Conversation about Psychedelics, Ego Theory, and Research Developments With a Leading Researcher – Dr. Robin Carhart-Harris – HPP 102

SPEAKERS
Keith Kurlander, Dr. Will Van Derveer, Dr. Robin Carhart-Harris

Dr. Robin Carhart-Harris 00:00
Drugs change consciousness if the unconscious exists. It stands to reason and that actually felt like a legitimate question if the unconscious exists so I was studying psychoanalysis but everything felt so flimsy in terms of evidence for the sort of Central sort of phenomenon in a way of psychoanalysis the existence of the unconscious mind.

Dr. Will Van Derveer 00:27
Thank you for joining us for the higher practice podcast. I’m Dr. Will Van Derveer with Keith Kurlander, and this is the podcast where we explore what it takes to achieve optimal mental health. I am beyond excited to welcome our guests today Robin Carhart-Harris to the show. Dr. Carhart-Harris is a leader and innovator and rising star in the world of psychedelics research. The mainstreaming of the brain network, the default mode network, is I think greatly due to the innovative research of Dr. Carhart-Harris. I’ve been following his work for years and looking forward to this conversation for quite some time. And we got to speak about a wide range of different topics from psychoanalytic conceptions of the self to neural networks and neurological substrates of the self, what happens on psychedelics, and really fun conversation. I hope you enjoy listening to it. Here is Robin’s biography. Dr. Carhart-Harris moved to Imperial College London in 2008 after obtaining a PhD in psychopharmacology from the University of Bristol focused on the serotonin system and a master’s degree in psychoanalysis from Brunel University in 2005. Robin has designed and carried out human brain imaging studies with LSD, psilocybin, MDMA and DMT, a clinical trial of psilocybin for treatment resistant depression, a double blind, randomized controlled trial comparing psilocybin with SSRI as the telepram for depression, which was published in the New England Journal of Medicine just a month or two ago. Very exciting to see that and a multimodal imaging study and first time users of psilocybin. Robin has published over 100 scientific papers. He founded the Center for psychedelic research at Imperial College London in April of 2019, the first of its kind in 2021. Te was listed in Time magazine’s 100 Next, a list of 100 Rising Stars shaping the future. Also in 2021, he’s about to move next month to the University of California, San Francisco becoming the Ralph Metzner and distinguished professor in neurology and Psychiatry. At UCSF Robin will serve as director of the new psychedelics division within the translational neuroscience center called neuro scape. We are absolutely delighted to welcome Robin Carhart-Harris to the show today. Welcome, Robin.

Dr. Robin Carhart-Harris 02:47
Thank you, nice to be with you both.

Dr. Will Van Derveer 02:49
I’ve been a huge fan for many, many years reading your papers and following along and been looking forward to this conversation for a long time. There’s a sense that I have with your background, not just deep in the neuroscience of psychedelics, but also kind of psychotherapy background, you’re uniquely positioned to talk about the integration of different aspects of healing and wellness, and so we have a lot of burning questions for you. First, I wonder if you’d be willing to describe for us, I believe you were in your master’s program, when you got interested in the question, and this comes from your TEDx talk when I was researching and getting ready for this that you were wondering, is there a drug that could help reveal the depths of the unconscious mind? What led you to ask that question? Is there a drug that could do this?

Dr. Robin Carhart-Harris 03:34
Yes, well, I suppose I don’t know if I knew it was psychedelics. It’s been a while doing the Masters in psychoanalysis. I was in my mid 20s, I think, and funnily enough, it had been a while since I personally encountered psychedelics, let’s just put it that way. So they weren’t really on my radar. And I’m not sure I was consciously thinking of psychedelics, but maybe unconsciously I intuited psychedelics. So you know, I was thinking, Well, you know, drugs change consciousness, if the unconscious exists, it stands to reason. And that actually felt like a legitimate question if the unconscious exists. So I was studying psychoanalysis, but everything felt so flimsy in terms of evidence for the Central sort of phenomenon in a way of psychoanalyzing the existence of the unconscious mind. I just thought, well, alcohol makes you sloppy and disinhibited, you do some things that you wouldn’t ordinarily do. But does it reveal the unconscious, well, I don’t know, in the sense of instinct being released. But it’s not it didn’t feel compelling, and so it was in tuition, I think and it must have been because I would have put in a library search with the term LSD I think, in the search and there it was. Directly in front of me are realms of the human unconscious, you know Stanislav Grof’s book, and that was it. There’s something to this and then to know committing and changing, actually, the master’s program that I was studying from something boring, like experimental psychology or some run of the mill kind of cognitive psychology master’s program. And taking that it felt slightly reckless but something I had to do to change my masters course, I was formally enrolled in this experimental psychology, I might have been Applied Psychology and then change to psychoanalysis in contemporary society was the master’s program. It required a bit of a leap of faith. And so I had to feel like, in a sense, was justified in doing it, and then maybe something was going on. Whereas thinking, Well, I’m hearing about all this fantastic stuff, Potanin to boo like, crazy, crazy ideas, and a lot of fun, but is it true? Does even the unconscious exist and then once I found Stan Grof book, I just said things like laboratory LSD with psychedelics, we have laboratory evidence for central tenets of psychoanalytic theory. I just thought Yes, yes, solid ground, here we go. Yeah.

