Joost Breeksema, director of the OPEN Foundation, made an appearance on Tuesday’s episode of Dutch talkshow OP1. The conversation delved into the use of psychedelics in psychiatry. Retired professional cyclist Thomas Dekker explained how he used magic truffles to fight his depression after leaving the sport. Joost joined the table as an expert on therapeutic applications of psychedelics and a proponent of a programmatic research and implementation programme.
With the attendance of Dutch Minister of Health, Ernst Kuipers, the discussion shed light on the therapeutic applications of psychedelics and the importance of more research in this field. Minister Kuipers expressed his enthusiasm for the ongoing research and thanked Joost for showing him the work being done at the University Medical Centre in Groningen, stating that it was very impressive.
During the conversation, Joost emphasised the importance of further large-scale research, regulatory frameworks and proper education of the public in order to protect vulnerable people in society. After the show he stated: “Although there isn’t enough time in a talkshow to convey all the nuances of this subject, it was still very encouraging to receive support from unexpected sources such as a professional athlete, the minister and the broadcasting company. The use of magic truffles to treat depression, as discussed by Thomas Dekker, still is a grey area that requires clinical testing and oversight before being approved for treatment.”
Minister Kuipers also publicly announced the establishment of a new state commission which aims to provide advice on the status of MDMA within the context of public health and the advantages and disadvantages of medicinal use.
It is a promising development that a topic as significant as the use of psychedelics in psychiatry was discussed on one of the Netherlands’ largest talkshows, with over 1.8 million viewers tuning in. This discussion has the potential to reduce the stigma associated with the use of illicit drugs in psychotherapy and encourages further research and exploration of therapeutic applications of psychedelics. We hope that this conversation will lead to more progress and support for scientific research in this area, ultimately benefiting those who suffer from mental illness.
On March 19 and 20, 2023, the European College of Neuropsychopharmacology (ECNP) organised the New Frontiers Meeting on Psychedelics in Nice, France. Various researchers and clinicians joined this event to talk about the current state of psychedelic-assisted psychotherapy (PAT). Here are some of the most interesting developments in the field of psychedelic research.
The ECNP New Frontiers Meeting: Psychedelics 2023 was kicked off by Gitte Moos Knudsen, the current Chair and president of the ENCP and professor of the neurology department at the Rigshospitalet and University of Copenhagen, Denmark. She laid out the program of the conference that consisted of three sub-topics, including pharmacology, clinical aspects, and clinical trials. Furthermore, Knudsen presented the Gartner Hype Cycle to the audience and asked whether there is a current hype in psychedelic research and where we might be in this Hype Cycle. Virtually everyone raised their hands which made it clear there is indeed a hype in the psychedelic field.
Knudsen’s introduction was followed up by Professor David Nutt from Imperial College London who gave an overview of the current state of psychedelics. In brief, he mentioned how psychedelics seem to show efficacy in depression and addiction and shared some of the therapeutic mechanisms of action in the brain, such as alterations in brain connectivity, reduced modularity, and increased neuroplasticity.
Most notably, Nutt shared one of the most recent brain imaging findings of N,N-Dimethyltryptamine (DMT) that were yet to be published. According to Nutt, this work is probably the “most impressive study ever done at our department” as it contains the most comprehensive view of the acute brain action of psychedelics to date. This was made possible through the use of both electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) to record brain activity before, during, and after the ingestion of intravenous DMT and comparing it to placebo in twenty healthy individuals. In general, the results of the now published study demonstrate that DMT is able to induce network disintegration and desegregation, decreases in alpha power, increases in entropy, altered traveling waves, and global functional connectivity. In other words, a lot is happening during the DMT-experience, and this naturally reflects the peculiar and extraordinary experiences that individuals generally report.
In the evening of March 20th, directly after the ECNP conference, the results of the study were published in The Guardian reporting how the recordings of DMT reveal a “profound impact across the brain.” One can safely say that this is a clear testament of the hype of psychedelic research and how the media wants to pick up on this latest news.
Nutt further showed yet to be published results from another neuroimaging study that is based on the well-known psilocybin versus escitalopram trial. The team already demonstrated psilocybin-specific effects in the brain last year, such as increases in global integration and decreases in modularity. And now they found more differences between the two substances, namely that escitalopram resulted in a blunted response towards emotional faces. This finding was not demonstrated in the psilocybin condition of the study and further adds to the view that antidepressants seem to blunt people’s emotions.
Finally, Nutt notified the audience of some future policy decisions. This included the statement that US president Biden will make psilocybin and MDMA legal in the next two years and that Australia will reschedule both substances by July 2023.
Animal research: psychoplastogens and affective bias tests
Another prominent subject that has recently entered the field of psychedelic research is the therapeutic use of so-called psychoplastogens. Psychoplastogens refer to a class of substances that are able to rapidly promote neuroplasticity without any hallucinogenic effects. This presentation was given by David Olsen, an associate professor of chemistry, biochemistry and molecular medicine at the University of California, Davis. Olsen is also the co-founder and Chief Innovation Officer of Delix Therapeutics, a company that focuses on the development of psychoplastogens.
As mentioned briefly, psychoplastogens are aimed rapidly promoting neuroplasticity. Olsen mentioned during his presentation that this happens through “transforming the structure of the neuron.” Psychoplastogens establish this transformation in particular through “targeting dendritic spine density and increasing both their growth and complexity.” According to Olsen, a lot of neuropsychiatric disorders are due to a lack of dendritic spine density, hence the recent development of psychoplastogens.
But how did the researchers know that the rodents were actually not hallucinating? This was established by using the so-called head-twitch response, which is suggested to be a rodent behavioural proxy for hallucinations induced by 5-HT2A agonists. But I always wondered: How do we really know? Is the head-twitch response truly representative of hallucinogenic effects? Not surprisingly, one of the audience members asked during a discussion session what actually occurs in rodents during the head-twitch response. As it turns out, when you compare rodents who received 5-MeO-DMT to those who receive tabernanthalog, the former will show a robust head-twitch response, whereas the latter will not.
Nevertheless, there are still many difficulties in translating subjective measures from humans to animals, particularly when doing research on depression-like behaviour. This was particularly signified by speaker Emma Robinson, professor of psychopharmacology at the University of Bristol. Nex to the head-twitch response, Robinson presented many other animal testing paradigms, particularly the sucrose preference test, forced swim test, and the novelty seeking test, which are used to assess depression-like behaviour in rodents. She stated that the use of any of these paradigms is suspect to lots of false-positives or false-negatives.
Because of the problems with current animal assays, Robinson and her team used the affective bias test (ABT) as it is suggested to have a better translational validity to humans. Within this assay, animals are trained for a week and have to learn to choose between two options (one positive, one negative) that will in turn reflect a positive or negative bias. It was developed to investigate the hypothesis that the cognitive processes associated with reward-related learning and memory may be modified by affective states. Robinson further explained that this is based on Aaron Beck’s cognitive triad model of depression, a cognitive framework that is often used to account for the negative views and dysfunctional thoughts observed in depression. The research that she presented is not yet published but revealed that one dose of psilocybin or ketamine is able to “completely attenuate the negative bias in rodents.” Translated to humans, this indicates that either psilocybin or ketamine might be able to help individuals with depression mitigate their dysfunctional and negative thoughts. But most importantly, it provides a therapeutic window and opportunity to develop a more realistic view about oneself, the world, and the future.
Drug-Drug Interactions to Increase Therapeutic Efficacy and Improve Harm Reduction
Robinson was followed up by professor of clinical pharmacology and internal medicine, Matthias Liechti, from the University of Basel in Switzerland. Liechti’s presentation was particularly mind-opening to me as he discussed some of the drug-drug interaction effects between psychedelics and other substances. For instance, when individuals with depression receive pre-treatment with the antidepressant escitalopram and then take psilocybin, there were less signs of anxiety and adverse cardiovascular effects. The most striking finding was that this interaction did not alter the psychedelic effects following the ingestion of psilocybin at all. Although this study was quite small with 27 participants and the daily pre-treatment of escitalopram only consisted of 7 days, this finding can be a huge implication for harm reduction in the field of psychedelic research.
