WEBVTT 00:00:00.000 --> 00:00:02.640 This episode is sponsored by Transcend, a veteran 00:00:02.640 --> 00:00:04.960 -owned and operated performance optimization 00:00:04.960 --> 00:00:08.039 company that I introduced recently as a sponsor 00:00:08.039 --> 00:00:10.820 on this show. Well, since then I have actually 00:00:10.820 --> 00:00:13.080 been using my products and I have had incredible 00:00:13.080 --> 00:00:15.939 success. There was initial blood work that was 00:00:15.939 --> 00:00:19.039 extremely detailed and based on that they offered 00:00:19.039 --> 00:00:23.519 supplementation. So I began taking DHEA. BPC 00:00:23.519 --> 00:00:26.399 -157 for inflammation based on the fact that 00:00:26.399 --> 00:00:28.300 I've been a stuntman, a martial artist and a 00:00:28.300 --> 00:00:30.579 firefighter my whole life. Lots of aches and 00:00:30.579 --> 00:00:33.880 pains. Dihexa to help cognition after multiple 00:00:33.880 --> 00:00:36.899 punches to the head and shift work and peptides. 00:00:37.079 --> 00:00:39.520 Four months later they did a detailed blood work 00:00:39.520 --> 00:00:42.259 again and I was actually able to taper off two 00:00:42.259 --> 00:00:44.479 of the peptides because my body had responded 00:00:44.479 --> 00:00:47.079 so well to just one of them that it was optimized 00:00:47.079 --> 00:00:50.530 at that point. So I cannot speak highly enough 00:00:50.530 --> 00:00:53.530 of the immense range of supplementation that 00:00:53.530 --> 00:00:55.789 they offer, whether it's male health, female 00:00:55.789 --> 00:00:58.530 health, peptides to boost your own testosterone, 00:00:58.649 --> 00:01:00.829 which I would argue is needed by a lot of the 00:01:00.829 --> 00:01:03.570 fire service, or whether it's exogenous testosterone 00:01:03.570 --> 00:01:06.750 needed, especially after TBIs or advanced age. 00:01:07.239 --> 00:01:09.480 Now, as I mentioned before, the other side of 00:01:09.480 --> 00:01:11.980 this company is an altruistic arm called the 00:01:11.980 --> 00:01:14.840 Transcend Foundation, which is putting veterans 00:01:14.840 --> 00:01:17.640 and first responders through some of their protocols 00:01:17.640 --> 00:01:21.359 free of charge. Now, Transcend are also offering 00:01:21.359 --> 00:01:24.019 you, the audience, 10 % off their protocols. 00:01:24.239 --> 00:01:27.120 And you can find that on jamesgearing .com under 00:01:27.120 --> 00:01:29.840 the Products tab. And if you want to hear more 00:01:29.840 --> 00:01:32.560 about Transcend and their story, listen to episode 00:01:32.560 --> 00:01:37.370 808 with the founder, Ernie Colling. or go to 00:01:37.370 --> 00:01:42.150 transcendcompany .com. Welcome to the Behind 00:01:42.150 --> 00:01:44.109 the Shield podcast. As always, my name is James 00:01:44.109 --> 00:01:46.049 Gearing, and this week it is my absolute honor 00:01:46.049 --> 00:01:49.750 to welcome back onto the show psychiatrist and 00:01:49.750 --> 00:01:54.790 MDMA -led psychotherapy researcher, Dr. Ben Sessa. 00:01:55.870 --> 00:01:57.609 Now, if you haven't heard my first conversation 00:01:57.609 --> 00:02:01.750 with Ben, it was episode 156, and I highly recommend 00:02:01.750 --> 00:02:04.930 you listen to that first. In this second conversation, 00:02:05.269 --> 00:02:08.469 we discuss a host of topics, from the continued 00:02:08.469 --> 00:02:12.629 success of using MDMA for trauma and alcoholism, 00:02:12.889 --> 00:02:17.930 ketamine, psilocybin, ibogaine, the psychedelic 00:02:17.930 --> 00:02:21.409 renaissance, his new book, and so much more. 00:02:21.770 --> 00:02:24.110 Now, before we get to this incredible conversation, 00:02:24.389 --> 00:02:27.110 as I say every week, please just take a moment, 00:02:27.229 --> 00:02:30.389 go to whichever app you listen to this on, subscribe 00:02:30.389 --> 00:02:33.990 to the show, leave feedback and leave a rating. 00:02:34.250 --> 00:02:37.710 Every single five star rating truly does elevate 00:02:37.710 --> 00:02:40.370 this podcast, therefore making it easier for 00:02:40.370 --> 00:02:44.310 others to find. And this is a free library of 00:02:44.310 --> 00:02:49.150 well over 1100 episodes now. So all I ask in 00:02:49.150 --> 00:02:52.159 return. is that you help share these incredible 00:02:52.159 --> 00:02:55.139 men and women's stories so I can get them to 00:02:55.139 --> 00:02:58.240 every single person on planet Earth who needs 00:02:58.240 --> 00:03:01.979 to hear them. So with that being said, I welcome 00:03:01.979 --> 00:03:26.379 back onto the show Dr. Ben Sessa. Enjoy. Well, 00:03:26.460 --> 00:03:29.439 Ben, I want to start by saying, firstly, thank 00:03:29.439 --> 00:03:32.039 you so much for coming back onto the Behind the 00:03:32.039 --> 00:03:35.599 Shield podcast. We spoke on episode 156 and now 00:03:35.599 --> 00:03:38.280 up to over 1100. So that was a long time ago 00:03:38.280 --> 00:03:41.780 in the end of 2018. So firstly, I want to welcome 00:03:41.780 --> 00:03:44.699 you back. Thank you for coming on. Well, brilliant. 00:03:44.819 --> 00:03:48.719 Thank you, James. I remember fondly the last 00:03:48.719 --> 00:03:51.979 session we did. And obviously so much has happened 00:03:51.979 --> 00:03:54.560 since then. So I'm thrilled to be back here again. 00:03:55.240 --> 00:03:57.620 giving you and the world a bit of an update on 00:03:57.620 --> 00:04:01.460 where things are from my perspective. And yeah, 00:04:01.539 --> 00:04:04.240 what great success on your podcast that we're 00:04:04.240 --> 00:04:07.319 over 1100 episodes in now and it's still going 00:04:07.319 --> 00:04:09.319 strong. So it's a great privilege to be here. 00:04:09.360 --> 00:04:11.500 Thank you. Well, we're going to get into that. 00:04:11.560 --> 00:04:13.539 I think there's a huge amount of success on your 00:04:13.539 --> 00:04:15.400 end as well. And we'll talk about obviously the 00:04:15.400 --> 00:04:17.420 kind of revolution that's happening in some of 00:04:17.420 --> 00:04:19.879 these other modalities that are helping in mental 00:04:19.879 --> 00:04:23.550 health. I think a good kind of... Jump off point, 00:04:23.610 --> 00:04:25.790 though, would be to talk about the pandemic. 00:04:26.750 --> 00:04:30.170 The reason being, whatever people's stance was 00:04:30.170 --> 00:04:33.269 at that moment in time, there were a few truths 00:04:33.269 --> 00:04:35.310 that were in the middle, that the healthier the 00:04:35.310 --> 00:04:38.290 human being, the better the outcome. And then 00:04:38.290 --> 00:04:41.769 also some of the choices that were made as far 00:04:41.769 --> 00:04:45.230 as isolation had a ripple effect on society and 00:04:45.230 --> 00:04:47.610 mental health. And sadly, I don't know if it's 00:04:47.610 --> 00:04:50.759 the same in the UK, but here. As we rounded off 00:04:50.759 --> 00:04:53.439 the end of that, it was all kind of swept under 00:04:53.439 --> 00:04:55.279 the rug and no one wanted to talk about it anymore. 00:04:55.519 --> 00:04:57.899 And I think it does a disservice because people 00:04:57.899 --> 00:05:00.100 are still dealing with the ripple effects today. 00:05:00.360 --> 00:05:04.839 So with that being said, what through your eyes 00:05:04.839 --> 00:05:08.199 was that pandemic experience like yourself? And 00:05:08.199 --> 00:05:10.500 then talk to me about what you've seen personally 00:05:10.500 --> 00:05:14.939 as far as the ripple effect of that. Yeah, I 00:05:14.939 --> 00:05:17.459 think it's really good to talk about the pandemic 00:05:17.459 --> 00:05:21.639 because... as you said, its effect is still huge. 00:05:21.879 --> 00:05:24.199 And although it may not be so much in the news 00:05:24.199 --> 00:05:28.199 these days, the devastation that the pandemic 00:05:28.199 --> 00:05:32.579 caused globally and to individuals is still very 00:05:32.579 --> 00:05:38.360 much being felt on so many levels. On a societal 00:05:38.360 --> 00:05:41.639 level, and particularly an economic health level, 00:05:41.899 --> 00:05:45.740 it was obviously absolutely devastating. The 00:05:45.740 --> 00:05:49.680 incredible amount of money that was spent on 00:05:49.680 --> 00:05:53.339 the health care, how that stripped resources 00:05:53.339 --> 00:05:57.139 that were already threadbare in the UK mental 00:05:57.139 --> 00:06:00.660 health services, diverting money into treating 00:06:00.660 --> 00:06:04.779 COVID. The money that the government spent on 00:06:04.779 --> 00:06:07.959 the furlough scheme, which all came out of the 00:06:07.959 --> 00:06:12.800 public purse, again, which has cut to the bone 00:06:12.800 --> 00:06:15.680 even further the resources available for mental 00:06:15.680 --> 00:06:20.939 health care. And on an individual level, people 00:06:20.939 --> 00:06:25.120 are still reeling with a kind of global PTSD 00:06:25.120 --> 00:06:29.660 from that experience of social isolation, losing 00:06:29.660 --> 00:06:31.839 their work and their jobs and their businesses, 00:06:31.879 --> 00:06:36.279 many of which never came back. Particularly in 00:06:36.279 --> 00:06:39.060 areas like the hospitality sector, they're still 00:06:39.060 --> 00:06:43.889 crippled. We changed our whole way of life. One 00:06:43.889 --> 00:06:45.829 of the good things that came out of it were so 00:06:45.829 --> 00:06:49.389 many podcasts and so many people moving from 00:06:49.389 --> 00:06:53.449 office work based environments to home based 00:06:53.449 --> 00:06:57.569 environments. I was actually doing telemedicine 00:06:57.569 --> 00:07:00.689 five years before the pandemic. So I was very 00:07:00.689 --> 00:07:03.350 much used to doing telemedicine on Zoom and other 00:07:03.350 --> 00:07:07.069 platforms. And then since then, it's just become 00:07:07.069 --> 00:07:11.610 very commonplace for mental health care personnel. 00:07:12.220 --> 00:07:15.939 to work from home um now there's there's there's 00:07:15.939 --> 00:07:18.480 pros and cons of that i mean i remember when 00:07:18.480 --> 00:07:21.000 the telemedicine and psychiatry started i was 00:07:21.000 --> 00:07:23.360 i was one of the people saying that's absurd 00:07:23.360 --> 00:07:26.240 it can never work you need that personal face 00:07:26.240 --> 00:07:28.779 -to -face contact with a patient in the room 00:07:28.779 --> 00:07:32.180 um you couldn't possibly do it by zoom but actually 00:07:32.180 --> 00:07:35.040 there are pros and cons yes you do lose that 00:07:35.040 --> 00:07:37.980 personal touch to some extent but there's gains 00:07:37.980 --> 00:07:42.019 as well um You know, if a patient has an appointment 00:07:42.019 --> 00:07:44.040 with their psychiatrist and they've waited months 00:07:44.040 --> 00:07:47.420 and months and it's a one hour appointment, they 00:07:47.420 --> 00:07:49.399 have to take the whole day off work. They have 00:07:49.399 --> 00:07:53.100 to drive somewhere. They have to park. It's very 00:07:53.100 --> 00:07:55.579 expensive. And a lot of patients really prefer 00:07:55.579 --> 00:07:58.759 jumping on a Zoom call for their psychiatric 00:07:58.759 --> 00:08:01.339 assessment. And although there are bits missing, 00:08:01.420 --> 00:08:04.180 I think on balance, it's increased accessibility 00:08:04.180 --> 00:08:07.360 to many patients. So it's now very commonplace 00:08:07.360 --> 00:08:10.810 for mental health professionals to do. on remote 00:08:10.810 --> 00:08:14.790 assessments and evaluations and monitoring of 00:08:14.790 --> 00:08:17.470 patients. And I think that does work. But it's 00:08:17.470 --> 00:08:20.170 not a complete substitute for the level of care 00:08:20.170 --> 00:08:25.230 that a psychiatric patient needs. So we're still 00:08:25.230 --> 00:08:28.649 reeling from that. And we also see a large proportion 00:08:28.649 --> 00:08:31.350 of patients who are reeling from the physical 00:08:31.350 --> 00:08:34.909 effects of COVID. And we're learning more and 00:08:34.909 --> 00:08:37.429 more about the mental syndromes that accompany 