Making Sense - Sam Harris - #127 — Freedom from the Known

How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence by Michael Pollan. In this episode, I speak with the author of the new book, How to Change your Mind, about psychedelics and his own experience with psychedelics, about how they have changed his life and how they can change the way we think about consciousness and mental health, and about the potential benefits and dangers of psychedelics. We also talk about why psychedelics should be seen as tools, not just addictions, and what they can teach us about consciousness, dying, addiction, and transcendence. This episode was produced and edited by Sam Harris. Our theme music is by my main amigo, Evan Handyside. The album art for the podcast was done by our super talented Ameya Vellian and our ad music was made by Ian Dorsch. Please consider becoming a supporter of the podcast by becoming a patron patron of Making Sense. Thanks so much to Sam Harris for making this podcast possible. You'll get access to all kinds of great episodes of the Making Sense Podcasts, including the podcast and much more. Subscribe to Making Sense, wherever you get your podcasts, including The Huffington Post, NPR, Slate, and the New York Times Magazine. To find a list of our sponsorships, go to bit.ly/OurAdvertisers. If you like the podcast, we'll be looking for your tickets to our upcoming events and support the podcast. Become a patron by clicking here. Thanks for listening and spreading the word out there! and spread the word to your friends and spreading it far and wide. Thank you, Sam Harris and I hope you'll find us everywhere you do it everywhere you listen to make sense. - Thank you! - Your support is appreciated! -- The Making Sense is much more than you'll get a chance to be heard by other podcasts like it helps us spread the message out there and help us spread it everywhere and spread it around the world. by spreading it everywhere. -- Thank you to you're listening to the world? - Sam Harris, too much of it's a good thing, and we're making sense, and I'm grateful that you're spreading it out there, everywhere and everywhere else too much love you do that's good enough, good enough to help us do it.

00:00:00.000 Welcome to the Making Sense Podcast.

00:00:08.820 This is Sam Harris.

00:00:10.880 Just a note to say that if you're hearing this, you are not currently on our subscriber

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00:00:46.620 My guest today is Michael Pollan.

00:00:50.140 Michael's the author of seven previous books, which include Cooked, Food Rules, In Defense

00:00:56.080 of Food, The Omnivore's Dilemma, and The Botany of Desire, all of which were New York Times

00:01:01.080 bestsellers.

00:01:02.320 And he's a longtime contributor to the New York Times Magazine.

00:01:05.680 He also teaches writing at Harvard and the University of California, Berkeley.

00:01:10.060 And in 2010, Time Magazine named him to its list of the 100 most influential people in

00:01:15.400 the world.

00:01:16.660 Today we're speaking about his new book, which is titled How to Change Your Mind, What the

00:01:22.100 New Science of Psychedelics, Teaches Us About Consciousness, Dying, Addiction, Depression,

00:01:27.140 and Transcendence.

00:01:28.820 And as I say in the outset of this conversation, many of us have been waiting for somebody to

00:01:34.080 write this book.

00:01:35.200 And it was really perfect that Michael was that person.

00:01:39.060 Anyway, I could have spoken to Michael for many hours about this, but he was in the middle

00:01:42.980 of a punishing book tour.

00:01:44.680 So I got about an hour and 20 minutes or so of his time, and I hope you think we put it

00:01:51.560 to good use.

00:01:52.940 And now I bring you Michael Pollan.

00:02:01.160 I'm here with Michael Pollan.

00:02:02.780 Michael, thanks for coming on the podcast.

00:02:05.040 Oh, great to be here, Sam.

00:02:06.420 I am so grateful that you wrote this book.

00:02:09.140 I think this must be a sentiment that has been expressed to you many times.

00:02:12.780 This book you have written, How to Change Your Mind, which is your deep exploration into

00:02:18.960 both the current science and clinical use of and your own personal experience with psychedelics.

00:02:26.480 It really couldn't be more timely.

00:02:29.840 And I just got the sense while waiting for the book in the aftermath of your New Yorker

00:02:35.400 article, which came out a few years ago, and in reading it, that this was just perfect.

00:02:41.620 You were just the person to do this, and you really delivered on a lot of promise that

00:02:46.940 was laid out in your article.

00:02:48.400 First, just thank you for doing this.

00:02:50.980 Oh, thanks for those generous words.

00:02:52.680 You know, I do feel, I mean, the book's only been out for a few days, but I do feel like

00:02:57.440 this was a conversation that the culture was waiting to have.

00:03:00.880 And I'm just really surprised.

00:03:03.560 First, how many people have come forward to tell me about their own experiences, which are

00:03:08.080 often profound and maybe have not been taken out of that box labeled weird drug experience

00:03:14.080 for 30, 40 years.

00:03:16.620 But also the fact that it seems like we're ready to have a kind of more matter-of-fact discussion

00:03:21.480 of these things and look at them as tools, what they're good for, what they're not good

00:03:25.720 for, rather than, you know, the usual kind of instantaneous reaction, you know, evoking

00:03:34.040 all the problems of the 60s.

00:03:37.320 So I've been hopeful by, you know, and encouraged by the response.

00:03:41.940 Yeah.