Dr. Will Van Derveer 06:27
That makes sense, given what I know, which is not a lot. But reading LSD psychotherapy, the incredible journey that Dr. Graf had from traditional Freudian analysis and attempting to do that with LSD and sitting behind the couch and finding out pretty quickly that he needed to innovate, that would be really useful, kind of maybe not mentorship, but a signpost for you to follow in terms of that transition, and you’re thinking.

Dr. Robin Carhart-Harris 06:52
yeah, yeah, it was just how deep it goes. And how that then took him on to a more jungian perspective, and then his own perspective inspired by auto rank and birth trauma, and yeah, how that led to the manifestation of his kind of cartography of the unconscious, in terms of what is the unconscious, like nailing it down, you find that it’s a bit of what’s the right word? Do they call it a kind of mirror anyway, it’s slippery. You think you’ve got it, and then it’s gone. And part of the realization for me, I think, over time is that it’s a vague phenomenon of a construct and such things exist in science, that’s not a cop out. It just means that the thing can be two things at once or not so crisply differentiated, whether something is memory, say or fantasy, these days, that’s how I see the unconscious that it’s sort of intrinsically dynamic, and abstract, and can never really be nailed down. So universal themes that are true in everyone will be something like the Oedipus complex sheep find it doesn’t hold up, it’s not too absolutist. But as an interesting theme that plays a role in the human condition. Yeah, it’s interesting. Yeah.

Dr. Will Van Derveer 08:24
Well, I’d like to fast forward to your early work with psilocybin and imaging. And you published a paper where you had really interesting, and I hope people listening to this podcast, you know what I’m referring to, if not, you can go find it in PubMed, but an interesting diagram of ordinary consciousness and level of communication between different brain regions, and then the level of communication or the diversity of different communication pathways on psilocybin. And I’m curious about whether you were surprised by the finding that came forward from that work?

Dr. Robin Carhart-Harris 09:02
Not really. You might even say it was a bit of a positive test strategy in the sense that the hypothesis was strong. And so we came in, and I yeah, of course, and it was in the early days of the birth of this entropic brain idea. And I was going to physicists or mathematically minded people who have the skills because I don’t need to do that kind of thing through collaboration. But I would say that I have this intuition that brain activity becomes more diverse under psychedelics, it just stands to reason that it should. How can we look at that? Then this measure of entropy, I think is interesting. How can we apply this? And then the clever people go off, in this case Dante Chialvo, Argentinian physicist with a keen interest in criticality, self organization. And I think at the time PhD student, he was supervising Enzo tablea azuki, another Argentinian. And together we collaborated and produced that work, and over time has just been reinforced in a number of different ways. I think it’s a really useful principle, the entropic brain one, we often sort of talk about in our research and still see it, finding it difficult to find sort of anomalies to the rule that says pretty solid. And these days, actually improving some of the measures as well, so that it’s an even more reliable reader. And just to say plainly, the entropic brain principle is that the entropy is an index of the unpredictability of a phenomenon like a system over time that if it’s disordered, for example, it’s harder to predict what it’s going to do next, like a molecule in a gas rather than a solid structure like ice, where it’s just you know where it is. And so the idea is that if you can index within a range of disorder, if you want, if you dial it up, in parallel, you’ll be dialing up the diversity, I call it the richness of conscious experience, that it be more range for, as you dial it up in parallel with what’s going on in the brain. And that would translate typically also into a diminished sense of assuredness about things. And it seems to hold up, it seems to hold up.