00:08:37.429 --> 00:08:42.330 long COVID. But I think the biggest thing is 00:08:42.330 --> 00:08:46.590 just the effect economically. And the mental 00:08:46.590 --> 00:08:50.230 health issues as an epidemic were already on 00:08:50.230 --> 00:08:53.289 the rise. They have been for decades. But since 00:08:53.289 --> 00:08:56.750 so many people lost their work and their income, 00:08:56.909 --> 00:09:01.210 and with that, their resources and their self 00:09:01.210 --> 00:09:03.909 -esteem and their accessibility to getting help, 00:09:03.970 --> 00:09:07.720 it's just gone through the roof. You know, so 00:09:07.720 --> 00:09:10.299 many of the patients that I see in my private 00:09:10.299 --> 00:09:13.100 practice now, the first thing they say when they 00:09:13.100 --> 00:09:16.879 sign up is, I tried to go to the NHS, but it 00:09:16.879 --> 00:09:20.639 just doesn't exist. There, of course, is an NHS 00:09:20.639 --> 00:09:22.679 mental health care service, and it's very good 00:09:22.679 --> 00:09:26.519 in some places, but it's very patchy. And obviously, 00:09:26.659 --> 00:09:30.419 with the high level of resources, demand rather, 00:09:30.559 --> 00:09:32.639 and the low level of resources, the bar is set 00:09:32.639 --> 00:09:36.370 very high. to get into nhs mental health care 00:09:36.370 --> 00:09:40.330 services so really you have to be psychotic and 00:09:40.330 --> 00:09:44.429 suicidal to get through the door um which is 00:09:44.429 --> 00:09:47.529 very frustrating you know when i trained as a 00:09:47.529 --> 00:09:49.549 doctor and then as a psychiatrist getting on 00:09:49.549 --> 00:09:53.649 30 years ago the whole model and standard of 00:09:53.649 --> 00:09:56.509 care was just different from what you do now 00:09:56.509 --> 00:09:59.850 um there's no way you'll you'd get through the 00:09:59.850 --> 00:10:03.139 door in nhs services with just low or moderate 00:10:03.139 --> 00:10:05.580 levels of anxiety or depression. You have to 00:10:05.580 --> 00:10:07.740 be very severe to even get through the door. 00:10:07.919 --> 00:10:11.539 So for me in private practice, this has opened 00:10:11.539 --> 00:10:17.039 up a lot more patients. But it's very sad that 00:10:17.039 --> 00:10:21.240 so many people can't get the care and support 00:10:21.240 --> 00:10:24.360 they need. And of course, it's a double whammy 00:10:24.360 --> 00:10:27.080 because there's a much higher mental health care 00:10:27.080 --> 00:10:29.419 need amongst people in lower socioeconomic groups 00:10:29.419 --> 00:10:31.840 with lower incomes. And so they can't afford 00:10:31.840 --> 00:10:33.580 to go private. So they just don't have health 00:10:33.580 --> 00:10:36.019 care at all. And I think you're in the States, 00:10:36.100 --> 00:10:38.639 aren't you? So, you know, you know more than 00:10:38.639 --> 00:10:40.679 pretty much any other nation on the planet what 00:10:40.679 --> 00:10:42.799 it's like to live in a nation that doesn't really 00:10:42.799 --> 00:10:45.799 have a public health care system. I think in 00:10:45.799 --> 00:10:49.120 the UK, we have one better than America. I think 00:10:49.120 --> 00:10:51.159 Malawi has a better public health care system 00:10:51.159 --> 00:10:54.539 than the United States, with some 71 million 00:10:54.539 --> 00:10:57.399 people with no access to any health care at all, 00:10:57.480 --> 00:10:59.679 is a headline I read the other day about the 00:10:59.679 --> 00:11:03.860 States. But yeah, just to bring us around to 00:11:03.860 --> 00:11:09.159 psychedelics, this is where faced with these 00:11:09.159 --> 00:11:12.500 kinds of challenges in mental health care, we 00:11:12.500 --> 00:11:14.840 need to be thinking outside the box about what 00:11:14.840 --> 00:11:17.539 can we do differently? What can be a game changer 00:11:17.539 --> 00:11:21.440 in improving the nation's mental health? And 00:11:21.440 --> 00:11:23.440 I hope we're going to get on to talking about 00:11:23.440 --> 00:11:26.000 psychedelics in that respect. Yeah, absolutely. 00:11:26.259 --> 00:11:28.980 Just before we do, though, firstly, the telehealth 00:11:28.980 --> 00:11:32.360 element. This obviously really was something 00:11:32.360 --> 00:11:34.100 I think from what I was told by a lot of people, 00:11:34.139 --> 00:11:36.299 a lot of the red tape around telehealth was cut 00:11:36.299 --> 00:11:38.559 around COVID. So people have said this was one 00:11:38.559 --> 00:11:40.419 of the good things that came out of it. And now, 00:11:40.419 --> 00:11:43.940 even from 911 or 999, you know, you have the 00:11:43.940 --> 00:11:47.559 abuse of ambulance, fire, you know, police, you 00:11:47.559 --> 00:11:50.039 have the ability now to integrate into the dispatch 00:11:50.039 --> 00:11:53.149 system. where someone calls with a low acuity 00:11:53.149 --> 00:11:55.870 cord or a low acuity mental health issue you 00:11:55.870 --> 00:11:58.009 know that's not you know a psychotic episode 00:11:58.009 --> 00:11:59.730 or something that would warrant us to really 00:11:59.730 --> 00:12:01.429 go there and medicate whatever it is that we 00:12:01.429 --> 00:12:04.509 have to do and now that person can sit in their 00:12:04.509 --> 00:12:07.330 home and they can speak to uh an er you know 00:12:07.330 --> 00:12:10.370 nurse or whatever the person is and then that 00:12:10.370 --> 00:12:12.889 will be a kind of treat at home element but also 00:12:12.889 --> 00:12:16.490 when i look now at all the incredible conversations 00:12:16.490 --> 00:12:19.730 i've had 95 of them have been exactly how we're 00:12:19.730 --> 00:12:21.309 doing it now because i always say i don't let 00:12:21.309 --> 00:12:23.269 geography get in the way of a good conversation 00:12:23.269 --> 00:12:26.570 yeah the depths of some of these people go to 00:12:26.570 --> 00:12:28.830 via this screen and a number of times i've been 00:12:28.830 --> 00:12:30.970 told that was like a therapy session thank you 00:12:30.970 --> 00:12:33.950 but it is it's through the screen but if you 00:12:33.950 --> 00:12:36.970 can connect and you can stay engaged it is i 00:12:36.970 --> 00:12:38.669 mean the gold standard obviously is sitting in 00:12:38.669 --> 00:12:42.059 a desk in sorry in a room across from each other. 00:12:42.259 --> 00:12:47.360 But it's not that far down as far as being present 00:12:47.360 --> 00:12:49.360 via a screen and being able to listen. And like 00:12:49.360 --> 00:12:51.879 you said, I think you offset that with the ease 00:12:51.879 --> 00:12:54.399 of access. We jumped on this and then the moment 00:12:54.399 --> 00:12:55.980 we hang up, we're both going to go and do something 00:12:55.980 --> 00:13:00.139 else now. It really does illustrate how powerful 00:13:00.139 --> 00:13:03.639 this medium is. And again, as far as the finances 00:13:03.639 --> 00:13:06.220 attributed to it, it's cutting a lot of costs 00:13:06.220 --> 00:13:08.440 just to be able to sit in your office and for 00:13:08.440 --> 00:13:10.620 me to sit here. And whether it's an interview 00:13:10.620 --> 00:13:13.299 or a counseling session, both of us, it makes 00:13:13.299 --> 00:13:16.500 it affordable from that point of view. Yeah. 00:13:16.580 --> 00:13:19.039 And, you know, as you said, that's a benefit 00:13:19.039 --> 00:13:22.080 of using this technology. And I think it's taught 00:13:22.080 --> 00:13:24.179 us all a lot because I suppose we were all quite 00:13:24.179 --> 00:13:27.200 Luddite about it in thinking it could never possibly 00:13:27.200 --> 00:13:29.580 work. And actually, we've all surprised ourselves 00:13:29.580 --> 00:13:32.340 to find it does work. In fact, it's sometimes 00:13:32.340 --> 00:13:35.840 superior for all the reasons you mentioned. So, 00:13:35.899 --> 00:13:39.500 yeah, that's the world in which we live. That's 00:13:39.500 --> 00:13:41.700 not an excuse to keep cutting mental health services. 00:13:42.419 --> 00:13:45.700 You know, people with severe mental health problems 00:13:45.700 --> 00:13:49.480 require holistic care, multidisciplinary holistic 00:13:49.480 --> 00:13:53.500 care. People in their local area, a community 00:13:53.500 --> 00:13:57.919 nurse, a consultant psychiatrist, a general practitioner, 00:13:58.179 --> 00:14:01.860 a community day hospital, as well as inpatient 00:14:01.860 --> 00:14:04.200 services, that whole cluster of multidisciplinary 00:14:04.200 --> 00:14:08.649 inputs. And of course... Remote sessions like 00:14:08.649 --> 00:14:12.029 this can be part of that, but it's not a substitute 00:14:12.029 --> 00:14:15.070 for all those other parts of care for those patients 00:14:15.070 --> 00:14:16.730 with severe mental health problems that really 00:14:16.730 --> 00:14:19.929 need all those other parts as well. Well, before 00:14:19.929 --> 00:14:21.730 we go into the world of psychedelics, one more 00:14:21.730 --> 00:14:24.690 area, because I mean, you and I grew up in the 00:14:24.690 --> 00:14:26.570 same area or you're in the same area now. I was 00:14:26.570 --> 00:14:29.149 from Bath originally and we're about the same 00:14:29.149 --> 00:14:32.970 age. And I talk very fondly about the NHS, the 00:14:32.970 --> 00:14:36.409 NHS that we grew up in the 70s and the 80s, and 00:14:36.409 --> 00:14:39.210 the philosophy that a nation would band together 00:14:39.210 --> 00:14:41.990 and take care of anyone who needed help at that 00:14:41.990 --> 00:14:44.590 moment, whether it was a pregnant family or whether 00:14:44.590 --> 00:14:46.230 it was someone that was hit by a car, whatever 00:14:46.230 --> 00:14:48.690 the thing was, we all take care of everyone. 00:14:48.730 --> 00:14:50.509 I think that's the ultimate, you know, it takes 00:14:50.509 --> 00:14:53.929 a village mentality. But what I've seen now, 00:14:54.049 --> 00:14:56.409 you know, as I sit here, 51 years old with, you 00:14:56.409 --> 00:14:58.470 know, fire experience and all these other things 00:14:58.470 --> 00:15:01.889 that I've done. And you see the NHS picked apart. 00:15:02.509 --> 00:15:05.049 The only way that that system is going to work 00:15:05.049 --> 00:15:08.649 well is, as you said, holistic, proactive, preventative 00:15:08.649 --> 00:15:12.230 practices. So you keep the nation healthy so 00:15:12.230 --> 00:15:15.509 they don't need the NHS until absolutely necessary. 00:15:15.909 --> 00:15:17.990 But I've seen the opposite. And when I go home 00:15:17.990 --> 00:15:19.809 now, it's heartbreaking. Not only the mental 00:15:19.809 --> 00:15:22.490 health elements, but also the obesity that's 00:15:22.490 --> 00:15:25.649 crippling our nation now as well. So through 00:15:25.649 --> 00:15:28.759 your lens. You know, how has this devolution 00:15:28.759 --> 00:15:31.500 happened? And if you were king for a day, how 00:15:31.500 --> 00:15:33.519 can we reverse it? Because I would argue it's 00:15:33.519 --> 00:15:36.220 the, at its core, the best healthcare system 00:15:36.220 --> 00:15:38.360 on the planet when it was originally conceived 00:15:38.360 --> 00:15:41.340 and fully funded. Yeah, that's a really good 00:15:41.340 --> 00:15:45.000 question. And I don't pretend to be an expert 00:15:45.000 --> 00:15:49.679 in this. Obviously, as a consultant with 30 years 00:15:49.679 --> 00:15:52.779 experience in medicine, I've got a pretty good 00:15:52.779 --> 00:15:55.830 opinion on it. um but i'm not an expert in health 00:15:55.830 --> 00:16:00.470 economics it's quite clear that it's not working 00:16:00.470 --> 00:16:02.309 at the moment i guess one way of looking at the 00:16:02.309 --> 00:16:04.590 nhs and what went wrong and why we're in this 00:16:04.590 --> 00:16:08.450 position is actually really simple when the nhs 00:16:08.450 --> 00:16:12.570 was set up in 1948 medicine was a far simpler 00:16:12.570 --> 00:16:16.009 place than it is today you know we only had two 00:16:16.009 --> 00:16:20.429 or three um antibiotics we had two or three painkillers 00:16:20.429 --> 00:16:24.659 we had a bunch of operations surgical operations 00:16:24.659 --> 00:16:29.779 which which you could have a long rehab process 00:16:29.779 --> 00:16:32.340 for and stay in hospital for 12 weeks you know 00:16:32.340 --> 00:16:36.779 to have your leg mended it's changed beyond recognition 00:16:36.779 --> 00:16:40.919 with technology that's very expensive pharmacology 00:16:40.919 --> 00:16:43.259 that's very expensive you know some oncology 00:16:43.259 --> 00:16:48.000 treatments are 1800 pounds per pill you know 00:16:48.000 --> 00:16:50.779 none of that existed it was it was affordable 00:16:50.779 --> 00:16:54.659 to provide the healthcare for the nation in 1948, 00:16:55.000 --> 00:16:59.740 based on simple taxes. The cost of medicine now 00:16:59.740 --> 00:17:04.279 is infinite. We can keep people alive indefinitely, 00:17:04.279 --> 00:17:06.740 depending on how much money we want to pump into 00:17:06.740 --> 00:17:11.140 them. So this makes me sound very non -socialist, 00:17:11.160 --> 00:17:13.980 because I'm very much a socialist, but there 00:17:13.980 --> 00:17:18.079 is a real argument for... In today's consumerist, 00:17:18.079 --> 00:17:21.660 very expensive, complex society, there simply 00:17:21.660 --> 00:17:25.220 is no room for free, universal, unlimited health 00:17:25.220 --> 00:17:28.160 care. It just doesn't work as a commercial model. 