Episode 188: This week on Real Health Radio I sit down with Will Siu, MD to discuss the current state of the research on psychedelics as well as their therapeutic potential.
Psychiatrist Will Siu, MD, approaches his work with the goal of lasting, patient-centered healing—using his skills and experience to help his clients and healing within themselves.
As part of that process, Siu manages psychiatric medication—including medication discontinuation for those who are ready—and provides integrative psychotherapy. For interested patients, this involves meditative and spiritual work and, in some cases, ketamine-assisted psychotherapy by oral lozenge or intramuscular injection. Siu also offers integration services for those who have experienced ayahuasca, LSD, psilocybin, or MDMA.
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Chris Sandel: Welcome to Episode 188 of Real Health Radio. You can find the links talked about as part of this episode at the show notes, which is www.seven-health.com/188.
Seven Health is currently taking on new clients, and there’s a handful of reasons that clients commonly come and see us. Hypothalamic amenorrhea is one of them, and that’s just a fancy way for saying not getting a period. This is often a result of undereating and over-exercising for what the body needs, irrespective of someone’s actual weight. It’s almost always coupled with body dissatisfaction and a fear of gaining weight.
Disordered eating and eating disorders would be another one, and we work with clients along the disordered eating and eating disorder spectrum. Sometimes clients wouldn’t think to use the term disordered eating to describe themselves, but they see that they’re overly restrictive with their eating, they fear certain foods – that could be breads or carbs or fat or processed food – they feel compelled to exercise excessively, and/or they find themselves binging and feeling out of control around food.
Clients that want to move on from dieting, so they’ve had years or decades of dieting and they realize it’s not working, but they’re struggling to figure out, how do you do food without dieting? What should they eat? How do they listen to their body? What will become of their weight? They’re just confused and overwhelmed.
Then the final area is body dissatisfaction and negative body image. Many of our clients experience feelings of body shame and hatred, and they find themselves fixated on weight and determined to be a particular size and frustrated by what they see in the mirror. They may even avoid social events or opt out of photographs or put off appointments as a result of their negative body thoughts.
All these are areas where we’re able to help, and we do so through a mix of understanding physiology and psychology, so understanding how to support the physical body and how it works, but also being compassionate and uncovering the whys behind clients’ behavior and figuring out how to change this.
If any of these are areas you want help with, then please get in contact. You can head over to www.seven-health.com/help, and there you can read about how we work with clients and apply for a free initial chat. The address, again, is www.seven-health.com/help, and I will also put that in the show notes.
Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I mentioned last time on the show that we are now giving away a book from our Resources page with every new episode of the podcast. You can see our Resources page at www.seven-health.com/resources. It’s also in the menu on the left-hand side when you drop down the normal menu as part of the website. The Resources page is still a work in progress, but you can see a list of our favorite books and favorite blogs there.
For the book giveaway this week, the winner is Emma U. Emma, we will be in contact to send you a book of your choosing. If you would like a chance to win, all you need to do is leave a review on iTunes, take a screenshot of it, and then email it to info@seven-health.com. Then you’ll be permanently entered into the drawing.
This week on the show, it is a guest interview. My guest is Will Siu. Psychiatrist Will Siu, M.D., approaches his work with the goal of lasting patient-centered healing, using his skills and experience to help clients find healing within themselves. As part of that process, Siu manages psychiatric medication, including medication discontinuation for those who are ready, and provides integrative psychotherapy. For interested patients, this involves meditative and spiritual work, and in some cases, ketamine-assisted psychotherapy by oral lozenge or intramuscular injection. Siu also offers integration services for those who have experienced ayahuasca, LSD, psilocybin, or MDMA.
This is actually an interview that I’ve been wanting to do for a really long time. For quite a while now, I’ve been watching the resurgence in research with psychedelic substances – substances that were banned back in the 1960s, but prior to this, for two decades, were being used with great effect to treat depression and anxiety and alcoholism and smoking and a number of other mental illnesses.
These substances, despite being banned for a really long time, are now making their way back into clinical trials and are actually on the cusp of returning to being legal medications again, and legal medicines. Will is someone who is a big part of this movement, and he’s doing phenomenal work both as a psychotherapist, but also as a level-headed advocate for how these substances can be reincorporated back into our society.
As part of this conversation, we cover Will’s background, studying as an M.D. and then joining Harvard Medical School to do his psychiatry residency, and then how he found himself disillusioned with what was on offer to help people. We chat about how he was first introduced to psychedelic research, which coincided with his own psychotherapy.
We go through each of the psychedelics, so we look at psilocybin (which is magic mushrooms), LSD, ketamine, MDMA (which is the substance in ecstasy), ayahuasca, and DMT. We look at what these substances are and the differences amongst them. We chat about where each of them are in terms of research and clinical trials and what they’re showing potential to be useful for in helping – and not just potential, but are actually helping.
We also then talk about the therapeutic process with these substances, because as Will points out, it’s rarely about just taking the substance and then the healing is done; it’s that they give access to trauma and aspects of the mind that then can be addressed through therapy.
On the day that we recorded this, the internet gods were in a malevolent mood. I’ve cleaned up the audio as much as I can, but the quality is a little patchy in parts at Will’s end. Unfortunately, this just sometimes happens with these kind of things.
But despite this, I’m so grateful for Will’s time and for this conversation. If you’ve read Michael Pollan’s book and are already excited about the potential of psychedelics, then I hope you enjoy this conversation with someone who is very much in the trenches, doing the research, and working with clients in this area.
And if this is something that is completely new to you, then I hope you enjoy it and I hope we’ve done a good job with it. I tried to make this a really complete beginner’s guide, so if you have no prior knowledge on the topic or the knowledge that you have on the topic is very limited to knowing that these substances were banned in the 1960s, then I hope that this is going to give you some new insight, that it is accessible, and that it’s easy to follow along with.
This is a topic that I see myself covering more this year. I already have another guest who is booked in. We haven’t recorded it yet, but she works with Johns Hopkins and is doing a trial with psilocybin and eating disorders. I’m very excited about that one.
At the end of this episode, I have a documentary recommendation for you, but for now, let’s just get on with today’s show. Here is my interview with Will Siu.
Hey, Will. Thanks for joining me on the show today.
Will Siu: Yeah, glad to join you, Chris.
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Chris Sandel: I’m really excited to be chatting with you, and this is a topic that I’ve wanted to cover for a really long time.
Will, just so you know, this is actually the first time I’ve covered psychedelics on the podcast. I’ve mentioned in passing that I’ve been interested in psychedelic therapy and the resurgence in the research into substances like LSD and psilocybin, and I listed Michael Pollan’s How to Change Your Mind as one of my favorite reads from last year and I explained a little about that on the podcast. But really, this is going to be a new topic for many or most of my audience. Given your incredible knowledge in this department, combined with your experience as a psychiatrist and psychotherapist, you are the perfect person to have this conversation with.
So yeah, there’s a ton I want to cover today, but to start with, can you share a little about your educational background? Where did you study, what have you studied, how did you get into doing what you’re doing now?
Will Siu: I was born and raised in Southern California. I did my university out here in neuroscience, and also went to medical school in Southern California at UCLA. In the middle of my studies in medical school, I decided to pursue the PhD. So I took a break in the middle. I got my PhD in immunology over at Oxford in the UK.
Subsequently, then I specialized as a psychiatrist in Boston at Harvard Medical School. It was there that I got first interested in psychedelics. Psychedelics were not anything I had taken before that. I didn’t have interest. Like most people, I thought they were dangerous and addictive drugs. I was raised Jehovah’s Witness, and really psychedelics were the last thing on my mind. I was very traditional in terms of antidepressants being the answer, and I wanted to research new forms of antidepressants.
But really, I ended up having my own mental health struggles, and it was through that experience that I realized that these medications, for the most part – meaning antidepressants – don’t really work, and they have a lot of negative side effects, and that we were really ready for something else.
A chance meeting with a faculty member in the same department as me ended up having me introduced to Rick Doblin, who started MAPS. It was that meeting that really got me into the research on psychedelics as a healing modality.
Chris Sandel: When you first started studying at medical school, where did you think that was going to take you? What were your initial thoughts of where you were going to end up?
Will Siu: [laughs] I rarely get asked that. Cool. When I first started medical school, I wanted to be a surgeon, actually. I was really into neuroscience. I thought the brain was very fascinating I was really into microsurgery. For about 6 years, I focused on becoming an ophthalmologist, so I wanted to specialize in eye surgery, and in particular inflammatory diseases of the eye. Very much not psychiatry and not psychedelics when I first started off.
