A young child has an entropic brain, and baby consciousness is so different from adult consciousness as to constitute a mental country all of its own. The closest we may be able to come to visiting that foregin land may be a psychedelic journey. A video of a discussion among Carhart-Harris and Alison Gopnik, author of The Philosophical Baby, can be seen on this YouTube video.

Gopnik draws a useful distinction between the "spotlight consciousness" of adults and the "lantern consciousness" of young children. The first mode gives adults the ability to narrowly focus attention on a goal. The child's attention is more widely diffused, allowing the child to take in information from virtually anywhere in the field of awareness, which is quite wide. Gopnik believes that the child (under 5) and the adult on psychedelics rely more on novel thinking than on applying known information to processing sensory information. This appoach may result in more errors and require more time and energy to process, but occasionally return answers of surpassing beauty and originality. In some experiments young children are better at problem solving than adults, precisely because of the requirement for novel thinking. In one experiment, she presented children with a toy box that lights up and plays music when a certain kind of block is placed on top of it. When it's programmed to only work when two blocks are placed on it, four year olds figure it out much faster than adults. Children test more "far-out" hypothesis than adults.

Both Gopnik and Carhart-Harris believe that the psychedelic experience, as they conceptualize it, can be helpful to help people who are sick and those that are not. For the well, psychedelics, by introducing more noise or entropy into the brain, might shake people out of their usual patterns of thought in ways that might enhance well-bering, make us more open and boost creatiity. It may help us acheive fluid thinking in a way that is second nature the children. For the unwell, those patients suffering from mental disordered characterized by mental rigidity may be helped, including addcition, depression and obsession. Each of these are associated with a narrow, ego-based focus.

Chapter Six: The Trip Treatment

Psychedelics in Psychotherapy

One: Dying

Traditional scientific methods do not translate well to psychedelic drug testing. For one, in double blind studies, it's not very difficult for the patient or the scientist to realize who is on the placebo and who is on the psychedelic. Moreover, set and setting seem to play an important role in the therapeutic value of psychedelics, while western medicine seeks to isolate a single factor, the compound being test, as having any causative effect.

Nonetheless, research into psychedelics comes along at a time when mental health treatment in the US is so "broken" (to use the word of Tom Insel, who until 2015 was the director of the National Institute of Health, that the fields willingness to entertain radical new approaches is perhaps greater than it has been for a generation.

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In April 2010, Patrick Mettes read the article Hallucinogens Have Doctors Tuning In Again, which briefly mentioned research at NYU where psilocybin was being tested to relieve existential distress in cancer patients.

The idea of giving a psychedelic drug to the dyning was first raised by Aldous Huxley in a letter to Humphry Osmond, proposing such a research project. Huxley has his wife give him an injection of LSD when he was on his own deathbed, on November 22, 1963. In 1965, Sidney Cohen wrote an essay for Harpers, LSD and the Anguish of Dying exploring the potential for LSD to alter the experience of dying.

Patrick started his experience in January 2011. Within 30 minutes it was clear that he had not received a placebo. Early in the journey Patrick encountered his brother's wife, who had died of cancer more than 20 years earlier. Other aspects of this part of his journey contained strong feminine energy. He felt the power of a mother's love and the realization that all mothers have love, and then experienced being re-birthed.

The experience was intense and at one point he asked to take a break. He sat up and reported: "I mentioned that everyone deserved to have this experience...that if everyone did, no one could ever do harm to another again... wars would be impossible to wage." He voiced reluctance to "go back in" but eventually did. From then on out, "love was the only consideration...It was and is the only purpose." At 12:15 he say "OK, I get it! You can all punch out now. Our work is done." But he continued, seeing the cancer in his lungs, and reported "I was being told (without words) not to worry about the cancer...it's minor in the scheme of things... simply an imperfection of your humanity and that the more important matter... the real work to be done is before you. Again, love."

At 3 p.m. it was over and he returned home. His wife reported that Patrick "looked like he had run a race. The color in his face was not good, he looked tired and sweaty, but he was on fire. He was lit up with all the things he wanted to tell me and all the things he couldn't." He told her he "had touched the face of God."