00:17:29.140 --> 00:17:32.359 Now, that makes me sound very unsocialist and 00:17:32.359 --> 00:17:34.900 that kind of comment would make me very unpopular 00:17:34.900 --> 00:17:39.339 with the basic narrative of the NHS, which is 00:17:39.339 --> 00:17:42.299 free, universal health care to everyone at the 00:17:42.299 --> 00:17:45.349 point of need for their whole life. no matter 00:17:45.349 --> 00:17:48.210 what they do with their life. And here's an even 00:17:48.210 --> 00:17:53.309 more contentious thing. Should the NHS be lifestyle 00:17:53.309 --> 00:17:57.930 means tested? I'm asking you this. Should it 00:17:57.930 --> 00:18:01.809 be fair that one person can smoke 80 cigarettes 00:18:01.809 --> 00:18:05.130 a day and drink two litres of vodka a day, eat 00:18:05.130 --> 00:18:07.650 lots of fatty food, become obese and never go 00:18:07.650 --> 00:18:11.269 to the gym, develop hypertension and obesity 00:18:11.269 --> 00:18:14.819 and diabetes by the age of 50? and then expect 00:18:14.819 --> 00:18:18.059 free, unlimited health care for those conditions 00:18:18.059 --> 00:18:21.160 for the next 30 or 40 years. And another person 00:18:21.160 --> 00:18:24.559 meticulously decides not to smoke, not to drink, 00:18:24.619 --> 00:18:28.740 go to the gym, eat all their vegetables and salads, 00:18:29.099 --> 00:18:32.200 and doesn't require any health care really at 00:18:32.200 --> 00:18:35.779 all until they're in their late 80s. What do 00:18:35.779 --> 00:18:39.759 you think? That's a very un -socialist thing 00:18:39.759 --> 00:18:44.480 to say. But is it a realistic thing to say? Should 00:18:44.480 --> 00:18:48.160 there be a lifestyle means test for access to 00:18:48.160 --> 00:18:51.180 health care? Now, the socialists would say absolutely 00:18:51.180 --> 00:18:53.539 not. It doesn't matter if you smoke and drink. 00:18:53.640 --> 00:18:55.519 You should still get free health care because 00:18:55.519 --> 00:18:57.880 that's what the NHS is. But I don't know. What 00:18:57.880 --> 00:19:00.539 do you think? So it's interesting because I'm 00:19:00.539 --> 00:19:04.940 person B in that example. So aside from drinking 00:19:04.940 --> 00:19:08.140 once in a while in the evenings, the rest of 00:19:08.140 --> 00:19:09.940 the stuff is me. I don't ever see a doctor. I 00:19:09.940 --> 00:19:13.059 have blood work done frequently. I adjust my 00:19:13.059 --> 00:19:17.460 nutrition accordingly. But I use this as a comparison 00:19:17.460 --> 00:19:19.839 a lot because this is something that people talk 00:19:19.839 --> 00:19:22.599 about. Well, who deserves the health care versus 00:19:22.599 --> 00:19:25.640 who doesn't? I grew up on a farm outside Bath. 00:19:26.170 --> 00:19:28.910 And, you know, we had livestock on the farm that 00:19:28.910 --> 00:19:30.670 we would eat. You know, we had a vegetable garden. 00:19:30.710 --> 00:19:33.569 We had an orchard. My day comprised of, you know, 00:19:33.569 --> 00:19:36.430 mucking out stables and herding geese and all 00:19:36.430 --> 00:19:40.269 these other things. So my baseline was forging 00:19:40.269 --> 00:19:42.470 health. You know, the activity level, understanding 00:19:42.470 --> 00:19:44.750 where the food came from, cooking whole food, 00:19:44.829 --> 00:19:48.190 basically almost never had any sort of fast food 00:19:48.190 --> 00:19:51.190 whatsoever. And then you compare someone who 00:19:51.190 --> 00:19:55.549 grew up in inner city London. grew up in a flat, 00:19:55.609 --> 00:19:57.670 you know, their local food was probably fish 00:19:57.670 --> 00:20:00.130 and chips or whatever it was. You know, their 00:20:00.130 --> 00:20:02.630 parents smoked, so they passively became addicted 00:20:02.630 --> 00:20:05.289 and they became smokers themselves, yada, yada, 00:20:05.369 --> 00:20:07.890 yada. So you have two children on two different 00:20:07.890 --> 00:20:10.710 paths. So I think that, you know, with this one 00:20:10.710 --> 00:20:12.970 or the other conversation always, you know, ends 00:20:12.970 --> 00:20:16.750 up with no resolution versus they're both correct. 00:20:17.480 --> 00:20:20.019 100 % is on the ownership of the individual, 00:20:20.220 --> 00:20:23.900 but what is the environment like? In America, 00:20:24.180 --> 00:20:26.940 everything's fast food, everything on every corner, 00:20:27.140 --> 00:20:30.200 drive -through everything. Even the PE programs 00:20:30.200 --> 00:20:32.980 at school have been sliced and diced. They serve 00:20:32.980 --> 00:20:37.200 processed food in school cafeterias. Yeah, there 00:20:37.200 --> 00:20:41.500 is no simple answer. It's not either or. And 00:20:41.500 --> 00:20:43.079 of course, when it comes to that question of 00:20:43.079 --> 00:20:45.890 who deserves healthcare, Obviously, everyone 00:20:45.890 --> 00:20:49.930 deserves health care. Also, another way of looking 00:20:49.930 --> 00:20:55.029 at this is that lifestyle is already taxed. When 00:20:55.029 --> 00:20:57.710 you buy alcohol, you're paying for liver units. 00:20:57.730 --> 00:21:01.210 When you buy cigarettes, you're paying for respiratory 00:21:01.210 --> 00:21:06.569 services. So I don't know whether when you buy 00:21:06.569 --> 00:21:08.609 fried chicken at McDonald's, you're paying for 00:21:08.609 --> 00:21:11.009 obesity and diabetes care. I'm not sure how that 00:21:11.009 --> 00:21:15.130 would work. Yeah, we're in a very difficult position. 00:21:15.369 --> 00:21:17.630 And I think going back to mental health care 00:21:17.630 --> 00:21:22.130 specifically, if you don't have an acute service, 00:21:22.289 --> 00:21:25.049 if you can't catch people early on, it's almost 00:21:25.049 --> 00:21:27.650 not worth having something at all. If you go 00:21:27.650 --> 00:21:30.609 to your GP and you're complaining of depression 00:21:30.609 --> 00:21:33.990 and anxiety and you're miserable and you've lost 00:21:33.990 --> 00:21:37.170 your partner and your children and your job and 00:21:37.170 --> 00:21:39.509 you're told, yeah, that's fine, I'll get you 00:21:39.509 --> 00:21:43.170 an NHS appointment, it'll be three years. You 00:21:43.170 --> 00:21:46.089 know, that's almost there's no point because 00:21:46.089 --> 00:21:48.630 all of those acute things will have passed. You 00:21:48.630 --> 00:21:51.589 need the help when you need it. And I think this 00:21:51.589 --> 00:21:56.009 is why we are spiraling downwards in terms of 00:21:56.009 --> 00:21:59.569 our management of the health of the nation in 00:21:59.569 --> 00:22:03.869 terms of mental health. Which is why we need 00:22:03.869 --> 00:22:07.839 something innovative and effective. fast working 00:22:07.839 --> 00:22:12.119 and efficient and financially efficient and psychedelics 00:22:12.119 --> 00:22:15.720 do bring us all of that well let's take a deep 00:22:15.720 --> 00:22:18.140 dive then the first time obviously we spoke about 00:22:18.140 --> 00:22:20.319 some of these areas but so much has changed now 00:22:20.319 --> 00:22:23.319 so many more studies so much you know so much 00:22:23.319 --> 00:22:26.490 more uh Even just advocation, I guess, is the 00:22:26.490 --> 00:22:29.069 best word since the last time we sat down in 00:22:29.069 --> 00:22:31.269 seven years. I think it's been a real kind of 00:22:31.269 --> 00:22:34.289 renaissance since then. So talk to me first. 00:22:34.329 --> 00:22:36.329 Let's start with MDMA, because obviously that 00:22:36.329 --> 00:22:38.150 was the one that we really honed in last time. 00:22:38.210 --> 00:22:40.650 That's ironically a compound that I have used 00:22:40.650 --> 00:22:45.069 recreationally in the past and is something that 00:22:45.069 --> 00:22:47.359 I actually want to do. pursue myself as far as 00:22:47.359 --> 00:22:50.460 the MDMA counseling, just to see if there's anything 00:22:50.460 --> 00:22:53.460 underlying. There's nothing that really troubles 00:22:53.460 --> 00:22:56.880 me specifically, but knowing the life that I've 00:22:56.880 --> 00:22:58.519 had, I got a funny feeling there's probably some 00:22:58.519 --> 00:23:01.079 boxes in there that are still locked tight. So 00:23:01.079 --> 00:23:04.299 let's start with MDMA. What's been the kind of 00:23:04.299 --> 00:23:07.960 evolution since the last time we spoke seven 00:23:07.960 --> 00:23:11.160 years ago? Well, it's an interesting question 00:23:11.160 --> 00:23:13.500 and it's a sort of both a positive and a not 00:23:13.500 --> 00:23:18.250 so positive answer. In terms of MDMA being a 00:23:18.250 --> 00:23:22.650 licensed prescribable medicine, it's still not. 00:23:23.670 --> 00:23:26.309 So in some ways, we're no further ahead now than 00:23:26.309 --> 00:23:29.230 we were 20 years ago or 30 years ago when the 00:23:29.230 --> 00:23:34.730 research started. In order to get a drug licensed 00:23:34.730 --> 00:23:38.380 as a medicine with a capital M. So this means 00:23:38.380 --> 00:23:40.640 a legal licensed medicine. I'm not talking about 00:23:40.640 --> 00:23:42.559 underground or illegal use here because that's 00:23:42.559 --> 00:23:44.759 just a different kettle of fish. But for a drug 00:23:44.759 --> 00:23:46.819 to be a licensed legal medicine, it has to jump 00:23:46.819 --> 00:23:50.039 through a whole bunch of hoops. And these hoops 00:23:50.039 --> 00:23:51.960 are not specific to psychedelics. They're the 00:23:51.960 --> 00:23:54.880 same for painkillers and antibiotics and cancer 00:23:54.880 --> 00:23:57.500 drugs. The same same set of research hoops. It 00:23:57.500 --> 00:23:59.460 has to jump through all those hoops. And then 00:23:59.460 --> 00:24:03.160 you have to submit to, in America, the FDA. And 00:24:03.160 --> 00:24:05.460 then they accept the drug or not. And it becomes 00:24:05.460 --> 00:24:08.700 an approved medicine. Until it's an approved 00:24:08.700 --> 00:24:11.039 medicine, it can only be used in a research setting 00:24:11.039 --> 00:24:13.579 under research protocols, which is a very small 00:24:13.579 --> 00:24:16.079 number, a couple of dozen of patients, very expensive 00:24:16.079 --> 00:24:20.339 to run research studies. The leading organization 00:24:20.339 --> 00:24:23.079 in the world for MDMA research is called MAPS, 00:24:23.140 --> 00:24:24.839 as you know, the Multidisciplinary Association 00:24:24.839 --> 00:24:26.900 of Psychedelic Studies. And they've been carrying 00:24:26.900 --> 00:24:30.740 out all of these research protocols, jumping 00:24:30.740 --> 00:24:33.160 through all these hoops. And then last year in 00:24:33.160 --> 00:24:35.480 2024, they submitted all of their data to the 00:24:35.480 --> 00:24:40.549 FDA. and it was turned down. So that was after 00:24:40.549 --> 00:24:44.529 20, 30 years and $100 million plus of research 00:24:44.529 --> 00:24:48.930 costs, the FDA turned it down on, quite frankly, 00:24:49.069 --> 00:24:54.470 rather spurious criteria. And so as we're sitting 00:24:54.470 --> 00:24:57.269 here today, MDMA is still not over the line as 00:24:57.269 --> 00:25:02.690 a licensed legal medicine. And that's true throughout 00:25:02.690 --> 00:25:05.430 Europe. throughout the States, Canada, United 00:25:05.430 --> 00:25:07.309 States, South America, anywhere. Anyone that 00:25:07.309 --> 00:25:10.549 says they are legally prescribing MDMA, they 00:25:10.549 --> 00:25:14.369 are not. It is illegal unless they are a researcher 00:25:14.369 --> 00:25:18.029 and they're doing this under research and the 00:25:18.029 --> 00:25:20.089 patients are participants in a research trial. 