Are Psychedelics the New Wonder Drug for Mental Illness and the Fear of Death? with Dr. Anthony Bossis

Welcome to the Doctor's Pharmacy. That's F-A-R-M-A-C-Y, a place for conversations that matter. I'm Dr. Mark Hyman. And this conversation I think you'll find really matters with Dr. Anthony Basinas, who's an NYU professor of psychiatry and has done some extraordinary research on the mind through the lens of how psychedelics can help us die, can help us deal with disturbing emotions, and this conversation wouldn't even have been had 10 or 15 years ago. Scientists studying psychedelics, but now it's sort of had this resurgence, and it's fascinating to look at the work you've done because you have been researching to start with how we can help people with the anxiety of death and the fear of death and the transition in palliative care. And you've done some remarkable studies on this. You're the co-principal investigator and co-author of this amazing study, which we'll talk about, and you showed significant emotional distress along with sort of enhanced existential well-being in these patients who were dying of cancer, just with a single psilocybin, which is magic mushrooms, for those who don't know what that is. Psilocybin-generated mystical experience with cancer. Now, first of all, science and mysticism seem like they never should come together, but you are bringing them together in this fascinating way, which is disruptive in the scientific paradigm. and you talk about things that scientists don't usually talk about, like unity, sacredness, transcendence, greater awareness, love, wow, love, science. Oh, wow, my mind's going crazy here. And you're supervising psychotherapy at the Bellevue Hospital. You're the co-founder and former co-director of Bellevue Hospital Palliative Care Service. And you've been studying consciousness, comparative religion, and how psychology and spirituality interface, and you have a private psychotherapy practice in New York City. So welcome, Tony.

Thank you.

Great to be here, Mark. Tony, you and I met a number of years ago, late at night at a bar in a hotel in San Diego at a medical conference, which was sort of like a un-medical medical conference. It was a futuristic conference. It was a futuristic conference about the future of healthcare. You were there and you were speaking about your experience with studying psychedelics. And I was like, Holy mackerel, this is actually happening after decades of suppression. And the history of psychedelics is fascinating. I want you to get into it, but you know, From the 50s, the discovery of psychedelics into the sort of subversion of its use by people like Timothy Leary who hijacked it away from the science and made it a pop culture thing to the suppression of psychedelics as a restricted drug under Nixon. And now after decades of dormancy in the scientific research, we now having a resurgence of asking questions about is there something in these substances just like we are with medical marijuana that might be beneficial medically? And then how do we sort of navigate the world of the historical context of this? Because these substances have been used for thousands of years in cultures all around the world. And how do we connect that to medicine, to healing? And, you know, how do we begin to think about this? So how did you get into all this stuff? I mean, you're a traditional trained psychotherapist, you're a professor at NYU. This is not like the typical topic that you should see an academic undertaker take?

It was not. Now it is again, which we are fortunate about. One thing about science and religion, it is true they are separate these days, but going back hundreds of years, they were not separate. Yes. They were both kind of centered around this impulse to describe what we are, what is this, what is trans- -Well.

The medicine man were the religious leaders.

-And Albert Einstein famously said, Religion without science is lame. Science without religion is blind. I mean, these two used to be together, then they split apart and we have that unfortunate gap now. I think like a lot of us in the field, I began with meditation back in my 20s, like so many of us, you know, first learning TM like many of us did, and going on to different meditative practices. And I was always interested in death and dying, probably as a little kid, I had this death anxiety when I.

Recall vividly when I was the Woody Allen version.

But it led me, like so many of us, to a path of studying comparative religion, comparative spirituality, and I came across this body of literature in the 60s through people like, you know, Ram Dass and, and this formerly known as.

Richard Alpert, Harvard psychology professor.

Right. Houston Smith, Aldous Huxley's writings. Yeah. And was stunned that there was a whole body of science that was used to invoke this mystical experience that we know is at the core of the major religions. So when you study the major religions, at this core is this common core thesis that the early were organized around this mystical experience. that we'll talk about today and define. And that these medicines could promote that in the right setting was incredible. And here we are 30-40 years later and I'm actually helping with the research that I'm really grateful for. Remarkably that these experiences while they offer insight about nature of self and all the things we find in and religious practice or meditation. They also now that we're going to talk about seem to promote healing and clinical applications. So death anxiety, a smoking sensation. So it may have clinical applications beyond just insights into self.

Yeah, I mean, this is not something that sort of just was discovered. I mean, these substances have been around in cultures for thousands and thousands of years, whether it's Ayahuasca, South America, whether it's psilocybin and mushrooms and Mexico, whether it's other types of substances that have been used like ibogaine in Africa. And these mind-altering substances have always been used in a religious context as a state of initiation or ritual or transcendence. And these are not new things, right?

They're not new. And that's a great point, Mark, about the set and setting, which we call today set, the mindset we bring to the medicine session, setting how it's done. And for thousands of years, indigenous cultures, use these medicines for spiritual revelation and religious purposes throughout the world. I mean, we know in ancient Greece, we think of the Eleusinian mysteries, there was a drink they called Kykeon, which was probably an ergot alkaloid similar to LSD or psilocybin. We know in India there's many references to Soma from a mushroom that was used in that culture. In Mexico we have psilocybin being used and that's how it led to our research actually. We'll talk about how psilocybin came to the West and how it became aware aware of it in the West. So throughout time, there's these medicines being used, indigenous cultures safely for spiritual transformation. And so here we are again looking at the benefits.

And this was something that was really aggressively studied by the government, by academic institutions in the 50s and 60s. It was thought to be one of the greatest boons to psychiatry. And what happened with all that research?

So that's a great story. It's a remarkable story. And a recent book, Michael Pollan wrote, you know, chronicled this history. history. The modern research begins in the late 30s when Albert Hoffman, a chemist in Europe, discovers LSD by accident. Yeah.

He got some on his fingers and sucked his finger.

