OPEN Foundation

Interviews

The Netherlands should be ‘at forefront’ of psychedelic research, says Dutch government

‘The Netherlands can play a pioneering role in developing the right frameworks, limiting potential risks, and designing training programs,’ the Dutch health minister said.

Author: Stephan Tap

Ernst Kuipers, the new Dutch Minister of Health, Welfare, and Sports, has given his green light to more research in psychedelic therapy, citing “promising results” for typically difficult-to-treat mental illnesses through psychedelics-assisted therapy. His endorsement came in response to questions from three members of parliament from the Dutch political party D66. Kuipers summed up his stance on psychedelic research in a letter directed to the Speaker of the Dutch House of Representatives, and its content is factual and amenable to recent scientific results.

This is a departure for the Dutch government, which in recent years produced more prohibition-focused or avoidant language when it came to issues surrounding psychedelics. The new government has also announced that a state committee will look into the medical use of MDMA – a political compromise arising from the ongoing discussion in the Netherlands about the possible legalisation of MDMA for recreational use.

The new government’s health minister demonstrated conviction about the prominence psychedelic therapy will gain in global healthcare in the coming years, and envisions how the Netherlands could become a leader at the forefront of psychedelic research: “It is paramount that these and other potentially innovative treatments are safely accessible to the target population,” the minister writes. “The Netherlands is one of the leading countries in research into psychedelics in mental health care. In addition, the Netherlands can play a pioneering role in developing the right frameworks, limiting potential risks, and designing training programs for therapists. I am in favour of sharing earned knowledge with parties in the field across different countries.”

The Netherlands at the forefront of psychedelic research

Apart from MDMA, other psychedelic substances – such as psilocybin1 and ketamine2 – have also demonstrated promise. Kuipers strikes a more cautious tone when speaking about these compounds, affirming the need for more research due to the preliminary nature of current results: “Most of these substances are still in the investigative phase of research. […] It is up to the relevant field parties to follow up on these results. This concerns conducting the necessary research, completing the step-by-step registration process for approval of the substance, and the development of guidelines and protocols necessary for treatment.”

Kuipers further stresses the need for extensive education, the training of psychedelic therapists, and the need to better understand individuals engaged in self-experimentation. He adds that he is “willing to play a facilitating and advising role” in implementing psychedelic research and that his ministry has recently conducted exploratory meetings with researchers and mental healthcare institutions.

He envisions the Netherlands as playing a major role internationally in the coordination and promulgation of psychedelic research, writing that “[t]he Netherlands can stimulate cooperation in a European and international context. In addition, the Netherlands can draw attention to removing barriers in conducting research. In the framework of the United Nations Commission on Narcotic Drugs, I continue to advocate for the removal of barriers to therapeutic use and research into substances on United Nations drug convention lists.

New Research

According to Kuipers, an estimated 1.2 million Dutch citizens currently seek curative mental healthcare each year. Another 215,000 citizens suffer from severe psychiatric illness, a segment of the patient population that is very difficult to treat with current therapies. Kuipers has announced he will allocate 35 million euros to mental healthcare research over the next four years, made available through the Dutch grant organisation ZonMw. Grants will support multidisciplinary studies focused primarily on clinical applied research.

The availability of these funds presents psychedelic researchers with a rare opportunity. Results from these new studies could further elucidate the therapeutic mechanisms by which psychedelics function, thereby putting their clinical application on firmer scientific footing.  Ultimately, Kuiper’s initiative offers the promise of advancing the field beyond its “investigative phase” and imagines a not-too-distant future in which psychedelics are used as legitimate therapeutic agents in clinical contexts, offering hope to the millions who suffer from severe psychiatric illness around the globe.

Barriers to breakthrough therapy status

The three representatives of D66 asked further questions surrounding the current “breakthrough therapy status” of certain psychedelics in the United States. A breakthrough therapy designation is granted to a drug that treats a serious or life-threatening condition, where preliminary clinical evidence indicates that the drug might demonstrate substantial improvement on clinically significant endpoints over available therapies.

Recently, the American Food and Drug Administration (FDA) granted ‘breakthrough therapy status’ to psilocybin for treatment-resistant depression and to MDMA for PTSD. Kuipers explains that a similar status within the Netherlands and other countries in Europe can be attained through organisations such as the European Medicines Agency (EMA).

The minister acknowledges the barriers that still exist for psychedelic research, like “a lack of financial resources for doing the necessary clinical research and developing an approved product for the patient. In addition, psychedelics are substances that are generally non patentable and thus do not fit the ordinary development and revenue model. The potential high costs for the therapeutic treatment with these substances (due to the large amount of hours therapists dedicate to patients during treatment) might also impede incorporating psychedelics as a standard treatment.” 

The issue of the relative expense of psychedelic therapy bears further scrutiny. How, for instance, would the cost of psychedelic therapy compare to that of treatment as usual (TUA) if we take into account factors such as the economic burden of different psychiatric illnesses and/or disability-adjusted life years (i.e,. the number of years lost due to an illness)? To resolve the issue of financial expenditure, cost-effectiveness analyses of psychedelic therapy should be conducted, such as that performed in 20203. This study found that MDMA-assisted psychotherapy versus TUA per 1,000 patients produced savings of up to $103.2 million over 30 years including costs, and surmised that “third-party payers are likely to save money within three years by covering this form of therapy [MDMA].” This, however, is just the conclusion of one study, and the issue of financing deserves further investigation.

Central management and the Netherlands

Kuipers acknowledges the risks involved in the lack of central management of psychedelics. Possible risks include personal experimental use of psychedelics and the development of  commercially exploitative practices that fail to the interests of patients first. Kuipers emphasises the urgency with which these questions need to be answered, and references the Dutch researchers and clinicians who authored Therapeutic use of psychedelics4: “[…] they can develop a framework for this new form of treatment by means of high quality guidelines, standards, and protocols.”

Finally, the new government of the Netherlands has called for more research into MDMA and the possible legalisation of it in the near future. Kuipers mentions that there will be a state committee specifically for MDMA. The state committee will “investigate the status of MDMA in the context of public health and provide advice surrounding the pros and cons of medicinal use by adhering to a multidisciplinary analysis, which takes into account potential risks for health, prevention, and the European context and its relevant treaties.” Kuipers expects to inform the House of Representatives of the committee’s findings in the second quarter of this year.

References:

1. Davis, A. K., Barrett, F. S., May, D. G., Cosimano, M. P., Sepeda, N. D., Johnson, M. W., … & Griffiths, R. R. (2021). Effects of psilocybin-assisted therapy on major depressive disorder: a randomized clinical trial. JAMA psychiatry, 78(5), 481-489.

2. Nieuwsuur (2022). Keta kan ‘revolutionair’ middel zijn tegen depressie, maar er zijn ook zorgen.  Consulted on 27 March 2022.

3. Marseille, E., Kahn, J. G., Yazar-Klosinski, B., & Doblin, R. (2020). The cost-effectiveness of MDMA-assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD. PloS one, 15(10), e0239997.

4. Universitair Medisch Centrum Groningen. Manifest therapeutische gebruik van psychedelica. Retreived March 20, 2022.

Farewell Letter to OPEN

After 15 years, Dorien Tatalas says goodbye

22-02-2022

After 15 years of service, I recently resigned from the board of the OPEN Foundation. In these words of goodbye, I’d like to share some personal reflections on the foundation’s (and to some extent, my own) journey into adulthood, as well as some of my hopes for the future. 

Magic Carpet Ride

In 2006 I was a psychedelically inquisitive cultural anthropology student, looking for her tribe. I longed for connection with others who were personally and academically curious about psychedelics and the states of consciousness they give us access to. The legendary LSD Symposium in Basel opened my eyes to the existence of a community of sciency psychonauts and I wanted to be part of it. Since the Netherlands lacked an organization that combined science and psychedelics, I did what young and naive idealists do: I decided to start a new organization. Little did I know that this foundation would become so intertwined with my life and identity, on so many levels. If psychedelics are the red thread in all of my adult life, OPEN is a delicately woven magic carpet – and I’m immensely grateful for the ride. It has brought me to new places, new ideas, and aspirations and it connected me with so many like-minded people, who over the years have become my colleagues, friends, and advisers. I even met my significant other – yes, OPEN has quite literally led me to my family. 

OPEN’s Journey

We started out as a local student-run organization with many dedicated and loyal volunteers. The taboo on the topic of psychedelics was still palpable, even in a country with a supposedly progressive drug policy like the Netherlands. To give an example: when OPEN wanted to become a customer at a national sustainable bank in 2007, we were denied a bank account because the topic of psychedelics was deemed too controversial – even in the context of academic research. How much has changed since those early days.

Over the past decade, OPEN has developed into a mature organization with an official tax-deductible non-profit status. If our foundation excelled in one thing, it’s in organizing conferences: the Interdisciplinary Conference on Psychedelic Research (ICPR) has become an internationally renowned event praised for its high academic quality. When we organized our first lecture in 2007 – “Ayahuasca & Anthropology” with Jeremy Narby – we could only fantasize about a psychedelic conference with accreditation for Dutch mental healthcare professionals. At ICPR 2016 this fantasy became a reality and ever since, our conference has been officially accredited by the leading professional mental healthcare organizations. 

