What are psychedelics?
For most Americans, psychedelics have long been associated with the counterculture of the 1960s, but did you know that psychedelic medicines have been used across the globe for healing and spiritual growth for thousands of years? Did you also know that, throughout the 1950s and 60s, psychedelic compounds such as LSD and psilocybin ("magic mushrooms") were among the most researched and most promising psychiatric medications? Over 1000 studies with over 40,000 participants were published demonstrating their effectiveness in treating everything from alcoholism and depression to end-of-life anxiety and dread. By the mid 1970s, however, due to the political climate and societal pressures, the War on Drugs ended all formal research, and these so-called classic psychedelics were relegated by the FDA to schedule 1 status, a category reserved for those substances considered to have “no currently accepted medical use and high potential for abuse." MDMA would face a similar fate approximately one decade later. As a result, much of the knowledge gained studying this class of medicines would be buried and forgotten for decades. Fortunately, research into psychedelics resumed around the turn of the millennium. And, just as before, studies have demonstrated that psychedelics are powerful healing agents with the potential to alleviate suffering for a sizable portion of the population worldwide for whom the panoply of current psychotropic medications and treatments have been ineffective.
What do you mean by “expanded and non-ordinary states of consciousness”?
Our ordinary waking consciousness is just one type of awareness, and, thus, most of us are only aware of a small fraction of who we really are. Non-ordinary and expanded states of consciousness allow us to access other ways of knowing and experiencing ourselves and the world. Expanded states of consciousness free us from the constraints of our ordinary waking minds and our usual way of operating, providing a more complete perspective on our lives. Experiencing an expanded or non-ordinary state of consciousness is kind of like getting an aerial view of oneself. Psychedelic medications, though powerful tools, are not the only way to induce non-ordinary or expanded states of consciousness. They can occur spontaneously or under many circumstances, including prayer, meditation, childbirth, or times of extreme stress. However they occur, these expanded states of consciousness can be deeply meaningful and transformational.
How do psychedelics work?
Psychedelic compounds have been shown to downregulate a person’s default mode network and enhance neuroplasticity. Basically, the default mode network is your usual (default) way of thinking, acting, and feeling. As you know firsthand, if you’re struggling with depression, your thoughts and perceptions of yourself and of the world around you are disproportionally negative. Neuroplasticity, meanwhile, refers to our brain’s ability to learn new things and to change. One way to think about these concepts is to imagine a sled going downhill in the snow. The more times a sled goes down a particular hill in the same spot, the deeper the tracks dig into the snow. Pretty soon, the sled is unable to deviate from this track because the grooves are so deep. This is kind of what happens in our brains. Each time we have the same thought or engage in the same behavior, the neural connections in our brain become more deeply ingrained through repetition. Without intention or awareness, our brains take us down the easiest path (just like the sled), and we literally get stuck in “thinking ruts”. What psychedelic medications have been shown to do is essentially flatten the snow, allowing our “sled” to freely move in all directions. Freed from these deeply entrenched patterns of thinking and behaving, we can establish new, more adaptive thought and behavioral patterns. Psychedelics also work as “nonspecific amplifiers” by making the unconscious (what is going on underneath the surface) conscious so that we can look at our issues squarely in order to work through them and heal.
Are psychedelics legal/approved by the FDA for treatment of mental health conditions? Can I hire you to guide me through a psychedelic journey?
Regarding the legal status of psychedelics, the short answer is that it depends on the jurisdiction, the type of psychedelic compound being consumed, and the context in which it is taken. Multiple cities across the nation have decriminalized psychedelics derived from plants or fungi (called entheogenic compounds) for personal use, but continue to prohibit the use of synthesized compounds, such as LSD and MDMA. Two states, Oregon and Colorado, have legalized psilocybin for use in therapeutic settings, and Colorado expanded decriminalization to several entheogenic psychedelic compounds for private consumption as well. And, although there have been countless research studies demonstrating the effectiveness of psychedelic medications for treating an array of mental health issues, to date, no classic psychedelic has been rescheduled (approved) by the FDA in the United States. Ketamine is (sort of) the exception. That is, strictly speaking, ketamine is not a psychedelic compound, but it can produce psychedelic-type experiences and has shown to have similar treatment outcomes when compared to classic psychedelics (more below). Currently, psychedelics are not legal in Illinois (where I am licensed as a practitioner), so I am not at liberty to sit with or guide anyone through a psychedelic journey. What I can offer, however, is preparation and integration sessions for those who are taking or planning to take ketamine/eskatemine treatments.
What is ketamine?
As previously discussed, ketamine is not a classic psychedelic, such as LSD or psilocybin. Instead, it is an anesthetic that was developed in the 1960s to use during surgery. Ketamine has never been illegal and has a well-established safety profile, making it the anesthetic of choice for even the most medically compromised patients. Ketamine, in doses which are a fraction of that given for surgery, can be used to induce non-ordinary/expanded states of consciousness, which are associated with several positive mental health outcomes. This "off-label" use of ketamine is administered via intramuscular injection (shot), IV, or sublingually. Esketamine, meanwhile, is the intranasal spray version of ketamine (brand name Spravato) which was approved by the FDA in 2019 to treat treatment-resistant depression and ruminative suicidal ideation.
One advantage ketamine has over classic psychedelic medicines is that it is short acting. For example, while the effects of psilocybin and MDMA last for 4-6 hours and LSD for 10-12 hours, ketamine’s effects are usually experienced for less than one hour. And, when compared to antidepressant medications, ketamine produces a rapid antidepressant effect, thereby obviating the need to take a medication daily for three to six weeks before reaping any noticeable benefit. Still, the antidepressant effects, though significant, are temporary, lasting only for a few days after a single dose. For more enduring and robust remission, ketamine requires multiple administrations over the course of several weeks. A person receiving ketamine treatment should also be engaged in preparation and integration sessions to leverage the benefits of the medication.
Why are preparation and integration important?
One of the fundamental principles of psychedelic therapy is the notion of an inner healing intelligence. Just as the physical body has innate ability to heal itself (think of cuts, wounds, broken bones, etc.), so, too, does the psyche. This is a radically different approach than that of mainstream psychiatry. Unlike with antidepressants and other psychotropic medications, the person who has ingested a psychedelic compound (including ketamine) is not a passive beneficiary of a biochemical process that is correcting some poorly understood "chemical imbalance" in the brain, but rather the source of his/her own healing. When one chooses to embark on a psychedelic journey(s), the healing process involves surrendering and trusting in the wisdom of one’s own psyche that whatever material comes up is in the service of healing. For this reason, psychedelics require ACTIVE participation before, during, and after the medication session(s).
Thoughtful preparation is vital because it lays the groundwork for you to get the most out of your medication session(s). This includes helping you set an intention, adopting an inward orientation, and learning to surrender fully to the process. Psychedelics have a way of magnifying our inner emotional states, which allows for deeper understanding and healing, but this process can be very challenging. You are less likely to be blindsided by distressing material and more likely to be open to face whatever comes up when you have spent time preparing and discussing possible scenarios beforehand with a therapist. Preparation also helps build a trusting therapeutic alliance, which has also been correlated to more robust therapeutic outcomes.
Integration helps you incorporate the insights and lessons from the medication session(s) into your daily life. Integration sessions should be held within 1-2 days after medication session(s) to take advantage of the window of increased neuroplasticity during which your brain’s ability to learn new things is enhanced. Integration helps leverage the biological benefits of the medication during these critical window when your brain is more malleable. This is especially true for ketamine/esketamine, which has the shortest neuroplastic window.
