Psychedelics and mental illness
stuartritchie.substack.com
stuartritchie.substack.com
However he shows the same kind of bias that he is speaking out again by not discussing the best known branch of such research. And that is MDMA for PTSD.
It is best known simply because it is, in fact, demonstrating that it works. The FDA has been repeatedly calling it a "breakthrough therapy" since 2017. It is in multiple phase 3 trials around the world that are going well, and full approval is expected this year. Research papers on it, like https://www.nature.com/articles/s41591-021-01336-3, are appearing in the top science journal in the world and are no less enthusiastic than a press release. Let me quote, "These data indicate that, compared with manualized therapy with inactive placebo, MDMA-assisted therapy is highly efficacious in individuals with severe PTSD, and treatment is safe and well-tolerated, even in those with comorbidities. We conclude that MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation."
So no matter how much questionable research there may be - and I'm sure it is a lot - let's not throw out the baby with the bathwater. There is also good research, and these drugs have the potential to make a huge difference.
The article actually discusses that very paper:
> While we’re here, it’s worth talking about the MAPS MDMA-therapy trial itself. In May 2021, to much media fanfare, they published their Phase III clinical trial in Nature Medicine. The trial reported enormous, nearly unbelievable effect sizes: 0.91 of a standard deviation difference in score on a PTSD questionnaire between an MDMA and a placebo group (both groups got therapy). That’s the kind of effect medical researchers fantasise about.
> Are these effect sizes plausible? Nature Medicine also published two critical commentaries on the paper. The first one points out the issue we discussed above: that the blinding was almost certainly compromised in the study, since the control group got a completely inert placebo and the treatment group surely could tell whether they’d been given ecstasy. Expectations could have played a major role, and might explain at least some of the huge difference between groups (the commentary also makes the interesting point that researchers used to be required to collect data on which condition patients thought they were in, but since 2010 this is no longer the case. It might be time to bring back this rule). The second commentary asked for studies with more relevant control groups and longer follow-up periods to check the safety of the treatment. The MAPS researchers also responded, somewhat limply.
> The journal also published an entirely uncritical commentary co-authored by Imperial College London’s David Nutt. Remember him? He was Fired4Truth as a drugs adviser by the UK Labour government in 2009 for criticising government policy on drug classification; he’s now a major psychedelics researcher who co-authored the psilocybin trial we encountered above. The commentary calls MDMA “remarkable” three separate times in about 1,000 words (it’s true the effect sizes in the study are remarkable, but what if they’re due to expectancy bias?). It also says it’s likely that MDMA “will be an approved medication within a few years”.
> So there’s a final potential harm that stems from the breathless hyping and cheerleading of psychedelic treatments way beyond the evidence: it could mean that therapies—which come with their own rare but real dangers—are approved and rolled out to large numbers of patients when we need a lot more evidence that they really are beneficial in the long term.
My guess is if this scientist did psychedelics he wouldn't have written this article.
That was my thought too, though that also runs into the author's argument that psychedelic research is heavily biased by people who have tried it. On the other hand, I think people who have not tried psychedelics have never experienced how much of what they think of as objective, rational mind is actually fairly fluid, and how much the referential frame of experience informs and influences what we'd consider objectivity.
Physics research is heavily biased by people who live in reality.
Oncology research is heavily biased by having study participants who have cancer.
Am I missing something?
I don’t know if someone who has never taken psychedelics can adequately understand what it is like, unless they have experienced something similar without taking psychedelic substances. (That is, spontaneous, visionary experiences). There’s an intellectualization of what the person thinks this experience is about, as a substitute for direct experience.
A physicist might study physical phenomena, but what they work with are models about those physical phenomena, and then call that “reality”. That isn’t reality. Those are models of physical phenomena with high degree of predictive ability.
Rather, if you want to use an example of someone who attempt to directly experience reality, we’re talking about Zen practitioners or one of those non-dual teachers. If you hear them talk, they spend a lot of time saying very plainly, you don’t really experience reality directly. But people hearing it pretty much nod their head and think that they do.
As far as oncology research goes, you are right. It is biased towards study participants with cancer. Not only do the _researchers_ themselves are not experiencing cancer themselves (unless they got cancer), but what is _not_ being studied is what health and wholeness looks like and contextualizing cancer that way. Instead, we’re getting to know a lot about the mechanisms of cancer, and the various causal chains of cancer, and this limits our view to that of the body as a machine. That by somehow understanding all the fiddly bits, we would understand the whole, and we won’t.
What if this were applied to everything? "95% of participants preferred the meal of pizza to the one that was hard tack and water. However, participants might have just had pre-existing bias that pizza was tasty, and they were able to identify whether they were eating pizza. No conclusions can be drawn whether pizza is actually tasty or this is simply a placebo effect caused by the participants' expectations."
Out of curiosity, is there anything specific about them that you think make them weaker critiques?
> either way they are doing another phase 3 trial so we will know.
As long as (potential?) weaknesses are not repeated; for example, if loss of blinding is indeed a significant issue and the second trial also suffers from the same flaw, then I think it's not unreasonable to call into question the utility of that second trial.
It's an interesting consideration that I think is part of the excitement and buzz these articles generate. I think many people would experiment with psychedelics and other harder drugs if they knew the safety was very high and that it might correlate to other benefits such as overcoming past emotional blockages or looking forward to tomorrow with brighter eyes.
