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Psychedelics: The Reason for the Season

It’s that time of the year again. According to that popular carol, it’s apparently the most wonderful time of the year. The festive season calls us to gather with loved ones and celebrate surviving another year — and what a wild one it’s been. While 2020 was a memorable moment in time, it might be a year we all would rather forget. Between a worldwide pandemic, environmental disasters, civil unrest and a growing mental health crisis, one thing is certain, change was a predominant theme for everyone this year.

Millions of people, all around the world, celebrate this bizarre tradition called Christmas. It turns out, it might be a little stranger than we thought. The image of Santa Claus has been around for hundreds if not thousands of years, and can be traced back to pre-Christian times, with its origins deep in Paganism, and Nordic mythology. We all sing along to the carols, decorate our trees, give gifts to friends and enjoy hearty feasts with our families. However, how often do we reflect about the roots of these traditions.

Could there be a link between psychoactive compounds found in mushrooms and the festive season? Is there an uncanny connection to Christianity and psychedelic brews? Do we know why it’s Christmas time at all?

Since pre-Christian times, this time of year has always been a period of festivities and celebration, with banquets, music, dancing, drinking and gatherings. Germanic peoples celebrated the Yule, a midwinter festival, which took place around the Winter Solstice and the Romans during an ancient festival called Saturnalia, in honor of the god Saturn.

Yet, during the winter season, in the Siberian and Arctic regions, shamans were known to drop into homes with a specific type of gift — magic mushrooms. The shamans give the phrase ‘Christmas spirit’ a new type of meaning, as they offered healing and a connection with the spirit world to the people. The sole purpose of the ritual, was to align others with their soul’s purpose. It is entirely possible that the idea of Santa, with his iconic red and white outfit, derived from shamans that did in actuality reside in the North Pole.

Amanita muscaria, commonly known as the fly agaric or fly amanita, is a mushroom native throughout the temperate and boreal regions of the Northern Hemisphere. This red and white-spotted fungi is arguably the most iconic toadstool species encountered in popular culture. Though poisonous if prepared incorrectly, the mushroom is noted for its hallucinogenic properties, with the main psychoactive compounds being the neurotoxins ibotenic acid and muscimol.

The indigenous arctic circle dwellers, specifically the Kamchadals and the Koryaks of Siberia, used the fly amanita as a part of their ancestral traditions to launch those who consumed into a spiritual journey. Legend has it that on the night of the winter solstice, the guides would harvest the hallucinogenic mushrooms and deliver them to the people of the region for healing rituals during solstice ceremonies. Often times entry through the door of the yurts are blocked with snow and access can only occur by going through the smoke hole at the top of homes.

This specific type of mushroom grows commonly under pine trees, because their spores travel exclusively on pine seeds, which could also explain why the pine tree is so closely related in Christmas festivities.

As previously mentioned, the Amanita muscaria is toxic, but becomes less lethal when dried out. To make them safe for consumption, the shaman would often hang the mushrooms on the branches of the pine trees or in a stocking over the fireplace.

Another way to remove the toxins was to collect the urine from reindeer, who actively seek out these mushrooms as a food source and to hallucinate. Their digestive systems filter out the toxins while the strongest psychoactive molecules pass through their bodies unmetabolised. The effects would give the reindeer and those who drank its urine psychedelic flights of fantasy. A common hallucination during a trip would also include visions of mystical realms, where one may encounter magical beings such as elves. Starting to sound a bit familiar?

Ethnomycologist, author and founding father of psychedelics — R. Gordon Wasson argues in his book, ‘Soma: Divine Mushroom of Immortality’, that the connections between Siberian shamanic traditions and the Western idea of Christmas aren’t merely coincidental. Why is it that these funny looking fungi were commonly illustrated on vintage Christmas cards or used as decorations? The red, white and green theme colours that have echoed through our culture may have unknowingly been inspired by psychoactive compounds that grew in the artic.

The mushroom species is thought to have had tremendous impact on many cultures for at least four thousand years. It is believed by some to be at the root of the origin of some of today’s religions, including Christianity. There is an undeniable connection between the festive season and Christianity, even though many who celebrate Christmas traditions don’t identify as a Christian. It is both a sacred religious holiday and a worldwide cultural and commercial phenomenon.

The English term “Christmas” comes from the combination of the word’s “mass” and “Christ,” however, December 25th is not mentioned anywhere in the Bible as the day Mary was said to have given birth to Jesus in Bethlehem. Historical evidence suggests that Jesus was actually born in the northern springtime. The reason these dates are associated is because in the fourth century church officials, specifically Pope Julius I, wanted to popularise Christianity and decided to institute the birth of Jesus as a holiday. Christian missionaries adopted Yule celebrations in order to convert and appease pagans who were deeply, spiritually attached to their own traditions. First called the Feast of the Nativity, the custom spread to Egypt and to England by the end of the sixth century.

The Germanic and Scandinavian Yuletide, was traditionally celebrated during the period from mid-November to mid-January. That’s right, “Yuletide carols being sung by a choir.” The same period was celebrated by the later Roman Empire at the Dies Natalis of Sol Invictus or the “Birthday of the Unconquerable Sun.” In the Julian calendar, December 25th marked the winter solstice, the shortest day of the year, after which the days begin to lengthen. After solstice, the renewal of light and the coming of the new year was celebrated.

Seems that the comprise for Christians to celebrate the birth of Christ may have been to attach it to a significant celebration of that time. Influenced by sun worship; a reminder to all life on Earth that we owe everything to the Sun. Sun worship is one of the main pillars of all religion, particularly ancient pagan rituals. Perhaps this is where the early religious institutions connected the birth of Jesus or the ‘Son of God’ and quite literally the ‘Sun’. This idea is not far-fetched, since many Christian scriptures have said to be influenced by the stars and cosmos.

The claim that psychedelic mushrooms played an integral part in early Christianity is controversial, but has been well discussed. Julie and Jerry Brown (Ph.D.), put forth this theory in their book ‘The Psychedelic Gospels’ and have a wealth of evidence to support it.

There is a surprising prevalence of mushrooms in early Christian art that contain multiple examples of both the Psilocybin cubensis and Amanita muscaria mushrooms. Including the one seen here at St. Michael’s Church in Hildesheim, Germany, depicting the transfiguration of Jesus.

