Body of Wonder Podcast

Episode #11 Psychedelic-Assisted Trauma Therapy - A New Frontier in Mental Health with Rick Doblin

Psychedelics are a family of psychoactive substances that induce a non-ordinary state of consciousness and altered sensory perception. Many individuals who have experienced psychedelics report transformative experiences, including a profound sensation of ego dissolution and deep spiritual awakening.

While psychedelics have a long and interesting history of human consumption, they were banned by the FDA in the 1970s, and to this day they hold the most restrictive classification as a Schedule 1 controlled substance. However, careful research by a dedicated group of scientists reveals that MDMA may prove to be a breakthrough treatment for difficult cases of Post-Traumatic Stress Disorder (PTSD) and emotional trauma.

In this episode Dr. Andrew Weil and Dr. Victoria Maizes welcome Rick Doblin, Ph.D, the founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS). Rick received his doctorate in public policy from Harvard's Kennedy School of Government and studied with psychedelics pioneer, Dr. Stanislav Grof. The MAPS organization is currently carrying out Phase III clinical research trials to assess the effects of MDMA-assisted psychotherapy in patients with PTSD and other forms of severe trauma.

Rick distinguishes MDMA from other classic psychedelics, describes how MDMA is being used in psychoanalysis, shares why he believes this will be a meaningful catalyst for the exploration of consciousness, and explains why micro-dosing may not achieve therapeutic results. Dr. Weil explains the importance of set and setting in psychedelics use, and Dr. Maizes asks what next for this promising field of research.

Please note, the show will not advise, diagnose, or treat medical conditions. Always seek the advice of your physician or healthcare provider for questions regarding your health.

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Guest Bio

Rick Doblin , PHD
Rick Doblin, Ph.D., is the founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS). He received his doctorate in Public Policy from Harvard's Kennedy School of Government, where he wrote his dissertation on the regulation of the medical uses of psychedelics and marijuana and his Master's thesis on a survey of oncologists about smoked marijuana vs. the oral THC pill in nausea control for cancer patients. His undergraduate thesis at New College of Florida was a 25-year follow-up to the classic Good Friday Experiment, which evaluated the potential of psychedelic drugs to catalyze religious experiences. He also conducted a thirty-four year follow-up study to Timothy Leary's Concord Prison Experiment. Rick studied with Dr. Stanislav Grof and was among the first to be certified as a Holotropic Breathwork practitioner. His professional goal is to help develop legal contexts for the beneficial uses of psychedelics and marijuana, primarily as prescription medicines but also for personal growth for otherwise healthy people, and eventually to become a legally licensed psychedelic therapist. He founded MAPS in 1986, and currently resides in Boston with his wife, dog, and empty rooms from three children, one of whom is in college and two have graduated.
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Dr. Victoria Maizes: Hi Andy. Dr. Andrew Weil: Hi Victoria. Victoria Maizes: Our next guest is Rick Doblin, who you've known for a really long time, Dr. Andrew Weil: Probably since the early 1980s. Dr. Victoria Maizes: Wow. So he's the president of MAPS which is the Multi-disciplinary Association for Psychedelic Study. And he's one of the people who's trying to get MDMA and other psychedelic medicines legalized. Dr. Andrew Weil: I think he's done more than any other single person to advance research on the therapeutic potential, especially of MDMA, but the psychedelics in general. Dr. Victoria Maizes: Well, let's get him on. Dr. Andrew Weil: Alright Intro Music Dr. Victoria Maizes: I'm delighted to introduce Dr. Rick Doblin, who's the founder and executive director of the Multi-disciplinary Association for Psychedelic Studies, also known as MAPS. He received his PhD in public policy from Harvard's Kennedy School of Government. Rick's goal has been to develop legal contexts for the beneficial use of psychedelics and marijuana, primarily as prescription medicines, but also for personal growth for otherwise healthy people and eventually to become a legally licensed psychedelic therapist. He founded maps in 1986 as a nonprofit organization, and he's raised over $80 million in donations for MDMA research. Welcome. Rick Doblin: Yeah. Thank you. We've just raised a bunch more. So actually we've raised over a $100 million now, but it's not just for MDMA it's for other psychedelic research and cannabis research and some public education and stuff. But yeah, we were shocked when we looked at, we have raised over $100 million dollars, all donations without strings attached. Dr. Victoria Maizes: So Rick, I must say that when we're all done with the podcast, I would like a lesson in fundraising from you. Rick Doblin: Well, it has to do with collaborations. Dr. Victoria Maizes: Yes, yes. Yes. So psychedelics are getting a lot of mainstream media attention these days and a lot of money. So just as an example, some recent headlines in the New York Times, Psychedelic Therapist draws veterans to jungle retreats. In courts wall street, donors are racing to back psychedelic