I said all of that to say that I take these articles with a grain of salt. Some of these well-known drugs may very well have amazing positive benefits for a select group of people experiencing a correlated negative existence, but I strongly doubt that any of them will be a panacea for any of the more universal ills, that is to say, I doubt casual sadness or unhappiness will ever have a treatment in pill form. These treatments will most likely be best reserved for the people who have deep and abiding emotional and psychological scars that traditional holistic approaches ("whole-body", not new age woo woo) would be entirely unable to treat.
We'd ordinarily use at least - at least - an alpha-2 agonist like prazosin. Even going with just that would be malpractice-bordering conservative for severe PTSD.
[0] https://stuartritchie.substack.com/p/psychedelics?s=r#:~:tex...
And the issue isn't just psychedelics being hard to study. Mental health is hard to study. An overweight man with no friends who plays computer games all day is not depressed unless he feels bad about it. Mental health depends on subjective feelings. Hard to study that!
My view is that we should continue to think about psychedelics from a religious or spiritual perspective. Even if that's literally incorrect, it's the correct metaphor. I'm also very skeptical of people who think widespread use of psychedelics can make society better. Lots of people used LSD in the 60s and 70s and as far as I can tell they didn't usher in a new age of love, peace, and tolerance.
This isn’t correct in a lot of places. There is a number of diagnostic criteria. The most important being how much it affects your quality of life.
This can be directly measured by looking at how the individual functions day to day. An example is “Was the person able to shower regularly?” (This assumes the person wishes to shower if they have the ability and opportunity.)
It’s pretty easy to record the number of panic attacks or how often the person has suicidal ideation.
ADHD can be measured by asking the individual to preform tests under specific conditions.
Significant changes in psychosis and paranoia can readily be determined with structured interviews.
The problem is most of these things are not easily and correctly measured by a questionnaire. You need more expertise to get this information out of a patient.
I think there's unavoidably an element of subjectivity here. You can attempt to minimize it but it's always there.
Well… yes? You’re not going to seek help for mental illness if you don’t think you have a problem. You’re also not going to enroll in a study, either.
This is unique among illnesses. Whether or not I have a cold does not depend on how much it affects my quality of life. Why is mental illness different?
By definition symptoms affect your quality of life.
A person’s baseline can be altered by mental illness but not severely enough to be indistinguishable from a personality difference. Telling the two apart is damn near impossible.
Since we don’t have blood tests, we cannot tell the difference. So we need to fall back on want little objective criteria can be found.
Behavioral criteria can be skewed due to environment. An active kid who wants to run around isn’t going to do well being stuck in a classroom for six hours. A curious kid with ADHD, who would otherwise be a good student also won’t do well because they can’t stay on task. These look identical. (This is why ADHD is both over and under diagnosed.)
This results in family history and quality of life being more objective than self-reported feelings.
Previously, we had a terrible habit of identifying "mental illness" by external factors, such as meeting social and moral norms (so being gay was considered a mental illness, as was being troublesome).
To avoid this, and given that our understanding of the fundamentals has barely improved, if at all, we have chosen to take an approach that is much less likely to cause extraordinary distress to people who are perfectly well.
Remember that being labeled mentally ill can durectly rob you of your most basic human rights, so this is not a diagnostic that should be easily applied.
I remember getting scores of “mild anxiety” or “mild depression” and just kind of sitting there confused and somewhat dismayed, thinking… “Why am I having such a hard time? What is actually wrong with me?”
Turns out some of my core issues were difficulty knowing and connecting with my emotional state, constantly trying to meet intense expectations that I believed were necessary regardless of how I was feeling, putting (what I imagined to be) the needs of others above my own needs, and having deep fractures in my sense of self-worth.
Five years ago, I was largely oblivious to all of that. All though some pieces of the puzzle had been slowly coming together for some time.
Some potentially more informative labels for what I’ve been dealing with: C-PTSD, emotional neglect, and / or highly sensitive person.
C-PTSD isn’t even in the frickin DSM! I had taken online questionnaires (the anxiety and depression ones mentioned earlier were from medical professionals) for PTSD. It didn’t really match up, which makes sense. There is less material for C-PTSD compared to PTSD. I did try one or two assessments I found online for c-ptsd and I think I got a score that was very close to the “clinical threshold”. Which was a little helpful. But it took me quite a while to get to that point and I was still confused and uncertain.
All that to say… The ”best in class” assessments, as well as our general ability to classify and understand the mental health difficulties that people experience, are not very good.
We can do much, much better. And doing so would alleviate an immense amount of suffering.
P.S. My advice for anyone who relates to this is to find a good somatic therapist who knows how to work with complex trauma / emotional neglect. It’s very difficult to work through this on your own. I was pretty skeptical about therapy… It took me 4 tries to find a good therapist. The first 3 were not that helpful. The somatic approach is important. If you haven’t found a good therapist, keep looking!
I get really turned off by any article that acts like we have a clear understanding of these things. Most things are actually just reactions to trauma.
Anyone with a non-trivial case ends up in informed (or poorly-informed) guesses territory.
> Most things are actually just reactions to trauma.
I don't think this is quite correct. Mental illnesses have a lot of overlapping and contradictory criteria because all of the categories are rough patterns.
Many share the same symptoms of trauma and people with mental illness are more likely to have trauma.
This does not mean the majority of mental illness is caused by traumatic events.