Something else that Liechti presented came from an older study that was published in 2015. This study demonstrated that the co-administration of bupropion significantly increased plasma MDMA concentrations and, as a result, prolonged the positive mood effects of MDMA. But maybe even more important, this is another drug-drug interaction that can be used to improve harm reduction during a dosing session due to bupropion’s ability to significantly reduce the heart rate response to MDMA. Together, this indicates that using MDMA with bupropion can enhance mood effects while also lower cardiac stimulation.
The Neurobiology of Psychedelics and Inter-Individual Heterogeneity
The second day was opened by Katrin Preller, a junior Group Leader at the University of Zurich, and a visiting Assistant Professor at Yale University. She talked about numerous subjects, including the neurobiology of psychedelics, the acute modulation of brain connectivity through psychedelics, and the four current network-level models of psychedelic action (for a full explanation of these models, please continue reading here).
Preller pointed out during her talk that virtually everything we know so far about psychedelics and their effects on the brain is based on averages of a group. This is why she asked the audience “what about inter-individual heterogeneity?” In other words, what about the differences between individuals when we compare them before, during, or after the psychedelic experience? Indeed, not everyone’s brain is exactly the same at the start of a clinical trial and it is something we should consider when evaluating the therapeutic effects of psychedelics. This conundrum led Preller to hypothesize the following, namely that “baseline connectivity is predictive of the acute effects and determines how someone responds to a psychedelic.” This hypothesis is explored further in upcoming papers that are yet to be published.
As a clinical neuropsychologist and someone who conducts neuroimaging research myself, I became very interested in this hypothesis and approached Preller during one of the coffee breaks to ask her how this brain connectivity would look like. She was not able to answer this question in detail because as the research stands, it has not been explored in full yet. I continued to ask whether such connectivity could be used as a marker to determine the dosage of a psychedelic or maybe even the type of therapeutic framework. We know, for example, that high connectivity in the Default Mode Network is associated with a high degree of rumination – one of the salient and important features of in major depressive disorder. Maybe this could in turn indicate the dosage amount and possibly even determine the choice of a specific therapeutic framework, such as Acceptance and Commitment Therapy targeted at increasing psychological flexibility. She partly agreed and reflected that it is particularly important to get a better understanding of the synergistic effects of both psychedelics and therapy that in turn optimize therapeutic outcome. But how brain connectivity can be used for this remains to be explored because we simply need more studies. Similar to how she concluded her presentation, we need to learn more about the brain so we can optimize PAT and prevent cost and frustration with patients.
The Design of Clinical Trials: a European Regulatory Perspective and Music
Nearing the end of the conference we were informed about the challenges regarding the design of clinical trials by Gerhard Gründer, Professor of Psychiatry and Chair of Department of Molecular Neuroimaging at Central Institute of Mental Health, Mannheim. As the research stands today, we have small sample sizes to fails to account for sufficient statistical power, there is a lack of control and difficulty with blinding, and an expectation bias with nocebo effects. These challenges are troublesome, but can be overcome when we conduct more research. Gründer also shared some e-mail messages from participants in order to show that the therapeutic alliance is the most important factor for efficacy and that we should take this into account when conducting trials.
To help establish the rigorousness of clinical trials with psychedelics, ECNP invited speaker Marion Haberkamp, a current core member of the CNS Working Party (CNSWP) at the European Medicines Agency (EMA), Amsterdam, and a long-time member and now expert of the Scientific Advice Working Party (SAWP). When it comes to psychedelic research, Haberkamp told the audience that “the findings are both intriguing and sobering” but that “we need longer and more trials.” Accordingly, Haberkamp talked about European regulatory guidelines and challenges that were recently published in the Lancet. As the age-old adage goes in academia, the authors of this paper posit that more rigorous research is needed, but not without giving any specific recommendations. For instance, they added that it is important to reconsider double blinding in clinical trials and the roles of both positive and negative expectancy created during preparatory sessions. Other points include the need to compare psychedelics with psychotherapy, further establish the safety profile of psychedelics, and continue to assess potential drug-drug interactions.
To realise all this, Haberkamp told the audience that there is direct help from the European regulatory office. For instance, researchers are able to come to the SAWP for qualification procedures. Moreover, there are already EMA guidelines for setting up clinical trials for major depressive disorder, substance use disorder, and anxiety. Haberkamp also announced that such guidelines will be available for psychedelics by the summer of 2023.
I want to finale bring attention to Tadeusz Hawrot from PAREA (Psychedelics Access and Research European Alliance). Hawrot is doing a tremendous job in bringing attention to patients’ perspectives, because according to him it is “the patients who are the experts and the most we can learn from.” And this message particularly hit home through the testimony of Dave Pounds, a 59-year-old patient who has been suffering from post-traumatic stress disorder (PTSD) for almost his entire life. A short summary of his story is described down below.
Dave explained to the audience that when he was just a young little boy, he witnessed his mother being raped and murdered at their home. This horrific experience led to the development of recurrent panic attacks in his teenage years and Dave was ultimately diagnosed with PTSD. He tried several types of treatment and an exorbitant amount of different drugs in order to get better, but nothing seemed to work. Even worse, the drugs only seemed to blunt his feelings. A few years ago, he discovered the work of Ben Sessa while Googling on the internet and read about the benefits of MDMA-assisted psychotherapy. He decided to try it out and told the audience about his 1st experience with MDMA. Dave mentioned first of all how this was all very lucid and completely sober. While on MDMA, he returned to his own bedroom at 12 years old, frozen with fear, knowing what had just happened downstairs. The perpetrator came to his room upstairs, but whilst under the influence of MDMA he was not frightened anymore. His mom was also present in the bedroom, while Dave talked to the perpetrator about how he is going to be punished for what he has done. The most striking part of this story is how his mom turned to the perpetrator, hugged him, and wished him well. This left Dave completely astonished, but it gave him the feeling and conviction that he was able to continue with his life, possibly through the act of forgiveness. Dave further stated that he had a long afterglow while in the hospital and never felt unsafe during his experience. What is more, Dave has developed a so-called MDMA mindset that he can access at will at any time during the day. This has finally brought him warmth and calmness after decades. Dave stated that “it is the best treatment I have had in almost 40 years.” But he is also “frustrated by the lack of governmental acceptance and approval”, as both he, and many others suffering from PTSD, have improved so dramatically after MDMA-assisted psychotherapy. Dave concluded his testimony by saying that stating that “this could be the most profound transformation in healthcare.” There are many profound stories out there like Dave’s that almost seem too good to be true. Right after this testimony, the audience was confronted with the dark side of psychedelics.
Jules Evans, an academic philosopher and director of Challenging Psychedelic Experiences Project, is aware of the ongoing psychedelic renaissance and many benefits associated with it, but he also acknowledges the various difficulties and challenges associated with psychedelics. This is based on his own personal experience and research with psychedelics. For instance, Evans had his own bad trip at 18 years and developed PTSD and social anxiety after taking LSD with some of his friends. Fortunately, Evans got better after receiving cognitive-behavioural therapy. Evans further gave notice of a bigger survey (n = 10,836) conducted by ICEERS that collected data from more than 50 countries to assess the adverse events following the use of ayahuasca. This survey showed that there is a high rate of adverse physical effects, primarily vomiting (69.9%), and adverse mental health effects (55.9%) in the weeks or months following consumption. Yet, the authors of this paper also concluded that these experiences “are not generally severe, and most ayahuasca ceremony attendees continue to attend ceremonies, suggesting they perceive the benefits as outweighing any adverse effects.” More recently, Evans has conducted an interview study with 30 individuals after a psilocybin truffle retreat in the Netherlands and was able to show that 30% of individuals experienced challenging experiences.