One of the most interesting and potentially revolutionary books that has been published regarding the connection between psychedelic drugs and the antecedents of European civilisation is again work from the mind of R. Gordon Wasson and a collaboration with Albert Hofmann and Carl A. P. Ruck. ‘The Road to Eleusis — Unveiling the Secret of the Mysteries’ was presented as a series of papers to the Second International Conference on Hallucinogenic Mushrooms held in the state of Washington in 1977.

 

The book explores the secrets of the kykeon, which was a potion that inspired the great philosophers, mathematicians, scientists, artists, architects and poets of ancient Greece who we recognise as the progenitors of Western civilisation. The consciousness-altering sacrament contained a somewhat equivalent of LSD: A naturally-produced lysergic acid alkaloid. Kykeon which in Greek, simply means “medley” was a drink mixed with Ergot, a fungus that grows on rye and related plants, which in that time was generally Barley.

The Eleusinian Mysteries were transformative rituals that took place in ancient Greece, extending out of Mycenaean traditions (approximately 1500 BC) and the Greek Dark Ages. Men, women, slaves, and emperors all went to Eleusis to drink kykeon, to experience healing and spiritual insights. The only requirements to participate in the rituals were to speak fluent Greek and never to have committed a murder. With the advent of the Holy Roman Empire, the Mysteries were banned and the healing potential of kykeon, began to go underground in the Western world.

There was never one monolithic form of Christianity, from the beginning there were always competing versions of the faith. Psychedelic trips might not have happened at every church. However, evidence suggests that the Eucharistic ritual of spiked wine was performed by a significant number of the ancient Christian population from Rome to Corinth to Ephesus.

For centuries the Inquisition persistently went after the witches and consequently erased much of the Old World’s pharmacological knowledge. It is exactly these sacraments that could help explain the secret to Christianity’s success in the first three centuries after Jesus.

Ever since the stone age, these drugs served a vital role in the development of our species. Powerful psychedelics can make seers of the spiritually blind. So, why did mystical experiences have such an influence on civilisations? Its possible psychoactive substances help us to face our own mortality in a way to create a healing journey towards acceptance.

It is often asked if psychedelics have a place in the modern world and if these archeological studies should be left in peace. Perhaps we don’t need the secret ancient teachings of the divine mushroom any longer, or do we need them more than ever?

After the immense amount of restructuring that has occurred during 2020, maybe it is time to once again embrace the power of these healing medicines. With Christmas approaching, the rescheduling of psychedelics could be our metaphorical gift this year. The advanced studies of the healing properties of psilocybin and other psychedelics, can provide us with some hope for a happier new year. Just like the pagans celebrating the end of the extensive darkness during the winter solstice, dark times are a catalyst for change. There is always light at the end of the tunnel.

The coronavirus and its incessant media coverage left us ruminating on the fragility of life. The thoughts of death triggered by the pandemic amplified the mental health crisis. Knowing that we will all die, and it can happen at any time, can give rise to potentially paralysing terror. We don’t die well in the Western world; the subject of death is taboo. There’s many people who suffer enormously and there are simply not enough tools to address that end-of-life distress.

Research published in the Archives of General Psychiatry, showed the results of administering psilocybin to terminally ill subjects could be done safely while reducing the subjects’ anxiety and depression about their impending deaths. In the study volunteers, 20 to 30 milligrams of psilocybin not only consistently stimulated “mystical insights” but also elicited “sustained positive changes in attitude, mood and behaviour.” Data shows the more robust that spiritual experience, the greater the magnitude of the clinical change.

Although mystical experiences are not fully understood in the science community, there is an explanation as to why psychedelics can produce these states. It has to do with ego dissolution or ‘ego-death’, specifically, a reduction in the self-referential awareness that defines normal waking consciousness. In other words, they cause the boundaries between self and nature to crumble. A human brain imaging study published in JNeurosci finds that LSD alters the activity of brain regions involved in differentiating between oneself and another person. Psychedelic drugs provide a fruitful avenue of research into the neuronal correlates of normal and abnormal self-awareness or ego-consciousness.

A significant amount of the research and success of these trials can be accredited to the Swiss chemist Albert Hoffman, known for being the first person to synthesise both LSD and the principal psychedelic mushroom compounds psilocybin and psilocin. The following quote is from Hoffman, during ‘The Worlds of Consciousness Conference’ — “It turns out it was very important, that the substances LSD, psilocybin and ololiuqui are closely related to substances we actually have in our brains. Psylocibin differs very little from serotonin, which controls our thoughts and emotions, they are so closely related that you need only re-position one oxygen atom to get it.”

If you read through any publications from the John Hopkins Center for Psychedelic and Consciousness Research and compare the testimonies of psilocybin volunteers to what has survived the ancient initiates, the similarities are obvious. Today, people are still experiencing the same heavenly visions. The results from clinical trials show people who have had a single psychedelic experience have overall reduction in anxiety, depression, and a host of existential measures.

It is no secret that loneliness and isolation negatively affect a person. During the psychedelic experience, when ego dissolution occurs, the individual can not only see themselves in a new perspective, but can understand the connectivity of the world around them. Quite literally, the patient has to lose themselves to find themselves.

These trials explore what indigenous communities such as the Mazatec shamans of southern Mexico, have proposed all along. Referring to magic mushrooms as flowers of the earth, holy children or flesh of the gods, the shamans used them to communicate with the natural world. The first people’s connection to their environment was a symbiotic relationship. Nature would provide what they needed to survive. Maybe to solve the many issues we face as a species, such as the pending doom of climate change, we need to cycle back to our exchange relationship with nature and the divine.

After the age of COVID, the disturbing statistics around the state of the world’s mental health have undeniably increased. Where are we headed? Within five to seven years, pharmacologists and clinical psychiatrists at places like Hopkins and NYU are hopeful that psilocybin will be the first psychedelic prescription medicine for restricted clinical applications: addiction, PTSD, anxiety, depression and end-of-life distress.

Brian C. Muraresku, explores in his recently published book ‘The Immortality Key’ the psychedelic theory of religion and points the way to a revolution in consciousness. He states “People of reason may have to concede that modern science has its limits. Not everything of value can be weighed and measured. People of faith may have to admit that we can no longer afford legend over history, or obedience over curiosity. In a rapidly accelerating world Big Religion has failed to keep up with a younger generation that prefers fact over fiction. But Big Science and Big Technology may be going too fast, distracting us from the ancient search for meaning that defined the original religion of the Western civilization. How do we bridge the gap?”