Again anecdotal, but every person I know (including myself) with some sort of mental illness has ultimately just been due to trauma. I'm sure there are other things that happen, but too many therapists jump over that toward some other diagnosis that's just a symptom, then have some specific treament/medication for that DSM-5 diagnosis.
I finally found a therapist that explained this to me and really dug in on what had happened in my life and I finally began processing it and I'm now better. This is after seeing ~7 different therapists and having ~10 diagnosis.
It sounds like you're agreeing. Mental health is subjective feelings. When we want to study it, we reduce it to an objective measure of a few dimensions, like those diagnostic questionnaires. This removes its complexities, but also allows some level of standardisation across studies.
That's an overblown stereotype. The vast, vast majority of people did not use any drugs in that era.
https://www.scientificamerican.com/article/americans-increas...
"In the late 1970s... 10 percent of high school seniors reported ever using LSD, compared with 6 percent today."
Ten percent isn't very much. Americans in the 60's and 70's were far more likely to support endless jail time for drug users than to be one themself.
Is this really a hill you want to die on? Seems like a rather large sample to me...
Here's a graph from wikipedia: https://en.wikipedia.org/wiki/History_of_lysergic_acid_dieth...
It took less than that to bring Pokémon-frenzy into my school, and it only takes 1-3% of a population to effect revolution.
I don't know, bud.
Things did improve, but of course how would you attribute it to that, and of course, how would you account for the effectiveness of the counter forces? Just because something didn't succeed completely doesn't mean we can conclude it has no effect, especially if it wasn't actually tried at the suggested scale. We have this problem in Vancouver with opioid addiction and there are some services in place but they are mostly shit and the government's overall plan is direly incomplete. Then people say "Wow, we spent money on harm reduction and still have addicts".
> And that, I think, was the handle—that sense of inevitable victory over the forces of Old and Evil. Not in any mean or military sense; we didn’t need that. Our energy would simply prevail. There was no point in fighting—on our side or theirs. We had all the momentum; we were riding the crest of a high and beautiful wave. . . .
> So now, less than five years later, you can go up on a steep hill in Las Vegas and look West, and with the right kind of eyes you can almost see the high-water mark—that place where the wave finally broke and rolled back.
That's Hunter S. Thompson on the 60s drug movement. I'm not saying it led to nothing but it certainly didn't lead where its members expected and its legacy is far from clear.
I think we should continue to study these drugs. I just think there's a lot of unwarranted optimism.
For example, I feel the same way about the 90's Internet...
It's hard to explain the optimism a lot of people felt at the time.
It seemed like it could fix the world, what if everyone could just talk to each other? Couldn't we fix the misunderstandings?
We were gonna route around the censorship and cryptography (not crypto...) was going to free us from The Man. State control of "the message" through TV and newspapers was over.
I look at what we got and there it is, human nature staring right back at me.
Anyway, what a sap.
This is entirely wrong. You can suffer from depression (and anxiety) and attribute it to other things, such as personality traits. Many people think "that's just me" with those that know them thinking the same. For less acute forms of depression such as dysthymia, that's common. People can think they're entirely normal and they're just not good at certain things.
If you talk to sufferers of serious and disruptive mental illnesses such as schizophrenia and bipolar with psychotic features, most of them will deny they're ill at all and rationalise their behavior. They'll generally talk about it by saying "well my doctors say..." and suggest that their doctors have been mislead or have misdiagnosed them.
It's much more complicated than it seems. It's all part of the perniciousness of mental illness.
My post explicitly says the hypothetical man is happy, not that he thinks "that's just me".
If you want to argue against that, you have to define mental illness from a behavoral or functional perspective which I don't think you've done.
> Your statements seem to assume everyone has the same perspective to measure against, but in reality people's perspective can be radically different
On the contrary, I think people have different perspectives. Two people can be in the exact same situation and their subjective feelings can be radically different.
We definitely need to make judgements based on both behavior and subjective thought processes rather than just one or the other
This does seem to be true for some forms of mental illness, depending on exactly how you define distress. For example, someone going through an episode of mania (such as in bipolard disorder) is typically subjectively extremely happy with their state.
I would argue that LSD helped end the war in Vietnam. It's also not a fair criticism because governments around the world demonized LSD and made it a crime to partake, so you took it in an atmosphere of fear and paranoia. Hallucinogenics are only now given a fair test. There's already lots of anecdotal evidence that hallucinogens changed lives for the better (Steve Job, Richard Alpert.) A lot more has to change before a new age of love, peace and tolerance comes about, things like human greed and selfishness. No one is claiming that LSD turns people into angels.
is it? what is mental health?
"I'm also very skeptical of people who think widespread use of psychedelics can make society better. Lots of people used LSD in the 60s and 70s and as far as I can tell they didn't usher in a new age of love, peace, and tolerance."
what was the control in this experiment?
Is there any research that attempts to put a number on what portion of the population was using LSD at this time?
There's a documentary on UK late 90's rave culture that noted that perhaps 60-100,000 people in the USA indulged in LSD during the period you mention. By contrast, somewhere on the order of 10-20 MILLION people dropped MDMA/ecstasy during the heyday of UK rave culture.
The documentary went on to note that there are a lot of professional, retail and public spaces in the UK that have been built in the last 15 years that show particularly strong connections to the "chill out room" vibe that became significant during the ecstasy+rave period. Even real estate agent office (realtors in the US) design is claimed to show many elements of chill out aesthetics.