Some of OPEN’s recent achievements that I’m proud of are the 2020 publication of the “Tijdschrift voor Psychiatrie” (the leading Dutch journal for psychiatrists) which was dedicated entirely to psychedelics; the ongoing collaboration with the KNAW (Royal Dutch Academy of Sciences) which so far has resulted in a several very interesting symposia; and the very recent manifest “Therapeutic use of Psychedelics” which has opened up a constructive dialogue with the Dutch Ministry of Public Health about the regulation of psychedelics assisted therapy. All of the above are examples of collaborative efforts and they illustrate one of OPEN’s core qualities: its ability to connect people and organizations, to build bridges between academic and professional fields. I haste to add that my felt pride in these achievements is purely from the sideline, as a board member – I haven’t been actively involved in any executive tasks for quite a long time. Full credits and gratitude for these achievements go to all of OPEN’s executive employees and the team of dedicated volunteers.

Exciting Times, New Challenges

As a network organization in the psychedelic field, OPEN is witnessing a huge change in the professional climate. Psychedelics are now being hailed as “the new promise in mental healthcare” by professionals from a multitude of backgrounds, as well as by mainstream media and multi-billion investors. The psychedelic renaissance has definitely shifted gears – and although these times are definitely exciting, they also come with challenges.

Commodification

One of the challenges that non-profit organizations like OPEN currently face, is how to relate to and navigate in an increasingly complex field, that includes stakeholders whose interests in psychedelics are mainly economical. What’s at stake in the rapidly commodifying field of psychedelics are, among others, safety and equal access. Such topics involve exploring ethical questions  – the answers to which will reverberate in the ways in which psychedelics will be integrated into our healthcare systems and societies. If you ask me, answering these far-reaching ethical questions should not be left to the market. Solving these complex issues is not the prerogative of the academic world either. The future of psychedelics now belong to a – primarily local, but increasingly global –  public debate, in which non-profit organizations in the psychedelic domain are contributing their independent, evidence-based, and objective voice.

Diversity

Another issue that I take at heart, which I hope OPEN will address within its own organization and events in the coming years, is the matter of equal representation and diversity. The psychedelic research world in 2022 is still primarily a white, middle/upper class, heterosexual, cisgender, male-dominated domain. Other ‘flavors’ of being human are painfully underrepresented or lacking entirely – not only as presenters at conferences but also as participants in psychedelic research and members of (advisory) boards. Alas, OPEN is no exception –  there is certainly room for improvement to diversify our board, advisory board as well as presenters at ICPR. Our very diverse base of volunteers does look very promising in this regard and hopefully will inspire other segments of the organization.

For a topic so rich and colorful as psychedelics, that pertains to a universal human experience, the lack of diversity is not only an embarrassing fact but such a missed opportunity. We are all biologically wired to experience psychedelic states of consciousness – but how we experience these states subjectively, how we reflect upon and interpret them, how we give meaning to them… how can this not be influenced by our subjective experience of ourselves and our relation to the world? Time and time again, it is stressed that set and setting are paramount in determining the psychedelic experience. Let’s not forget that gender, cultural background, ethnicity,  socioeconomic status (among others) are all part of that set. Diversity is a rich palette of all the different hues of human experience – if there’s one research area that can’t get away with using greyscale only, it’s psychedelic research. 

Precious Jewel

As my concluding thoughts, I want to build on a well-known metaphor of psychedelics as a multi-faceted diamond. In contemporary western societies, psychedelics have long been a diamond in the rough, valued for their potential by a relatively small group of people. They have been polishing the gemstone by using the scientific method, and by doing so, are attracting more and more people who, for various reasons, are interested in this jewel. Although psychedelics are being hailed as a promising tool in medicine, it’s important to emphasize that clinical research into these substances is just one of the diamond’s many facets. Psychedelics and the states they induce are such a rich and complex research subject – to study them from one discipline only wouldn’t do justice to it. The sociological, anthropological,  philosophical, neurobiological, and psychological perspectives – just to name a few – are all equally deserving of being studied. They are also intricately related to each other. By stimulating an interdisciplinary approach, organizations like OPEN contribute to the polishing of the entire diamond.

It’s worth noting here that many non-western cultural traditions have appreciated the richness of psychedelic consciousness for centuries and that there is a lot to be learned from such traditions – even if they take an angle that at first glance doesn’t seem compatible with our materialist scientific approach. The reverence and respect with which they treat psychedelic agents are exemplary and there is much wisdom in the ritual infrastructure in which psychedelic journeys are embedded in their societies.

As the academic world at large is becoming increasingly attracted to the precious gemstone called psychedelics, so are other domains of our society drawn to its shimmer and shine. The resulting tension raises fundamental questions, a few of which I will leave you with to consider. If all humans are biologically wired to get a glimpse of this diamond – can it ever be claimed as someone’s property? Will this diamond divide us, once again? Or does its true power lie in its ability to connect us?

Thank You & Fare Well

On this note, I would like to say goodbye. I wish OPEN all the best – may you continue to connect people, organizations, and the many different academic disciplines from which psychedelics can be studied. May you show the academic world what a fascinating diamond the psychedelic state of consciousness is while maintaining an objective and independent voice.

A huge thank you to everyone who has been involved with OPEN in the past 15 years – and a prospective word of appreciation for all of the foundation’s future supporters. 

Farewell, dear OPEN Foundation! I will happily take a seat in the audience at ICPR 2022. Or… perhaps I will apply as a volunteer!)

Yours truly,

Dorien Tatalas

Co-founder, former Chairwoman & former board member of the OPEN Foundation

With my dear friends and (former) board members of OPEN, at the first ICPR in 2012

The Legitimation of Psychedelic Science: An interview with Danielle Giffort

“I am proud to have ‘killed’ government-authorized research on psychedelics.”
Timothy Leary, 1992

Most stories about the early psychedelic research in the 1960s tend to converge towards a common narrative: Timothy Leary, a rogue researcher turned LSD prophet, triggered the social backlash that would ultimately condemn psychedelics to decades of prohibition. In her book “Acid Revival”, sociologist Danielle Giffort explores the history of psychedelic science and how the controversial figure of Leary has shaped the path towards legitimacy for contemporary researchers. In this interview, we discussed Leary’s responsibility for the demise of the first wave, as well as the history of self-experimentation, controlled methodologies and spirituality in psychedelic science.

Dr Danielle Giffort – Assistant professor of Sociology at St. Louis College of Pharmacy

How did you become interested in the history of psychedelic science?
I have always been very interested in Science & Technology Studies (STS) work on non-knowledge or what’s sometimes called “scientific ignorance”, not in the sense of studying public ignorance of science but in the sense of studying what kind of knowledge is not produced in science and why is that the case.
Psychedelic science offered a really good case to study how a group of scientists rallies to bring their field back to life. I wanted to trace the trajectory of psychedelic science to understand its ebbs and flows from knowledge to nonknowledge and back again.
When I started this project, as a sociologist, I thought I would be writing a broad institutional story about how governments, science, and the media shaped this field. But as I interviewed the researchers doing this work, listened to their presentations at conferences, and read their published commentaries and research, I found that their explanation for what happened to their field was very different. They told me that Timothy Leary, the infamous Harvard psychologist turned countercultural guru, caused the demise of this field. The consistency with which he came up in my data was such that I ended up organizing my whole book around the story.
In your book, you argue that Leary represents the figure of the “Impure Scientist” for contemporary researchers. Can you elaborate on what you mean with this concept?
I argue that the researchers are not necessarily just talking about Leary in their stories but that he comes to symbolize a larger figure in the field. The impure scientist is a person who defies the norms and the boundaries of science. In each chapter, I show how Leary crossed different boundaries in ways that caused all sorts of problems for the field of psychedelic science. First, there’s the boundary between science and pseudoscience. In other words, I’m talking about the legitimacy of the methods researchers are using. Second, there’s the boundary between objectivity and subjectivity in science; in the case of psychedelic science, this boundary has to do with whether a researcher has personal experience with these substances and whether that spoils, so to speak, their objectivity. Third, I discuss the seemingly irreconcilable gap between spirituality and science, which comes up again and again in psychedelic therapy with its recurrent focus on mystical experiences. Finally, I cover the boundary between “mainstream” society and the counterculture.
But I also found evidence of other researchers that did quite similar things during the first wave of psychedelic science. That’s why I say Leary, as the impure scientist, is a figure. Even though many other researchers could be accused of the same behaviors, Leary becomes the fall guy because he is this easily identifiable person that they can all point to and say: “He did it, he crossed these boundaries and polluted the whole field”. Leary represents a bad expert that current researchers are really trying to push away from. Ostensibly, they do that by being the opposite of what the impure scientist was, what some have even dubbed the “Anti-Leary.”
You stress that the goal of the book is far from reassessing the historical responsibility of Leary in the failure of the first wave of psychedelic research. At the same time, after reading your book, readers may wonder what criticism he rightly deserves for his behavior.
I am explicit, as you said, about how the point of the book is not to ask whether this story is true. That is, whether Leary is really to blame or not. In the book, I am  more interested in studying how people use these subjective narratives and their accompanying performances to make sense of their situation and take action. So I asked myself, if psychedelic researchers are using this idea of the impure scientist to make sense of the situation, regardless of its truth, how does that interpretation influence what they do? 
Ultimately, I am not blaming Leary nor exonerating him because the reasons why psychedelic science became forbidden knowledge are multifaceted. If Leary had been a bit more reserved, would it have caused such a media spectacle and subsequent public backlash against psychedelic drugs? The stories suggest that might be the case, but the fact that there were other researchers at the time who were doing similar things, even before Leary came on to the psychedelic scene in 1960, also suggests that what happened to this field is not all about him. He was a part of it, for sure. But Leary, the government regulations, the media coverage, the scientific expectations, the cultural panic; they all contributed to what happened with psychedelic science.
In the end, the focus on Leary does serve a strategic purpose. Instead of blaming institutions like the FDA or DEA (in the US), which are necessary for this research to happen, the story blames an individual. While the narrative avoids making a more direct critique of institutional systems of power, at the same time it still allows researchers to get work done within the system, potentially making change from within, for example, getting psychedelic drugs rescheduled. 
You dedicate one chapter to the topic of objectivity and scientists’ self-experience with the drugs they study. This is still a contentious issue today when it comes to whether therapists should have personal experience with psychedelics to guide patients. Can you elaborate on this method of drug self-experimentation and how it has played out in the history of psychedelic science?
One of the first recommended uses for LSD was self-experimentation. The idea was that psychiatrists who took the drug themselves could understand what their schizophrenic patients were feeling because, at the time, LSD was thought to mimic endogenous psychosis. As such, it offered a tool for healthcare professionals to develop empathy towards their patients and a shared understanding of their mental health problems.
As many LSD researchers moved away from this “model psychosis” framework towards studying potential therapeutic uses, some investigators said that it was also important for therapists to take the substances themselves. The thinking was that if you have had a psychedelic experience, you can develop a kind of tacit, embodied knowledge that can help you as a healthcare provider know when to step in and offer support for your patient or when to back off and let them be. Here, self-experience was once again about empathy but also about patient safety. 
Not everyone self-experimented because it raised questions about objectivity. Some argued that if the researcher has had a psychedelic experience, it will  influence how they interpret their data or how they guide their participants through a psychedelic therapy session, potentially in a way that leads to a particular outcome.
Personal experience with psychedelic drugs continues to create dilemmas for researchers because objectivity is synonymous with legitimate science. The public wants you, the researcher, and all your values and opinions, to be detached from what you are studying so that I, as the consumer of knowledge, know that the knowledge produced from your research is credible. That is the public imaginary around science. So there is a desire among many psychedelic researchers to keep hush-hush about any personal experiences with these drugs to avoid accusations of being biased or being like Leary, but at the same time, these experiences are very meaningful for those who have had them. Like their predecessors, the researchers I spoke with agree that, although not strictly necessary, self-experimentation is important for patient safety and empathetic interactions. 