Right. So in '43, a couple of years later, he actually ingested it by accident, had the first human LSD experience, and then began the research of what is the state of awareness about? And became research with alcoholism, and people who were dying of cancer throughout the late 50s, more into the early 60s, that could this medicine-induced experience that looked just like mystical experiences that we find naturally occurring throughout the ages. And we define that as they did in the 60s in this research as unity, a strong sense of everything's connected, a sense of transcendence, transcending time and place, past, present and future. Awe, sort of awe and ineffability, difficult to describe. And so they found they could promote these experiences and it showed promising clinical benefits in alcoholism and in people who were dying of cancer.

Back in the 50s and 60s.

Back in the 60s, at Johns Hopkins, that Spring Grove was the name of the place back then. and it's incredible work being done. It's a solid body of literature. And then, as we all know, and there was also a study with theology students where they gave them psilocybin to see if the experience was like the naturally occurring kind of mysticism throughout time. It was called the Good Friday Experiment. Walter Penkhe, a great psychiatrist, and it must have been a very good Friday. It was a very good Friday for these 10 students up in Boston at Marsh Chapel. And it's a very famous study, the first one with healthy participants to show that, and Eustace Smith, the great religious scholar, was a student in that study. Oh. And kick-started his life journey, you know, further deepening his interest in religion, but also these experiences of psychedelics or entheogens, as we call them as well, meaning the divine within. And then, as we all know, in the mid-60s, the counterculture began using them more and more. It got on their way.

They weren't even illegal back then.

They were not illegal. So they were using research and they would become used recreationally. And then Timothy Leary and many others began to speak of its benefits and it caught on with the culture itself. And by 1970, Richard Nixon signed a congressional law policy that made these medicines not only illegal for the culture, but out of the reach of research, which is stunning. And you never see that in medicine.

That's not science.

It's not science. When would a compound be taken out of this sphere of research with clinical application because of a cultural problem? You've never seen that. It's a remarkable benchmark.

1970 was a rough year and Richard Nixon was probably afraid of all the hippies taking over the country.

There is speculation that there's some documents that it was a part of political move. And LSD had become actually illegal a few years before, 1970 he made this out of the realm of research. It'll be similar today. I mean, opiate is a horrible opiate problem, but we use them also medically. So that was stunning. And for 30 years or more, nothing happened, which is really incredible. It's this promising medicine and more importantly, the experience that they generate, not just the medicine. I try to always remember to say it's not a drug study per se. It's about the experience it invokes. Then in the late 90s, Rick Strassman began doing some work with the DMT. Then in the 2000s began this psilocybin work. Fresh was healthy normals, as we call them, healthy people. And then the study we'll talk about today, people with anxiety associated with a cancer diagnosis and other applications as well.

So the avenue of sort of psychedelic research was sort of started as a sort of almost a medical inquiry.

Yeah.

And got sidetracked. And now we're coming back into it. So is there an understanding of the biology of what's happening? Because it seems like, you know, we all have had in our lives a moment of mystical connection, whether it's in the moment of love, whether it's being on top of a mountain, whether it's just some spontaneous experience that is fleeting and short-lived that we can't get back to. But something's happening biochemically in our brain that's causing that. So what are the properties of these substances that do this? And what is the neurobiochemistry of these states? Do we know? -Yes, we know a bit.

I am not a neuroscientist, but I will get to that in a second. But I like that you mentioned that we all have these experiences. So, they have been called different things: peak experiences, mystical, luminous. And they occur naturally all the time. Children have them, we all have them. But you are right, little brief glimpses during meditation. -We are enraptured.

We are rapt in our experience.

-Yeah, I mean, the foundation of religion, the saints and the mystics seem to have these naturally occur. meditation, being in nature, dancing, there's a host of activities that could trigger a peak or mystical experience. Abraham Maslow, the great American psychologist, called them peak experiences. And they were natural. There's a recent Pew study that shows 49% of people report having mystical experiences in their lives. Just naturally. I mean, it's incredible. These medicines promote it in a very significant way, hours of the experience versus a few minutes. In terms of the neurobiology, we know that it activates upon a serotonergic receptor, which is the primary receptor for these medicines. When that receptor is blocked, the experiences don't happen the same way. So, it is serotonergic modulator immediately.

Was it like super Prozac or?

Well, you know, we know very little about the neuroscience, but we know the serotonin. And, there's now speculation something the default mode network gets quiet down, which is kind of this part of the brain that links to part of our mind that forms a sense of self, the so-called ego. And that quiets down, but other parts of the brain might be able to cross talk in a more direct way.

So, well, it's interesting, you know, we as humans think that everything we see, feel, smell, touch, hear is all that there is. But we know that there are many other sensory experiences that we don't have the bandwidth for, our spectrum of light, our spectrum of hearing, our spectrum of smell, spectrum of temperature sensation. I mean, snakes can actually have this massive ability to detect temperature changes so they can see if there's something warm around them to go bite or eat, you know? And, and yet we think what we see is all there is.

Right.

It's a, it's a very interesting thing. And so maybe these drugs actually help us expand our sensory ability to kind of process information or see different things or relate to what we're doing differently.

It seems to do that, Mark. Yeah, it's It's easy to talk about the biology a lot because we can see that as well in terms of fMRIs and PET scans. What I find remarkable is that it seems to, again, trigger something that's naturally occurring in humans. And, did the MRI and functional things actually show changes?

They show parts of the brain light.

Up that are similar to meditation studies as well. But again, I'm not the neuroscientist, but there are these overlapping parts of the brain that we think are linked with both experiences. But what I'm struck by is that we're wired for meaning, right? and these experiences, meaning making, transcendence, ineffability, sacredness, awe, unity, happen naturally. So something in our nature has us wired for these incredible experiences. They seem pro-ethical and pro-social.

And then you said something really important, which is they help you dissolve the ego.

The sense of... We live in a.

Very structured view of the world most of the time. Most of us, with very limited understanding of our connection to everything else. So it's almost like we live in this world where we're focused on our ego and our own life and our own needs and our own purpose and our own connections, but not really understanding the ways in which we're connected to everything that matters. And I think that's what these drugs seem to do. They seem to sort of break down and dissolve the ego, which can take decades of meditation. It's almost like a spiritual shortcut.