Chris Sandel: What was it within psychiatry that then changed that direction for you?
Will Siu: For me, it was actually realizing – like a lot of students, definitely in the United States, at medical school, I was looking for what we call the lifestyle specialties, specialties that pay really well and that you don’t have to work that hard. It’s funny; I’m smiling right now even saying that, to think that that’s the way I used to think. But there’s a handful of specialties, and usually they’re surgical subspecialties, where that’s the case.
What I ended up realizing when I had to actually make the decision of what to do was that surgical subspecialties have become incredibly specialized. There’s I think six or seven different surgical specialties of the eye. You’ve got people that just train to do surgery on the front or the back or the middle or just do inflammation. Essentially, at least with ophthalmology, you do two or three different procedures 90% of the time the rest of your life.
What I realized for myself was, yes, I can make a lot of money, but I thought my future was pretty bleak in terms of keeping things interesting, and that it was going to get boring if I just did surgery.
As I struggled with that, that was when I started seeing a therapist for the first time. I was like, “whoa, the mind.” For the first time I got exposed to Freud and what the unconscious was and how much that influences our everyday life. It was incredibly fascinating. I met a lot of older psychiatrists who still had practices and were still very engaged in their profession and really loved what they did. That was the trajectory to getting me into psychiatry.
Chris Sandel: At what point then, with getting into psychiatry and however long you were practicing that, was the discovery of psychedelics?
Will Siu: I was interested in psychiatry; I changed trajectory to go into that in my last year of medical school. Then I applied to residencies, and then I moved to Boston to do my training at Harvard.
It was one year after arriving there that – again, I had this fantasy in my head that I was going to be a researcher with an M.D. and a PhD, and that I was going to discover new antidepressants, and this was going to be my contribution to the world.
I remember it was a year into that training where we got a lecture on antidepressants for depression. At that time – and I still think it holds – the largest scale psychiatric trial, double blind placebo controlled, was – it’s called the STAR*D, which is antidepressants for depression. I remember them presenting it this way, that this is the best data we’ve got. I was all excited about it. They were like, basically, with this double crossover study, one-third of people no longer have depression after this 6 month trial. I can’t remember how many years the follow-up was. I was like, a third? I trained for 15 years after the age of 18 or high school here for a third of people getting better?
Then they compared that to placebo, which was around 19% or 20%. So basically, I was like, what the hell did I just do? For 10% better than placebo, that’s what I did all this training for? It really just hit me. I was like, “Oh my God, I’m in my mid-thirties, I’m in a lot of financial debt – what do I do? I just wasted my life.”
That was really my deep entry into my own psychotherapy, into my own mental health treatment, and it really had me look at life – I guess it took a lot of the fantasy and made me really sit and think of what I actually want to do with my life.
So I went into psychotherapy. I had a childhood best friend that, as I was going through this crisis, he happened to have a friend that introduced him to a psychedelic called DMT. It was totally by chance. For months and months, he was saying, “You should read about these. They’ve been doing clinical trials.” I’m like, “No, these are dangerous. They’re addictive.”
Finally, he got me reading about this. As I was mentioning earlier, it piqued my interest. Then Rick Doblin, who started MAPS, happened to live a few blocks away from the hospital. It was really the combination of all of those things that made me realize, wow, these are very powerful. They have a lot of potential. Because of political/legal reasons, they were made illegal in the late ’60s, early ’70s, but wow, these actually hold tremendous value.
On top of that, in modern days, starting in the ’90s, there was a resurgence in research of MDMA, especially in psilocybin or magic mushrooms. It was just like being in the right place at the right time, and then I got involved at that time.
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Chris Sandel: I know we’ve both used the word “psychedelics” a number of times already, and we’re going to keep saying it in this conversation, so I think it would probably be useful for you to define it. What is a psychedelic, just for people who haven’t heard that term, or have heard that term but don’t really understand what it means?
Will Siu: That’s a great thing to cover early on. I agree, it is getting thrown around as just this general term. Psychedelics are actually incredibly varying in their effects and their impact.
Dr. Stanislav Grof is a psychiatrist – he’s still alive; I think he’s about 90 – he has what I think is the best definition for psychedelics. He is really well-known, is really the grandfather of the field. He was working as a psychiatrist in the Czech Republic when Albert Hofmann discovered LSD. This was in the 1940s. He actually did something close to 5,000 legal LSD psychotherapy sessions.
But anyway, to go back to the definition, he called psychedelics “non-specific amplifiers of the unconscious.” To me, that is my favorite definition, because it’s really just saying these different compounds open up different aspects of our mind, of our body, and it honors that we don’t know what it’s like. Sometimes it’s visual, sometimes it’s emotion, sometimes it’s physical sensation. But they really just open up what’s under the surface.
Chris Sandel: What substances typically fall under the category of psychedelic? Just so we can start that. I want to, at some point in the conversation, go through each of them and have a bit of a chat around the research around them. But just as a starting point, what falls into the general category of psychedelics?
Will Siu: I’d say the classic ones are LSD, magic mushrooms. These days, ayahuasca is certainly one that’s in that category. MDMA, or the active compound in ecstasy – I consider it very much psychedelic. Ketamine would be probably the fifth other big one out of that category.
Chris Sandel: You made reference to it with the fact that there was this big amount of research going on, and I think this is one of the things when I read Michael Pollan’s book, but I’d also read a book a number of years ago called Acid Dreams that really brought this to my attention, of just how much research there was going on with these substances back in the 1940s and ’50s and early ’60s, before they became outlawed.
I don’t think you need to give people a complete history lesson, but are you able to speak about some of the research that was going on back then?
Will Siu: There was a lot. This is literally after it was discovered in the ’40s, so ’50s and ’60s were a huge time for psychiatry. You look at a lot of the literature at that time, this is all that people were looking at. This was much before the discovery of antidepressants and Prozac and Zoloft. That was all the ’90s. Back then, psychiatry was really psychotherapy. All psychiatrists were trained as therapists, and there was a handful of medicines that they were using for this.
For me, the most impactful thing as I was early on researching this was that I had looked up a paper that had been published by Julius Axelrod, who was at the National Institute of Health in the United States. Most people outside of medicine probably won’t know him, but he won the Nobel Prize a few years before this paper was published that I’m about to mention for discovering the biological significance of adrenaline, so norepinephrine/epinephrine.
After he won the Nobel Prize, he was researching the psychedelic called DMT, which these days is very much connected to like Burning Man/hippie culture, and it’s this very powerful psychedelic. But I’m like, wait, why is this researcher – again, at one of the top institutions in the world, who won the Nobel Prize – researching DMT and it’s getting published in literally one of the two most prestigious journals? This was in Science. The journal is called Science. He published a couple papers in there.
That was, to me, one of the significant pieces of evidence from a physician’s point of view. I was like, whoa, these were all being researched by the top mental health professionals in the world at that time.
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Chris Sandel: What stopped that and made these illegal? Was it the whole counterculture that went on in the 1960s, and they just had to pull the plug and that’s the explanation? Or what happened that meant that these drugs couldn’t be used?
Will Siu: I would say the major hurdle in the end ended up being the political piece. Richard Nixon I think in ’73 signed the Controlled Substances Act, which basically made all psychedelics illegal, even for research. It really put a full stop on research.
It’s interesting, because I think of it in today’s context here in the United States. It would be like Donald Trump all of a sudden saying today, “We’re making this compound illegal.” It wasn’t the doctors that were standing up, saying that this is dangerous, that this is addictive. It was not the researchers. It was the president of the United States that made it illegal.
In terms of why, I’m not someone who likes to blame and say “I know this was purely political.” It was clearly a political decision in the end, but I think what was leading up to it probably had some concern. You had Timothy Leary and Richard Alpert, more recently known as Ram Dass, this group – I can’t remember the third guy now, but these were all Harvard research professors who were studying LSD, and they started giving it to students and handing it out outside of the research environment.
I have a mentor who’s very much into philosophy and history who says he doesn’t judge things in history as good or bad until at least a few hundred years after they happen. Which is basically to say, I don’t know what Timothy Leary did. Was it good or bad, or was this whole thing just – the way I think of it is just what was happening in the culture at that time. Would it have been good at that time, or even now, to just say “let’s give everyone wide access to LSD and psilocybin”? I don’t know.