Should psychedelic guides keep spirituality out of the therapy room? – Interview with Daan Keiman

Spirituality has featured prominently in psychedelic research throughout its history. How would you evaluate the relation between spirituality and science in the field of psychedelic research?

Since the early days, spirituality has also been controversial in psychedelic therapy. Some people believed that spirituality wasn’t compatible with scientific inquiry. It would bring up questions, such as, “How do you objectively quantify a psychedelic-induced spiritual experience?” which then brings up larger scientific issues surrounding conceptualization and operationalization. In other words, how are we defining what we are studying and how are we measuring it? Answering these questions has been key to demonstrating scientific objectivity.

Despite such obstacles, we see this mystical discourse popping up again in the revival. Some research teams, like the group at Johns Hopkins, have embraced this approach, and they have worked to validate mystical experience questionnaires that they use to assess people’s experiences and outcomes. Neuroscientists are also using  brain scans to study the spiritual experiences induced by psychedelics, although some groups, such as the team at Imperial College in London, prefer the language of “ego dissolution” to describe them. If scientists can actually uncover these processes happening in the brain, then they can make the case that what happens when people take psychedelics is not simply a subjective experience. They can back up patient accounts with quantified questionnaires and brain scans. That kind of evidence could help legitimate psychedelic treatments further, as numbers and neuroscience hold a lot of weight in today’s scientific environment.
So far, it doesn’t seem like people are totally against the idea of mystical experiences in psychedelic science. Research on this exact topic is getting published in mainstream scientific journals, getting approval from advisory boards, and getting a lot of positive attention in the media. So, although it continues to create dilemmas for researchers on their road to legitimacy, I see this intertwining of spirituality and science unfolding a bit differently than it did in the first wave.
Findings from LSD research in the 60s are often dismissed because of the lack of rigorous methodologies. In the book you say that questions about aligning psychedelic therapy with the method of randomized controlled trials (RCT) remain in the renaissance. What methodological lessons do you think contemporary researchers have learnt from the first wave?
They learned that to be seen as legitimate researchers, they need to use controlled methodologies.The US-based researchers I spoke with regularly shared with me the arduous process of getting FDA approval, and how they need to submit proposals that include an experimental group, a placebo, and so on. So RCT methods have been legitimated institutionally, not just within scientific cultures. Looking at the past, researchers learned that they need to play that game for their studies to get approval, get funding, and get published.
But I think that today’s researchers are also careful to avoid past mistakes that happened when researchers who didn’t have a lot of experience doing LSD therapy focused too closely on sticking to the RCT model. The poor treatment outcomes observed in some of the studies of LSD therapy for alcoholism in the 1960s were not necessarily because the treatment didn’t work, but because researchers failed to optimize set and setting. One group of researchers, for example, gave LSD to patients, strapped them to a hospital bed and left them alone for hours. Based on what we know about the interactive effects between drugs, the mind, and the physical and social environment, it is not surprising that these patients consistently reported terrible LSD trips and that the drug was deemed not therapeutic by some researchers.
So I think that today’s researchers learned that controlled methodologies are legitimate and they need to use them, but at the same time, they recognize that an excessive focus on that step-by-step process isn’t a good fit for psychedelic therapy. That is why you see this merging of set and setting, such as preparing the treatment room and the patients to optimize the experience, while also having placebos and control groups, in much of today’s psychedelic research protocols.

The influence of society on the psychedelic experience – Interview with Ido Hartogsohn

At the OPEN Foundation, we try to foster interdisciplinary dialogue between the social and the medical sciences. How do you think that psychedelic researchers may benefit from reading your book?
I still can’t decide if I want to be a historian or a sociologist. But here is where my historian side comes out. Delving into the past can be very important for helping us understand how people act in the present. Regarding psychedelic research in particular, this means understanding not just cultural narratives about Leary or figures like him, but understanding, for instance, the institutional regulations in the first wave regarding scientific methods that changed how clinical research gets approved, conducted, and hence, legitimated. Knowing these contextual influences can change what researchers  do in the present in ways that can help them make this work happen.
From a sociological perspective, I hope that the book helps researchers and readers think about science not as insular but very much as a social endeavor. The production of scientific knowledge does not exist in a vacuum, and psychedelic science is a great example of this. As Ido Hartogsohn shows in his book “American Trip”, for example, in developing protocols for psychedelic therapy, researchers  not only have to take into consideration the setting of the therapy room itself, but the broader environmental factors that are shaping this research in the first place. They must navigate different social obstacles and opportunities, such as government regulations for clinical drug trials or public preconceptions about psychedelic drugs. Thinking sociologically about science and psychedelic drugs helps us take into consideration larger social factors that potentially affect this work, both in ways that can help and in
ways that can hinder psychedelic research.

Danielle Giffort: Author of Acid Revival: The Psychedelic Renaissance and the Quest for Medical Legitimacy (2020)
Art taken from the front cover of Acid Revival
Interview by Alberto Cantizani López