therapy and in the Wall Street Journal, Silicon Valley and wall street elites, pour money into psychedelic research. I guess you've gotten some of that. Rick Doblin: Yes. Yes. That was our article in the wall street journal about completing a $30 million fundraise. Yeah. And the other thing to say is that there's a company called Compass a for profit company that's developing psilocybin and they're talking about going public and they're. Putting their evaluation at over half a billion dollars. And there's another company called The Mind Med. The first one that was on the stock market. They're talking about somewhere like $125 million valuation without having done anything. Dr. Victoria Maizes: Well that may be corporate America. Dr. Victoria Maizes: I'd love to hear from each of you the story of how you met and I'm going to start with Andy. Dr. Andrew Weil: Well, I'm not, I don't know that I remember, but actually, uh, just coincidentally yesterday in the mail, I received a card and a photograph from Alyssa Carlino, who was the daughter of Lou Carlino, filmmaker who Rick and I both know who was early interest in psychedelics and the photo is of a conference at Esalen Uh, which looks like, I mean, from the state of my beard, which is quite black, either in like 1982 or something like that. And I'm pretty sure you're in that photo Rick. And my, my memory is that we met at one of those early psychedelic conferences at Esalen. Rick Doblin: Yeah. Yeah. That's right. I think it was 84. I remember you camping out in a tent, you man, and, um, yeah, yeah, it was, is this, um, sort of gathering of those people that had been caring about psychedelics gathered by Dick Price who was one of the cofounders of Esalen and Stan Grof and others to sort out a lot about MDMA as sort of a new legal substance that we could um, share with others. And we had a brief period of time we knew that it was just two, because both it was being called Adam, as an underground psychedelic therapy drug, it wasn't illegal, but it was also being sold as ecstasy. And that was being done in public settings. Yeah. And it was clear that during Nancy Reagan and just say no, an escalation of the drug war that we only had a limited time where it was still going to be legal. And so these meetings at Esalen were, um, absolutely you know, essential to building this new community and organizing us so that once the DEA did move in the summer of 84 to criminalize MDMA, we were prepared and I went to DC and, um, we have 30 day public comment period. And, um, actually it was through you, Andy that through Rick Cotton, um, that, um, that you had friendship from Harvard, with a lawyer who is part of a big Washington DC law firm and they agreed to represent us pro-bono. Dr. Andrew Weil: I forgot that. Rick Doblin: That was the, yeah, that was the only way that we could do this. We had this big DC law firm working for free to help us sue the DEA. Dr. Victoria Maizes: Rick, because in your phase three trial, you have been doing this MDMA assisted psychotherapy, and I'd really love for you to explain to our listeners what that looks like. What happens when someone comes in and has this experience. Rick Doblin: Okay. Um, well, first off we felt because of the stigma of psychedelics that we needed to work with the hardest cases. So we work with, um, chronic, severe PTSD in phase two. Everybody was treatment resistant right now we don't require treatment resistant, but almost everybody is. So the program itself is three and a half months long. And the reason I preface this by saying that we work the hardest cases is that the treatment for people with milder PTSD might be shorter. During this three and half month process there's two therapists, male, female is the standard model, but there can be two women, two men, two non-gender, non-binary people. But yeah, but the idea is that a lot of people who are traumatized are resilient and do recover, but often those people who are traumatized and don't recover and tip into PTSD, you have had, um, childhood trauma, not always the case, but, but often. So we feel like this is kind of a two-person, male, female team enhances the efficacy. And provides additional safety as well. So in the three and a half month process, there are three only three times they get MDMA once a month and it's eight-hour long sessions and there's 12 90-minute non-drug psychotherapy sessions three before the first MDMA to build the therapeutic alliance and for preparation, and then three of these integrative sessions after each MDMA session for, you know, continuing the therapeutic process. And then, because we are concerned, people might say, oh, it's a psychedelic afterglow, you know, but yeah, it's kind of fade. Um, and we know that ketamine for depression often does fade. That we have our primary outcome measure is two months after the last, uh, experimental session. Then we also do a 12-month follow-up, which is more for insurance companies to try to demonstrate that it's durable and to look at healthcare utilization, things like that. So, yeah, treatment manual that we have up on our website, if anybody wanted to look at our treatment method, we've manualized it. And so you just go to the MAPS website, maps.org, and it's um, under research under MDMA the bottom of the page, but it's basically something that we've learned from Stan Grof, who's our mentor. It's very similar to the approach with, um, LSD therapy. And the idea is that there's nothing really structured