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Primary Body Text Psychedelics: Lifting the Veil A TED Talk by Robin Carhart-Harris
Secondary Text Comfortably Numb Pink Floyd From The Wall
Illustrations All illustrations done by Oliver Hibert
Hello, is
there anybody in there?
It’s easy to be captivated by the world out there. It is a fascinating place. It’s deserving of this attention. But what if we were to invert our focus and look inside, what would we find? Well, I study psychedelic drugs for a living. And the reason why I do this — often could fault you — is because I think they’re special. And the reason why I think they’re special is that I believe they have a unique ability to reveal to us the very depths of our minds, dreams, and perhaps a select few other states may hint at what lies beyond the reaches of normal consciousness. But psychedelics, in my view, are really unrivaled in their ability to do this. Now, many of you are familiar with the word psychedelic but I doubt so many of you are familiar with its origins or what it means.
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So “psychedelic” was a word that was coined in the 1950s by the British psychiatrist Humphry Osmond with reference to the class of drugs that I study. And it combines two Greek words: psyche and delos which when put together mean to make the mind manifest or to reveal the soul. Now I’ve been fascinated by psychology for most of my adult life. The single question that always bugged me is why can’t it prove the existence of the unconscious mind?” Is it because it does not exist? Or is it because it’s especially difficult to see? Now I have come to believe quite strongly that it is the latter. But the key question is: how can we make it easier to see? Freud famously told us about dreams, how they are a window in on the Unconscious of Royal Road. The problem is that dreaming occurs while we’re asleep. And then when we wake up, all we’re left with is this flimsy memory of what we actually experience. So it was while I was studying for my Masters that I found myself asking whether a drug exists that can facilitate access to the unconscious mind. I did a brief library search and I came across this book: Realms of the Human Unconscious: Observations from an LSD Research Study written by the Czech psychiatrist Stanislav Grof in 1975. I swiftly took this book out of the library. I brought it back to my room. I opened it and I read. Many of the phenomena in the LSD sessions can be understood in psychological and psychoanalytic terms. They had a structure not dissimilar to that of dreams. And Freud once said of dreams that they are a Royal Road to the knowledge of the unconscious mind. But to an even greater degree, this seems to be true for an LSD experience.
Just nod if you can hear me Is there anyone at home? Come on now I hear you’re feeling down Well I can ease your pain And get you on your feet again 7
Can you show me where it hurts? And finally, the capacity of psychedelics to exteriorize otherwise invisible phenomena and make them the subject of scientific investigation gives these substances unique potential as research tools for the exploration of the human mind; does not seem inappropriate or an exaggeration to compare their potential significance for psychiatry and psychology to that of the microscope for medicine or the telescope for astronomy. So you can imagine, after reading these things, I was filled with a very strong sense of purpose and direction. I wrote to Professor David Nutt then at the University of Bristol. And I told him I wanted to study the brain on LSD and to see whether it looks like the dreaming brain.
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Anyway, David was kind enough to allow me to join his team and then four years later I completed my PhD with him. Soon after that, I was lucky enough to begin some quite exciting brain imaging research with psychedelic drugs, first with Psilocybin which is the active ingredient in magic mushrooms and more recently with LSD. It’s quite difficult to explain to people how psychedelics work in the brain and it’s hard to still to try and do that in 18 minutes. So instead, what I’m going to do is show you a few pictures and give you a few analogies to think about. So what we’re looking at here are communication pathways in the brain. Each line is a communication pathway between two different regions in the brain. And, believe it or not, there are
Just the basic facts Can you show me where it hurts? There is no pain, you are receding
actually an equal number of lines or pathways in each of these two circles. Yet they look very different; don’t they? Essentially what we are seeing here is the normal brain on the left where communication is confined to particular communities or cliques in the brain. For example, visual regions are talking mostly with other visual regions. This is what happens ordinarily. Then we look at the psychedelic brain on the right. There’s much less of this clicking, much more of an open freer conversation going on across the brain. Another useful way to think of how psychedelics work in brains is to think of what it is like to be an infant, experiencing everything is a novel, feeling emotionally labile at your laughing and extra crying, having a wildly overactive imagination and being
A distant ship smoke on the horizon You are only coming through in waves 11
I can’t explain, you would not understand,
mesmerized by the likes of iggle piggle or makka pakka. It’s no coincidence therefore that if you look at how the brain develops as we develop from infancy into adulthood and you compare that with how the brain changes under a psychedelic, what you see are kind of mirror opposites. So instead of a brain becoming more sophisticated as we develop more finesse but also more constrained, you have a brain that is simpler and freer in its functioning. Third useful way to think of how psychedelics work in the brain is to think of the dream state. Here we’re looking at the effect of LSD on the brain. And what we’re seeing is that much more of the brain contributes to the visual experience under LSD than it does ordinarily. And this effect actually correlated very strongly with the dreamlike visions that people reported under LSD when their eyes were closed.