It’s more just observing what happened at that time. Yes, there was the counterculture movement. Press against the Vietnam War was not going well. People were starting to question why we were doing what we were doing, and all this got held up. So I more look of it as, yeah, it happened.
Chris Sandel: When did the shift then start to happen that these substances started to be investigated again and started to enter back into research trials?
Will Siu: That I really credit Rick Doblin. For those who don’t know, Dr. Rick Doblin has a PhD from the Harvard Kennedy School of Government. He was I think a little bit, age-wise, behind the generation of Timothy Leary and Ram Dass and those guys. Probably one or two generations. He’s in his mid-late sixties right now. But Rick became very aware at that time – he had been using psychedelics, including MDMA, at that time and found them incredibly powerful for human connection and for couples therapy. A lot of therapists at that time when it was legal were using it with their clients.
Rick really became passionate, after MDMA was made illegal, because he really thought that we were losing an incredibly powerful tool for human connection. He formed, I think formally, MAPS – MAPS is the Multidisciplinary Association for Psychedelic Studies – I think in 1986. But obviously, the idea for that came earlier. His goal with MAPS was one of two. Part of it was to get marijuana medicalized and legalized, but the other major one was really for MDMA.
Rick, essentially from the late ’70s, early ’80s, was planning what is happening right now. It was really a lot of foresight. He went to the Kennedy School and that’s when he got his PhD at Harvard, and his thesis was on Timothy Leary’s study of magic mushrooms on spiritual leaders at Boston University. He did a follow-up study of Timothy Leary’s original study and then started really educating himself and working to lobby and to give evidence to different players in the government – the FDA, the DEA, etc. – which ultimately led to the first modern psychedelic studies in the mid-late 1990s with MDMA for PTSD, which was the root of everything that is happening right now.
Chris Sandel: I know in Michael Pollan’s book, he talks about the fact that the pipeline to create a new drug is just so long, and there really isn’t much being created in the area of to help with mental illness, and that that’s then created an environment that makes the FDA more open to these kind of substances when maybe they wouldn’t be if there were alternatives. Is that the way you see it as well?
Will Siu: I think that’s one of the factors. I can’t remember if I mentioned – MAPS, which Rick started, is the Multidisciplinary Association for Psychedelic Studies, and just to mention that it’s a nonprofit that he started back then. I don’t know if I said that.
I think that’s one of the factors. I definitely think that we don’t have medicines that work. The reason Rick picked MDMA for PTSD was because mid-to-late ’90s, we were having a lot of veterans, whether they were from the Vietnam War, the Korean War, etc., who had become homeless, who were suiciding, etc. It was in part a strategic thing. The government was not able to help these war veterans, and they were being violent towards themselves and other people. They were not able to reintegrate as normal members of the society.
So Rick saw an opportunity there for MDMA for a population of people that the government did and should really care a lot for. That was the original reason for PTSD being picked.
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Chris Sandel: How do psychedelics work? How are they useful in a therapeutic setting?
Will Siu: The way I think of psychedelics, if we take Stan Grof’s definition, non-specific amplifiers of the unconscious – and I’ll reiterate that I think it’s an emotional unconscious, a physical unconscious, a mind unconscious – it opens up what’s tucked under the surface, is the way I think about it. That’s why you can have painful experiences or you can have happy experiences or you can have visual experiences or physical experiences.
The way I think that psychedelics work with therapy is that in many cases, when we’ve experienced something challenging – I don’t necessarily love the definition of trauma because a lot of people say it has to be something really terrible, a big accident or physical or sexual abuse. But really, we’ve all had numerous, numerous instances of trauma.
But what happens is that as a society as a whole right now, we are not good at expressing what we think of as weak emotions – sadness, fear, and shame. I think it’s a little different for each gender, but in the Western world, certainly for men, we’re considered weak, we’re considered not leaders, if we cry, if we admit that we’re scared, etc.
What happens when we have emotions that are not fully expressed, when we experience a painful or traumatic experience, is it essentially gets tucked away in the unconscious. For all of us, this is built up over the course of our lives, and if we don’t express them, if we don’t heal them, those will continue to sit with us until we get a chance to actually have that happen.
We can see that perhaps more apparently in veterans that have experienced numerous traumas in war. When a military officer has their tank blown up or they’re getting shot at, etc., that’s not a time when you want to fully express fear or break down and cry, because it can get you killed. So then you have to deal with whatever you deal with. But again, since society isn’t really there to help them when they get back, you remain frozen in this trauma state.
What happens in the therapy room is that the process or the connection between two human beings is enhanced by these medicines. I say enhanced because I think the process for healing is available with or without the psychedelics, but especially, again, for people who are cultured to not express emotion, you could end up sitting in therapy one-on-one with a therapist for years and really not dig into the deepest of the issues.
But what we’re seeing, with the facilitation of MDMA especially, is that these painful emotions, these painful memories come to the surface much, much more easily, and that they’re expressed. You have these really long therapy sessions, 7-8 hours at a time, and you really see drastic differences just within months of treatment for people with very severe trauma.
Chris Sandel: The thing you mentioned there in terms of the way we think about trauma – yes, trauma can be to the extent of PTSD or to something that’s happened to a veteran or this really extreme event in life, but it can also be a lot more of the little ‘t’ trauma that all of us have gone through.
Again, with reference to Michael Pollan, in his book, he talks about at this stage, the real focus is on treating more of the extreme end of the spectrum than being able to use these substances for the betterment of health and happiness or the betterment of healthy individuals. But I guess if trauma has affected all of us, then all of us can be in need of these substances in the right setting.
Will Siu: That is absolutely my belief. All of us have some level of unexpressed painful experience that, if we were to heal, really, life would look very differently.
I think the exciting thing about psychedelics – yes, at the individual healing level, but when I started thinking about our society, our political structure, how it has responded to a traumatized society over decades, and looking at what our world looks like right now politically, with so much separation, so much hurting, so much anger, so much violence that seems to only be escalating around the world – really, what are the larger implications of healing trauma in the populace with psychedelics? How quickly, perhaps, could we shift to something else?
It seems like it’s a tool that we have at our disposal really for the first time in history at the scale that it’s available, potentially.
Chris Sandel: You talked there about in the therapeutic session, it helps to break down some barriers, so people are able to open up and chat about things that they potentially otherwise wouldn’t be able to, or it just gets them there a lot quicker.
In terms of our understanding of how this works in the brain, do we know how these substances are able to do this and how they’re able to then lead to changes in people after those experiences?
Will Siu: It’s interesting. You mentioned the brain; as a physician, I have moved more towards what do these medicines do in the room? What do people talk about? How easily do they access emotion? There is a good amount of data out there that shows default mode network, for instance, is more suppressed or less suppressed given this.
But the reason I don’t like diving too much into that is that I think one of the errors, or one of the areas that neuroscience and psychiatrists have relied too much on in the last at least two or three decades, is brain imaging or neurotransmitters. Like serotonin – there was the serotonin hypothesis for depression in the ’90s, and that’s why these medicines were developed. Low levels of serotonin, to this day, have not been shown to be the driver for depression. But the entire field for the last three decades has now been behaving as if that’s the case.
What I think psychedelics are showing is that – again, I’m much more into the emotional component, the human connection component. The expression of sadness, fear, shame is really the healing tool. I don’t doubt that there are some changes in the brain or brain imaging, but I like to think of it more as what’s the cause and what’s the effect? I happen to think that it’s really the healing from the emotional component that will lead to the brain changes, and not the other way around.
Chris Sandel: Which is why having it be part of a wider therapy experience, where there’s work that goes on beforehand and then there’s work that goes on afterwards and the whole integration process, is so important as opposed to just the substances on their own doing all the work.
Will Siu: Absolutely. I think that’s why also – you have plenty of people taking MDMA or mushrooms or LSD at Burning Man or festivals, and we’re not seeing 70% remission of PTSD and depression like you do with MDMA and psilocybin in the clinical trials. That I think is further anecdotal evidence that no, it’s not just taking this and it hits the brain and all of a sudden things are better. It takes the interpersonal human connection to really do the healing work.
Chris Sandel: At this stage, are you involved in any studies, in any research at the moment? Or your role is more now as a psychotherapist?
Will Siu: I’m a therapist. I have a private practice. I use ketamine, which is a legal form of psychedelic therapy right now. I’m prepping a clinical trial for MDMA for fibromyalgia with MAPS right now. So those are the current things I’m involved in.