00:03:42.080 And you were especially well-placed, in my view, to write this because, I mean, not only

00:03:46.620 your background as a writer and journalist, but because the 60s had sort of passed you

00:03:53.180 by, you were born right in this valley where you were sort of young enough to kind of miss

00:03:59.380 the summer of love.

00:04:01.000 So you were not this old acid head who is now dusting off his interest in altered states

00:04:06.980 of consciousness.

00:04:07.460 You were exploring this for the first time.

00:04:09.920 I guess the first question is, what was that like?

00:04:14.700 You're 60 now or you're 61?

00:04:16.500 I'm 63 now.

00:04:17.520 I was in my late 50s when I started working on this.

00:04:20.580 So that is precisely the time where people's risk aversion seems to be kicking into high

00:04:27.360 gear.

00:04:28.220 And, you know, as someone who has done a fair amount of psychedelics in his youth, but has

00:04:34.120 since done none for precisely the reasons that might have given you some trepidation,

00:04:39.920 to do this in the first place, what was that like?

00:04:42.920 How long did you have to negotiate with yourself and with your wife and your agent?

00:04:48.840 What was the process before you jumped?

00:04:53.080 Well, I definitely didn't tell my agent about it.

00:04:56.000 Not at the beginning.

00:04:57.540 You know, I was a very reluctant psychonaut.

00:05:00.780 I hadn't really had experience of these drugs except for a couple of very mild so-called

00:05:06.300 aesthetic experiences with psilocybin in my late 20s.

00:05:10.420 I came of age at a moment where the moral panic was in full flower and I heard all the

00:05:15.660 horror stories.

00:05:17.000 And honestly, I didn't feel like I was a psychologically sturdy enough person to do this.

00:05:22.240 And so I stayed away.

00:05:26.620 Then to approach it later, I mean, it's true.

00:05:29.020 When you're 20, you know, when you were having your experiments in Nepal, you believe you're

00:05:36.780 immortal.

00:05:38.620 And you are, you know, I mean, men that age are great risk takers.

00:05:43.040 That's why we send them to war. 1.00

00:05:44.180 And, um, but here I was approaching 60 and, you know, was not unhappy and had a pretty

00:05:52.460 good life and why mess with it?

00:05:54.120 Uh, and on the other hand, um, uh, so I had to overcome a lot of reluctance, uh, so many

00:06:00.400 things.

00:06:00.840 I mean, the fear of the drugs and the experience, the, uh, the new age kind of woo woo, uh, vocabulary

00:06:07.300 of my guides, um, the music that they played so many things just rubbed me the wrong way.

00:06:14.060 You're unusually hung up on the music.

00:06:15.700 That was, I know, I don't know why it's kind of adorable that that was such a sticking point.

00:06:19.820 It really got to me.

00:06:20.900 It was the kind of music you might hear at a high end spa while you're getting a massage

00:06:24.920 for, for some reason, this is profound to some people.

00:06:27.860 Uh, so, and my, you know, I argued with myself before every one of my trips, I had, uh, an awful

00:06:34.920 sleepless night where part of me was arguing, are you crazy?

00:06:39.940 You know, you're going to go up to the top of this mountain. 0.55

00:06:41.960 You're going to be with someone you barely know.

00:06:44.540 You could have a heart attack and he's not going to call nine one one because it's going 0.98

00:06:47.980 to get them into trouble.

00:06:49.520 And, um, and then the other half would be saying, but aren't you curious?

00:06:53.300 You know, you've never had a spiritual experience.

00:06:55.920 Aren't you, um, uh, you know, plus you've got a book to write.

00:06:59.780 And, um, so it was, uh, you know, this ping pong match, but every night.

00:07:05.300 And I realized eventually that that was my ego trying to stop me from what was going to

00:07:10.140 be a full assault on it.

00:07:13.580 Um, so I, uh, fortunately I overcame that reluctance.

00:07:17.740 I mean, I'm very glad I did, but I could see how easily you would not do this.

00:07:22.720 Now you hadn't taken any trip yourself when you wrote the New Yorker article.

00:07:27.560 Is that right?

00:07:27.940 That's right.

00:07:28.340 I hadn't done it then.

00:07:29.420 And, and that article was kind of straight ahead science writing.

00:07:32.400 I think the New Yorker would have been frightened off had I said, Hey, and I, and I'm going to

00:07:36.440 have a trip too.

00:07:37.640 I had to stick to the people in white coats, you know, that's, that, that's to get it in 0.98

00:07:42.540 the New Yorker.

00:07:43.100 It was hard enough to get a piece on psychedelics into the New Yorker in 2014.

00:07:47.200 That's interesting.

00:07:48.120 That actually took some negotiation with your editors.

00:07:50.940 Well, I mean, think about it.

00:07:52.160 There was a, I mean, I did, I proposed it to them and they bit, but then I handed in 14,000

00:07:57.540 words on science that had not yet been peer reviewed.

00:08:00.540 So I could see why it was a bit of a stretch.