If we all died before we died, maybe we too would discover the secret of these ancient teachings. We are all a part of God, a part of nature. As the Gospel of Mary Magdalene said “The son of Man is within you.” This is the key of immortality. Heaven is not what happens when the physical body wastes away, there is no afterlife, because there is simply no after. Energy cannot be created or destroyed, there is only the infinite present. Every moment is an eternity of its own. This is best summed up in the words of Graham Hancock. “I’ve seen much to convince me that although consciousness manifests in the body during life it is neither made by the body, nor confined to the body, nor inevitably extinct on the death of the body.”

In today’s society this prevalent state of mind which is merely an attitude for survival produces much suffering and unfulfilled lives. The intellectual horizon of humankind is, or should be, far more universal than mere survival and reproduction. Just as light allows your eye to see, perhaps psychedelics allows your brain to experience things that are always there, but cannot be perceived with our normal senses.

It is no secret that these potent substances give us a knowledge about the sacred or divine, opening the individual up to the spiritual realm. Call it God, Buddha, Spirit, Muhammad, Lord, Universe, whatever ‘it’ is, it does not reside in a holy book. Whether the Bible, Qur’an or Vedas, the mystics don’t find God by reading about God. It has nothing to do with belief or faith, the only way to know God is to experience God. These psychedelics act as that catalyst, allowing us to access deeper dimensions of the psyche. This is something that many scholars, researchers, visionaries, saints and shamans knew. It appears that magic mushrooms certainly are food for thought.

So, Merry Trip-mas to all, here’s to a transformative 2021.

Wishing everyone happy and healing hallucinations.

On the Need for a Bioethics of Psychedelic Psychotherapy: A Few Preliminary Challenges

Psychotherapy assisted by psilocybin, a naturally occurring compound in ‘magic mushrooms’, has recently received ‘Breakthrough Therapy’ status from the FDA, in recognition of the substantial benefits witnessed in clinical trials investigating treatment-resistant depression. A number of trials of psilocybin-assisted therapy are also underway for major depressive disorder, one of the most significant causes of disability worldwide (1), and the modality has the potential to support the long-term cessation of tobacco- addiction to which kills some 5,000,000 people per year – more effectively than any other available treatment (2). As such, it seems certain that therapy assisted by psilocybin and other psychedelics will receive significant interest from the biotechnology sector, psychiatry research and public health policy over the coming years.

However, for all its apparent promise, psychedelic-assisted psychotherapy remains extremely under-researched from a bioethical perspective. This is a serious shortcoming, and with licensing around the corner, it is now also an urgent problem. Against the backdrop of regular healthcare, the experience of psychedelic-assisted psychotherapy, its mechanisms of action, and its downstream consequences, are all pretty unusual. So perhaps unsurprisingly, pre-existing bioethical accounts of mental health treatments are challenged by this new treatment along a number of directions.

A full account of potential ethical challenges embedded in psychedelic-assisted psychotherapy, and a clear articulation of the clinical and policy choices that can defuse these challenges, will be a vital component in establishing psychedelic-assisted psychotherapy within the mainstream of healthcare.  The clinical promise of psychedelics is only part of the story – the success of a technology or treatment depends not just on its efficacy, but also on a slew of social facets of the culture it is embedded in. Not only do we want to have our ethical house in order before there is widespread uptake of psychedelic psychotherapy, but getting the ethics right will also facilitate widespread uptake.

Suppose we forge ahead without deep, critical ethical engagement, and we overlook something that we could have fixed, that leaves patients feeling let down, violated, or otherwise not properly considered. Not only would that amount to a failure of a physician’s duty of care, it would cost the psychedelic psychotherapy movement itself: maybe the loss of the public goodwill that has been so hard to build, maybe a series of litigation actions that make treatment providers, insurers, and decision-makers in other jurisdictions considerably less enthusiastic about facilitating psychedelic psychotherapy, ultimately meaning that many other people who could benefit would miss out. By seeking out potential problems now, and thinking about how to manage or accommodate them, we thereby minimise these risks.

A useful prism through which to understand some of these bioethical challenges is the tranche of unusual, non-clinical ‘side-effects’ of psychedelic experiences. Alongside the target clinical effect, psychedelic experiences can increase prosocial disposition, affect attitudes towards death, enhance aesthetic appreciation and improve patients’ sense of personal well-being and life satisfaction (3,4,5,6). Perhaps most interestingly, they can induce mystical experiences of long-lasting spiritual significance (7), and produce robust changes to religious belief (8) and personality (9,10). Such experiences appear to be a feature, rather than a bug, of psychedelic psychotherapy, with the intensity of the mystical experience correlating with the extent of clinical benefit. Of potentially wider significance, they might cause long-term changes to political values and, perhaps, behaviours (3, 11).

The focus on the therapeutic potential of psilocybin-assisted therapy has meant that the significance of these non-clinical outcomes has been underestimated. But their importance could hardly be overstated: even where psilocybin-assisted psychotherapy proves an effective treatment, participants can report this clinical success as one of the least important effects of the experience, when compared to the other changes (6). Given the unique power that this treatment has to influence facets of a patient’s character that cut to the very core of their identity, it is imperative that the breadth of its potential impact is carefully and critically examined. With the knowledge of these changes, clinicians who conduct psychedelic-assisted psychotherapy are knowingly changing people in a fundamental sense, far beyond the bounds that are usually seen within medicine.