Why can't it be? Why can't we just start doing studies on people who have already had positive experiences with these drugs? Why is there an assumption that one size has to fit all? The data collected from them would useful as a control group regardless.
Psychedelics are even worse. The same dose of the same drug can produce wildly vary effects in the same person depending on factors we have trouble nailing down. "Set and setting" and the Erowid wisdom are all very well, but they are barely enough to describe the area and edges of the therapeutic window in a general way. Your trip, today, is still going to be an experiment.
I do have great respect for "real" shamans. But I met way too many fake ones, handing out horrible and dangerous advice, while glowing in their self declared illuminative state of higher consciousness.
Most are quite harmless and you still can have interesting conversations with them. Some are more weird and even dangerous, like this individual, which I have not met personally, but people like him.
It wasn't the first time I was doing Cannabis, but I haven't done any more ever since then.
High-THC cannabis has a very negative effect on my mind, mood, and motivation. But CBD-rich strains with low THC are perfect for handling my anxiety and autoimmune symptoms.
Research is particularly difficult in this area because the study volunteers are self-selecting for psychedelic research. Basically, anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out. This creates a huge risk of placebo effect when your patients are arriving with huge enthusiasm and preconceived notions of efficacy. Combine that with the weirdness of a psychedelic trip and it's a recipe for a sort of super-placebo.
However, that's doubly interesting in that maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo. Put someone through a weird, confusing psychedelic experience and tell them that it their life will be radically different afterward and maybe they'll believe it so much that it becomes their new reality. Weirdly enough, we have the opposite problem with SSRIs right now because so many patients will start googling side effects and become convinced that they're not going to work before they even take the first dose.
It's an interesting area of research, but I think right now there's too much crossover between the research and the pop-culture phenomenon of "psychedelics cure everything". It's also strange that so few people are questioning why all of the previous psychedelic users didn't notice that the drugs were treating depression. In fact, the common wisdom among psychedelic enthusiasts years ago was that psychedelics were to be avoided if someone was not in a good mental state, largely due to all of the negative reactions they noticed. It seems that telling someone "this will cure your depression" provides a different set and setting than just giving them the psychedelics without context.
What bothers me is the incessant pushing of this agenda:
> anyone ending up in a psychedelic research study is doing so because they think psychedelics are promising for mental health and they want to try it out
> maybe the real reason psychedelics show efficacy in depression is that they are a sort of super-placebo
This amounts to uninformed armchair dismissal that is inconsistent with a growing body of scientific evidence, and easily refuted by a cursory survey of recent literature and clinical trial results.
Surely you’re familiar with double blind randomized placebo controlled studies? I’ve linked you to recent ones in other comments.
These methods aren’t perfect and your concerns certainly have merit in general - I just don’t understand why you continue to make these broad and suggestive claims without any supporting evidence.
How can you not be aware of whether you have consumed a psychedelic substance or a sugar pill, assuming we are not discussing something like micro-dosing?
The short answer is yes: beyond mannitol, niacin, and even bespoke substances designed to mimic the organoleptic properties of ayahuasca have been used effectively as placebos.
At modest dosages (above the threshold of perception but within the therapeutic window) the side effects can be surprisingly similar in the general population, and thus difficult to distinguish for the average joe.
Of course studies vary widely in quality and rigor, so one must critique experimental design on a case by case basis.
I could not find any "placebo"-related links in your last 3 months of comments. https://news.ycombinator.com/threads?id=criticaltinker
Why didn't you include an actual link into your comment instead of referring to your unspecified past comment?
Oh yes, I've had a run in with a "psychedelic enthusiast", and this is so accurate. It was my girlfriend during my late 20s, a woman who was 12 years older, very into psychedelics, and pretty obnoxious about how beneficial they were. Of course, at the time I ate it up because I was kinda lost in life, and let her overcome my better judgement with her guru bullshit.
I'd previously only ever used marijuana, and had mostly negative experiences resulting in anxiety, so had mostly sworn off the idea of trying psychedelics until she came into my life. Long story short, I tried mushrooms once with her, fun for a bit, but then led into a crazy making spiral leading me to be convinced I'd never be the same.
I guess I was a glutton for punishment back then, because I also tried LSD with her twice, and it had pretty similar results. In fact the second trip shook me up in such a bad way that I think it took nearly a year to get the negative bits still remaining out of my head.
Of course her reaction after all this was that I was being too resistant and that I simply needed to have a "corrective experience". Fuck that! She seriously couldn't comprehend the fact that everyone reacts to psychedelics differently and that they might be quite dangerous for some people. Which seemed kinda crazy because she was actually highly intelligent, but possibly too arrogant to look outside her world. I seriously could have ended up in an institution if I had stayed with that woman (can you tell I'm venting a tad :) ).
I've later come to learn that I have a genetic mutation that reduces my ability to degrade dopamine in the prefrontal cortex by 75% (COMT met/met), leading to much higher baseline dopamine levels. After learning about this, it makes a ton of sense why I have such bad experiences with dopaminergic drugs like caffeine and Adderall (euphoria followed hours later by intense anxiety). Now I don't know how LSD and mushrooms impact the domaine system, but it does make me wonder if this genetic SNP, partially explains my propensity to anxiety/psychosis on these drugs. High baseline dopamine leads to hyperfocus, which is great for coding or other technical work, but terrible when you're stuck in a spiral of thinking you're going crazy and will never be the same.
