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Will Australia take a lead in psychedelic therapy?

Papercut head

By Kevin Ke

On September 30th 2021, the Therapeutic Goods Administration (TGA) of Australia published an eagerly awaited report on the use of psychedelics in treating mental health conditions. It is an independent review of the evidence surrounding two particular substances: MDMA and psilocybin, commissioned by the regulatory agency in order to inform its decision making process towards these substances. Currently, these substances are placed in ‘Schedule 9’ of the ‘Poisons Standard’ – the most restrictive classification which includes other substances like heroin. The TGA is in the midst of evaluating a proposal to move them into ‘Schedule 8’, a less restrictive category. Schedule 9 substances are considered ‘Prohibited substances with high potential for abuse and misuse’, and are only accessible for purposes of medical research, in order to severely limit access. Although we are in a time of increasing awareness and interest in psychedelic substances, the history of psychedelic research in the modern era is complex. The current restrictions on psychedelic use for recreational and medical purposes are closely intertwined with US government anxieties about counterculture movements in the Vietnam War era.

The proposal to reschedule is led by an Australian nonprofit, Mind Medicine Australia (MMA), and has the support of world leading experts in psychedelic research. If successful, it will lead to a situation where Australian patients suffering from mental illness can access psychedelic substances for use in therapy. There are no proposed changes to the status of recreational use of psychedelics, which will remain in Schedule 9. A range of safeguards will be in place – for example, prescription will be restricted to being prescribed by psychiatrist or specialist addiction physician. MMA has been training cohorts of qualified psychotherapists specifically in psychedelic-assisted therapy in anticipation of future demand. Access is envisioned to occur in a medically controlled environment with the patient never taking the substances home. As unregistered medicines, prescribers will still require approval on a per patient basis from both the TGA (under Special Access Scheme B) and the State or Territory Government where the treatment is to occur. Mental health conditions like post-traumatic stress disorder (PTSD) and depression are frustratingly difficult to treat, with debilitating impacts on patient’s lives and those around them – and it is envisioned that these patients stand to benefit from a psychedelic experience given in a controlled and supervised setting.

 

What’s the evidence for psychedelic-assisted therapy?

In recent years, psychedelic research has reached an inflection point, with accelerating recognition worldwide of its therapeutic value in a range of mental health conditions. A landmark phase 3 trial evaluating MDMA for the treatment of PTSD read out earlier this year, sponsored by the pioneering US based nonprofit MAPS. A total of 91 patients with severe PTSD were randomised to two groups, with the average patient having carried the diagnosis for 14 years. A large majority (92%) of patients had experienced suicidal ideation during their lifetime, and 1 in 3 had attempted suicide in the past.

Both groups received a structured program of therapy over 18 weeks, but only one group received MDMA across three sessions, with the other receiving an inactive placebo in its place. The group that had received MDMA-assisted therapy responded considerably better than the group without – with 67% (28/42) of patients no longer meeting the criteria for PTSD diagnosis, compared to 32% (12/37) in the therapy-only group, as measured 18 weeks after initiation of treatment. In a patient group with such severe and intractable disease, these results are remarkable – clearly demonstrating the potential of psychedelic assisted therapy to heal patients who may otherwise never respond to conventional treatment regimes.

 

How does psychedelic assisted therapy work?

The experience of increased empathy and connection appear to be central to the way that MDMA seems to produce these results. Pharmacologically, the drug increases levels of serotonin in the brain, also acting to increase noradrenaline and dopamine to lesser degrees. Modulation of serotonin neurotransmission is the primary proposed mechanism by which both MDMA and psilocybin are able exert psychological effects. On one hand, an increased level of serotonin binding to the 5HT-1A receptor is thought to lower anxiety, while action on the 5HT-2A receptor increases neuroplasticity and the capacity for learning. In this state of lowered barriers and heightened flexibility of thinking, the individual is able to confront and reprocess their trauma with the assistance of their therapist. Unlike MDMA, psilocybin is a ‘classic psychedelic’ as it predominantly acts on the 5HT-2A receptor like LSD, DMT and mescaline. Experiences of psilocybin have been demonstrated to be effective for conditions like depression, even when the patients are resistant to other therapies. When 5HT-2A receptor activation increases, patients enter into a state of cognitive flexibility and creative thinking where enduring patterns of thought are able to be rewired. Individuals often rank it as among the most challenging and meaningful experiences of their lives – undergoing intense emotional realisations which persist long after the therapy has ended. In this way, psychedelics represent a different approach to treating conditions characterised by fixed mindsets and beliefs like depression and anxiety. Treatment is considerably shorter in duration (a few sessions), and may have more durable results than other treatment modalities. This is quite significant because conventional antidepressants and psychotherapy are known to take several weeks to months to achieve effect, requiring considerable resources. Psychedelics therefore represent a novel modality with distinct therapeutic benefits.

According to proponents of psychedelic assisted therapy, the therapy itself is a crucial part of healing. Also, it is emphasised that the substances are medical grade, produced to purity and stability specification – reducing risks of contamination and adulteration. Theoretical risks that arise from overdose or drug interactions can further be mitigated when given in a supervised setting. While the history of psychedelic research is intricately linked to diverse fields including psychoanalysis, consciousness, religion, and anthropology, the current movement is seeking first to focus on the medical applications, and this stands to reason. It has been reported that the growing acceptance of recreational cannabis use stems largely from its recent medicalisation, with cannabis being explored for a range of diverse applications ranging from anxiety and stress to autism and seizures. In medical cannabis, the TGA also has an important precedent for psychedelic regulation. In February this year, low doses of cannabidiol (the non psychoactive component of cannabis), were rescheduled to Schedule 3, the category for over the counter sale. In practice, it will be some time before pharmaceutical companies achieve registration of their medicines – requiring demonstration of efficacy and safety through clinical trials, a process that can take years. Nonetheless, similar arguments can be drawn between ‘psychedelics’ and medical cannabis, and the shifting tide of public opinion towards this group of substances is also self-reinforcing.

 

An independent expert review

The original TGA submission from MMA dates back to July 2020, and from there, the original decision of the regulatory agency was to retain the status quo and to not reschedule. Some groups have a different perspective of the benefits and risks of this psychedelic assisted therapy. Medical bodies like the Australian Medical Association and the Royal Australian and New Zealand College of Psychiatrists emphasised a need for clinical trial processes, including careful assessment of efficacy and safety, under strict protocols and ethical oversight. For these groups, psychedelic research is still in its infancy, with ‘limited but emerging evidence that psychedelic therapies may have therapeutic benefit’, and emphasis is placed on their status as illicit substances. The initial decision was challenged by MMA, prompting an independent review of the evidence, bringing us to the recent report.