Een van de weinige Nederlandse psychiaters die werkt met psychedelica

Psychiater Tijmen Bostoen werkt als trauma-expert in Centrum ‘45, waar binnenkort een gerandomiseerd gecontroleerd onderzoek (of RCT) van start gaat met MDMA in de behandeling van PTSS. Daarnaast behandelt Bostoen sinds dit jaar patiënten die zowel een psychotrauma als een depressie hebben met ketamine, aan het LUMC. Daarmee is hij één van de weinige psychiaters in Nederland die zich bezig houden met psychedelica. We spraken hem over zijn ervaringen.
Waar is je interesse in psychedelica begonnen?
Dat begon voor mij op ICPR 2016. Tijdens het congres werd me duidelijk dat psychedelica-onderzoek interessant is en dat ik er meer van wilde weten. Het onderwerp intrigeerde me heel erg omdat de onderzoeksresultaten zo veelbelovend zijn. Wat me tijdens het congres opviel, was dat er echt goed opgezet onderzoek is gedaan met RCTs. Dat maakte voor mij duidelijk dat ik het onderwerp serieus moest nemen.
Ik had al wel eens iets gehoord over behandelingen met psychedelica, met name omdat Bastiaans daar in de jaren ’70 mee bezig is geweest. Soms had hij opvallende resultaten met LSD-behandelingen bij de ernstigst getraumatiseerde concentratiekamp-overlevers. [Bastiaans was hoogleraar psychiatrie en net als Tijmen verbonden aan Centrum ‘45 in Oegstgeest, red.]
Maar als je er dan induikt, dan blijkt dat er best al veel onderzoek gedaan is in de vorige eeuw en dat er veel al is uitgezocht. Met hele interessante resultaten. Niet echt volgens de wetenschappelijke standaarden van nu, maar toch. Dat was echt een eye-opener voor me.
Vier jaar later ben je één van de weinige psychiaters in Nederland die met deze middelen werken. Dat is best snel gegaan.
Ja, inderdaad. Toen Rick Doblin (de directeur van MAPS) in Nederland was voor ICPR’16, werd ik uitgenodigd voor een etentje. De directeur van Stichting OPEN en mijn collega Eric Vermetten waren daar ook bij aanwezig. Tijdens dat etentje is onze interesse gewekt om zelf een studie op te zetten naar MDMA, met ondersteuning van MAPS.
Toen een paar maanden later bleek dat de MDMA-assisted psychotherapy for PTSD studie in Amerika zó voorspoedig ging dat MAPS eerder dan gepland in Europa onderzoek wilde gaan doen, wisten Eric en ik meteen dat we daarbij wilden aanhaken.
Binnenkort gaat de pilot van start bij ons in Centrum ‘45. Dit is een opmaat naar de fase 3 klinische studie waarmee MAPS MDMA wil registreren als medicijn voor PTSS. Met die registratiestudie hopen we over een jaar te starten. De voorbereidingen zijn volop aan de gang.
Daarnaast werk je sinds begin dit jaar ook met ketamine, aan het LUMC. In welke context doe je dat?
Ik behandel patiënten die zowel een psychotrauma als een depressie hebben. We behandelen die patiënten volgens een depressieprotocol met ketamine. Dat zijn zes ketaminesessies in twee weken. Dat is een heel intense behandeling.
Het is voor ons ook een beetje pionieren, omdat we nog niet zo goed weten hoe ketamine nou bij PTSS werkt. We willen toewerken naar een gespecificeerde PTSS-behandeling met ketamine. Deze pilot is vooral bedoeld om ervaring op te doen met ketaminebehandelingen en om te kijken of dit depressieprotocol ook aanslaat bij patiënten die naast depressieve klachten ook last hebben van een psychotrauma / PTSS.
Het is heel mooi dat we hierin kunnen samenwerken met het LUMC en ervaring op kunnen doen met deze behandeling.
Hoe kan het dat je PTSS-patiënten al mag behandelen met ketamine, terwijl er nog geen klinisch onderzoek naar is gedaan?
Het is een off-label behandeling. Ketamine is een geregistreerd geneesmiddel, dat eerder al uitgebreid onderzocht werd en inmiddels al vele tientallen jaren gebruikt wordt door anesthesisten: we weten wat het doet en wat de bijwerkingen zijn. De laatste jaren wordt gekeken wat de effecten bij psychiatrische aandoeningen zijn en dan vooral bij depressie. Als je een medicijn off-label gebruikt dan komen er wel extra criteria bij. Je moet bijvoorbeeld heel goed overleggen met de patiënt en goed duidelijk maken dat je iets voorschrijft voor een aandoening waarvoor dat middel niet bedoeld is. Je moet uiterst zorgvuldig te werk gaan. Maar dan mag het wel, binnen de geneeskunde.
Hoe reageren patiënten, slaat de behandeling aan?
Ik vind het in ieder geval opvallend hoe goed en snel ketamine werkt op de depressieve symptomen. Of het ook specifiek effect heeft op alle PTSS-symptomen, dat moet ik nog zien. Ik kan me er wel iets bij voorstellen dat ketamine de gangbare traumabehandelingen beter werkzaam maakt. Maar ik weet het nog niet zeker, daar is het te vroeg voor. Ik wil er meer van zien en er op een gegeven moment ook klinisch onderzoek naar gaan doen.
Wat voor dosis geef je patiënten en krijgen ze daar een psychedelische ervaring van?
We gebruiken 0,5 mg s-ketamine per kilogram lichaamsgewicht. Of het echt geestverruimend is zoals je bij de klassieke psychedelica of MDMA ziet dat weet ik niet, maar het geeft zeker veranderde bewustzijnseffecten. Je ziet echt wel dat mensen heel fors onder invloed zijn en moeite hebben de intense ervaring onder woorden te brengen. Maar vaak kost het deze getraumatiseerde mensen moeite zich over te geven aan de ervaring.
Zijn die psychedelische effecten onderdeel van het werkingsmechanisme, of eerder een bijwerking?
Sommige onderzoekers zien het inderdaad eerder als een bijwerking. Zoals ketamine nu vooral wordt toegepast, is als een biologische behandeling. Dus: je geeft een geneesmiddel dat processen in het brein op gang brengt, wat maakt dat er minder klachten zijn. Maar wat ik vaak zie: als de ketamine aan het uitwerken is, gaan mensen toch reflecteren op de ketamine-ervaring zelf, en vaak hebben zij daarin elementen van hun traumageschiedenis beleefd. En mijn indruk is dat dat wel belangrijk is, in ieder geval bij PTSS.
MDMA behaalt indrukwekkende resultaten in de MAPS-studies – er is zelfs een breakthrough therapy status aan gegeven door de FDA. Wat maakt ketamine dan nog interessant voor jou als behandelaar en onderzoeker?
Ketamine wordt vooral bij depressie ingezet en zorgt ook bij heel hardnekkige vormen van depressie voor opvallende resultaten. Dat is echt heel bijzonder. MDMA is eigenlijk nog niet bij depressie ingezet maar vooral bij PTSS. Dus dat is een beetje appels met peren vergelijken in die zin.
Ik wil heel graag weten of de ketamine-behandeling langduriger werkt voor depressie als je de setting verandert en meer gaat werken vanuit het kader waarin MDMA wordt gegeven. Want dat is bij ketamine het geval: het verlicht de symptomen heel goed, maar dat effect is na een aantal weken vaak weer uitwerkt. Misschien dat je dat wel kan veranderen als je veel meer doet aan de set en setting en de psychotherapeutische follow-up. Momenteel is er beperkt onderzoek naar de effecten van ketamine op PTSS. Daar ben ik heel benieuwd naar: heeft ketamine vergelijkbare resultaten bij PTSS zoals we bij depressie zien? En wat voegt een specifieke set en setting toe? Als we wat beter zicht hebben op wat bij PTSS zou kunnen werken, dan willen we dat verder onderzoeken in een goed onderzoeksontwerp.
Waarin verschillen de kaders waarin met MDMA en ketamine wordt gewerkt het meest?
De MDMA wordt op een hele andere manier gegeven: in drie sessies van acht uur met twee therapeuten. De ruimte zelf wordt mooi aangekleed, zodat mensen niet het gevoel hebben dat ze in een ziekenhuis liggen. Er wordt veel psychotherapie gegeven voor en na elke sessie. Dat is echt een totaal andere manier van werken dan wat nu met ketamine gebeurt.
Ik denk dat het best zou kunnen dat ketamine net als andere psychedelica werkt en dat de ervaring zelf heilzaam kan zijn. Dat dit nog niet zo uit de verf is gekomen, ligt misschien toch aan de dosering die gebruikt wordt en aan de setting. Nu krijgen patiënten de ketamine echt in een ziekenhuissetting: ze liggen aan een infuus in een ziekenhuiskamer. Als je het vergelijkt met de MDMA-behandelingen voor PTSS, dan is er erg weinig tijd voor voorbereiding op en integratie van de andere bewustzijnsstaat. Ik denk dat als je ketamine op dezelfde manier zou inzetten als psilocybine of MDMA, dat het best zou kunnen dat je ongeveer dezelfde veelbelovende effecten ziet: een grote en blijvende afname in symptomen. Maar dat moet nog blijken.