00:25:20.250 --> 00:25:22.809 Now, there is a slight caveat to that in that 00:25:22.809 --> 00:25:25.369 what's happened a couple of years ago in Australia 00:25:25.369 --> 00:25:29.829 is that MDMA and psilocybin were given a special... 00:25:30.279 --> 00:25:34.039 Not a full medical license, but an approval to 00:25:34.039 --> 00:25:37.420 be used in large numbers of people. And so in 00:25:37.420 --> 00:25:40.460 Australia, MDMA is available in a number of clinics. 00:25:40.759 --> 00:25:43.480 And I was very privileged a couple of years ago 00:25:43.480 --> 00:25:45.740 to go out to Australia on two separate occasions 00:25:45.740 --> 00:25:49.079 for about 10 weeks each to take part in training 00:25:49.079 --> 00:25:51.859 schemes. So there's a furious rush in Australia 00:25:51.859 --> 00:25:55.000 to get lots of people trained, doctors, nurses, 00:25:55.160 --> 00:25:58.839 therapists, to deliver MDMA therapy. in Australia 00:25:58.839 --> 00:26:03.799 for Australian nationals. So it's really moving 00:26:03.799 --> 00:26:05.819 ahead in Australia, which is kind of ironic because 00:26:05.819 --> 00:26:08.299 Australia has always just been a backwater in 00:26:08.299 --> 00:26:11.420 terms of psychedelic research, but it suddenly 00:26:11.420 --> 00:26:13.779 leapt into front position with this government 00:26:13.779 --> 00:26:16.980 initiative. But in the United States and Europe, 00:26:17.240 --> 00:26:19.420 MDMA is still not a licensed legal medicine. 00:26:19.579 --> 00:26:26.490 Now, the setback that MAPS had in summer 24 It 00:26:26.490 --> 00:26:29.109 means they've got to retake, redo some of their 00:26:29.109 --> 00:26:31.450 studies. And I think that's I think the last 00:26:31.450 --> 00:26:33.710 I heard from Rick Doblin was it's going to be 00:26:33.710 --> 00:26:36.349 another two or three years and another however 00:26:36.349 --> 00:26:39.789 many tens of millions of dollars to then get 00:26:39.789 --> 00:26:42.750 that data again, then resubmit and hopefully 00:26:42.750 --> 00:26:44.990 get approval. And then once it gets approved 00:26:44.990 --> 00:26:48.690 as a medicine, then practitioners with the appropriate 00:26:48.690 --> 00:26:51.849 training and support and facilities can use it 00:26:51.849 --> 00:26:55.160 as a medicine, not just as a research. investigative 00:26:55.160 --> 00:26:59.460 tool. So in answer to your question, in some 00:26:59.460 --> 00:27:02.220 ways, we're no better off now than we were when 00:27:02.220 --> 00:27:04.299 I last spoke to you. In other ways, an awful 00:27:04.299 --> 00:27:07.059 lot has happened. And there's an awful lot more 00:27:07.059 --> 00:27:10.660 people trained to deliver MDMA therapy now. And 00:27:10.660 --> 00:27:14.160 certainly, the public perception is further along 00:27:14.160 --> 00:27:16.799 positively. There's much less stigma. There's 00:27:16.799 --> 00:27:19.420 much more public acceptance. And there's much 00:27:19.420 --> 00:27:23.059 greater need. We are more than ever. in need 00:27:23.059 --> 00:27:26.460 of MDMA -assisted psychedelic therapy than we 00:27:26.460 --> 00:27:29.220 were back then. We're just waiting for that green 00:27:29.220 --> 00:27:31.940 light from the approval services to start opening 00:27:31.940 --> 00:27:35.420 clinics and delivering the treatments. It's funny 00:27:35.420 --> 00:27:37.660 you say that because I have literally about to 00:27:37.660 --> 00:27:40.900 interview an Australian firefighter who did MDMA 00:27:40.900 --> 00:27:43.839 in Australia and had incredible results. And 00:27:43.839 --> 00:27:46.559 funnily enough, we were talking, and I'll get 00:27:46.559 --> 00:27:50.359 to this in a minute, but you hear the... Some 00:27:50.359 --> 00:27:52.099 of these places that offer these treatments, 00:27:52.259 --> 00:27:54.440 as you said, whether it's legally or illegally, 00:27:54.900 --> 00:27:57.579 ketamine is a good example. Obviously, it's legal 00:27:57.579 --> 00:28:01.099 here. And every time I've heard someone say with 00:28:01.099 --> 00:28:03.619 ketamine, oh, it didn't work, usually they were 00:28:03.619 --> 00:28:05.700 hooked up to an IV and the person walked out. 00:28:05.759 --> 00:28:07.960 They weren't doing any sort of kind of guiding 00:28:07.960 --> 00:28:11.900 or counseling alongside. But his experience with 00:28:11.900 --> 00:28:15.579 MDMA, he was extremely well -researched. I mean, 00:28:15.599 --> 00:28:18.920 he's doing a master's on this at the moment, 00:28:18.960 --> 00:28:22.250 I believe. So had an excellent grasp on all these 00:28:22.250 --> 00:28:24.809 therapeutic modalities, went in thinking, OK, 00:28:24.890 --> 00:28:26.670 my relationship with the counselor is strong. 00:28:26.849 --> 00:28:29.210 This is what's going to be the winning factor. 00:28:29.630 --> 00:28:32.049 And actually, he said the medicine was actually 00:28:32.049 --> 00:28:34.509 really what did most of it. He was quiet and 00:28:34.509 --> 00:28:37.029 in his own head for most of the time. So I'm 00:28:37.029 --> 00:28:39.509 actually going to be able to storytell an Australian 00:28:39.509 --> 00:28:42.049 firefighter success story with MDMA literally 00:28:42.049 --> 00:28:45.589 in a few weeks. Yeah. And, you know, there's 00:28:45.589 --> 00:28:48.329 a real debate raging at the moment in psychedelics 00:28:48.329 --> 00:28:51.819 in terms of. The narrative has always been it's 00:28:51.819 --> 00:28:54.180 a combination of the drug and the psychotherapy 00:28:54.180 --> 00:28:59.480 and the drug opens the door, primes the brain, 00:28:59.640 --> 00:29:04.180 a process called neuroplasticity or neuroflexibility. 00:29:04.960 --> 00:29:07.839 And then when the brain is in that neuroplastic 00:29:07.839 --> 00:29:11.680 or neuroflexible state, you throw the psychotherapy 00:29:11.680 --> 00:29:13.859 at them and that's where you get the great results. 00:29:14.099 --> 00:29:18.680 And that's always been the model. We're starting 00:29:18.680 --> 00:29:21.200 also to challenge that. And more and more people 00:29:21.200 --> 00:29:23.680 are finding, certainly with neuroscientific studies, 00:29:23.720 --> 00:29:26.279 that simply taking the drug without psychotherapy 00:29:26.279 --> 00:29:29.539 is also highly beneficial because of that neuroplastic 00:29:29.539 --> 00:29:32.079 effect that it has. And we've learned a lot of 00:29:32.079 --> 00:29:35.400 this from ketamine, interestingly. So, I mean, 00:29:35.420 --> 00:29:37.819 we can certainly talk about ketamine because 00:29:37.819 --> 00:29:41.680 you're quite right. So ketamine, as you know, 00:29:41.759 --> 00:29:44.579 is a licensed medicine. It doesn't have to go 00:29:44.579 --> 00:29:46.640 through that approval process of becoming a licensed 00:29:46.640 --> 00:29:49.619 medicine. It's been around since the 1970s as 00:29:49.619 --> 00:29:54.559 a anesthetic. And it's a very, very important 00:29:54.559 --> 00:29:57.619 and useful anesthetic. It's used all over the 00:29:57.619 --> 00:29:59.640 world. In fact, it's on the World Health Organization, 00:29:59.980 --> 00:30:03.640 their list of top 10 essential drugs that every 00:30:03.640 --> 00:30:06.099 country must have up there with morphine and 00:30:06.099 --> 00:30:09.950 penicillin. It's a very useful anesthetic. And 00:30:09.950 --> 00:30:13.009 then around about 2001, it was serendipitously 00:30:13.009 --> 00:30:17.750 found to be that it also worked to reduce depression. 00:30:18.430 --> 00:30:20.990 It was found by an anesthetist who was prescribing 00:30:20.990 --> 00:30:23.829 it for his anesthetic, for his surgical patients. 00:30:24.809 --> 00:30:27.029 And he found that those with depression had a 00:30:27.029 --> 00:30:29.410 better mood for a week afterwards, after this 00:30:29.410 --> 00:30:34.930 infusion of ketamine. And so we then saw this 00:30:34.930 --> 00:30:39.220 springing up of its use in psychiatry. And yeah, 00:30:39.319 --> 00:30:42.180 the beginning of these so -called ketamine clinics, 00:30:42.380 --> 00:30:44.700 it was just getting the infusion. You would go 00:30:44.700 --> 00:30:46.339 along to the clinic. There'd be no psychotherapy. 00:30:46.519 --> 00:30:49.299 You would have an IV drip. It would last a couple 00:30:49.299 --> 00:30:51.559 of hours. The practitioner would say to you, 00:30:51.599 --> 00:30:53.440 oh, I'm really sorry. You're going to feel a 00:30:53.440 --> 00:30:55.339 bit weird for a couple of hours, but don't worry, 00:30:55.480 --> 00:30:59.819 it'll pass. And then the antidepressant effects 00:30:59.819 --> 00:31:02.519 will start in a few hours later and it'll last 00:31:02.519 --> 00:31:05.279 a week or so. So that's what most of these ketamine 00:31:05.279 --> 00:31:07.480 clinics were. But then what we've seen in more 00:31:07.480 --> 00:31:10.859 recent years is using MDMA like we would use 00:31:10.859 --> 00:31:15.339 psilocybin or MDMA, not considering the intoxication 00:31:15.339 --> 00:31:17.900 as just an irritating side effect of feeling 00:31:17.900 --> 00:31:21.500 a bit weird, but actually a positive mental state 00:31:21.500 --> 00:31:25.700 that we can work in and alongside. So combining 00:31:25.700 --> 00:31:28.480 that with psychotherapy like we would for MDMA 00:31:28.480 --> 00:31:31.539 and psilocybin. And this is called CAP, ketamine 00:31:31.539 --> 00:31:35.089 -assisted psychotherapy. as opposed to just what 00:31:35.089 --> 00:31:38.309 we would call RAAD, rapid acting antidepressant 00:31:38.309 --> 00:31:41.789 effects. And more and more, we're seeing CAP 00:31:41.789 --> 00:31:44.109 being used. But I think you're right. I think 00:31:44.109 --> 00:31:46.210 the vast majority of so -called ketamine clinics, 00:31:46.349 --> 00:31:49.849 even today, are not doing CAP. They're just giving 00:31:49.849 --> 00:31:53.069 the infusions. Now, it's not a bad thing. It's 00:31:53.069 --> 00:31:54.990 a good antidepressant. The trouble is you have 00:31:54.990 --> 00:31:57.009 to keep doing it. It's a maintenance therapy. 