Two months later, slowly dying of cancer, Patrick "feels the happiest in his life" and reports "I am the luckiest man on earth."

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How much should the authenticity of the experience concern us? Researcher Tony Bossis shrugged "that's above my pay grade" when asked if the experiences of the patients were of real cosmic consciousness. Bill Richards cited William James, who suggested we judge the mystical experiences not by its veracity, which is unknowable, but by "its fruits". And researcher David Nichols told Science magazine "If it gives [terminal patients] peace, if it helps people to die peacefully with their friends and their family at their side, I don;t care if it's real or an illusion."

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In December 2016, a front-page story in the New York Times reported on the dramatic results of the Johns Hopkins and NYU psilocybin cancer studies. Some 80 percent of the cancer patients showed clinically significant reductions in standard measures of anxiety and depression, an effect that endured for at least six months after their psilocybin session. Few if any psychiatric interventions of any kind have demonstrated such dramatic and sustained results. Patients with the strongest mystical experiences had the best outcomes. The trials were small -- 80 subjects in all -- but the results were promising enough to win the attention and cautious support of the mental health community. Dozens of medical schools have asked to participate in future trials and funders have stepped forward to underwrite these trials. For a critique of the study and the media coverage, see here.

In a follow-up study to the NYU trial, "Patient Experiences of Psilocybin-Assisted Psychotherapy", Alexander Belser interviewed volunteers to better understand the psychological mechanism underlying the transformation they experienced. A few key themes emerged: All the patients described powerful feelings of connection to loved ones and a general shift to a feeling of interconnectedness. In most cases there were also powerful emotions, with difficult passages of the journey typically followed by positive feelings of surrender and acceptance as fears fell away. A co-author on the paper interprets what happens during the session in terms of the ergolytic effects... the drug's ability to either silence or at least muffle the voice of the ego.

Existential distress at the end of life may lead to a hyperactive default network, including obsessive self-reflection and an inability to jump the deeping grooves of negative thinking. The ego, faced with the prospect of its own extinction, turns inward and becomes hypervigilant. But if one can leg go and surrender, powerful and usually powerful emotions flow in, along with formerly inaccessible meteors and sense impressions and meanings. And for many people, there is an experience of a great flood of love.

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After Patrick Mettes psilocybin session his life was filled with a great many unexpected satisfactions, alongside Patrick's dawning acceptance that he was going to die. He spent much of the time walking New York City, trying new lunch spots and telling Lisa of his experiences. But his good days got fewer and fewer, and in March 2012 he told Lisa he wanted to stop chemo. "He didn't want to die," Lisa says, "bit I think he just decided this is not how he wanted to live." He lived his last days in the hospital, and lived them with joy. When he died, it "was a good death", Lisa told Pollan. She felt "indebted to [the NYU team] for what they allowed him to experience--the deep resources they allowed him to tap into. These were his own deep resources. That, I think, is what these mind-altering drugs do."

Two: Addiction

Matthew Johnson directed a pilot study at Johns Hopkins on smoking cessation. Before the study commenced participants were required to have quit smoking (which was confirmed by carbon-monoxide monitoring in the blood). The study was tiny and not randomized, but the results were striking. Six months after the psychedelic sessions, 80 percent of the volunteers were confirmed as abstinent; at the one-year mark the figure had fallen to 67 percent, which is stila better rate of success than the best treatment now available. Participants with the most complete mystical experience had the best outcomes. Many of the participants Pollan interviewed reported typical mystical journeys, and ended with the conclusion that smoking was simply unimportant, irrelevant or counter productive.

Participants have insights, like others on psychedelics, that appear very obvious. They know smoking is unhealthy, expensive and unnecessary, but under the influence of psilocybin that knowing acquires a new weight, becomes something they feel in their gu... it becomes more compelling and stickier and harder to avoid thinking about. The session deprive the participants of the luxury of mindlessness, our default state, and one in which addictions flourish. It is also possible that psychedelics relax the brains inhibition on visualizing thoughts, allowing us to see them clearly, making them authoritative and memorable.