The expert panel was tasked with reviewing the available evidence on MDMA and psilocybin for the treatment of mental health conditions. Benefits and risks, therapeutic value, and applicability to the Australian healthcare system, were all aspects that were considered. For MDMA, a total of 8 randomised controlled studies were found to be relevant and pooled together, and their results analysed. The rationale is that looking at the results in totality may provide us with better estimates than looking at these studies individually. Results are collated and compared using the statistical quantity ‘standardised mean difference’, or ‘effect size’ – calculated by taking the difference in mean severity scores between groups relative to the standard deviation in these scores. This can be helpful when a range of different severity scores are used between trials, as ‘effect size’ allows for comparisons between different disease scoring systems. However, comparing interventions indirectly through looking only at ‘effect size’ can also be misleading, as different trials inevitably recruit patient populations which are heterogenous or homogenous in their own ways. Trials involving more homogenous patient populations will inevitably have higher effect sizes, while the converse is also true, with all else being equal. With that said, in our report, MDMA assisted therapy was found to have an effect size of -0.86 compared against the control arms, considered generally as a large effect size (almost one standard deviation). This is a promising result considering that the controls also received placebo medication, and the same course of intensive psychotherapy. In other words, patients will experience a large benefit from this treatment, beyond what you might expect from psychotherapy alone. The importance of these results are highlighted when we consider that the only two FDA-approved drugs for PTSD are the SSRI drugs sertraline and paroxetine, which both have modest efficacy, being 2-3 times less effective than MDMA, when compared using absolute change in the CAPS-2 score (and effect size). For psilocybin, six studies were identified by the panel as relevant to their evaluation. Their main findings were that psilocybin was better than placebo for treatment resistant depression, and that it showed efficacy for treatment of anxiety. It was also compared to escitalopram, a common antidepressant – and no ‘statistically significant’ differences were observed, although there is a good argument to be made that this is due to limited statistical power. A closer, critical read of an important recent trial comparing psilocybin with escitalopram would be worthwhile for any interested reader, as the data itself is promising (additional data is in the article appendix).  The authors of our TGA report conclude: “MDMA and psilocybin may show potential as therapeutic agents in highly selected populations when administered in closely supervised settings and with intensive support. Evidence appears strongest for MDMA.”

The case for psychedelic assisted therapy is strong, and the high quality evidence which has been generated to date cannot be ignored for long. The recent independent review highlights the clinical efficacy of this treatment, and the TGA is well placed to enact regulatory changes that will encourage the development of the field. In the midst of our current mental health crisis, patients with intractable conditions stand to benefit considerably from a rescheduling of these medicines.

Anyone for a Magic Mushroom Medicine?

In the lucky country we like to think of ourselves as free, prosperous and privileged. But is our luck running out and what might we do to get it back? Australia is now ranked as the OECD’s worst performer on tackling climate change, our vaccination rollout has by every measure been a dismal failure with Australia today ranked 113th in vaccinating its people, and we are now the nation with the second worst mental health statistics in the world, with only Iceland behind us. Something is clearly not right.

Somehow, we have created a society which promotes the consumption of all forms of alcohol, and where gambling is an addictive source of government revenue. Yet fungi that possess incredible medicinal powers and grows all by itself can, if consumed, put you behind bars.

We allow Australians to drink and smoke, eat ever-growing amounts of sugar, trans-fats and processed foods, causing an obesity epidemic of massive proportions that costs society billions of dollars a year. Doctors easily dole out anti-depressants and pain-killing opiates. Only an estimated 30-35% of depressed individuals in the general population experience remission from current pharmacotherapies or psychotherapies, with the majority experiencing ongoing symptoms, and significant side effects, and between 50% to 80% relapsing after treatment stop. To create positive change and healing, we need to be innovative and broaden the tools available to our medical practitioners and qualified therapists working in this area.

And how free are we if we don’t have access to all of the safe and effective medicines that could cure us when we are ill?

History, science and increasing amounts of data, now clearly demonstrate the enormous potential social benefits of psilocybin mushrooms (psilocybin is the psychoactive component in magic mushrooms) to our mental health, creativity and productivity. Yet digestion of psilocybin remains illegal in Australia, both for medical and recreational uses. Why do prevailing State laws make it illegal to eat completely safe, non-addictive, non-toxic and free wild mushrooms, which may just be growing right outside your door in this magic mushroom season? And yet it is perfectly legal to pick a poisonous mushroom growing nearby that may possibly kill you!

 

 

Far from making us ‘lose our minds’, it turns out that the educated, careful and responsible consumption of psilocybin mushrooms might just make us better and healthier people. And yet our minds, the cornerstone of everything we do in this short and finite life, are not as free as we may think.

There is nothing particularly radical or new about humans picking and consuming mushrooms, even those with psychoactive properties. Indeed, we would be hard pressed to find a single human culture anywhere, throughout thousands of years of recorded human history, that did not revere and use these medicinal sacraments to heal a variety of physical and mental ailments. Indeed, many now believe that the original story of our beloved Santa Claus is thought to have come from Nordic indigenous peoples who, along with their reindeer, were known to have regularly consumed the famous Amanita Muscaria mushrooms.  Their white dots against a red-capped mushroom dome became the key colours of Christmas cheer.

Though these mushrooms may have a reputation as daunting and dangerous, the science clearly shows that the individual and social dangers associated with the taking of psilocybin is far safer than almost all other drugs, even in recreational environments.

In scores of medical trials of these therapies at the world’s most prestigious Universities including Yale, Harvard, Oxford, Imperial and Johns Hopkins we are seeing remission rates of 60-80% amongst thousands of patients suffering with depression, anxiety, addictions and end-of-life distress. These results occur after just two to three medicinal doses in clinical settings, combined with a short course of psychotherapy. They have been shown to be effective, safe and non-addictive. Many patients describe the therapy as one of the top five most meaningful experiences in their lives! Whoever says that about any medicine?

These outcomes are so promising that psilocybin-assisted therapies are now being studied for the treatment of anorexia and other eating disorders, a range of addictions, obsessive compulsive disorder, dementia, Parkinson’s disease and cluster headaches. The therapeutic use of mushrooms has been legalised in Canada and the U.S. State of Oregon, and compassionate access to these treatments for treatment-resistant patients is being granted in the USA, Switzerland, Israel, and even Australia.

Aside from the realm of mental health, mushrooms are known to fundamentally change things for the better. The pioneering work of globally well-known mushroom experts, including American Paul Stamets, demonstrates that mycelial networks from which mushrooms grow constitute a significant portion of the world’s precious topsoil. They are the neural pathways by which trees and other plants actually communicate with one another. These infinitely complex networks also have qualities that can detoxify waste and greatly enhance the strength and resilience of topsoil. Clearly, mushrooms can do extraordinary things!

Psilocybin mushrooms can intensely reconnect one’s mind and significantly alter consciousness in ways almost impossible to describe to those who have not had this experience. Psilocybin binds to a serotonin receptor called 5-HT2a and takes the brain into a state where it can flow more freely, unconstrained by prior and rigid beliefs about how the world is supposed to work. Psilocybin works through cracking open complexes of suffering contained within the body and brain. It is often said of conventional antidepressants that they merely ‘plaster over’ the root causes of suffering, whereas the defining property of psychedelic therapy is the ability to accelerate self-understanding through revelation leading to complete remission for many.

How can ingesting a mushroom that grows naturally all over Australia still be illegal? In a country that is ‘free’, how can picking a magic mushroom in your garden leave you subject to prosecution and imprisonment? Increasingly, with compassionate motivations, we allow people to use drugs to end their lives via euthanasia, yet we prevent the management of mental illness with a safe and effective medicine that could assist millions to overcome a whole range of health challenges.