00:31:57.349 --> 00:31:59.710 You might do it once a week, once a fortnight, 00:31:59.789 --> 00:32:02.630 once a month. But you have to keep topping up 00:32:02.630 --> 00:32:04.950 in that way. It's a bit like dialysis for the 00:32:04.950 --> 00:32:07.710 brain. Whereas when you combine it with psychotherapy 00:32:07.710 --> 00:32:12.490 in the form of CAP, the hypothesis is that like 00:32:12.490 --> 00:32:16.009 MDMA and psilocybin, you make important realizations, 00:32:16.109 --> 00:32:21.109 reflections on aspects of your psychology that 00:32:21.109 --> 00:32:23.849 were stuck. And the psychotherapy is much more 00:32:23.849 --> 00:32:25.950 effective and long lasting without having to 00:32:25.950 --> 00:32:30.410 repeat it. So it's really ironic that right now, 00:32:30.809 --> 00:32:32.849 when most people think of psychedelic therapy 00:32:32.849 --> 00:32:35.049 they probably think of ketamine therapy because 00:32:35.049 --> 00:32:38.150 it's by far the most used it's the license and 00:32:38.150 --> 00:32:41.029 it's used all over the world um but if you take 00:32:41.029 --> 00:32:43.130 those three psychedelics ketamine psilocybin 00:32:43.130 --> 00:32:46.509 and mdma i would argue that ketamine is the poor 00:32:46.509 --> 00:32:49.549 cousin of mdma and psilocybin when it comes to 00:32:49.549 --> 00:32:52.230 agents to assist psychotherapy it's good ketamine 00:32:52.230 --> 00:32:54.490 therapy it's better than no ketamine but it's 00:32:54.490 --> 00:32:57.150 no mdma and it's no psilocybin but ironically 00:32:57.150 --> 00:33:02.599 it's the one everyone's got So, you know, if 00:33:02.599 --> 00:33:04.740 if we could have made that choice, you know, 00:33:04.740 --> 00:33:06.619 20 years ago, which of those three should we 00:33:06.619 --> 00:33:09.319 have? It wouldn't be ketamine, but it is ketamine 00:33:09.319 --> 00:33:13.440 because it's already licensed. And so we're honing 00:33:13.440 --> 00:33:15.559 ways to do ketamine assisted psychotherapy better 00:33:15.559 --> 00:33:18.339 and better and make it more effective. But like 00:33:18.339 --> 00:33:21.059 you said about your your patient who who is a 00:33:21.059 --> 00:33:23.720 firefighter, a lot of people come out of the 00:33:23.720 --> 00:33:26.700 ketamine experience saying it's all right. But, 00:33:26.819 --> 00:33:30.230 you know, it wasn't mind blowing. Whereas with 00:33:30.230 --> 00:33:33.410 MDMA or psilocybin, they pretty much all, without 00:33:33.410 --> 00:33:37.529 exception, say that was profound and mind -blowing. 00:33:37.789 --> 00:33:40.630 And with MDMA particularly, it was also very 00:33:40.630 --> 00:33:43.390 pleasant and tolerable. And they immediately 00:33:43.390 --> 00:33:46.750 talk about the amazing gains they've made. So 00:33:46.750 --> 00:33:49.170 now there are no magic wands in mental health 00:33:49.170 --> 00:33:52.049 at all. But if there was one, it would be MDMA. 00:33:53.210 --> 00:33:55.329 It's interesting because someone asked me the 00:33:55.329 --> 00:33:58.059 other day. um you know something to do with psychedelics 00:33:58.059 --> 00:34:01.240 and i had this realization because on this journey 00:34:01.240 --> 00:34:03.799 that i'm on and i'm you know advocating for all 00:34:03.799 --> 00:34:05.940 these things when it comes to you know the physical 00:34:05.940 --> 00:34:09.039 health the mental health one of the questions 00:34:09.039 --> 00:34:12.239 is well why am i not struggling i'm no more you 00:34:12.239 --> 00:34:15.039 know No different a human being than all of the 00:34:15.039 --> 00:34:16.719 men and women I know that have been suffering 00:34:16.719 --> 00:34:18.940 alcoholism, they've taken their own lives, et 00:34:18.940 --> 00:34:21.079 cetera, et cetera. Now, part of it is definitely 00:34:21.079 --> 00:34:23.420 my upbringing, going back to that farm. I was 00:34:23.420 --> 00:34:24.880 surrounded by a lot of things that we know are 00:34:24.880 --> 00:34:26.900 very healing. But there was a lot of trauma. 00:34:27.019 --> 00:34:28.619 I almost died in a house fire when I was four 00:34:28.619 --> 00:34:30.920 years old. Parents had a horrible divorce. There 00:34:30.920 --> 00:34:33.800 was another near -death incident. So there's 00:34:33.800 --> 00:34:37.099 a lot of compounding things, big T's and little 00:34:37.099 --> 00:34:41.239 t's. But when I lived in Japan, mushrooms were 00:34:41.239 --> 00:34:45.380 legal. So, and then MDMA wasn't, but we did it 00:34:45.380 --> 00:34:47.699 anyway. But it was in a kind of, you know, the 00:34:47.699 --> 00:34:51.639 rave setting as it were. So legalization aside, 00:34:51.780 --> 00:34:55.739 I was exposed to MDMA and psilocybin during those 00:34:55.739 --> 00:34:58.280 times. And it wasn't specifically to deal with 00:34:58.280 --> 00:35:00.559 trauma, but I wonder again, if, you know, just 00:35:00.559 --> 00:35:03.400 by osmosis, there was a healing element of that. 00:35:03.460 --> 00:35:05.860 So you've got the holistic healing. that offset 00:35:05.860 --> 00:35:08.179 the childhood, then you've got exposure to these 00:35:08.179 --> 00:35:09.820 two compounds that we're talking about today, 00:35:10.000 --> 00:35:12.219 which ironically, when I was honest about my 00:35:12.219 --> 00:35:14.659 very first firefighter application, which I hadn't 00:35:14.659 --> 00:35:17.300 done them for years, I was, I basically had the 00:35:17.300 --> 00:35:19.679 application screwed up and thrown in my face. 00:35:19.780 --> 00:35:22.000 And now here we are talking about how effective 00:35:22.000 --> 00:35:23.760 they are to heal first responders. It was kind 00:35:23.760 --> 00:35:26.139 of ironic, but I wonder if, you know, that was 00:35:26.139 --> 00:35:30.320 one of the reasons why after a 14 year career. 00:35:31.490 --> 00:35:34.389 With arguably a decent amount of trauma that 00:35:34.389 --> 00:35:37.570 I was able to be in a slightly better place than 00:35:37.570 --> 00:35:41.070 some of my peers. Well, I don't want to take 00:35:41.070 --> 00:35:43.469 the wind out of your sails with that idea, James. 00:35:44.190 --> 00:35:47.190 But I would say what we know about the etiology 00:35:47.190 --> 00:35:51.190 of mental health problems and the prevalence 00:35:51.190 --> 00:35:53.130 of mental health problems amongst different groups 00:35:53.130 --> 00:35:55.789 and what are the big causative factors. By far, 00:35:55.789 --> 00:35:58.230 the two biggest factors are probably initially 00:35:58.230 --> 00:36:00.869 genetics. which of course you have no control 00:36:00.869 --> 00:36:03.210 over it's the genes you're given and the other 00:36:03.210 --> 00:36:07.489 is your very early attachment experiences so 00:36:07.489 --> 00:36:11.110 you know what happens in your first 48 months 00:36:11.110 --> 00:36:15.389 of life um in terms of that nurturing experience 00:36:15.389 --> 00:36:18.769 with your primary caregiver um so if you get 00:36:18.769 --> 00:36:21.570 that right and you've got good genes The likelihood 00:36:21.570 --> 00:36:24.849 of you having a resilient adult mental health 00:36:24.849 --> 00:36:27.670 for the rest of your life is by far the biggest 00:36:27.670 --> 00:36:30.809 factors. It's a nice romantic idea to think that 00:36:30.809 --> 00:36:33.869 your exposure to recreational MDMA and psilocybin 00:36:33.869 --> 00:36:37.809 later in life has had a bolstering effect. And 00:36:37.809 --> 00:36:39.969 maybe it has. And, you know, of all people, it 00:36:39.969 --> 00:36:41.590 should be someone like me who would say that's 00:36:41.590 --> 00:36:45.789 true. It certainly could have had a positive 00:36:45.789 --> 00:36:48.789 effect and to continue to do so and to continue 00:36:48.789 --> 00:36:52.019 to use it in a. in a healthy facilitated way 00:36:52.019 --> 00:36:55.239 is a healthy thing to do um but when you actually 00:36:55.239 --> 00:36:57.300 look at the prevalence and etiology of mental 00:36:57.300 --> 00:36:59.300 health disorders i think those those other two 00:36:59.300 --> 00:37:02.420 factors genetics and very early attachment are 00:37:02.420 --> 00:37:04.900 the biggest protective factors get those right 00:37:04.900 --> 00:37:07.719 and we are resilient to adult mental health problems 00:37:07.719 --> 00:37:10.260 far more so than people who don't have those 00:37:10.260 --> 00:37:13.260 parts which is why you know we can't do much 00:37:13.260 --> 00:37:16.619 about genetics um at least not not easily or 00:37:16.619 --> 00:37:19.369 ethically um But we can certainly do something 00:37:19.369 --> 00:37:22.550 about attachment. And often I say in my talks, 00:37:22.650 --> 00:37:25.789 we could close half of the prisons and half of 00:37:25.789 --> 00:37:28.590 the hospitals tomorrow if we had really good 00:37:28.590 --> 00:37:31.130 care for single mothers with children under five. 00:37:31.690 --> 00:37:35.590 Because get those early attachment years right. 00:37:36.349 --> 00:37:39.030 Attachment becomes this blueprint for the rest 00:37:39.030 --> 00:37:41.929 of your life. The experiences you have in those 00:37:41.929 --> 00:37:46.030 pre -verbal years become the blueprint, the benchmark 00:37:46.030 --> 00:37:50.400 for... every aspect of our psychology um trust 00:37:50.400 --> 00:37:55.159 love fear acceptance violence aggression addiction 00:37:55.159 --> 00:37:58.639 all of those things are very very early imprinted 00:37:58.639 --> 00:38:02.519 in in that pre -verbal child and we can do something 00:38:02.519 --> 00:38:04.900 about that with really really good public health 00:38:04.900 --> 00:38:07.820 care and support for single single parents not 00:38:07.820 --> 00:38:10.039 not just mothers usually mothers but single parents 00:38:10.039 --> 00:38:14.389 and children um But yeah, ongoing adult support 00:38:14.389 --> 00:38:17.889 with psychedelics is another great way of mopping 00:38:17.889 --> 00:38:20.090 up some of the difficulties when you haven't 00:38:20.090 --> 00:38:23.010 got those kind of resiliences. Well, when you 00:38:23.010 --> 00:38:25.510 say genetics, there's more and more discussion 00:38:25.510 --> 00:38:27.989 now of epigenetics. And again, before we hit 00:38:27.989 --> 00:38:30.110 record, I was talking about the book I just wrote 00:38:30.110 --> 00:38:33.329 and the multigenerational trauma. One of the 00:38:33.329 --> 00:38:35.329 very snide comments that you hear now is, well, 00:38:35.329 --> 00:38:37.309 the problem today is these broken families. And 00:38:37.309 --> 00:38:39.119 it's like, yes, it is. But what are we going 00:38:39.119 --> 00:38:41.599 to do about that? This is a generational issue, 00:38:41.679 --> 00:38:43.159 as you said, whether it's addiction, whether 00:38:43.159 --> 00:38:45.139 it's incarceration, there are a lot of families 00:38:45.139 --> 00:38:49.199 that that's already happened to them. But I believe 00:38:49.199 --> 00:38:52.559 that if we start healing these households with 00:38:52.559 --> 00:38:54.280 all these initiatives that we're talking about, 00:38:54.340 --> 00:38:57.980 whether it's taking care of... The households 00:38:57.980 --> 00:39:02.460 that need more care, the Norwegian prison model 00:39:02.460 --> 00:39:05.960 where we're truly rehabilitating people so they 00:39:05.960 --> 00:39:08.119 come back and become functioning members of society, 00:39:08.340 --> 00:39:11.659 the Finnish education system, the Portuguese 00:39:11.659 --> 00:39:14.679 decriminalization system, where you're holistically 00:39:14.679 --> 00:39:18.489 healing a nation. I believe that... epigenetics 00:39:18.489 --> 00:39:21.090 will be where now you have the opposite effect 00:39:21.090 --> 00:39:23.190 and you start, you know, reducing the amount 00:39:23.190 --> 00:39:25.590 of people that have prevalence for, you know, 00:39:25.610 --> 00:39:29.090 addiction, alcoholism, et cetera. Yeah. No, I 00:39:29.090 --> 00:39:32.690 mean, absolutely. There's no doubt that maximizing 00:39:32.690 --> 00:39:37.329 all of those social measures improves outcome 00:39:37.329 --> 00:39:39.670 for mental health and physical health illnesses. 00:39:39.769 --> 00:39:43.699 There's no question. All of these illnesses cluster 00:39:43.699 --> 00:39:46.320 in the lower socioeconomic groups, whether it's 00:39:46.320 --> 00:39:51.280 epigenetics or just episocialization. I think 00:39:51.280 --> 00:39:55.059 is I mean, I think if you if you live in poverty 00:39:55.059 --> 00:39:57.420 and you don't go to and you don't have further 00:39:57.420 --> 00:40:00.639 education and you can't find employment and nor 00:40:00.639 --> 00:40:02.780 could your father and nor could your grandfather 00:40:02.780 --> 00:40:06.860 or his father. Is that epigenetics or is that 00:40:06.860 --> 00:40:11.219 just transgenerational? poor social conditions. 