Both are extremely "set and setting" sensitive. Take either on a bad mood day with bad weather, a dirty house, and stuff on your mind... and you won't have a good time.
That doesnt sound like the start of an apparently very promising candidate for treating depression and PTSD. Just goes to show how different experiences are, I guess...
It's an interesting experience, though.
I personally have no experience with psychedelics (and no desire to get any), so I am just looking with a bit of wonder at the differences from the sidelines.
What I find fascinating is that CBD absolutely has a psychoactive effect on me. I suspect that this is because of my prolific use of typical cannabis. The components of CBD must tickle the same pathways that are so accustomed to psychoactive cannabis.
The result is that I often get reasonably high from CBD hemp and CBD tinctures.
A high tolerance for cannabis seems to create a stronger response to CBD, at least in my case!
(Except maybe ketamine. Ketamine seems pretty consistent, in my anecdotal experience.)
The idea that cannabis would have inconsistent effects, or the effects of different strains was always a mystery to me until I watched it.
Isn't the same true for stuff like SSRIs? We don't know if/how they are going to affect the patient.
My wife has a good one: she burns opiates different, so they don't really benefit her. she just gets nausea from them. They've got her down as a "drug seeker" now cuz she refuses them.
> Just as you’d feel extra-sceptical if all the research showing that pork is unhealthy was written by Muslims who’d already decided for religious reasons not to eat pork, you should be worried about the sheer number of studies by psychedelic researchers who are themselves aficionados of the drugs.
Perhaps a better analogy would be: just as you'd feel extra-skeptical if all the research showing that exercise is beneficial was written by exercisers who'd already decided for experiential reasons to exercise, ...
It's not like people are born into the religion of psychedelia and have strong cultural reasons to conform. If something truly is good, of course the people researching it are going to be "aficionados" of it. And this doesn't save it:
> (You might wonder if they’re into psychedelics precisely because the research shows such impressive benefits, switching around cause and effect. But as we’ll see below, that evidence doesn’t exist yet. That particular horse is coming way after the cart).
Why can't they be into it simply because it worked for them?
There's nothing about the fact that psychedelic researchers are excited about psychedelics that by itself is suspicious, as we are strongly being led to believe.
I think an interesting observation is that this anti-psychedelics post is written by someone who doesn't even want to try them, so this argument of his also says to treat this blog post with skepticism.
It's also quite possible that they are excited about the potential to try a different method of reducing the suffering of patients with mental illness with more efficacy, or fewer side effects, or some other positive change. Anybody can be excited about something while doing another thing. Presumably at least some of these people wish to provide aid, um, when they are not reeling from acid, and grooving on E's, or apparently, assaulting patients, based on the article.
By the way, how does he know they use the drugs? He said some guy said he knew a lot of people who did. A valid concern with mental health is the difficulty of evaluating statements people make about their, or other peoples internal states, and for what reason they make such statements. Basically he's saying, "They're addicts! Some dude told me!"
That's literally hearsay, although this is not a court environment, I suppose. Still, I, for one, would prefer a bit more rigorous statement about this endemic drug use among researchers.
As for his example, lots of people don't eat pork, for a variety of reasons. If someone follows their procedure and replicates their results, then does it matter if they were Muslims? Skeptical? Have some bacon and do the experiment, see if you get what they got. Of course you wouldn't just take it on faith, my goodness! Not all, certainly, but some people don't allow their desires to supersede their professionalism. I don't know, are Muslims even that invested in not eating pork as to fake a bunch of studies to fool the masses into not eating back bacon?
Actually, given what we know about the replication crisis.. hmm.
But surely people who take psychedelics have their own subculture, right? Dr. Alice and Dr. Bob might spend long weekends listening to Cream and obviously Black Sabbath, and definitely some jazz, staggering high because they are trying acid to wean them off of the Oxy's they were into 3 years ago, or the boozing they did under quarantine ... but what if they got results that are worth looking into? Anybody who's known someone using psychoactive drugs surely... well the drugs available now sure seem sub-optimal.
( What about their kids? They're trippin with the kids? Really? REALLY? )
You know, I'm quite unsure about this assumption that the researchers need to spread their drug of choice to people claiming ( skepticism about the afflicted seems to be a theme in the comments? I guess they should just snap out of it? ) mental defect to a third party, which is a life changing decision.
I'm not saying that these things are impossible, or inconceivable. Unfortunately. I question the number of people who act like this, while maintaining well enough to author research papers and do Guardian interviews, vs the number of people who are enthusiastic about reducing suffering and are pursuing a surprising and somewhat promising avenue to do so. They would be in a great position if this work led to a better way of treating mental illness. Seems exciting.
Serious research with people who are detached from the drugs is something we should all want, especially because we've only had a short time for detailed records of psychedelics experiences to exist at all and most experiences to this day aren't really observed scientifically at all. I believe that science is the best thing we've got to approach the unknown, psychedelics aren't a "godly exception".
I also remain aware that science doesn't always offer answers right away and we just keep on going anyway. It's been true for most technologies, for a lot of what goes in our food every day, for how we've structured society, etc. We accept that there's unknown risks, we try to mitigate what comes our way and prepare for what we can estimate, and we learn to live through what we didn't see. But we still eat the food, use the technologies, try social systems, and so on.
