenever signs and symptoms appear. The problem is that a concussion can be hard to diagnose accurately on the field. Symptoms can mimic orthopedic conditions (ie. when ataxia is misdiagnosed as a limp). And some symptoms, such as nausea and vomiting, blurred vision, numbness, dizziness, and seizures may not develop until hours, days, or weeks later. Some symptoms are relatively vague, including moodiness, irritability, memory loss, and sleep disturbance. The first concussion is serious enough, but if the player sustains a second concussion, even a mild injury before he recovers from the first one, it can be deadly. (Second Impact Syndrome) And we all know that repetitive traumatic brain injury increases the risk of dementia (Chronic Traumatic Encephalopathy)

~"If in doubt, sit them out."~

~Sydney Children's Hospital Network~

The protocols that guide concussion diagnosis and management have been under study and revision for as long as I have practiced medicine. Most of the early research concentrated on childhood injuries without establishing clear guidelines for adults. So, while this effort to mitigate the toll traumatic head injuries exact on professional football players sounds like a good thing, it seems to me a case of too little, too late. It does nothing to prevent concussions. By the time the problem is recognized, diagnosed, and treated...it is too late. The damage has been done. And if you are willing to acknowledge the fact that many players sustain hundreds, even thousands, of blows to the head over the course of their careers, you might wonder why we allow it. Encourage it. Cheer it on...

"The millionaire players of professional football

are suiting up for the new season

with a startling caution on their locker room walls.

A poster headlined “CONCUSSION” warns players

that lifelong brain damage can result

if they persevere with macho gallantry

through multiple head injuries."

~NYT Editorial quoted by Michael Craig Miller, MD

in Harvard Health Publishing~

It's a tragedy that the sports culture in this country refuses to protect young men who are conditioned to become macho millionaires at all costs. 

"(American) football is not a contact sport.

It is a collision sport.

Dancing is a contact sport."

~Vince Lombardi~

jan

everything you need to know about life

 

Four books are stacked on my desk within an arm's reach when I sit down to write...which is every day. These are the books that taught me how to write, and why I should stick with it. They inspire me. They motivate me. They fill me with desire and longing. With envy. They are always at my side.

A couple of years ago a friend of mine pried my clenched fist open and pressed a copy of Elizabeth Berg's book, "Talk Before Sleep", into my hand.

She insisted I read it. She begged me to give it a chance. But back then, I didn't read fiction. Ever. Who had time? I read about medicine. I studied medicine, I lived it, I dreamt it. Still, she assured me that this would be a quick read, and because I love her, I did it for her. I took it to the beach with me that summer, and I read it.

Well, let me tell you...I loved this book so much I wanted to crawl inside of it and stay there forever...while at the same time, I grew to despise this woman, Berg. I was that JEALOUS of her. I couldn't imagine how she'd come to write so beautifully. And because I thought it was impossible for me, I abandoned my own dream of writing out of pure, unadulterated despair.

And then, my muse stepped in.

"Fool,'' said my muse to me.

"Look in thy heart and write."

~Philip Sidney~

Now, you have to know my muse. She possesses a pretty mean oppositional-defiant streak. In fact, she can be an absolute nag. So...of course, she put her foot down and started feeding me little snippets of character, scene, and dialogue at the oddest times...when I was walking the dogs, or daydreaming in church, or fetching the mail...serving up tidbits of inspiration like manna in the desert.

As if that weren't enough, the "boys in the basement" got into the act, too. They started sending up some pretty darn decent plot points. And they kept fanning the ashes until a lone smoldering cinder of desire reignited my passion for writing.

"We don't choose

what's going to wake us up."

~Dani Shapiro~

So...I guess you could say that the book that nearly extinguished my desire to write was the same book that ultimately inspired me to try. Which is why I keep it close.

"Broken Open", by Omega Institute co-founder Elizabeth Lesser is an absolutely lyrical book about how to navigate difficulties in life, and how they can help us grow. It is simply a pleasure to read her beautifully written words, so I keep her nearby, too.

"Memoir as Medicine" by Nancy Slonim Aronie is there, too. I have been fortunate to have studied with her at numerous workshops over the years, absorbing nothing but positive energy when she teaches. Encouragement. Support. Affirmation. Something we all need every day.

But...this is THE BOOK:

If you are a writer, or you yearn to write but don't think you have it in you, or you simply appreciate good writing when you read, you should run right out and get this book. If you want to know what it's like to live the life of a writer...if you wonder how all those books get onto the shelves, and who does all that writing, and what it takes to stick with it, you should get this book. If you appreciate honesty, seek truth, and love metaphor...this book delivers it all. To me, it felt as though the author and I must have met over a cup of coffee or a glass of wine in some previous life and shared everything we knew about the life of a writer...the pleasure and the pain, the victories and defeats, the humor and the gravity of it all. It was as though she somehow captured every unspoken thought of mine and translated each one into words on the page. 

Which writer inspires and motivates you? What books do you keep close at hand? 

When will you write yours?

"Everything you need to know about life

can be learned from a genuine and ongoing

attempt to write."

~Dani Shapiro~

jan

you really should watch this

 

Last weekend, I was speaking to a friend of mine who is thinking about retiring from medical practice, not because he can no longer keep up with the demands of patient care or the new technology. Not because of ill-health, or exhaustion, or forgetfulness. The problem is a health care system that subscribes...indeed, surrenders...to the demand for power, speed, and profit at the expense of excellence, compassion, and human connection.

"America's health care system

is neither healthy, caring, nor a system."