00:40:11.639 --> 00:40:16.760 I think it's probably the latter. Whether that's 00:40:16.760 --> 00:40:19.219 imprinted into the genetic code or not is almost 00:40:19.219 --> 00:40:21.320 irrelevant. I think the effect of that would 00:40:21.320 --> 00:40:24.340 be tiny compared to the very obvious in -your 00:40:24.340 --> 00:40:27.659 -face issue of we live in poverty and all these 00:40:27.659 --> 00:40:31.719 generations have. And I don't know that there's 00:40:31.719 --> 00:40:34.699 much of genetic tweaking that needs to be done 00:40:34.699 --> 00:40:37.190 there. You just need to... look after these groups 00:40:37.190 --> 00:40:40.570 from a social and economic perspective. But yeah, 00:40:40.670 --> 00:40:45.090 I mean, epigenetics is a field that is fascinating 00:40:45.090 --> 00:40:49.829 to study and understand. Personally, my understanding 00:40:49.829 --> 00:40:53.269 of it is that the effect is not nearly as great 00:40:53.269 --> 00:40:55.369 as some of the things we actually know loads 00:40:55.369 --> 00:40:58.869 about, which is the social situation and the 00:40:58.869 --> 00:41:02.909 effect that that has on transgenerational populations. 00:41:03.840 --> 00:41:05.880 of children becoming adults, having children, 00:41:06.059 --> 00:41:08.699 et cetera. So epigenetics is an interesting field, 00:41:08.800 --> 00:41:12.059 but not as interesting as good education and 00:41:12.059 --> 00:41:17.840 employment and tackling poverty on a social level, 00:41:17.920 --> 00:41:22.059 I think. That's my personal opinion. Yeah, no, 00:41:22.119 --> 00:41:24.800 I agree. I mean, the statement about which label 00:41:24.800 --> 00:41:27.320 is irrelevant, if we find solutions, proactive 00:41:27.320 --> 00:41:29.739 solutions, and I think this is underlined, ironically, 00:41:29.739 --> 00:41:33.489 circling around to the FDA. who approved OxyContin, 00:41:33.670 --> 00:41:36.389 where we saw the highest prevalence of addiction 00:41:36.389 --> 00:41:39.090 were places where there used to be a high level 00:41:39.090 --> 00:41:41.389 of industry. And then it was taken away, whether 00:41:41.389 --> 00:41:43.690 it was mining towns or the steel industry or 00:41:43.690 --> 00:41:47.289 the auto industry. So was it an addictive hook 00:41:47.289 --> 00:41:49.670 that those people all had genetically or was, 00:41:49.710 --> 00:41:52.570 as you pointed to, a lack of community, a lack 00:41:52.570 --> 00:41:55.849 of stability financially that then created this 00:41:55.849 --> 00:41:58.420 void that then... you know they were far more 00:41:58.420 --> 00:42:02.400 susceptible to this fda approved painkiller and 00:42:02.400 --> 00:42:06.260 then ironically mdma is is not approved yeah 00:42:06.260 --> 00:42:08.880 i mean it's actually both because what we see 00:42:08.880 --> 00:42:11.059 in genetics is what's called a genetic drift 00:42:11.059 --> 00:42:15.039 of the genes are not equally spread amongst the 00:42:15.039 --> 00:42:18.719 environment um the the genes for depression anxiety 00:42:18.719 --> 00:42:22.840 personality disorders addictions um psychosis 00:42:22.840 --> 00:42:27.179 ptsd all of these genes cluster in the poor areas 00:42:27.179 --> 00:42:30.500 um because over the generations you slip off 00:42:30.500 --> 00:42:33.360 that social ladder and find yourself living in 00:42:33.360 --> 00:42:36.880 the ghetto and so it would you know all the nice 00:42:36.880 --> 00:42:39.239 posh kids that go to the posh schools and have 00:42:39.239 --> 00:42:41.079 the wonderful parenting and all the money and 00:42:41.079 --> 00:42:45.179 the jobs and the university and the and the brilliant 00:42:45.179 --> 00:42:48.550 support systems they've got all the best genes 00:42:48.550 --> 00:42:51.070 in that part of town, in the nice part of town. 00:42:51.150 --> 00:42:54.389 And that difficult part of town with transgenerational 00:42:54.389 --> 00:42:59.030 drug misuse, addiction, poverty, unemployment, 00:42:59.250 --> 00:43:01.809 poor education, that's where depression, anxiety, 00:43:02.230 --> 00:43:05.730 PTSD genes cluster over the generations because 00:43:05.730 --> 00:43:08.849 you slip down. That's called genetic drift. Yeah, 00:43:08.889 --> 00:43:11.510 I mean, this is highly unethical. But one way 00:43:11.510 --> 00:43:13.630 of tackling this is to have this kind of eugenics 00:43:13.630 --> 00:43:15.869 scheme where you get all the nice, posh people 00:43:15.869 --> 00:43:17.849 to mate with all the poor people in the difficult 00:43:17.849 --> 00:43:20.110 part of town and spread the genes around. Now, 00:43:20.130 --> 00:43:23.730 of course, that's an absurd idea. But yeah, what 00:43:23.730 --> 00:43:26.909 this conversation is pointing out is the double, 00:43:26.949 --> 00:43:30.630 triple, quadruple whammy that comes when you 00:43:30.630 --> 00:43:34.809 look at risk of mental health prevalence. It's 00:43:34.809 --> 00:43:38.579 not ever as simple as... Just the genes, just 00:43:38.579 --> 00:43:41.239 the childhood, just the environment. Most of 00:43:41.239 --> 00:43:44.639 the patients that I would see in secondary or 00:43:44.639 --> 00:43:47.219 tertiary mental health services have multiple 00:43:47.219 --> 00:43:49.960 risk factors. They've got the poor genes, the 00:43:49.960 --> 00:43:52.400 poor environment, the poor parenting, the poor 00:43:52.400 --> 00:43:57.719 childhood, the trauma, all of those things. Because 00:43:57.719 --> 00:44:00.119 any one of those getting it right acts as a very 00:44:00.119 --> 00:44:03.420 strong protective factor. um against the developing 00:44:03.420 --> 00:44:05.559 the end phenotype which is the mental disorder 00:44:05.559 --> 00:44:08.460 so you know you can protect against it so we 00:44:08.460 --> 00:44:10.519 have to do what we can do and we can't do much 00:44:10.519 --> 00:44:13.500 about the genetics at this stage but we like 00:44:13.500 --> 00:44:15.340 you said i think we both agree the things we 00:44:15.340 --> 00:44:17.119 can do something about is where we should be 00:44:17.119 --> 00:44:21.559 targeting our resources i don't know if i asked 00:44:21.559 --> 00:44:23.960 you this back in 2018 so i will again because 00:44:23.960 --> 00:44:26.340 this is again when you've done over a thousand 00:44:26.340 --> 00:44:29.429 interviews the venn diagram intersects pretty 00:44:29.429 --> 00:44:31.690 profoundly. And you see these truths really arise 00:44:31.690 --> 00:44:33.250 because these people are from, you know, all 00:44:33.250 --> 00:44:36.369 walks of life all over the globe. But, you know, 00:44:36.369 --> 00:44:39.849 the conversation around that time in my profession 00:44:39.849 --> 00:44:42.630 was we've got to smash the stigma. It's, you 00:44:42.630 --> 00:44:44.849 know, it's okay not to be okay. All these kind 00:44:44.849 --> 00:44:48.090 of, you know, buzz phrases. But one of the ones 00:44:48.090 --> 00:44:51.449 that I saw or heard over and over and over again 00:44:51.449 --> 00:44:53.809 that I just don't hear discussed and I feel like 00:44:53.809 --> 00:44:56.610 it needs to be front and center was the feeling 00:44:56.610 --> 00:44:59.449 of burdensome. And when, just as you alluded 00:44:59.449 --> 00:45:02.530 to, these first responders have that perfect 00:45:02.530 --> 00:45:06.710 storm from their early life, the trauma that 00:45:06.710 --> 00:45:08.550 we see, the sleep deprivation, the organizational 00:45:08.550 --> 00:45:10.789 betrayal, the side effects of alcohol, psych 00:45:10.789 --> 00:45:13.650 meds, et cetera, et cetera, et cetera. And they 00:45:13.650 --> 00:45:19.190 get to this point, the voice in their head has 00:45:19.190 --> 00:45:22.510 literally distorted their reality. to the point 00:45:22.510 --> 00:45:25.710 where they truly believe that if they just took 00:45:25.710 --> 00:45:29.090 themselves out of the equation, that their family 00:45:29.090 --> 00:45:31.670 would be better off, that that would solve the 00:45:31.670 --> 00:45:33.789 problem. And you have, you know, a profession 00:45:33.789 --> 00:45:36.929 where we train diligently not to die. And I always 00:45:36.929 --> 00:45:38.550 say, if you stand on the top of us, you know, 00:45:38.550 --> 00:45:41.150 a high rise building and go near the edge as 00:45:41.150 --> 00:45:44.010 an invisible hand, like pushing you back. I feel 00:45:44.010 --> 00:45:46.489 like through this change of, you know, brain 00:45:46.489 --> 00:45:49.559 chemistry, you know, psychology. That hand almost 00:45:49.559 --> 00:45:51.760 goes behind you and is pushing you towards the 00:45:51.760 --> 00:45:55.840 edge now. So in all the people that you hear 00:45:55.840 --> 00:45:57.820 that are really getting close to that suicidal 00:45:57.820 --> 00:46:02.179 point, talk to me about that distorted reality 00:46:02.179 --> 00:46:06.199 and that. belief that they are the problem and 00:46:06.199 --> 00:46:08.780 if they just take their own life everyone will 00:46:08.780 --> 00:46:10.519 be better because we've talked about suicide 00:46:10.519 --> 00:46:13.300 being cowardly and selfish but when you hear 00:46:13.300 --> 00:46:15.440 these people some of whom have survived survived 00:46:15.440 --> 00:46:17.599 their attempts that have been on the show you 00:46:17.599 --> 00:46:20.480 realize at that moment in that distorted mind 00:46:20.480 --> 00:46:23.500 it was actually a courageous and selfless act 00:46:23.500 --> 00:46:26.199 even though to a healthy mind it made no sense 00:46:26.199 --> 00:46:30.639 yeah it's such a difficult subject to talk about 00:46:30.639 --> 00:46:33.880 um And especially if somebody's lost a loved 00:46:33.880 --> 00:46:37.980 one to suicide themselves. And of course, in 00:46:37.980 --> 00:46:40.719 some ways, it's a moot point because we don't 00:46:40.719 --> 00:46:44.059 know the psychology and the cognitions of a person 00:46:44.059 --> 00:46:49.719 who completes suicide. We can't. We can know 00:46:49.719 --> 00:46:52.219 those that attempt suicide and don't complete 00:46:52.219 --> 00:46:56.519 it. And then indeed, they say the things like 00:46:56.519 --> 00:47:00.219 you're saying. They may do it to escape their 00:47:00.219 --> 00:47:03.829 own pain. And the commonest thing you hear is 00:47:03.829 --> 00:47:08.070 I just want the pain to stop. And this will make 00:47:08.070 --> 00:47:11.150 the pain stop. And again, another reason you 00:47:11.150 --> 00:47:13.110 might say is not just for me, but I want the 00:47:13.110 --> 00:47:15.570 pain to stop for those other people because I'm 00:47:15.570 --> 00:47:18.369 also causing them pain. But of course, as you 00:47:18.369 --> 00:47:21.949 rightly say, when a person dies from suicide, 00:47:22.230 --> 00:47:26.530 that causes immense pain to all these people 00:47:26.530 --> 00:47:31.300 they were hoping to protect. So it's very hard 00:47:31.300 --> 00:47:34.019 to know what's actually happening. I think the 00:47:34.019 --> 00:47:36.639 other side, the sort of existential philosophical 00:47:36.639 --> 00:47:41.920 side is, I suppose everybody does have that option 00:47:41.920 --> 00:47:54.239 to live or die by their hand. And in some strange 00:47:54.239 --> 00:47:58.400 way, we have to almost respect that decision. 