Yeah.

Is that a bad thing?

That's a bad thing. I think you described it very well, actually.

I'm not gonna be in a cave for nine years in the dark.

Right, right, right, right. 20 years of meditation practice. It does remove the part of the mystical experience definition is it removes the observer-observed kind of the boundaries, right?

Yeah. It's like that joke about this guy on a news show asked a Dalai Lama, have you heard about the, what kind of pizza the Dalai Lama likes? And he goes, I won with everything.

Right, right, right.

I didn't know what he was talking about.

Right, but that oneness with everything is really, I mean, in the cancer study, that was healing. I mean, it's part of this notion of transcendence, which is just incredible to hear the stories from these patients. They transcend this, whatever this me is, this body, right? and the attachments to identity, you're a doctor, you're this, we're a man, begin to kind of dissolve or fade away. So then what's left? If we lose all these attachments to the body to our identity, then what's left and they experience that, what they tell us often is there's something more enduring within me or outside biology, outside my, because we don't know what generates consciousness, right? Yeah, it's the brain or if it's somehow out there and where this is a mediator for it. Yeah. And to hear people with cancer whose body's beginning to fail and may stop functioning, death, that I'm not just this body. Yeah, I'm not this cancer. It's incredible.

I'm not my mind, I'm not my thoughts, I'm not my emotions, I'm not my body.

I'm not this body. So this body's breaking down and stopping to work, but I'm not that I'm something else. And again, those are spiritual insights we see in religion as well, in terms of pure awareness, or it's called different things, Brahman or Christ Consciousness, Buddha nature. But to hear a person dying of cancer say that, and that alleviates their fear of death because I might be something more.

It's powerful.

What a gift, right? What a gift. It's really, we hear that over and over in terms of those. It's interesting too, the mediating factor in the research, in a few of these studies, including the cancer study, is that the more robust, the mystical the greater increase in clinical outcome. In other words, the more they endorsed feelings of sacredness, transcendence, unity, ineffability, these core constructs of a mystical experience, the greater the decrease in depression, anxiety, something called demoralization, an awful experience when you are dying, hopelessness. So again, we are wired for these experiences, the greater that experience, and then all have the mystical experience. There are different levels of -Is it dose dependent? We don't think so, to a degree it is. I'll get into that in a second. But the greater that experience or when it's achieved, you get these clinical outcomes as well, which is remarkable. So that oneness with everything, it has kind of a 60s, the pizza story, right? But to experience that briefly for a few hours and come back and then report their experience and then see these changes. So we saw changes in depression, anxiety, demoralization, up to six months and 80% of the patients, and we're gonna keep tracking them.

Yeah, and it's remarkable. It's not like, you know, going to a party or going to the Grateful Dead concert and taking some mushrooms. You're actually in a very specific therapeutic setting. And I'd love for you to share some stories and the experience of what people go through and how you set it up. You call it the set and the setting and why that's important and what people actually experience.

That's great. So it's really, and I'm glad you brought that up. It's important for the viewer to know that There's a certain way we do this.

Because a lot of people take these drugs and they don't have those experiences. They might be at a party or, you know, it's like they're not necessarily having that.

No, they may have panic experiences. Panic is the most common adverse effect. So, importantly, we're so indebted to the prior researchers. The way we do the research now is the same as was done back in the 1960s. We have better research methods and statistical analyses, right? But the method builds upon these early pioneers. So, an important distinction, most medicines people take, blood pressure, anti-anxiety, pain medicines, whatever they're taking, they take every day to maintain the desired effect, right? The studies, this medicine is used once.

One dose.

One dose out of your short half-life, so out of your system by the end of the day, before the day is over, actually. And the experience can generate changes, significant changes, for a period of time going out. I mean, there were people from the 60s who have followed up decades later, and they still report it as the single most meaningful or spiritually significant experience of my life. So it's more like an experience study versus a drug study. The drug is a catalyst for that experience. Then the experience it just seems to change us when we recalibrate what we are. So, yeah, sense of nature. In terms of the day, it's so we meet, let's say, the cancer study. We meet them and we spend four weeks getting to know them, like meeting once a week, preparing them for the session. And the most important preparation is to let them know that the most important position to take during the experience is to let go into the unfolding changes in consciousness.

Don't try to control it.

Don't try to control it or avoid something. Sort of like if a positive meditation, mindfulness, we say with the unfolding changes, and no matter what comes up, even something's frightening, these people are dying, some of them. So death itself, dark images, difficult memories, move into it. Stay with it. You'll be safe. Go into the experience. And I've never seen an experience where it didn't change to a teacher. a transformational moment. So by staying with it, it changes to something more, you know, an insight, which in itself is remarkable. If they avoid it, it can create kind of panic or anxiety. So we spent four weeks getting to know them. Trust and rapport is the single most buffer against an adverse effect. So they feel safe in the room, they feel safe with us.

Because you're with them.

We're right there. I'll describe that.

It's like a living room.

It's a gorgeous setting, nice rug and art. and dim lighting. And so they're prepared for four weeks. Then the day of the session, they come in early. Again, the recommendations, trust yourself, trust wisdom, trust consciousness, trust the medicine, trust the guides you're working with. So trust is really kind of cultivated. They take the capsule, which in this study were double blind, meaning the researchers nor the patient knew was it placebo or psilocybin.

Yeah.

And if it's psilocybin within an hour or so, it'll begin to have its effects. They spend the day lying on a couch made into kind of a bed for the day, wearing headphones that play a gorgeous playlist of music, mostly classical.

Grateful Dead.

No, Grateful Dead. It would be nice, but it's mostly classical and strings and kind of background instrumental music to serve as a trajectory for the experience in a way. And there were eye shades. And both are there to encourage going within.

And they're not talking to you.