~Walter Cronkite~

Back when I started out in medicine, in the early 1970s, the problem was oppressive paperwork. Now-a-days it's an oppositional defiant electronic medical record. A baffling coding and reimbursement system. The ever-present threat of litigation. A pharmaceutical industry that invests as heavily in marketing as it does in service. A health insurance industry whose number one priority is corporate profit, not compassionate care. 

My friend feels he has no choice but to retire.

"You can quit your job,

but you can't quit your calling."

~Lissa Rankin~

Reflecting on his predicament, I put a series of rhetorical questions to him:

• What happened to the drive for excellence in patient care?
• What does that excellence embody?
• When did our priorities as providers shift in favor of speed, power, and profit?
• Is it possible to restore the sanctity of the doctor-patient relationship?
• Is there any time or space for compassion, communication, and connection in patient care?

He met my gaze with a blank stare.

Then I remembered a TED Talk by Abraham Verghese, titled "A Doctor's Touch." You can view it here:

https://www.ted.com/talks/abraham_verghese_a_doctor_s_touch

 Don't get me started...

In this video, he discusses the laying on of hands by the physician...the importance of touch in patient care. He reminds us that modern medicine is in danger of losing this powerful diagnostic and therapeutic tool because, in today's health care system, patients have been reduced to mere data points. He calls for a return to the traditional one-on-one physical exam. This belies the glorification of the 10 minute office visit, the game of "Beat the Clock" doctors have to play in order to meet productivity quotients. In order to generate income.

These trends in the practice of "modern" medicine, among others, are what led me to bow out of medical practice when I did. I retired out of fear of the inevitable: that someday a patient of mine would suffer or die because there simply wasn't time for me to do my job well. It has happened. 

It happened to the patient who was admitted through the emergency room with a diagnosis of acute appendicitis when the ER doc, in his haste, missed the pulsating mass in her right lower quadrant that would have clued him in to the dissecting aortic aneurysm that brought her in that night.

It happened to the eighteen year-old who died of complications of sub-bacterial endocarditis that was missed because it can be hard to palpate an enlarged spleen or to hear a soft heart murmur when you're in a hurry.

It almost happened to the woman in the ER who claimed to have sustained a injury to her right eye when she tripped and fell against the corner of her nightstand...when in truth, a blow from her muscle-bound boyfriend's clenched fist had caused a fracture of the orbit that required urgent surgical intervention. Try teasing that out of an EMR. It also meant we had to notify law enforcement, and social services to secure safe shelter for her when she recovered...if she recovered. None of which could be rushed.

These are all true stories. 

Thankfully, there are physicians like Abraham Verghese who are willing to speak up while the rest of us struggle to collect our thoughts. How did this happen? Who is in charge here? Is there any hope for us? We are defeated by our failure to act on what we know to be true. Discouraged from exercising our deepest intuition and hard-earned wisdom. Defeated by a system that is on the wrong trajectory and doesn't grasp the problem.

"We touch heaven when we lay our hands

on a human body."

~Novalis~

Next, we need to tackle the absence of eye contact with our patients.

jan

the final common pathway

Toni Morrison probably said it best:

 "If there's a book you really want to read,

but it hasn't been written yet,

then you must write it."

~Toni Morrison~

So, this is the book I really want to read, or to write. It would be titled: "The Final Common Pathway." It would reference the hundreds, if not thousands, of practices and techniques that are employed all over the world to help people heal--physically, psychologically, emotionally, and spiritually--all of them intended to promote a more peaceful, mindful, and joyful way of life. These practices range from hypnosis to meditation to yoga, from EMDR to Emotional Freedom Techniques (EFT) such as tapping, to chanting, to qigong and tai chi. From shamanic rituals to diet and exercise. To psychedelics. All of them proven to be effective for some, but not for all. 

For example, back in the seventies, when "alternative" medicine was regarded with the same disdain as snake oil, I breezed through a surgical procedure under self-hypnosis. I believed in it because I'd seen it work. I studied it, and I practiced it until I was ready to use it. Hypnosis is one of those techniques you have to want to practice in order for it to work. If you don't believe in it or trust it, you won't be able to surrender to trance. So, it works for some people but not for everyone.

"Allow yourself to see

what you don't allow yourself to see."

~Milton Erickson~

From hypnosis, I went on to study and practice meditation and yoga. Just practicing breath control (pranayama) helped me navigate a difficult time in my life without surrendering to anger, or bitterness, or regret. It got me through three lonely pandemic years with unexpected peace and happiness. 

Now I'm exploring Qigong as a way to access and channel energy in the body. It resonates with what I already know about therapeutic touch and the flow of energy within, around, and between us. It connects consciousness and movement with neuroplasticity and human physiology. It makes sense to me.

"Qigong is the art and science

of refining and cultivating internal energy."

~Ken Cohen~

If you're curious about how these techniques work, and whether or not they could help you, you may have to try several practices before you find the one you trust to be authentic and effective. One that you are willing to practice with patience and perseverance. One that works as well for you as hypnosis did for me in the OR...

...which is why I can't help but wonder if all of these practices don't simply work through some final common pathway. If, no matter which practice you choose, the same circuit is activated, or the same switch is flipped, and that sets change in motion. After all, they all seem to embody:

INTENTION

BELIEF

PRACTICE

In other words, they all seem to work a lot like hypnosis.

They all empower us to live a more mindful, peaceful, and happy existence.

"Attached to nothing. Connected to everything."

~author unknown~

jan