Robin Carhart-Harris

April 16, 2020
Spotlight

What do you believe is the most important thing for people to understand about the future of psychedelics as medicine?

Probably that all of the significant clinical work done during this present renaissance has been on psychedelic therapy, i.e. not just the drugs themselves but a particular way of giving them that is combined with psychological preparation, supervision, music-listening and after care. How many people are aware that music-listening has been present in all of the modern psychedelic therapy trials? All of them! Thus, if we're to properly appreciate psychedelics, we need to understand that they are a particularly novel approach to mental healthcare that seems very much to depend on a synergy between a drug action on the brain (e.g. increased plasticity) and how the ensuing state is prepared for, mediated and integrated and exploited afterwards.

We also need to better test this assumption, as well as what we mean by it. For example, when people think of 'set and setting' or what I prefer to call 'context' (as it's shorter and a bit less psychedelic centric) - they rarely think of their childhood as being a contextual factor or even recent events, such as a global pandemic. I think there's scope for the science of psychedelic medicine to better consider this temporally extended definition of context - and how we might accommodate it into future therapy models.

You have been a leading researcher and vocal advocate for the study of psychedelics for nearly 10 years. Do you find the new attention on the space concerning, exciting, or both?

It's both concerning and exciting. It's intriguing to watch all the fuss about microdosing for example - a phenomenon that rests on pretty threadbare evidence. It's remarkable how influential a bunch of anecdotes, and a few books and magazines can have! Very little of any scientific substance has been published on the phenomenon in terms of rigorous new studies. We've done a couple of prospective (before vs after) studies ourselves using mostly online sampling via the web tool psychedelicsurvey.com and the main thing to come out of that work - which we're presently writing up - is just how influential prior expectations are.

Someone really does need to do a proper, sizeable double-blind, randomized controlled study of microdosing. My prediction would be that the mental health benefits (versus placebo or an active control) would be far more modest than many people would assume - and the assumption that microdosing is something you can do safely without a care for psychotherapy or context more generally - is something I think we would be wise to question.

What is the most common misconception you hear about psychedelics?

It's easy to present to a public audience and have someone ask whether we should be concerned about the addiction potential of psychedelics. Whenever I hear this, I take it as a useful reminder of where we are in relation to public awareness.

It's easy to get caught in the psychedelic 'bubble' and forget that there are many people out there who haven't read Michael Pollan's book and still think psychedelics are hedonic drugs like so many of the others.

At the other extreme, it's easy to find a lot of romanticism, sanctimony, and woolly thinking among the psychedelic zealots. It's a fine line to tread! The lack of appreciation for the explanatory power of depth psychology (e.g. psychologists such as Carl Jung) and preference to entertain supernatural explanations for psychedelic experiences and related phenomena bothers me quite a lot.

There's a psychology to the defence of supernaturalism in the same way as there is a psychology to biomedicine in psychiatry. Indeed, there's a psychology to more or less everything! We should always be watchful of our own positions on things - including how blind we can be to our own defences.

What made you personally want to get involved in this field of research?

I discovered Stan Grof's 'Realms of the Human Unconscious' while studying Psychoanalysis for a Masters Degree. I was about 25 yrs old at the time and psychedelics hadn't been on my radar for some years and this book just blew it all open for me.

I was fascinated by psychoanalysis and this intriguing thing they call 'the unconscious mind' - but it seemed so slippery and out of scientific bounds. All of a sudden, there it was: LSD makes available the unconscious mind to consciousness! Why hadn't this insight translated over into mainstream psychology? It's implications are massive! Why did I have to spend so many years studying psychology to discover this vital principle? Why hadn't anyone used modern brain imaging to look inside the brain during an LSD trip to understand the biological nature of 'the unconscious' and its relationship with the rest of the mind? I thought it remarkable that there had been such scientific oversight. I licked my lips - and dived in! I've been feeding ever since, and it's a delicious, ever-giving feast!

What obstacles and challenges do you think psychedelic-focused companies and researchers will need to overcome from an investment perspective?

Well, there's a lot of strong feeling in the psychedelic community about the sacredness of psychedelic medicine and the unholy, if not down-right rotten nature of capitalism. I hear much of this sentiment. Sometimes it's over-said and can feel like sanctimony, but I don't want to reject it outright.

I've rubbed shoulders with many people positioning to make money out of psychedelic medicine and most seem motivated by good intentions, usually linked to how they've personally been helped, or seen others benefit. It's not always easy to see what the primary driver is but you can be pretty sure you'll be told it's something noble!

I do feel that investors would be wise to honour the good sentiments of those within the psychedelic community who care about access and respect for those who have a longer heritage with these medicines than us. Equally however, I hope the community can respect that many of current investment efforts are about bringing this wisdom to the masses here - improving access and changing the present prohibitive policies we have in place in the West.

What a sad reflection it would be if the development of psychedelic therapy was fraught with unnecessary in-fighting. I hope we can all be respectful of each other - even if we disagree. I'm still learning in this respect.

Which current studies are you most excited about and why?

Shamelessly I'll refer to one of our own: a very recently completed two-arm double blind randomised controlled trial of psilocybin (two 25mg sessions, 3 weeks apart + 6 weeks of placebo) versus escitalopram (daily doing for 6 weeks + two 1mg sessions, 3 weeks apart).

From what I've seen so far (50 of 59 patients' data analysed) it would be entirely proportionate to forecast that the impact of the findings from this study will be greater than anything in psychedelic science since the discovery of LSD, and in depression research since, well, maybe the discovery of SSRIs. I'd say the (preliminary) findings of this study frighten me as much as they excite me.

Are you currently advising or assisting any psychedelic-focused companies with plans to take on public investment?

Yes, I advise a few of them now and believe at least one have plans for public investment. I'm happy to assist them scientifically and learn new things about development and regulation in the process. I very much hope their endeavours succeed in doing good on an individual and societal level.

Who would you like to see Psychedelic Finance interview next?

How about good ol Bill Richard? If you ask him, send him my love.

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