I think that attitude is also one to have with psychedelic experiences. That happens through testing what you have, guided experiences if and when there's a need or uncertainty, "set & setting" and discussing them beforehand, being gentle with dosage, making a sincere attempt at an inventory of the self before deciding on taking the psychs, and so on and so forth. And some people try some of it, some people don't, and that's OK as long as everyone strives to have an experience they can handle with what they know. Just like with everything else.
Occasionally I'll get crippling anxiety when I think about how one day I'm going to stop existing and there's absolutely nothing I can do to stop that.
I've heard people say that [some drug] has shown them how to no longer fear death and always wondered about that.
My personal standpoint is fairly different from yours because my anxiety is permanent and a measure of the "agitation" of my existence, to which death is almost a relief really. From that standpoint I've never quite had to confront much of anything about mortality or death. In fact I've almost always felt more alive during trips, at peace with whatever flowing model of the self and existence experienced in the moment. Psychedelic effects can make our senses feel more 'salient' too (for me musical experiences can be very profound), which I've used to contemplate extremes (like noise-cancellation silence after a roaring musical piece).
The main regularly noticeable thing I experience after just about every trip (of various kinds of psychedelics) is severe depression being alleviated for anywhere between a couple days to a few weeks.
Ultimately though, most of what I would say is just likely to be whatever personal theory I've built up this unique stream of experiences. That's why we really need people to get in there and do the difficult work.
edit: also the "some drug" in question is most likely DMT, and I've had extensive experiences with it (on its own or not) and absolutely appreciate that others would have religious experiences, near-death experiences, etc.. but I don't think anybody with any experience of DMT that goes beyond a one-shot would testify to the reliability of trips of such nature. It can be a very volatile experience, as well as being much less predictable from person to person than the more mild stuff like low doses of mushrooms etc. Again, science might eventually come to the rescue :)
I find it's common to see forum comments like "we know this researcher is a big advocate of X so this study is bias". I find this critique is usually very shallow and sets an impossible standard.
Where are you you going to find researchers pouring years of their life into researching a subject they have no interest in or opinions of?
If you were studying vegan or Atkins diets for example, it's an ongoing personal choice in your day-to-day life if you're going to switch to/from that diet or not, where either choice could be used to imply bias in your future studies. And after a few years of research, how could the evidence you collect not impact your personal choice? And if it doesn't, what would that say about your belief in your own research?
Researchers are trained to be aware of their biases, to devise experiments that reduce these biases, and peer review helps identify problems here also. Another part of peer review where the media jumps the gun is that other researchers should be able to replicate the studies themselves to check the results - if you become known for producing highly biased research that can't be replicated this is surely going to impact your career (e.g. less citations, less funding, distrust from peers) so there's a very strong incentive to keep this in check?
I think in general, the real problem here is the dysfunctional click-bait approach the media has with scientific reporting (exaggerated, sensationalist, premature, lacking any nuance/caveats/details) and the public's understanding of the scientific method is very broken e.g. the notion that scientists are always changing their minds, little understanding of how to evaluate how strong evidence is before accepting it as true, which includes dismissing everything about a study because they can create a story about one researcher being bias.
I would strongly say no.
If the vast majority of studies in the “soft” sciences are already not reproducible, the risk to a person’s career is minimal.
This is before accounting for the pattern of prioritizing short term gains over mitigating long-term risk, especially if that risk is considered to be low.
Let’s not be so arrogant as to say this is isolated to the soft sciences. Soft science is only the most obvious because it’s much harder to run science experiments in the real world. Let’s not forget the fact a computer science PhD student committed suicide because of the degree of academic fakery he was being forced to participate in at an elite institution. That we still have nonsense like unreproduceable ML papers, and physics has multiple examples of older models being wrong and only being held up by the political power of the academics who built their careers off them.
Neat list of mushroom trip experiences.
Ranging from schizophrenic horror unimagined to unenglishable religious experiences.
I've had both experiences in the same trip. I'd hate to be on my deathbed and have a bad trip tho.
Reminds me of a recent report that human sacrifice victims in the Inca empire were given ayahuasca and coca:
Ritual drug use during Inca human sacrifices on Ampato mountain (Peru): Results of a toxicological analysis
https://www.sciencedirect.com/science/article/abs/pii/S23524...
How is it different than trying to double blind talk therapy. Obviously someone knows that they are getting talk therapy, likewise, people obviously know they are getting psychedelics.
Yet we are still able to get experimental results supporting talk therapy and no one complains, right?
It feels more like they are just looking for a critique. All in all it looks eons better than most SSRIs we prescribe willy nilly every day.
I know that some psychedelic researchers use a suitable dose of niacin as the control arm. The person will experience some flushing and a faster heart rate. If they are new to psychedelics, they don't what psychedelics are supposed to feel like, and so they assume it is the real thing.
Wrong. https://blogs.bmj.com/bmjebmspotlight/2020/10/07/seeing-is-b...
I think this is a problem that is generally recognized. Also the science on psychological interventions is generally quite messy.
I think that some of the most interesting applications for psychedelics as medicine target treatments that aren't strictly mental health related. Ketamine is already approved for ischemic brain damage or stroke, like you better hope that's the first thing you get in the ambulance to prevent glutamate excitotoxicity from getting really nasty if you fall of a motorcycle or whatever - But DMT actually shows a lot of promise for recovery too, and I'm actually getting involved in a project tangent to that research right now. We're talking sub-psychedelic micordoses to build people's neurons back from brain damage, one of those things in modern medicine we're still generally hopeless about. Pretty interesting stuff! [1]
[1] https://www.technologynetworks.com/neuroscience/blog/could-t...