The reflexive response to such ‘side-effects’ from some strains of medical ethics would be to square them away by appeal to the dominance of autonomously given, informed consent: so long as a patient is adequately briefed of the possible consequences of a treatment, their decision to continue with a treatment is conclusive. But the intuitive understanding of informed consent faces a number of challenges with psychedelic-assisted psychotherapy. The superficial challenge is that the very nature of the mystical experience induced by psychedelics runs contrary to the mainstream understanding of informed consent. A core characteristic of mystical experiences is that they are ineffable – inexpressible or incomprehensible in linguistic terms. Insofar as patient briefing takes place linguistically, securing informed consent will not be straightforward.The deeper problem with understanding informed consent in the context of psychedelic medicines, is to find a secure standpoint from which to make judgments of autonomy.  Commonplace advice to people considering whether to undertake a medical intervention, is to choose whichever option leads to a better quality of life, all things considered. But judgments about quality of life are necessarily dependent on a system of values, and values themselves can be changed by psychedelic-assisted psychotherapy. If you know your perspective on life may radically change following psilocybin, how do you adjudicate between your current evaluation of prospective quality of life after psilocybin, and your likely post-psilocybin evaluation of quality of life after treatment? (12) This is not a mere philosophical puzzle. How might we counsel a prospective patient considering psilocybin-assisted therapy who has debilitating depression and is a fervently proud, card-carrying materialist atheist. From this patient’s perspective, coming out of treatment believing in God or some sense of Ultimate Reality may be more horrendous to consider than continued clinical suffering. But, were this patient to proceed with treatment and have a religion-inducing ‘God-encounter experience’ (8), they would not have nearly as negative an evaluation of this newfound belief, after the fact.

With the non-clinical changes following psilocybin administration come questions of authenticity, self-conception, and self-development. Psychedelics are far from the first treatment to challenge these notions in psychiatry. The expansion of SSRI prescription in the 1990s led to worries about ‘cosmetic psychopharmacology’ and patients ‘losing themselves’ to Prozac (13,14) . The personality characteristics and outlooks that develop in users of SSRIs do not truly belong to them, it is argued, given their lack of connection to the patient’s overall narrative arc and  environment (14). Prima facie, some drivers of change seem more authentic than others. Changes that come about from slower-acting, experiential factors (a period of missionary work, the raising of a child) seem intuitively more plausibly ‘authentic’ than those that come about by faster acting, exogenous, artificial factors clearly linked to neurological disruption (a railroad spike through the left frontal lobe, a six week course of SSRIs). But psychedelic-assisted psychotherapy refuses categorisation under this schema. Although the changes are detectable rapidly, and come about following the administration of a drug with a dramatic acute and post-acute effect on brain function (15,16), psychedelic experiences are, nonetheless, experiences. Indeed, they are experiences that tend to be ranked among the most meaningful in a patient’s life (3), making them more credible candidates for authentically cohering with, or indeed shaping, the narrative arc of a patient’s life. Further exploration and elaboration of these ideas, as well as being philosophically interesting, can usefully feed into public narratives about the meaning and significance of clinically administered psychedelic experiences: it is a strange medical treatment indeed that returns patients to their loved ones not only freed from their tobacco addiction, but also with a perceptibly different personality, a penchant for spending time in nature and art galleries, and a newfound spirituality (2, 6). A clear articulation of the authenticity of these changes, if they can be understood as a natural and comprehensible expression of continuity, rather than an exogenously-imposed transfiguration, could serve to assuage suspicion or mistrust of psychedelic medicine among patients’ loved ones, and the wider public.

These are just a few of the surprising ethical quandaries that lurk within psychedelic medicine. While some of the challenges may seem theoretical or philosophical, the sharp end of each of them is to be found in the clinic, requiring sincere and critical reflection on the part of the psychedelic research community, and perhaps ultimately incorporated into the soon-to-be-expanding training programmes for therapists.

 

By Eddie Jacobs

 

References

1.     https://www.who.int/news-room/fact-sheets/detail/depression

2.     Johnson, M. W., Garcia-Romeu, A., & Griffiths, R. R. (2017). Long-term follow-up of psilocybin-facilitated smoking cessation. The American journal of drug and alcohol abuse, 43(1), 55-60.

3.     Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., …& Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of psychopharmacology, 30(12), 1181-1197.

4.     Ross, S., Bossis, A., Guss, J., Agin-Liebes, G., Malone, T., Cohen, B., … & Su, Z. (2016). Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. Journal of psychopharmacology, 30(12), 1165-1180.

5.     Garcia-Romeu, A., R Griffiths, R., & W Johnson, M. (2014). Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction. Current drug abuse reviews, 7(3), 157-164.

6.     Noorani, T., Garcia-Romeu, A., Swift, T. C., Griffiths, R. R., & Johnson, M. W. (2018). Psychedelic therapy for smoking cessation: qualitative analysis of participant accounts. Journal of Psychopharmacology, 32(7), 756-769.

7.     Doblin, R. (1991). Pahnke’s “Good Friday experiment”: A long-term follow-up and methodological critique. Journal of Transpersonal Psychology, 23(1), 1-28.

8.     Griffiths, R., Hurwitz, E. S., Davis, A. K., Johnson, M. W., & Jesse, R. (2019). Survey of  subjective” God encounter experiences”: Comparisons among naturally occurring experiences and those occasioned by the classic psychedelics psilocybin, LSD, ayahuasca, or DMT. PloS one, 14(4), e0214377.

9.     MacLean, K., Johnson, M., & Griffiths, R. (2011). Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness. Journal of Psychopharmacology, 25(11), 1453-1461.

10.  Erritzoe, D., Roseman, L., Nour, M. M., MacLean, K., Kaelen, M., Nutt, D. J., & Carhart‐Harris, R.L. (2018). Effects of psilocybin therapy on personality structure. Acta Psychiatrica Scandinavica,138(5), 368-378.

11.  Lyons, T., & Carhart-Harris, R. L. (2018). Increased nature relatedness and decreased authoritarian political views after psilocybin for treatment-resistant depression. Journal of Psychopharmacology, 32(7), 811-819.

12.  Schick, F. (1997). Making choices: A recasting of decision theory. Cambridge University Press.

13.  Kramer, P. D., & Kramer, P. D. (1994). Listening to prozac. London: Fourth Estate.

14.  Elliott, C. (1998). The tyranny of happiness: Ethics and cosmetic psychopharmacology. Enhancing human traits: Ethical and social implications, 177-188.

15.  Carhart-Harris, R. L., Erritzoe, D., Williams, T., Stone, J. M., Reed, L. J., Colasanti, A., … & Hobden, P. (2012). Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin. Proceedings of the National Academy of Sciences, 109(6), 2138-2143.

16.  Carhart-Harris, R. L., Roseman, L., Bolstridge, M., Demetriou, L., Pannekoek, J. N., Wall, M. B., … & Leech, R. (2017). Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Scientific reports, 7(1), 13187.