Dr. Will Van Derveer 11:35
And for our audience, I’m wondering if you could connect this entropic brain sense with what people often talk about now, as part of things to you and others, the default mode network has become part of the sort of conversation about neuroscience and about depression and OCD, even schizophrenia and so forth. How would you describe in lay terms, the role of the default mode network and its place in mental health and what we should know about that?

Dr. Robin Carhart-Harris 12:06
Yeah, well, the default mode network has sort of entered people’s consciousness. And it’s sort of taken over from hemispheric differences in a way, it’s something that people can get a handle on about the brain, and it does seem to be an important network in the brain. And some reasons why it’s important, it has disproportionately high metabolism, blood flow and connectivity. And that’s involved in brain development, genetically so within our lifetime. And also evolutionarily. It’s involved in particularly high level psychological functions, like what’s called mental time travel, imagining the past and the future, the opposite of mindfulness. And we often say, of being present centered, so daydreaming, and imagination, fantasy, you know, it seems to be part of a pattern of distributed brain regions that may even be human specific or disproportionately expanded in our species. And also, there’s a ton of serotonin to a receptors, which is what I work on, I would say, These days, the only qualifier to this rule that the default mode network is interesting, particularly interesting in the context of psychedelics is to say that it’s not just about the dmn, the default mode network. These days, I said, Do you think dmn plus, because there are other very expanded cortical regions close by that seem to be at least as important as the default mode network. And actually, these days when I think in 2010, I’d written this paper called Friston inspired by an early kind of schooling and reading and psychoanalysis. Default Mode Network was discovered, you could say in 2001, Marcus Reiko has this famous paper on it. So it’s a hot topic, and I thought, ah, could that be the ego? And so I’m looking at brain imaging studies saying that it’s activated, especially during sort of tonic cognition and sort of offline introspective ruminative thought, yeah, yeah, you know, and then looking at some of the regions that engaged during sort of suppression of thoughts like the medial prefrontal cortex and our ego functions and But these days, it’s sort of, it’s more in the brackish water, I would say between, I mean, and this is a bit of a dangerous game to be playing but you know, putting modules onto constructs like the ego and the unconscious, but I would say that the dmn is more of in the brackish water, the space between the interface between the unconscious and the ego, you might say, think of things like fantasy and imagination. You: Is that really ego? Where does he end and unconscious begin? Yeah, so. And actually there might be other parts of the brain systems in the brain that are more involved in what you might more classically call ego functions. So I would say, take ideas like that with a pinch of salt. In a sense, we’re always learning as you go on these days, I think it’s more about sort of default my network plus and yeah, there’s some interesting stuff in that direction.

Dr. Will Van Derveer 15:34
Speaking of brackish waters, what is your current sense of where the self ends? And where another begins in this kind of fuzzy gray area between the individual, the sort of the I and the other?

Dr. Robin Carhart-Harris 15:47
Yeah, yeah. Well, this recently came up in the context of thinking about some of Carl Fristen’s work and how it might be used to make sense of entity encounters on the DMT. You know, that substance in particular seems to have become associated with, and we’ve seen it empirically in our work about 40-50%. at a moderate high dose of DMT, we give on IV will report these the sense of presence, sense of otherness. And that’s where the otherness entered my consciousness, that is the DMT experience, quintessentially one of ego dissolution. Well, maybe it’s a big feature. But is it really a dominant feature, ego dissolution as such, is what people say when they come back, and probably more, there’s this sense of otherness. There’s other consciousness, other intelligence in that space. And so I think, where there’s anything that we talk about and have names for, they have some degree of separateness from other things. So I think there is something at least in normal waking consciousness and in consciousness generally, that’s different about other to self that of course, the unitive experience where there is a disruption of the ego boundaries, and the sense of self and other collapses is that it fascinating case where the separateness between self and other breaks down. Yeah, and I mean, some of our work most recently, Leo Roseman, a postdoc in, in our team at Imperial has done some really nice work on Israelis and Palestinians drinking Ayahuasca together, and how they talk about how the otherness there in that classic geopolitical religious conflict is a problem, and you have the polarization because all the conflict. And what came out of these interviews he did with these mixed groups of Arabs and Jews drinking Ayahuasca together was the appreciation of otherness. It wasn’t just all themes of shared humanity, we’re all the same. Like all your cultures, actually really interesting, Oh, it’s interesting. When I hear you sing in Arabic, it provokes me. I’ve been sort of caught through circumstance and to hear that as bad an enemy. And actually, it’s rich and beautiful and fascinating. So I thought that was interesting.