I’m also very much involved in doing public speaking and public education around psychedelics. To me, that’s an incredibly important aspect, because people are out there right now using psychedelics, what we call in the underground setting, with friends or their therapists, because they’re so desperate for healing. I’m not opposed to that type of approach, but I want people to have as much information as possible so that they can get the most out of it.
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Chris Sandel: It’s interesting you mention about doing a study with fibromyalgia, because I think of fibromyalgia as much more being a physical illness, as much as it is to do with mental. I think there is so much of an overlap between the mind and body. It makes me think of Gabor Maté’s When the Body Says No and all the burgeoning research around psychoneuroimmunology and that false dichotomy between mind and body. So the fact that you’re talking about psychedelics being used for something that would be thought of maybe more as a physical illness or ailment – that’s really interesting.
Will Siu: Yeah, that’s actually been a pet project of mine for the last 5 years. I do think that there’s a dichotomy between the mind and the body in the Western world, and honestly I think that’s probably a large piece of why we’re in the problematic area that we are in right now with mental health in the Western world.
A good friend of mine – and I’ve actually talked to him about this project – all the excitement around psychedelics is still psychiatry right now. MDMA for PTSD, psilocybin for depression, ketamine also for depression. But for those of us that are in the mental health field, and the physicians especially, we know that psychiatry is still the adopted or the stepchild of medicine. There’s all the medical specialties, and then there’s psychiatry. People don’t really understand what we do. We sit in a room with someone, we talk to someone; we don’t do physical exams, really, anymore.
I am very much a believer in the mind-body connection. There’s so many things that we know now – a lot of it with evidence – we know there’s massive clinical trials that have shown that heart disease gets worse with stress. We know that things like lupus, multiple sclerosis, other inflammatory diseases, get worse with stress. So to me, it’s very interesting to think that something like psychotics could very much – what I think would be very interesting is to pick something that’s within both mental health and physical health.
Maybe I think of fibromyalgia as a psychiatric illness, because we learn about it and I see patients with it, but it’s really a patient population that struggles for any sort of real help. They kind of jump around and see different doctors in different specialties, and no one can provide any help. Interestingly, it’s a pain disorder, but really, we don’t see the levels of prescription or addiction to opiates that we do in fibromyalgia with other pain syndromes. Patients will take it and it doesn’t help them.
I think it’s more of a physical manifestation of PTSD as opposed to classic PTSD, which appears to be more in the mental health realm. There’s also a very large correlation between PTSD and fibromyalgia, something like 70% correlation.
So my goal with a project like this would be if we can heal something that’s chronic and hasn’t been treated well with a psychedelic in a very short period of time, will we get the attention of the rest of the medical specialties – really of the mind-body connection, but also of just psychedelics as a healing tool? Could we use psychedelics for autoimmune illnesses or other diseases?
Chris Sandel: Do you know of other trials that are going on that really interest you in that realm, like it feels like it’s moving out of the mental illness space and is doing something a little different?
Will Siu: No, as far as I’m aware, I’m the only one that’s been working to do this.
00:43:20
Chris Sandel: You mentioned MAPS before, and I know you’ve studied with them. You did the MDMA-assisted therapy course. What was it like doing that training?
Will Siu: It was incredibly powerful. I’ve done three separate weeks of it. They’ve since consolidated it to one week. I think my first training with MAPS was back in 2014. It was incredibly powerful, because at that time, even though I had an intellectual interest in psychedelics, I didn’t really know how it worked. I had not been an experienced therapist yet.
The training was beautiful. It was with Michael and Annie Mithoefer, who were the main researchers, in their home in South Carolina. We got to review a lot of the video sessions of patients that they had seen. It was really a huge, huge turning point for me to consider the possibilities of not only psychedelics, but really the field of psychiatry, what was possible.
For the first time – I think by then, I had been thinking and talking about psychedelics for about 2 years, and certainly the time is different now, but I had gotten a lot of feedback from professors saying, “Don’t talk openly about this. You’re going to ruin your career. These things are dangerous.” But for the first time, meeting other physicians and therapists at MAPS, it was like, wow. I finally met a community of people who I felt looked at mental illness in a similar way, and we were talking about emotions, and talked about the trauma being held in the body and fascia, and body work and breath work and stuff. It was a very beautiful experience.
Chris Sandel: Did that feel like a big deal? You’ve come up through this very classical training with prestigious universities, and to then talk about psychedelics feels so different. I can almost forget now, because it’s been brought so much into the wider consciousness with people like Michael Pollan talking about it more, but I’m guessing back in 2014, it was a very different space. Most people hadn’t heard about this, and most people in the medical field would’ve thought of this as quite a detour. So did it feel like a really big decision?
Will Siu: It was huge. Honestly, at the time, I was really afraid. Again, I’d gone from this M.D. PhD, I had gotten all these degrees from prestigious places, and I was like, am I making the biggest mistake of my life by associating with psychedelics and this Burning Man hippie community?
But yeah, it was really a big test, and honestly a thing that’s continued to give me many gifts of following my intuition and my heart. It was one of the major times – not that this happens all the time, but for me at the time, it was like, is the rest of the world or is the rest of the field – are all of these professors potentially wrong, and I’m right? As a trainee especially, or as a young person in any field, often we’re told to read the books and listen to our professors, and that that is the way the world works.
So it was a time where I was finally like, “No, I know what is right. I know what I want to pursue. I know that this makes sense.” It didn’t matter that all these institutions and professors at these major places, both in private and in public, were saying that these were not to be looked at, that these were dangerous and addictive. Now you’ve got the very major universities in the United States all starting psychedelic research centers. So yeah, it’s very powerful and beautiful.
I actually had my program director, who was in charge of the trainees – I gave a talk at Harvard at the psychiatry department 2 or 3 years ago, and she came up to me and she’s like, “Will, what’s it feel like? I remember when you were first talking about these.” I told her what I told you, and she’s like, “Yeah, you really did see it from the start.” Well, not really the start, but that was still pre-Michael Pollan.
But yeah, it feels good. I hope it’s an inspiration for anyone out there to really believe in yourself and what your intuition is telling you.
00:48:10
Chris Sandel: As part of the MAPS, I know you then did an MDMA-assisted therapy, like you were part of a trial. How was it for you when you finally then got to experience that?
Will Siu: That was incredibly powerful. A few years after the training, in February of 2017, so about 3 years ago now, I got to participate in a one-week-long clinical trial so that I could take MDMA in a therapeutic setting, and it was legal.
It was really multifold. First of all, it was so that I could take MDMA and experience what it’s like, so when I see clients that are having these transpersonal experiences with psychedelics, I know what it’s like and I can relate to them.
Second, I think it’s also important because as someone who wanted, and now does a lot of public speaking about this stuff – especially my generation. You’ve got the professors who are in their sixties or seventies who say that they did psychedelics, and they did it legally in the ’60s. But someone in my generation isn’t able to do that. So then if you’ve got doctors that all of a sudden are out there saying, “I believe in this and I did it at Burning Man,” it can, at its extreme, get us in trouble in terms of getting our licenses taken away. So it was a beautiful chance to experience psychedelic medicine in a legal setting.
The part that I had least anticipated at the time, funny enough, was my own healing. I was like, “Oh, okay, I can go and do this thing,” but that was the greatest gift of all. It really helped me through a trauma that I had been carrying since probably about the age of 9 or 10. Within that week-long experience of taking MDMA and then the integration experiences in therapy in the weeks after – it’s silly to throw a number, but I did work there that would’ve taken me years if not decades to do.
Chris Sandel: So I guess the proof’s in the pudding where you were finally like, “Okay, I get to do this substance, and then it does the things that I’ve been hoping that it would do because of all the study I’ve done and all the testimonials that I’ve heard from other people.” You got to experience that yourself.
Will Siu: Yeah, it was incredibly special on many levels.
Chris Sandel: Obviously you talked about being able to do it in a legal setting – how does it work as a therapist? Is there an amnesty that is given so that therapists can take it so that they then know what it’s like for the people that they’re working with? I mean this as well for the people running the clinical trials, because it’s not like heart medication or diabetes medication. If you’re doing therapy with someone in that setting who is having this altered experience, you want to know what that experience is like for yourself.
Will Siu: Yes. There is no amnesty whatsoever right now, and it’s tough, because I think it’s a major hurdle right now. MAPS is expanding their ability to train therapists and provide them the experience. The FDA recently gave them more slots for therapists in training. I know one or two of the other organizations that are starting or have already started the magic mushroom/psilocybin clinical trials also have a similar – or it’s in the plans for them to be able to take psilocybin in a legal setting.
