EP 175 Navigating the Psychedelic Frontier in the Mental Health Revolution | Erica Zelfand, ND

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Hi, welcome to the Radical Responsibility podcast. This is your host, Fleet Ball. Today I'm going to share a conversation with you that I had with Erica Zelfand. She's a naturopath, a naturopathic doctor who's very involved in psychotherapy and especially psychedelic assisted psychotherapy and all kinds of healing work. And we talk about the global mental health epidemic and both that is really impacting all of us and the entire world and especially those of us living in modern cultures and also looking at how that manifests across the fault lines of many kinds of injustice as well, and the necessity for really innovative psychotherapeutic approaches and methodologies. And we had quite a bit of conversation about psychedelics and kind of demystifying the world of psychedelics through the scientific research and, and really understanding their potential for therapeutic, positive therapeutic impact and looking how that could really transform our mental health system. Right. The means that we bring to people to help with mental health challenges, the way the whole system is structured, which in many ways is not serving currently. So this is really a great conversation which someone who's thoroughly committed to transforming our mental health system and is incredibly knowledgeable about the science of psychedelic assisted psychotherapy as well as plant medicines.

And I'm really happy to be here today with Dr. Erica Zelfan. Welcome, Dr. Zelfan.

Thanks so much for having me. Good to be here.

Well, we're really happy to have you be here and be part of this summit. And I'm going to share, to start with, I'm going to share a bit of your background, your bio with our audience so they're more familiar with your work and then we'll jump right into the conversation. Sound good?

Sounds Great.

Okay. Dr. Erica Zelfend is a naturopathic family physician renowned for her wide ranging expertise in both conventional and natural therapies. Her approach is rooted in patient centric nature, honoring methodologies that seek to identify and address root causes of health issues, treating a diverse patient demographic from newborns to the elderly. Dr. Zelpan Areas of specialization encompass preventive medicine, chronic illness management, endocrinology and integrative mental health. In addition to clinical work, Dr. Zelfan is a sought after medical writer, educator and speaker who frequently lectures on psychedelic science at medical institutions globally. She also facilitates therapeutic psychospiritual Experiences and provides professional training through her educational platform. Possessing an infectious zest for life, Dr. Zulfan shares her vast knowledge, deep respect for nature, and her characteristic sense of humor with patients, clients, colleagues, and worldwide audiences alike. So that's a big bio, and I'm really glad to have you here today. I'd love to start with kind of a big overview question, since your clinical practice blends Eastern and Western approaches, holistic perspectives, and so let's start with how does the integration of these different modes of knowing influence your understanding of mind, consciousness and spirit, whatever we want to call it, particularly in relationship to the use of psychedelic therapy? So these different sort of worldviews and ways of knowing, you know, we have the Western scientific, we have the Eastern contemplative, we have the holistic, integrative perspective, and we have the indigenous perspective. So I wonder if you could talk about how the integration of this works out and plays out for you and your work.

Yeah, I think it would help if instead of focusing on the kinds of therapies, meaning, you know, is it herbal, is it pharmaceutical, is it psychedelic, is it energetic, rather than focusing on the types of the therapies, instead, focusing on the philosophy really helps guide how I work with clients and how it's different. And the philosophy is, as you mentioned in my bio, it's very patience centered. And so I sometimes get called a healer, and I don't feel comfortable with that label because I really don't do any healing. The healing happens within the person's own being. Every person has their own inner healer, their own inner wisdom. And it is our inherent nature to want to come into equilibrium and come into harmony and coming at it from that way. When I see someone who has a disease, I don't necessarily see the disease as the problem. I see the disease as that intelligent organism's adaptation to a problem. And coming at it from that way, I then see, okay, what is the best way that I can enhance the power of this person's inner healer and remove the obstacles to that process from taking place? And so I often use this analogy of someone stepped on a nail and they come and see me and they say, Dr. Erica, I've got a nail in my foot. Please heal me. What I would do is I would remove the nail from their foot. So all I'm doing there is removing the obstacle to healing, right? And then I would clean out the wound.

And then I would tell them, don't walk on your foot. And I'd ask when their last tetanus shot was, and What I'm doing there is I'm just creating the proper conditions for healing. But what actually knits that hole together has nothing to do with me. That's the person's own healing capacity. And sometimes people ask me, well, how do you justify using psychedelics and herbs and pharmaceutical medicines? Don't they all kind of argue with one another?