As Covid-19 has shown, it is easier to treat an illness if you understand it. Mental illness is the world’s number one cause of disability, and depression is the largest contributor to this burden. Pre-Covid-19, anti-depressant medications were prescribed to one in eight of the adult population in Australia including one in four older adults and one in thirty children.  And yet our rates of mental illness and suicides continue to grow. We clearly need a better approach based on science and proven treatments that get to the root cause of our suffering.

Our hope is that professionally delivered psychedelic therapy using psilocybin mushrooms can meet the massive need for breakthroughs in mental health care.

Action is needed now to ensure that these medicines are accessible and affordable to all and prevent further avoidable suffering and suicides. The recently completed Global Drug Survey showed that thousands of people sought self-treatment for psychiatric conditions and emotional distress with psychedelic-assisted therapies:  85% of them said their conditions improved as a result. People are taking matters into their own hands because they cannot wait any longer for a legal and medically controlled pathway.

Australia was a world-leading innovator in major issues such as the eight-hour work day, women’s vote, our superannuation and healthcare system and so much more. We often initiated positive change, but now our reefs, forests, unique animals, climate and coastlines are under severe threat and our international reputation is losing its shine. We need to find a way back.

Providing safe, medically controlled and legal access to effective medicines to everyone who needs them may be one of the answers. If we want to regain our world leading stature, we all need to reassess what it means to truly be free and make choices about the medicines that may heal us.

The Therapeutic Goods Administration (TGA) is currently conducting an Independent Review to reconsider the rescheduling of MDMA and psilocybin from Schedule 9 (Prohibited Medicine) to Schedule 8 (Controlled Medicine), while the Australian Government also recently announced a $15 million grant round for research into psychedelic-assisted therapies. However, huge obstacles remain, and there is still much to achieve to ensure we catch up and heal the immense suffering.

The next step is to ensure that all Australians enjoy the right to the highest attainable level of health, a right that is recognised under a plethora of human rights treaties Australia has freely ratified. To fully possess this right, everyone needs to have access to all the medicines in the medicine cabinet, and that includes magical mushroom medicine.

Tania de Jong AM

LL.B (Hons), GradDipMus

Tania de Jong AM is a trail-blazing Australian soprano, award-winning social entrepreneur, creative innovation catalyst, spiritual journey woman, storyteller and global speaker. Tania is one of Australia’s most successful female entrepreneurs and innovators developing 5 businesses and 3 charities including Creative Universe, Creativity Australia and With One Voice, Creative Innovation Global, Mind Medicine Australia, Dimension5, MTA Entertainment & Events, Pot-Pourri and The Song Room.

She works across the public, private, creative and community sectors and is passionate about mental health, innovation, diversity and inclusion.  Tania speaks and sings around the world as a soloist and with her group Pot-Pourri releasing twelve albums. She is Founder and Executive Producer of future-shaping events series, Creative Innovation Global.

She was appointed a Member of the Order of Australia in June 2008. Tania was named in the 100 Women of Influence, the 100 Australian Most Influential Entrepreneurs and named as one of the 100 most influential people in psychedelics globally in 2021. Tania’s TED Talk ‘How Singing Together Changes The Brain’ has sparked international interest. Tania’s mission is to change the world, one voice at a time!

Scott Leckie

Scott A. Leckie is an international Human Rights lawyer, Law Professor and Director and Founder of Displacement Solutions, an NGO dedicated to resolving cases of forced displacement throughout the world, in particular displacement caused by climate change. He also founded and directs Oneness World Foundation (www.onenessworld.org), a think tank exploring questions of world-centric political evolution and new forms of global governance.

He hosts Jointly Venturing, a podcast dedicated to the question of world citizenship, and manages the One House, One Family initiative, an ongoing project in Bangladesh building homes for climate displaced families. He regularly advises a number of United Nations agencies and conceived of and was the driving force behind more than 100 international human rights legal and other normative standards, including UN resolutions – most recently the Peninsula Principles on Climate Displacement Within States. He has written 22 books and over 250 major articles and reports.

A Mother’s Prayer To The TGA

Woman on boat

I am writing this as a mother, in the hope that my words may open the closed minds of our politicians, the TGA and the RANZCP, who we rely upon to ensure every Australian has access to the latest medical therapies.

Our 26-year-old daughter suffers from treatment resistant PTSD and severe depression as a result of a trauma when she was only 11.  Rape at any age is devasting, but for a child the impact is profound. We live with the daily fact that with the current treatment of anti- depressants and anti- psychotic drugs available to her in Australia, there is only a 5% chance of her getting well. We also live with the fear that we could lose her. We have journeyed with her for the past 15 years and have seen her suffering as she has tried every treatment available to her. We have all been profoundly impacted by her illness. Our current mental health system has failed our daughter. We need answers. We need treatment. And, we need it now. Tomorrow our daughter may not be here.

Unless you have lived with the fear of your child taking their own life, you will never truly know how it feels. Thousands of mothers, live with that fear every day. Our journey has taken us to countless specialists and across the world. We have watched the work with treatment resistant PTSD using Medicinal MDMA, which is often confused with the recreational drug Ecstasy, Ecstasy is frequently adulterated with more dangerous substances and taken in unsafe environments. We learnt about the outstanding remission rates from Medicinal Psilocybin (which in its natural form comes from certain mushrooms) for treatment of depression. We are confident that these medicines offer real hope. We know that no treatment, even the current ones advocated by our government, is without risks and that the answers are not simple. But we deserve hope.

Clinical trials with medicinal MDMA conducted overseas demonstrate remission rates between 60-80% for treatment resistant PTSD. We were confident Australia would embrace this research in an applied way. Surely, we would act when potentially one of the greatest shifts in psychiatric medicine is knocking on the door? You can imagine our dismay when the TGA refused to reschedule MDMA in its recent Interim Decision. The news was heartbreaking.

The irony is that the TGA is already authorising individual requests from psychiatrists to use these medicines with therapy under its Special Access Scheme, but their listing as prohibited substances in Schedule 9 of the Poisons Standard means that there is no ability to get State and Territory Government approval which is also required so that patients can be treated and have a chance to finally get well.  All this will change if they become Schedule 8 Controlled Medicines.  What a cruel system we have. Providing hope with one hand and taking it away with the other.

I contacted the TGA for answers and found their response deeply disturbing. Their justifications were not based on data or science, but rather demonstrated deep bias and misrepresentation (for example, calling these medicines ‘illicit substances’ when they would, in fact, be used only in clinical medical environments). Their responses were offensive to sufferers and their families.

I contacted the RANZCP in the hope that they would show the capacity to lead us out of this crisis. It was clear that they cannot accept the facts which are undeniable and globally supported by leading experts, that these treatments are a viable and safe treatment option.

These bodies MUST begin to rely upon the validated data generated by the wider medical community. Do they suggest the outstanding research done at the leading Universities around the world is not valid or sufficient? Do they believe that countries that have enabled psychiatrists to use these therapies under Expanded Access Schemes have done so without high levels of regard?  These therapies have been granted Breakthrough Therapy Designation by the USA regulator and my daughter should be given the chance to access these therapies in Australia. Sadly, the Australian community is losing trust in the ability of our institutions to lead us forward. They risk becoming irrelevant as more and more Australians seek treatments conducted illegally by underground therapists.