Our very own Joost Breeksema also acknowledges in a recent review of 44 articles that psychedelics are associated with adverse events and that they are probably underreported due to a lack of systematic assessment and sample selection. Yet, this review also stated that challenging experiences can sometimes be therapeutically meaningful and that we should focus on “disentangling truly adverse events from potentially beneficial effects in order to improve our understanding of psychedelic treatments.”
The amount of knowledge gaps discussed during the conference are manyfold. One message seemed to reverberate through the two days of the ENCP conference – and that is we simply need more research. We need larger studies with more participants and longer follow-ups. Besides this, I went over and compared all my notes from the conference and was able to distil the most prominent knowledge gaps consistent among both speakers and attendees. Here are the three key knowledge that can help move the psychedelic research forward in the upcoming years.
First and foremost, there is the question whether subjective effects are truly responsible for the therapeutic efficacy of psychedelics. Novel psychoplastogens as tabernanthalog developed by David Olsen seem to negate this view. However, the work that has been done so far is based entirely on animal research paradigms, which Emma Robinson pointed out lacks translational validity in humans. It would be interesting to see Olsen and Robinson pair up in order to assess whether the findings still hold up when rodents receive the non-hallucinogenic compound tabernanthalog and are put to the ‘affective bias test’.
Second, our understanding of the neurobiology of psychedelics remains somewhat underdeveloped. Katrin Preller signified this during her talk by pointing out the degree of inter-individual heterogeneity. To reconcile this, we simply need to conduct more studies that are longer and more complex. The multimodal brain imaging study conducted by Imperial College London that assessed the effects of psychedelics before, during, and after a DMT experience using both EEG and fMRI serves as a perfect example of such a study. And we need lots of it.
Third, the investigation of drug-drug interactions, be it the antidepressant escitalopram, bupropion, or ketanserin, show their utility for potential harm reduction and how through pharmacological interaction we could improve psychedelic therapy and outcome. This could have huge implications for how we conduct psychedelic therapy
The Hype is Real
After the ECNP conference, I can confidently say that “the hype is real” in the field of psychedelic research. Even though the legendary hip-hop group Public Enemy stated that we should not believe the hype, I have garnered only more hype in the form of inspiration, enthusiasm, and realistic optimism. The future for psychedelic research looks promising with lots of different topics to explore and it is truly great that European regulatory committees as the SAWP are involved to help establish rigorous and robust scientific research that will only affirm the validity and credibility of psychedelic-assisted psychotherapy. And we are very fortunate that all this is accompanied by a healthy dose of scepticism by the likes of individuals as Jules Evans. Ultimately, there is enough balance of both yin and yang that can help move the field forward and I am proud to be a part of it.
There were other speakers that I did not mention as this was beyond the scope of this blog post. Despite this, I wanted to clarify here that their talks were greatly appreciated during the conference and have listed their names and credentials down below.
David E. Nichols, Adjunct Professor at the University of North Carolina, Chapel Hill, NC, is a Distinguished Professor Emeritus at the Purdue University College of Pharmacy. Nichols talked about the basic pharmacology of psychedelics.
Tomas Palenicek, head of the Psychedelic Research Centre at National Institute of Mental Health, Czech Republic. Palenicek talked about how music genres like psytrance and classic music seem to show the most benefit during psychedelic therapy.
Jan Raemakers, Professor of Psychopharmacology and Behavioral Toxicology at Maastricht University. Raemakers talked about the feasibility of 5-MeO-DMT in healthy volunteers and individuals with treatment-resistant depression.
David Erritzoe, Clinical Senior Lecturer and Consultant Psychiatrist at Imperial College London and in CNWL Mental Health NHS Foundation Trust. Erritzoe talked about psilocybin therapy for depression.
Drummond McCulloch is a PhD who studies the effects of psychedelic drugs on the brain using PET and MR imaging at the Neurobiology Research Unit in Copenhagen. His talk included qualitative data analyses of a clinical trial showing how individuals come more connected to their self, others, and the environment.
Jaskaran B. Singh, Psychiatry Franchise head at Neurocrine Biosciences. His talk consisted of Industry aspects, precompetitive questions, experience from a related area (esketamine).
Tiffany Farchione, Director of the Division of Psychiatry in the Office of Neuroscience at FDA. Tiffany’s talk includes regulatory perspectives of the Food and Drug Administration.
This report (only available in Dutch) describes the current state of (es)ketamine treatments within mental healthcare in the Netherlands. The report aims to contribute to an effective and safe implementation of ketamine in the Dutch mental healthcare system. The first chapter discusses the history of ketamine, its mode of action, administration forms, and its use in mental healthcare. The second chapter discusses ketamine in the Dutch healthcare system. The third chapter focuses on ketamine as an antidepressant. Chapter four discusses the risks associated with its implementation. The last chapter addresses unresolved issues and steps that can be taken in the future. In addition to studying relevant information from previous studies and reports, information was also obtained from a large number of Dutch professionals and experts in the field. Six psychiatrists, five therapists, and three scientific researchers contributed their perspectives on current ketamine treatments, identified existing challenges, and shared their visions for the future of ketamine treatment in the Netherlands. The unanswered questions are included in chapter five and serve as a starting point for further collaborations and study of outstanding issues. The report aims to provide a clear overview of registration, implementation, unresolved issues, and guidance so that the implementation of ketamine as a treatment for TRD can be realized efficiently and safely.
On Monday, March 6th 2023, the report ‘Therapeutic applications of psychedelics’was presented to Dutch minister Ernst Kuipers of the ministry department Health, Well-being, and Sport. Joost Breeksema, executive director of the OPEN Foundation and co-author of the report, was one of the organisers of this event that took place at the University Medical Centre Groningen (UMCG). The report discusses the current state of the therapeutic applications of psychedelics and details the various opportunities, challenges, and recommendations regarding research and implementation of psychedelic-assisted psychotherapy in health care.
A Dutch version of this blog post can be found here.
It is estimated that approximately 200,000 individuals in the Netherlands suffer from severe psychiatric disorders such as treatment-resistant depression and post-traumatic stress disorder, despite currently available treatment in healthcare. Last year Dutch minister Kuipers was already positive about the potential therapeutic application of psychedelics within this group of patients. At the University Medical Centre Groningen, Kuipers was further informed regarding the current state of psychedelics and talked to researchers, therapists, and patients. Similar to last year, Kuipers has shown approval and enthusiasm regarding psychedelic-assisted psychotherapy (PAT).The report ‘Therapeutic applications of psychedelics’ was presented to Kuipers during a mini-symposium at UMCG by managing director of ZonMw, Véronique Timmerhuis. ZonMw is a Dutch organisation that subsidises scientific research to develop and innovate healthcare. The report is written by professor of psychiatry Robert Schoevers, researcher and OPEN executive director Joost Breeksema, and neuroscientist Rutger Boesjes, commissioned by ZonMw.
The report describes the current state of affairs regarding PAT, including the various target populations that could be eligible to receive this particular treatment, but also the various opportunities, barriers, and challenges regarding scientific research and the ultimate implementation of PAT. Furthermore, it offers several recommendations, such as a national research program that could be able to facilitate fast, efficient, and coordinated knowledge developments within the current rapidly developing field. Finally, the report focuses on the development of accredited education institutes to secure the quality of PAT.
Joost Breeksema mentioned after the mini-symposium that “it is very promising to see so much interest in this subject: from ZonMw, the political arena, and from the top of the ministry department of Health, Well-being, and Sport. Similarly, Erwin Krediet, chair of Stitching OPEN, was present during the mini-symposium and said “it was an absolute milestone.” Krediet additionally added that “it was impressive to see how quickly the attitude towards psychedelics is changing – politicians and employees of the ministry were talking about psychedelics in a way that suggests there is not that much stigma left regarding the therapeutic use of these substances.”