But it’s really incredibly limited right now. It’s an important topic. The resolution is not clear right now.
00:52:00
Chris Sandel: What I want to do is go through a number of the different psychedelics and discuss where we are at the moment in terms of research, what’s been shown to be useful, and just get a bit of a state of play with each of them. Can we start with psilocybin, magic mushrooms? What is it? Can you explain a little bit about it?
Will Siu: Psilocybin is what we in the West would say is the main psychoactive compound within magic mushrooms. Obviously there’s different types of mushrooms. Another way to say it is it’s an ergot derivative. There’s many different mushroom species that have psilocybin in it. There’s also derivatives of psilocybin. There’s also other compounds within psychedelic mushrooms that are psychedelic that are not psilocybin.
That’s one way to say it, but it’s been the focus of the research. Psilocybin is like an isolated compound, either outside of those mushrooms, or it can be manufactured in a laboratory from other chemical precursors.
Chris Sandel: Am I right in assuming that part of the reason they’ve used psilocybin is because it just doesn’t carry the same baggage that LSD did, so it was easier to slightly fly under the radar because it didn’t raise as many flags?
Will Siu: I don’t know how much that has played – a major thing at this point is the amount of time that it lasts. Psilocybin experience, under the guidance of a therapist, can probably last anywhere from 5 to 8 hours, as opposed to LSD, which tends to be more on the order of 10 to 12 hours. A major reason why I think LSD at this point is not used is just because it’s so time-consuming.
One of the things that is going to be important going forward is the availability of therapy because of the cost. Most of the psychedelic trials, if not all of them right now, require two therapists to be in the room. That’s going to be a major hurdle for cost. You’re talking about a 6 or 8 hour cost of a one-day therapy with MDMA or psilocybin, or 10 or 12 with LSD. So the major piece is really about the length, the time it lasts.
Chris Sandel: What is the research with psilocybin at the moment? What has it been shown or proved useful with?
Will Siu: The major things in the United States is psilocybin for end-of-life anxiety. The first major trial of psilocybin in the U.S. was at Johns Hopkins, where they looked at people with basically life-threatening conditions – cancer, heart disease, etc. – and they gave them psilocybin, I think it was one dose, and looked at decrease of symptoms of anxiety. It was hugely significant.
I would say the major thing happening right now is psilocybin for major depressive disorder and treatment-resistant depression. There are two parallel clinical trials that are happening by two different sponsors. Those are both now, I think at this point, at the Phase III clinical trial stage, which is the last major stage that the FDA puts up before something is prescribable. Those are large scale trials happening right now.
Chris Sandel: What would a session with psilocybin look like for someone in the room? What is going on, what is the aesthetic of the room, what are they doing while it’s all happening?
Will Siu: I’ve seen the room at NYU; I was at NYU for a little bit as a faculty member. They tend to be calming, low light. I guess maybe spiritual or Buddhist type of décor. [laughs] It sounds horrible to say it that way, for some reason, but very much a calm setting. The clients will usually be wearing an eye mask and wearing headphones that play music, the vast majority of the time. The music tends to be non-directive, so it does not have lyrics in it. It tends to be instrumental. But really, the choice of the sound is usually up to the therapist.
By talking to the researchers in the psilocybin trials, from what I’ve heard, most of the clients spend most of the time with the headphones and eye mask. That would be a little bit different than with MDMA for PTSD. With MDMA, it tends to be more interpersonal and much more talking. Psilocybin tends to be much more of an internal experience, and the therapists are more there to provide support.
Chris Sandel: As best as you can describe it for someone, what is that internal experience like?
Will Siu: It can be all of the above. It can be from seeing, like literally re-experiencing a memory or an event from earlier in life, childhood or not. It could be a traumatic experience; it could be a very loving, beautiful experience.
It could also be a very physical experience, where people are not having a narrative that’s playing out but are experiencing a sensation in the body that they normally have when they are scared or when they are sad, but it intensifies and it pulses and it shifts and it can move to other parts of the body, and therefore having movement or body work by an experienced therapist can be helpful to move the trauma out of the body.
You can also have people have transpersonal experiences – transpersonal meaning experiences that are thought of as non-ordinary in our current culture. So could they have an experience of being revisited by ancestors or dead relatives, or could they connect to a previous life, a reincarnation, or an experience of themselves in the future or something like that? I would say those are examples of different experiences that someone can have.
Chris Sandel: With the current research trials, how much time do they then get after that session? Is there a follow-up for one session with the therapist, for multiple sessions? How is it normally structured?
Will Siu: The MDMA trials, for instance, we think of them as 3-½, 4 month trials where people are coming in to see their therapist every single week, and about every 4 weeks, people will have a session with MDMA. So three sessions over 3 or 4 months. It’s similar for the most part for the psilocybin studies, except some of them have done one dose, some of them have done two doses, and some I think are planning or doing three doses.
It’s essentially three or four preparation sessions, you have the experience, and then you have three or four sessions to make sense and to make the most out of the experiences.
01:02:35
Chris Sandel: In terms of the next psychedelic, LSD, what’s the research with LSD like at the moment, and what’s underway?
Will Siu: The only trial that I’ve been aware of is an LSD microdosing study in the UK. Actually, I think there may be one also active in Australia. In terms of a clinical trial for something for a clinical indication, there was an LSD trial where they looked at brain imaging, but it wasn’t looking at a clinical outcome like depression or anxiety or something.
The microdosing study also may be or may have been more of a survey, surveying people that had microdosed. LSD is definitely not at the stages where MDMA or psilocybin are in terms of clinical research that’s sponsored.
Chris Sandel: Can you explain what microdosing is, for anyone who doesn’t know what that means?
Will Siu: It’s kind of a hot topic. Microdosing in its original definition, people would say it’s like taking a sub-perceptible dose of a psychedelic, meaning you take it and you don’t notice any effects during the day, consciously at least. Most people would report that to be like 5% or 10% of a normal dose of mushrooms or LSD.
If you take it supposedly every 3 days or so – 3 days, that timeframe is provided because most molecules have a period where the biology limits it from working as fully within a certain time period. For most psychedelics, meaning LSD or psilocybin, that’s 3 days, meaning if you took the same exact dose of LSD every single day, it would stop working pretty quickly.
The point of microdosing would be to take the small dose of a psychedelic and take it every few days at some sort of regimen and have some thought that that might be helpful for mental illness or something. I think the way most people are practicing it these days – again, I don’t love the word “microdose.” I think it’s just taking smaller doses of psychedelics, more in the range I would say of 10% to 20%.
In my opinion, I think it’s interesting to take something that is slightly perceptible. The way I think of microdosing, or the potential benefit of microdosing, is that it’s kind of like if we’re going out on a date or we’re going out with some friends and we want to drink a glass of wine or a beer, where it can take away some of the jitters. We can maybe be a little bit more of ourselves, that we’ll take some risk. That’s the way I think microdose is helping. You can have maybe more difficult conversations, you can be more open with emotions, etc.
I like that about the analogy with alcohol. But obviously, most of us don’t stop after one drink, and then alcohol has this piece of disinhibition, so then we start behaving in ways that are not actually in line with the way we want to behave.
That’s where I see microdosing having a very interesting potential in the future. It’s a dose that you can take that is not going to be a full dose of mushrooms or acid, where you couldn’t walk around, couldn’t talk to family members or friends, and you would be in a different plane than the rest of them. But it’s a little bit that you can take to test the waters and to potentially have more authentic communication with a group of people.
Chris Sandel: You said that there’s one trial or potentially two trials looking at that?
Will Siu: Yeah. In the very, very early stages, though.
01:06:45
Chris Sandel: Ketamine, then. What is ketamine?
Will Siu: Of all the psychedelics at this time, it’s the one that I’m most excited about. Ketamine is a legal medication that doctors have been using for decades now, 30-40 years, mostly within the realm of surgery.
A lot of people think of it inaccurately as like a horse tranquilizer. Is it used as a horse tranquilizer? Yes. But it’s really an anesthetic, and it’s a very powerful anesthetic. Most emergency rooms and operating rooms around the world use ketamine as an anesthetic, and for many, many reasons, it’s incredibly useful and powerful, and it’s also very cheap and it works quickly.
The history behind ketamine is I think about 20 years ago, there was a surgeon who had been using different forms of anesthesia for his clients and then started looking at his data and started seeing that the patients that had depression – surgical patients that he was seeing, anyway, that happened to be depressed and were anesthetized with ketamine were doing a lot better.
