That’s the first part of the title of Michael Pollan’s most recent best-selling book. The rest of the title is, What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.
Pollan is the consummate storyteller. Remember Omnivore’s Dilemma? I just finished How to Change Your Mind, and it was quite a trip (pun intended). It’s all about the redemption of Psilocybin and how this misunderstood drug of the 60’s can be of benefit to our mental health. Really?!
1. What is psilocybin? Psilocybin is a naturally occurring hallucinogen that is found in the psilocybe genus of mushrooms, giving them the name “magic mushrooms.” These magic mushrooms are found in the wild and can also be cultivated. In the US, psilocybin is classified as a Schedule 1 Drug, which means that it has high risk for abuse and no currently accepted medical use. But Michael Pollan and some highly respected scientists think it is time to redeem Psilocybin by recognizing its potential to treat certain mental health conditions.
2. A brief history on psilocybin. Around the world, magic mushrooms have been used for thousands of years to enhance spiritual rituals and elicit transcendent experiences. Swiss Scientist Dr. Albert Hoffman isolated psilocybin as the psychoactive component of these mushrooms in 1958. (He was also the first person to synthesize, ingest, and learn of the psychedelic effects of lysergic acid diethylamide, or LSD). LSD and psilocybin were legal in the early sixties and ripe for study. Most famously, in 1960 Drs. Timothy Leary and Richard Alpert set up the Harvard Psilocybin Project, but by 1963, their research methods were widely criticized, and they were fired from Harvard. By the end of the sixties and psychedelic drugs, including psilocybin, became illegal, and most countries outlawed possession of mushrooms containing psilocybin. The stage was set for what became a decades-long war on drugs in the US and elsewhere. Leary never wavered in his belief in the spiritual and medicinal potential of psilocybin and became the face of the counterculture drug movement. He was incarcerated 36 times, foreshadowing the criminalization of drug use that was to come in the US.
3. How Psilocybin Works. Psilocybin is ingested orally, and it is quickly converted into psilocin. In turn, psilocin acts on serotonin receptors in the brain to produce hallucinogenic effects similar to LSD and other psychedelic drugs. Within only 30 minutes, psilocybin stimulates dramatic increases in connectivity in the brain as illustrated in the photo above. This activity peaks at 2-3 hours and then decreases by end of a 6-hour session. During this time, individuals can experience visual illusions, greater emotionality, heightened cognitive processing, and distorted perceptions of time. They often report some transcendent (described by researchers as mystical) experience that is difficult to articulate verbally.
4. Set, Setting, and Suggestibility. From the beginning, Timothy Leary recognized that the effects of psilocybin are highly variable and depend on the mindset and environment in which the user has the experience. These factors are commonly referred to as set and setting. Factors such as group size, dosage, preparation, and expectancy are important determinants of the drug response. Individuals tend to be in a state of heightened suggestibility while under the influence of psilocybin, which may be an essential aspect of the therapeutic opportunity. Some trials aimed at helping individuals quit smoking and stop drinking support the idea that in combination with an intentional environment and mindset, psilocybin may create a state of openness and suggestibility that facilitates therapeutic behavior change.
5. Does Psilocybin really have therapeutic benefits? Dr. Roland Griffiths at Johns Hopkins at the Center for Psychedelic and Consciousness Research is one of the leading scientists studying the therapeutic benefits of psilocybin. He and colleagues have been researching psychedelic drugs for over 20 years and have seen approximately 370 patients over 700 sessions. According to Griffiths, there is reason to be optimistic. Psilocybin does not have addictive properties, and it has shown the potential to help individuals who have treatment-resistant depression and depression and anxiety linked to life-threatening cancer. While in a psilocybin session, patients often report feelings such as joy, peacefulness, and a sense of meaning. And some effects seem to be long-lasting. But not all of the research has been positive. Although less frequent, some patients report negative feelings of suspicion, fear, and anxiety while in a psilocybin session and afterwards. We do not yet know whether the positive findings to date translate into meaningful therapeutic interventions for significant mental illness.
In the sixties, politics shut down science. Today, we are witnessing an easing of the political lockdown, and funding is now being directed to study the potential therapeutic use of psilocybin. The challenge for the scientific community is that we do not have enough data to properly inform policy change on psilocybin just yet. And when policy gets too far ahead – or out of sync – with scientific evidence, we run the risk of serious health consequences. That’s clearly part of how the opioid crisis happened. So for now, I am optimistic that we will learn more by being open to studying psilocybin, but it is too soon for me to make up my mind about its potential in the treatment of individuals with mental illness.