Breeksema also gave a brief presentation towards the audience. He talked about how since the founding of OPEN foundation in 2007, a lot has changed: “attention towards psychedelics is generally positive. Not only between scientists, psychologists, and psychiatrists, but also in the media. These messages are received by a lot of patients currently suffering from a severe psychiatric disorder. However, it is very rare for these individuals to receive treatment other than enrolling in a clinical trial with psychedelics. This development increases the risk of patients seeking care outside regular healthcare or self-experimentation with psychedelics, which in turn increases the risk for incidents and adverse events.
The field is making significant and rapid developments in the past two years. For instance, there are tens of millions of dollars in investments and numerous studies being conducted by the pharmaceutical industry. It is highly likely that different types of psychedelics will be registered as approved medication in the upcoming years. At the same time, an important point of consideration is that we develop the necessary expertise and therapists in order to professionally administer these substances and provide the necessary after-care and integration.
Breeksema: “It would be very valuable if the Netherlands could be at the forefront regarding this area of development and demonstrate how a tight cooperation between all interested parties can lead to safe and careful implementation of PAT in current healthcare. Despite many positive developments, we need to proceed with caution and remain critical regarding PAT. These substances are able to induce very confronting experiences that could be painful and complicated to comprehend. This requires professional facilitation and guidance in order to accompany this process.”
Ultimately, Breeksema thinks that the message has been received by Dutch minister Kuipers, particularly regarding the necessity for more and bigger research. Kuipers acknowledges that he sees the importance from a systematic approach – it will take too long for these treatments to arrive at patients when we only have a handful of small studies. Breeksema agrees: “this is something we emphasise in particular in the report.”
After the mini-symposium, there was room for a private session with some patients, therapists and minister Kuipers. Breeksema: “I am very happy that minister Kuipers and member of parliament Wieke Paulusma took the time to talk with both therapists and patients about their experiences with psychedelics. Those sessions are not always easy and I think that we clearly showed how significant it is to take patients seriously and that professional guidance by healthcare practitioners, which includes training as well, remains an essential requirement for the success of these treatments.”
From touching talks to insightful perspectives, and profound new ways of thinking about reality to practical tips about doing therapy or research: ICPR 2022 has been an inspiring, thought-provoking, educational, and uplifting experience. Thanks to you all so much from the bottom of our hearts, whether you were a visitor, volunteer, speaker, presenter, digital visitor, or fan from afar: you made this conference what it was.
A common theme at ICPR 2020 was figuring out what is next for psychedelics and psychedelic therapy, now that their efficacy has been proven, their acceptance is broadening, and a professional ecosystem is developing. The presentations at ICPR were able to satisfy some questions with answers but mostly helped us all to develop new and better questions about the challenges we are dealing with in our own fields.
“We can set the standard for how this is done in the future,” as MAPS director Rick Doblin asserted at the closing panel of ICPR 2022. “And I think the most important thing right now is the training of therapists,” Doblin said, constantly pushing the envelope on where this field might go. “Let people watch videos for example. But also make sure there is a clear and defined way for therapists themselves to take MDMA legally as part of their training.”
At the same time, Paul Stamets stated, we should not forget to look for knowledge outside of the rigor of scientific research and prohibitionist laws – and appreciate more that some of these substances, experiences, and knowledge have been with humanity for a very long time: “We shouldn’t ignore that millions of people have been using these substances for thousands of years,” Paul Stamets stated.
There was special attention for the participants of psychedelic trials, who were featured on a panel to bring a much-needed perspective to ICPR that had been missing at earlier conferences. It was the first time -as far as we know- that a panel of trial participants was featured at a psychedelic conference.
Participants Ian Roullier and Leonie Schneider stressed the need for extensive and thorough support before and after the psychedelic experience: “set and setting, for as participants, apply before, during and after treatment. It’s not just during the medical intervention itself.”
So psychedelics give us the opportunity to radically rethink human healing, was an often-heard sentiment at ICPR: “It’s time we treat people like plants”, Pedram Dara, ICPR Manager and panel member of the participants’ trial asserted. He alluded to the care we take to change the environment of a plant when it’s not doing well – with light, water and nutrients – instead of trying to ‘fix’ the plant itself.
Leonie Schneider underlined the need for an infrastructure and ecosystem. “Tweak the environment so that it supports them. We are not dots on a graph, we are not lab rats, we are human beings. So how do we create peer circles and support groups – a community infrastructure – going forward?”
FUTURE OF PSYCHEDELIC Therapy
Mendel Kaelen, music researcher and the CEO of Wavepaths, underlined the importance of experience as a healing agent: “We learn to walk by walking, we learn to talk by talking and we need to learn to feel safe by feeling safe” – Mendel Kaelen, CEO of Wavepaths.
Janis Phelps shared her qualms about the psychedelic experience being boxed-in too much: “I’m afraid the experience will be overmedicalized,” she said, “that we lose that sense of awe and gratitude that Roland Griffiths talked about. I don’t want to have done all this work just to the benefit of wealthy people.”
Future research was also announced and highlighted. Beckley Foundation founder and director Amanda Feilding announced a first proof-of-concept study with Basel university to study microdosing LSD in mild Alzheimer’s disease. Rick Doblin posed difficult questions around PTSD in children and proposals to explore MDMA-assisted therapy for 11-year olds.
Charles Raison examined the agent of change in a psychedelic experience: are psychedelics more like psychotherapy or more like standard antidepressants ‘on steroids’? To test this, an upcoming study by Raison will administer psilocybin to sleeping participants. Will they experience a meaningful change without having conscious thoughts?
Torsten Passie reflected on his experience in psychedelic therapy: “We are not treating people. We are moderating self-healing. This is why we should guide rather than interfere with the process”, explained Torsten Passie.
There were bigger and smaller findings about how psychedelics compare to more traditional antidepressants. Emotional blunting is a common side effect reported with antidepressants, Matthew Wall explained. And his research found that psilocybin affects emotional responsiveness less than escitalopram – as measured by the emotional faces task. In simpler terms: it found psilocybin offered a greater antidepressant effect with less downsides.
Frederike Holze presented the results of a recent study at University Hospital Basel with Peter Gasser, that a single dose of LSD correlated with a rapid, long-lasting reduction in anxiety symptoms. And that mystical experiences are correlated with longer-lasting effects.
Jennifer Schmidt presented a study that found that Methylone showed the strongest possible antidepressant effect in the forced-swim-test in rats. The study also found that methylone does not have a negative drug interaction with SSRIs, like MDMA does.
David Erritzoe found that participants who were weaned off antidepressants before taking psilocybin experienced a smaller change in depression reduction than those who were fully naive to antidepressants. David Erritzoe explained that the expectancy effect of escitalopram predicts greater efficacy than the same expectancy effect with psilocybin.
We’ve hardly had time to catch our breath after the afterparty (and the after-after-party…) but we didn’t want to leave you with the sincere wish we can do this all again soon! The great success of ICPR 2022 means that the OPEN Foundation has a runway to organise and expand the psychedelic scientific ecosystem for the upcoming years. And it is with that confidence and love that we want to invite you to the next ICPR – now planned for 2024. Because there is much suffering in the world, the questions that psychedelics force us to ask are urgent, and there is much need to separate fact from fiction, and hype from hope, in the prospering psychedelic ecosystem.
This overview was but a snippet of the hundreds of hours we could spend on its content. But rest assured that more videos from ICPR2022 will appear over the coming weeks. Watch your email and follow us on social media to stay up to date. The community platform is where these videos will be released.
Thanks again to all the volunteers helping out, and especially the photography, video, livestream, content and social media teams! Special mention to @martin_spijker for his amazing portraits and photos.
Wow, we’re already on the final day of ICPR 2022! We’ll hear from Roland Griffiths (virtually), trial participants, Rick Doblin, Gitte Moos Knudsen, Bernardo Kastrup and others on topics such as MDMA-assisted psychotherapy, indigenous medicine, business, microdosing, and critical perspectives on the quality of psychedelic research.
Just before lunch, there will be a screening in the Wasson Room of the film Descending the Mountain at 11:50, followed by a Q&A with co-producer Annette Badenhorst. At that same time, Corine de Boer will give an update on MDMA-assisted therapy in Europe, followed by Rick Doblin who will give an overview of the work of MAPS on MDMA.