I contacted every Australian Senator and the common response I have received was “we are sorry for your suffering but it is in the hands of the TGA and RANZCP”. These responses reveal that the TGA and RANZCP have too much power; beyond that of even my elected representatives. I elected my politicians to speak for me and lead us forward, and, as yet, few seem willing to ask if these bodies are advising them correctly and acting in the best interests of Australians. Who will challenge them on my behalf? Has my government forgotten they are here to serve my daughter?

This is so much bigger than my daughter. I speak also for those who don’t have a voice. For the lives already lost and for the families too enmeshed in simply surviving to speak out. Our nation is in a mental health crisis where 1 in 5 Australians have a chronic mental health condition and at least 1 in 8 are on antidepressants including 1 in 4 older adults and 1 in 30 young children.

Anxious adult

Australia should be leading the world in treatment, but instead our system is on its knees, bogged down by regressive thinking that places us as one of the poorest performing countries. We need innovation and leadership from our politicians and our medical establishment.  We can make Australia a leader in this field.  I imagine a day when the world looks to us. A day when no Australian suffers unnecessarily or dies from a treatable mental health illness.

I have NO doubt that the tide is turning and we will see these medicines rescheduled. The push from Australians like myself, WILL bring about this change. I believe the government knows this too.  They know they WILL lose the battle but don’t seem to care about those that will die in the final days of this “war”.

So, it’s time. Enough procrastination, posturing and politics. Our representatives MUST do the job that we have a right to expect of them.

I am praying that the TGA’s announcement this week, that it will be seeking further advice before making the final rescheduling decisions for MDMA and psilocybin will at last mean that the data and facts will come to the surface and block out the bias and stigma. Then finally, change will happen. The TGA has promised an Independent Expert Review into the therapeutic value, risks and benefits to public health outcomes for these medicines. My daughter and so many other sufferers need this so urgently, but I am not holding my breath.

If our government and health agencies continue to fail us, we will be forced to re-mortgage our house and attempt go overseas for treatment. To countries that lead the world in the treatment of mental health. To countries that care in actions, not just words. I will then shout from the roof tops, that my government has failed me and I am deeply ashamed of the country we have become.

Annie Mason

Annie Mason is an educator with a wide range of experiences including classroom teaching K-12, Special Education and Student Wellbeing. She was a Principal for over 15 years and has a special interest in Gender Equity, Social Justice and Women in Leadership. She is a strong advocate for the legal and ethical rights of those with mental health issues.

Healing A Troubled Mind: A Personal Perspective On Victoria’s Stagnant Mental Health System

Person standing near lake

The Royal Commission’s report on the Victorian mental health system sent shockwaves throughout the State, one of which landed squarely on a patient of mine. They noted that Victoria’s mental health system is “not geared for…change”. Just to ensure we got the message, and despite a Federal Government TGA approval, my request to treat my traumatized patient with MDMA-assisted therapy was declined by our state’s regulatory authority.

To be clear, my disappointment lies not with the state government regulators, nor with the medical opinions suggesting MDMA-assisted therapy should not be used for treatment of traumatized patients (despite excellent emerging evidence that it works with little risk). I understand these opinions, though I certainly do not agree with them.

My issue is a more troublesome one. Underlying these opinions is a problem with how we practice psychiatry, which in turn reflects the alienated community in which we live. Mental health paradigms are always a reflection of the society which supports them. You see, us Australians are alienated both intra-personally (from our own emotional worlds) and inter-personally.

Our current paradigms tend to view mental illnesses in a biologically reductive way. In other words, mental illnesses are both understood and treated primarily as biological diseases (which they are not). The posters at your doctor’s rooms will teach you – depression is just like any other medical disease, such as heart-failure or emphysema. In this paradigm, entities such as addictions and depression are seen as distinct phenomena. They are treated in our current system as totally different diagnoses by entirely different teams. The alienated individual who suffers from depression and addiction is labeled with the alienating and erroneous term ‘dual-diagnosis’, which enshrines the division. Furthermore, if addictions are understood (as they are) as inherited conditions (which they are not), and primarily as brain diseases based in dysfunctional dopamine rewards circuits, they will be primarily treated as inherited brain diseases, by doctors with medications.

But what if we have got it all wrong (which we do). You see, addictions are heritable but not inherited (there is a big difference, I recommend looking it up), and the chemical dopamine in no-way explains addictions. Rather, it is the human experience of dopamine (along with numerous other chemicals) which explains addictions, suggesting that addictions are rooted in difficulties with the human experience of life, rather than the neural correlates of those experiences.

The events which lie at the root of illnesses such as addictions and depression are those which overwhelm the mind’s ability to process and integrate. We know that the presence of adverse childhood experiences is present in the majority of (if not all) people with addictions and chronic depression. But rather than seeing these conditions as consequences of trauma (which they are) and treating the underlying emotional issues (which would help), our society mistakes the symptoms (depression and anxiety) for the disease itself. We treat depression as depression and addiction as addiction and all the while we are missing the forest for the trees. The real disease is the high prevalence of trauma, alienation, and neglect in our society. After all, it is these conditions which twist and distort the mind into the contortions which fill the latest catalogues of mental illnesses.

Which brings me back to my patient. Traumatized when young, she has suffered from every diagnosis a psychiatrist’s finger can point at. She has had every treatment a medical guideline can fathom. Yet her trauma remains in place, because no-one has been able to reach it. Suddenly, on the horizon, a change is coming. Treatments like MDMA-assisted therapy appear to touch the root of the trauma, allowing individuals to process the unintegrated parts of their minds, and offer the chance of real healing. But we don’t change. Our outlooks have ossified, our diagnoses have desiccated. And all the while we suffer in our own blindness. People continue to kill themselves, and my patient will continue to suffer in silence until the Victorian Government allows me to access a new treatment which may finally bring peace to a troubled mind.

Dr Eli Kotler

MBBS MPM FRANZCP Cert. Old Age Psych. AFRACMA

Eli is a consultant psychiatrist, holds an academic position at Monash University through the Alfred Psychiatry Research Centre, and is the medical director of Malvern Private Hospital, the first addiction hospital in Australia. He is a member of the Australasian Professional Society on Alcohol and other Drugs (APSAD). Clinically, Eli is interested in the deep connections between trauma and addiction and works within a neuro-psychoanalytic framework. Eli has overseen the development of a clinical program for addictions focused on trauma, particularly developmental trauma. This has led to an interest in medication-assisted trauma therapy. Eli worked for many years researching neurodegenerative diseases and was the principle investigator on numerous trials for novel therapeutics. He is founding member of the Melbourne Neuropsychoanalytic Group and welcomes new members. Through involvement with Monash University, Eli oversees the addiction rotation for medical students.

Eli graduated from the first intake of the Certificate in Psychedelic-Assisted Therapies (CPAT) in June 2021. He has also been recently appointed as the Principal Investigator to lead Emyria’s upcoming MDMA trial.

When You Trip Upon A Star

 

Unraveling the inspiration behind various acclaimed Disney films.

Can psychedelics be used to address childhood trauma and better understand imagination?