00:47:59.280 --> 00:48:03.460 How ghastly though it is when someone is in such 00:48:03.460 --> 00:48:06.500 a position that they take that decision. And 00:48:06.500 --> 00:48:10.079 we're mental health workers because we don't 00:48:10.079 --> 00:48:13.099 believe that is ever the right decision. And 00:48:13.099 --> 00:48:18.840 there has to be an alternative to that. But there 00:48:18.840 --> 00:48:21.360 is also that in the mix, that it is a philosophical 00:48:21.360 --> 00:48:24.219 decision for a person to make. And of course, 00:48:24.219 --> 00:48:28.440 not all people who take their lives. have mental 00:48:28.440 --> 00:48:32.820 illness. Some people do decide to make that decision 00:48:32.820 --> 00:48:36.280 in a degree of clear consciousness. I think it's 00:48:36.280 --> 00:48:39.000 relatively rare. And of course, we wouldn't be 00:48:39.000 --> 00:48:41.000 doing our jobs as psychiatrists if we believed 00:48:41.000 --> 00:48:45.960 that that was a reasonable way out. But yeah, 00:48:46.039 --> 00:48:48.400 when you look at society, and particularly post 00:48:48.400 --> 00:48:53.280 -COVID, and then really sadly, you throw in the 00:48:53.280 --> 00:48:55.159 fact that people are not getting resources and 00:48:55.159 --> 00:48:58.610 not getting access to support and care. more 00:48:58.610 --> 00:49:01.090 and more people are thinking that that is a valid 00:49:01.090 --> 00:49:03.489 way out to end their pain and to end the pain 00:49:03.489 --> 00:49:06.409 of others. And it's tragic. That's tragic. Yeah. 00:49:06.489 --> 00:49:09.190 I mean, you just alluded exactly to the point 00:49:09.190 --> 00:49:11.409 that I'm hearing is the people that actually 00:49:11.409 --> 00:49:13.969 went through with it. Kevin Hines, when he left 00:49:13.969 --> 00:49:16.329 the Golden Gate Bridge, Emma Benoit, when she 00:49:16.329 --> 00:49:18.969 pulled the trigger, immediately there's this 00:49:18.969 --> 00:49:23.460 kind of return to... to the original state, to 00:49:23.460 --> 00:49:25.280 their healthy mind state. And it's like, no, 00:49:25.360 --> 00:49:27.360 I don't want to do this. And thank God they survived. 00:49:28.360 --> 00:49:31.019 But you hear, especially with the use of alcohol 00:49:31.019 --> 00:49:33.000 as well, there's that blurring of consciousness 00:49:33.000 --> 00:49:36.000 by that point. So yeah, if you've got someone 00:49:36.000 --> 00:49:38.940 who's got ALS and they're end stage and they 00:49:38.940 --> 00:49:42.449 choose euthanasia. With a healthy mind, absolutely, 00:49:42.730 --> 00:49:45.630 that should 100 % be everyone's choice. But it's 00:49:45.630 --> 00:49:47.909 when the unhealthy mind is telling them lies 00:49:47.909 --> 00:49:50.690 that I think that your profession and the other 00:49:50.690 --> 00:49:54.510 world of psychology and psychedelics, that's 00:49:54.510 --> 00:49:56.329 where we're able, I hope, to pull the people 00:49:56.329 --> 00:50:00.590 back from the edge, restore their original frame 00:50:00.590 --> 00:50:02.510 of mind, and then hopefully they'll be like, 00:50:02.590 --> 00:50:04.829 oh, thank God I didn't do that. That would have 00:50:04.829 --> 00:50:08.230 been amazing. Like you say, the acute event itself. 00:50:09.480 --> 00:50:12.619 is very, very often associated with alcohol or 00:50:12.619 --> 00:50:15.900 other drugs because of their disinhibiting effect. 00:50:16.420 --> 00:50:20.000 So not just having an addiction to those substances 00:50:20.000 --> 00:50:22.619 and all of the destruction that that causes, 00:50:22.699 --> 00:50:25.320 but the acute event, the disinhibition. I mean, 00:50:25.340 --> 00:50:27.840 we've all said and done things when drunk that 00:50:27.840 --> 00:50:30.840 we wouldn't have done when sober. And that also 00:50:30.840 --> 00:50:34.559 accounts for self -harm and completed suicide. 00:50:36.519 --> 00:50:38.480 I'm not sure what the figure is. I think it's 00:50:38.480 --> 00:50:42.599 something like 90 percent of suicides that the 00:50:42.599 --> 00:50:44.679 patient is intoxicated with alcohol. Don't quote 00:50:44.679 --> 00:50:49.559 me on that, but it's very high. Yeah. But then 00:50:49.559 --> 00:50:51.239 we all get drunk and we don't all try and kill 00:50:51.239 --> 00:50:53.480 ourselves. So it's not that the two go together. 00:50:54.739 --> 00:50:57.639 It's obviously rooted in longer term mental health 00:50:57.639 --> 00:50:59.300 problems and strife. And that's where we can 00:50:59.300 --> 00:51:01.639 intervene. I think one thing that I've just reminded 00:51:01.639 --> 00:51:07.519 of in what we're talking about here is. You talk 00:51:07.519 --> 00:51:09.619 about those people who came back from an almost 00:51:09.619 --> 00:51:14.679 completed suicide with a new life or a new lifestyle 00:51:14.679 --> 00:51:18.099 or a new reflection. I've always been sort of 00:51:18.099 --> 00:51:23.340 cautious about that narrative that somehow awful 00:51:23.340 --> 00:51:26.539 trauma makes you stronger. I hate that phrase, 00:51:26.639 --> 00:51:28.500 that that doesn't kill me makes me stronger. 00:51:28.980 --> 00:51:32.179 It's not true. In the majority of cases, that 00:51:32.179 --> 00:51:36.159 that doesn't kill me. gives me ptsd and heroin 00:51:36.159 --> 00:51:39.739 addiction you know um it's a bit of a romantic 00:51:39.739 --> 00:51:44.079 idea that when we're stressed and we're pushed 00:51:44.079 --> 00:51:46.980 and we lose our jobs and we lose our money and 00:51:46.980 --> 00:51:49.980 we lose our family and we lose our hope that 00:51:49.980 --> 00:51:53.260 somehow there's this amazing ray of sunshine 00:51:53.260 --> 00:51:56.900 that comes out of such adversity and means oh 00:51:56.900 --> 00:51:59.619 now we're going to be okay because we've experienced 00:51:59.619 --> 00:52:03.179 such lows That's not what the statistics show 00:52:03.179 --> 00:52:08.400 us. Adversity causes pain. It's a very Hollywood 00:52:08.400 --> 00:52:13.360 Disney idea that extreme adversity turns you 00:52:13.360 --> 00:52:16.139 into a strong fighter. It usually doesn't. It 00:52:16.139 --> 00:52:18.800 usually kills you. You know, why do we avoid 00:52:18.800 --> 00:52:23.360 adversity? Because it kills us. And I think going 00:52:23.360 --> 00:52:24.960 back to what you said about, you know, the idea 00:52:24.960 --> 00:52:30.780 of reducing stigma. Part of that is being able 00:52:30.780 --> 00:52:34.940 to say, I am really, really unwell and really 00:52:34.940 --> 00:52:39.139 unhappy. And no, I haven't been made stronger 00:52:39.139 --> 00:52:43.440 by losing my job, my money, my family. It hasn't 00:52:43.440 --> 00:52:45.780 turned me into this, wow, everything's going 00:52:45.780 --> 00:52:47.980 to be great now. It's actually killing me and 00:52:47.980 --> 00:52:51.900 I might die from it. And I think sometimes sufferers 00:52:51.900 --> 00:52:55.619 of PTSD, they see that sort of Hollywood Disney 00:52:55.619 --> 00:52:59.219 message that... adversity will make you strong. 00:52:59.599 --> 00:53:02.360 It doesn't usually. It usually kills you. That's 00:53:02.360 --> 00:53:04.480 why it's adverse. I don't know what you think 00:53:04.480 --> 00:53:06.219 about that. Do you get what I'm saying there? 00:53:06.679 --> 00:53:09.760 I think so. Those events, it was immediately 00:53:09.760 --> 00:53:12.940 like the split second after the suicide attempt 00:53:12.940 --> 00:53:15.820 that they had this no moment. So it wasn't like 00:53:15.820 --> 00:53:18.280 they suddenly were stronger. Where I see the 00:53:18.280 --> 00:53:19.960 strength, and I've talked about this a lot, and 00:53:19.960 --> 00:53:22.320 I think this is what we need from the mental 00:53:22.320 --> 00:53:25.320 health conversation now, is where that strength 00:53:25.320 --> 00:53:28.369 is gained is that journey. you know, MDMA, whatever 00:53:28.369 --> 00:53:31.489 the toolbox that you choose, that healing journey, 00:53:31.590 --> 00:53:33.309 that growth journey, because yeah, the adverse 00:53:33.309 --> 00:53:36.190 event, I agree with you 100 % was horrible. That's 00:53:36.190 --> 00:53:40.070 why it's a trauma. But doing the work then, and 00:53:40.070 --> 00:53:41.849 obviously, ultimately, you're going to unpack 00:53:41.849 --> 00:53:44.389 in my profession, well, it's not just that horrible 00:53:44.389 --> 00:53:47.710 car crash that we went to. It's actually This 00:53:47.710 --> 00:53:49.949 happened when I was a child and this relationship 00:53:49.949 --> 00:53:52.090 issue and this financial issue. And you start 00:53:52.090 --> 00:53:56.110 addressing the laundry list of other things that 00:53:56.110 --> 00:53:58.050 you've kind of buried down in the past. So I 00:53:58.050 --> 00:54:00.510 think that's the hope of post -traumatic growth 00:54:00.510 --> 00:54:03.650 is the journey that you go, the healing journey. 00:54:03.789 --> 00:54:08.110 And then being James 2 .0, not like I'm 18 -year 00:54:08.110 --> 00:54:10.269 -old James or 12 -year -old James. I'm a totally 00:54:10.269 --> 00:54:13.809 different person. But I think then seeing those 00:54:13.809 --> 00:54:16.119 people that have gone through it. the empathy, 00:54:16.199 --> 00:54:18.440 the compassion, you know, it's not that they're 00:54:18.440 --> 00:54:20.619 bulletproof anymore. It's just that they've been 00:54:20.619 --> 00:54:23.260 there. It's kind of that analogy with the man 00:54:23.260 --> 00:54:25.699 in the hole, you know, the man jumps down. He's 00:54:25.699 --> 00:54:27.440 like, why did you jump in with me? He said, because 00:54:27.440 --> 00:54:29.059 I've been here before. I know how to get out. 00:54:29.300 --> 00:54:31.920 That to me is the kind of post -traumatic growth. 00:54:32.039 --> 00:54:34.800 Not as you said, oh, because I lost my child. 00:54:34.900 --> 00:54:37.320 Now that was a gift from God. And now I'm going 00:54:37.320 --> 00:54:39.599 to have this superpower. I think it's just these 00:54:39.599 --> 00:54:41.639 traumas send us on this healing journey. And 00:54:41.639 --> 00:54:43.960 that's really what the superpower is. You're 00:54:43.960 --> 00:54:47.280 absolutely right. The adversity and the trauma 00:54:47.280 --> 00:54:50.420 itself is not inherently strengthening. It's 00:54:50.420 --> 00:54:55.599 inherently damaging. But what you do with it 00:54:55.599 --> 00:54:59.340 afterwards can result in this kind of epiphany 00:54:59.340 --> 00:55:03.199 of new direction in life. I mean, you know, I 00:55:03.199 --> 00:55:06.119 mean, we're in agreement here. And we take these 00:55:06.119 --> 00:55:07.679 things for granted now with our understanding 00:55:07.679 --> 00:55:10.739 of trauma. But it wasn't that long ago that even 00:55:10.739 --> 00:55:13.000 science didn't see things like that. You know, 00:55:13.000 --> 00:55:15.710 the Victorians talked about tough love. It's 00:55:15.710 --> 00:55:17.909 good to beat children. It's good for them. It 00:55:17.909 --> 00:55:20.550 makes them strong. And that's where this phrase, 00:55:20.650 --> 00:55:22.389 that that didn't kill me, made me strong. This 00:55:22.389 --> 00:55:24.369 is where that phrase came from. The idea that 00:55:24.369 --> 00:55:27.489 adversity is somehow good and to be welcomed. 00:55:28.110 --> 00:55:31.289 And we have thankfully moved on from that, you 00:55:31.289 --> 00:55:34.690 know, because most of the time it doesn't result 00:55:34.690 --> 00:55:36.750 in good outcomes. It results in poor outcomes. 00:55:37.960 --> 00:55:40.380 so we have moved on by far the best way to to 00:55:40.380 --> 00:55:43.079 make a strong a child strong is to love them 00:55:43.079 --> 00:55:46.480 and cuddle them and praise them and and give 00:55:46.480 --> 00:55:49.300 them a nice warm gentle life that's the way to 00:55:49.300 --> 00:55:51.960 make a child strong not to hurt them and humiliate 00:55:51.960 --> 00:55:54.820 them and and beat them up to make them tough 00:55:54.820 --> 00:55:57.599 but you know like i said it wasn't long ago in 00:55:57.599 --> 00:56:00.199 society and in psychiatry that we didn't see 00:56:00.199 --> 00:56:03.840 things like that I use that example of Victorian 00:56:03.840 --> 00:56:05.920 times. That's when we used to have children in 00:56:05.920 --> 00:56:07.960 factories and going up chimneys at five years 00:56:07.960 --> 00:56:10.039 old. So just because that's the way they used 00:56:10.039 --> 00:56:14.059 to do it doesn't mean it's right. But, you know, 00:56:14.079 --> 00:56:16.300 if you look at it the other way, paradoxically, 00:56:16.320 --> 00:56:18.639 look at the high levels of mental illness that 00:56:18.639 --> 00:56:22.099 we seem to have. Well, with that being said, 00:56:22.199 --> 00:56:25.840 what about the prevalence in... Knife crime and 00:56:25.840 --> 00:56:27.500 those kind of things that we're seeing. What's 00:56:27.500 --> 00:56:29.420 your perspective through a psychiatrist lens 00:56:29.420 --> 00:56:32.059 as far as the root cause of this violence that 00:56:32.059 --> 00:56:36.159 our children are seeming to lean into now? I 00:56:36.159 --> 00:56:41.079 think, again, it's multiple factors. I would 00:56:41.079 --> 00:56:44.920 say it's probably more than anything, it's psychosocial 00:56:44.920 --> 00:56:50.519 factors of just economics and poverty and poor 00:56:50.519 --> 00:56:55.920 education and lack of opportunity. Knife crime 00:56:55.920 --> 00:57:00.179 exists amongst richer kids, but it's much, much 00:57:00.179 --> 00:57:05.300 smaller. And then you've got the internet, the 00:57:05.300 --> 00:57:11.300 media, the glamorization of that. It's really 00:57:11.300 --> 00:57:14.079 scary for young people. You know, I've got teenage 00:57:14.079 --> 00:57:18.000 children and it's really scary to think that 00:57:18.000 --> 00:57:21.380 they could be involved in, you know, a skirmish 00:57:21.380 --> 00:57:23.960 on the street at night. and could be stabbed. 