Could the embrace of psychedelics lead to a mental health revolution?
by Maya Singer | Vogue | 12 Feb 2021
AT SEVEN O’ CLOCK on a recent evening, I dim the bedroom lights, call out a reminder to my boyfriend to rouse me in an hour with a gentle tap, and close the door.
“Have a great trip,” I hear him say from the living room as the two ketamine tablets I’ve pressed into the pockets of my cheeks dissolve, leaving a bitter residue. Minutes later, I’m flying over water that reflects a sourceless golden light. Am
I the light? The thought triggers a sensation of being stretched like taffy in all directions. It’s not my body being stretched—I don’t have a body anymore—but the immaterial me moving in tune with the ambient music in my headphones. I stretch and spread until at last I’ve dissolved—pixelated—at which point a small voice in my head calls out,
“Do you really think this will help you quit smoking?”
The last time I was on ketamine, I was hooked up to an IV following surgery. This time, the drug—in general medical use as an anesthetic since 1970—arrived on my doorstep courtesy of Mindbloom, a new telemedicine company specializing in ketamine-based psychedelic therapy. This was no shady dark-web deal: Prescribed by a psychiatric nurse practitioner following an extensive intake evaluation, and compounded by a licensed pharmacy, the ketamine came bundled with an eye mask, a hardbound journal, and a blood-pressure cuff that I was instructed to use before and after dosing, to test my vitals. The tablets themselves were housed in a mirrored pouchette with the tagline ACHIEVE YOUR BREAKTHROUGH spelled out in sleek, sans serif font. I was tempted to post a shot to Instagram, but I had a Zoom call with my psychedelic-integration coach in half an hour, and I wanted to meditate first.
Welcome to the brave new world of psychedelic wellness. After decades underground, psychedelics such as ketamine, LSD, psilocybin, and MDMA are getting a fresh look from the medical establishment, thanks to myriad studies suggesting silver bullet–like efficacy in the treatment of anxiety, depression, and addiction, among other ailments. MDMA, renowned for its bliss-inducing effect—hence the street name “ecstasy”—is on course to be approved for the treatment of post-traumatic stress disorder (PTSD) within the next year or two. Synthetic forms of psilocybin, the active compound in magic mushrooms, were given “breakthrough” designation by the FDA in 2018, allowing for fast-tracking of drug trials. Meanwhile, this past November, Oregon became the first state in the nation to legalize psilocybin for medical use, an advance not lost on the investors flocking to start-ups like MindMed and Compass Pathways, both of which are developing psilocybin treatments in anticipation of a cannabis-style psychedelics boom. A mental-health revolution is at hand—and it’s long overdue, according to experts such as Frederick Streeter Barrett, Ph.D., assistant professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine and a faculty member at the university’s recently opened Center for Psychedelic & Consciousness Research.
“The current model for treating problems like anxiety and depression just isn’t very good,” Barrett says.
“Patients take pills every day, for years, and these medications not only have nasty side effects, they often don’t even work. But with psychedelics-assisted therapy, there’s the potential to truly alter someone’s life with just one or two sessions, because you’re getting at suffering at the source.”
I’m not suffering, exactly, but for lack of more technical language, I’ve kind of been freaking out. Straining to maintain a productive work schedule under lockdown, I fell back into the habit of smoking as I write—and soon thereafter, the habit of trying to quit. The addiction struck me as fundamentally psychological: If I was so hooked on nicotine, why did I reach for my American Spirits only when I was stuck at my desk, staring down a deadline? But reach for them I did, and the harder I worked not to—with the aid of gum, apps, hypnosis, you-name-it—the more fixated I became on the fear that I simply could not write without cigarettes. I was starting to feel truly hopeless when I stumbled across a news item about studies showing that with the aid of psilocybin, longtime smokers were quitting cold turkey and sticking with it at rates that put all other remedies to shame; two-thirds of participants in one recent study were confirmed cigarette-free after one year!
Intrigued, I did a little more digging and discovered that ketamine—a dissociative hallucinogen that is already legal for supervised medical use, including in the treatment of depression—seemed to draw out the mind in a way similar to psilocybin by putting the brain in a “neuroplastic” state, explains Julie Holland, M.D., a New York–based psychiatrist and the author of the 2020 book
Good Chemistry. “They have different chemical properties, but both ketamine and psilocybin have an ego-dissolving effect, where you’re breaking the mental loop that’s symptomatic of conditions like depression and anxiety and addiction, and allowing the brain to form new connections.”