In 2012, a meta-analysis that combined data from the six best randomized controlled studies done in the 60s and 70s (involving more than 500 patients in all) found that indeed there had been a statistically robust and clinically "significant beneficial effect on alcohol misuse" from a single dose of LSD, an effect that lasted up to six months. "Given the evidence for a beneficial effect of LSD on alcoholism it is puzzling why this treatment has been largely overlooked" the authors concluded.

It may be odd to think about offering addicts drugs to treat their addictions. One might think of the rat park experiment. Rats in a cage given access to drugs of various kinds will quickly addict themselves, pressing the little levers for the drug on offer in preference to food, often to the point of death. Less talked about, however, is the fact that if the cage is "enriched" with opportunities for play, interaction with other arts, and exposure to nature, the same rats will utterly ignore the drugs and so never become addicted. The rat park experiments lend support to the idea that the propensity to addiction might have less to do with genes or chemistry than with one's personal history and environment.

Now comes a class of chemicals that may have the power to change how we experience our personal history and environment, no matter how impoverished or painful they may be. "Do you see the world as a prison or a playground" is the key question one scientist takes away from the rat park experiments. If addiction represents a narrowing of one's perspective, behavior and emotional repertoire, the psychedelic journey has the potential to reverse that constriction. "People come out of these experiences seeing the world a little more like a playground."

Awe is common in psychedelic experiences. And perhaps we can break addiction cycles. Addiction is fundamentally selfish, with a consuming self-interest in pursuing the addiction. Awe promotes a sense of the "small self" that directs our attention away for the individual to the group and the greater good.

Three: Depression

Something unexpected happened when, early in 2017, Roland Griffiths and Stephen Ross brought the results of their clinical trials to the FDA, hoping to win approval for a larger, phase 3 trial of psilocybin for cancer patients. Impressed by their data, and seemingly undeterred by the unique challenges posed by psychedelic research, the FDA staff surprised the researchers by asking them to expand their focus and ambition: to test whether psilocybin could be used to treat the larger and more pressing problem of depression in the general population. A similar occurrence resulted when in 2016 researchers approached the European Medicines Agency seeking approval to use psilocybin in the treatment of anxiety and depression in patients with life-hanging diagnoses.

In a series of interviews of people participating in psychedelic sessions for depression, Rosalind Watts found two "master" themes. One, was that the volunteers depicted their depression foremost as a state of disconnection, whether from other people, their earlier selves, their senses and feelings, their core beliefs and spiritual values or nature. Psychedelic experiences promoted re-connection. The second theme was access to difficult emotions, emotions that depression often blunts or loses down completely. This is especially true in cases of childhood trauma. Psychedelic experiences allow people to become in touch with the emotions again. Unfortunately, for half of the volunteers in one study, depression returned, so it seems likely that psychedelic therapy for depression, should it prove useful and be approved, will not be a one time intervention.

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Will psychedelic therapy ultimately have the benefits that are appearing in current studies. Likely it will be less than initial indications show. Early studies tend to overstate effects. Researches can hand choose participants and give them significant attention. And the placebo effect is most pronounced. Larger studies will need to be completed to determine the ultimate impact of psychedelics on mental health.

And is it even possible for a single class of compounds to treat many different disorders. Some say yes. There is a continuum between disorders, which is not taken into account in DSM classifications. For example, there are links between addiction and depression. Depression and anxiety are related as well (depression is a response to past lost, anxiety is a response to future loss).

The default mode network is the work performed by the so-called atobiograpal or experiential self: the mental operation responsible for the narrative that links our first person to the world. Becoming overly attached to these narratives, taking them as fixed truths about ourselves rather than as stories subject to revision, contributes mighty to addiction, depression and anxiety. Psychedelic therapy seems to weaken the grip of these narratives.

Aand then there is the ego, which is fundamentally conservative. The ego "keeps us in our grooves". For better or worse. The ego can become tyrannical and turn its formidable powers on the rest of us. Perhaps this is the link between the various forms of mental illness that psychedelic therapy seems to help most: all involve a disordered ego -- overbearing, punishing or misdirected.

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