Walt Disney films are a cornerstone of childhood. Today, the Disney corporation is one of the most powerful media and entertainment enterprises in the world. Without even realising it, the company has probably influenced your own imagination, and in some way shaped your beliefs, values, and morals. However, before it turned into a global giant, it all began with a mouse.

Undeniably, Walt Disney had an enormous influence on the animation industry. He is the most renowned animator, filmmaker, screenwriter, and producer in cinematographic history. Hailed as “the Father of Animation”, he was the first to pioneer full length cartoons with synchronised sound and technicolour. Walt had one of the most important impacts on the development of animation and ultimately produced over 650 films or shorts in a career that spanned decades. Since then, Disney researchers and animators have continued his legacy, with further contributions to animation, science, and technology.

While Walt Disney’s career is not without pitfalls and controversy, it is indisputable that he changed the world with his creativity. How did he manage to always keep that childlike perspective? As Walt himself said, “That’s the real trouble with the world, too many people grow up.”

Disney was known for being an innovator. He was continually one step ahead of his peers and was constantly seeking new ideas. Could it be that the act of his creative mind was influenced by psychedelics? Walt is not alive to confirm or deny these rumours, yet widespread speculation of his use of hallucinogens is commonly assumed. Perhaps we will never be able to prove these claims, but there is one thing that is certain — the magic of Mr. Disney was his ability to preserve his childlike imagination throughout his lifetime.

There has long been reports that members of the creative Disney team were involved in the use of psychoactive substances. Is it such a far cry for Walt himself to have indulged as well? According to a letter by Paul Laffoley, an American visionary artist, Disney was indeed influenced by the hallucinogen mescaline, found in the Peyote cactus (Lophophora williamsii).

The letter goes on to say that in an attempt to explain “artistic implications of the new field of animation”, Walt arranged an interview with Josef Albers, the artistic director for the experimental liberal arts school — Black Mountain College in North Carolina. Josef, however, turned down the request. As a result, Walt then switched his intentions to the students at the college to aid his animated ventures. It was during this interaction with the students that he learned of their avid use of mescaline during their summer breaks in Northern Mexico. Laffoley claims this was the catalyst needed for Disney to become a frequent user himself.

Mescaline is a psychedelic alkaloid that occurs naturally in Peyote, San Pedro, Peruvian Torch, and other cactus varieties. These plants produce an experience similar to LSD or magic mushrooms: extravagant visuals, increased sense of connection, appreciation toward small and mundane details, and novel interpretations of the world around you. Studies show that mescaline can enhance creativity, which would explain why the art students would be enthusiasts of the substance.

Walt genuinely was determined to make real art. He was not only inspired by the natural world, but also by other visionary artists. This motivated him to team up with famed surrealist artist Salvador Dalí for the movie ‘Destino’, which initially started in 1945 but only saw eventual completion in 2003 by Walt’s nephew Roy E. Disney. Although the project was put on the back burner, both artists got more than what they bargained for out of their partnership. What started as a creative collaboration led to a lifelong friendship. Salvador Dalí is well known to have incorporated the psychedelic experience in many of his creations. With infamous artwork such as ‘The Psychedelic Flower’ and ‘The Hallucinogenic Toreador’, it would seem Dali was very open about referencing psychedelic terminology.

Another good friend of Walt Disney was none other than well-known and prolific English writer Aldous Huxley. Best recognised for his novel ‘Brave New World’ which presents a world where psychological manipulation is encouraged by regularly taking the drug ‘Soma’ — a potent hallucinogen that creates a strong sense of well-being. Additionally, Huxley is known for the notorious psychedelic inspired ‘Doors of Perception’ where he openly recounts his experience with the psychoactive compound mescaline.

In the fall of 1945, Disney brought in Huxley to work on the live action animation script for what was to become ‘Alice and the Mysterious Mr. Carroll.’ It has been stated that Walt rejected the script because it was too “literary” and didn’t capture what he wanted. Sadly, a fire destroyed more than four thousand of Huxley’s annotated books and documents, including most of his involvement on the ‘Alice’ project. Fortunately, the Disney Archives still has some of the story meeting notes and parts of the original script.

The classic children’s book ‘Alice’s Adventures in Wonderland’ by Lewis Carroll, is a tale that revolves around a girl who quite literally falls down a rabbit hole and finds an entirely new world to explore. Examining the psychedelic undertones within Alice in Wonderland’s storyline is not a recent phenomenon. The theory has been pursued by artists and critics alike. There is a possibility that people attribute this because it was written during an era when psychedelic use was rampant, not necessarily because Carroll was actually under the influence of anything. However, with characters like the hookah smoking caterpillar and the fact that Alice finds herself under the influence of a mushroom does make you wonder if the story was a by-product of mind-altering drugs.

No one knows for sure if Walt Disney himself was truly an avid user of hallucinogens. None the less, there is no doubt that he had many connections with certain collaborators who were well-documented in partaking in altered states of consciousness. Additionally, Disney’s work frequently reflected that of the psychedelic experience itself.

These references in Disney films are not an unusual occurrence. The feature film ‘Fantasia’ was even re-released in 1969 with a psychedelic poster and embraced by the counterculture amid speculation that Walt was under the influence when he produced it. The popular hallucinogen at that time was LSD, which wasn’t brought to the USA until 1949, too late to have been the original driving force behind Disney’s Fantasia. It is more likely that mescaline was involved.

The combination of classical music and visuals of nature coming to life is a typical blueprint of the entire psychedelic experience. Even the casual observer would notice the impressive context and landscapes in Fantasia. In particular, scenes such as the dancing Amanita Muscaria toadstool mushroom fuels the psychedelic influence speculation. The species contains two main psychoactive compounds, ibotenic acid and muscimol.

This scene was created by animator Art Babbitt, who was fully aware of the gossip surrounding the film and its possible link to drugs. So much so that in an interview, he sarcastically quipped: “Yes, it is true. I myself was addicted to Ex-lax and Feenamint” — which are merely over the counter laxatives. Other psychedelic plants can similarly be spotted in the film. These include: Morning Glory (LSA), Angel Trumpets (Scopolamine), Poppies (Opium), and what appears to be Datura (Atropine).

Fantasia is still considered one of the best visual works of all time. It continues to astound even though it was made in 1940. It’s mythological, spiritual, and occult visuals mixed with massive musical scores paved the way for animation. It allowed other animators to think outside the box. Walt even invented the multiplane camera to give the film the depth and dimensions to immerse the viewers visual senses. Disney was aware that the feature was an intricate and complex piece of art, that was unlikely to grab the attention of young children. What he wanted was to create discussion among the adults by presenting a work that changed the way they thought.

Fantasia is not the only Disney film that includes psychedelic undertones. Another infamous substance inspired clip was in the 1941 film Dumbo. The Pink Elephants on Parade is one of the most iconic trippiest scenes in cinematic history. Naturally at the time, it was negatively received and a risky move for a company who was in financial distress. The song is the result of a drunken trip Dumbo and Timothy have after inadvertently drinking a bottle of champagne. The pair start to hallucinate a collection of Pink Elephants. The lyrics of the song do a decent job of summing up the intensity of a psychedelic trip — “Technicolor pachyderms is really too much for me.” The scene is unlike anything Disney had ever done or has ever done since.