Your lips move but I can’t hear what you’re saying When I was a child I had a fever
this is not how I am
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Okay,
just a little pin prick So we could think of both these states: the dream state and the psychedelic state as conditions where the brain becomes untethered or unanchored from incoming sensory information. And then in this state, it can operate in a more anarchic freewheeling kind of way, conjuring up imagery from the very depths of the mind and the brain, rather than relying on sensory information coming into the brain. But perhaps, the most important thing to have come out of our research with psychedelics isn’t a knowledge of how they work in the brain but rather some idea of how they may be useful or how they can be applied. In this vein, we’ve recently completed the first phase of the first-level clinical trial looking at psilocybin magic mushrooms as a treatment for major depression.
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Now it’s important that I make you aware of the magnitude of the problem of depression that really isn’t something that should be swept under the carpet, although unfortunately often it is. It is a leading cause of disability worldwide. It actually affects 350 million people. To put that in perspective, that is more than the population of the United States. And if you care about money, it is also especially costly. It is the most costly brain disorder in all of Europe and its yearly cost to the US alone is $200 billion. That is roughly the GDP of the Republic of Ireland. And depression is quite an insidious disorder. It’s often evident by the absence of something that might be the absence of pleasure or positive mood more generally. Or, it could be the absence of the individual themselves and they simply not get out of bed in the morning and make it into work. Depression is the leading cause of absenteeism in the workplace. But depression can also be more stark in its presentation and it is often tragically when it’s too late. Some 15% of patients with major depression will take their own lives. And it’s a frightening statistic now that suicide is the leading cause of death among males under the age of 45 in the UK. So what can be done about these things? How effective are current treatments? Well, the good news is they’re not ineffective. This chart shows the relative effect size of different treatments for depression. To give you some perspective on it, it’s convention to consider an effect size of 0.8 which is where the line is as large, so you see that antidepressant medications, psychotherapy and placebo, all have large effect sizes in depression.
My hands felt like two balloons Now I’ve got that feeling once again I can’t explain, you would not understand This is not how I am I have become comfortably numb
There’ll be no more “AHHHH!” but you may feel a little sick 19
But even so around about 50% of patients won’t respond to the antidepressants that their doctors prescribe them and as many as 20% fail to respond to any treatment at all. And it’s these particularly refractory treatment resistant cases that we’re seeing in our current trial. But before I tell you about our results, I think it’s important that I emphasize to you, especially to those of you who are naive to the effects of psychedelics, that an experience with one of these drugs can be among the most profound of the whole of your life. So evidence suggests that in terms of meaningfulness, it can be up there with pretty much anything, facing death, falling in love, or bringing in new life. So the key point is that these are not party drugs, they’re incredibly powerful substances that should be treated with respect as they have been by certain cultures for hundreds, if not, thousands of years. It’s also important to emphasize that when we give psilocybin to our patients, we do so with full legal and ethical approval. And we simply don’t tell them to simply chuck a bunch of magic mushrooms down their necks and hope for the best. We carefully prepare them for their experiences. They are looked after by trained team of therapists. They have two sessions with the psilocybin. They are looked after throughout and the therapists help them make sense of things afterwards. So here we can see the magnitude of the effect that we’re seeing with psilocybin so far. Psilocybin shown in blue and you can see the data at two weeks post treatment and three months post treatment.