Maybe a little ego-dissolution was the answer, I mused as I stamped out another butt in the ashtray next to my laptop and googled “ketamine therapy—New York.”
“THE TRUTH IS, WE DON'T REALLY know how this stuff works,” Michael Pollan, author of the best-selling psychedelics primer
How to Change Your Mind, tells me.
“A leading theory is that psychedelics quiet the brain’s ‘default-mode network,’ and that opens up new pathways for thought.” As Pollan goes on to explain, the default-mode network is where “the ego has its address”—it’s the part of our brains where we construct the narrative of who we are and, thus, the place we get stuck in destructive thought patterns about ourselves.
“That could be ‘I’m a worthless person who doesn’t deserve love,’ or it could mean telling yourself that you can’t get through the day without smoking,” Pollan continues.
“Either way, the idea is that, by muffling those thoughts, psychedelics help you out of the rut.”
Pollan’s précis on the science of psychedelics is reassuringly down-to-earth. For years, I’d been put off by the drugs’ woo-woo connotations, and to judge by the refined, minimalist aesthetics of new ketamine-therapy chains such as Field Trip Health, which has serene locations in New York City, Toronto, Atlanta, Chicago, and Los Angeles, I’m not the only person with zero interest in a tie-dye mental makeover. It’s all a far cry from Timothy Leary and
The Electric Kool-Aid Acid Test. But Leary—who famously conducted psychedelics experiments at Harvard in the early 1960s, before he ran afoul of the law and, in turn, helped prompt the criminalization of psilocybin and LSD—does continue to exert an influence: His “set and setting” theory is a cornerstone of all contemporary psychedelics-aided therapy.
“Set basically refers to mindset, going into your journey, and setting is your environment,” explains Ronan Levy, who cofounded Field Trip in 2019 after establishing—then selling—Canada’s largest network of cannabis clinics.
“They matter as much as the drug you’re taking,” he continues.
“You need to be in a place—mentally and physically—where you feel inspired and at ease.”
Because I’d chosen to work with Mindbloom, thanks to their COVID-friendly process, the setting for my four, hour-long treatments, was my bedroom. To be perfectly clear, I wasn’t microdosing. Nor was I popping a pill just to see what colors spilled out of my head. Prior to receiving my Mindbloom package, I spent over an hour on Zoom with a board-certified psychiatric nurse practitioner who quizzed me on everything from my family medical history to my typical responses to stress. (According to Mindbloom founder and CEO, Dylan Beynon, about 35 percent of potential patients are screened out at this point, for reasons such as past experience of psychosis or, at the other end of the spectrum, not meeting the threshold for a diagnosis of anxiety and/or depression.) “Set” was established in conversation with Laura Teodori, my psychedelic-integration-support coach, who—after obtaining confirmation from my boyfriend that he’d check on me every 20 minutes—helped me formulate an “intention” for the trip immediately after our call. My goal, we ascertained, was to recall moments in my life when I could create without smoking. With that in mind, I tucked the tablets inside my mouth, pressed play on the Mindbloom-curated soundtrack that would be piping through my headphones, lowered my eye mask, and waited for my default-mode network to go off-line.
PSYCHEDELICS COME IN MANY FORMS, from the low-dose ketamine I was taking to wallop-packing plant medicines, like ayahuasca and ibogaine and peyote, that have been used in sacred rituals for hundreds, perhaps thousands of years (and that are illegal in the United States). But a feature common to all is the sense of coming into contact with the cosmic.
“It’s like there’s no boundary between you and others, or you and the universe,” notes Johns Hopkins’ Barrett, saying that virtually all subjects in psilocybin studies have reported such a feeling of oneness.
“Some people call this an experience of God, or nirvana.” I went into my first ketamine journey matter-of-factly, with a problem to solve, and even so, that first trip commenced with a vision of the world rewinding, a kind of reverse big bang that exposed the heretofore invisible filaments connecting everyone and everything. The vision moved me—tears puddled behind my eye mask—and then it yielded to more personal impressions, such as a recurring image of myself, age six or seven, playing with my dollhouse.
“What do you think was important about the dollhouse?” Teodori asked me in our post-trip call. I was still pretty woozy as we Zoomed—the effect wore off by the next day—but suddenly, it was like a light bulb went on in my head. “
I think…I think I was remembering what it felt like to create without smoking,” I told her.