And they don't when I use this philosophy. So with each individual person, I see, what is this inner healer trying to heal? What's stopping that from happening? And what tools here in my toolkit are gonna support them the best in that process. And so in that way.

There'S harmony. And then the tools in my toolkit become ways for me to customize how to best support my patients, rather than pushing my opinions or belief systems on, that's a bad medicine and that's a good medicine, which I don't really buy into.

So I'm really intrigued by what you just said about being uncomfortable with the label of being a healer, and also about pointing people back to gain access to their inner healer, their inner capacity for healing, self healing. And so I'm curious if what is the relationship between, of psychedelic medicines, helping people access their inner healer versus other things like herbal medicine and other interventions that, that you employ in your practice?

I think there's a reason that we have so many different kinds of medicine on this planet, because different things are going to work better or worse for different people at different chapters of their lives. And what I find with psychedelic medicine is you can use it like a pharmaceutical, or you can use it like an energetic medicine, or you can use it like an herbal medicine. And it doesn't actually have to do with whether or not the substance is a synthetic or a natural. For example, ketamine versus psilocybin, it's how you use it. So are you using it, for example, in the case of ketamine, which I do administer ketamine in my practice, I could use ketamine like a pharmaceutical in the sense of you have depression because there's a dysregulation in the glutamate system in your brain. We're going to tweak the brain chemistry and you're going to feel better. Right. That is a very allopathic or conventional way of thinking about disease. Right. The problem is depression. Another way to use ketamine is there's a disharmony between your body and your spirit. And we are going to use this medicine to help deepen your relationship with your spirit so that it can guide what you need to do next in your life.

Same drug, but very different uses. And something I really appreciate about psychedelics is they allow us to get to that psycho spiritual layer much more effectively than most of the other types of medicine that I have access to. Homeopathy does that as well. But I'm just going to confess, I'm not very good at that modality. I've taken additional coursework in it. It's like you either have the brain part or you don't. But a medicine that is going to bring somebody back home into themselves, understanding that there's nothing wrong with them. There are just things that are in harmony and out of harmony, and then comes our work. There's this saying after enlightenment, the laundry. Sometimes patients, coming from a western medical model, they treat psychedelics as if they are pharmaceutical medicines that are just more natural. Meaning, I want to take this drug because it needs to fix my anxiety, which is very different than there's some kind of disharmony within me and I could use some support into getting into alignment. And the latter takes more work. It needs more than just the drug and it works better and the effects last longer. So it's the tool, but it's also how we use it, and it's also how the patient approaches it as well.

So does that begin with how you frame the process for the patient? In other words, you could frame it in a somewhat pharmaceutical or conventional allopathic way that they're presenting a problem and you're going to provide them with some medicine that can fix it, or you can present it in this more holistic, integrative way, inviting them to be more engaged in the process and understanding that what they're presenting represents some kind of underlying disharmony, trauma, what have you, disconnection. And so you're inviting them to engage with this psychedelic medicine in a way that's addressing that. And so the way you frame it for the patient, you know, would really. Again, we're talking about set and setting here, right? So this is the set part. And. And so also curious, you know, are you able to do this with all of your patients? Or does it kind of depend on their willingness, how much they're willing to be involved in the healing process? They may arrive.

In their work with you with that mindset. I came to the doctor wanting you to just give me some medicine to fix this. I'm just curious how that works out. But it's really fascinating that the way you frame it can really determine the actual process of how the psychedelic medicine is going to be used and how it will work for the patient.

It can be. It can also be just where the patient is at. So sometimes we have folks who are, for example, deep in the throes of suicidal ideation and they're talked out, they can't engage in talk therapy anymore. They're just too deep in the well in those situations, like, you know what, let's use a band aid. That band aid can be a pharmaceutical, that band aid can be a psychedelic, doesn't matter. I need that person to get enough relief that they can hit a baseline place and then decide, are we going to engage or are we not? Personally, the way that I like to work with patients is that my first appointment is an hour long. It's an hour long because it needs to be an hour long. And we do a lot of talking. And I don't do straight up psychotherapy. I'm a little bit more outcomes focused on where's the dysfunction in your thinking here? Where's the disharmony between your spirit and how you're living your life? And once we can see that, it's almost like a layer has already happened before the person takes the psychedelic medicine and then the psychedelic can just boom, get really targeted and deep into where it goes. Whereas if you don't do that, you know, the psychedelic might end up working on some of the outer layers, which is still great, but we might not go as, as deep or as transformational with the work, which is okay too. Not everyone can go super fast, super hard right away. Some people don't ever want to go there. Some people come and they say, I don't want to talk about my mother. I don't care about this woo woo stuff. I don't want to integrate. I just want to change my brain chemist. And I say, okay, you're probably not the best fit for my practice, but I could still help you. We could still work with that. And a psychedelic might be a tool for working with that. It's how we use it.