This will be a hard block to choose from, because at the same time we’ll hear from participants of psychedelic trials in the Shulgin Room.
After lunch, Bernardo Kastrup will give a keynote speech on how the effects of psychedelic point towards a much bigger puzzle about the nature of reality – while the Wasson Room will feature talks on Indigenous medicine in and beyond the Amazon.
For reflecting on three days of psychedelic discourse, there will be a closing panel starting at 17:30, with time to relax and connect afterward. For those who have signed up for the afterparty in Amsterdam: see you there! (Afterparty has a waitlist – check your email for more info)!
As for recordings for all rooms, we’ll need time to process. Most talks will be available for later viewing, but there is no timeline available for this yet. We’ll keep you posted.
And we’re off! After an amazing, warm and inspiring first day where we hugged old friends and greeted new faces, we’re now on to our second day of ICPR! Hopefully everyone knows their way around the building (and to the different “toiletten” tucked in the building) a bit more.
Friday Highlights Some highlights of Friday are LSD Research, the mainstreaming of psychedelics, the future of funding, and psychedelic neuroscience.
David Nutt and Amanda Feilding will dive into the neuroscience of psychedelics in the morning. And Bill Richards will give an update about his work around palliative care and psychedelics – some of the longest-running research into the possibility of psychedelics to relieve suffering of terminal patients. While Torsten Passie will teach lessons from the first wave of psychedelic research in the mid-20th century.
One panel will be about the mainstreaming and commercialisation of the psychedelic field and will include Rick Doblin, VICE-journalist Shayla Love, North Star project leader Julia Mande and professor in clinical pharmacology and long-time psychedelics researcher Matthias Liechti. The conversation will be hosted by journalist Thijs Roes.
Having such a wide range of topics on one day again shows the value of having an interdisciplinary conference. So again, on this Friday, there is again so much to choose from.
Highlighted topic of the day: LSD From its accidental discovery to its long-lasting effects, and now a renewed interest in the therapeutic potential of the substance in modern psychiatry: lysergic acid diethylamide (LSD) is unique in the world of psychedelics. On day 2 of ICPR, you will hear from Friederike Holze and Peter Gasser about the recently published results of one of the biggest trials with LSD in the treatment of anxiety with or without a life-threatening illness.
After many months of planning, ICPR 2022 is finally here! In this post, we’d like to look ahead to the first day of ICPR: Thursday. Here are some highlights, to help you with your planning for the three days of psychedelic science. You can find the full programme here for all the specifics about who is where and when. The full list of speakers and presenters is on the ICPR website. If you have an in-person or livestream ticket already, be sure to check your e-mail for all the latest news and updated – like getting access to our new OPEN Community Platform.
ICPR 2022 will be hosted at the Philharmonie building in Haarlem from approximately 9:00 to 18:00 each day across three stages, which include the Huxley Hall, the Shulgin Stage, and the Wasson Room. Lunch will be served in the main hall and poster presenters will have their own room.
On Wednesday, we’re first holding The Psychedelic Science, Ethics & Business event, featuring in-depth discussions about the way forward in the business side of psychedelics. Supplemental live stream tickets are still available for those who need them and more information is here.
Let’s now dive into the programme so you can get planning and make sure you don’t miss any of the action!
On the first morning of ICPR 2022, Joost Breeksema, director of the OPEN Foundation, will kick things off with an official opening at Huxley Hall at 9:15. This will be followed by chemist David Nichols, who will set the scene with an overview of psychedelics from prehistory to the present. After that, the presentations will generally run parallel.
Later highlights of this first day are neuroscientist Kim Kuypers about microdosing, mycologist Paul Stamets about synthetic psilocybin vs. psilocybin mushrooms and the three interesting panel discussions in the afternoon. Topics will be psychedelic research in the Netherlands, therapist self-experience, and the relative novelty of psychedelic compounds.
Be sure to take a good look at the programme so you can plan accordingly. Because other topics for this first day will range from the commercialisation of psychedelics to mysticism, 5-MeO-DMT for depression, diversity and inclusion in the field, and psychedelic aesthetics.
To round off the day, there will be a musical performance by Vincent Moon at the Shulgin Stage (de Kleine Zaal).
We are like islands in the sea, separate on the surface but connected in the deep – William James
One of the most fascinating findings coming from the scientific literature on psychedelics is their ability to drastically alter our beliefs and worldview. These form the basis of how we relate to ourselves, each other, and the world. As a result, they determine how we attach meaning to our lives and whether we ultimately feel happy, sad, or depressed. Our beliefs and worldview can, in short, be considered as one of the most important aspects of who we are and how our lives unfold.
The current prevailing worldview in Western society to which most of us pledge allegiance is that of materialism. I am not referring to materialism in the consumerist sense, wherein the main preoccupation of the human being is the pursuit and obtainment of things, but materialism from the viewpoint of metaphysics, the branch of philosophy that is concerned with the study of the fundamental nature of reality.
Bernardo Kastrup, one of the speakers at ICPR 2022, challenges the current worldview of metaphysical materialism. Specifically, he proposes analytical idealism as an alternative, the notion that reality is essentially mental and inseparable from mind. Bernardo has been leading the modern renaissance on metaphysical idealism for the past ten years and is considered one of the most energetic, diverse, and original thinkers alive today.
The story of how Bernardo came to idealism is truly fascinating. For those who are interested, I highly recommend two podcast episodes (listed below) in which he explains how he arrived at this particular understanding of metaphysics. In short, Bernardo started his career as a computer engineer, working for some of the biggest and most important companies in the world, including the Dutch company ASML, the world’s leading computer chipmaker for the semiconductor industry, and the European Organization for Nuclear Research (CERN) that operates the largest particle physics laboratory in the world (i.e., the Large Hadron Collider).
Despite these prestigious positions, Bernardo always remained a philosopher at heart and was thus concerned with the bigger questions: “What is life? Where do we come from? What happens to our consciousness after we die?” More than anything, he pondered endlessly as a computer engineer on the possibilities and limitations of artificial intelligence: “If you put enough elements of a computer and chips together to aggregate computing power, when will it become conscious? More so, can it become conscious?”
Materialism and The Hard Problem of Consciousness
The unanswered question refers to a notorious problem that has been troubling scientists and philosophers alike for decades. It was first coined as ‘The Hard Problem of Consciousness’ by Australian philosopher David Chalmers in his famous essay Facing Up to the Problem of Consciousness, which has been declared as the second most important unanswered question in science by Science. According to Bernardo, it should have been number one.
Before we continue, let’s first briefly discuss what materialism is all about. This way we can better comprehend the Hard Problem.
Metaphysical materialism states that all of reality is composed of a small set of fundamental subatomic particles, which are described in the ‘Standard Model’ of particle physics. These particles are the basic building blocks of nature and responsible for the character and behaviors of all known phenomena, from the chair you are sitting on to the entirety of the Milky Way, to your body and loved ones, and of course your mind.
Materialism assumes that these subatomic particles are “dead” and, therefore, absent from consciousness. Now here is the rub: “How do you eventually get consciousness simply by arranging ‘dead’ subatomic particles together?” Alas, we have arrived at the Hard Problem of consciousness. Bernardo calls it a sore on the foot of materialism. In fact, it is such an obstinate problem that materialist philosophers, such as Daniel Dennett, have been accused of ‘explaining it away’.
How do you eventually get consciousness simply by arranging ‘dead’ subatomic particles together?
Other famous neuroscientists, such as Christof Koch, remain hopeful and claim that it is only a matter of time before we resolve the Hard Problem. Koch initiated his quest alongside molecular biologist turned neuroscientist and Nobel Prize winner Francis Crick in the 1990s. Most of all, their primary objective was to discover the neural correlates of consciousness (NCCs), which refers to the “the minimum neuronal mechanisms jointly sufficient for any one specific conscious experience.”
