As our prosperity rises, our mental health is on the decline—and fast. Rates of depression, anxiety, suicide, addiction, and other psychological disorders have skyrocketed in recent years, and nobody knows what to do about it.
Enter psychedelics: LSD, magic mushrooms, mescaline, ayahuasca—drugs you’d expect to find at a rave or a music festival, not in your psychologist’s office. But that may be about to change, as research in psychedelics increasingly shows their potential for treating psychological conditions.
Previously known as a food and nutrition expert thanks to books like The Omnivore’s Dilemma and In Defense of Food, author Michael Pollan switched tracks a bit for his latest project. His newest book, How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, published last year, has been an integral part of de-stigmatizing the psychedelics conversation.
In a fascinating talk with The 4-Hour Workweek author Tim Ferris at South By Southwest earlier this month, Pollan shared insights from his research and his personal experiences.
The word ‘psychedelics’ was coined in 1957 by English psychiatrist Humphry Osmond. It combines the words for mind (psyche) and manifest (delic, from the Greek dēlos). “It’s vague in a way, but it’s suggesting that these drugs bring the mind into kind of an observable space,” Pollan said. “I tried in my book to rescue the word from all the encrustation of 60s Day-Glo acid rock and see if we could reclaim it, because it means the right thing.”
It was their association with 60s counterculture, Pollan explained, that ultimately caused psychedelics’ decline as a scientific tool. By the time the public first heard about the drugs in the 60s, researchers in Europe and the US had already been studying them for 15 years, and using them to treat conditions like addiction and depression, with positive results. “The standards for scientific drug research then were different,” Pollan said. “The double-blind placebo controlled trial didn’t exist until 1962.”
The anti-establishment subculture embraced psychedelics. But in 1965—the year the US first deployed troops to Vietnam—the government and the media started demonizing the drugs. They were labeled as immoral, and stories abounded about people having bad trips, ending up in psych wards, or staring at the sun until they went blind (the first two did happen, but the last was made up).
“Nixon regarded LSD as one of the reasons that boys weren’t willing to go fight in Vietnam,” Pollan said. For most of history, he explained, young men sent to war to defend their country just went—they didn’t ask questions. But suddenly, young American men were asking questions—big ones, like “Is this a just war?” and “Is this something I want to fight for?”
“LSD encourages people to question all sorts of frameworks in their lives, and may have contributed to that,” Pollan said. “It was a very threatening drug.” At least, Nixon thought so, and as a result he started his war on drugs. Psychedelics research gradually ground to a halt, and the drugs stopped being taken seriously as having any medical potential.
Until now, that is.
Changing Our Minds
Pollan shared that what really got him interested in psychedelics was hearing about their effects on people who’d been diagnosed with terminal cancer. “They were paralyzed by fear of death, and they had these transformative experiences that in many cases completely removed their fear. It was the most astonishing thing,” he said.
The drugs have shown promise for alleviating a host of other disorders, including anxiety, depression, and addiction. Psilocybin is being used (“with striking success,” as Pollan put it) in a study of smokers at Johns Hopkins and a study of alcoholics at NYU, and has potential to treat eating disorders as well.
If it seems surprising that one type of drug could treat so many different disorders, consider their common link: they all involve repetitive loops and destructive narratives. The part of the brain where this takes place—called the default mode network—is the part of the brain psychedelics affect, in the sense that the drugs quiet the network, thereby giving users a chance to escape destructive patterns of thought.
The default mode network is a group of structures in the brain that connect the cortex to the areas involved in memory, emotion, and other inwardly-focused thinking, like self-reflection. The default mode network is least active when you’re focused on a task, and most active when you’re at rest without any external stimuli—which is when you start to daydream, remember things about the past, imagine things about the future, and simulate or replay your interactions with other people.
“When they image the brains of people on psychedelics they expected to see a lot of activity, but they were surprised to see that the default mode network was suppressed, with less blood flow and less energy going to it,” Pollan said. “If the ego has an address in the brain it’s somewhere in this network. And this is the region that gets quiet.”