Let me ask you about some of the ways that you perhaps use psychedelic medicines in your practice that might be somewhat outside the most common usages that we're aware of today and that the research is focusing on like severe depression, anxiety, post traumatic stress disorder and addictions and so forth. So in your practice, you know, you're working with, helping patients manage chronic illness, you're involved in preventive medicine, working with chronic pain and so forth. So I'm wondering if there are ways in which you incorporate psychedelic medicines in that part of your practice.

It's a good question. It comes back to that philosophy. And sometimes I get invited to write articles or speak about, can you tell us about psychedelics and eating disorders? Can you tell us about psychedelics and anxiety? Can you tell us about psychedelics and chronic pain? And to me, it's always a little funny because it's the same thing. Whatever the dysfunction or disease is, it is an expression of something not being quite right. And when you kind of take off those. The blinders that a horse has, instead of being super targeted on, this is good for pain, this is good for autoimmune disease, this is good for that. That way of thinking is very focused on the disease and not on the person. Something that I love about psychedelics is they're very focused on the person. And so those chronic headaches that you get might actually be related to the insecure attachment style that you have, and you might not even realize it. And something that blows me away with this work is sometimes I go in thinking we're treating one thing, and then by the end of the session, I'm realizing, oh, we're actually treating something very different. And that very different thing is the root of this more superficial problem. And I have. It's both a blessing and a curse. I get bored really easily. And that plays out in my life. I like to travel. I like to move around a lot. I have a lot of interest. And something I love about psychedelic medicine is right when I feel like I've got its number and I understand, okay, this is the pattern. This is how it works. I feel like the medicine goes, oh, really, girlfriend, watch this. And completely surprises me and blows me away with.

Its versatility and the way in which it can go deep without being violent. And I think often in our culture, we have this. We have two polar opposites here. One is, give me the pill to fix it. I don't want to do my work. The other is healing has to hurt. Healing is like a punishment. And if you want the wound to heal, you got to grit your teeth and scrub that wound clean with a stiff brush. And it hurts. But that's how you got to do it.

Those are two extreme opposites. And there are a million shades of gray in the middle there.

And I actually think that psychedelics can hit any of those stages in the middle, too.

That's just so obviously true. These. These polar opposites in our conventional mindsets around illness and medicine and healing and so forth. And it's really fascinating that you're exploring all these many shades of gray in the middle there in your own practice and with your patients. And so, morning, you mentioned before that there is some difference between synthetic psychedelic medicines like ketamine and perhaps some of the others that have been synthesized, mdma for example, and then some of the more natural psychedelic medicines, psilocybin and so forth. And of course there are both natural and synthetic forms of those. But in terms of the differentiation between synthetic and natural psychedelic medicines, is there a difference in how you work with those? And this whole process of engaging the patient more in the process. So it's not just this pharmaceutical allopathic approach, but it's a more integrative approach and really dealing with the underlying issues and engaging, you know, helping the patient access their own capacity for self healing. So again, is there just a differentiation around how you work with that and how that plays out in terms of synthetic versus natural psychedelic medicines?

I think each medicine has its own flavor and its own harmony, that it, that it dances with a person. And when I'm working with patients, most of what I do, I would say comes through my conscious intellectual brain. But there is an element of intuition as well. And sometimes I just get this hit. I'm like, you know what? I really think that you and the spirit of Ayahuasca would just work beautifully together. Sometimes I get this hit on people. I'm like, I think for you, you're going to be annoyed and distracted by the spirit of this plant. And let's just go with, I don't know, lsd, let's just go with ketamine. Let's just have it be a deep dive into your own brain without the dmt aliens and their carnival show or, you know, and it's not that one is better than the other, it's that they all have their place and they all work a little differently and different people are going to like different things.

I don't think that synthetics are any worse than the natural ones, to be honest. Sometimes people respond better to natural, sometimes people respond better to synthetic.