It was really from that root that then mental health started looking at ketamine. So really, ketamine’s not new; it’s just more new in the news in the last year or two. Psychiatrists and mental health folks have been using it for probably at least about 15 or 20 years to treat depression.
Ketamine is interesting. I like to think of it in two different categories. Ketamine at a high dose, for someone who’s depressed and suicidal – and I mention depression and suicide; most of certainly the published data is in that realm for ketamine, and also anecdotal evidence from my own practice. Ketamine at a high dose for someone who’s very depressed acts like resetting your computer or forcing your phone to restart after it’s frozen. It’s like this way of almost electroconvulsive therapy, just jolting the system and doing a quick reset.
It works uniquely, unlike any other medicine that we have in mental health for that. So that’s one way I think of ketamine working.
The other way I think of ketamine working is with lower doses, where people are not completely dissociated. That’s a term I should talk about. Ketamine is a dissociative, meaning that it at high doses can disconnect the mind from the body. Again, in the realm of anesthesia and surgery, if you disconnect the mind from the body, you can cut someone open because they won’t feel it.
At lower doses, though, if you take advantage of that effect to where people have a lot less connection of the mind and the body, but it’s in a therapeutic setting, it’s more akin, I would say, to something like hypnosis, where someone’s in a state of comfort, of calmness, and they can also have access to old memories, old emotions, and physical sensations in a setting where a mental health practitioner can help them process through those types of trauma.
Chris Sandel: With the lower dose ketamine therapy, is that more similar to the MDMA therapy, where there’s more talking? Or is it more like the psilocybin, where the mask is on and the headphones are on, and it’s more of the person going inwards?
Will Siu: It’s much more like the latter, I would say. You definitely get a little bit of processing at the end, but I would say most of it is in the weeks that follow.
Or actually, another thing that seems to be very unique about ketamine is that ketamine – and I’ve talked to many, many practitioners, and all of them have this experience – people tend to get better in between sessions, and it’s not so reliant on the therapist. It’s almost as if they’re building a resiliency of their own therapist within themselves. It’s very beautiful and has a lot of potential, I think, because of that. There doesn’t seem to be this large dependence on ongoing psychotherapy – as much. It is still there.
Chris Sandel: In terms of its administration, how is ketamine administered?
Will Siu: There’s at least five different ways, but commonly within mental health, there’s three. Or four, I should say.
There’s an intranasal version, which I think is not a good way to take it. It’s the newer version that has been licensed by a pharmaceutical company, but really the consensus within those of us who have been using it is that it’s not so useful and it has a large potential for addiction. But in terms of press out there, it’s getting the most, because you’ve got a large pharmaceutical company that’s really pushing for it.
The two most useful ways that are used with psychiatrists and therapists are intramuscular, so injection into the arm, kind of like a flu shot, and then intravenous. So you would have a bag dripping with diluted ketamine into the vein over the course of 40 minutes or so. Those are the two most common.
A fourth administration route would be oral ketamine, like a lozenge that would dissolve under the tongue.
Chris Sandel: I know you use ketamine therapy, so what is your preferred method?
Will Siu: I actually have become a huge fan of and believer in intramuscular ketamine. From a physician’s point of view, in an office it’s administered very quickly, without all of the extra equipment that’s needed for an IV. It’s very quick.
There’s different ways of administering all these different types of ketamine, but I’m a big fan of administering three doses of ketamine over 45 minutes. The nice thing about dosing it like that is that you can connect with the person, and some people don’t necessarily want all three, or you might want to change the dose to a higher or lower dose. So there’s a lot more play.
Also, the effects of it go away quicker than with IV, meaning the lingering effects. So you can have it nicely more contained in a shorter experience.
Chris Sandel: What’s the research that’s going on with ketamine at the moment? Is there clinical trials with it as well?
Will Siu: Those I’m not so up on. You do have companies now – really, there’s a large, large amount of data already on ketamine for depression. The lack of current clinical trials is because once a drug like ketamine has become generic, it’s very cheap. The drive to study something that’s already generic is usually low to none because the profit for a company would be very low.
What you’re seeing happen now is that some pharmaceutical companies – and it’s kind of a gimmick – they try to alter or separate different parts of a drug that’s already become generic, and then they try to sell it as a new drug, basically. So there is some of that happening right now. I think the generic ketamine is really where the majority of the data is, and it’s available now. I’m not so interested in the clinical trials for ketamine at this time.
01:14:45
Chris Sandel: Then MDMA. Talk a little about what it is.
Will Siu: MDMA is the medicine that’s in ecstasy. Ecstasy was popularized in the ’90s as a rave drug, and even then, ecstasy was never sold as pure MDMA. Really, it was MDMA plus methamphetamine plus speed. It was this mixture drug that people were taking at parties.
For a variety of reasons, when it was made for clinical trials, the component of it that was really valuable was that of, again, feeling safe to open up about previous experiences that were traumas, emotions that we were afraid to express. MDMA is really the strongest component of what was in ecstasy before. So that’s the compound that’s been studied since the mid to late ’90s, mostly for PTSD.
That’s definitely the one, of all the psychedelics, that’s further along in the clinical trial process. MAPS is midway through their Phase III clinical trials right now in the United States – and again, Phase III being the last big, critical stage before it becomes more widely available.
Chris Sandel: Maybe this is a difficult one to answer, but how long could it be? If things go to plan from where we are now to when MDMA is more widely available – at least, widely available in a therapeutic setting – how long is that away?
Will Siu: It’s not that far off. Probably within a year or two. The FDA and MAPS announced in the last month that there’s this program that opened called expanded access, which basically means that later this year – but not that much later this year, within a month or two – in the United States, at least, MDMA for PTSD will be available as a paid-for treatment outside of the clinical trial stages.
It’s very limited because you have to have been trained by MAPS and they have to approve the sites and all this other stuff, but really, it’s something that is becoming available already in the next weeks. But at a wider, wider scale, we’re talking a year or two. If all goes well.
Chris Sandel: How easy is it, then, to say “it works for PTSD, so we’re now also going to be using it for this other trauma or in this other setting”? Do you have to have another whole trial for that? Or how does it branch out from there?
Will Siu: I think for the most part, the way we see other medicines happening is that once something is FDA approved for an indication, then it can be used off-label for other things. Ketamine, for instance, I think has two FDA-approved indications, for pain and for anesthesia, but people use it in mental health. Prozac and Zoloft are used for anxiety even though the approval is for depression, for instance.
So if it follows the way pharmaceuticals have before, it could in theory be used off-label without having to do large scale clinical trials.
Chris Sandel: How is MDMA administered?
Will Siu: It’s an oral capsule with a crystallized or powdered pharmaceutical grade MDMA.
Chris Sandel: With this, the therapy is going on during the session that the person is taking the MDMA?
Will Siu: Absolutely. MAPS hasn’t published a study looking at the participants, but I would say that 50% of the time or so, people are engaging in talking about their experience, while the other half of the time, they’re with the eye mask or the headphones. But sprinkled out, going in and out every 30-45 minutes or so.
01:18:50
Chris Sandel: The next one – and I don’t know if I need to put these two together, ayahuasca and DMT. Do you want to deal with them separately or as the same?
Will Siu: They’re different, I think. DMT is the active psychedelic that’s in ayahuasca. When you say DMT, it’s a powder that’s smoked, and it can provide a very powerful experience within a very short period of time. People used to call it “the lunchtime trip” in the ’60s. I think that’s accurate, meaning you can have a very, very powerful experience and be back at work within an hour, and you can have the most powerful experience of your entire life.
Essentially, by administering it in an inhaled form, you get this, again, incredibly powerful transpersonal experience that begins within 15 or 30 seconds. The peak will hit within a few minutes, 2, 3, 4 minutes. You’re pretty much back to baseline within 20 or 30 minutes.
I say transpersonal because a DMT experience or ayahuasca experience, as compared to say MDMA, can feel not connected to this reality, meaning you’ll have experiences of time travel, of space travel, of connecting to perhaps non-human entities, etc.
Ayahuasca is interesting. It’s a brew that’s been made in the Amazon and different countries for hundreds, if not thousands, of years, that’s a drink. I think it’s accurate to think about ayahuasca as a sort of DMT experience that’s spread over hours, but there’s a lot more subtlety to that because there’s a huge cultural component of ayahuasca. There’s a ceremonial component. Ayahuasca is a brew of at least two different plants, usually, so you have all the different substances and compounds that make up that plant in it, too. So it’s a little bit more complex like that, but it can sometimes be helpful to think of it that way.