during these eight hours. It's not like an hour one you have to talk about your trauma at hour two you have to talk about your family. We believe that there's this inner healing mechanism. Dr. Victoria Maizes: That sounds familiar. Rick Doblin: Totally the case. We all know that's the case for our bodies, but we believe our psyches have something like that. e call it the inner healing intelligence. You could say it's a hypothesis. But what it means is that we call [it] our inner directed therapy. They don't use the word guide. We are not the guide. We don't know the territory. We don't know the memories. We don't know the experiences that people have had. So we have this trust that what emerges ?So it?s the opposite of trying to suppress symptoms that a lot of psychiatric medicines do.When people have memories of trauma, often if it's too painful, it comes through the body. So, this is like a mind-body treatment. And then as you work to let it exaggerate or to let it really open, a lot of time, the body things turns it into a story and then the story will turn into emotional release or shaking or fear or things like that. We do have, um, this belief that from our perspective from therapy, let's say somebody recovers a memory of childhood sexual abuse, whether it really happened or not, whether a hypothesis. But what it means is that we call our therapy inner directed therapy. They don't use the word guide. We're not the guide. We don't know the territory. We don't know the memories. We don't know the experiences that people have had. So we have this trust that what emerges. Is in some sort of an order that the people need that this inner brings to the surface and that they can hear handle it. So it?s the opposite of trying to suppress symptoms that a lot of psychiatric medicines do. So when people have memories of trauma, often, if it's too painful, they, they, it comes through the body. So this is, this is a very like mind-body treatment. And then as you work to let it exaggerate or to let it really open to it a lot of time, body things turned into a story and then the story will turn into emotional release or shaking or fear or things like that. We do have, um, this belief that from our perspective from therapy, let's say somebody recovers a memory of childhood sexual abuse, whether it really happened or not, whether it's symbolic of something else doesn't seem, it's not our primary concern. Our primary concern is helping that to be expressed and experienced. So it's actually, maybe people think that because MDMA has been called ecstasy, that you take it in a therapeutic setting and all of a sudden you feel great and your problems are all gone. It's not that way at all. Many of our subjects have said, I don't know why they call this ecstasy because they're shaking their head. They're crying. They're struggling with things that have been difficult that have been. They'd haven't wanted to recognize it. And then they've never really been able to fully process. So I think a good way for people to understand it, it's like grief. You can hold in grief for a very long time. If you can release it, then you can move through it. Um, Stan has said something that I think is very wise. He said the full expression of an emotion is the funeral pyre of that emotion. Beautiful and everything changes. And if you can fully express it, it will move to something else. So if you feel like you're trapped in eternity in hell and this kind of horrific situation, the solution is not to run away from it, it's just to accept that. And then if you fully accept it, then something will change. So in the, there's a fundamental difference between the work with classic psychedelics, like LSD or psilocybin, and that work with MDMA. So we play music, we have people with eye shades on and have phones on. And for MDMA around half the time, half the eight hours, people are having their own inner magical experiences. And it's very metaphorical. It's just incredible. The stories that are wrapped up in these healing processes. Of what they're experiencing. And around half the time people are having these kinds of inner experiences with their eyes, closeness, listening to the music. The other half of the time, they're speaking to the therapists with LSD or psilocybin, it's more like, you know, 80 -90% of the time they're having an internal experience and they're then speaking with therapists. Now we also know that with the LSD and psilocybin research, it's been widely reported in multiple different studies, starting in the sixties and the current studies that there seems to be a correlation between the depth of the mystical experience of this unit of experience being part of something bigger being part of this, this whole answer and therapeutic outcomes. And we use the same questionnaire, the mystical experience questionnaire and our MDMA research. And what we have discovered is people score surprisingly high on the mystical experience questionnaire, but there's no correlation between the depth of the mystical experience and healing from PTSD. What we do is we just support people as whatever is emerging. I mean, a lot of times the therapists are sort of sitting there meditating, but not with their eyes closed. They're trying to look at body signals and body language. And is the person open to it or not? What whatever's happening, how they're dealing, they'll check in every 45 minutes or an hour just to see how the person's doing. But, so there's a lot of