Waarin verschilt het effect van ketamine met dat van MDMA, zoals je dat in patiënten waarneemt?
Met ketamine zijn mensen veel minder in staat om hun gedachten te ordenen en in gesprek te gaan. Dat maakt ketamine echt anders dan MDMA. De effecten treden ook veel sneller op en werken veel sneller weer uit. Bij MDMA zie je het effect langzaam opkomen en patiënten zijn juist heel goed in staat om hun gevoelens te beleven, te duiden en erover te vertellen – vaak beter dan in de normale bewustzijnsstaat. Bij MDMA gebeurt dat al tijdens de sessie zelf.
Ben je ooit bang geweest dat de stap naar psychedelisch onderzoek negatieve consequenties zou hebben voor je carrière?
Dat valt wel mee. De meeste collega’s en peers zijn echt geïnteresseerd. Mensen stellen soms wel gezond kritische vragen en dat is logisch. Maar ik heb niet het idee dat het een soort taboe is of dat het meteen van tafel geveegd wordt ofzo.
Toen ik zag dat er echt methodologisch goede studies zijn gedaan, heeft dat mij over de streep getrokken. Maar ik blijf ook kritisch. Ik ben redelijk onder de indruk van de psychedelica. Maar een wetenschappelijke houding, goed meten van de effecten en mogelijkheden goed in kaart brengen is voor mij de enige manier om goed met dit onderwerp om te gaan.
Welke uitdagingen kom je tegen als psychedelica-onderzoeker?
Het is heel lastig om aan te geven wat psychedelica nou precies doen. Dat onderzoek is ingewikkeld. We weten wel veel, maar wat nou precies de werkende elementen zijn… dat is nog steeds lastig te zeggen. Psychedelica doen veel op het niveau van neurotransmitters en hormonen en met fMRI kan je processen in het brein in kaart brengen die door psychedelica beïnvloed worden. Maar psychedelica geven ook hele krachtige subjectieve effecten. En het lijkt soms wel of dat twee parallelle werelden zijn. Want dat van die subjectieve effecten, dat zou meer passen binnen een psychotherapeutisch kader: je werkrelatie verdiept, er is meer ruimte voor reflectie en voor catharsis. Dat is heel psychotherapeutisch beschreven. Maar tegelijkertijd hebben psychedelica ook echt een heel krachtige biologische werking… en dan zit je weer in dat straatje van hoe we met medicijnen omgaan. Je licht iemand voor, je geeft een bepaalde dosis van een middel en vervolgens laat je dat middel als het ware zelf z’n werk doen.
Zoals dus nu bij ketamine gebeurt.
In het geval van ketamine zie je die parallelle werelden heel duidelijk. Het wordt heel biologisch benaderd door een aantal mensen. Er zijn ook mensen die zeggen dat je het juist psychotherapeutisch moet kaderen. Vervolgens moet je het ook hebben over wat nou de werkzame elementen zijn: of je bijvoorbeeld optimaal moet doseren op basis van een bepaalde bloedspiegel die bepaalde neurotransmitters in gang zet. Of dat je juist een subjectieve psychologische staat beoogt waarin je kan werken. Wie weet zijn die twee werelden ook wel nauw met elkaar verbonden… dat zijn echt dingen die uitgezocht moeten worden.
Dan heb je ook nog verschillende aandoeningen. We hadden het net al over PTSS en depressie. Daar is zeker overlap, maar het zijn wel echt andere stoornissen. En er zijn ook ideeën over de toepasbaarheid van psychedelica bij andere aandoeningen. Denk aan OCD, verslaving, persoonlijkheidsstoornissen… Er is zich echt een heel nieuw onderzoeksveld aan het openen. Heel interessant. Ik ben echt heel benieuwd waar we over tien jaar staan.
Om aan het MAPS MDMA-onderzoek mee te mogen werken, moest je eerst een speciale training ondergaan. Welke extra vaardigheden heb je daar geleerd?
Er werd sterk gehamerd op een hele open therapeutische houding, waarin je vooral het proces ondersteunt waar iemand zelf, onder invloed van MDMA, inkomt. Je doet zeker interventies, maar die zijn allemaal in dienst van het proces waar de patiënt in komt. Je werkt samen met de patiënt met wat er dan ook maar naar boven komt tijdens de sessie. In de gangbare traumatherapie ben je juist heel vaak erg sturend, in de zin van dat echt over de trauma’s zelf moet gaan en over de gevoelens die daar omheen hangen. Dat is echt een heel andere houding.
Pas je die open therapeutische houding ook toe als je patiënten met ketamine behandelt?
Ketaminebehandelingen zijn veel korter dan MDMA-sessies, waardoor ik dan toch geneigd ben om iets meer te sturen. En van wat ik tot nu toe bij ketamine zie, hebben mensen meer hulp nodig om te begrijpen wat er op dat moment gebeurt. Bij MDMA hebben mensen vaak een heel goed overzicht, maar bij ketamine zijn mensen meer los van wat ze normaal kennen. De ketamine-ervaring is meer vervreemdend, in die zin. Mensen hebben dan toch iets meer structuur van buiten nodig om daar mee om te gaan.
Als onderdeel van de MAPS-training tot MDMA-therapeut, onderging je zelf ook een MDMA-sessie – in een zelfde soort setting als je toekomstige patiënten.
Ja. Ik denk dat het echt van meerwaarde is dat als je met psychedelica werkt, je zelf ook weet wat die middelen met je doen. Want die veranderde bewustzijnsstaat is zo enorm uitgesproken, dat het wel heel moeilijk voor te stellen is hoe dat voor iemand is, als je het niet zelf hebt meegemaakt. Als iemand wil begeleiden in zo’n bewustzijnsstaat helpt het echt dat je een idee hebt wat iemand op dat moment doormaakt.
Voordat ik meedeed aan de MAPS-training had ik er eerlijk gezegd wel m’n twijfels bij. Ik dacht dat ik wel ongeveer zou weten hoe de ervaring met MDMA zou zijn. Maar nu ik het eenmaal zelf heb meegemaakt en de intensiteit en de diepgang van zo’n proces heb ervaren denk ik: dit is echt met niets te vergelijken. En dat is niet alleen mijn ervaring. Ik heb het ook aan anderen gevraagd die in dezelfde context een eigen ervaring opdeden met MDMA en bijna iedereen vindt het zelf ondergaan van een MDMA-sessie een meerwaarde.
Dus je pleit ervoor dat alle behandelaren die met deze middelen (gaan) werken in ieder geval een keer zelf ervaren wat het inhoudt?
Als het in het kader is van een psychedelics-assisted psychotherapy, dan wel. Als je met een patiënt in gesprek wil over zijn ervaringen, en zeker als je dit gesprek voert terwijl de patiënt onder invloed is, dan vind ik zéker dat eigen ervaring met deze middelen er toe doet. Als je psychedelica voorschrijft vanuit een meer biologisch kader (zoals bij ketamine) dan weet ik niet of het echt zoveel meerwaarde heeft.

Psychedelics: key to consciousness

Even if psychedelics have long been regarded as tools to explore or expand one’s consciousness, they have only been picked up by consciousness researchers rather recently. Experiments with LSD, Psilocybin or DMT are starting to offer helpful insights to scientists about the nature of consciousness, mind and brain. We asked Enzo Tagliazucchi to give us his perspective on how psychedelics can be used in consciousness research.
Enzo Tagliazucchi is a neuroscientist and a professor at the University of Buenos Aires. He will be speaking at ICPR2020 about the first electroencephalography (EEG) research project of DMT in naturalistic settings.
This is part two of a three-part interview series with Prof. Enzo Tagliazucchi
Part one: The Science and Folklore of DMT
Part two: Psychedelics: key to consciousness
Part three: DMT and near-death experiences
You came to psychedelics from consciousness research with the conviction that altered states can be used as helpful tools in the cognitive neuroscience of consciousness. What do you think psychedelics tell us about the relation between mind and brain?
Studying consciousness is difficult for many reasons, for example, how can you know that somebody is having a certain conscious experience?
Now, answering this question with human subjects is not as difficult as with animal models, because I can assume a lot of things about your behavior that I cannot assume in a monkey’s or a rat’s behavior. And this is because I am a human, like you are.
But the cognitive neuroscience of consciousness advances by doing experiments in which we have to assume that there is something like the “normal mind”, so that we can interpret the answers for participants and draw conclusions about their subjective experience. This is to say, we interpret the behavior of our research participants in experiments about consciousness by mentally putting ourselves in their shows and asking what our rational core would do in that circumstance. That is, we idealize our subjects as rational agents, adopting what Daniel Dennett calls the intentional stance.
Following this line of thought, cognitive neuroscience builds up a computational analysis of the mind in which you have to assume some standard functions like attention, language, memory, decision-making, etc. And it does a good job investigating standard human functioning, especially in situations where humans do not deviate from rational behavior.
However, if you go to Google Scholar and type “cognitive neuroscience of schizophrenia”, you are going to find very few papers on that topic, precisely because you can no longer adopt so easily the intentional stance towards these patients. It is as if they had a different kind of mind, and you just do not have a common ground anymore to apply the methodological perspective of classic cognitive neuroscience.
Here is where I think psychedelics enter. They can be useful to establish that common ground. Again, you won’t be able to do normal cognitive neuroscience experiments on somebody on a high psychedelic dose,  because whatever function you are trying to probe is not going to work the way you expect it to work. It is a bit like the case of schizophrenic patients and also that of animal models, in that we lack the proper perspective.
But the thing with psychedelics is that you can increase the dose very slowly. So you can start from a very low-level dose and then you can get a mind that is almost like yours, you can disarrange it a little bit. You have this parametric way of moving away from what is the “normal human mind”. You can see how these functions slowly become disarranged as you increase the dose, and I believe this is invaluable. Most neuroscientists haven’t yet realized this, but when they do there won’t be a coming back to the old ways of doing things.
I believe that researchers do not really realize this yet because they are really focused on studying the acute effects of psychedelics (I myself am, too), a state in which it will be very difficult to adapt the very successful program of cognitive neuroscience. But if you focus on microdosing and start climbing up from there, you could build a map of how the mind gets changed parametrically into something different. This is really the huge promise of psychedelics to understanding the healthy human mind.
Psychedelic users have been greatly influenced by Aldous Huxley’s ideas about consciousness. In the sixties, he popularized the theory of the brain as a “reducing valve” that could be opened by the use of psychedelics in order to let a greater degree of awareness or “Mind at large” enter individual consciousness. How would you assess this theory in the light of current neuroscientific knowledge?
There is something to what Huxley said. Something that psychedelics are showing us is that you cannot think of the brain as a machine that you can turn on and off. The brain is always undergoing some storm of electrical activity, a flurry of spontaneous activity. That never stops.
So if I put you in an fMRI machine and you close your eyes, I will still find strong brain activity signals within your visual cortex. Since there are a lot of things going on in the visual cortex even with your eyes closed, it seems that you should be seeing something but, as a matter of fact, you just don’t.
Why are you not conscious of this activity? What is stopping you from seeing all that spontaneous storm of activity in the brain?
A popular theory is that alpha rhythms have something to do with the inhibition of all that activity which is irrelevant to whatever task you are doing at the moment, which is very convenient. So if you ask a subject to perform certain activity you will find alpha rhythms increasing in the brain regions that are not relevant for the task at hand.
But then, one of the most robust signatures of the psychedelic state is that the alpha rhythm is blocked. Jack Cowan’s theory is that all the patterns and fractals you see under psychedelics are precisely what the spontaneous activity of your brain would look like if you could see it – which you can, under the right dose of a psychedelic compound. In fact, the visual cortex is organized following geometric patterns, so no wonder that you are seeing geometric patterns when this activity enters your stream of consciousness.
You could compare the brain with an artificial neural network. These days neural networks can do pretty sophisticated visual processing by representing images in successive layers of artificial neurons. The first thing they do is exactly the first thing the visual cortex does: extract geometric primitives, like all the edges and all the corners of the image. Starting from that, they begin to combine these primitives to build progressively more complex representations, until you get the complete image.
Visual percepts are sort of created in layers, as in artificial neural networks, but in your conscious experience you are never aware of the intermediate layers, you only get the end result. From an evolutionary perspective, you do not need the intermediate representations. They are just part of your internal computational machinery. What you really want to know is what the final object is like.
I think that when someone is under psychedelics, representations enter consciousness too early. You are getting the half-cooked images so to speak. And this is precisely because psychedelics tamper with the inhibition of spontaneous activity. Actually, this hypothesis could be tested using a method from computational cognitive neuroscience known as representation similarity analysis.
Whatever Huxley was thinking with his “reducing valve” wasn’t this, but still there is something that is stopping all this activity from entering consciousness, and whatever that is my conjecture is that psychedelics are good at removing that block.
Strangely enough, contemporary philosophers like Peter Sjöstedt or Thomas Metzinger find in the psychedelic experience arguments for theories as disparate as panpsychism (i.e. everything has mental properties) and eliminative materialism (i.e. consciousness is an illusion). You seem to see the potential of psychedelics for consciousness research from a rather materialist perspective. But why do you think that there is a push for rather the opposite panpsychist views among people interested in psychedelics and the study of consciousness?
Because of the mystical experience, I suppose. One of its major components is the unitive experience, the feeling of not having boundaries, of being part of everything. I think this experience can lead some people to believe in their consciousness as a whole united with everything.
I certainly don’t have anything against this perspective, understood as a philosophical argument. So panpsychism might be fun for philosophers to discuss, but is not very interesting for scientists because you can’t work on that hypothesis. I haven’t seen any serious proposal to apply the scientific method to the question of panpsychism, and I seriously doubt it can be done.
Anyways, scientists aren’t as detached from these philosophical issues as they wished they would be. Actually, they tend to be divided in their positions, even if they cannot state them clearly and explicitly. Some scientists will say that consciousness is only an informational processing procedure in the brain, that it doesn’t really have anything in terms of first person perspective and therefore, that all phenomenal properties are illusory. Philosophers like Keith Frankish or Dan Dennet argue that you cannot really have qualia, at least not qualia with the properties we usually assign to them.  This is the core of functionalism, the philosophical perspective that is informing research in cognitive neuroscience.
There is of course the other side of this debate, with people who argue that phenomenology or the first person perspective is the single most important thing that has to be explained about consciousness, and that it cannot be dismissed as illusory. You will find papers of very influential neuroscientists seriously taking their own introspection as grounds to formulate theories about consciousness. And then again, you will find others who only look at third-person data, and dismiss whatever their inner mental life is suggesting about the nature of consciousness.
As opposed to many psychedelic scientists who have extensive experience with these substances themselves, I am in the field of those who believe there is nothing except third person data to be explained. I suppose this position isn’t very common for someone with my research interests and with a long and rich history of personal experience with psychedelics. So what is going on?
I ended up thinking very often, how could one use psychedelics to actually discern a solution in this divide? How can you interpret the psychedelic state not as a panpsychist revelation, but as the way in which the illusion of your qualia starts to disarm, to finally realize that there is nothing at all to realize? For those claiming that qualia are illusory, like Dennett of Frankish, I tend to believe the burden is on them to unravel this illusion. I’d expect that most of them would consider psychedelics (and other altered states) as invaluable tools to achieve this purpose, but for some reason this isn’t a frequently adopted perspective. And I wonder why.
I often have talks with hardcore functionalists who defend that consciousness is just computation and, to my surprise, several of them are ready to claim that psychedelics will “fry your brain” (I got this from Daniel Dennett once, and he made his position public in a recent interview given to ALIUS). I guess there are very academic types who think: “there is my private life, and then there is my life as a scientist, and if I start messing around, mixing one with the other, then I am going to lose my objectivity”.
But I have had my fair share of experimentation and that never happened to me. I am even more convinced after taking psychedelics, that they are somehow disarming this sort of qualia illusion.
Perhaps altered states of consciousness are so interesting because they transform consciousness into something that is easier to dispel as an illusion. They are a tool to show to the brain that the brain itself is no more than a bunch of neurons connected together doing computations. That is my grand picture of how I see psychedelic fit into the scheme of consciousness research.