Dr. Will Van Derveer 18:31
Yeah, much more nuanced than just the melting away, and the unique experience and interesting, I’ve been wanting to ask you, I recently heard Roland Griffis interviewed, talking about, of course, psilocybin and psychedelics. And one thing he said in the interview was that he believes that in 30 to 40 years, we’re going to look back at psychedelics and say, these were a crude tool that pointed us toward what he suggested in the interview is that there may be technology coming that would be able to create, and maybe I’m reading in too much into what he said, but perhaps create mystical experiences or create psychedelic experiences in a more controlled and precise way. And I was just as curious if you have the perspective that we’re right now for the time being, working with cruder tools that later on will be refined as we develop our understanding about what it is about psychedelics that’s sort of like what’s the crucial mechanism or or ingredient there?

Dr. Robin Carhart-Harris 19:31
Always a fascinating thought to think 30 years ahead and whether we would think that deep brain stimulation, for example, or trends, cranial magnetic stimulation TMS people would refer to as blunt tools, quite crude drugs of course it chronic medication, drugs that in a sense, so sort of dirty in their action, they’re hitting everything, there’s a lack of precision there. Yeah, would we see psychedelics as blunt tools? I mean, the drugs themselves, yeah, but the psychotherapy is such a key component of it, you would have to say, Oh, we would have an intervention to do what the drug does, which in produces, you know, a hyper plasticity and an openness, and so we wouldn’t need the psychedelic drug to do that. And then we might have some kind of, gosh, like ultrasound, I don’t know, something that isn’t a drug that is maybe more precise, and maybe like a flip a switch and it comes on. There’s no anticipatory anxiety, necessarily, you’re just there. And then when you want to come out, you can dial it down as fast or slow as you want. I mean, that would be neat, but technologies like ways of delivering the drug with a short half life, a lot of these psychedelics have DMT, five MEO, we can do that with things like continuous infusion and steady state. And then you want to turn it off, you just stop the infusion, and there’s a fast metabolism and you calm down. So yeah, could that be done without the drug? Well, of course, whether or not of course, well, it could conceivably, and that’s an interesting thought. But what the future entails for psychotherapy, the idealist in me thinks so, you always need a human being with the other human being, being human beings in the same time in space and time. And that being a crucial component. Sure, you know, digital tools will help. And I’m a believer in that I’m involved in a startup around that. But it’s not for replacing human beings, it’s just for supplementing in the way that technology does.

Dr. Will Van Derveer 21:42
Yeah. It’s an interesting question. I mean, we’re in the question here, as we develop our psychedelic therapy training, the hybrid model of how much can be done online and how much needs to be done in person for similar reasons, there’s an advantage of being able to train more people online. But obviously, there’s a huge disadvantage of not feeling the heart rate variability impacts on the other person and all of the things that happen energetically in the room in training, so it’s interesting.

Dr. Robin Carhart-Harris 22:10
Yeah, that there is huge scope. I mean, even if you know what’s going on in one’s physiology, that you could have that recorded and fed in real time, and you can see what’s going on, and it usually pays to be brave about where things are going and how it could help. And these things tend to happen whether you like it or not, you know if they can happen, but I mean, the extreme of it is some kind of robot Sharman just to sort of play on provocative terms and archetypes, but I don’t know about that. Really, here.

Dr. Will Van Derveer 22:41
First thing’s first, in terms of taking psilocybin through phase three. And maybe that’s the first, where are we in the art of psilocybin and clinical research?

Dr. Robin Carhart-Harris 22:50
Yeah, it depends how you look at it, what the model is, if it’s national and international approval through regulators with psilocybin, it’s not as close as it is with MDMA therapy for PTSD, which are gunning for 2023 of course. So how close is it? And I don’t think anyone really knows, I mean, best case scenario 2024, but could easily slip on, easily slip on, and so we’ll wait and see. But that is the sort of mainstream medical model with like FDA approval for a given indication, maybe treatment resistant depression could be major depressive disorder, but then you have these other routes, like the Oregon model, and now California, moving in a similar direction, and likely elsewhere, is moving so fast, it’s hard to keep on top of it all. But that model is very interesting. And that looks set to be the first mover in terms of some sort of infrastructure level change, even though it’s not national, it’s still a big change and requires rollout. And it’s regulated. And so that I think that’s a fascinating model to watch and the plans, the roadmap is for that to open up in Oregon in 2023, the people being treated, whether they’re patients or even healthy people. So yeah, I guess let’s watch this space a lot going to be happening in 2023 it seems.