The main idea behind psychs is that they allow you to operate in a vastly different regimes. And, unlike McDonalds, and compared to other drugs, they are INCREDIBLY safe. It should be a no brainer for anyone needing them to use them.
“sit in chair for 30 minutes everyday and be mindful of your breathing.”
Now this is great advice for everybody. Unless during these quiet times the weight of the world lays upon you, or your grasp over your inhibitory system is not sufficient to find stillness, never mind finding discipline of the breath.
What about the people who's affliction is not due to some implied lack of industry or effort? What if the problem is not ... sloth?* ... but actually a flaw in the brain, or imbalance?
I guarantee you that there are not a billion people who are gagging for psychedelics as a solution to their mental problems. The question is: Are they in fact a solution?
Prayer: Unless you are praying to some entity who publishes regularly, I feel this avenue has been tried and found to be lacking.
[*] I do not endorse this concept. I don't think you can just "apply yourself" and heal your mind, any more than you can do could with your lung cancer. Sure it helps, but we'd like to minimize the suffering, not endure as much as possible.
This is from a person who used MDMA to heal bipolar / schizophrenia in an underground setting; ran an underground clinic for 3 years; took funding from Dr. Bronner to found a non-profit to decriminalize plant medicine; and was featured in a PBS documentary administering MDMA in an underground setting.
Also, the author obviously hasn't done psychedelics ;) and he states as such.
"I’d think about taking them if I had a relevant condition and the evidence they worked was convincing." You could argue that the relevant condition is that you are a living human, and we've evolved to be in relationship to altered states of consciousness.
This is just reductionist thinking, which can be good to temper things and reduce harm, but the authors bias is pretty readable
I also have to wonder how many of those beliefs can only be corrected by something as drastic as a foreign substance acting on it against our will.
In some other universe, the world might become a very different place if the people in power chose to take LSD with an open mind. If so, there would be no "meaning" we could attribute to that radical change except that it was the result of a chemical formula.
It feels like there is something profound about that related to the meaningfulness of all things, but since I haven't taken psychedelics, I guess I am still blind to what it is.
His main three themes (author bias, statistical significance, double-blinding/scientific rigour/confounding) are not at all unique to research with psychedelics. If the author's point is that we should take all studies with a grain of salt then why focus on psychedelics? If psychedelics is really such a problem field then I would expect more evidence than a couple bad actors (the MAPS stuff sounds terrible!) and light issues in a few studies that were brought up in reviews before publication.
It seems the main point isn't research as much as the public's perception and hype (partially fueled by researchers to be fair). That's a good point and I'm totally against the psychedelics version of "weed cures cancer" bros. But, as the author points out, this isn't unique to psychedelics either! Ironically, I found the intro and most of the article to sound much more critical of the research than the conclusion really is.
In reality this is why we need serious research into these drugs. I am sure there are therapeutic benefits and also yet unknown risks. Would be nice to study them formally.
To your second point: I know very few people without mental illness. GAD and generalized depression account for a large part of it, but so do neurodivergenicies like autism. Chances are much higher than you think that you yourself have one or more condition like this. That’s not to say I wish for you to have one, just that statistically speaking lots of people have them, so much so that the current advice is to establish mental healthcare same as you do with a primary care physician and have at least yearly checkups.
Anyways. In general, HN is a community that is highly focused on emerging technologies, and undervalued, overlooked or novel solutions.
Psychedelics, in my opinion is fertile ground for discovery and just super interesting, so it gets my upvote.
Scientific studies that ingesting chemicals like THC are one of the reasons we have things like the Rockefeller drug laws. Activism from some in the scientific community is one reason people are rotting in jail for selling marijuana (while tobacco companies donate to politicians and in return get trade deals where it is illegal to have a law requiring warnings on cigarette packs.
People can be arrested for ingesting mescaline from peyote plants like Native Americans used to, scientific studies and activism is one reason for this, but scientists asking for people not to be imprisoned for getting mescaline from a cactus is not "appropriate".
(I have never tried mescaline but don't want to be imprisoned if I ever do)
So we can't say that they can cure it, but they most certainly can cause it. Perhaps the sword needs to cut both ways to be effective?
For the record, I have been both helped and harmed by psychedelics and in net believe their return is positive. I’ve seen enough oddities in the Bay Area psychedelics and mental health scenes to warrant some serious caution about the current path we’re taking.
I’m reminded of something the PhD Pharmacologist Psychiatrist told us during med school - effect size of new depression meds decreases over time (probably because you have an early positive result and then it’s pushed in and then later better quality studies show smaller difference) so the joke is ‘every time a new depression medication comes out there’s a race to use it before it stops working!’
Do psychedelics cause mental illness or treat mental illness?
Our minds are so weird that I have a simple theory that we are all slightly insane in at least some small way.
But from what I have observed from friends who take them - they cause them to cope with troubles that are normally difficult to deal with.
I guess I’m not brave enough to try them to deal with my own troubles myself right now.
Psychedelics just allow us to step out of our rigid framework for a few hours. For people with flexible/creative minds it might not be such a big deal as they are used to looking at reality and asking "but what if it were this way...", but lots of us have rather rigid conceptions of reality. Taking mushrooms and realizing that most of our worries are 'made up' in the sense that they don't relate to our basic needs can be eye opening.