this, um, inner work. And then a lot of this dialogue with the therapists. Dr. Andrew Weil: Rick referred to the classical psychedelics, LSD and psilocybin, and many people would say that MDMA is not a classical psychedelic it's chemically related to one family of psychedelics. The depend ethyl means, but it's a unique agent and it's been called an empathogen, uh, because of this remarkable potential to create empathy um between people and put people in touch with feelings. And I wonder how you feel about that. How would you define that? Rick Doblin: Yeah, well, the, the word psychedelic was developed to mean mind manifesting. So. You know, when you run a nonprofit too, you don't want to limit yourself by definition. So we have the broadest definition of psychedelic. Um, I, I fully agree that MDMA is not like a classic psychedelic. Um, one way you don't understand it is actually in 1953, the US army chemical warfare service, looking for mind control drugs, tested eight drugs for toxicity, and on one side with this mescaline and the other was methamphetamine and MDMA was in the middle. So mescaline is the drug that's the classic psychedelic that's most like MDMA. And so it's different from methamphetamine in that you've got the alerting properties of methamphetamine, but you can sit still, you can meditate. Um, and it's got some of the flow into consciousness, the mind manifesting properties of mescaline, but it doesn't have much in the way of, uh, classic ego dissolution or visualizations. So, yeah, I think that in empathogen entactogen, those words were developed when we were trying to, to, um, you know, sue the DEA and block them from criminalizing it and it and trying to say that it was a different class. It wasn't a real psychedelic and therefore it shouldn't be seen that way, but, but I think those are good words and empathogen and entactogen, but I, I like to define psychedelic as its original meaning mind-manifesting and holotropic breathwork or breathwork exercises can be psychedelic. Meditation can be psychedelic in certain ways. So I don't think it's that crucial to quibble on the terminology. But I, I like, I don't like hallucinogen and I don't like entheogen its too positive. Hallucinogen is too negative. It's like psychedelic is more neutral, but it's got all this kind of cultural baggage, but the culture baggage is mostly been falling away. Dr. Victoria Maizes: Andy, you have often talked about the great importance of set and setting when somebody, uh, takes any kind of medication, actually, what do you think about the set and setting that Rick just described for this therapeutic use of MDMA. Dr. Andrew Weil: Well, I think that, I think it's all important that the, the, the expectations of the person taking the substance and the setting in which it's taken. So I think that, um, the model that's been created for MDMA assisted psychotherapy works very well. It's producing the outcomes that we want. Um, I, uh, there's two examples that I often give about how important these non-pharmacological variables are with psychedelics. Uh, one is that in 1960, before anyone had really heard about any of these substances, most people never heard of LSD. I knew several people who were dosed with LSD at a party without their knowledge, when they felt the effects of the drug, they interpreted them as the onset of food poisoning. And just recently, a few months ago, a paper appeared, Science journal, uh, titled The Placebo Effect, Psychedelics Tripping on Nothing in which a group of subjects were given a psilocybin and 0.2 people. And in the placebo group, the percentage of people who had psychedelic effects was 61%. So there's enormous room for expectation setting to modify pharmacology. And here you have, you know, with MDMA, this is an agent that has tremendous potential if it's used in the right way. I, I feel sorry for people who have only taken this in parties with loud noise and combining it with alcohol and other substances, I think they're likely to miss out on a lot of the positive potential and for people who have a history of trauma, um, I think to be able to use it in this therapeutic setting is marvelous. Rick Doblin: Yeah, we have some really interesting information about the placebo effect as well. So we have permission from FDA for a protocol where we can give therapists MDMA as part of their training. It's a four-day protocol, a double-blind placebo-controlled crossover. Meaning that the first day you either get placebo or MDMA, then you have a day of integration. Then the third day you get whatever you didn't get on the first day. And then the fourth day is another day of integration and the therapist who participate we've had over 90 participate in this already. They've previously done like a 14-hour online course, and they've also participated in a week-long course in-person watching videotapes of therapy sessions. So we've had this only happened twice, but both times it was two psychiatrists who'd never done psychedelics before. And it was with, uh, we have two, um, both actually husband, wife teams, Michael and Annie Minho for Anne and Marcello Talara and Bruce Poulter, who are the trainers as they're extremely experienced. So on the first day of, um, of this four day for these two psychiatrists early on they were really thrilled that they had gotten the MDMA and they did this tremendous processing of childhood trauma, and other issues with their relationships. And it was really deep and profound. And, um, the