Now I should caution that it’s early days yet; we had 12 patients in the trial at this stage. Now actually have more data and the effects look even better. But even so there were several hundred patients in these other studies. Also all the patients knew that they were going to receive psilocybin whereas these other studies had a placebo control element. That’s actually what we are going to be doing next. Even so with these caveats entered you can see that the magnitude of the effect that we’re seeing so far is considerable, even at the three month post treatment period where they have not received any treatments for that duration of time. Also, remember that our patients had treatment resistant depression. Many of our patients reported having had depression
Can you stand up? I do believe it’s working, good That’ll keep you going through the show
for most of their adult lives. The average duration of the illness in the sample was 18 years, yet all of them showed improvement in their depressive symptoms for at least three weeks after their treatment. Two-thirds, 67% met criteria for remission one week post treatment. Remission means they’re essentially depression free. And 42% maintained the status of being depression free for three months after the treatment. So to finish, I’m just going to read you a short case report written by one of the patients in our trial. He is a male, aged 52, has a long history of depression, quite severe depression stretching back to his 20s. He’s tried a number of different medications all of which haven’t worked for him and also psychotherapy. About his baseline state before the treatment, he says the following: “Four decades I battled depression, the awful feeling that you
Come on, it’s time to go. There is no pain you are receding A distant ship smoke on the horizon
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You are only coming through in waves
Your lips move,
but I can’t hear what you’re saying.
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don’t matter, you’re not making a difference that everyone else is having a better life, the utter pointlessness of it or getting no real enjoyment from anything.” Then about the experience, he says, “These simply aren’t words to describe it but I can say that the usual negative self narration that I have had vanished completely. It was replaced by a sense of beautiful chaos, a landscape of unimaginable color and beauty. I began to see that all of my concerns about daily living were not relevant that they were a result of a negative spiral. I also felt like I was learning without being taught that intuition was being fed. Fleeting feelings from my past came back, memories too, both of which had seemed long forgotten.” Then about the outcome, this was written a couple of weeks after he had completed the trial. He says, “Although it’s in its early days yet, the results are amazing. I feel more confident and calm than I have in such a long time. My outlook has changed significantly too. I’m more aware that it’s pointless to get wrapped up in endless negativity. I also feel as if I’ve seen a much clearer picture. Another side to it is that I feel like I’ve had a second chance like a survivor. I can enjoy things now the way I used to without the cynicism, without the oppression. At its most basic I feel like I used to before the depression.” If you’re curious how this patient is doing in the longer term, we have collected his 6-month follow-up data now. I’m pleased to say that he’s still in remission. You can see his data highlighted
When I was a child I caught a fleeting glimpse Out of the corner of my eye I turned to look but it was gone I cannot put my finger on it now 27
The child is grown,
here in blue. Of course, I’ve cherrypicked a particularly good example here and you can see from some of the other patients on this chart that at the three-month follow-up period are showing some signs of relapse. So this is an important opportunity to say that this isn’t a magic cure, it’s not a golden bullet that’s going to help everyone. There is much more work that needs to be done to learn how to optimize this treatment and further test its effectiveness. But hopefully you’ve got a sense from that case that I reported. And I can tell you from many other cases that I have sat with that when this is done properly with the correct level of preparation, good drug effects working in synergy with good therapy to lift the veil on the mind and exercise all that lies beneath, it can truly work like a dream.
the dream is gone,
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I have become,
comfortably numb.
This Editorial was designed by Claire Warhover for Typography II in Fall 2018 at the Sam Fox School of Design & Visual Arts. Typefaces used are Fairplex Wide and Synthemesc. All Illustrations were done by Oliver Hibert. The back cover illustration is titled “Sailing into Oblivion.� The interior illustrations are titled as follows:
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Self Portrait Die WD Cover Death at First Sight In Her Own Rainbow of Doom Darrier of Doom Psychic Rainbow of Doom