Chris Sandel: In terms of clinical trials, are there any that are ongoing at the moment with either DMT or ayahuasca?
Will Siu: Not that I know of, no. Not with those two.
Chris Sandel: Is there talk about trying to get them into that realm, or they’re just substances that people aren’t going to –
Will Siu: I think it would be hard. In terms of say ayahuasca, it’s not a chemical compound; it’s a mixture. You have a very widely varying experience of the client. It can be very much less predictable.
In terms of a pharmaceutical development in the United States or in Europe, I think that’s going to be a long time coming, if it ever happens. And I don’t necessarily see it needing to be that way. It’s just not something that’s going to fit in a pill bottle and be sold at the drugstore down the street.
DMT is interesting. There’s definitely some interest in some of the nonprofit and for-profit pharmaceutical companies. Some people are playing with the possibilities of an injectable form of DMT and could that be facilitated in a psychotherapy type experience. But these are all at early stages. Maybe. I don’t know how those will pan out. But nothing’s on the immediate horizon right now.
01:22:55
Chris Sandel: What about the addictive nature with any of these psychedelics? I know a lot of times they’ve been used to help with alcohol addiction or with smoking cessation, and it can feel weird to be recommending a drug to replace another drug. Are there any worries around addiction?
Will Siu: I think those of us that have been working with it and know how they work don’t – because I wouldn’t think of it as a drug replacing another drug. There are certain substances or compounds or foods or liquids that people take because it predictably helps them feel less anxious or less depressed in the moment, like alcohol, like nicotine, like opiates, like benzodiazepines. Those are the ones that I think people are addicted to.
I don’t even like the word “addiction,” really. In many ways, it can be clever. I think many people who have very serious, painful difficulty with emotion wouldn’t be alive if it wasn’t for alcohol. One can even argue they wouldn’t be alive if it wasn’t for heroin. So many people would’ve killed themselves long ago. These aren’t good long-term solutions, certainly, but maybe not even short-term solutions, but that’s all that most of these people have. If most of these people could have a manageable emotional life without these, they would.
The reason why I don’t like to think of them as one drug for another – and it’s not uncommon for people to call them that – is because these are not. You don’t have someone who’s feeling anxious or depressed at the end of the day – we know, again, if you drink a glass or two of wine, you’ll feel better. But if you have a hard day at work and you take a tablet of MDMA or you take a capsule of psilocybin, it’s not going to predictably calm you. You could have a very powerful experience; you could be very sad, you could be revisiting really difficult stuff.
What makes something, in my mind, under the category of addiction is something that predictably helps you feel better in the short term. Psychedelics are not that.
Ketamine, maybe a little bit. But really, I was much more concerned about the addiction potential of ketamine, and we really don’t see it so much in the clients. That, of any of the psychedelics, I think has potentially the highest abuse concern because it can predictably help people escape difficult emotions in the short term.
Chris Sandel: What about from a toxicity standpoint? Are there any concerns with any of these? Or does the fact that you’re doing it so infrequently mean that’s not really something to worry about?
Will Siu: I haven’t seen anything that seems worrying from damaging of neurons or anything like that. I think part of it, as you say, is the infrequency of use when used in a therapeutic setting.
01:26:05
Chris Sandel: Then talk about what the integration process looks like after a session. Obviously, it can go in so many different ways in terms of what happens with someone’s experience depending on the psychedelic that they’re using, but what is integration and why is it so important, and what does that look like?
Will Siu: The way I think of integration is that – integration has almost become a buzzword also, these days, where people are like “you’ve got to train in integration.” I don’t think of it that way. I think about it as if you have a therapist that really knows how to help people feel better, that knows how to connect to their humanity, that knows how to listen, that’s what we’re talking about in integration.
Basically, people have these very powerful experiences that make them look at themselves, their world, what they’ve been doing, their family, their friends very differently, and arguably, I think, at a more authentic or genuine level of where they want to be in life. That can be very powerful in a short period of time.
What I think about, though, is as a person has that experience of seeing the world more authentically and how they want to be, they then have to go out and test the waters. Like, will the world respond to me in this way? Will some of my friends respond? Yeah, but not all will. And am I willing to make the changes in my life, or do I need to change my job to be able to spend my time doing the things that I want to do or have the energy at the end of the day or on the weekend to do what I want to do?
The way I think about integration is, can a person be supported after a very powerful psychedelic experience to make the changes in their life or to maintain the changes in their life that it takes to support their new outlook and their new way of being in the world?
That, under the medicalization of psychedelics, has been called psychedelic integration therapy. But if we’ve got a really amazing group of friends or supportive family members, or if we can seek those people out, the integration can happen through those avenues as well.
Chris Sandel: With the clinical trials, is there much of a focus on that part of it and trying to work out what can help –
Will Siu: All of them really focus on that. I think it’s critical. I tend to say 80% or 90% of the long-term benefit of psychedelics is in the sober work that’s done in the weeks and months after. We see very often these days, with retreats popping up, that people will go do mushrooms in Jamaica or in Amsterdam, or they’ll go do ayahuasca in Peru. They’ll feel amazing, and they’ll come back and are preaching to everybody about how amazing these medicines are, and within a few months they’re back where they were again. It’s really because we don’t see the ongoing support.
In part, I think it’s because not that many people have the awareness and the knowledge to be able to provide this kind of support for someone, but the other piece is that that’s not the piece that’s as sexy as having these intense visions and going through this thing and charging a bunch of money to do it. On many levels, people aren’t willing to put in that work. That’s where I think it’s important to have some focus.
I really look at psychedelics simply as a tool. It’s like meditation, or it’s like having a Buddhist practice, or it’s like having any other tool, but if you don’t support it fully, the tool itself isn’t going to lead to long-term wellness.
Chris Sandel: Definitely. Do you think part of that is down to a mis-explaining about how powerful psychedelics can be and not talking about everything that has to happen after that kind of an experience? People think “I just go off to the Amazon and I do this experience with a shaman and then everything’s done”?
Will Siu: Yeah. Like I said, I think part of it is education, and part of it is, again, it’s not as flashy. To be like, “Yeah, I went down to Peru for 2 weeks and I threw up, and oh my God, I met this person from here and saw this snake” – that’s some of the stuff that you see in books like Michael Pollan’s, all the phenomena. People get interested in and they’re fascinated by the phenomena that happen.
But the reality is, we still have to come back to this human experience. To say, “I had to go reach out to my sister who I’ve only spoken to three or four times in the last 2 years because we really haven’t gotten along since we finished school, and she got married, and I tried to talk to her and be more authentic with her, and maybe it worked a little bit, but it was really shitty and we ended up getting in an argument” – that’s the stuff that’s not sexy, but that’s the stuff that it takes to shift our life and to really become more connected human beings.
Or it’s the “Yeah, I came back and I had to have this talk with my girlfriend or boyfriend. But it’s really scary to break up with them because I feel a sense of aloneness. So I know this relationship’s not good for me, but I’m staying in it anyway right now, and I don’t know what to do.” That’s the integration that needs to happen. Again, that’s not something that’s exciting to write in a book or watch in a documentary. And that’s the work.
01:32:10
Chris Sandel: What you’ve just given there is a really valuable piece of information. What other suggestions would you have for people – because the vast majority of people who are wanting to do this aren’t going to be able to get into clinical trials, so they are going to go off to retreats or they’re going to find an underground therapist or something along those lines. Is there any ideas that you would say of “watch out for this” or “they should be able to do that,” or anything that would be helpful for people?
Will Siu: To me, it’s really about authenticity. It’s getting in touch with, okay, if I look at the different realms of my life – my work life, my relationships, meaning romantic relationships, my friendships, my family life – how do I want those four things to look? Who are the people that I want to keep? What’s keeping me from being in the type of relationship I want to be in with them now? Who are the people that I don’t want to keep, and why are those people in my life right now? Actually looking at those ahead of time and then seeing what we need to do. Often, they’re just difficult conversations to have.
I’ve been telling people an interesting thing to do is something like microdosing. If you got together, Chris, with a bunch of your friends, four or five people who you really think are genuine and you connect to – say you or any group of friends get together every Sunday night for 2 hours, and you guys put away your phones, don’t drink alcohol, and say, “We’re just going to sit here and talk about these different aspects of our lives and how we want them to be better.” Say you meet weekly; once a month, or once every couple months, you take a 20% dose of mushrooms together.