“When there wasn’t any pressure, and I could just play.”
This download is part of integration, another cornerstone of modern psychedelic medicine.
“The goal is to take advantage of the neuroplastic state, which lasts for about a week after dosing,” explains Beynon.
“You want the changes in your brain to stick, so the question becomes, How do you turn these new thoughts into new behaviors?” For me, this entailed finding ways to get back in touch with that dollhouse sense of play.
Easier said than done. My ketamine experiences were clarifying and often even profound, but they didn’t change certain nerve-racking facts of life, such as that I write for a living and thus have deadlines to meet if I wish to pay my bills. Or that it’s hard—like, really hard—to stay motivated in the midst of a global pandemic, when each day brings fresh spurs to panic and depression.
“There’s a huge mental-health crisis happening parallel to, and in response to, this pandemic,” notes Benjamin Brody, M.D., assistant professor of clinical psychiatry at Weill Cornell Medicine in New York, and chief of the Division of Inpatient Psychiatry at the university hospital, where ketamine infusions are typically administered.
“People who are grieving, people who have lost jobs, people who are feeling disconnected, whose lives have been upended .…” With demand for care rising “across the board,” as Brody notes, it’s no surprise that psychiatrists such as Amanda Itzkoff, M.D., are seeing a huge uptick in inquiries about ketamine therapy. But it may or may not be the right tool for every job, Itzkoff points out.
“The thing is, if you got laid off and you don’t know how you’re going to pay rent, ketamine won’t change that,” says Itzkoff, an early adopter who has been providing ketamine infusions at her Manhattan practice since 2014.
“It doesn’t remove the external pressures. But when you’ve got someone with severe depression, who has kind of given up, then there’s real promise in this treatment.” Itzkoff cites the example of a former patient, a high-powered attorney and mother of two, who was on disability and “almost catatonic” when they began working together.
“She had to be retrieved from this state,” recalls Itzkoff.
“By breaking the negative thought loop—even temporarily—you show someone it’s possible to feel another way. And that,” she adds,
“can be channeled toward getting people back on their feet.”
Chad Kuske didn’t just get back on his feet following his first psilocybin treatment a year and a half ago; he experienced what he calls an immediate and profound
“sense of meaning and a desire to live.” A former Navy SEAL, Kuske, 40, had tried psychoanalysis and various pharmaceuticals before being medically retired from the service in 2017. Reentering civilian life, he found himself using drugs and alcohol as a way of coping with the anxiety, depression, and alienation that he now comprehends as the symptoms of PTSD.
“Nothing else had worked. And I knew that sooner or later, if I kept doing things the same way, my life would be over—either literally or metaphorically, like I’d wind up in jail,” Kuske explains.
“The mushrooms helped me see my situation clearly: I was in hell, but it was a hell of my own creation, and I could make the choice whether to stay there and suffer or leave and start the work of changing.”
One of the key insights Kuske has taken away from his trips—and from his integration process, which is ongoing—is that he’s not alone in struggling to meet the challenges of daily life. Likewise, Itzkoff suggests that the feeling of interconnectedness induced by psychedelic therapy—and near-psychedelics, such as ketamine and MDMA—may help alleviate the isolation brought on by COVID. It may also play a role in helping the people hardest hit by the pandemic recuperate: Nautilus Sanctuary, a nonprofit psychedelics-research and training center in New York, is already planning a study exploring the use of MDMA to treat frontline workers with severe PTSD—one of the many inquiries to expand on the drug’s groundbreaking FDA trials sponsored by MAPS, which entered phase three in 2017. Other studies sponsored by the organization have focused on veterans in Israel and the United States, and the Department of Veterans Affairs has exhibited a willingness to approve such studies, so long as they are safe, beneficial, and scientifically sound.
This kind of conservative approach is merited, notes Weill Cornell’s Brody.
“I’m very concerned about this atmosphere, that the floodgates are opening. I work with ketamine, a drug that’s been in use for decades, and even there, we don’t know all that much about its long-term effects,” says Brody, who provides ketamine-infusion therapy only to patients in whom he’s observed severe, treatment-resistant depression—and who was positively aghast when I relayed rumors that self-dosing with inhalers of esketamine, a synthetic form of the drug given FDA approval for supervised use in 2019, was all the rage in L.A.