Countless other scenes in Disney animations such as Pinocchio, Peter Pan, 101 Dalmatians and The Little Mermaid show characters smoking. As a result, these movies have now had their availability limited on streaming services. Obviously, not all these scenes are referring to psychedelic use, however, some do seem questionable. In particular, the clip of Pinocchio’s reaction after inhaling what appears to be an ordinary tobacco cigar. His head spin seems fairly intense after his ne’er-do-well friend Lampwick tells him he is not doing it right. “Take a big drag. Like this.” The effect suggests many Disney animators might have been familiar with a bong.

You may be asking yourself; okay Disney was possibly inspired by psychedelics? So what? Well, since psychoactive compounds are still illegal in most countries, I believe it is critical to expose and emphasise the numerous key public figures that used these medicines. Not only have they certainly been the motivation for art and music, but behind notable innovations that have impacted the world, and changed the course of history. We may owe a lot more to psychedelics than we think.

They additionally have the potential to change the current mental health paradigm. Statistically this is getting worse every year, especially in children, and exaggerated by the current Covid-19 pandemic.

Sure, back in Walt Disney’s time the state of the world was certainly not all positive. Post World War II would have had an enormous traumatic effect on the collective consciousness. However, in general people’s lives would have been much more sheltered, contained and community based.

Humans today are exposed to more information than ever before. Scientists concluded that in 2011, Americans took in five times as much information every day as they did in 1986. This overwhelms the brain and continues to cost our mental faculties a great deal. The rise of social media in combination with consumerism, has led to an unrealistic view of our ourselves and what we think we should be. Constant exposure to the world’s troubles, have a detrimental effect on our psyche and raises levels of depression, anxiety, and addiction.

Walt was always focused and dedicated to family entertainment. He was determined to create Disneyland even when it was shunned by the rest of the Disney team. It was a major financial risk to the company, and Walt had to borrow from his life insurance to help fund the project. Fortunately, his vision paid off and today Disneyland is considered the most successful amusement park of all time. Walt truly wanted a place for children and adults to come together. Encouraging grown-ups to connect to their imagination without fear of judgement.

Interestingly, psychedelics seem to aid in connecting fully developed adult brains to their childhood state of mind. Carhart-Harris, a popular psychedelic researcher and Alison Gopnik, a researcher of Psychology at UC Berkeley, have both stated that the effects of psychedelics seem to resemble the mind of an infant.

Research using fMRI scans show that children have decreased default mode network (DMN) activity compared to adults, something that is observed in psychedelic users as well. The DMN is thought to be involved with ‘resting state consciousness’ and tasks requiring one’s attention seem to suppress this network. The DMN is not as strong in children because they have yet to develop strategies of ‘auto-pilot’ work, requiring more immediate awareness than adults. It also has to do with a less conditioned state of mind, as the DMN can be known as our ‘inner critic’.

Dr. Robin Carhart-Harris explains how the effects of psychedelics can assist those struggling with psychopathologies, that can be caused by certain childhood traumas and experiences. “Certain patterns, certain configurations in the brain can become overly reinforced. And some of the range of brain activity becomes sort of narrowed and limited. If you have these very debilitating disorders, then perhaps you could introduce something like LSD, which works to introduce a kind of window of plasticity or malleability — conditions for change, essentially — to try and sort of dismantle these entrenched patterns.”

It goes without saying that these medicines should only be used by adults. Legalising psychedelic psychotherapy could greatly assist those struggling, therefore, having an immediate effect on the way we raise the children of tomorrow. If done so with careful preparation, attendant psychotherapy, and proper integration psychedelics perhaps have the power to create a better future for all.

Disney Pixar’s newly released ‘Soul’, is an incredible exploration of the meaning of life. It is not the first time a Disney movie has posed the kind of big-life questions that face many middle-aged adults. The film is known in the Disney community as a sort of next chapter of the animation ‘Inside Out’ (which depicts characters that represent certain emotions, in the hopes of explaining psychological concepts to children). Both were equally successful at the box office and in exploring the metaphysical.

Soul’s protagonist, Joe, goes on a spirited adventure and is faced with questioning his purpose, if his dream was enough to fulfill him, and what life is really about. After finally getting his big break, Joe accidently dies and is drawn towards the proverbial light (similar to descriptions of 5meo-DMT and near-death experiences). Ultimately, spoiler alert, one of the movie’s many morals is that it is the little things that truly make life worth living. Joe realises that happiness may not arrive from accomplishing that which he dreamed of, but rather, by appreciating each quotidian moment.

In the film, “lost souls” wander the astral plane because they are anxious and depressed. Becoming too obsessed with anything, even if you believe it is your purpose, can lead to dissatisfaction and a disconnection from reality. Moonwind, the captain of a psychedelic galleon bearing a troupe of “mystics without borders”, helps rescue the lost souls. These characters also mention other transcendental practices or techniques such as yoga, meditation, drumming and psychotherapy.

The movie wants to leave its audiences asking questions about the meaning of life and the human experience as a whole. Introducing complex themes to children such as the idea of the flow state in the creative process, the fleeting nature of life itself and other philosophical debates. The fact that Disney animation is so comfortable with talking about the meaning of existence is a testament to how far we have come.

Personally, it is similar to my own experience with taking psychedelics, which in fact was the inspiration behind this article. I suppose the teachings and insights I received were similar to those themes explored through various Disney movies, even once seeing the Cheshire Cat during an Ayahuasca session in Peru. While there is already wisdom behind this character, the cat strangely explained to me through various visions that life is a riddle, and I will never figure it all out. Further reminding me that life is absurd and laughing at that is part of life’s whole trip.

I have directly struggled with mental health issues, especially with my own self-image. I believe this is associated with my childhood experiences; however, it has been further exaggerated by societies focus on the external. Psychedelics helped me better embrace my quirks, talents, and gifts that I have to give to the world. It was the first time I truly saw myself for who I am — a spiritual being having a human experience. It gave me a deeper understanding of the reasons why we are here.

Disney has always provided its audience with profound meanings. Some films are majorly influenced from ancient cultures and native indigenous spirituality, some who are well-documented for using plant medicines as a healing tool. These messages can be heard in the soundtracks from films such as Pocahontas, Brother Bear, The Lion King, Tarzan, Moana, Mulan, and the Hunchback of Notre Dame. Disney has forever been teaching children about understanding those with different backgrounds. With lyrics like “Show us that in your eyes, we are all the same” from Brother bear or “You think you own whatever land you land on; the Earth is just a dead thing that you claim” from the renowned ‘Colours of the Wind’. And who could forget the deep-rooted ideas in the iconic ‘Circle of Life’ from The Lion King, showing us the connectivity of everything.

In a world that is trying to make us fit in, Disney inspires us to stand out. What makes us different, makes us unique. As we grow older, we are no longer encouraged to be creative or playful. Becoming an adult is inevitable and can be wonderful when we hold onto our childlike curiosity. Certainly, nobody wants to be that person with Peter Pan syndrome. Yet, it is healthy to be reminded that we once were all children, trying to figure out and navigate the world around us. We still have an inner child; we must learn how to connect and heal them. A great deal of work is done in therapy around parenting your own inner child.