You're not talking. Now, if they like, they could take them off, of course, and sit up and talk if they need to. They have to go to the restroom often, so we take them out for the bathroom. But on ideal days, they're saying very little. And part of the prep was, don't feel a need to report to us what's happening. Go into the experience. We're here watching your body and you're safe. but go into the experience and we'll talk tonight and more so the next day. So if we can, we turn off the intellect for the day and have them go into the experience. If they need to, we're there for reassurance. We're right there the entire time providing assurance. That may mean holding a hand during a rough stretch or to reassure them they're safe. The peak stretch of this is about three hours. where a lot happens for them internally. You don't always see it from observing them.

They just got the eyeshades and the headphones on.

So you may see tears, they may be laughing, it's because it's joyful in many parts of it. It's glorious, they would say. It's also difficult at times. They may speak and I write down what they're telling me so I can tell them later what they said and remind them what was that stretch about. It's moving, Mark, to see, to hear the stories.

So what happens after? Then you meet with them and- Then.

Around four or five o'clock, they're coming out of that state of awareness, back into ordinary consciousness. They do some question and answer for us, of course, it's research. And they go home at five, six o'clock, back in ordinary consciousness. Then we have a series of meetings, it's called integration meetings, where we talk about the experience.

What do you hear?

Well, we hear remarkable stuff. So in the cancer study we hear, often you hear that consciousness may not stop at the body. So I'm not this body. So that's obviously profoundly mitigating.

If this is all there is, then it's kind of bleak.

However, some say that happens. It's when I die, I die, but they accept it. We spoke earlier about love comes up a lot, which is striking to hear. So we're scientists. And throughout this research, the Contemporary Studies at Johns Hopkins, UCLA, NYU, going back to the, you know, half a century ago, this notion of love being spoken about so frequently. It's remarkable. And we hear that that was part of the experience that recalibrated their thoughts about death. And it's not just love for each other. So we hear three kinds of love, the way I try to categorize it. One is they have a kind of a pronounced loving kindness towards themselves, so they're dying. So forgiveness towards myself, towards others, a loving kindness to accept how they live their life. a loving kindness towards others in their life, including throughout their lifespan, even difficult relationships, revisiting those relationships, offering forgiveness internally. And then what I find remarkable is this great old love that you hear in religion or meditation research, that love is the ground of being. It's a substance of existence. I like to use the word Greek word agape, right?

Yeah.

And they use this. over. And from within that framework, there's a sense that I'm okay. No matter what happens, I'm fine. As dark as it gets.

They live in a bigger world than just the small s self. It's a big. Right. The big s connected.

I like to say it pulls a lens back from experience. So here we are in, you know, George Harrison's song, I Me Mine, though. Everything's just around the ego. Like you talk about it.

Well, the Beatles got it right. Love is all there is, right?

Beatles got it. Love is all you need. And then it pulls it back where they see themselves in a much broader landscape. And people see solar systems, people see the universe unfolding, and they see themselves in a much larger kind of fabric. And it really recalibrates the sense of self in terms of what else we might be connected to. And also people have a lot of biographical experiences, autobiographical or psychodynamic in nature, revisiting past relationships. that were confluctual or traumas and those being resolved by moving into those unfinished business. So there's just so many vignettes that come our way and it's remarkable. It's powerful.

So the people change the relationship of death to themselves, to their view of what matters.

What matters.

And it's a single dose that drives sort of long lasting change. which is pretty powerful in the space of mental illness. And we are in an epidemic crisis of mental illness. Obviously, the opioid epidemic with killing 70, 000 people a year, depression, anxiety, bipolar. I mean, so many people suffer from deep mental illness and some varying degree of it. And we've all probably had moments of depression or anxiety in our life. How do you see this? tool being used therapeutically? And where is this research going and what have we learned so far? Because you've been focused on the death experience, but other people are working also in this space, right?

Yeah, so a lot's happening. It's really, it's been called the Renaissance, but I, you know, I like these words, the re-emergence of these medicines, this research. So, there's a few main avenues where we might see clinical research. Of course, one end of life, which.

You know, it's easy to do.

It makes sense, right? So, I worked in palliative care. So, part of my work has seen that we don't die well in America. We don't die well. We don't even talk about it until now we're making some progress. Palliative care and hospice is shifting the conversation. There's been conferences around the country and big events organized around death and dying. Let's talk about death and dying. We're all dying at some point, right?

From the minute you're born, you're dying.

From the minute you're born, you're dying. So, we don't die well. And it's always important to note the first two indications coming out of the 60s research was end of life distress and addiction. These are the two main arteries of research and Aldous Huxley being very important to the end of life research, the great literary writer who spoke about LSD being helpful in the end of life experience.

And, he took huge doses of LSD at the end of his life.

Huxley took LSD many times when he was alive and healthy. and allowed him to kind of cultivate his theory about the perennial philosophy that these experiences are at the core of all religions. And these entheogens can, you know, trigger that experience. What you're referring to is quite interesting. When he died, he had asked his wife, Laura Huxley, to administer LSD to him as he was dying. Yes. He scribbled it presented it to her and she injected him. They had talked about it before. And as he died, she was reading to him from, so there's the Tibetan Book of the Dead, a very famous Tibetan manual about dying and the bardos and transition phases. Yeah, and she was reading from a version that was not published yet by Timothy Leary, Ralph Metzner and Dick Alpert, Ram Dass, a psychedelic version of that. and reading in a sense, go forward, go towards the light, go up, you're safe. And it's quite a, it's a poignant vignette she talks about. And he passed away, historical note, he passes away and she walks out of the bedroom and many people were in the living room at the house supporting her. He was a very, well, a very famous figure and they were all huddled in a TV set.

Watching Kennedy be shot.

Exactly.

Yeah.

The same day. And she writes about that. She says they were both.

It was my birthday. I remember that day, 1963.

That was your birthday?

Yeah, I was four.

Yeah. Yeah.

I'm like, why is everybody crying on my birthday?