00:08:03.020 And there was this very interesting moment two or three days before close where, uh, I

00:08:08.600 got word from my editor that I had to find a prominent, uh, psychiatrist or somebody who 0.97

00:08:14.980 thought this was all bullshit. 0.92

00:08:16.800 And, uh, so I spent a day dialing, you know, dialing around until I found, I thought Tom 0.99

00:08:21.820 Insul, the, uh, former head of the National Institute of Mental Health would give me the

00:08:25.760 establishment cautions.

00:08:27.600 But when I reached him in Davos, he was like, he was on acid.

00:08:30.600 No, this, this research is really interesting.

00:08:32.820 I think we, I think we need to do it.

00:08:34.940 And, um, I finally got, uh, uh, the head of the National Institute of Drug Abuse to give

00:08:39.720 me the quote I needed, which was these drugs can be abused, which we know.

00:08:45.300 I don't disagree with that.

00:08:46.880 That's the squarest quote you could find.

00:08:48.900 Yeah, that was the best I could do.

00:08:50.200 That's funny.

00:08:50.620 Right.

00:08:51.140 Well, so I think we should probably, uh, give our own disclaimer here.

00:08:54.900 It's certainly clear if listeners have read anything I've written about psychedelics, and

00:08:59.660 it would be clear to anyone reading your book that there's potential downside.

00:09:04.800 First, we have to acknowledge that the word drugs names a very wide spectrum of compounds

00:09:12.480 that are significantly different, both psychologically and physically.

00:09:16.420 So, you know, much of what we're going to say about the classic psychedelics doesn't

00:09:20.780 necessarily apply to something like MDMA, which has also therapeutic value, and people

00:09:26.720 have derived a lot of benefit from it.

00:09:28.560 But unlike the classic psychedelics, LSD, psilocybin being the most common here, but you would

00:09:36.020 add DMT as well, you can make the case that MDMA is physically not good for you.

00:09:43.320 It's very hard to make that case with LSD and psilocybin.

00:09:47.260 They seem to be impressively non-toxic, but they produce such a strong experience psychologically

00:09:54.600 for good or for ill that you can't recommend this without serious caveat to people.

00:10:03.100 And people who can't afford, as I think I said when I wrote about this, to give the anchor

00:10:08.060 of sanity, even the slightest tug, really, really shouldn't.

00:10:13.220 And so it's, you know, if someone's at risk for schizophrenia or worries that they could

00:10:17.940 be destabilized in some permanent way by experiences like this, this isn't just a matter of what

00:10:25.020 one would want to say about psychedelics.

00:10:27.460 This applies to even long-term meditation practice.

00:10:30.820 I wouldn't recommend that someone go into silence for a month and do nothing but meditate if

00:10:34.980 they're at risk for a condition like schizophrenia.

00:10:37.860 So we're about to say some very positive things and we should just anchor that.

00:10:42.860 Yeah, I'd like to say an additional word about risk.

00:10:45.620 I think it's very important to preface any conversation with a sense of risk.

00:10:49.840 The risks are, as you suggest, less physiological than they are psychological.

00:10:56.320 Physiologically, the drugs, as you say, are relatively non-toxic.

00:11:00.240 I mean, there are lethal doses of all sorts of over-the-counter drugs that you have in

00:11:04.080 your medicine cabinet and there doesn't appear to be lethal doses of the classic psychedelics.

00:11:09.620 And I agree with you that I would take MDMA out of that, that it is more toxic.

00:11:13.840 I would also add to that, though, that they don't appear to be addictive and that, you know,

00:11:19.520 in animal experiments, you know, in the classic setup where the rat has a lever that administers

00:11:25.120 cocaine to itself and another lever for food, it will press the lever endlessly for cocaine

00:11:32.380 until it dies.

00:11:33.540 Whereas in the case, if you do that setup with LSD, it'll press it once and never again.

00:11:39.540 No, the first reaction after a big psychedelic trip is not, where can I get some more?

00:11:43.860 It's just too powerful an experience.

00:11:46.240 But psychologically, some people do get into trouble.

00:11:48.580 And, you know, and I'm hearing those stories when I talk to audiences about this.

00:11:53.660 I can't, you know, it's anecdotal, but there are casualties.

00:11:57.160 And we don't know whether psychedelics have ever created a case of mental illness where

00:12:03.740 there was no predisposition for it.

00:12:06.480 That's really not clear.

00:12:08.820 But certainly people have very powerful reactions.

00:12:11.420 They can be just panic reactions sometimes, but they can also be psychotic episodes.

00:12:15.000 And in some very few cases, psychotic breaks.

00:12:18.360 So in the trials that are going on, people are screened very carefully.

00:12:22.760 And if they have a family history of schizophrenia, you know, they're just not allowed in.

00:12:28.740 And some personality disorders too.

00:12:30.700 I think people who have bipolar, they also don't let into their trials.

00:12:35.040 So all of that is very important.

00:12:37.400 But on this other point that, you know, we're going to be talking about this together,

00:12:40.380 I just want to say that your own accounts of psychedelics, especially in waking up,

00:12:46.400 were incredibly important to me as I was deciding what to do in this book.

00:12:51.980 And that they really emboldened me, that a person of your reputation and evidence sanity

00:12:57.220 and that you would be willing to describe your experiences so openly,

00:13:04.920 made it a little easier for me to do that too.

