TRIP TO THE DOCTOR
Stuart Saker is a Newcastle-based psychiatrist who’s spent almost two decades as an army reserve medical officer. Most of his patients are veterans, police officers or ambulance workers who suffer from some combination of treatment-resistant depression, PTSD and alcohol use disorder.
Were he suddenly allowed to treat his patients with psilocybin or MDMA, “I’d be planning a session for this weekend,” he says. His research into the effects of psychedelic therapy, which included a trip in 2011 to Israel’s Beer Yakkor Mental Health Center, where PTSD patients were being treated with MDMA in clinical trials, has convinced him it would be a game-changer. His reading of the trial data is that 60-80 per cent of depressed patients treated with psilocybin are significantly improved by two or three treatments. If and when authorities in Australia give the greenlight, Saker is ready to go: earlier this year, he completed the Certificate in Psychedelic-Assisted Therapy provided by Mind Medicine Australia, a not-for-profit focused on making psychedelics available to qualified practitioners. “The need is huge,” says Mind Medicine co-founder Tania de Jong. “More than 15,000 health professionals have reached out to us because they don’t currently have the tools in their toolbox. That’s what they’re saying – that they can’t get their patients well with current treatments.”
As to the mechanism by which psychedelics may help mentally ill people, Saker puts a colourful, anthropomorphic spin on the role of the DMN. “I describe the default mode network as the brain’s version of resting bitch face,” he says. “It’s scowling at everything else the whole time, and it doesn’t let any other brain structures connect. It’s a control freak. It’s a source of constant unhappiness, of a sense of mediocrity and failure, and all that stuff feeds into depression. But when you turn it off, that bullying harassment from the DMN that makes some people sick, stops.”
Of course, the DMN will look to resume control once the effects of the psychedelic wear off, but it’s as though you’re now partially inoculated from misery. Now that those other, previously siloed, parts of your brain have got talking, “people can come away with feelings that are the antithesis [of what they’d been mired in],” says Saker. “We’re all in this together. We’re part of the planet too. We’re in an ecosystem. Why do I hate that person? I don’t want to be racist anymore. Whatever it is, it’s something different to bashing yourself up.”
I ask Saker what’s known about the risks of psychedelic therapy – about the likelihood of bad trips, if you like, resulting in panic attacks or worse, full-blown hallucinogenic disorders. After all, it’s one thing to go mad. But to bring it on yourself, to invite into your mind some demon that refuses to leave, to shift into an alternative state of consciousness from which you can’t escape… that’s the stuff of nightmares.
“The evidence of anyone having lasting psychosis from this in research settings is infinitesimally small,” says Saker. It’s not going to make a sane person psychotic, he adds, but you would never use this form of therapy on someone who has say, schizophrenia – or a familial history of it.
“We’re talking two doses in a controlled environment,” says Saker. Let’s say that while under the influence of psilocybin you visualise a snake. Saker might guide you to crawl into the snake’s mouth and peer through its eyes. The point is, you’re encouraged to trust, let go and be open.
RESISTANCE FROM “THE MAN”
In May last year, the Royal Australian and New Zealand College of Psychiatrists issued a clinical memorandum on the therapeutic use of psychedelic substances. Acknowledging the “emerging evidence” that these drugs may be of benefit in the treatment of a range of mental illnesses, it called for further research to assess their safety and efficacy.
Professor Ian Hickie, co-director of health and policy at the University of Sydney’s Brain and Mind Centre, concurs, arguing the force of advocacy for psychedelic medicine has outstripped the evidence for its usefulness provided by trials that have been mostly underpowered and lacking controls. “The exceptionalism that’s been attached to [these substances] is entirely unjustified,” says Hickie. “It’s become a crusade, a battle against authority. Plenty of other drugs – not so sexy but with equal claims to novel pathways – are sitting there too awaiting approval but attracting little or no interest.”
Before filing the above as typically conservative obstinancy, know that Liknaitzky, the country’s leading investigator into psychedelic therapy, is also adamant it’s too soon to make these drugs available to anyone. “There is an enormous amount of hope associated with psychedelic treatments, and for good reason. But attached to that hope is hype,” he says. If psychedelics are eventually to be used effectively in clinical practice, Liknaitzky adds, there needs to be a workforce and infrastructure that are “fit for purpose – and fit for purpose in this case is no trivial matter”. For most doctors and mental healthcare professionals, psychedelics are “not just another tool in the toolkit – you really have to get a new toolkit”.
Emyria, a Perth-based clinical-services and drug development company with seven sites around Australia, is ready to step up, says its managing director, Dr Michael Winlo,
who was approached by Mind Medicine Australia last year to assist with the opportunity emerging around psychedelics.
“The psychedelic community is a very broad church,” observes Winlo. “You’ve got people on one side saying this is a natural plant-based medicine that should be taken out in the bush, and then you’ve got others taking a more medical view, and [these groups] are sceptical of each other’s intentions. Somehow, we’ve got to find a way to be comfortable with private industry’s interest here because it can bring money and resources and traditional drug-development skills.”
SEARCH FOR MEANING
As things stand, resourceful people can easily get their hands on magic mushrooms. They’re being used by folk who are neither ill nor hippies – guys like fortysomething teacher Aden [not his real name], a father of three who lives in northern Sydney.
In recent months, Aden and his wife have tripped together in nearby bushland. Their experiences, he says, have been “beautiful . . . nature looks incredible, and the connection I felt to it was powerful”. Something else that is great: no hangover – and no urge to do it again tomorrow or even next month.
Here’s something Aden and his wife would really like to know: why? Why do naturally occurring psilocybin mushrooms exist? Could they be here to help us, not just to ease our psychic ills but to point the way to a sweeter, simpler, calmer life in which feelings
of love, empathy and belonging swamp all the agitation and striving and division? Is that just faintly possible? It’s such an intoxicating question, you could almost be tempted to take a trip in search of the answer.