I guarantee you over time, that would be a huge shift for you or for most people. It’s not something complicated. You don’t have to go pay $3,000 and fly down to Jamaica. But it’s not easy; most people won’t be able to do that – meaning it’s not easy emotionally or vulnerably. But in reality, it’s something that’s pretty easy to do. It’s essentially saying, “How can I talk to those people around me about who I am, what I want to be, what I want my life to look like?”
In these days of underground therapy, there’s a lot of problematic shaman out there. There’s sexual abuse happening in the underground community, and there’s people charging bunches of money for doing work that isn’t helpful. Psychedelics almost integrating into society is really what the future looks like, and into community, and leave the more challenging cases. Leave the really complex cases to the psychiatrist and the therapist, but can these just be tools to help people be more authentic in their immediate communities?
Chris Sandel: That’s really nice to hear from someone like yourself, who’s spent so much time researching psychedelics and has made this your life. You aren’t putting them up on some false pedestal. You’re like, this is how these things can be helpful in the right context, and all of the other bits and pieces that go into making them useful need to be thought about, and the actual psychedelic experiences are a very small component of what makes it useful in the end.
Will Siu: Absolutely.
01:35:35
Chris Sandel: What would you say if someone wants to find out more about this topic in terms of books to read? I obviously made reference to Michael Pollan’s book; I said that I previously read Acid Dreams. Are there books that you tend to push or suggest that people check out if they’re interested in this topic?
Will Siu: I’m not a huge fan of Michael Pollan’s book, for a variety of reasons. I mean, the information’s good in there. I think Stanislav Grof, his book – again, this guy’s a psychiatrist. He’s still alive. He has seen more legal psychedelic sessions than any human being that’s alive right now. To me, he’s the godfather. He wrote multiple books.
I think a really good one to start with – there’s two, actually. I would say Holotropic Breathwork that he wrote, which has a huge section on psychedelics. Stan Grof, for those who may not be familiar with holotropic breathwork, developed that line of healing modality. But really, the basis of it was psychedelics. Stan developed holotropic breathwork after LSD was made illegal to research.
He also has an amazing book called LSD Psychotherapy, and that’s essentially what I think will, for some period of time, become the clinical manual of how to do psychedelic-assisted therapy. He really goes through the history, and he actually goes through LSD for this indication and LSD for personality disorders and LSD for anxiety. Through the 5,000 or so cases that he did, he wrote about them in this book.
So I think those are – and they’re old books, but they’re really excellent. There’s another one. He also wrote Realms of the Human Unconscious, which I think is a really excellent book. So anything by Stan Grof, basically, is really good to look into.
Chris Sandel: What is it about Michael Pollan’s that you didn’t like?
Will Siu: To me, it’s a bit sensationalized. There’s a lot of phenomena in there. From a clinical perspective, I don’t think there’s a focus on how does this work, what’s the authenticity piece, what is the human connection piece? From my perspective.
Also, there was a piece that he wrote for the New York Times recently, mid last year, where he said psychedelics should not be decriminalized; it should be kept within the medical research community. That, based on what I was telling you before about the accessibility, to me is not something that is true. He’s not a clinician; essentially, he’s a writer, and to put out big statements like that I think is irresponsible.
Chris Sandel: Are there any documentaries you think are useful for people to watch? I know for me, I watched Trip of Compassion, which is looking at – I think it was the Israeli MDMA trials. It had some of the videos of that. And then another one, From Shock to Awe, which was looking at veterans using ayahuasca. I’m always conscious that a documentary is trying to tell a very specific narrative, so that can impact on how much it matches up to the real state of research and all those things. But do you think those are good documentaries, and any that you would recommend?
Will Siu: What was the name of that first one you just mentioned?
Chris Sandel: Trip of Compassion.
Will Siu: Yeah, that one I heard is really excellent. I have not watched it. It’s pretty recent, right?
Chris Sandel: Yes. I think Tim Ferriss was involved in getting it made because of some of the work that he’s done.
Will Siu: Yeah, that one I’ve heard is excellent. Like I said, I have not watched it myself. There’s shorter pieces, also. Vice on HBO did a piece on MDMA I think in late 2018, early 2019. It’s a 15-minute one that focuses on MDMA that I think was really well-done.
I worked on one with Goop, which is Gwyneth Paltrow’s wellness company, that just came out on Netflix last month. That one is available widely.
My critique of all of these right now is I think most of the documentaries out there are essentially saying, “Psychedelics: they’re exciting, there’s lots of potential.” I think at this point in time, we all now know that. Michael Pollan’s book, that is one thing it did do very well; it brought awareness to a large population of people.
But now the important thing to me is not saying “psychedelics are important, you should take them in the right setting.” It’s like, how do we actually go about doing this now? How do we actually practically make this happen for ourselves and our loved ones? So taking it more in-depth.
In many ways, I really like what we did here today, because the podcasts that I’ve done so far, no one focuses so much on the different psychedelics. It definitely took some time to go through, but this is the future, I think, because they’re not all created equal. There’s some that are better, there’s some that are gentler for different indications. I think that, going forward – and that is a documentary that’s yet to be made, really looking at the different impacts of the different psychedelics.
Chris Sandel: I thought the Trip of Compassion one, from my perspective, was really useful. It was almost like being a fly on the wall in a therapy session, and it gave you a real sense of what goes on during a session and how useful they can be. It didn’t feel so sensationalized. They’re all video recordings from when they’d done the trials.
I guess for a lot of people who have absolutely no experience with this and have never seen it or experienced any of these things for themselves, it gives them a little bit of a view of what that would be like, when it’s like trying to explain to a 10-year-old what it’s like to be drunk if they’ve never been drunk before.
Will Siu: That’s what I’ve heard. I haven’t watched it, but it sounds like a very beautiful piece that they did.
Chris Sandel: Yeah, it was good. That would probably be my recommendation if someone’s wanting to have a bit of an insight into visually what it’s like with some of the stuff we’ve chatted about today.
Will, I know we’ve talked for quite a while now and covered a lot of ground. Is there anything I haven’t asked or anything you didn’t talk about that you wanted to cover today?
Will Siu: No, not really. This is definitely the longest podcast I’ve ever done. [laughs] But it was really helpful to look at them in different categories. That’s all on my end.
Chris Sandel: Perfect. The final thing is just where should people be going if they want to find out more about you? Social media handles, website, that kind of thing.
Will Siu: I guess my Instagram handle is where I tend to put the most content out right now. It’s just @will.siu.md. My clinical website also, I guess – I don’t have that much information, and I’m definitely very full in terms of clients, so that’s a limited use because I’m not taking new people.
I am launching, probably within the next 3 or 4 months – that will be the place to see on Instagram. I’ll be launching an educational piece for therapists that are interested in learning more about psychedelics, how to work with clients that come in, that sort of thing. I’m thinking soon after that to do more of a general online course and webinar for everyday people. That’ll be in the next 3 to 6 months. But I’ll announce all that on Instagram.
Chris Sandel: Perfect. I will put your handles in the show notes, and people should check that out. Thank you so much for your time and for having this conversation. It’s been amazing.
Will Siu: Yeah, likewise. Thanks, Chris.
Chris Sandel: That is it for the episode. Will is a phenomenal human being, and I am eagerly watching the clinical trials to see how things are going to pan out, because at this stage, barring some surprising results, it feels like the substances will be back in legal use in the next handful of years, and I think that is a really good thing based on the research that I’ve seen.
As I mentioned last episode, I want to start making recommendations at the end of the show of things that I’ve watched or listened to and really enjoyed.
For today, I’m going to just suggest checking out the documentary that I already mentioned in the show with Will called Trip of Compassion. It really is an incredible fly-on-the-wall documentary as you watch two people go through MDMA-assisted therapy. It’s not glitzy. It’s very simple, yet powerful. It shows that it’s not simply about the substance, but the therapy work that happens alongside that beforehand and during and afterwards.
If you want to better understand today’s conversation in terms of what it practically looks like to be in the room when someone is going through a session like this, then I would highly recommend checking it out. It’s called Trip of Compassion. If you just google it, you’ll be able to find it. I think it’s on Vimeo, if I’m remembering correctly. It’s a pretty insignificant amount to pay to watch it.
That is it. As I mentioned at the top of the show, Seven Health is currently taking on clients. If you are struggling with dieting or disordered eating or eating disorder or recovery or body issues or really any of the topics that we cover as part of this show, then please get in contact. You can go to www.seven-health.com/help. I will catch you next time.
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