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Hope in Returning to the Road Not Taken in Psychiatry

Summary:
I have just begun listening to Peter Attia’s podcasts in his podcast series “The Drive.” So far, they seem very much in the same spirit as what I have been writing in my diet and health posts. I first listened to Peter’s interview of Matthew Walker. That makes me look forward to reading Matthew Walker’s book Why We Sleep. The basic message is: “Respect sleep. If you don’t, you will pay.”Peter’s very first podcast interviewing Tim Ferris is also powerful. Therapy using psychedelics such as LSD, psilocybin, MDMA (a pure form of “ecstasy”) and mescaline shows great promise. Two reasons psychedelics can help is (1) they can loosen the hold of longstanding top-level

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Hope in Returning to the Road Not Taken in Psychiatry

I have just begun listening to Peter Attia’s podcasts in his podcast series “The Drive.” So far, they seem very much in the same spirit as what I have been writing in my diet and health posts.

I first listened to Peter’s interview of Matthew Walker. That makes me look forward to reading Matthew Walker’s book Why We Sleep. The basic message is: “Respect sleep. If you don’t, you will pay.”

Peter’s very first podcast interviewing Tim Ferris is also powerful. Therapy using psychedelics such as LSDpsilocybin, MDMA (a pure form of “ecstasy”) and mescaline shows great promise. Two reasons psychedelics can help is (1) they can loosen the hold of longstanding top-level brain patterns, allowing a psychological “reboot” and (2) they can induce a temporary suspension of our normal intense awareness of the self-other distinction, allowing new, less self-centered perspectives to get in. I have zero personal experience with psychedelics, but I suspect that meditation and spiritual practices such as extended free-form personal prayer of the sort I used to do when I was a Mormon can induce similarly profound changes in brain activity.

A thumbnail history is that psychedelic therapy got derailed by government restrictions and cultural opprobrium in oppositional overreaction to the counterculture’s embrace of psychedelics in the 1960s. As a result, we may have lost the use of powerful therapies for many psychiatric ills for more than half a century.

I wonder, in particular, if my son Spencer’s suicide could have been averted with the help of psychelic therapy. (On that sad event, see my wife Gail’s guest post “The Shards of My Heart.”)

There is hope. Approval of MDMA to treat PTSD has been fast-tracked and it is possible it will be available for routine use by psychiatrists as early as 2021.

The way things work, as soon as a drug has been approved for one use, the system trusts medical doctors (including psychiatrists) to use it off-label. So demonstrating conclusively the value of one use case opens up the possibility of other legal therapeutic uses by medical doctors without going through the full (and expensive) drug approval process.

One example of an off-label use of a drug is the use of ketamine—which is approved for use as a anesthetic—to treat depression. I had a friend who was treated with a small dose of ketamine for serious depression that didn’t response to other treatments. It worked remarkably well. Ketamine is not a psychedelic but seems to have similar underutilized psychiatric potential.

Let me insert here a warning that (a) street drugs are often impure and (b) proper psychedelic therapy involves a lot of expert supervision. You could be in for a very bad trip or worse if you try to wing it. But in the hands of psychiatrists trained in their use, psychedelics have the advantage of being “anti-addictive” in the words of the podcast. Unlike opiates, where the benefit is upfront and the harm comes later, psychedelic experiences are often unpleasant while under the influence of the drug, but then leave lasting benefits.

I honor those who have been and are now pursuing research into the psychiatric potential of psychedelics. There is real hope that some of our most intractable psychiatric problems can be blunted.

I can’t fail to mention two relevant books. Reading my friend Randolph Nesse’s book Good Reasons for Bad Feelings: Insights from the Frontier of Evolutionary Psychiatry gave me an acute sense of how bad the current state of psychiatry and psychiatric treatment is. Breakthroughs are desperately needed. From reviews, Michael Pollan’s book How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (which I haven’t read yet, but want to), has a message similar to the message of Peter Attia’s interview of Tim Ferris.

For annotated links to other posts on diet and health, see:

Miles Kimball
Miles Kimball is Professor of Economics and Survey Research at the University of Michigan. Politically, Miles is an independent who grew up in an apolitical family. He holds many strong opinions—open to revision in response to cogent arguments—that do not line up neatly with either the Republican or Democratic Party.

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