Keith Kurlander 24:18
We kind of want bottom up in terms of a lot of constructs that kind of might lead into a bigger conversation of just what the human mind is and how you’re framing that in your self these days and how you approach research in terms of what are you really going after terms of understanding the human mind and I’m assuming there needs to be some working definition of the human mind as you’re exploring it and how all these different networks we’re talking about. And then psychoanalytic concepts and then methods of action and how you just think about the mind as a kind of large construct.

Dr. Robin Carhart-Harris 25:00
Yeah, I guess coming into this space, I never wanted to hold a particular philosophical view on the mind and the brain or even I just sort of went with the flow. And it’s only in time that you realize, or you do have a particular perspective. And part of this has become clearer to me as we started to try to become a bit more precise in making mappings between brain activity and experience, and part of the endeavor there is to try and do it dynamically. So the psychedelic state has never been one state and it does it a huge disservice, to even call it the psychedelic state neural correlates of the psychedelic state, of course, I’m guilty of it was the title of one of our papers. And so the point is that we can do much better than that. And can we look at psychedelic sub states and what they look like both experientially or how they’re felt, how they’re experienced, and what mirrors those experiences in terms of brain activity. And when you go in that direction, you realize that at this time in history, these different domains were making mappings between these domains, and that’s where we are. So there is an essential kind of pragmatic dualism, in a way to this endeavor. And I’m quite sort of accepting of that at this stage, I think for some cognitive neuroscientists, they feel that it’s somehow a cop out or weak science to not just see everything through the lens of the brain. But I just mean, ultimately, could we get there? I don’t know, I’m a bit doubtful about whether we could mean, the domain of experience of meaning is always the domain of experience and meaning. How could understanding the brain in a more complete way ever sort of collapse all of that, or make it just redundant? I just don’t think it ever could. So I think probably there would always be this essential dualism there. But anyway, these days, I’m very interested. And this is what I hope to do at UCSF, moving to UCSF formally on the first of July, and then in person in August. But this is part of the program of research that we want to carry out there is to try and drill down into psychedelic sub states find reliable correlates of different dynamic experiences, like the entity encounter, like list dates, profound bliss states, what about struggle under a psychedelic looping struggle that you can see during periods of particular distress and psychological challenge. What about sudden insight? What about cathartic release? What are the correlates of these experiences? How can we decode them, and then perhaps even detect them in the brain and body through recordings, and perhaps even do that in real time, and that will be useful. Now this is where technology could aid the guides of the future, because they could see this readout and think without having to blunt tool, or check in with them and say, Where are you which disruptive, could also be good, of course, but it could be disruptive, but know that someone is gravitating into distress, they are a struggle state, and then at least have that inflammation. And that feels entirely possible? That kind of scenario.

Keith Kurlander 28:37
I’m curious about the way you’re contextualizing some of the more what we would call on transpersonal psychology, well, let’s call it expansive states, expansive consciousness, sort of the relative frameworks of time fall way. You mentioned ego dissolution at one point, you know, mystical experiences that happen on psychedelics, do you contextualize these as transpersonal? And beyond the personal relative identity of a human? Do you just contextualize them as something that happens in the imagination of ourselves? Do you take a Jungian view where it’s more of a collective consciousness we tap into? So I’m just curious, like, what your frameworks have been and how you’re holding that and when you ask research questions?