next day they did a lot of integration and we do ask the therapists and patients to guess what they think they got. And so they all said that they had gotten the MDMA and not only that, but the, our trainers said that they had gotten the MDMA. And then on the third day, uh, when they were all expecting to get a placebo, um, it turned out that that was the MDMA. One of the psychiatrists was so shocked that he was wrong like that, that he couldn't speak for about three hours. Um, and what they both said afterwards though, is that watching all the videotapes of the therapy sessions and knowing what MDMA did, and being hungry for that kind of healing, that they were able to will themselves into a state that was like that. But they also said that the actual MDMA was deeper more profound. And they were able to do even deeper work with it so that they could see that you can, you can, will yourself into this and, um, in a very deep and profound way, and it's shocking, but it doesn't mean that the drug does nothing. Dr. Andrew Weil: No, of course. As, as this psychedelic renaissance unfolds, I think a critical need is that we need people who were trained to be guides, whether they call them therapists or guys, you know, I'm pleased to see, I think MAPS is one of the organizations that's offering trainings of this sort, but there's going to be a tremendous need for people who are trained in and also have personal experience with these substances and know how to work with set and setting, to get the maximum benefit. Rick Doblin: Because the treatment is not the drug. Uh, you could take MDMA and end up worse off. Particularly if you try to take it in a setting where difficult emotion comes up, you try to stuff the feelings down and you could be worse off for months or years afterwards. So the, the, yeah, one of the key scaling factor is training therapists and our, our, our current model. What we're hoping to do is by 2030, Have trained 20,000 therapists. Dr. Victoria Maizes: Well, I'm going to say that this is an area we should partner because a lot of our trainees in integrative medicine are really interested in developing skills along these lines. And we have been very much pioneers in developing online trainings that can scale. Dr. Andrew Weil: So all of this is predicated on the assumption that these substances will be made legally available for therapy and at the moment, they're all in schedule one under the US controlled substances act. If they're defined as having high abuse potential and no therapeutic potential. So how?s it going to get out? How's all this going to get out of schedule one. What do you see happening? Rick Doblin: Well, um, since 1992, FDA has really been science over politics. Now, most recently, very recently, Trump has been trying to politicize the FDA, the CDC, which is very worrisome, but I think because we have um, prior agreements with FDA because we actually have support from a lot of, or not a lot, but some Trump supporters. So the only way to get out is to really go through the regulatory process through the FDA or through the European medicines agency. And the FDA has declared MDMA for PTSD a breakthrough therapy. The FDA has declared suicide ban for a treatment resistant depression, a breakthrough they've declared, um, psilocybin a breakthrough therapy for major depressive disorder, a Compass Pathways that I just said, um, is saying their values over half a billion dollars they've got, uh, they're very well-funded. They've raised, uh, summer like $150 million in cash from investors. So I think that what we need to do is the clinical trials to develop these drugs through the regulatory agencies. And I think that likely that will. The data will be evaluated. Honestly, I don't think it's going to be a repeat of the backsplash from the sixties. Um, you know, we, we have a lot of support from veterans just for an example um you know, Trump is very big on veterans. The Navy seal funding contacted me a few days ago. And they've changed their, uh, the board of directors have changed their regulations and they can now fund research, not just evidence-based treatments. And they're interested in funding, psychedelic research, cause they know about a lot of Navy seals are using ibogaine and MDMA and psilocybin. And so we are now, um, about a month away from having. The data from a first of two phase three studies, as far as whether it's statistically significant Dr. Andrew Weil: And Rick, what does it mean to be defined as a breakthrough therapy? Rick Doblin: Well, I'm a big pharma wants to have a breakthrough therapy because if you get that designation, it's the most important designation that FDA can give for the most promising drugs. Two thirds of applications from big pharma are rejected. What it means is you get more meetings and shorter timelines are placed on the review process for going through the regulatory system and that they are almost partnering with you to try to help you succeed. Now, the FDA has only declared two drugs, breakthrough drugs for PTSD. One is MDMA assisted psychotherapy, which is a drug therapy combination. The other was a drug called tanmaya, which was repurposed sleeping pill from 30 years ago by Tonics pharmaceuticals. So they were also breakthrough therapy. In phase three and they had their interim analysis in February and they were told that they should stop the study for futility. So just because you have been designated a breakthrough therapy, it doesn't mean it's going to