Similar to philosopher Daniel Dennett, consciousness has in their view a mechanistic basis and is ultimately a scientifically tractable problem. So long as we keep collecting more data about the inner workings of the brain through state-of-the art neuroimaging techniques and aggregate this over the years, we will eventually find the much sought after NCCs. The phenomenon of consciousness is, after all, produced by an assembly of dead subatomic particles that we would call a human brain. Consciousness is material brain processes at work.
It is here that Bernardo firmly states that such (scientific) pursuits are – and will remain – futile. We cannot solve the Hard Problem through science because of the simple fact that science cannot look at what nature is – science can only look at what nature does: “The scientific method allows us to study and model the observable patterns and regularities of nature […] But our ability to model the patterns and regularities of reality tells us little about the underlying nature of things”, writes Bernardo.
Tackling the Hard Problem: Idealism to the Rescue
To tackle the Hard Problem, we need to approach it through metaphysics, it being the branch of philosophy that concerns itself with the study of the fundamental nature of reality. Metaphysics looks at what nature is.
Now, Bernardo does not actually “solve” the Hard Problem, but rather circumvents it through his metaphysical framework of idealism. In fact, he suggests that there is no problem at all; it is only a problem when we believe the metaphysics of materialism to be true. And so long as we adhere to the materialist worldview, we keep misconstruing our conception of reality through a flawed conceptual framework that is ultimately nonsensical and self-defeating.
As I was reading about the Hard Problem and delved more and more into the framework of idealism, a quote from Einstein came to mind that perfectly encapsulates the current predicament: “We cannot solve our problems with the same thinking we used when we created them.” Within the metaphysical framework of materialism, the Hard Problem cannot possibly be solved. It is created within a certain mode of thinking, a mode of thinking that is, according to Bernardo, the wrong one.
The Hard Problem is only a problem when we believe the metaphysics of materialism to be true.
So what, then, is idealism? As mentioned before, idealism consists of the notion that mind and reality are inseparable. Put slightly differently, it states that ‘mind’ is the medium of reality, not ‘matter’. This sounds rather abstract and confusing at first, because mind is generally referred to as something we use (although I have my doubts about some individuals) or lose. We see this particularly reflected in our everyday language: “use your mind for once!” or “he has lost his mind!”
Within the metaphysical framework of idealism, however, the mind is defined as something entirely different. In the opening of Chapter 3 in Why Materialism is Baloney, Bernardo provides a “most natural and obvious answer” to the question of what ‘mind’ signifies within the framework idealism: “Mind is the medium of everything that you have ever known, seen, or felt; everything that has ever meant anything to you. Whatever has never fallen within the embrace of your mind, might as well have never existed as far as you are concerned. Your entire life and universe – your parents and the people you love, your first day at school, your first kiss, every time you were sick, the obnoxious boss at work, your dreams and aspirations, your successes, your disappointments, your worldview, etc. – are and have always been phenomena of your mind, existing within its boundaries.”
Yet this description of mind within the framework of idealism remains just that: a description. Again, I want to emphasize here that in order to intuitively understand, or “grok” (to borrow from Bernardo’s lexicon), requires a different mode of thinking. Speaking from personal experience, this is an arduous process, particularly because the worldview of materialism is so firmly ingrained within us. It is a firmly established belief system accompanied by a habitual mode of thinking that is often considered infallible.
Mind is the medium of everything that you have ever known, seen, or felt; everything that has ever meant anything to you. Whatever has never fallen within the embrace of your mind, might as well have never existed.
To avoid eating the menu, we can use metaphors to get an initial taste of idealism. Fortunately, Bernardo provides no shortage of these in Why Materialism is Baloney – a triumphant feat on par with the wit of Alan Watts. In my view, the most intuitive analogy to start off with when trying to “grok” idealism is the whirlpool.
Whirlpools Within the Lake of Mind
Consider ‘mind’ as a lake of water. When this lake is still, water is flowing along freely without any hindrance. The water is not localized. Now, imagine a small whirlpool within the lake. All of a sudden, there is an identifiable pattern that assembles the water molecules in place within the lake. In other words, the whirlpool reflects a pattern that localizes the flow of water (see Figure 1).
We are able to point at this pattern and say: “Here is a whirlpool!” Other water molecules that are not localized through the whirlpool are ‘filtered out’ – they are kept away by the particular dynamics of the whirlpool. From this, Bernardo makes two observations regarding the whirlpool metaphor, namely that 1) the whirlpool reflects a localization of water within the lake and 2) that there is a ‘filtering out’ of the other remaining water molecules.
Figure 1 The whirlpool in a lake is a metaphor for a brain in the medium of mind (from Kastrup, 2014)
These observations lead to the following conclusion, namely that “there is nothing to the whirlpool, but the lake itself.” It is important to remember this statement in the next few paragraphs, because it contains the essence of idealism. Once more, the only thing that the whirlpool reflects is a very specific pattern of water that has been localized within the lake. Ultimately, it is all water. It is all one.
There is nothing to the whirlpool but the lake itself.
Bernardo mentions the brain as something very analogous to the whirlpool in the lake. More specifically, he talks about the brain as “an image [pattern] in mind, which reflects a localization of contents of mind.” And just like there is nothing to the whirlpool but the lake, there is nothing to the brain but mind itself. Within the metaphysics of idealism, the brain represents an identifiable pattern of the localization of mind. Similar to the whirlpool within the lake, we can point to the brain within the medium of mind and say: “Here is a brain!” And just as the whirlpool captures water molecules from the lake, the brain assembles subjective experiences from the medium of mind and ‘filters out’ experiences of reality that under ordinary circumstances do not fall within its boundaries.
There is nothing to the brain but mind itself.
Consider the following. Would you say that a whirlpool causes water? Or that flames are the cause of combustion? What about lightning being the cause of electric discharge? My guess is probably not. In fact, you would be rather perplexed when someone gives you these presuppositions: “Of course a whirlpool does not causewater. It is exactly the other way around; the water, or the lake, is the very thing that causes the whirlpool!” Naturally, the whirlpool and water are very much related to each other, but the whirlpool only represents a “partial image” of the whole process that is lying underneath it.
And the same can be said of the brain. It too represents a partial image within the broader medium of mind. According to Bernardo, saying that “the brain generates mind is as absurd as to say that a whirlpool generates water!” (italics added).
Understanding the brain to be a partial image within the broader medium of mind eliminates the Hard Problem entirely, because the aforementioned NCCs can now be interpreted differently. Yes, there still exists a clear and obvious relationship between brain states and someone’s state of ‘mind’, but now the former can be seen as a partial image of the latter. As Bernardo concludes: “The brain is an experience, an image in mind of a certain process of mind.”
What materialism is trying and claiming to accomplish is the impossible. It maintains that the brain is the very thing that causes consciousness and the plethora of subjective experiences that go along with it. But if you understand just a little bit of what has been presented so far, you can begin to see that this is a complete non sequitur. It does not follow that consciousness is the cause of brain processes, as one would similarly not infer that combustion and water are respectively caused by flames and whirlpools. Trying to fix it only results in what is keenly illustrated on a subreddit that creates some hilarious memes of Bernardo and idealism.
Of course, it would be unfair to entirely negate materialism based on just this metaphor, albeit it being a very useful one. This is where psychedelics come in, as their effects on the brain help make sense of this metaphor.
Brief Peeks Beyond: The Acute effects of Psychedelics on the Human Brain
In the past decade, Bernardo has written extensively about the acute effects of psychedelics on the human brain. More specifically, he has provided evidence of how neuroimaging studies seem to support the tenets of idealism – much to the dismay of other materialist neuroscientists, which include previous ICPR speakers as Enzo Tagliazucchi and Robin Carhart-Harris.
To be clear, Bernardo never suggested “malicious intent.” Rather, the intention was to emphasize how “paradigmatic expectations can make it all too easy to cherry-pick, misunderstand and then misrepresent results so as to render them consistent with the reigning [materialist] worldview.” Indeed, it is a clear example of how materialism permeates the culture and how unaware we are of our philosophical presuppositions.