The reason Disney films are notorious for striking a chord with our emotions, is because it reminds us of our own childhood. We become nostalgic of a more innocent time when we would let our imaginations run wild. Sentimental of a period when the little things in life bought us so much joy. This is a key ingredient to healing the trauma of our collective past. Psychedelics reminds us of the magnificence of creation. They push us to take better notice of the beauty in nature or the emotion behind music. They help us see the interconnectedness of everything.

So, perhaps next time you sit down to watch a treasured Disney film or go to play one of their unforgettable classic movie soundtracks; you will have greater appreciation for those magical plants that maybe inspired fantasy worlds to be bought to life. I believe that they influenced and even played a starring role in countless Disney masterpieces. Seems in many ways, psychedelics and Disney go hand in hand, always encouraging us to bring more animation into our lives.

 

REFERENCES

Fast Company. 2021. Why It’s So Hard to Pay Attention, Explained by Science. [online] <https://www.fastcompany.com/3051417/why-its-so-hard-to-pay-attention-explained-by-science> [Accessed 6 March 2021].

Flicks.com.au. 2021. The meaning of Fantasia, Disney’s beloved psychedelic masterpiece. [online] <https://www.flicks.com.au/features/the-meaning-of-fantasia-disneys-beloved-psychedelic-masterpiece/> [Accessed 2 February 2021].

Maltin, L., 2021. When Disney got trippy. [online] Bbc.com. <https://www.bbc.com/culture/article/20151112-when-disney-got-adult-and-trippy> [Accessed 2 February 2021].

Medium. 2021. LSD, Childhood Memories, And the Science of Nostalgia. [online] <https://medium.com/@psychedelicsaremedicine/lsd-childhood-memories-and-the-science-of-nostalgia-32bebb1fe1e9> [Accessed 6 March 2021].

Npr.org. 2021. NPR Cookie Consent and Choices. [online] <https://www.npr.org/2016/04/17/474569125/your-brain-on-lsd-looks-a-lot-like-a-babys> [Accessed 6 March 2021].

Open Culture. 2021. When Aldous Huxley Wrote a Script for Disney’s Alice in Wonderland. [online] <https://www.openculture.com/2014/12/when-aldous-huxley-wrote-a-script-for-disneys-alice-in-wonderland.html> [Accessed 15 February 2021].

Paullaffoley.net. 2021. » Walt Disney and Josef Albers Official Paul Laffoley Website. [online] <https://paullaffoley.net/writings-2/walt-disney-and-josef-albers/> [Accessed 21 February 2021].

Psychology Today. 2021. “Soul:” A Psychedelic Adventure into Meaning. [online] <https://www.psychologytoday.com/us/blog/psyche-meets-soul/202101/soul-psychedelic-adventure-meaning> [Accessed 25 February 2021].

Gwerky science. 2021. The Phoenix Effect: Reversing Mental Age with Psychedelics. [online] <https://mad.science.blog/2020/08/16/the-phoenix-effect-reversing-mental-age-with-psychedelics/> [Accessed 6 March 2021].

Secret of the Vine. 2021. Disney Psychedelics & the Occult | Secret of the Vine. [online] <https://www.secretofthevine.com/disney-psychedelics-and-the-occult> [Accessed 28 January 2021].

A Magic Medicine Journey

Psychedelic Prism

I want to start with a snapshot of how I am possibly different from the average person. I don’t smoke or drink. Before this chapter of my life began, I’d never taken any drugs besides prescription medication (and those as rarely as possible). I live in Melbourne, the coffee capital of Australia, and don’t even drink it.

Yet today, my life revolves around psychedelic medicines – heavily stigmatised substances still illegal in most countries. This huge shift is likely confusing. However, my personal journey can hopefully provide a deeper understanding of why I co-founded Mind Medicine Australia (MMA), and how psychedelic-assisted therapy could change the face of mental health treatment.

Helping People find their Voice

Over the past two decades, I’ve founded 6 companies, 3 charities and am a Member of the Order of Australia. I’m a global speaker and an international soprano – performing both as a soloist and as part of a group and have released 12 albums.

Singing has always been a huge part of my life. This motivated me to create the charity Creativity Australia and social inclusion program, With One Voice. My mission was to bring together people from different backgrounds, generations, faiths, and cultures by forming social inclusion choirs that bring together ‘haves’ with ‘have-nots’. Singing together can help alleviate loneliness, depression, and social isolation. I explain this further in my recent TED talk, which has received over 100,000 views so far.

I’ve personally witnessed that helping people find their voice can unlock their full creative potential. Similarly, I also believe psychedelics have a monumental role in helping achieve this. I know they will allow me to scale this mission… but I’ll get back to that. First, I think it’s important to tell you about my own experiences with psychedelics.

From Sober to Psilocybin Seeker

Taking an illegal substance had never occurred to me until I stumbled across Michael Pollan’s article in The New Yorker titled ‘The Trip Treatment.’ Reading it not only made me aware of the current resurgence in psychedelic research but also helped me to understand how these ancient plant medicines were assisting people to heal from a host of mental health issues.

From that point on, my interest in trying these hallucinogenic plants began to grow. I had no idea what it was like to be drunk or out of control. Yet the majority of people expose themselves to these altered states on a regular basis. I wondered if perhaps I was missing out on an essential human experience. What could psychedelics teach me about who I am or who I could be? Through exploring my psyche, what unknown parts of myself and our cosmos could psychedelics grant me access to?

So, I recruited the support of my now-husband Peter, and set out on a quest to have a therapeutic experience with psilocybin mushrooms. Having sadly lost his father to suicide in his early teens, Peter was also interested in dealing with past traumas.

However, being able to do this in a safe and legal setting proved difficult. After first trying and failing to get into global trials for healthy patients, we were ultimately referred to a private therapist in the Netherlands, where the use of psychoactive truffles is legal. We ingested a large dose of psilohuasca – a combination of psilocin-containing fungi and Syrian Rue, a MAO inhibitor used to enhance and prolong the effects of a trip.

The Inner Journey

Fair warning – describing what it’s like when you take psychedelic substances is difficult. My first time was completely removed from anything I’d encountered before. Unless you’ve personally experienced it, there’s really no reference point for understanding what it’s like. However, I can tell you that from then on, my life veered off in a very different direction.

The combination of having never lost control before and hearing stereotypes around psychedelics, made me incredibly nervous. I believed that it was going to destroy my brain. Turns out, this is far from reality. What happened was one of the most meaningful experiences of both our lives.

Firstly, the medicine completely shot us into space and, at the same time, through the Earth, rivers and oceans. What initially overwhelmed me was this incredible sense of oneness.It was as if all boundaries dissolved and I was left with the sheer magnificence of our planet. The connectivity of everything was indescribable. I haven’t been able to eat meat or even step on an ant since.

Being confronted with personal pain is a common experience during a psychedelic trip. For myself, as the daughter and granddaughter of Holocaust survivors, I’ve lived with transgenerational trauma my whole life. I was faced with this horror during my experience and have undergone transformational healing as a result.