work. It just means that the preliminary data was promising. Dr. Andrew Weil: But how has that effected scheduling status? Rick Doblin: Oh, well, if we get the FDA to say that there is a safe and effective use of MDMA assisted psychotherapy for PTSD, the DEA must reschedule. Now the FDA controlled substances staff and the DEA have a series of meetings along with the sponsor providing what's called an eight-factor analysis of abuse-liability, and they'll come up with a recommendation for what schedule it should be and that it will either go to schedule two, schedule three, or even potentially schedule four, but it will always be, um, scheduled. And, and one of the things that I think makes it easy on the FDA and the DEA. Is that the drug is not the treatment it's drug assisted psychotherapy. So it's only going to be administered by train therapists only under direct supervision. So it's never a take home medicine. It's not like here's five doses of MDMA may take home and you know, you do it with your friends or whatever. So I think the rescheduling um, will take place if FDA says yes, the DEA must reschedule. The other thing is that States have to reschedule as well. So 25 States in America automatically reschedule if FDA and DEA do, but the other 25 States like California requires a separate bill from the state legislature before it can be prescribed. And most of the other 25 States or the board of pharmacy or some other regulatory agency like that very few actually required a new bill, but in Europe where it's national healthcare systems, you have another situation is that they can reschedule, but their health systems might not decide it's cost effective and might not decide to fund it. So in the US, whether it's fundable, whether insurance company will cover it is independent of the scheduling decisions in Europe. It's a little bit more connected um, but still you can get it rescheduled and they just won't cover it and you'll have self-pay people. Advertisement: ?Body of Wonder is Brought to You by AWCIM + COVID-19? Dr. Victoria Maizes: Now I gotta take you back to something you said earlier, you talked about people have having a bad experience with the MDMA I think it's really important as we put this out the world, the podcast out into the world, um, who is likely to be a harmed who should avoid MDMA experience. Rick Doblin: Well, I want to first off make a distinction between difficult and bad, you know, so difficult is not always bad. So it has to do again with this sentence setting so that if you're just looking at, I want to have a party, I want to have fun and difficult stuff comes up and your friends are there with you and they, you don't want to talk about any difficult you stuff, your feelings down. Dr. Victoria Maizes: Right Rick Doblin: So it has to do again with this sentence setting so that if you're just looking at, I want to have a party, I want to have fun and difficult stuff comes up and your friends are there with you and they, you don't want to talk about any difficult you stuff, your feelings down. Um, you can be you know, worse off. But the same time as if you're with friends that are willing to talk about it, then you can make a lot of progress. So, um, as far as who should take it, who shouldn't take it, um, Jeffery Lieberman who used to be the President of the American Psychiatric Association, he's at Columbia, one of his psychiatrists that he works with Elijah Duckworth, they want to do a study with MDMA with schizophrenia. I think it can be integrated, but it would be done on an inpatient basis. They would be observing people that would be longer periods. So we don't necessarily think it's good for bipolar disorders or, uh, frank psychosis. But it, it can't dissociative identity disorder it can be very helpful with, but again, the more serious psychiatric indications other than PTSD and depression and anxiety or social anxiety, or we're now starting a study with eating disorders, which is very fatal. Um, so it's more about whether people are willing to feel what emerges, when the context is supportive. We do currently exclude people with personality disorders, but we think it can be very helpful to people with personality disorders. They just are going to need a few more treatments. Dr. Victoria Maizes: There was all of this interest in micro dosing now. And, um, clearly, we're talking here about let's say full dose. What do you think about micro dosing Rick Doblin: My general thing is that for, um, mental conditions, I'm not very interested in micro dosing because I want people to be able to be free of drugs. I think it's better to use full doses in a therapeutic context with the goal of getting to the core of the problem so that people don't need medication, you've worked through it. Maybe it takes several sessions. I've only heard, um, very few cases of people um micro dosing MDMA and not really cause micro dosing means that it's below, below your level of perception. Dr. Victoria Maizes: Andy, I know you've talked about the potential for, uh, psychedelics I'm not sure whether you included MDMA in your thinking, uh, but psychedelics helping all kinds of physical symptoms. So Rick has just pointed to a lot of, uh, what we call mental health, uh, psychiatric, but I'm wondering if you could talk about your, uh, ideas about how this could help physical problems and the place in integrative medicine. Dr. Andrew Weil: You know, Victoria, I first wrote about this in the Natural Mind in 1972, and I