She writes about a book called this Timeless Moment. And she writes about them saying they were both different in many ways, different backgrounds. and she writes about they were both dedicated their lives to kind of increasing love in the culture. It's quite touching. So he was a big figure. So in terms of the clinical work, the end of life distress, we're all dying. Ideally could this be used in helpful ways? We create centers people go to, have the experience, then go back to their home after hopefully a transformational experience about death and dying. Addiction, There are studies happening with alcoholism, one at NYU. There's a study beginning with MDMA, not.

Psilocybin, which is a version of ecstasy.

Exactly. With PTSD, post-traumatic stress disorder. We're seeing a new wave of research with psilocybin with major depression that's been untreatable, treatment resistant. At Hopkins, there was a wonderful study with, going on with smoking cessation. tobacco. People have the experience and then the decrease in their wants to smoke has been relieved. So the applications seem to be, you know, numerous. We're seeing all these possibilities.

And is there any emerging conclusions from some of the research around anxiety or PTSD or with ecstasy or MDMA or even with depression and psilocybin?

So, PTSD is just starting. So we'll see that there was a phase two study that showed efficacy and that allowed them to advance to this larger series of studies. So, it does seem to work with MDMA. A little different. MDMA is not a classic hallucinogen, so I should frame that. Classic hallucinogen category is LSD, mescaline, psilocybin, DMT. And MDMA is what's called an empathogen.

You just said DMT. We're going to come back to that.

Okay. Yeah. And, empathogen, that the subjective experience is one of the, you know, love and empathy. And that seems to also reset these traumatic experiences people are having from war or childhood trauma. You know, so much of trauma is the body and the mind, both physically and emotionally, reacting to an event that's no longer happening. But if people take MDMA and go to a club, it's not going to do it.

They have to be in a therapeutic setting.

Same with psilocybin. So people take, you know, psilocybin and run to a concert. It's different. Intention matters, you know, why we're taking this medicine and people, we cultivated attention in our research. The set and setting is crucial. Without the proper set and setting, I mean, all bets are off as to what the outcome might be. These people are in a safe setting, prepared, and then going within to the experience in a safe way. Imagine having eyes open, being at some party or some rave, and all the stimuli coming in and you're young, possibly maybe too much medicine. And we'll talk about those in a second.

Yeah.

So intention matters. MDMA is a different class of medicine.

So are people getting results around depression? It's treatment resistant or.

That's still new. That's, that's about to happen in states and in Canada. We only know through the cancer study that we saw in the cancer study that they were less depressed. So importantly, on clinically on the cancer studies at Hopkins, at NYU and then a prior study with UCLA, depression, anxiety dropped off the day after the session. So, you see depression and anxiety then we see compared to placebo, day after session, after the medicine session, it just drops off to these dramatic levels statistically and sustains up to the end of the study. A demoralization, an awful experience of hopelessness, meaninglessness decreases rapidly. spiritual being increases. 70% reported it was the single most meaningful experience of my life. That's incredible.

So you've got all this work going on around therapeutic uses for people with very degrees of mental illness or distress. Has anybody sort of looked at using these substances as a way of taking people who not suffering from those, but enhancing their life experience, changing their worldview, changing their relationships, being a better person, connected to something. I mean, I just wonder if, you know, we would have wars and violence and all these things if everybody had to go through some initiation, right, when they were growing up and changing their worldview, what matters and what's connected to what.

That's the most common question we get asked.

Is it really? Yeah.

There isn't a talk we give her that, you know.

And the answer is?

The answer is, but it's like a birthright, people. Why should everyone have this, right? Or it's been phrased as the betterment of all people. Why do we have to have a clinical disorder? So obviously as a clinical research, doing FDA research, you know, we can't speak about giving, you know, healthy people using it. But that's a strong indication. Could it be used in healthy people? And it has been used with healthy people. the Good Friday Study, work with meditators and healthy normals at Hopkins, and we're seeing the same experience.

You're doing a study on religious leaders.

And we're doing a study with religious leaders who are healthy people.

And again, the same experience. I'd love to know what happens with a Dalai Lama when he takes psilocybin.

It's like nothing, it's fine. I've been in the study already. It's one leader we didn't get for a research, the Dalai Lama, and we'll speak about that. But, I mean, you said a good word, pro-social, pro-ethical implications. You know, people tell us, and again, we're scientists, you hear this language over and over again, that we're all connected. Now, again, we hear that through our religion, and they say, well, it's an illusion, we're separate. So if that's true, you know where this is going, how do we hurt one another? I mean, the Buddhist notion of, If.

You were me and I am you, why would I? Yeah.

I mean, so we're all connected and so then the violence would. So that as of now, there aren't a lot of research studies for healthy people. Could this down the road have centers where they're regulated therapists and they're used? We'll see. I want to make the point that these should only be used in regulated, I think licensed.

And the truth is, you can get this. This is only under research protocols. Now, if you can't go to your psychiatrist, hey, can you take me through this?

This.

He can't or she can't do that. It has to be on an approved scientific protocol.

Right. And there's very few going on that. There's a few, but clinical trials.

I bet you have everybody knocking on.

Your door to get in.

Yeah.

And it's a bit, it's poignant as people write us or call us looking for the medicine because they're suffering of some sort of human suffering. And we have, we have the answer.

And Michael Pollan's book, How to Change youe Mind, is really about the exploration of this work and what's possible across the spectrum of disorders takes you through the history of this from an ancient point of view as well as sort of a modern scientific point of view. It's really quite a field. And, you know, we chatted a little bit earlier, but I recently encountered a number of people who tried something called ibogaine, which is from a bark of an African tree which has been used for, I don't know, how many hundreds of years. as part of ritual initiations and healing. And the stories around that are fascinating because it's been used for treating heroin addiction back in the 70s and then it got kind of outlawed and now it's not even available under any protocol here. And there are places in Mexico and other places where people can actually go and have this experience which is medically supervised in a controlled environment. And we were talking about earlier but people who go through heroin withdrawal is a very serious physiological mechanism that somehow gets interrupted by this drug. And it's a one-time treatment. And on top of that, people share that their personalities change, that their mood disorders changes, that their brain changes, that these are profound effects. And we're so afraid of these things because they're illicit drugs or they're not understood or they're natural substances that who knows what they do and are they safe? But the stories I've heard are just remarkable. People have been alcoholics for years, who've had personality issues, who've had severe depression, who aren't functional, all of a sudden get their life back in one day.