00:13:06.800 So I'm grateful for that.

00:13:07.880 Oh, nice, nice.

00:13:09.260 Well, I was glad to see that you didn't take 400 micrograms of acid in the middle of a canoe

00:13:13.440 in the middle of a lake in the middle of Nepal.

00:13:16.520 I'm not 20.

00:13:18.000 It wasn't good even if you were 20.

00:13:20.520 But yeah, so that's great.

00:13:22.040 I'm very happy to hear that.

00:13:23.960 And for those who want to hear more of my cautionary tale with respect to psychedelics,

00:13:30.200 they can read that chapter in Waking Up.

00:13:32.360 It's also a blog post titled Drugs and the Meaning of Life.

00:13:35.700 But the flip side, of course, is that both of us are convinced that these drugs have immense

00:13:43.280 promise, both therapeutically for people who are in one or another state of obvious unwellness,

00:13:51.580 but also, as you phrase it many times in the book, the betterment of well people.

00:13:57.180 And that's the more controversial side of this, that people who are experiencing ordinary

00:14:03.640 levels of happiness and well-being still stand a lot to gain from these sorts of experiences.

00:14:12.940 I mean, that's certainly been my experience and it's been yours.

00:14:15.520 Again, we'll dive into that.

00:14:17.520 But, you know, the disclaimer still stands.

00:14:19.980 And, you know, people need to find whatever experts in their life to consult before they

00:14:24.300 take any implicit advice coming from us here.

00:14:27.000 And also, ideally, I mean, one way to mitigate the risk is to work with a guide, someone who

00:14:33.520 is a professional, someone who really knows the territory.

00:14:37.000 And we'll talk a little later about how a guided experience differs from a so-called recreational

00:14:42.240 experience.

00:14:42.820 But I think it's a profound difference and it definitely mitigates the risk.

00:14:48.260 I guess let's start with a snapshot of the landscape here.

00:14:54.300 I guess I've distinguished two aspects to it here.

00:14:57.340 There's the renewed clinical interest.

00:14:59.980 Maybe you can describe how that looks now and the conditions for which people are, you

00:15:05.480 know, marshalling psilocybin and other drugs.

00:15:09.200 And then we can talk about the notion of the betterment of well people as well.

00:15:13.840 Sure.

00:15:14.200 Well, what's happening right now and has been happening now for really almost two decades is

00:15:20.300 a renaissance of research that was going on in the 1950s that I was not aware of.

00:15:26.300 I think many people, I mean, even I talked to young psychiatrists.

00:15:29.040 They never heard about this in their education.

00:15:31.260 But that in the 50s, there was a really fertile period of experimentation by, you know, serious

00:15:39.100 psychiatrists and academics to try to figure out what LSD and then a little later psilocybin

00:15:44.400 might have to contribute to mental health treatment.

00:15:46.800 And the work that's been going on now since the late 90s is really attempt to pick up

00:15:53.960 that thread that was dropped during the moral panic that led to the backlash against psychedelics

00:16:01.080 in the 60s.

00:16:02.360 And, you know, we had this 30-year hiatus in research, which is, I don't know if I can

00:16:07.100 think of another example of a promising line of inquiry that scientists were very excited

00:16:13.400 about.

00:16:13.660 I mean, many people thought this was going to be a psychiatric wonder drug that was completely

00:16:18.400 suppressed for a period of time and then resumed.

00:16:22.940 And we can only imagine what we might know had we continued and had that other 30 years

00:16:28.080 of experience and research with these drugs.

00:16:31.900 But anyway, the work that's going on now so far is mostly repeating experiments that were

00:16:36.620 done in the 50s, but doing them to much better standards.

00:16:40.460 The randomized, double-blind, controlled trial is really, doesn't really come into common

00:16:46.600 use until 1962 or 3 after the solidamide scandal or tragedy.

00:16:53.620 And that's when we had an experience with a drug that was being given to pregnant women 0.95

00:16:57.580 that led to birth defects. 0.59

00:16:59.040 It was a horrible episode.

00:17:00.400 And it was only then that we started regulating the drug approval process the way we do it

00:17:05.300 now.

00:17:06.280 And so these trials that were done in the 50s, by modern standards, aren't adequate.

00:17:12.320 They often weren't controlled.

00:17:14.340 And it is hard to control a psychedelic experiment because you usually can tell who got the acid

00:17:20.140 and who got the placebo.

00:17:21.560 The double-blind thing becomes unblinded pretty quickly.

00:17:24.940 Pretty quickly.

00:17:25.820 And so the kinds of indications they're using the drugs for now are the anxiety and depression

00:17:32.600 felt by cancer patients after they get that life, you know, either that terminal or life-threatening

00:17:39.180 diagnosis.

00:17:40.440 That was done in the 60s also in the 50s.

00:17:42.980 And it is being done now with remarkable success.

00:17:47.140 These studies that I wrote about in that New Yorker piece have been published since.

00:17:51.560 In December 2016, and they were done at Johns Hopkins at NYU.

00:17:56.720 So top institutions.

00:17:58.180 And they found that in 80% of the volunteers, there were statistically significant reductions

00:18:07.360 in standard measures of anxiety and depression.