have written about it and in many of my other books as well, I think one of the great potentials of psychedelics is that they can give you the possibility of interpreting, uh, sensations in new ways. So for example, if you are living with chronic pain, they can give you at least the temporary experience of what it's like to not have pain. Uh, they can change allergic responsiveness, they can change immune responsiveness. Um, so I see vast potential for them in physical medicine for, um, changing auto-immunity for example, for changing all sorts of chronic conditions through changing and this is taking advantage of the mind body connection, which as we know in integrated medicine is the all-important and all powerful. Um, I recount this on my own personal experiences with it that you've heard. Um, but I would love if they become available for therapeutic use I hope it will not just be for in psychiatric medicine, but in general, because I think there's so much possibility there. Rick Doblin: We're working with some doctors who are interested in MDMA for fibromyalgia. And also for irritable bowel syndrome, but, um, we, we have this, um, anti-patent strategy so nobody can patent the uses of MDMA, which means making things public. And I often tell the story about, uh, Andy, how you refer a patient to me that said that, uh, MTMA cured their rheumatoid arthritis. So we got that story we posted, we did our website now nobody can patent MDMA for rheumatoid arthritis because there's prior arc. They didn't invent the idea. Yeah. So I think this idea of the mind-body connection MDMA in particular really seems to open up the mind-body connection in a great way but we're focusing initially on the psychiatric indications because we think they're going to be more reliably demonstrable. Yep. But, um, you know, this whole thing about the placebo effect, what we just said is that, um, one day one hopes that we will learn through meditation or through who knows what biofeedback, how to catalyze our own placebo effect. And I think that you know, psychedelics can play a role in us learning how to do that. So we're just at the early stages now of trying to support these independent investigators to do this, uh, MDMA fibromyalgia study. They don't have the funding for it, but that'll be one of the first ones where we try to look at the physical illnesses. Dr. Victoria Maizes: Rick as you've studied people with PTSD, I'm guessing some of them have physical illnesses as well. Have you heard any, uh, impressive, spontaneous healing stories or have people talked about changes to their physical state? Rick Doblin: Well, yeah. Um, some of them have had tinnitus ringing in the years that is substantially diminished. Now, whether that's physical again, that's kind of a physical, mental thing. Others have had a traumatic brain injury thing that go down. Um, pain often goes down. We, we had one person was in our study who was on opiates for pain and after MDMA was able to get off the opiates. And, and he realized that it was not just for pain, it was for escapism. There was one doctor that I worked with and under the influence of MDMA his arm became paralyzed. And we knew that it wasn't really MDMA paralyzing as are. And over the, we said, don't worry about that. We're not taking you to the hospital. You're not really paralyzed. And over the next course of a bunch of hours, what developed is that, um, a story was that he and his mother and his siblings were at the, um, death bed of their father. And he was completely hooked up to all sorts of machines. And wasn't really uh, living in, in much of a way at all. And they had to decide whether to take him off life support. And, um, he was the one because he was the doctor they all decided to do that. And he wrote the order and he said, the problem was that he hated his father. And so this conflict was, did he kill his father or not? Um, and so that paralysis was a reflection of this unconscious conflict. Did he kill his father? And then over time, as he was able to share that and realize his mother, his siblings, he really thought his father did want that even though we hated him, that he didn't really kill his father, then the arm fully healed and he could move it again. Dr. Victoria Maizes: Yeah. Um, Andy, I I'd like to take us back um, you have a long history of, um, paying attention and to psychedelics, um, personal history with them, but I'm wondering if you could take us even further back in human history and talk about how psychedelics were used in ceremony, um, shamanic practices, uh, the cultural significance of these medicines to our ancestors. And even what do you think that they were trying to achieve? Dr. Andrew Weil: Well, that's a big question. Many of these, uh, uh, substances, uh, are in plants and have been used by traditional societies, particularly in the new world. Um, there's only one old world psychedelic, iboga, which was used in Africa source of ibogaine, but new world natives, uh, really explored the plant kingdom to find, um, plants that had these potentials and use them in various ways. In many, shamanistic cultures, it was shamans who were most experienced in them. And they were in charge of ceremonial use of them. And shamans also used them in, in individually and healing and used them in healing interactions with patients. Um, so I think they were very central to Native American religion, shamanism medicine, uh, as I say, particularly throughout the new world. Rick Doblin: Yeah. Yeah. And there's the Eleusinian Mysteries from 1600 BC. And that was with an LSD-like-potion called kykeon. It's the foundation of a Western Greek culture. Dr. Andrew Weil: Correct. Right. Now, there are people who are so focused on psychedelics who see them as you cannot imagine that people could have spiritual experiences without them and I think don't believe that Terrance McKenna has this stoned ape hypothesis, that mushrooms were the key that caused the enlargement of the human brain. I just don't believe that. I think that in ancient times that if people accidentally ate the psychedelic mushrooms, that would put them at a great disadvantage. If there were saber tooth tigers around, or I think that disordering of perception would not be a positive attribute until there was enough civilization to create safe spaces in which people could use these things ritually. Rick Doblin: I think it's very important to acknowledge that there's a lot of other ways to have spiritual experiences other than psychedelics because then when you can say, look, this psychedelic is releasing something that's naturally inside. It's not a distorted psychedelic experience. You can get to it many ways. It's part of our makeup. Yup. Um, but, but Andy when, um, Victoria wanted to take you way back, um, I wasn't sure where she was going, but I'd like to take you back to 1972 in 1972 I was 18 years old. That's when I first read Stan Grof Realms of the Human Unconscious and decided to devote myself to psychedelics. And that's also when you publish the Natural Mind. And so I'm wondering that was after the backlash, after the controlled substance act of 1970 psychedelic research was being wiped out around the world. So I'm wondering, what did you think then about how long it would take or if it would ever come back or what your sense is about that? Dr. Andrew Weil: I think it's, it seemed to me to be very far off in the future, uh, that there was just so much fear around these, uh, these agents. And also this was a time of great, like now great political turmoil in the country. And a lot of the polarization was between with the counter culture, uh, that use different substances from the dominant culture, you know, instead of using alcohol, they were using cannabis and psychedelics, and that really became a symbol of, uh, you know, other people that the dominant culture was pretty much afraid of. So it just seemed to me that it would be a long, long time. And I must say that I'm both incredibly pleased and surprised to see how fast this revolution is coming now and how much psychedelics have penetrated main stream culture. Dr. Victoria Maizes: You say fast, but I just want to say that uh, my understanding is that Rick, you have devoted, uh, more than 30 years of your life to carry out the science that will ultimately influence the FDA. And I know that we're close, but I want to acknowledge your devotion because this is a life's work. Rick Doblin: Well, you know, I think also when you're looking into the future, it seems like it goes on forever. But now that we're both 50 years older from 1970, or 48 years older. It doesn't seem like that long of a time. Right. I mean, you know, cultural change happens slow. So to, to happen in a space of 48 years where we're both alive to watch this psychedelic renaissance, you know, it just takes people in groups a while to grow up to certain things or to integrate certain things. And so, yeah, I didn't know how long it would take either, but it, it felt to me like it didn't matter how long it took because, um, the, the psychedelic mystical experience in particular. Cause I decided this before I even knew about MDMA that the sense of connection with everything that, that was the antidote to, um, genocide and the antidote to prejudice and destruction and destruction of nature. So it didn't matter how long it took. And you know, one of the things that I'm most proud of that MAPS has done in our entire history is that we managed to start LSD research in Switzerland a few months before Albert Hoffman died. And also before he needed his wife died, she died a few months before he did, but he could see the glimmerings that there was this sort of cycle that was coming back. And he could see that. Dr. Victoria Maizes: Thank you so very much for taking the time to have this conversation with Andy and me. I think that it is going to be a great interest to our listeners. Rick Doblin: Yeah, it's been a pleasure and I'm just so great to be so happy to be on this with you and Andy too, just because of what we were talking about. These meetings at Esalen. You know, when it looked like, and it was that MDMA was doomed and was, you know, becoming criminalized. And now after all these years to see it coming back in a way that I think, um, well, what I think is that integrative medicine that you guys have pioneered and also mindfulness, you know, that they have become more mainstream and it's building on that. And building on the mainstreaming of yoga and the mainstreaming of meditation that we can now layer in psychedelics. So much of what happened during the sixties. Culture was not prepared for it at all. And in many ways, many different ways, the work of integrative medicine that the work of, um, you know, meditation and yoga has prepared the ground for bringing psychedelics back now. Rick Doblin: Thank you. It's been a pleasure. It's so great to do this with you. Victoria Maizes: Thank you so much. Rick Doblin: Alright, bye. For now.