 

Common Views and Attitudes Towards Psychedelic Medicines and Therapies

 


Psychedelics have a rich history, from use amongst indigenous people, guided by ancient knowledge passed on through centuries of traditional practices, to their discovery by modern science leading into a hampering period of criminalisation and finally through to a resurgence of research into uses in modern psychological treatment. A brief insight into the research, past and present, shines a light on the profound potential of psychedelics. Many studies have perfected the formula for safe therapeutic use, right dose and setting with skilled facilitators. This combination, with few treatment sessions, has provided sufferers of treatment resistant major depressive disorder, depression and anxiety associated with diagnosis of terminal illness, severe posttraumatic stress disorder (PTSD) and substance use disorder, with exceptional enduring therapeutic benefits (Bright & Williams, 2018; Carhart-Harris et al., 2018; Daniel & Haberman, 2017).

The state of mental health is at a tipping point, on the verge of further decline with exacerbation from an imminent economic depression and the increased psychological distress experienced due to the COVID-19 situation. A new approach to mental health treatment is an impending necessity, to help curb future burdens associated with increasing levels of mental distress. Psychedelic research has provided promising results, making psychedelic medicine an obvious candidate for the progression into a new paradigm for treating mental illness. Given the significant benefits of psychedelic medicines, relaying this information to the general public effectively is an important step towards the acceptance and integration of psychedelic-assisted therapy.

This exceptional period of rapid change that we currently find ourselves in has exposed a deep divide in understandings, views and opinions amongst individuals, communities, governments and within institutions. The COVID-19 situation, which is both symbolic and symptomatic of this complex time, has on the one hand produced an enormous amount of conflicting information coming from multiple sources, while on the other hand has not produced a single authoritative position, making it hard for most to differentiate fact from opinion and science from politics. These tensions are not unfamiliar to researchers in the area of psychedelic medicines; however, the scale of the current crisis changes the way we see the problem and directs us to new ways of responding. The COVID-19 situation has shown that when deciphering information, there is an obvious disparity between and within, science, medicine, politics and industry.

Information from highly influential sources leading to impulsive decision-making, has the capacity to produce unforeseen undesirable implications. We have seen an example of this recently with the initial predicted COVID-19 death rate — later found to be highly inaccurate — resulting in the instantaneous introduction of new policies worldwide. With the implementation of these policies, we are now witnessing a rise in mental illness, substance abuse and suicide risk (Wesley Mission & Suicide Prevention Australia, 2020). In hindsight the inadequacies and long-term implications of these policies are becoming visible, highlighted by new and upcoming research (Atkeson et al., 2020; Kaplan et al., 2020; Madhi, et al., 2020; Miles et al., 2020).

The complexity and tensions inherent within the COVID-19 situation present a unique opportunity for reflective research in that it surfaces, in a very explicit way, the challenges associated with the delivery and receipt of information. Learning from the COVID-19 situation, more focus can be placed on the fundamentals of the spread of information within the area of psychedelic medicines and how information flows impact on consensus and associated behaviour and attitudes.

The public perception of psychedelic medicines, relates back to the criminalisation of psychedelics in the 1960’s. The residual effects of this classification, including stigmatisation, rejection and fear, is central to the continuous spread of confusing and incorrect information within the public domain (Belouin & Henningfield, 2018; Bright & Williams, 2018; Sessa, 2016). The spread of this information has both created serious limitations for scientific research, and the uptake of the medicines and therapies themselves (Belouin & Henningfield, 2018; Bright & Williams, 2018; Sessa, 2016).

The way in which information is delivered can either be, a shortcoming for the distribution of correct information, or a catapult for the distribution of incorrect information, leading to a myriad of challenges for policymakers and public health. The dissemination of information in the COVID-19 environment has brought into focus the associated challenges, highlighting how advancements in the use of psychedelic assisted therapy may be curtailed. It is an important consideration when making informed decisions regarding the delivery of information, to examine and understand the sources, intended purposes behind, and the interpretation.

Misinformation can be described as information that originates from an absence or lack of supporting empirical or factual evidence. History tells us that the current scheduling of psychedelics follows on from the criminalisation of LSD in 1966 (Belouin & Henningfield, 2018; Sessa, 2016). LSD was completely banned for any use, including research purposes, on the basis that it posed a danger to the public, despite thousands of studies on the therapeutic use of LSD during the 1950’s and 1960’s deeming LSD, when used in controlled settings, to be “overwhelmingly safe and effective” (Sessa, 2016, p. 8). Based on this, the criminalisation and stringent scheduling of psychedelics is not supported by empirical evidence and based on misinformation.

In understanding the roots and propagation of misinformation, it is important to examine the sources. A study by McCright and Dunlap (2017) discusses the origins and spread of political misinformation and outlines that it is; often based on ideological agendas, deeply ingrained and mutually reinforced by the public, and cohesively promoted through collaborative relationships with industries and media outlets. This study highlights the disregard for accuracy in the delivery of highly influential information and also the difficulties in rectification at this level.

Research suggests that information is often selectively chosen, skewed or sensationalised for entertainment purposes (Klin & Lemish, 2008). With the media driven stigma of a ‘dangerous party drug’, ecstasy is an unregulated drug found to often not contain MDMA at all (Rickwood et al., 2005). MDMA, the psychedelic component in what’s been classified as breakthrough treatment for PTSD (Doblin et al., 2019) is often misleadingly referred to as ecstasy. This demonstrates the potential for incorrect terminology to exacebate misconceptions. However, becoming aware of misleading terminology allows for intervention to expose and correct it, helping to conteract misconceptions.

Aside from understanding and acknowledging the origins of information and misinformation, it is equally important, to recognise and understand how it is received and absorbed. Deciphering whether information is correct or incorrect involves not only the way it is delivered but also how it is interpreted, transferred into knowledge and beliefs, and interacts with prior knowledge and beliefs. Amongst the general population there are many misconceptions associated with psychedelics as a result of misinformation, such as, they are dangerous, toxic and addictive physically, psychologically and/or socially (Belouin & Henningfield, 2018; Byock, 2018). These misconceptions have been refuted by the large amount of research that has taken place since psychedelic medicines were discovered by scientists in the 1890’s (Bright & Williams, 2018; Nichols, 2016; Sessa, 2016), but the obvious dilemma is that such research is not readily available to, or accessed by the general public.