The Science and Folklore of DMT

Being one of the most powerful psychedelics we know, it is not strange that DMT has become the subject of numerous speculations over the years. Theories linking this molecule to the pineal gland, to dreams or near-death experiences have circulated persistently among users and researchers – yet the scientific evidence just doesn’t seem to be there. 

It has been established that DMT occurs in many organisms endogenously, like plants, animals and humans. Besides that, much has yet to become established science in the academic world. Is DMT synthesized in the pineal gland? If so, what is its function? Is it involved in generating dreams or normal consciousness? Is it behind so-called near-death experiences?

We approached researcher Enzo Tagliazucchi to help us bring some clarity and a scientific perspective to these questions. Tagliazucchi is a neuroscientist and professor at the University of Buenos Aires. He will be speaking about his research and the first Electroencephalography (EEG) study of DMT in naturalistic settings at ICPR 2020.

This is the first part of a three-part interview series with Prof. Enzo Tagliazucchi

OPEN Foundation: Twenty years ago, Rick Strassman popularized DMT as the “Spirit Molecule”. In his popular book, he made the claim that this psychedelic compound is endogenously synthesized in the human pineal gland. What led him to this hypothesis?

Enzo Tagliazucchi: It would not be strange if DMT would actually be synthesized in the pineal gland because melatonin, a molecule that is pretty similar in its structure compared to DMT, is released there. All the necessary enzymes in the corresponding metabolic pathway are present in the pineal gland. You have all these coincidences that seem to suggest that it is a natural process that is creating the molecule, and that this process can take place in the pineal gland.

Strassman was, in fact,  interested in melatonin research at first and then came across DMT. From there, he started to convince himself that it was synthesized in the pineal gland and started wondering about its function. People have been trying to find a role for DMT from the moment it became obvious that it is an endogenous molecule, for instance, some have the hypothesis that DMT is actually a neurotransmitter still without a known receptor (the sigma receptor was considered as a candidate for some time but eventually it was abandoned). Of course, whatever the function was, they conjectured, it had to be something related to the phenomenology of the psychedelic state.

In his investigations, Strassman came across these really strange experiences reported by his research participants, which he actually describes as a kind of shock for him. Confronted with this bizarre information, he hypothesized that DMT is present in the brain to signal certain important moments in life, and that these moments are experienced as strange DMT-like experiences, such as birth and death. This is why he coined the popular phrase “the spirit molecule” in reference to DMT.

Last year, a research team from the University of Michigan led by Jimo Borjigin reported concentrations of DMT in rats’ brains to be similar to that of other neurotransmitters like serotonin during induced experimental cardiac arrest. What are the implications of these findings and what do we know about the endogenous levels of DMT in the human brain?

Recently there was some controversy because of this paper, in which Strassman was actually co-author, showing in an animal model that you can find large amounts of DMT produced near the moment of death.

David Nichols tried to refute this hypothesis years ago arguing that even if DMT is actually synthesized in the pineal gland, you will never get sufficiently high concentrations of endogenous DMT to ever produce a psychedelic-like experience. That was the end for a while, and then came this article which Strassman and others took as evidence to support his theory.

David Nichols again published a rebuttal arguing that the finding of high amounts of DMT is not really conclusive because at that critical moment you get a massive release of several neurotransmitters. If you have twice the usual concentration of DMT, then you also have twice the usual concentration of serotonin. And since serotonin is competing with DMT and it has a higher affinity for all serotonin receptor sub-types, then why would you get an endogenous DMT trip considering these difficulties in binding to serotonin receptors?

I think if I had to bet money, I would say that there is DMT in the pineal gland. It is a very simple tryptamine and you have a lot of different possible pathways to get it. All the chemicals you need for the synthesis of DMT can be found in the pineal gland. I would even bet that when you have hypoxia or if there is a critical injury in the brain, there is a spike in DMT concentration. But at such a moment, you have spikes of several neurotransmitters. However, if somebody finds a high spike of DMT alone, that would be a remarkable finding.

I think that more research is needed because it is really strange that DMT is in the brain. People should keep doing this research and should keep asking: Why is DMT there? What does it do? What receptors does it bind to? What is its role? These questions are important, even if the findings so far have been, for the most part, negative.

We don’t really have any proof at all that Strassman’s theories are more than attractive hypotheses. Something valuable about Strassman’s work is that it made a lot of people think for the first time about the possibility of endogenously triggered altered states of consciousness. Unfortunately, I think there is yet nothing to the claim that DMT is behind these experiences.

It seems that Borjigin’s research has been welcomed by DMT enthusiasts who link this molecule to dreams and normal consciousness. If it is present in the human brain at significant levels, could DMT be considered a neurotransmitter playing a role in generating ordinary consciousness or in dreaming, as it has been claimed?

The challenge is to find DMT in a sufficiently high concentration to produce such effects. You would need around 25 mg of DMT being produced in a short period of time for something like that to happen in your consciousness and, apparently, there is no way that can happen. The endogenous concentrations are in the microgram range, below the active levels by orders of magnitude. The reason why it can’t happen is not only because researchers have not found such high levels, it is because essentially the metabolic pathways do not seem to be able to support that massive biosynthesis.

Similarly, it does not seem that DMT is produced with a sufficiently high concentration to be involved in dreaming, and so on. I do not think it is even needed to explain the phenomenology of dreaming. We understand more or less the neurochemistry of dreaming and serotonin, in fact, tends to be blocked during REM sleep. So the neurochemistry does not seem to suggest at all that 5-HT2A receptor activation by any molecule, let alone one in such small quantities, is responsible for dreaming. This does not preclude, of course, that the phenomenology of dreaming and psychedelic states are very similar. You might get to the same effect following different routes.