In general, neuroimaging studies examining the acute effects of psychedelics on the human brain demonstrate that there is an inverse relationship between brain activity and subjective experience. Wait, what? Yes, you read that correctly. Psychedelic substances are found to reduce brain activity, rather than increase it. Such results vehemently oppose the intuitions of materialism. After all, it is brain activity itself that is supposed to constitute subjective experience: “consciousness is brain activity.” How else are we going to find the NCCs?
Down below follows a summary of two important neuroimaging studies and Bernardo’s interpretations of their results, which led him to conclude that the evidence thus far supports idealism.
The first study examined the neural correlatesof psilocybin. According to Bernardo, this study was “extremely well designed” as it countered the “uncertainties of measuring brain activity with an fMRI scanner.” Here, he is alluding to the fact that the researchers used two ‘signals’ in determining brain activity, namely arterial spin labeling (ASL) and blood-oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI). More specifically, ASL is a non-invasive fMRI technique for measuring cerebral blood flow (CBF): the amount of CBF indicates the amount of brain activity. On the other hand, BOLD measures the difference between oxygenated and deoxygenated blood in various brain regions that indicates the level of metabolism. Ultimately, it is the amount of metabolism which indicates the amount of brain activity in a given brain region.
With both these measures, here is what the authors from the psilocybin study reported: “we observed no increases in cerebral blood flow in any region” (italics added). Even more ‘alarming’: “the more the drug deactivated the brain, the more intense were the subjective experiences reported by the subjects” (italics added).
Reading further into the study, results become particularly worrisome for materialists when study participants made report of having had extremely rich subjective experiences, which included “geometrical patterns”, “extremely vivid imagination”, “seeing their surroundings change in unusual ways”, and having experiences that feature a “dream-like quality.”
Bernardo summarized the findings in one of his many blog posts and stated: “the brain largely goes to sleep. Who, then, is having the trip? It doesn’t seem to be the brain.”
Neuroimaging studies examining the acute effects of psychedelics on the human brain demonstrate that there is an inverse relationship between brain activity and subjective experience
Fast forward four years later and another study came out that examined the neural correlatesof LSD. This time the findings received much more attention from the public and was covered by prestigious media outlets, such as The Guardianand CNN. Bernardo responded to this “fanfare” and explained to his readers how they are being “subtly deceived (again).” Because, similar to the psilocybin study, results yet again demonstrated observed reductions of brain activity across the entire brain (see Figure 2). As you can clearly see, there is a whole lot of blue. In fact, everything is blue which indicates reductions in brain activity.
Now, to be fair, the authors from the LSD study did find one small inconsistency when comparing findings to the psilocybin study. Apparently, there were results that indicated increases in CBF in the visual cortex of the brain when LSD was compared to placebo (see third row Figure 3). Such a finding would indeed support the view of materialism, i.e., more activity in the brain equals more subjective experience.
Figure 2 Brain activity as determined by magnetoencephalography
Yet, the authors from the LSD study concluded that the observed localized increases in CBF were possibly the result of measurement artifacts: “one must be cautious of proxy [indirect] measures of neural activity (that lack temporal resolution), such as CBF or glucose metabolism, lest the relationship between these measures, and the underlying neural activity they are assumed to index, be confounded by extraneous factors, such as a direct vascular action of the drug.”
Figure 3 Cerebral blood flow as determined by ASL
This is why the authors opted to put more emphasis on findings from Figure 2, as it represents the results of magnetoencephalography (MEG). This is another widely used functional neuroimaging technique for mapping brain activity. As opposed to indirect measures such as BOLD and ASL, MEG represents a directmeasure of neural activity. Naturally, the LSD study authors concluded that MEG: “should [thus] be considered [as] more reliable indices [measures] of the functional brain effects of psychedelics” (italics added).
Of course, these were only two studies that examined the acute effects of psychedelics on the brain. But as many of you probably know, the psychedelic renaissance has been on full throttle in the past years. As both Bernardo and Prof. Edward F. Kelly alluded to in an opinion piece on Scientific American: “these unexpected findings have since been repeatedly confirmed with a variety of psychedelic substances and various measures of brain activity” (see 2013, 2015, 2016, and 2017).
Let us now transpose these neuroimaging findings in context of the whirlpool metaphor. Remember how we said that both the whirlpool and brain analogously represent an identifiability pattern, or image, within the broader medium of the lake and mind, respectively? And remember how we also said how they both reflect a localization and filtering of the contents of mind, which led us to conclude that there is nothing to the brain but mind itself? Here is what psychedelics seem to do.
Psychedelics perturb the dynamics of the brain to such a degree that there is a non-localization of the contents of mind (i.e., subjective experiences that are, under ‘normal’ circumstances, assembled by the brain). But now, by bringing psychedelics into the mix, subjective experiences from the medium of mind are suddenly no longer filtered out. The whirlpool stops existing, water molecules are able to flow along freely, and thus become one with the lake. Analogously, the brain stops “existing” as activity goes down that results in a bombardment of subjective experiences (e.g., “extremely vivid imagination” as the psilocybin study participants reported). Ultimately, the contents of mind that were, under ‘normal’ circumstances, assembled by the brain become one with the medium of mind. To put it in Aldous Huxley’s words, the psychedelic experience can bring about the realization that “each one of us is potentially ‘Mind at Large’.”
The contents of mind that were assembled by the brain become one with the medium of mind
A sweet moment of irony, particularly for Bernardo, is how the authors from the psilocybin study unintentionally hinted toward the whirlpool metaphor themselves by mentioning Aldous Huxley’s metaphor of the reducing valve: “This finding is consistent with Aldous Huxley’s ‘reducing valve’ metaphor … which propose[s] that the mind/brain works to constrain its experience of the world.”
For people who are unaware, the reducing valve metaphor is a result of Huxley’s experience with the psychedelic substance mescaline. He reported his experiences in The Doors of Perception and Heaven and Hell. Huxley’s description of the brain as a reducing valve – and its similarities with the whirlpool metaphor – become immediately apparent in the following passage: “The suggestion is that the function of the brain and nervous system and sense organs is in the main eliminative and not productive (italics added). Each person is at each moment capable of […] perceiving everything that is happening everywhere in the universe. The function of the brain and nervous system is to protect us from being overwhelmed […] by shutting out most of what we should otherwise perceive or remember at any moment, and leaving only that very small and special selection which is likely to be practically useful.” To clarify here, when Huxley mentions that the brain’s job is “to protect us from being overwhelmed” seems to be analogous to the localization of the contents of mind. The same can be said for how subjective experiences are “shut out” and the filtering out process in the whirlpool metaphor.
Finally, these so-called peak experiences associated with psychedelics are not only reserved to dedicated psychonauts. In fact, “there is a broader pattern associating peak subjective experiences with reduced blood flow to the brain”, says Bernardo. This is further exemplified in Why Materialism is Baloney and another academic article in which he lists a host of findings from different domains (e.g., hyperventilation, meditation, gravity-induced loss of consciousness, cerebral hypoxia, cardiac arrest, and even brain damage). All seem to corroborate the phenomenon that less blood flow equals richer subjective experiences, not less.
Ego Death: Becoming One With the Medium of Mind
What I find is the earlier observation and remark that the brain, for a brief period, stops “existing.” I am alluding here to a widely studied phenomenon in the psychedelic literature referred to as ego death, or ego dissolution.
The experience of ego death consists of an altered state of consciousness in which there is a dramatic breakdown of one’s “sense of self.” Several neuroimaging studies have consistently demonstrated that psychedelics reliably facilitate this breakdown, something that occurs through the disintegration of an important brain network called the Default Mode Network (DMN) (see 2015, 2019 and 2020). The DMN is regarded by some neuroscientists to represent the neural correlates of the self or ego, as increased brain activation is primarily seen during self-referential processing.