Misconceptions and misinformation are difficult to counteract, as they become imbedded in beliefs and attitudes. The “war on drugs” campaign, led by politics and propagated by mass media has left an unfortunate legacy. The campaign established psychedelics position as an enemy and threat to society. In establishing this position, knowledge was tactfully directed, shifting and cementing the general public opinion of psychedelics. In a study reviewing literature on cognitive biases that influence social perceptions, Marks and Miller (1987) found that values and beliefs held by individuals are often influenced by social groups and the selective exposure to biased samples of information that agrees with and maintains a desired or already held position.

It has been proposed that individuals generally only seek new knowledge when it is necessary or vitally important to do so (Thon & Jucks, 2017), and when it comes to acknowledging new information — whether it is evidence based or not — an individual’s prior knowledge and beliefs are often defended and upheld (Pennycook, 2020). Clearly, prior knowledge and beliefs play a significant role in the adoption of new information, exemplifying the difficulties in shifting firmly held beliefs and gaining trust and acceptance.

The “war on drugs” has been described as, a war on “sovereignty over consciousness” (Hancock, 2015, p. 3). In the current media climate we are witnessing an increase in censorship and a polarisation of information, which similarly to the “war on drugs” can be described as a war on sovereignty over knowledge. Ideally there should be accountability for ingenuousness within sources of information, but it is instead, left to the individual to firstly identify misinformation and secondly rationally and logically question it. Awareness leads to change and begins with acknowledgement and acceptance. Acknowledging and accepting the dilemmas within the delivery and uptake of information, will therefore bring about awareness necessary for change.

Misinformation is somewhat complicated and incorporates many variables from all parties including the sources of information and the intended audience, and many aspects that influence the interpretation and accommodation of information. Misinformation has effectively sustained misconceptions and stigmatisation surrounding psychedelics. It is therefore relevant to investigate and understand in order to move forward and create a model for initiating and establishing positive views and attitudes towards psychedelic medicines and therapies. Further research is needed to explore the barriers surrounding misinformation, to aid successful advocation for psychedelic medicines and promote their place in therapeutic, psychological and clinical practice.

By Candice Folkard

 

References

Atkeson, A., Kopecky, K., & Zha, T. (2020). Four stylized facts about COVID-19. NBER Working Paper №27719. https://doi.org/10.3386/w27719

Belouin, S. J., & Henningfield, J. E. (2018). Psychedelics: Where we are now, why we got here, what we must do. Neuropharmacology, 142, 7–19. http://doi.org/1016/j.neuropharm.2018.02.018

Bright, S., & Williams, M. L. (2018). Should Australian psychology consider enhancing psychotherapeutic interventions with psychedelic drugs? A call for research. Australian Psychologist. https://doi.org/10.1111/ap.12345

Byock, I. (2018). Taking psychedelics seriously. Journal of Palliative Medicine, 21(4), 417–421. https://doi.org/10.1089/jpm.2017.0684

Carhart-Harris, R.L., Bolstridge, M., Day, C.M.J. et al. (2018). Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. Psychopharmacology, 235, 399–408. https://doi.org/10.1007/s00213-017-4771-x

Daniel, J., & Haberman, M. (2017). Clinical potential of psilocybin as a treatment for mental health conditions. Mental Health Clinician, 7(1), 24–28. https://doi.org/10.9740/mhc.2017.01.024

Doblin, R. E., Christiansen, M., Jerome, L., & Burge, B. (2019). The past and future of psychedelic science: an introduction to this issue. Journal of Psychoactive Drugs, 51(2), 93–97. https://doi.org/10.1080/02791072.2019.1606472

Hancock, G. (2015). The devine spark, psychedelics, consciousness and the birth of civilization. London: Hay House UK Ltd.

Kaplan, G., Moll, B., & Violante, G. L. (2020). The great lockdown and the big stimulus: tracing the pandemic possibility frontier for the U.S. NBER Working Paper №27794. 1–53. https://doi.org/10.3386/w27794

Klin, A., & Lemish, D. (2008). Mental disorders stigma in the media: review of studies on production, content, and influence. Journal or Health Communication, 13, 434–449. https://doi.org/10.1080/10810730802198813

Madhi, S. A., Gray, G. E., Ismail, N., Izu, A., Mendelson, M., Cassim, N., Venter, F. (2020). COVID-19 lockdowns in low- and middle-income countries: success against COVID-19 at the price of greater costs. South African Medical Journal, 110(8), 724–726. https://doi.org/10.7196/SAMJ.2020.v110i8.15055

Marks, G., & Miller, N. (1987). Ten years of research on the false-consensus effect: an empirical and theoretical review. Psychological Bulletin, 102(1), 72–90.

McCright, A. M., & Dunlap, R. E. (2017). Combatting misinformation requires recognizing its types and the factors that facilitate its spread and resonance. Journal of Applied Research in Memory and Cognition, 6, 389–396.

Miles, D. K., Stedman, M., & Heald, A. H. (2020). “Stay at home, protect the national health service, save lives”: A cost benefit analysis of the lockdown in the United Kingdom. The International Journal of Clinical Practice, 1–14. https://doi.org/10.1111/ijcp.13674

Nichols, D. E. (2016). Psychedelics. Pharmacological Reviews, 68(2), 264–355. https://doi.org/10.1124/pr.115.011478

Pennycook, G. (2020). Belief bias and its significance for modern social science. Psychological Inquiry: An International Journal for the Advancement of Psychological Theory, 31(1), 57–60. https://doi.org/10.1080/1047840X.2020.1722577

Rickwood, D., Crowley, M., Dyer, K., Magor-Blatch, L., Melrose, J., Mentha, H., & Ryder, D. (2005). Perspectives in psychology: substance use. Melbourne: The Australian Psychological Society Ltd.

Sessa, B. (2016). The history of psychedelics in medicine. In M. V. Heyden, H. Jungaberle, & T. Majić, Handbuch Psychoaktive Substanzen (pp. 1–26). Berlin: Springer, Berlin, Heidelberg. https://doi.org/10.10.1007/978-3-642-55214-4_96-1

Thon, F. M., & Jucks, R. (2017). Believing in expertise: how authors’ credentials and language use influences the credibility of online health information. Health Communication, 32(7), 828–836. http://dx.doi.org/10.1080/10410236:2016.1172296

Wesley Mission & Suicide Prevention Australia. (2020, June). Policy and Advocacy. Suicide Prevention Australia: https://www.suicidepreventionaust.org/policy-advocacy

Psychedelic-Assisted Therapy For Criminal Offenders — A New Paradigm For Rehabilitation?