Dr. Robin Carhart-Harris 29:26
Yeah, I think transpersonalism is a really useful term. And so I like it. I like constructs and themes very much that I find in Jungian psychology, that feel very useful. And as Stan Grof realized, probably more useful, well at least as useful as Freud constructs because he came up with some we’ve discovered some real gems that we talk about all the time, but his contribution was massive. And so I find that very useful. I never feel any need to, I don’t know, diminish the experiences by saying that they’re just imagination, I guess it depends what we’re talking about here, but nothing is ever just imagination that sort of makes it then seem not real. And that question of what’s real is a slippery one anyway. And things are psychologically real. I mean, if someone comes to you and says, I believe that I transcended the known dimensions of space and time, and traveled through another diamond or something like that, then that’s something that they’re saying to me. But whatever they experienced, they experienced and had a psychological reality, or someone with schizophrenia comes and says, I believe x, y, z is happening aliens from another planet, to read in my thoughts, psychologically real for that individual. If we want to get into the technicalities and break it down and look at it’s sort of literal reality, then we might see it’s fallible on that level. And if someone was say, I feel like I’ve transcended these dimensions of time and space and transcended this, whatever this dimension is, and then we can say, Okay, let’s look at the science of that. And we may find that it’s actually fallible, or there’s not really anything there, or what’s offered is flimsy and sort of pseudo scientific. But I see the danger of being like, derogatory about people’s experiences, if ever it said, they’re just imagination.

Keith Kurlander 31:34
Yeah, I like how you use the term psychological reality, that psychologically everything’s real, that a person experiences if we’re just looking at sort of a psychological reference point of the individual.

Dr. Robin Carhart-Harris 31:47
Yeah, so dreams. Yeah. I mean, when you’re in them, you’re immersed in them. It’s as real as anything else. You smoke, some DMT, or whatever, you go into that world, it’s as real as anything else. It’s your reality at that time, that you come out of a dream, you come out of a DMT state to then think, Oh, no, that place does exist in some other dimensions, space and time is an interesting creative idea. But where do we start in terms of finding any sort of evidence for such a thing?

Dr. Will Van Derveer 32:22
And sometimes people describe these experiences as hyper real, even more real than ordinary life feels real to people. Do you have a sense of what’s under that in terms of the correlates of why that DMT experience would feel more real than ordinary?

Dr. Robin Carhart-Harris 32:40
Yeah, I could only have a stab at it. And I say if there are impressions, there’s some kind of signaling happening in the body in the brain, maybe bottom up signaling. And we have some evidence for this, we’ve got a paper traveling waves in the brain, which flip when you enter the DMT state, they go from a top down direction, from the frontal cortex to the occipital nerve, to a bottom up from the accipiter to the frontal, as if they’re seeing things just like what the brain does when you go from eyes close to eyes open. Now your actual information, there’s an actual signal coming into the train, which is driving an information flow up the hierarchy, because there’s stuff to see. And you see that under DMT. So then the question is, where’s that coming from? Well, all the information that we have at the moment is just where it’s coming from back in the brain, the occipital cortex off, but then what about before that comment from the retina like it is when you open your eyes? And if it’s not, where is it coming from? Well, they’re the best evidence for inducing dreamlike experiences through electrical stimulation that is in the medial temporal regions, the old brain, you know, the mammalian brain, as Paul McLean called it and called it the limbic system. And this is the system, an old system that seems to engage during REM sleep dreaming. And yes, if you want to induce these dreamy states, which are actually called dreamy states in the literature, if you’re going to stimulate anywhere in the brain, you stimulate the medial temporal regions like the hippocampus and surrounding structures. And then you know, not infrequently and this has been done historically in patients with epilepsy and so on, stimulates there and then people have these vivid recollections you stimulate elsewhere in the brain. And you get very different experiences, you might move a limb or feel a sensation in the limb or if you stimulate the visual cortex itself, not much happens, you might get some flashes of light. So in order to initiate a kind of cascade of activity, presumably up a hierarchy, you have to stimulate the medial temporal regions. So my wager would be on Some kind of release of medial temporal lobe activity that is propagating into the visual cortex and then up the hierarchy still, and that’s happening with DMT.

Keith Kurlander 35:13
In a lot of I would say the last 15 years, with the emergence of a lot of new trauma, psycho therapies really coming forefront, there’s been a lot of language around dissociation and presence more so than probably prior in terms of like, are the people we’re sitting with, are they dissociated? Or are they present enough to integrate the material they’re facing right now? Or are they in some kind of ego defense strategy? Or even just the brain is really dissociating on some level and they’re not present enough to deal with the overwhelming. There’s a lot of sort of tracking of physiology for that. And I’m curious if that framework is relevant when doing psychedelic medicine? Is this person dissociated? Does that term even mean anything on psychedelics? And is it just more trusting the medicine and just helping people with overwhelming states and not worrying about their level of presence to be integrating what is actually going on?