If it is in the concentrations it is suspected to be in, there is no way it can influence consciousness. That is the current state of knowledge.

See Enzo’s talk titled The neural and psychological correlates of inhaled N,N-dimethyltryptamine (DMT) in natural and ceremonial settings at ICPR2020.

Matthew Jonhson: psychedelics are brain plasticity-inducing

MatthewJohnson
Matthew Johnson is associate director of the Center for Psychedelic and Consciousness Research at Johns Hopkins University – a center created last year. Johnson is one of the world’s leading researchers in psychedelic science. The Open Foundation asked him to reflect on some hot topics in psychedelic science today – like the mystical experience, business players entering psychedelic research and new avenues of clinical research.
In September of 2019, Johns Hopkins launched its Center for Psychedelic and Consciousness Research. Just a few months earlier, Imperial College in London had started its own Centre for Psychedelic Research. The creation of the Hopkins center seemed like a ‘response’, in a way. Is there some rivalry we need to know about?
The seeds were being sown long before we were aware of the Imperial center, so I wouldn’t say so. There’s far more room for synergy and collaboration than for rivalry in this field. Of course, you always like to be the first to publish a paper on a given subject, that’s just human. But in the big picture, it’s really great that there are two large, very credible centers in the world, and the hope is that it’s going to keep growing. There’s even a third center in South Carolina now, with Michael Mithoefer and others.
What’s the added value of dedicated centers for psychedelic research?
The center is a term used in academics to mean a certain level of funding that allows for an increased concentration and focus on a research area. Functionally, the important thing is that it’s dramatically increasing the throughput of our work on psychedelics.
Your group at Hopkins seems to place a good deal of emphasis on the mystical experience and considers it the mechanism of action for therapeutic outcomes of psychedelic therapy, whereas Imperial focuses more on imagery and neuroscience. Where does this focus on the mystical experience come from?
I think there’s a focus on the biology and the neuroscience at both sites. I’m conducting a study with 80 people on smoking cessation where subjects are undergoing fMRI with a variety of tasks before and after the experience. Fred Barrett in our group is a neuroscientist, and he’s conducting a number of studies right now. In terms of the psychology, the Imperial group has used more of a Freudian model and we have focused more on the mystical experience, but I think empirically we’re likely talking about the same thing. The term ‘ego loss’ has a high correlation to the mystical experience of unity. The focus on mystical experience dates back to William James, and I see it as continuing a thread of interest in this kind of experience that human beings, around the world and throughout time, have consistently reported. It seems that psychedelics prompt those types of experiences, so that interest is far larger than the therapeutic use of psychedelics, which in itself is very important. It taps into the idea that these can be tools for understanding the biology and the very nature of these extraordinary human experiences, and their ability – however occasioned – to prompt behavior change.
The Hopkins Center is set to research interesting new indications: anorexia, distress associated with Alzheimer’s, and aftercare for Lyme disease.
We have started the first two. We’re actively recruiting for the anorexia treatment study, and we’ve actually run participants through that study, but not enough to discern any results yet. We’re also actively recruiting for the mood within Alzheimer’s disease study. We have the funding for the other study, on post-treatment Lyme disease syndrome, as it’s come to be known, and we’re preparing the regulation to be able to conduct it. We should be starting it within a few months.
What exactly is the aim regarding Alzheimer’s?
The primary aim is clearly the mood of patients, through the lens of cancer research, where the focus is not on treating the disease, but the psychological suffering that so often comes with it, and the existential distress that is also there with dementia. But we’re also going to look at the cognitive outcomes, because there are some interesting animal studies that suggest that there are potential positive cognitive effects of these compounds. Also because having a profound psychological reorientation, where you have reductions in depression, might in itself lead to improved cognition and slow the disease process. We’re not holding our breath that we’ll see something there, but it’s worth a look.
Both the center in Baltimore and the one in London are funded by private donors: do you understand the concerns of people who are wary of the increasing interference of big business with psychedelic research?
There are many opinions out there, so I’m not sure what the concerns exactly are. The Center is funded through a non-profit model and it’s 100 % philanthropy, so I think it’s unrelated to any concerns about business involvement in this area.
Well, people like Tim Ferriss raise some questions. He’s an investor, and investors are known to seek some kind of return on their investments. Some people are quite suspicious of that.
At the surface level I can understand the concerns, if people don’t know the details. From knowing the details, I can say that if his goal was to have a financial return on investment, he’s done a very poor job at setting things up. However, he’s been very clear that the goal was to leverage the growth of an area and the advancement of science.
Humans are interested in leaving a legacy, and being known for having had an impact, so that may be relevant to anybody who makes an investment in an area with a hope for its growth. I think he wants to see this area take off, and a lot of people look to him as someone who sees what’s coming in the future. I also think this has already been an advantage in terms of people paying attention to this area.
Are you concerned that, once legal, psychedelic therapy might turn into big business? The business press is already touting psychedelic therapy as the next big cash cow.
If we’re on to something – and I think we are – then this will happen. There are niches to fill. So the real questions become: What are the actions of any particular entity? Are they operating ethically or unethically? The commercialization of psychedelics raises concerns about the potential for bad actors, but there can be bad actors in pure non-profit and in pure academia. The potential on the monetary side is obviously increased once you introduce a business model. So I think there’s a rationale for increased concern about bad actors. But the fact that business is jumping into this is not a bad thing in itself. It’s a 100 % expected outcome, and overall it’s a good thing. We just have to keep our eyes on the way people are operating.
The title of your ICPR talk will be: “Psychedelics as behavior change agents.” What can we expect?
I want this to be a big-picture presentation that draws from multiple lines of evidence. Not about the treatment of this or that disorder, or this or that effect, but really drawing across all that. The overall point is that psychedelics can occasion behavior change. They seem to be powerful ways to induce mental and behavioral plasticity. We have a whole lot more to figure out on the biology of that and how to most properly leverage psychedelics towards those aims. There’s also a lot to figure out about so-called ‘integration’, but it’s probably that people are left in a state of increased neuroplasticity, which can depend on many mechanisms. So I’d like to present the basic argument that, in the broadest sense, these are plasticity-inducing agents.

Anonymous donation on Reddit ‘changed everything’ for MDMA research

When MAPS founder Rick Doblin was in Amsterdam for our event on MDMA research, he sat down with journalist Thijs Roes for a wide-ranging conversation. One of the topics they touched upon, was how recent MAPS funding had gotten off the ground.

In 2017, MAPS was a much smaller organisation. With no help from any government and no large funds available to them, MAPS had to get by on relatively small donations. Until an anonymous Reddit user called Pine suddenly announced that he had millions of dollars available to support causes that would otherwise be overlooked. She (or he) had bought bitcoins for an incredibly low price, and had had an epiphany while on Ketamine-therapy: the best way to live life was to help other people, and give as much the newly gained wealth away.

“MDMA-assisted psychotherapy will be a gift to the world from the psychedelic and cryptocurrency communities,” Rick Doblin wrote earlier. And in the interview he says the grant “changed everything for us”. Pine ended up giving $5 million dollars to make MDMA-assisted therapy a reality. MAPS is now in phase 3 studies to get MDMA approved and legal for clinical therapy.

Rick Doblin will be speaking at icpr-conference.com – the leading scientific psychedelic conference of Europe, held from September 22 until 24.