In a good setting with good guides it can be wildly transformative in a positive direction.
This in turn gives lasting perspectives in the form of "hey, I am able to think and feel about things differently and not locked into this pattern of thought", which could be the necessary catalyst for change.
Psychedelics treat mental illness and cause mental illness. They treat it by causing it.
Regardless, mental illness seems highly relative to societal norms. And psychedelics have a way of minimizing the importance of societal norms, so maybe thats a factor too.
This can be hugely beneficial to figure out the root cause of some mental health issue one suffers, because they often lie in those two areas - mistreatment of oneself, and/or traumas caused by other people's behavior that we're conditioned to treat as normal. But that knowledge is also something that'll nag you ever after, and might make you more politically active, which is its own can of worms in terms of mental health.
LSD occurs naturally in the Ergot mushroom: > The ergot fungus contains a number of highly poisonous and psychoactive alkaloids, including lysergic acid (LSD), which was synthesized from the ergot fungus in 1938 by chemist, Albert Hoffmann [1]
What the author means is that it's synthetically made these days. Psilocybin can also be synthetically made these days.
psychedelics are the best hope humanity treating refractory mental illness. I know at least 5 people personally that have embarked on psychedelic voyages to treat their demons. Some of them are renowned psychiatrists.
[1] https://www.fs.fed.us/wildflowers/ethnobotany/Mind_and_Spiri....
Ergot is not a mushroom and it does not contain LSD. But LSD is derived from the ergot alkaloids.
It's correct that the fungus does not contain LSD the chemical, but it does contain lysergic acid which is colloquially LSD the drug. For a short, layman-targeted article I'm inclined to give the US Forest Service a pass on this one.
The chemical differences between "lysergic acid" and LSD areas significant as the differences between morphine and heroin, if not more so. Pure lysergic acid is closer to LSA, which is still categorically not the same thing as LSD - to the point that many people will refuse to take the former when a test kit reveals they got that as opposed to the latter. They are not colloquially equivalent.
TL;DR: This is a dangerously biased dismissal of actual science and historical progress in understanding of various 'psychedelics', and it's exactly the kind of cherry-picking dismissal that's been fought against for decades.
Drugs are tools. Know yourself, know what you're taking, and plan accordingly.
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Not sure how this relates to the article.
Not that this would get past any ethics board, but it would be an interesting experiment if you took someone suffering from severe depression, fed them 10 grams of shrooms to reset their brain, and then put them in a remote village in South America with no phone or internet where basically their entire day has PURPOSE - i.e wake up, do work with fishing/farming/hunting construction, socialize in the evening, all as a group activity.
I personally would very much like to use my phone after somebody fed me TEN GRAMS of shrooms. I strongly feel that I would want to do them on the plane, and not in a remote village where I don't even speak the language, and I've got to occupy myself in the darkness with strangers who are going to make me stagger into the jungle and fish, or farm, or hunt. Something I was not severely depressed about would be my very low parasite load, or the lack of arthropods in close proximity. In fact, there are virtually none here. Somewhere in South America there are very large spiders. We don't have them here. I would certainly not be depressed about this. In fact, I am jubilant and appreciative of my good fortune.
In fact, were I to have this condition, it would stem from an imbalance in my head. Because of it I would become depressed. This would be different than me not being "tuned" to my lifestyle, it's not clinical depression if I just need to paint my walls orange or just stop being such a mopey downer, it's a real drag, pitter patter, let's get at er! WEW! PROBLEM SOLVED!
It's like going bald, or having asthma, or being washed away by a tsunami while you are on a date. Sometimes things happen, which are not ideal and also not because of any defect or sin on your part. Sometimes things just happen, sometimes they happen to you.
For example, the poor person who's mind you reset with TEN GRAMS of shrooms and fired off thousands of miles from home and back in time thousands of years to do backbreaking manual labor among strangers. Seems unusually coercive, no? Punitive. Would you do that to your dog? A dog? For being sad too long?
Depressed is not stupid, after the monumental shroom trip, you'd have to force them to stay there, surely? This is probably the part where the ethics board might ask more questions, I reckon. We agree on that at least. Anyway, what if they in fact are not shamming and succumb to despair? Or simply tip the canoe or whatever over learning how to fish? TEN DAMN GRAMS of shrooms is going to make skills acquisition difficult, for quite some time after they eat them.
Socialization might be a lot to ask, do we share a language? What's the purpose of this anyway? Shouldn't this PURPOSE be something defined by me? Lack of agency was not a problem I had before, why is it part of your experiment? I mean, you don't even give me a choice, can't I volunteer or something? My friends probably are not sick, can I socialize with them? Instead of the strangers? In the village? How about you send me to work in Milan? Ok, Wales? Scotland? Missis... hmm. Scotland?
I mean really, you think phone and internet need to go, but instead want to force group interactions with strangers instead?
By the way, about your "personal opinion." If you know a whole bunch of people with ranges of issues, how did you achieve the deep insight into las depresionistas? Or are you saying that slacking is the root cause of mental illness? Force them into paleolithic lifestyle and they'll snap out of it? Would you say you've read 10 books on the subject? How many more than 10? Lots? I'm just trying to properly value your opinion here. How's your results?
Finally, I have to say that your experiment kind of seems similar to pray away the gay camp or whatever name was used for it. Isolation, coercion, duress and reconditioning. Plus TEN GRAMS OF SHROOMS.
Whole thing seems a bit sus, frankly.