00:18:11.900 Quite remarkable.

00:18:13.620 Results you can't get with an antidepressant.

00:18:16.600 So very high effect size.

00:18:18.880 Now, these are just phase two trials.

00:18:20.440 You know, we're talking about 80 volunteers, and they need to be replicated on a much wider

00:18:24.880 scale.

00:18:25.500 And that will happen fairly soon.

00:18:27.900 So that's been one promising area of research, and perhaps the most advanced in terms of scale

00:18:33.280 and rigor of the experiments.

00:18:35.600 There's also been a pilot study of smoking cessation.

00:18:39.380 You know, smoking is a very hard addiction to break.

00:18:42.520 And in 15 people, 67% of them were abstinent after a year, which is quite remarkable.

00:18:51.680 I think the standard of care for that, I think it's Shantex or something like that, is 20%

00:18:57.220 after a year success rate.

00:18:58.960 So that's pretty remarkable.

00:19:00.200 But again, needs to be and is being repeated on a larger scale.

00:19:03.620 There have been, there was one study for obsessive compulsive disorder that showed encouraging

00:19:09.200 results.

00:19:09.980 Another pilot study in New Mexico for alcohol addiction that was encouraging enough in its

00:19:15.500 results to lead to a very large phase two trial that's underway right now at NYU.

00:19:21.400 So it's addiction, depression, anxiety, obsession.

00:19:25.000 I think there's great potential for eating disorders, and I know the people at Hopkins are

00:19:28.660 looking at that, it seems to do best in disorders that are characterized by kind of obsessive

00:19:35.760 thinking, rigid thinking, people getting trapped in a narrative about themselves that is, you

00:19:41.420 know, unhelpful.

00:19:42.160 And that one of the most striking things to me is the drug, the success of psilocybin.

00:19:48.920 And by the way, I should point out that today they use psilocybin almost exclusively and stay

00:19:54.660 away from LSD for two reasons, even though LSD was used a lot in the 50s and 60s.

00:20:00.940 The effects are quite similar.

00:20:02.820 The psilocybin trip is much shorter, though.

00:20:05.780 It's only like five or six hours, as opposed to a potential 10 or 12 with LSD.

00:20:11.760 And that's very hard to fit into the therapeutic workday.

00:20:16.220 I mean, if the...

00:20:17.680 You can't get home for dinner.

00:20:18.720 Yeah, they want to get home for dinner.

00:20:19.800 And then there is also the fact that LSD carries so much more cultural baggage and that you're

00:20:26.440 much more likely to excite a reaction on the part of some, you know, congressman standing

00:20:31.220 up and saying, why are we doing research with LSD?

00:20:34.080 He can't get the same bang talking about psilocybin, which he might not be able to pronounce, and

00:20:38.920 his audience doesn't know what it is.

00:20:41.260 So psilocybin can operate under the cultural radar a little bit, at least so far.

00:20:45.420 So the indications that it works best, you realize, have something important in common,

00:20:51.160 which is that the ego or the self is kind of stuck in these stories, these narratives

00:20:57.860 that are really unhelpful.

00:20:59.340 You know, narratives like, I can't get through the next hour without a cigarette, or narratives

00:21:03.200 like, I'm worthless, or narratives that, you know, I'm about to die, and what's the meaning

00:21:08.560 of life, and, you know, I'm confused.

00:21:10.860 And so they kind of dope slap people out of their stories.

00:21:15.560 And I think that's a very, I mean, it's kind of a new model for psychotherapy, right?

00:21:21.040 Because you're really administering an experience, not just a chemical.

00:21:25.500 Yeah, well, so you remark on this at some point in your book that it may, at first glance,

00:21:29.320 seem surprising that a single antidote is being proffered for all of these diverse conditions.

00:21:36.360 But when you boil it down, and I guess my experience in meditation would tempt me to boil it down

00:21:43.120 even further, all of these conditions, as you say, have this common feature of the mind

00:21:49.200 being imprisoned by certain patterns of thinking.

00:21:52.940 And, you know, I would say that basically all of mental suffering has this feature, that it's

00:21:58.720 really significantly or entirely mediated by thinking and one's relationship to one's thoughts.

00:22:05.920 And so you're left with a few options.

00:22:08.060 You can either change your thoughts or change the world so as to be convinced by it that

00:22:14.340 a change in your thinking is warranted.

00:22:16.500 You can change your relationships.

00:22:17.820 You can change your career.

00:22:18.960 You can change your health.

00:22:20.420 You know, you can rearrange the deck chairs on the Titanic.

00:22:24.060 Or you can change your relationship to your thoughts.

00:22:27.180 And there's something about a psychedelic experience that I would argue does both.

00:22:32.600 Meditation is, and we'll talk about the differences here, because I think it's a

00:22:35.900 in the Venn diagram of remedies for existential problems.

00:22:40.580 I think that meditation and psychedelics overlap significantly, but not entirely.

00:22:46.040 Meditation is much more weighted on the side of changing your relationship to thoughts in

00:22:51.400 a pure way without really changing content.