Ido Hartogsohn on the influence of society on the psychedelic experience

collective set and setting
Ido Hartogsohn is one of the first and few researchers to focus on psychedelic research from a social technological perspective. The assistant professor from the Science, Technology and Society program at Bar Ilan University in Israel has just published a new book called American Trip, in which he explores how the social conditions of the 1960s shaped the American psychedelic experience itself. 
In his recently published book he inquires how the LSD experience was shaped by the social conditions and predominant values of the fifties and sixties, portraying LSD as a “psychopharmacological chameleon” dependent on culture. With this move, he expands the traditional meaning of set & setting in psychedelic therapy to include the broader contexts in which these substances are used. He calls this the “collective set and setting”: the broader cultural and social contexts in which these substances are used. 
His work brings a sociological perspective that invites us to rethink psychedelic drugs beyond their mere pharmacological properties.
How do your views challenge conventional understandings of drug effects in pharmacology?
One of the defining ideas of pharmacology is an often implicit notion which scholar Richard DeGrandpre termed pharmacologicalism: the assumption that a drug is exclusively defined by its inherent pharmacological qualities – that it has one type of discrete effect independent of any variables.
The closer we look at the effects of drugs, the more we see that they do not work like that at all. The effects of drugs, not just psychedelics, can change radically depending on the social and physical environment.
Think of the example of US soldiers returning from Vietnam in the 1970s. The American army tried numerous plots to help these soldiers kick their heroin habit while they were in Vietnam, but all of these ultimately failed. Then, as the soldiers returned home, suddenly 90% of them were able to kick the habit spontaneously, without going through any kind of treatment.
Once the setting changed we could see that – even in the case of the supposedly most rigid, inflexible and essentially physical drugs, effects were highly dependent on the set and setting of use.
This is something that pharmacological discourse has been reluctant to acknowledge over the years. It makes sense because once you acknowledge that, it complicates drug trials and discussions around drugs. It forces us to think about not only the very chemical product that we give to patients but how we give it to them and the whole clinical environment. It also forces us to forsake these very naive ideas of drugs as magic bullets that have one specific effect and one specific and highly discrete application.
The cultural malleability of psychedelic experiences has great implications for drug policy. How do you think that prohibitionism and anti-drug propaganda could have infiltrated the very experiences of psychedelic users?
There is this classic study by the sociologist Richard Bunce about the dramatic increase of bad trips at the end of the 1960s as authorities were pushing different scare theories such as the idea that LSD creates chromosome damage or that it will “fry your brain”. All of that stuff was completely debunked later on but once you have these ideas percolating inside the culture, they can easily penetrate people’s experiences. Given this type of ‘collective set and setting’, levels of paranoia shot up among users. Experiences that could be interpreted as quite benign and pleasant turned in a way that is very scary.
This kind of effect is something anthropological literature was predicting already a decade earlier. In the late 1950s, anthropologist Anthony Wallace argued that psychedelic users in the West were more liable to have negative experiences than those that had them in traditional or indigenous societies. Societies, like in the West, that conceive of hallucinations as something that is inherently dangerous and meaningless increase the chance for harmful experiences.
I believe that there have been so many psychedelic trips gone awry as a result of prohibition; so much mental energy that has been squandered; so many positive experiences of users over the years that took a bad turn when they for example encountered police during a trip or were somehow perturbed by the ideology, propaganda and policy of the war on drugs.
So, if we are to take a harm reduction approach to drug use, what can we do to improve the collective set & setting of psychedelic use today and in the future?
One of the most beautiful things that is happening today in the so-called “psychedelic renaissance” is this burgeoning culture of set and setting: the growing awareness of the importance of preparation, intention, and integration – of knowing your substance, your set and your setting.
Psychedelic users today are much more “psychedelically literate” than the ones in the 1960s, and that’s a result of a very rich culture of discourse and practice informed by the idea of set and setting. So we now have safezone organizations which provide for example psychedelic first aid or peer support in festivals like Burning Man or Boom; we have online trip-sitting services run by volunteers; books and websites guiding about the principles of safe and transformative psychedelic voyaging, and there are more and more studies that aim to study how set and setting work.
These are all very hopeful signs that the appreciation of the importance of set and setting is more and more widely recognized in the field of psychedelics, for the broader community as well as for the clinical community.
Governments that want to approach this subject from a progressive perspective need to realize that outmoded, ideologically rigid approaches to drug use fail their citizenry and ultimately the entire society. Governments are betraying their role when they prosecute users. What they should be doing is helping the general public get the know-how, the information and the resources that could help minimize harmful experiences and maximize the potential for safe, positive and meaningful experiences.
You argue that the placebo effect can be understood as a form of meaning response, in which clinical improvement follows from the mere manipulation of meaningful cues in the therapeutic process. Accordingly, the meaning-enhancing properties of psychedelics turn them into some kind of “super-placebo”. What would be the consequences of this reconceptualization for current clinical trials with psychedelics and their placebo-control methodologies?
Over the years the pharmaceutical industry has been invested in the attempt to minimize or eliminate placebo effects. If you are selling a drug like they are, you probably want to give a decisive answer about its effects. But once [the placebo-effect] enters the picture, it appears much more uncertain what the drug actually accomplishes by itself.
After clinical trials, we see that the efficacy of that same drug diminishes from year to year of use in the market, or from culture to culture, because of the changes in the placebo response and in the meaning attributed to the drug. We can therefore see that drug effects are much more fluid than we are led to believe.
Medical anthropologist Daniel Moerman draws our attention to the fact that placebo response can more intelligibly be conceived as just meaning response. When you bring this insight into contact with the field of psychedelics something quite interesting emerges, because one of the main effects of psychedelics is to enhance the perception of meaning.
This then raises the possibility that psychedelics may enhance the placebo response by enhancing our perception of meaning. This potential of psychedelics to enhance placebo really holds a valuable alternative to the classic pharmacological model and an opportunity to think about how meaning intervenes in therapeutic processes.
I don’t think that we are about to see the end of the blind trials paradigm anytime soon. But rather than looking for an objective response to a drug and leaving it at that, we would achieve better results if we focused our energy at examining the nexus between drug, set and setting, to optimize the overall therapeutic process in a way that transcends commonplace flat and impoverished conceptions of the drug responses.
You have approached psychedelics from a science and technology studies (STS) perspective. What has that taught you?
When you look at LSD and psychedelics in general, you have a technology whose effects are highly malleable. Depending on the set and setting, a hallucinogenic agent like LSD can be a psychotomimetic (psychosis mimicking) and it can be therapeutic. It can be anxiety-inducing and it can be mentally soothing.
The effects of LSD are so radically transformed in relation with user’s mindsets and settings that you could argue that LSD, as a technological artifact, is recreated every time it is used. This recognition leads to the concept of psychedelics as a technology that is culturally and socially constructed in a radical way.
One of the main takeaways that I am trying to convey in my book is the idea of a “psychedelic technology”. Going back to the very meaning of the word psychedelic as “mind-manifesting”, the category of “psychedelic technology” would then refer to technology that is shaped in accordance with the mind-set and the environment (hence the idea of an ecodelic) of the user. This is an interesting way to think about technology that is a radical extension of the social constructivist way to think about technologies in the field of STS.
My perspective on psychedelics later shifted to the STS idea of co-production, the question of how the effects of LSD and other psychedelics are shaped and formed by social values, norms and conditions, and how LSD and other psychedelics simultaneously bring about changes in social and cultural movements creating a kind of positive feedback loop, an idea that I explore in my book.
What will be the major takeaways that potential attendees of ICPR might expect from your talk or about your book?
One of the main things my book tries to do is to really expand our understanding of set and setting in order to transcend that more narrowly defined, individualized concept of set and setting. I think the book makes clear that no factor in the individual, specific or concrete set and setting of a psychedelic experience is independent of the larger social and cultural picture, and so I try to answer the question how our collective historical and social forces worked to shape the psychedelic experience in the West since the 1960s and to this day.
Ido Hartogsohn talk at ICPR 2020 will explore the relationship between set and setting, meaning-enhancement and placebo as a central axis on which the psychedelic experience can be interpreted and understood.

Janis Phelps on training the first psychedelic therapists

Professor Janis Phelps PhD

Janis Phelps is the founder and director of the CIIS Center for Psychedelic Therapies and Research, which conducts the first academically accredited, professional certificate training programme for psychedelic-assisted therapy and research. 
At ICPR 2020, Dr. Phelps will address her experience in setting up a licensed training program for people working in research and therapy with psychedelics. 

You founded the first licensed training program for psychedelic therapists. How did this come about ?
The genesis of this program came about in 2014 at a Heffter Research Institute board meeting, where one of the trustees of our college heard the dire need for psychedelic therapists to be trained.
Our university has been training about 250 therapists a year in 6 different programmes for over 30 years. Stan Grof, Ralph Metzner and other psychedelic researchers have been teaching at CIIS for decades. CIIS trustees gave us seed money for a 3-year grant. I was the founder and creator of the programme, and the opportunities for this were very rich.
We wanted to bring in indigenous ways of knowing as well as the approach typically used in the research protocols for both psilocybin and MDMA.
What are the challenges you faced in this process ?
Well, we were creating something in a vacuum. There were no guidelines yet for how to do this, because no-one had done it before. For a year, I consulted with researchers, underground and above-ground therapists, and in related areas such as hospice care centres and emergency rooms, on how to work with people in altered states.
To devise the programme, we drew from anthropology, clinical and transpersonal psychology, psychoanalysis and ceremonial uses. The challenge was to try to integrate all these in the best possible way.
However, we chose to emphasise the research approach for now, because of the need for therapists to be in FDA-approved clinics. This is a compromise we made, but the upside is that now our graduates get hired by these research entities and they’re opening clinics that will be ready to use MDMA and psilocybin in the next couple of years.
Things seem to be progressing quite fast these days. Are you sometimes concerned they may be going too fast?
I’m concerned about the decriminalisation movements in the US. They’re going quicker than I’m comfortable with. The general public is not sufficiently aware of the hazards and the benefits of the use of plant medicines. Even physicians and nurses don’t know enough, and neither do school teachers.
So we’re working on scaling up our programme to include the general public and give them information online for free: interactions with medications, incompatibilities with certain psychological difficulties, how parents can talk to their kids about psychedelics, etc. I’m concerned there might be another backlash like we had in the sixties if these medicines are not used responsibly.
My other concern is that we’re training only 75 people a year, about 300 so far. MAPS has only trained about 250. We need thousands of therapists trained. I’m concerned that when the medicines get rescheduled, there won’t be enough therapists, with resulting insufficient access to the medicines for patients. So we’re looking to scale it up and develop affiliations with other universities.
What have you taken away from this whole adventure so far?
I’ve been delighted to witness the integrity of the therapists and medical doctors wanting to come into this space. They want to see healing happen, they’re concerned about what’s happening on the planet in terms of politics, genocides and global warming.
They know that psychedelics are not the only way for people to heal, of course, but the kind of therapy we can do is augmented tremendously by the use of plant medicines. I see them changing psychiatry and psychology for nothing but the good.
On average, the professionals who apply for the programme have 15 years of licensed practice, so they’re quite experienced in their work. Some were retired medical doctors who reactivated their license in order to do this work. I also witnessed our students building community with each other, creating associations, building salons, and it’s very exciting to see this flourish across the United States, into Canada, South America and the EU. I realised once again how desperate people are for community. And finally, it’s been wonderful to meet the new generation, I’m very happy to pass the hat to younger people.
Dr. Phelps’ talk at ICPR 2020 will be titled: “Training future psychedelic therapists