Though we do know this much, we don’t know a lot more, about either how psychedelics work or how the brain works. “Our understanding of the brain is really primitive,” Pollan said. “We know psychedelic drugs bind serotonin to a receptor, then there’s a cascade of effects leading to synesthesia.” What takes place during that cascade, though? No idea.
There may be modes of communication going on in the brain that we don’t even know about yet; Pollan cited a 2018 study where a hippocampus—the brain region associated with memory—was sliced in half, and neurons on either side could still interact without direct contact.
“It’s really important to be humble in anything we say about the brain,” Pollan said.
Keeping Them Changed
If what takes place during psychedelic use is a temporary rewiring of the brain—the compounds are out of the brain within four to eight hours—why is it that using the drugs has an enduring effect on so many people?
“It’s not a purely psychopharmacological effect that they’re having, it really is the experience,” Pollan said. “It’s kind of like a reverse trauma. Many people who undergo this treatment say it’s one of the two or three biggest experiences of their lives.”
The most positive and lasting effect of psychedelics, he explained, is the experience of ego dissolution. It’s our egos—our sense of ourselves—that write and enforce destructive narratives. “The ego builds walls. It isolates us from other people, it isolates us from nature, it’s defensive,” Pollan said. “And when you bring down those walls in the psyche, there’s less of a distinction between you and that other, whether that be other people in your life or the natural world or the universe. There’s this incredible flow, and powerful feelings of love and re-connection.”
Though the experience may last just a few hours, people often feel that the insight or epiphany they have isn’t just a subjective opinion or idea, but a deeper revealed truth; the mind can be reset in a way that would take years of sessions with conventional therapists or psychiatrists. Just as a single trauma can put your mind on a new path, perhaps permanently, a single mystical experience may be able to do the same.
“The mind has certain moments where right angle turns happen, and perhaps it can happen in a positive way as well as a negative way,” Pollan said.
The psychedelics renaissance is coming at a time when new tools for mental health are sorely needed.
Other branches of medicine—cardiology, oncology, infectious disease—have made huge strides in the last 50 years, both in reducing suffering and prolonging life. But mental healthcare has essentially been at a standstill since the introduction of the antidepressants known as SSRIs in the 1980s.
To go from their current classification as Schedule 1 drugs—high potential for abuse and no currently accepted medical use—to getting approved as a medicine, psychedelics need to go through the standard three-phase FDA approval process: first an open-label, no-placebo pilot study, followed by a placebo-controlled trial, then a larger placebo-controlled trial.
Pollan believes MDMA and psilocybin could be approved within five years; the FDA has granted breakthrough therapy status to both, which means they actively help researchers design trials that will move the drugs to approval. MDMA is already in Phase 3 trials.
The biggest bottleneck is funding. The studies are expensive and controversial, and the National Institute of Mental Health has a minuscule budget compared to that of the National Institute of Health. Thus far, psychedelics research has been privately funded.
“It’s not a right-left issue, especially when it comes to treating soldiers with PTSD,” Pollan said. But there is the issue of how to incorporate the drugs into mental healthcare as we currently practice it. The pharmaceutical industry isn’t interested in a drug people only need to take once; likewise, the therapy business model depends on people coming back every week for years. Even if this shifted, therapists would need extensive training before being able to administer psychedelics.
“I think we’ll figure it out, but it’s a whole new structure, a whole new paradigm, and that may take a little while,” Pollan said. After all his research, though, he for one is highly optimistic.
“One of the things that excites me most about psychedelics is that yes, there’s a treatment here—but they’re also very interesting probes to understand the mind,” he said.
“[Psychiatrist] Stanislav Grof wrote that psychedelics would be for the study of the mind what the telescope was for astronomy or the microscope for biology. Now that is an audacious claim—but I no longer think it’s crazy.”