Bernardo interprets the neuroimaging findings in the context of idealism by using the whirlpool metaphor: “I couldn’t help but visualize the deactivation of the ego functions as analogous to someone inserting one’s hand in a whirlpool, disrupting the ‘loopy’ flow that maintains it, and thereby allowing the water molecules originally trapped in it to escape.” Within this metaphor, the hand represents psychedelics that perturb the dynamics of the brain and how it dissolves the sense of self, or ego, through disintegration of the DMN.
We have read before that study participants report “geometrical patterns” and experiences of “dream-like quality.” What else do they report during a psychedelic peak experience? More importantly, what do they report when experiencing ego death, or ego dissolution, once their DMN disintegrates? Lots of anecdotal reports can be found from the Erowid experiences vault, but these might not be considered as reliable or valid. Fortunately, there also are findings from clinical trials.
Six months later, the study participants were interviewed by one of the research team’s clinical psychologists Dr. Rosalind Watts. She asked them a series of questions to assess patient experiences during the psilocybin sessions, including the million dollar question: “What happened during dosing?” I refer the reader to the article itself or to watch Watts’ presentation to prevent you from becoming overflowed by tedious and superfluous amounts of awesome quotes. Down below I have listed some of the most revealing descriptions that seem to correspond with the whirlpool metaphor and idealism.
In an entire paragraph devoted to the ‘Connection of a spiritual principle’, Watts describes what happened during the psilocybin session. Here, patients frequently report “strong feelings of compassion, love, and bliss” that were often beautifully put, almost poetically. For instance, one of the participants stated that during the dose: “I was everybody, unity, one life with 6 billion faces, I was the one asking for love and giving love, I was swimming in the sea, and the sea was me.” This is a particularly clear example that corresponds with the metaphor of the whirlpool, as the participant literally mentions how she was swimming in the sea and realized being a part of it.
Another report hits the nail on his head by exemplifying this transition: “Before I enjoyed nature, now I feel part of it. Before I was looking at it as a thing, like TV or a painting. You’re part of it, there’s no separation or distinction, you are it” (italics added). Other participants reported similar experiences during the dose, such as “connecting to all other souls” or that it “felt like sunshine twinkling through leaves, I was nature” (italics added).
I was everybody, unity, one life with 6 billion faces, I was the one asking for love and giving love, I was swimming in the sea, and the sea was me
In general, the reports seem to follow a common narrative, namely that they are part of something greater than their little ‘selves’. Study participants as whirlpools have become one with the medium of the lake again. We can even be bold to suggest that these participants realized that they were “nothing to the whirlpool, but the lake itself.”
Analogously, the ego and the sense of self stops existing, as the DMN disintegrates and the contents of mind become one with the medium of mind. The great philosopher Alan Watts provides the quintessential description: “We do not ‘come into’ this world; we come out of it, as leaves from a tree. As the ocean ‘waves,’ the universe ‘peoples’. Every individual is an expression of the whole realm of nature, a unique action of the total universe” (italics added).
Future Musings and Grokking Idealism
As mentioned in the introduction, our view of the world determines in large part how we relate to ourselves, others, and the world. Now, if we maintain that the metaphysics of idealism is true – and we are indeed all whirlpools of the same lake – consider first how this will affect your life and how you will behave to your fellow human beings. Bringing hurt to someone else would then literally mean bringing hurt to oneself.
But I think the implications of idealism go much further than this. In fact, idealism made me think a lot about what Carl Sagan alluded to in his brilliant TV series Cosmos: A Personal Voyage: “a new consciousness is developing which sees the earth as a single organism and recognizes that an organism at war with itself is doomed.” And this is what idealism does – it recognizes that we are all, in Huxley’s words, potentially Mind at Large.
This has led me to ask two fundamental questions that hopefully can be answered in the near future. Might the metaphysical framework of idealism result in a significant reduction of unnecessary conflict and suffering in the world as it sees that we are all connected? And what important role do psychedelics play in facilitating this worldview?
The possible transition of materialism to idealism will probably take some time. In part, this is because it is extremely difficult to intuitively understand, or “grok”, idealism. This inability is exacerbated through our cultural milieu that always rejoices in the viewpoints of materialism: “we grew up to believe that mind is a product of the brain, not the other way around”, says Bernardo. As a result, it has been imprinted in our very way of being and can be considered as the lingua franca of contemporary metaphysics. It is the exact reason why Bernardo provides some solace to his readers through the advice of giving all this some thought to let the metaphysics of idealism sink in.
Indeed, the drastic change in worldview does not come naturally to us. It requires what is coined by renowned philosopher of science Thomas Kuhn a paradigm shift – a fundamental change in the basic concepts and experimental practices of a certain discipline. What is more, we are protected by ourselves from what is referred to as an “ontological shock.” This happens particularly when beliefs are diametrically opposed to prior held personal, religious, or spiritual beliefs – something that OPEN director Joost Breeksema and neuroscientist Michiel van Elk refer to in Working with Weirdness.
Bringing it all together, I believe we are at the precipice of another Copernican revolution and that Bernardo represents a modern day version of Giordano Bruno. Bruno was a 16th century philosopher tried for heresy by the Roman Inquisition and subsequently burned at the stake for his cosmological theories (e.g., stars were distant suns surrounded by planets). Such ‘theories’ are now considered common knowledge, and more importantly, common sense. Only centuries later, Bruno has been characterized as a martyr for science. Might the same be said of Bernardo? Possibly so, as in his own words, “future philosophers will be merciless at our stupidity.” Let us not “burn” him at the stake, for Bernardo’s thoughts too can one day become common sense.
Bio Bernardo Kastrup is the executive director of Essentia Foundation. His work has been leading the modern renaissance of metaphysical idealism, the notion that reality is essentially mental.
He has a PhD in philosophy (ontology and philosophy of mind) and another PhD in computer engineering (reconfigurable computing, artificial intelligence). As a scientist, Bernardo has worked for the European Organization for Nuclear Research (CERN) and the Philips Research Laboratories (where the ‘Casimir Effect’ of Quantum Field Theory was discovered).
Common misconceptions There are several misconceptions about idealism (listed below). For this I refer the reader to pages 64 to 69 in Why Materialism is Baloney: 1. Idealism is not solipsism; 2. Idealism is not panpsychism; 3. Falling back into realist assumptions: “where is this mind stuff?” 4. Why can’t we influence reality at will if everything is in mind?
Dr. Mendel Kaelen doesn’t believe the perfect playlist for psychedelic therapy exists. After ten years of research, Dr. Kaelen, Founder and CEO of Wavepaths, has developed an evidence-based, person-centered generative music product that allows the user and therapist to create a tailored music experience.
Wavepaths provides music both for and as psychedelic therapy, Mendel explained to the OPEN Foundation: “Music is a very powerful tool and I’m confident that we can view music as a psychedelic.”
He has understood this as a result of his experiences at Imperial College in London, where he worked as a PhD and postdoctoral neuroscientist, studying music’s role in psychedelic therapy.
“Psychedelics act as an agent that can reveal deeper parts of our being deeper parts of ourselves,” he explains, “and thereby can facilitate experiences that are meaningful and potentially life-changing.”
That’s revolutionary, he says: “Psychedelic therapy research is hinting at a new paradigm of understanding mental health: that the most effective way to facilitate change is by providing an experience. Not an idea, not a conversation but a directly felt fully embodied experience.”
“I’m talking about music in itself. So what we’re seeing already right now in our community is we have psychotherapists right now organically that joined our platform that are doing psychotherapy without psychedelic drugs. They are using Waveparts as an adjunct to deepen a particular experience.”
At ICPR 2022, Dr. Kaelen will shed light on the central role of music in psychedelic therapy, and hold a presentation titled The essential role of music in Psychedelic Therapy: 10 years of research.
A few last spots are still available for his workshop “Music For/As Psychedelic Therapy”, held on Wednesday September 21. Find out more at Mendel’s workshop page on the ICPR website.
Join us for a LIVE Q&A with Paul Stamets and Dr. Pamela Kryskow