It's stunning. What do you make of that? Well, you know, some of that's similar with psilocybin. You know, the Hopkins study showed that A sense of openness, one of the most important personality constructs changed for the better in the whole time of research. That's not seen before. Because our personalities are formed in the late teens, early 20s, early adulthood, and they're kind of concrete, they're static. They open your heart when you're in your 20s.

And then they shut.

Doors shut for years. Right. Studying about the ibogaine, we don't do ibogaine research, but you mentioned this, that the physiology withdrawal, which is an awful experience for a heroin user, which is why people return to it. to it, right? Even those who have stopped opiates and have passed acute withdrawal can later still return because of that. They still don't feel right. It's called post acute withdrawal syndrome. It can go on for two years, some people say.

Yeah.

Acute withdrawal is over, but there's something uneasy about their experience.

But the IVIG patients say that the craving just stops.

It stops. So how, you know, I could kind of understand.

Does it work for sugar? I hope so.

I would be helpful. Sign me up, right?

Right.

Sign me up.

Books from Dr. Hyman.

Right. No more donuts. And we see that also in the psilocybin study. We see the emotional changes, but to kind of abort the physiology withdrawal. Stunning. So we're kind of at a cusp of this new direction.

It's fascinating because we've sort of been so afraid of these things. And, and yet there may be treasure troves of natural substances that work with our biology to actually help enhance our life experience. What's striking to me is that people who've had these experiences, it does change them. It changes their whole life. Like you said, Houston Smith, who was a student at this seminary who actually- Remarkable.

Yeah.

Yeah, who I've read a lot of his books on Buddhism and Asian philosophy and religion, changed his life. And I think you look at Aldous Huxley, he wrote the Doors of Perception after someone introduced him to mescaline. And from a very sort of descriptive analytical point of view, he described his experience. And it's led to, you know, his, his whole movement of human Consciousness and human potential that sort of came out of that. It's like a, it's like a, it's like a little rabbit hole you go down like Alice in Wonderland. It's a shortcut. And, and I think there's some judgment about, you know, wow, well, this is just a shortcut. You're not really, you know, waking up. You're not really becoming conscious. You need to meditate for 30 years. And, but you're saying that this actually is just people. in some permanent or semi-permanent way.

Yeah, we're certainly seeing that. And to revisit Huxley, which I'm always happy to do, it's unfortunate that the 60s experience, whatever that was, got such a large part of the story. It's a small part of the story. I mean, thousands of years of these medicines used in religious and spiritual frameworks. 50s and 60s research, people like Huxley and Smith, right? Huxley and Smith. And then this, you know, mid-60s phenomena that drove it all off, you know, stopped the research. But we are seeing those changes. Huxley spoke about them. He felt this tapped into that mystical experience, the kind we see that occurs naturally. You know, Walter Stace, the great researcher, someone asked him about mysticism. Are these the same as an actual naturally occurring experience? Because it isn't similar, it's the same. It's the same experience. And again, we keep coming back to that. I mean, we're wired for meaning. Why they're so infrequent is a big question. If these experiences we're wired for are so pro-ethical, pro-social, why are humans a species so why they're so infrequent, because look at the world around us. And we're speaking today from it's a very tough Zeitgeist in our world. Right.

I mean, historically, we were part of cultures that had embedded in them regular practice of ritual and tradition and creating context for these experiences, whether they were dancing around the fire or drumming or chanting or practices that engendered the same type of experience, whether they were vision quests. And every culture has these rituals and rites of initiation and some of them don't use drugs. Like, you know, for example, if you are a Native American, you go take a sweat lodge and you go fast for four days and, you know, that'll change your consciousness.

Right.

You know, and I've done that when I was younger. It really shifts your relationship to yourself, to the world around you, to what matters, to what's meaning. And it drives, you know, a life that is more full of love and connection and appreciation and takes down a lot of the things that are emerging in our world today, which is hate and division and separation, otherness, sort of the opposite of that. I wonder if we got all the world leaders together and all the haters together and just took them through these guided experiences, I wonder what would change.

That's what Ronald Ginsburg wanted to do back in the 60s.

Oh, yeah.

It does, it's interesting that these medicines are returning now as well. I mean, it's kind of a tenuous time in the world. Again, these medicines and these experiences seem to promote unity. It's interesting at the core of each religion, you said it beautifully, that this is experience. Every religion began with a mystical experience by one person or a few people. Then next step was people organized around that person and created scripture and symbols. But as the centuries go on, we're left with these silos of ritual and scripture, but the initial mystical experience is removed. moved. Yeah. So we're left with all the framework and the symbols that connect us to the sacred, but the initial mystical core is now just recedes. So the religions are just incredible frameworks to connect to that. That's how they began. And the reason for the study we're doing. So you mentioned earlier the Religious Leaders Study.

Yeah, tell us about that.

Yeah, so it's really a lifelong dream. So kind of piggybacking back in this famous study from 1970s.

-We'Ve been O'Malley, come on and take some mushrooms.

Rabbis, you know.

Come on, take a little mushroom.

And we've been doing that. So, you know, again, Walter Pankewitz was a remarkable figure from the early 60s. He passed away early in his life, but was doing this study with theology students. So this study, which is just a, you know, remarkable and a lifelong dream, us and a group at Hopkins recruited religious leaders, ideally from all the traditions we are hoping to get, primarily from Judeo-Christian, because that is the most common.

I want to get the Buddhist monks who have been meditating for 50 years.

Right, and there is a meditator study at Hopkins as well that looks at that. And since these experiences can be described in a spiritual way, why then have them have the experience, to have them help us describe what is called the phenomenology of the experiences, this landscape, to better get a sense of what is the ground of these experiences. these are healthy people. Right. So it isn't a clinical study. It's called basic science or to understand the phenomena of something. And they have two sessions in this study, two psilocybin sessions, no placebo, so they know they're getting the real thing both times. And it's been really gratifying to, to be with them, to watch the experience. It's not published yet, so I can't.