“Ketamine is a serious drug!” he reiterates.
“This isn’t a spa service. It’s not like getting Botox. And what worries me about all these clinics popping up is that people are going to start thinking about it that way.”
Brody is hardly alone in fearing the commercialization of psychedelics—a trend that, if canny investors like Peter Thiel, a backer of Compass Pathways, are correct, is on pace to increase rapidly.
“It’s a unique space because so much of the technology has been developed by Indigenous healers,” notes Pip Deely, co-founder of the venture-capital firm Delphi, which is eyeing investments in psychedelics start-ups and supporting a new psilocybin-legalization campaign in Hawaii.
“We see a lot of dread that if this all goes the way of cannabis, the people who have been doing this work the longest will be cut out of the conversation, and those Indigenous roots will be erased.” Unprompted, I hear a version of this concern from one Berkshires-area healer who, for legal reasons, prefers to remain unnamed; she tells me that, although she supports expanding access to psychedelics, she worries about the experience becoming pro forma and “clinical.”
Though they come at their misgivings from opposite angles, both traditional healers and Brody are wary of psychedelics’ getting marketed as a quick fix—and in all honesty, I’m the target demographic for that pitch. When I sat down at my computer to fill out Mindbloom’s candidate questionnaire, what I wanted was to detangle a few mental wires. By the time I’d completed my final ketamine treatment, I’d come to realize that those wires were crossed very deep down: My writing-while-smoking problem was really a problem with the little voice in my head telling me that I’m not good enough, I haven’t achieved enough, I’m falling behind. As I wrote in my integration journal after my second session,
“Every little deal is a big deal.” I added a frowny face to underline the point.
I can’t blame Mindbloom for my failure of mindset. All my conversations with Teodori were oriented around getting me to probe the heart of my fears, and she was diligent in supporting me as I attempted to integrate the lessons of my journeys into daily life, checking in with me every few days via text and reminding me that she was always available to talk. Alas, I didn’t take her up on that offer as often as I should have—I had a ton of writing to do!—and in the end, I felt changed but not transformed. Which could be a me thing, or it could be a drug thing. Barrett of Johns Hopkins pointed me to studies from the university’s Center for Psychedelic & Consciousness Research indicating that, where smoking cessation is concerned, the more “mystical” the trip, the more effective the treatment.
“There’s a big difference between a low dose of ketamine and taking what we call a ‘breakthrough’ dose of psilocybin,” he notes.
“That’s where you’re really going to break down your sense of self.”
Is that what I want? Is that what we all want, in some subconscious way?
“There’s a spiritual hunger these medicines satisfy,” Pollan points out, and I can attest that once you’ve visited the astral plane, you want to go back. Most hallucinogens are not physically addictive, but the psychedelic experience is itself addicting. I spoke to numerous people for this story who described their encounters with psychedelics as “life changing” in ways large and small; one woman even credited peyote with restoring movement to her paralyzed arm. But Ann Watson’s account is the most relatable. A former VP and fashion director at Henri Bendel in New York City, and now a cochair of The Vaquera Group, a global marketing firm, Watson, 52, is also a self-described “explorer” who, like me, kept a pretty tight lid on her deepest, darkest feelings—until she began working with psychedelics 12 years ago.
“My childhood was chaotic; there was a lot of abandonment, but I didn’t associate with the word trauma, because I thought it was reserved for people who have experienced things like rape or war. But I was seeking something,” explains Watson, who tried a variety of treatments to relieve an “ever-present vibration of anxiety,” including counseling and prescribed antidepressants, before experimenting with a long list of psychedelics. Eventually she arrived at a treatment plan with a doctor in Los Angeles she sees four times a year for guided psilocybin trips; she also microdoses psilocybin on a more regular basis, mixing magic mushrooms with Lion’s Mane.
“It’s an ongoing process,” she tells me.
“The thing is, once you start looking inward, you realize there’s always more to see.”
Perhaps that is the main takeaway from my own journey: that I’m just at the start of it. I have work to do on myself. But in the meantime, I also have work to do, period—as in, I’m on deadline for this piece. And I regret to inform you that as I write these words, I am indeed smoking.
As certain drugs receive “breakthrough” status from the FDA for the treatment of depression, anxiety, and addiction, the medical community—and the wellness industry—are rallying around their promise.
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