00:22:55.040 And the thing about a psychedelic experience is the contents of consciousness change so radically

00:23:00.520 that you can't help but be shoved into different patterns of thinking about yourself and your

00:23:07.500 place in the world and what it is to be an ape confronted by the cosmos.

00:23:11.580 It's not actually a surprise that these experiences change people's suffering with respect to many

00:23:18.580 different conditions and probably many conditions that are not on anyone's list yet.

00:23:22.720 I want to come back to a few things you mentioned here, because in your book, there are these

00:23:27.540 fascinating anecdotes.

00:23:29.780 Well, first, you mentioned the application to treatment-resistant depression.

00:23:34.180 I was astonished to hear from you that that idea actually came from the FDA.

00:23:39.980 That was thrust upon researchers who were looking for a more narrow application.

00:23:44.940 And the FDA opened the door to that.

00:23:46.840 Yeah, that was fascinating.

00:23:49.480 So when the researchers from Hopkins at NYU brought the results of these phase two trials

00:23:55.160 to their meeting at the FDA, they were hoping to get approval to do a phase three study of

00:24:02.500 the same thing, depression and anxiety in cancer patients.

00:24:07.300 But it was the regulators at the FDA, and this reporting is based on what the researchers

00:24:11.660 told me.

00:24:12.180 The FDA wouldn't say a word about it because they don't disclose anything about drug approval

00:24:16.400 processes, but that they said, you know, there's a strong signal here that this is effective

00:24:20.960 with depression.

00:24:22.400 And we have a tremendous problem with depression and very few tools to treat it.

00:24:27.840 The SSRIs, antidepressants like Prozac and Paxil, you know, there are a lot of problems

00:24:34.580 with them.

00:24:35.000 There was recently a meta-analysis that showed they only do slightly better than placebo and

00:24:40.000 that their effects fade over time and that they're very hard to get off.

00:24:43.360 And people really hate the side effects very often.

00:24:45.600 So the FDA was very open to studying depression in a larger population.

00:24:52.760 In America, it's not, just to correct you, it's not going to be treatment-resistant depression.

00:24:56.920 It's going to be major depression.

00:24:58.580 In Europe is where they're going to do treatment-resistant depression.

00:25:01.920 These are depressions that have failed to respond to two courses of treatment.

00:25:06.380 And so that was, as one researcher described it to me, said it was a surreal moment.

00:25:12.700 And one of the reasons they had worked, wanted to work with cancer patients is they thought

00:25:17.060 it was a particularly sympathetic population that we had very little for because antidepressants

00:25:24.700 really don't help very much if you're, you know, facing your mortality, if you have what

00:25:30.200 they call psycho-spiritual distress.

00:25:32.260 So, yeah, that was another indication, I think, that there is a receptivity to this work right

00:25:39.340 now that really flows from the desperate straits of the population and the limitations of mental

00:25:46.220 health care right now.

00:25:47.840 And, you know, Tom Insull, the former head of the National Institute of Mental Health, he

00:25:52.020 was really the one who sensitized me to this.

00:25:54.120 And he points out that if you compare mental health treatment, which, by the way, only reaches

00:25:58.600 half the population of people who need access to it right now, if you compare it to any other

00:26:04.720 branch of medicine, to oncology or cardiology or infectious disease, it's achieved very little.

00:26:11.680 And there is a tremendous amount of sufferings out there.

00:26:14.260 You know, the rates of depression are climbing.

00:26:16.320 Suicide is going up alarmingly.

00:26:18.240 And addiction is, rates of addiction are raising.

00:26:22.060 And addictive behavior is, you know, rampant.

00:26:25.860 So, and big pharma, the pharmaceutical industry, apparently has very few what are called CNS drugs,

00:26:32.440 central nervous system drugs in the pipeline.

00:26:34.860 So I think even the FDA is a little desperate when it comes to looking for innovation in mental

00:26:41.540 health treatment.

00:26:42.340 And there really hasn't been much innovation since the early 90s.

00:26:45.940 So I think psychedelics come along now at a very propitious moment.

00:26:50.400 Yeah, I want to spend a couple of minutes on the end of life care and the cancer patient

00:26:56.380 stories you tell, because there's one in the book that is fairly arresting and inspiring.

00:27:02.700 And also, I just had recent experience with this.

00:27:05.620 Someone close to me in my family recently died of pancreatic cancer.

00:27:09.300 And I was, you know, for the first time in many, many years in the situation of being close

00:27:17.600 to someone who was dying and just being taken through every stage of the medicalization process

00:27:25.140 of death, where treatment is no longer treatment and you go into a hospice situation.

00:27:30.620 And, you know, I was struck at every stage along the way that the promise of bringing equanimity

00:27:37.920 to the person who's dying, it's really not just about the person who's dying.

00:27:43.500 The state of mind of the person who's dying affects everyone around him or her.

00:27:48.820 And to some degree, this is just luck of the draw.

00:27:50.980 I mean, it's just, you know, you're lucky not to have dementia.

00:27:54.080 You're lucky not to be in excruciating pain.

00:27:56.160 And, you know, there are treatments for both of those things are, in the first case, basically

00:28:01.540 non-existent.