Dr. Robin Carhart-Harris 36:19
Yeah, it’s a fascinating question. I wonder how MDMA therapists would answer this. MDMA therapists dealing with patients with post traumatic stress disorder where dissociation is a major part of the presentation. And if they go back there, then back to the trauma, then dissociative response is quite common. Yeah, and presumably, that is less common. There’s more contact with MDMA on board and doing MDMA therapy, which is a fascinating thing. To try and better understand that. I have witnessed a dissociative response, which was highly atypical in a patient in our first depression trial, where he sort of went offline and efforts to check in weren’t being responded to and you can imagine this was really disconcerting. Thankfully, we had his physio monitoring kit by the bedside, and we would check his vital signs and everything’s fine. Except he wasn’t responding you know, so it was, it was pretty scary. And David Nut caught it, maybe an elective mutism, which I thought was interesting. Like he just decided he didn’t want to know, he was somewhere. He didn’t want to know, there was only afterwards he described it, and it wasn’t unpleasant is how he described it. He said it was like a sort of orgasmic experience that he was locked in, and he just didn’t want to be disturbed. So it can happen. It’s highly unusual. Is that a defense mechanism? I don’t know, or a very deep emotion. You could easily construe something as a dissociation if it’s a very deep emotion. Let’s imagine someone’s DMT high dose and you try to check in with them. And they just don’t say anything. Do you call that dissociation? Not sure. So yeah, interesting.

Dr. Will Van Derveer 38:22
With MDMA, we at least in our phase two trial here in Boulder, we had a dissociation scale that we ran subjective scale, and it there were trends in the data that the more dissociation was a part of the trauma presentation, the more challenging it was to achieve efficacy with MDMA psychotherapy. But in terms of like, inside the sessions, we didn’t see increased dissociation with those participants per se. If anything, I can give DNA as more of the opposite of a dissociative, it’s more of an associative term of people actually feeling their physical experience in their body and being more present. Yeah.

Keith Kurlander 39:02
Yeah, it’s also interesting because ketamine, obviously, is intrinsically dissociative. But yet, you can do trauma work, even though you’re sort of technically dissociating on ketamine. So it’s just an interesting thing. Because in let’s say, like EMDR, or somatic experiencing, like you would really be working hard to help people to slow down if there’s any dissociation happened. And maybe these are different concepts. I don’t know. I think with psychedelics, it opens up kind of a rabbit hole, like what dissociation and psychedelics amplify so much that it’s maybe even a different conversation of what happens on psychedelics?

Dr. Robin Carhart-Harris 39:46
Yeah, yeah. If there’s a collapse in the ego and ego functions, then if dissociation is an ego function and a defense mechanism, then is it sort of a valid dynamic Make any more run under secretary? It’s an interesting Oh, is this more just a facet of, of a normal waking conscious mind and brain? Moving on? Yeah. Great, great topic.

Keith Kurlander 40:14
We should wrap up. So we asked this question to every guest at the end, which is if you had a billboard, every human would see it once in their life. There’s a paragraph on it. What message would you want each person to know?

Dr. Robin Carhart-Harris 40:27
Message from me? Oh, gosh, I basically hold it all lightly. In fact, that came to me once. In the kind of context that is relevant here. Hold it all lightly. Yeah, I’ll do lightly and the analogy and well remember after we’re off this call, who this comes from, and others will know the idea that we’re all falling in you see this big rock, can you grasp you’re on the big rock, but you don’t realize that it’s falling to like an anti grasping thing. Hold it on lightly.

Dr. Will Van Derveer 40:59
Beautiful.

Keith Kurlander 41:01
Thanks for the interview.

Dr. Robin Carhart-Harris 41:02
Oh, my pleasure.

Dr. Will Van Derveer 41:08
Here at IPI we’re excited about the possibilities represented by psychedelic assisted therapy and the future of mental health care. And we have a new program in psychedelic assisted therapy, which is starting this summer in mid July 2021. If you are interested in applying to the program or want to read more about it, you can find that info at psychiatryinstitute.com/psychedelic, that’s psychiatry Institute, all lowercase all one word.com forward slash psychedelic. We look forward to connecting with you again on the next episode of The hire practice podcast where we explore what it takes to achieve optimal mental health.