Can you share some of their experience?

I can't because we're not published yet, but I could say in a general way, one, these are incredible people, such gratitude to these people, unsung heroes. I mean, out there, social justice, feeding the poor, making a living out of trying to do religion, which already are connected, right? They are connected. These are ordained clergy. And then it's best religion is doing the work of why are we here? Suffering, love, misery, what is this? Being seekers. And so they come in and have just wonderful experiences. I will say this, they're not different from the non-religious leaders, because in the end, we're basically, we're simply human, as Sullivan once said, Harry Stuck Sullivan. So the experience is described in the same way often, love, connectivity, compassion, forgiveness, where forgiveness comes up a lot. So, but it's also remarkable to hear them talk about it, hopefully in their own their own vernacular, their own. These are professional people in religion.

Yeah.

So they have a vernacular. They've trained to study these experiences.

A language.

A language. Now they can have the experience. So we'll probably publish it in about two years. We're still Midway through, and. But it's very exciting. It's really very exciting.

So you're dealing with people in different states of suffering, Consciousness, mood disorders. death and even the well. Often people, as a legacy of the 60s, have heard about the bad trip, the triggering psychosis, triggering anxiety, freaking out, having to go be talked down. I mean, in the context of the work you're doing, I mean, I understand that if you're at some, you know, the Woodstock and it's a zoo and you got like everybody's energy and lights and craziness that you could have a bad trip. But what's the data show really about the reality of this fear that people have about losing their mind or having a bad trip or becoming psychotic?

So it's a great question and it leads to the fear of these medicines, right? But I do want to be clear, you could have panic and people do have so-called bad trips. Is that a great term? I'll try to redefine it. When they do it, you know, their own, right? So, it could be quite anxiety producing. But, right, there was that folklore that if you took it, you would lose your mind, which may or may not.

Really have been true. I don't know how much evidence there was to that effect.

It was amplified and distorted somewhat. But, we screen carefully. We screen for medical disorders and psychiatric histories. There's a voice in your head before.

You take the mushrooms.

You can't be in this center. So, people that have schizophrenia, schizophrenia or psychotic spectrum disorders or various psychiatric disorders would be screened out of the study because that might be, that would be a contraindication and might provide the ground for someone to have so-called a psychotic experience or an anxiety-provoking experience.

Although we don't really know, we're just assuming that those are potentially at risk people.

Right. Well, we know if someone has a history, it could trigger that so the so-called, there was the folklore that people, it triggered a psychotic break or schizophrenic episode. More likely was that they might have been dormant in their genetic, right there, early 20s is where people have their first breaks. So that might have been co-occurring. But in our research, while there are anxiety-provoking stretches in the session, Again, anything can come up autobiographical throughout your lifespan, recover traumas, images of death, all types of archetypal and visionary experiences. Many could be challenging, but by moving into it in the safe setting, we see them become teachable moments. We're not seeing the bad trip. The reason why I said, try to frame it differently, I like the word better, a difficult experience, which we all have every day in our life. You know, walking to the bus stop, you're having a thought about something, and that could be a difficult experience. Things happen all the time that are difficult. In the research, no one leaves that night. No one's left our session at 5:00 p.m. after this extraordinary change in consciousness, and sometimes challenging with anxiety or a panic or memories of a bad trip. Right? So that's important to know.

It tells you something.

Which isn't the same, when setting isn't regulated.

So people listening are probably wondering, how do I get this? When can I get it? I have this problem. I'm anxious, I'm depressed, nothing's working. They want to do shock therapy, they want to ketamine, they want to give me five different drugs. I just, I'm tired of this suffering. And yet we're not really there yet. And it's challenging for people to think about that. that waiting period. So how far away do you see the FDA approval for this work? How much work more needs to be done? What can we hope?

It's a good point. I think we were speaking earlier, I'm not sure if on camera or off, but we get all these emails now, people looking for the medicine who are suffering because of the press and the books and all the literature that's talking about it and the studies themselves. Most likely, so we're now in, so there are phase two research is done to show, demonstrate safety and efficacy. And the next step is called phase three trials, which is a multi-site. And if those findings mirror phase two findings, then you're on your way to it being rescheduled by the FDA for a narrow specific clinical application or a reason, right? So the first few that will likely be become rescheduled, hopefully, five, ten years. Wow. Somewhere in there.

It's a while.

Some say a little sooner, some say a little more, but I think it's a safe bet between five and seven or eight, nine, ten.

How does this work? Because these are not drugs. They're natural substances which can't be patented.

Right. So first, the application might be probably end of life to stress, hopefully depression, PTSD, addiction. Those top four might be the first ones going through the for rescheduling, hopefully.

Who's paying for these studies if they're, you know, 'cause those are- They're not government funded.

It is primarily philanthropy, private donors. And yes, these are found in nature, but so we're not giving patients mushrooms, by the way. Laboratory makes psilocybin, the compound from mushrooms, specific magic mushrooms. And it's in a capsule that they take. How would this look if rescheduled?

World.

It wouldn't be at your CVS. People wouldn't go and find it somewhere. Albert Hoffman's vision, the founder of LSD, was to create centers where people would go for the clinical reason, depression, anxiety, end of life, addiction, maybe spend a week or two in a safe setting, preparation, other, you know, holistic, healthy modalities, have the experience or experiences and return to their world. to their life. That's what ideally looked. Or, in clinic settings, the medicine would be attached to a setting.

There's not gonna be little shops like there's pot shops all over now.

Yeah, I hope not.

Yeah, no, it's interesting. We often miss things that are so important in science because we have beliefs or fears. And, you're one of the few who's brave enough to say, well, this is a scientific question. Let's generate a hypothesis. Let's test it. Let's see what happens. It may be good in here. And.

We'Re grateful, and again, to the first wave of research, we're really kind of picking up where they left off back in the 60s and early 70s.