00:28:02.360 In the second, imperfect.

00:28:04.220 But, you know, as it happened, my family member got very lucky and he died in a state of just

00:28:10.420 virtually unbroken gratitude and love.

00:28:15.100 And it was just, you know, he won the death lottery, essentially.

00:28:18.200 And the effect...

00:28:20.160 Why?

00:28:20.500 What happened?

00:28:20.980 He was not someone who was at all overcome by regret or...

00:28:27.200 I mean, he was just feeling gratitude and love for seemingly every conscious moment that

00:28:33.820 was left to him.

00:28:34.760 And the experience of being with him and mourning the loss of him was totally different than

00:28:43.140 if he had been in some radically different state of, you know, being terrorized by the contents

00:28:48.360 of his own mind, which is the way many people die.

00:28:51.800 And you tell a story in your book of a cancer patient who, you know, on the basis of, I think

00:28:59.640 it was one psilocybin experience, was set on course to have an extraordinarily beautiful

00:29:06.180 process of dying which affected everyone around him.

00:29:09.840 Yeah.

00:29:10.200 You're talking about Patrick Metis, who is a...

00:29:13.580 was a journalist in New York, worked for MSNBC, was about my age.

00:29:18.180 At the time, in his 50s.

00:29:19.640 And he had bile duct cancer that had spread to his lungs.

00:29:22.580 He was really paralyzed by anxiety and depression.

00:29:26.340 And he read about the trial at NYU in the same article I first heard about it, actually,

00:29:32.220 in the New York Times.

00:29:33.060 And he immediately called them and applied to get in.

00:29:36.740 It's interesting.

00:29:37.340 His wife, Lisa, was against it and thought that this represented a surrender to death and

00:29:44.660 that he had given up fighting.

00:29:46.980 And that's a very common reaction.

00:29:48.440 And indeed, most oncologists, at least when that study was going on, reacted the same way.

00:29:55.360 They had a lot of trouble getting referrals because the oncologists see any acceptance of

00:29:59.920 death as a defeat.

00:30:02.020 And they take it personally, as if it were their defeat.

00:30:05.580 So, but he went ahead anyway.

00:30:06.620 And he had a profound experience that involved a rebirth.

00:30:13.180 He suddenly started shuddering and lifted his legs and held on for dear life with one

00:30:20.820 of his guides.

00:30:22.180 And where he said, and he said to them, life, dying and being born is a lot of work.

00:30:28.280 And he was being born or he was giving birth.

00:30:30.500 And he was giving birth to himself, he felt, after it had happened.

00:30:35.680 And there was a very rich kind of feminine principle at work. 1.00

00:30:39.560 Michelle Obama showed up in his trip and his late sister-in-law.

00:30:45.820 And he had an interesting experience with his mother, who I think he had problems with.

00:30:51.180 I never really understood what those problems were.

00:30:53.200 But he had an epiphany that a mother had to love her child.

00:30:58.580 And so, perhaps what he had failed to understand as love was love.

00:31:03.700 And then he had this interesting experience.

00:31:05.780 And I'm cutting out lots of things.

00:31:07.300 Derek Jeter showed up.

00:31:09.100 He had this whole riff on aesthetics and why we need to simplify everything we do, that we

00:31:15.460 put too many notes in the songs, too many elements in the TV program, and that we needed

00:31:20.300 to focus on love, and that love was the most important principle.

00:31:23.900 And I'll get back to that, because the problem of platitudes on the psychedelic experience

00:31:29.760 is interesting, if it is a problem.

00:31:32.240 And then he had this experience of kind of climbing up to this precipice that was made

00:31:36.820 of stainless steel, and it was kind of sharp.

00:31:39.100 And looking out over it and seeing this plane of consciousness that was infused with love.

00:31:47.060 And he saw that as a form of consciousness outside of himself that would survive him.

00:31:55.460 And he could go there now, he realized.

00:31:58.100 He could go over to that side, but chose not to, that he didn't want to leave his wife yet,

00:32:03.660 and that he still had some time that he wanted to spend in this world.

00:32:08.560 When the trip ended, he was sweaty, exhausted.

00:32:13.060 His wife said he looked like he'd run a marathon.

00:32:15.940 And he wrote a beautiful account of it that his wife and his doctor allowed me to quote at

00:32:20.640 length, and it's extraordinary.

00:32:23.140 And he spent the next 17 months in a very different frame of mind.

00:32:28.840 He, at one session, I had the therapeutic notes with his palliative care psychologist.

00:32:33.640 He spent his days walking around Brooklyn, finding interesting places to have lunch,

00:32:40.320 savoring every moment, like the family member you were describing.

00:32:44.240 And in one session with his shrink, he said he'd never been so happy in his life as in

00:32:49.600 those last months because of the gratitude he had for the time he had left.

00:32:53.480 And his focus turned from the quality of his time to the quantity.

00:32:57.340 And in fact, he did stop chemo eventually.

00:33:00.020 Not because he wanted to die, he said, but because he didn't want to live that way while

00:33:03.480 he was still alive.

00:33:05.160 Toward the end, his lungs began to fail, and he went into the hospital at Mount Sinai.