I have a lifelong interest in decreasing violent crime and imprisonments rates. For 21 years I was a proudly activist judicial officer seeking to reduce both — definitively a barbed-wire fence proposition.

I have a more recent interest in the treatment of mental health issues by the use of psychedelic assisted therapy. At first glance, it may appear that these two interests are disconnected. The purpose of this short blog is to explain that they are intricately linked, and thus my excitement at being on the advisory panel for Mind Medicine Australia.

I have personal experience of vicarious trauma detailed in my Tristan Jepson Memorial Foundation lecture[1], and am happy to disclose that I have been flirting with the idea of psychedelic assisted therapy for myself.

So, let’s play ‘what if’ for a while.

1. What if psychedelic assisted therapy could make a real dent in the numbers of those suffering from substance abuse disorder, PTSD and depression/anxiety?

2. What if a substantial proportion of those who commit crimes and are imprisoned are suffering from those conditions?

3. What if there was broad availability of these treatments for violent offenders?

4. What if there was broad outspoken support from the criminal justice sector?

As to the first ‘what if’, having read the research, I am comfortably satisfied that psychedelic assisted therapy including psilocybin and MDMA has great results in treating conditions such as substance abuse disorder, PTSD and depression/anxiety. The phase three trials will undoubtedly cement psychedelic assisted therapy as a key treatment to these ailments. However, I notice that much of the recent research has been on those perceived to be worthy — those dying of terminal illness, Vietnam veterans, AIDS survivors, anorexia patients and the like. There are some studies of those with substance abuse disorders, but having read that research it is notable that violent offenders are not the target tested group.

Yet, and this answers the second ‘what if’, those suffering abuse disorder, PTSD and depression/anxiety are responsible for much of the violent crime in Australia.

I know it’s academically sound to start with the empirical evidence-based studies, however sometimes anecdotal evidence has more punch. As a children’s court magistrate, I noticed something very quickly — there were no repeat violent offenders who had not witnessed or been the victim of violence in the home. None, zero. Every sentencing report detailed PTSD from living in fear as a child. Every single one. All of these kids I had to lock up had experienced seeing their mum beaten up, or been abused themselves.

And with violent women offenders, it soon became apparent that the vast majority had been victims of sexual abuse and suffered from PTSD or substance abuse disorder as a result. For men, the picture was more complex with a range of diagnoses — until the Royal Commission. Suddenly, it became acceptable for men to admit to the abuse they had suffered and a PTSD diagnosis became more and more common. For most violent male criminals, alcohol abuse disorder was a regular feature.

This anecdotal evidence is, unsurprisingly, supported by the research. For women prisoners, two thirds had a mental health condition, and one third for men. A third of women had a history of self-harm. A quarter of all entrant prisoners were taking medication for a mental health condition[2]. This is a world-wide phenomenon — for example, the prevalence of psychosis in a London prison population was found to be more than 20 times that of the general community, and almost 70% of people in prison had more than one mental health disorder[3].

The figures don’t distinguish between violent and other offenders, and nor do they inform of the type of mental illness. I plan to dig deeper on these issues, however my hypothesis is that the research will conform with my observations –the vast majority of violent offenders have mental health issues that lend themselves to psychedelic treatment. There are two important caveats to this hypothesis worth keeping in mind — firstly, the vast majority of those who have mental health conditions are not violent. Secondly, those with mental health conditions are much more likely to be victims of violent crime.

And to the third ‘what if’ — imagine if there was broad availability of psychedelic assisted treatment of these violent offenders. I’m not suggesting we lace prison water with LSD a la Timothy Leary, however surely psychedelic therapy holds more likelihood of rehabilitation than the rigid discipline of time behind bars and a lifetime of psychiatric medication. I opine that violent offenders ought to be the first for whom this treatment is available — because there is a sure and clear test of effectiveness. They either re-offend or they don’t.

And finally, to the fourth ‘what if”. There certainly are some barriers to getting criminal justice support for psychedelic therapy — there are deeply entrenched views that mimic those of Mr Mackey in South Park — all drugs are bad. Of course, the logical flaws in that approach are obvious but should not be discounted as it is the dominant hegemony. Such views are shared by the majority of police, judges and lawmakers in the country. Medicinal cannabis has faced decades of prohibition until very recent times in this country, and still the barriers are significant. Legitimising psychedelics is a hurdle that may take some time and effort.

The other hurdle is that psychedelic treatment will not of itself impact on the sociological causes of crime for which treatment of individuals is but a small part. Chronic inequality, institutionalised racism, toxic masculinity and a lack of rehabilitation services all contribute to rising crime. There are no magic bullets for these. However, if the focus is on violent crime — particularly domestic and family violence — then criminal justice system support may be easier to garner.

So, if we are serious about decreasing the prison population and reducing violent crime the criminal justice system ought support psychedelic therapy availability. The current law and order ‘solutions’ to violent crime — more police, longer sentences, tougher prisons — demonstrably are not working. It is time to try a more scientific approach.

By David Heilpern

References
[1] https://www.judicialcollege.vic.edu.au/sites/default/files/2019-07/Helipern%20%282017%29%20TJMF%20Lecture%20-%20Lifting%20the%20Judicial%20Veil.pdf

[2] https://www.aihw.gov.au/getmedia/2e92f007-453d-48a1-9c6b-4c9531cf0371/aihw-phe-246.pdf.aspx?inline=true

[3] Bebbington P, Jakobowitz S, McKenzie N, Killaspy H, Iveson R, Duffield G & Kerr M 2017. Assessing needs for psychiatric treatment in prisoners: 1. Prevalence of disorder. Social Psychiatry and Psychiatric Epidemiology 52(2):221–9. doi: 10.1007/s00127–016–1311–7

Breaking Down the Stigma and Shame of Psychedelics

 

Psychedelics have a history rich in stigmatisation and misunderstanding. For example, during the 60s (whilst psychedelics research and trials occurred in reputable universities around the world) the anti-Vietnam counterculture, who were associated with psychedelics, rose up against the establishment. Subsequently, President Nixon declared a War on psychedelic drugs which was highly sensationalised, politicised and not based on scientific evidence. As divisive psychedelic pioneer Terrance McKenna asserts “Psychedelics are illegal because they dissolve opinion structures and culturally laid down models of behaviour and information processing. They open you up to the possibility that everything you know is wrong”.