Yeah, it's powerful. And I think it's important to understand this thinking differently about the brain, because what you're suggesting is that there are substances out there that come from the natural world that are working in ways that we've never seen drugs work, which is you take one dose. It's like taking one dose of aspirin and never getting a headache again. It just doesn't work like that. You can't take one dose of a statin. Your cholesterol is down forever. You're actually seeing profound changes in people's well-being in their sense of self and their relationship to others and. compassion for the world, for what matters. And it's, you know, I think, you know, we're all looking for the quick fix, but in a sense, in a sort of context of ritual, of like you call it set and setting with a purpose, that these are very profound substances that take us to places in our consciousness that are very hard to access for the average human. And if you're living in Tibet in the 1800s and you can meditate in a cave the whole time. You might get there, but most of us aren't really able to do that. And I think I find this fascinating, not just from the point of view of therapeutic doses and therapeutic treatments, but from the point of view of, what does it mean for exploration of human consciousness and awareness? And I just had lunch with Deepak Chopra a couple of days ago. We were talking about this and he says, I want to spend the rest of my life focusing on the nature of consciousness.

It is all there is. Where is consciousness?

Yeah, I have no freaking clue.

No one does, right?

I think it is my left ear, maybe.

What is it, where is it? And can these medicines be tools to understand the newer biology of mystical experience and to help us understand what is consciousness? It really is a paradigm shift in medicine. And I will quote the great Houston Smith again. He says famously, A spiritual experience doesn't make a spiritual person necessarily. It's what you do with it. So the idea, and I'm glad you said quick fix, this isn't a quick fix. People can't go take this medicine, but it's the sense that it and then what they do with it, that's the integration part. Take this experience and how does it change your life? Implement some of the changes. So it really does to be a paradigm shift and we'll see again, it's slow, it's moving forward. Safety, efficacy, and then hopefully in 10 years we'll see where we are.

What makes you realize that your narrow sense of the world, your sensory experience of what's true and not true, is just one narrow sliver of reality and that we can actually access other aspects by these sort of trap doors, if you will, whether it's various practices like meditation or more sort of shortcut experiences like using substances to change parts of your brain chemistry to allow you to start to have these perceptions. And then that has a huge impact for who you are and what you are. And I, I, I wouldn't wish this on my worst enemy, but about a year or two, two years ago, I got very sick and my body shut down, my brain shut down. My emotions were really not available to me. Very, very ill in bed for five months. And the only thing I had was my consciousness. and I began to sort of identify that I wasn't all these things. I wasn't my body, I wasn't my thoughts, I wasn't my emotions. There was something else. And that had a profound impact on me. And I've been studying this for my whole life in terms of human Consciousness. I've majored in Buddhism in college. I've explored all these worlds, read these books, and I find that, you know, that experience sort of knocked me down, but forced me to be aware of the fact that this physical realm is just one piece. And that I wouldn't wish that on anybody, but if you could take a mushroom trip and have that might be okay. Wow, that was two years ago.

Yeah. So that's the insight we're seeing, right? Yeah. You had, you cultivated, that's what we're seeing. Yeah. Which again, is at the foundations of religion. You study Buddhism, I mean, and there's overlapping constructs in Buddhism, you know, sannyasa, the emptiness of all existence, but it's filled with everything this as interconnectivity. In Christianity, they call the apophatic theology, these similar constructs. Could this provide a way for inter-religious dialogue? That while different frameworks, they spring from the same source of being.

That's true.

So you get these clinical applications, very concrete, and you get these kind of more lofty insights into the nature of self. What is religion? What are we? I mean, I love your story.

Essentially, you talked at the beginning about Einstein's quote about God and science and religion, and we've done a lot of work in our culture to separate science and religion and having no contact between the two or context to understand how they relate. And yet, there's not science and religion, and I don't even like the word religion. It's more of a spiritual sort of framework of us as human beings. That is something that we we sort of keep separate. And unfortunately, we don't need to do that. And you really are of Soto, who are talking about love and God and consciousness. And these are really far out there things for most people to sort of put together.

They were not separate. I mean, Carl Sagan, the great Carl Sagan, you know, said the same thing. Alan Watts, the great Jesuit priest, then Alan Watts, then Zen Buddhist and kind of 60s leader. And many others have said, you know, Sagan they were not separate. It is only in the 1500s, 1600s that religion and science became kind of separate avenues. They both came out of an impulse, a human impulse to describe what is this? Science and spirituality, and that they are separate is really unfortunate. Ideally we do not lose sight of the shoulders we stand upon and the prior experiences, not only in terms of religion and the origins of religion, but these figures, Alan Watts, incredible figure, Aldous Huxley. Yeah, on and on. Incredible figures and kind of pushing forward this idea that both science and religion are here to help describe what this is. That's what religion should be, not just a bunch of my, you know, tribalism, my God's better than your God. How can they be different universe, you know, you know, that's the work. And it's so, yeah, Alan Watson and, and Sagan, you know, there's a great, you know, William James wrote this famous, the variety of the religious experience. And Sagan wrote, there's a book edited of his lectures, the variety is of scientific experience. And there's one also called mystical experience from a different author. But they're all leading to the same, ideally leading to the same. Impulse. What is this, Mark?

You've been listening to the Doctor's Pharmacy with Professor Anthony Bossis, who's from NYU, talking about his research on psychedelics, both in transition to end of life, anxiety, depression, the nature of the mystical experience, religion, science, all of it. It's quite mind-blowing. And, I really am grateful for you being on the podcast with us today. Tony.

This is great. I really enjoyed our conversation.

So you've been listening to the Doctor's Pharmacy with Dr. Mark Hyman, the Place for Conversations that Matter. And if you love this podcast, please leave a review. We'd love to hear from you. Share with your friends and family on Facebook and Twitter. And we'll see you next time on the Doctor's Pharmacy. Thanks, Mark. Don't forget, there's a way to listen completely ad free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts and Try Free to start your 7-day free trial.