These realisations were profound, but it’s the deeper insights we gained about ourselves that have left a lasting impression. The self-development Peter and I dove into following that first overseas expedition was vital for us to really integrate our life-changing experience. These lessons were so powerful, we didn’t feel compelled to have another session for a whole year. Research shows that the psychedelic experience significantly decreases activity in the brain’s default mode network. However, it’s the work that’s achieved in subsequent integration that leads to lasting wisdom. Incorporating the experience into your life, is just as important as the experience itself.

The neurogenesis and increased neural plasticity created by the medicines is truly remarkable. It’s like hitting the reboot button on your brain’s computer and defragging the faulty drives. I’ve noticed my creativity has increased tremendously. I’m able to access more moments of flow and purity in my singing, public speaking and writing. I’ve also recognised real lifts in my energy and consciousness. I feel many neural pathways have reconnected for me, new ones have formed and missing parts of myself have been found.

Psilocybin and Placebo

Creating a Movement and Making a Difference

Fast forward a few years later and Peter and I now seek out a session every four to six months. We call it our reset button. Every time we work with these medicines, we get new downloads and join more dots. Not only have we woven psychedelics into our lives, but the immense value we’ve gained from these magical medicines is what inspired us to establish our fifth charity, Mind Medicine Australia in 2019. Whilst our other charities are helping thousands of people through women’s shelters, social inclusion choirs, educational programs, poverty alleviation and microfinance, we acknowledge that at the heart of any kind of social isolation or disadvantage lies mental illness.

Mental illness keeps a person isolated. Sufferers often deal with rigid, negative thought patterns and intense feelings of despair. Every day we get emails and calls from those who’ve tried medication or therapy and are at the end of the road. We need to treat the underlying cause if people are to genuinely heal and lead more meaningful lives.

Having celebrated our second anniversary in February 2021, MMA is focused on expanding the treatment paradigm available to specialist health practitioners to reduce Australia’s terrible mental health statistics, which are worsening because of the current and ongoing COVID-19 pandemic. Of particular concern and pertinence are the high levels of mental illness, addiction, and suicide amongst the veteran, first responder and other marginalised population groups.

Before the pandemic, 1 in 5 Australians were experiencing some type of mental illness. 1 in 8 adults, 1 in 4 older people and 1 in 30 children (some as young as four) were estimated to be on anti-depressants. Their use across the country has risen by a massive 95% over the past 15 years. Still, mental health statistics continue to get worse, resulting in one of the highest rates of mental illness in the world. Recently, mental health experts announced that the COVID-19 crisis could lead to a 25% increase in suicide rates. Incidence of trauma, anxiety, depression and substance abuse are all accelerated by the pandemic.

Depression treatment methods haven’t substantially changed for decades and reversion rates are as high as 80% following medication. Side effects and withdrawal symptoms are common problems. Anti-depressants and psychotherapy lead to remission for less than 35% of suffers and the rates for PTSD are around 5%.

On the other hand, MDMA and psilocybin-assisted therapies are considered safe with remission rates of between 60-80% being achieved from over 150 current and recent trials. Evidence suggests psychedelics are low in toxicity, non-addictive, and show no signs of producing organ damage or neuropsychological side effects. These medicines are also proving to be very effective at treating various addictions. Practitioners describe them as ‘antibiotics for the mind’ due to their outstanding efficiency and short nature of treatment programs.

Research showing the benefits of these therapies are taking place at many of the world’s most prestigious universities including Johns Hopkins, Yale, UCLA, Harvard, Oxford and Imperial College London. Furthermore, these therapies are already legally available in the USA, Switzerland, Canada, Israel via Special Access Schemes. Some psychiatrists and prescribing physicians we work with have also recently received approvals for use of MDMA and psilocybin-assisted therapy for their treatment resistant patients via Australia’s SAS-B pathway.

Psilocybin-assisted therapy for depression and MDMA-assisted therapy for PTSD have achieve “Breakthrough Therapy” designation from the FDA in the USA. This designation is only granted to medicines that could be vastly superior to existing treatments to fast-track the approval process. MDMA, which is in Phase 3 trials, is likely to be a prescribed treatment for PTSD in the USA within 18 months. There are also trials underway for the treatment of end-of-life depression and anxiety, alcohol and drug addiction, dementia, strokes, anorexia and other eating disorders, cluster headaches and chronic pain.

Scaling the Mission to Set People Free

In preparation, we need to ensure that practitioners are properly trained. Our Certificate in Psychedelic-Assisted Therapies commenced in January 2021. This is the first course of its kind in this field in the Southern Hemisphere and is being designed in collaboration with the world’s leading programs and features a Faculty of global leaders in this field. Both our intakes for 2021 are proving popular with practitioners including psychiatrists, psychologists, GPs, mental health nurses and social workers.

Mind Medicine Australia is in the process of establishing an Asia-Pacific Centre for Emerging Mental Health Therapies. Its main mission is to expand the mental illness treatment paradigm in Australia and boldly position Australia as a global leader in mental health innovation, with partnerships encompassing University, philanthropic, private industry, and government sectors. MMA is also a part-funder of the nation’s first psychedelic clinical trial, currently underway at Melbourne’s St Vincent’s Hospital. We are also currently planning a Major International Summit for 2021, attracted a great Board, Advisory Panel and have support from major players in the psychedelic space. These include pioneers Roland Griffiths from Johns Hopkins University, David Nutt and Robin Carhart-Harris from Imperial College London, Rick Doblin from MAPS and many others.

What psychedelic medicines provide is an extremely effective treatment option for medical professionals who are desperately seeking innovation in the way we treat mental illness. They can help us rediscover our connection to ourselves. We can’t love others unless we first love ourselves. Psychedelics used intentionally also have the potential to help us solve other serious challenges, such as environmental and political issues, homelessness, and domestic violence.

A great deal of pain and suffering could be alleviated by introducing genuine connection back into people’s lives. If the pandemic is teaching us anything, it’s that humans are social creatures, and losing that connection can drastically affect our health and wellbeing. My first mission was to heal through the power of music, and don’t get me wrong, I’m still very dedicated to doing this. Yet today, with MMA, we’re taking that mission and scaling it in a way I could’ve never imagined possible.

Tania de Jong AM

LL.B (Hons), GradDipMus

Tania de Jong AM is a trail-blazing Australian soprano, award-winning social entrepreneur, creative innovation catalyst, spiritual journey woman, storyteller and global speaker. Tania is one of Australia’s most successful female entrepreneurs and innovators developing 5 businesses and 3 charities including Creative Universe, Creativity Australia and With One Voice, Creative Innovation Global, Mind Medicine Australia, Dimension5, MTA Entertainment & Events, Pot-Pourri and The Song Room.

She works across the public, private, creative and community sectors and is passionate about mental health, innovation, diversity and inclusion.  Tania speaks and sings around the world as a soloist and with her group Pot-Pourri releasing twelve albums. She is Founder and Executive Producer of future-shaping events series, Creative Innovation Global.

She was appointed a Member of the Order of Australia in June 2008. Tania was named in the 100 Women of Influence, the 100 Australian Most Influential Entrepreneurs and named as one of the 100 most influential people in psychedelics globally in 2021. Tania’s TED Talk ‘How Singing Together Changes The Brain’ has sparked international interest. Tania’s mission is to change the world, one voice at a time!

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.

 

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