Over the last twenty years there has been a renaissance in psychedelic science and people ‘coming out’ in support of utilising these treatments for mental illness and powerful tools to expand consciousness and spirituality.  Whichever perspective you take, the fact remains, backed by evidence-based research, that psychedelics have a lot to offer in the ever-advancing world of psychedelic-assisted therapies and the pioneering of better mental health treatments.

So why, in 2020, as the world finds itself in the midst of both a global health pandemic and mental health crisis, are psychedelics, the one treatment that could offer hope to millions of people, still so heavily stigmatised?

 

Is history to blame?

Thanks to President Nixon’s war on drugs, law reform on psychedelic medicines ultimately saw them classified as a schedule 1 drug. Which is the highest, most restricted and regulated drug schedule of the US Controlled Substances Act of 1970. Similar laws were soon seen internationally, thus seriously limiting the continued research into psychedelic medicines and their potential as a mental health treatment response.

While psychedelic medicines may be enjoying a research renaissance and offering a glimmer of hope to those living with mental health conditions, for many, the poor media portrayal of such hallucinogens, coupled with the tiresome war on drugs and protest from medical professionals, has tainted the name of psychedelics. Today, psychedelic drugs such as psilocybin and MDMA (among others) have recently generated new interest in the treatment of mental illness. Both medicines have been given breakthrough status as therapies for several brain-related disorders. While this is an incredibly positive step towards mental health care reform, the need for research into such medicines and the perceived benefits to come from them, is still heavily stained by misinformation, fear and stigmatisation, continuing to hinder attempts to bring psychedelic-assisted therapy to the forefront of mental health treatment. It seems the stigma attached to psychedelics decades ago is still polluting the minds of both countless medical professionals and the public alike.

 

So… just what is stigma?

In layman’s terms, stigma is ‘a mark of shame or discredit’ or ‘a set of negative and often unfair beliefs that a society or group of people have about something’. Stigma is a multifaceted social construct that includes public, self and structural components, which once attached to something, leaves a distinctive mark of social disgrace.

As socially constructed attitudes, values and laws evolve, we often witness the dismantling of stigma. This is evident throughout history and seen in the changes of attitudes towards such issues as women’s rights, the treatment Aboriginal and Torres Strait Islander people and the wider acceptance and celebration of the LGBTQIA community.

Now it is time for a change in attitude towards psychedelics. It is simply another chapter in our history of evolution. This shame and stigma needs to shift now. The mental health crisis continues to grow. Thousands of Australians are dying by suicide, caused by outdated beliefs which are no longer supported by science. Current pharmaceutical interventions for mental health are failing! Psychedelic-assisted psychotherapy is a matter of human rights.

 

So… how do we destigmatise psychedelics?

Several studies show that stigma usually arises from lack of awareness, lack of education and lack of perception. Currently, psychedelics are often still stigmatised and associated with the negative. We are all responsible for dismantling this stigma. People should be encouraged to come out and share their knowledge. Engage in open, honest and factual conversation with friends, family and peers. By knowing the science behind psychedelics and sharing facts rather than propaganda, fear can be reduced and acceptance a welcome change.

 

Shifting the mass perception

Today, there is a growing consciousness, eagerness, and hopefulness towards the use of psychedelics in therapy. There are over a hundred psychedelic research trials happening globally as we speak. In countries such as the Netherlands, psychedelics are legal and embraced as a mental health solution. Psilocybin mushrooms can be bought in cafes. The Netherlands is also home to world-class psychedelic therapy centres with many legal organisations dedicated to protecting this therapy. Education and acceptance of psychedelics is embraced rather than demonised. As a result, stigma and shame towards psychedelics is limited. Other countries are following suit and the same can changes can happen in Australia. We simply need more education consisting of honest, factual and up-to-date information. Surely, we are able to have the same change in perception towards psychedelics that we have had towards previously stigmatised groups.

 

A forward-thinking future

Policy change surrounding psychedelics is essential in mitigating stigma. The Therapeutic Goods Association’s recent agreement to accept submissions advocating for certain psychedelics to be rescheduled from category 9 drug (prohibited substance) to category 8 (controlled substance), is a massive step forward. In addition to this, greater advocacy and community education is needed. If research can progress freely, devoid of crippling regulation and government agenda, and if the media can be encouraged to publish articles based on hard fact, rather than falsehoods and fear, the future of psychedelic-assisted therapy may just have a gleamingly bright future.

 

Saying goodbye to stigma and shame

We need to better address the rapidly growing mental health crisis and we need to do it now. If the past has taught us anything, it’s that stigma and shame lead to negative outcomes for those with mental illnesses and disrupt pathways to potential treatment options. The war on drugs and continued spread of misinformation surrounding psychedelics has no doubt caused great setbacks in the development of psychedelic-assisted therapy. However, there is hope. If stigma stems from a set of negative beliefs, then the key to mitigating stigma must lie in early intervention and education.

As a social work student, who you would think should be taught about the most up-to-date and promising treatments for mental health, there is only one point during my entire degree I remember hearing anything about psychedelics. It was not positive. I was told that psychedelics can cause psychosis and are dangerous. Nothing was ever mentioned about the promises of psychedelics used in therapy. Why not? If anything, this gap in education should be seen as an opening. An invitation to network and get into universities. Start spreading the word as early as possible about the promise of psychedelics. This responsibility also lies with therapists and other healthcare professionals, who can use their own power and authority to dismantle and reject stigmatised beliefs and myths surrounding psychedelics. By engaging in informed, expert conversation, providing professional education and continuing to advocate for improved mental health treatments and the promise of psychedelics, a change will be possible. Education has been proven to reduce stigma. I encourage all of you to take a stand and educate yourselves as much as possible. Read articles, research, have uncomfortable conversations. Use some of your spare time to volunteer for an organisation such as Mind Medicine Australia. Be the change you want to see in the world! If psychedelics are the future of mental health treatment, then education (in all its forms) will see them get there.

 

By Eleanor Andrews and Dr Alana Roy

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