00:33:10.000 And Lisa, his wife, and Tony Bosas, his therapist, said that his room in the palliative care unit

00:33:18.000 at Mount Sinai became this gravitational field in the hospital.

00:33:22.060 Everybody on the floor wanted to spend time in that room because he was putting out so much

00:33:26.320 love.

00:33:27.500 His wife said it was like he was a yogi.

00:33:29.280 They all wanted to be near this presence.

00:33:32.340 You know, here is someone facing death within a matter of days, yet is putting out this

00:33:38.460 energy that, you know, we normally turn away from the dying.

00:33:42.280 You know, we have to work very hard not to.

00:33:45.280 But this was quite the opposite.

00:33:47.080 You know, I never met him.

00:33:48.220 Everything I know about him came from interviews and reading these notes.

00:33:51.940 He had died before I wrote about him.

00:33:54.300 But there's a moment where his wife sent me a photograph that she'd taken four or five

00:34:00.180 days before he died.

00:34:01.860 And I remember vividly the moment I clicked it open on my computer screen.

00:34:06.260 And here was this man.

00:34:07.440 I had never seen a picture of him.

00:34:09.420 He was emaciated.

00:34:11.220 He was very, very thin.

00:34:12.240 He had an oxygen clip and was wearing that blue hospital scrubs.

00:34:15.820 And he was shining blue eyes that he had.

00:34:18.820 And he was beaming, absolutely beaming.

00:34:22.220 And it was it just took my breath away.

00:34:24.940 And he died, you know, in a very deliberate way.

00:34:27.960 He was ready and with what appeared to everybody around him to be complete equanimity.

00:34:33.860 But your point about the caregivers and how important it is to them, too, because it's

00:34:40.560 very hard to take care of someone who is suffering in that existential way, you know, let alone

00:34:47.460 the pain and the, you know, all the physical problems of dying.

00:34:52.560 And actually, there are some some of the therapists who've done this work thinks that, you know,

00:34:56.740 there's a place for giving it to the caregivers also and that it could help them.

00:35:00.560 So what happened in the mind of Patrick Metis is a question that I became intensely concerned

00:35:08.480 with.

00:35:08.840 I wanted to understand that.

00:35:10.840 Had he had a glimpse of an afterlife?

00:35:12.960 Was that what it was?

00:35:13.960 I don't think exactly.

00:35:16.160 But he'd had a glimpse of a kind of consciousness that was literally selfless.

00:35:23.280 It was a consciousness that was outside of him, that was universal in some ways, and that

00:35:30.900 he was part of and would continue to be part of even when his when he died.

00:35:36.280 Now, you can argue if that's a form of immortality or not, but it is a transcendence of the self.

00:35:43.620 And I think part of what's going on here is people are, they're rehearsing their death.

00:35:48.440 You know, an ego death is a death.

00:35:50.120 And it can feel like a death.

00:35:52.080 And it can be agonizing or ecstatic, depending on your preparation and your set, your mindset.

00:36:01.040 And that rehearsal, I think, and what you're rehearsing is letting go also.

00:36:05.720 And that's very important.

00:36:06.880 And because we cling, you know, we cling to all sorts of things.

00:36:10.620 And to let go of yourself and have that experience, I think, equips you to die.

00:36:16.540 Well, I want to talk about the experience and your experiences in particular and what they

00:36:22.420 may or may not mean, kind of the metaphysics lurking at the back here.

00:36:26.900 But I think we should deal with this problem of platitudes that you raised a moment ago.

00:36:33.940 And this relates to the so-called and much remarked ineffability of the psychedelic experience.

00:36:41.400 It's not that it is.

00:36:42.600 I mean, it can certainly be hard to remember.

00:36:44.920 Many psychedelic states have somewhat the quality of dreams where, you know, they can be incredibly

00:36:50.060 intense, but paradoxically, very hard to remember even a few moments later.

00:36:56.340 But I don't think they're as ineffable as all that.

00:37:00.300 You do a good job of effing in this book.

00:37:03.460 If anyone's heard Terrence McKenna talk for 14 hours about any of his drug experiences,

00:37:10.800 he's quite articulate on all the details.

00:37:14.760 So you can capture many of the features of interest here.

00:37:18.060 The problem of platitude, and again, you remark on this at several points in the book,

00:37:22.640 and it's something I'm sensitive to also as a writer.

00:37:25.640 You hate to boil it all down to a sentence that belongs on a Hallmark card, I think, as you put it.

00:37:32.600 But I think there's a principle of charity you have to extend to the other person and even to

00:37:38.820 your former self when you're trying to capture these experiences.

00:37:41.760 Because a statement like love is the principle of being, say, right?

00:37:47.220 Love is everything that matters, is the only thing that matters, yes.

00:37:50.080 Right, that, like, if you actually do the work to capture what that state of mind is,

00:37:55.060 it's worth doing.

00:37:56.600 Yeah.

00:37:57.280 So I have a slightly different take on the platitudes.

00:37:59.540 Like, I think they're true.

00:38:01.240 I think that a platitude is a truth after you've trained out all the important things.

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Making Sense - Sam Harris - May 28, 2018

#127 — Freedom from the Known

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