And I used to be very sanctimonious about that point, especially being trained in herbal medicine. I always thought the herbal thing, it's always better, it's always better to go with nature.

And while I would never turn my back on nature, I do think the synthetics bring a lot of value. And they can do things that the naturals can't. And the naturals can do things that the synthetics can't. And that's why I think we need all of them.

That's really interesting. And it Sounds like you've shifted a little bit away from maybe a bias towards the naturals. And you do see a lot of value and potential in the synthetic psychotic medicine. So I wonder if you could just say a little more about that and sort of tease out these differences between the synthetic and natural psychedelic medicines and how you work with those and their capacities for inviting someone into their self healing capacity given different things they may be struggling with.

Yeah, so let's take the case of depression, because that's one I see very commonly, and it is the leading cause of disability worldwide is depression.

I have seen pharmaceutical medicines help people in certain situations more than any psychedelic has.

In other situations. I've seen people fail several antidepressant medications and then it was that mushroom trip that unlocked their brain and helped them get free. I've also seen people who have tried ayahuasca and psilocybin and this and that and MDMA and MDMA plus the psilocybin in a variety of settings. Clinical, shamanic, et cetera, et cetera, et cetera, Ketamine this way, ketamine that way, ketamine rectally, ketamine nasally. And what they really needed was Cymbalta. And once we got them on the right antidepressant, then they could have that level of stability where they could actually engage in therapy, where they could lean in and talk about some of their issues without becoming dysregulated.

And I also want to say that having doing this work for as many years as I've been doing it in the way that I've been doing it, the people who come to see me are not the simple cases. And so I know that there are a number of people whose cases were much more straightforward than warranted. Making an appointment with me, by the time somebody sees me, usually they've already tried a few other things from both sides of the fence and they're thinking maybe it's time to give up. And that's where we need to get creative and that's where we really need to challenge.

Our stories about what medicine can and cannot be, and our stories about, on the conventional side, our stories about psychedelics, and on the shamanic or psychedelic side, our stories about pharmaceuticals and synthetics. And when I graduated from medical school, I was very well, I'll never prescribe an antibiotic, you know, kind of in that camp. And I really got beat up out there in clinical practice because guess what? The rest of the world didn't read Dr. Erica's philosophy on how healing should go right.

They didn't read my guidelines on how it should be. And so I had to bend. I had to bend to meet my patients. And it's like, okay, well, do I want to be right or do I want my patient to heal? I want my patient to heal. I'll also just. Since this is a psychedelic summit, I feel like I can get a little woo here. I had a very powerful trip on mushrooms once where I got to speak with the spirit of certain pharmaceutical medicines.

It started with opioid medications and then it went to a number of different pharmaceutical antidepressants. I was like, oh, you have spirits? They're like, yeah, we have spirits and we get no respect and we don't understand why everyone's mad at us.

And it was actually quite beautiful, especially to speak with the opioid spirit, like, we don't understand why everyone's mad at us. You. You told us you wanted us to make the pain go away, and we do that. So why does everyone hate us? Like, there was this, like, wanting to please and being confused and being a little heartbroken energy there. And. And then, you know, I, I spoke with. I think it was. Who was it? I think it was Fluoxetine, which is generic Prozac. It was like, why does anyyahuasca get to wear the tiara all the time? Do you feel like. Like, you're right. You've actually saved more lives than ayahuasca has. When we look at the population of the world, we haven't even had 1% of the population access psychedelic medicine. Yeah. You have saved more lives than ayahuasca has. You're absolutely right. Maybe I should respect you a little bit more.

So let me ask you, Dr. Zelpin, you lecture widely on psychedelic medicine, psychedelic science and so on. So I wonder.

Maybe you do talk about this in your lectures, but I wonder if you could talk here a little bit about these different ways of knowing the Western scientific, which ranges from the very conventional allopathic to what's arising in Western medicine in terms of integrative and holistic approaches, which is still in the minority of the Western model, unfortunately. But it's. There was more Eastern contemplative worldviews, where consciousness tends to be more primary rather than simply being regarded as an epiphenomena of neurological processes and then indigenous worldviews as well. So I wonder if you could just talk about that landscape a little bit as it applies to your work as a integrative health practitioner.

And a practitioner of psychedelic medicine.

I think that people now are sicker than they've ever been.

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