00:57:26.840 --> 00:57:29.500 I'd like to think that, you know, my children 00:57:29.500 --> 00:57:31.440 wouldn't instigate such a thing, but they could 00:57:31.440 --> 00:57:34.400 be a victim of it, you know? But of course it 00:57:34.400 --> 00:57:36.280 could be anybody. So yeah, these things seem 00:57:36.280 --> 00:57:38.800 to, they go hand in hand with social deprivation 00:57:38.800 --> 00:57:43.639 and social stress. And I think, I don't know 00:57:43.639 --> 00:57:46.199 enough about this in terms of the clear data, 00:57:46.400 --> 00:57:48.900 but I think that from what I understand, issues 00:57:48.900 --> 00:57:51.780 like the glamorization in certain aspects of 00:57:51.780 --> 00:57:56.409 the media. and the access to the internet augment 00:57:56.409 --> 00:58:00.289 the problem, as far as I can understand. But 00:58:00.289 --> 00:58:04.750 that's kind of a lay opinion. Shifting back to 00:58:04.750 --> 00:58:08.289 MDMA, and then we'll get to the book. I remember 00:58:08.289 --> 00:58:10.690 in our first conversation that it was originally 00:58:10.690 --> 00:58:15.449 a marriage counseling style drug. So I'm assuming 00:58:15.449 --> 00:58:19.869 back then there was a level of approval. So how... 00:58:20.329 --> 00:58:23.130 is a drug that was for a while actually approved 00:58:23.130 --> 00:58:26.289 to being used then demonized to the point where 00:58:26.289 --> 00:58:29.070 even in 2025 you guys can't get that it regulated 00:58:29.070 --> 00:58:32.449 again well it was never approved it's never been 00:58:32.449 --> 00:58:35.650 approved it's just it wasn't an illegal substance 00:58:35.650 --> 00:58:39.670 on the list of banned substances so mdma therapy 00:58:39.670 --> 00:58:43.250 came to the fore in the sort of mid to late 70s 00:58:43.599 --> 00:58:46.340 And it was taken up particularly by a group of 00:58:46.340 --> 00:58:48.579 psychotherapists who had been LSD therapists 00:58:48.579 --> 00:58:53.820 in the 60s. So, of course, LSD psychotherapy 00:58:53.820 --> 00:58:58.039 became a relatively big thing in psychiatry in 00:58:58.039 --> 00:59:01.360 the late 50s and early 60s. And it was being 00:59:01.360 --> 00:59:03.300 used on tens of thousands of patients. And it 00:59:03.300 --> 00:59:05.260 was it was effective and it was safe and it was 00:59:05.260 --> 00:59:09.500 doing well. And then, of course, the 1960s. drug 00:59:09.500 --> 00:59:13.079 revolution happened and Timothy Leary and psychedelia 00:59:13.079 --> 00:59:15.980 and the rest of it. LSD was banned pretty much 00:59:15.980 --> 00:59:19.579 everywhere by the end of the 60s. And the doctors 00:59:19.579 --> 00:59:21.800 and the therapists stopped using it. Of course, 00:59:21.800 --> 00:59:23.679 the banning did nothing to stop the recreational 00:59:23.679 --> 00:59:27.420 use, which kind of spiraled ever since. So banning 00:59:27.420 --> 00:59:29.079 things doesn't make them go away, but it does 00:59:29.079 --> 00:59:31.820 make respectable people like doctors not use 00:59:31.820 --> 00:59:34.000 them if they're told they're not allowed to. 00:59:34.099 --> 00:59:38.780 So MDMA came in in the late 70s. It had been 00:59:38.780 --> 00:59:42.579 around since 1912, but it wasn't really a recreationally 00:59:42.579 --> 00:59:45.679 used drug. It was pretty much unheard of until 00:59:45.679 --> 00:59:49.760 it was rediscovered, if you like, by a chap called 00:59:49.760 --> 00:59:54.860 Sasha Shulgin, who introduced it to another psychotherapist 00:59:54.860 --> 00:59:59.000 called Leo Zeff. And he was using it. He was 00:59:59.000 --> 01:00:01.679 previously an LSD psychotherapist and he'd stopped 01:00:01.679 --> 01:00:05.079 using LSD when it was banned. But then when he 01:00:05.079 --> 01:00:07.539 was introduced to MDMA. It wasn't a banned substance. 01:00:07.659 --> 01:00:10.500 It wasn't even a known substance. So it wasn't 01:00:10.500 --> 01:00:12.380 that it was licensed. It's just that it wasn't 01:00:12.380 --> 01:00:16.699 banned. And then lots of success with thousands 01:00:16.699 --> 01:00:20.059 of patients. But then MDMA went broadly the same 01:00:20.059 --> 01:00:24.420 direction as LSD had done 10, 15, 20 years earlier. 01:00:24.559 --> 01:00:28.480 It leaked from the medical community, started 01:00:28.480 --> 01:00:30.739 turning up in nightclubs and police seizures. 01:00:31.000 --> 01:00:36.389 And then it became banned in 1985. And then since 01:00:36.389 --> 01:00:39.230 then, that's when Rick Doblin set up MAPS in 01:00:39.230 --> 01:00:44.010 1985, 86. And since then, he and MAPS have been 01:00:44.010 --> 01:00:46.550 working to unban it, if you like, and get it 01:00:46.550 --> 01:00:49.590 licensed as a medicine. That's where we are today. 01:00:49.769 --> 01:00:52.269 It's still not quite over the line. There's been 01:00:52.269 --> 01:00:54.510 lots and lots of research over the last 20, 30 01:00:54.510 --> 01:00:56.650 years. Hundreds, thousands of patients have been 01:00:56.650 --> 01:01:00.409 treated legally with MDMA in research settings, 01:01:00.570 --> 01:01:02.869 but it's still not over the line as a licensed 01:01:02.869 --> 01:01:08.030 medicine. What are you seeing as far as the resistance? 01:01:08.510 --> 01:01:11.349 For example, I've had a few guests on when it 01:01:11.349 --> 01:01:15.590 comes to CBD, literally hemp -based therapeutic 01:01:15.590 --> 01:01:18.809 plant medicine, no kind of real psychoactive 01:01:18.809 --> 01:01:21.429 effect whatsoever, and they've had such resistance. 01:01:21.769 --> 01:01:25.210 Now, my perspective is obviously there's so much 01:01:25.210 --> 01:01:27.389 money in other drugs, you can see that there 01:01:27.389 --> 01:01:30.909 would be pressure from markets that would be 01:01:30.909 --> 01:01:34.300 threatened if... addiction mental health were 01:01:34.300 --> 01:01:37.579 vastly improved in a much smaller amount of you 01:01:37.579 --> 01:01:41.179 know therapeutic applications from behind the 01:01:41.179 --> 01:01:44.159 scenes why is there so much resistance to you 01:01:44.159 --> 01:01:46.840 know whether it's iboga mdma psilocybin these 01:01:46.840 --> 01:01:49.559 compounds that are clearly having a lot of effects 01:01:49.559 --> 01:01:51.760 as you said you know whether it's a hundred year 01:01:51.760 --> 01:01:54.360 of the drugs being here or in some of these plant 01:01:54.360 --> 01:01:57.760 medicines even thousands of years yeah i mean 01:01:59.079 --> 01:02:02.400 My sense is there isn't actually lots of resistance. 01:02:02.639 --> 01:02:05.780 It just simply hasn't jumped through the hoops 01:02:05.780 --> 01:02:09.519 and got the approval. Yeah, sometimes people 01:02:09.519 --> 01:02:13.000 say, hey, man, the reason governments ban LSD 01:02:13.000 --> 01:02:16.400 and mushrooms is because they know that if people's 01:02:16.400 --> 01:02:18.300 eyes were opened and they became enlightened 01:02:18.300 --> 01:02:21.460 by these compounds, they would rise up against 01:02:21.460 --> 01:02:24.260 the governments and be free. I just don't believe 01:02:24.260 --> 01:02:27.320 that for a second. I think that is massively 01:02:27.320 --> 01:02:30.719 flattering. the intelligence of governments that 01:02:30.719 --> 01:02:33.440 they have that kind of a narrative going on. 01:02:33.880 --> 01:02:36.980 You know, I would be incredibly impressed if 01:02:36.980 --> 01:02:38.840 there's members of the government saying that 01:02:38.840 --> 01:02:41.300 we can't let psychedelics become legal because 01:02:41.300 --> 01:02:44.300 then everyone would rise. That's absurd. The 01:02:44.300 --> 01:02:46.340 reason psychedelics are not legal is because 01:02:46.340 --> 01:02:48.639 the governments have no idea about their benefit 01:02:48.639 --> 01:02:51.039 and potential. The reason they're illegal is 01:02:51.039 --> 01:02:52.920 because they think of them as crack and heroin. 01:02:53.159 --> 01:02:56.139 They think that magic mushrooms, MDMA and psilocybin. 01:02:56.440 --> 01:02:58.900 are the same as crack and heroin. They're killer, 01:02:58.940 --> 01:03:01.539 dangerous, addictive drugs. And that's why they're 01:03:01.539 --> 01:03:03.639 not being used. It's not because they're trying 01:03:03.639 --> 01:03:07.320 to save themselves from the magical therapeutic 01:03:07.320 --> 01:03:10.460 properties of these drugs. If only they were 01:03:10.460 --> 01:03:13.920 so bright and astute to be banning them for that 01:03:13.920 --> 01:03:16.179 reason. So the reason they haven't got over the 01:03:16.179 --> 01:03:18.360 line is they simply haven't jumped through the 01:03:18.360 --> 01:03:21.619 hoops that are required for licensed medicines. 01:03:25.539 --> 01:03:28.340 It is more complex than that. Why have they not 01:03:28.340 --> 01:03:29.960 jumped through the hoops? Because they haven't 01:03:29.960 --> 01:03:32.019 had the money spent on them to jump them through 01:03:32.019 --> 01:03:34.820 the hoops. It's incredibly expensive to get a 01:03:34.820 --> 01:03:38.260 drug to market, whether it's an antibiotic, an 01:03:38.260 --> 01:03:40.320 analgesic, a cancer drug or a psychedelic. It 01:03:40.320 --> 01:03:42.119 doesn't matter. It's the same rules for all of 01:03:42.119 --> 01:03:45.059 those. There's not extra rules for psychedelics. 01:03:45.219 --> 01:03:47.719 All of those different compounds of drug have 01:03:47.719 --> 01:03:50.539 to jump through the same hoops. to get licensed. 01:03:50.719 --> 01:03:53.539 And it costs loads of money. It costs $150 million 01:03:53.539 --> 01:03:57.440 and it takes 15, 20, 25 years. So we're just 01:03:57.440 --> 01:04:01.519 on that journey. Now, it's certainly, on the 01:04:01.519 --> 01:04:03.639 other hand, arguable that because there is a 01:04:03.639 --> 01:04:07.400 stigma around these drugs, perhaps getting licenses 01:04:07.400 --> 01:04:11.099 to do research studies is harder. Certainly because 01:04:11.099 --> 01:04:16.300 they're scheduled drugs, Schedule 1 drugs, it 01:04:16.300 --> 01:04:18.920 costs a lot of money and it's difficult and complex 01:04:18.920 --> 01:04:22.599 to get. permission to do research on them but 01:04:22.599 --> 01:04:24.960 it's not impossible and it's not blocked because 01:04:24.960 --> 01:04:29.199 of stigma at least not that's not the main reason 01:04:29.199 --> 01:04:31.860 if we had the money they would be over the line 01:04:31.860 --> 01:04:35.099 if now then that goes back to the other part 01:04:35.099 --> 01:04:37.179 of the question why would we not have the money 01:04:37.179 --> 01:04:40.639 why are big pharma not spending money on psychedelics 01:04:40.639 --> 01:04:43.900 i again i think it's a bit of a urban myth amongst 01:04:43.900 --> 01:04:46.739 the psychedelic community that big pharma are 01:04:46.739 --> 01:04:48.670 suppressing it because they're They're terrified 01:04:48.670 --> 01:04:51.909 of the competition. We are nowhere near psychedelics 01:04:51.909 --> 01:04:57.289 being a competition for SSRIs. It's a multi -trillion 01:04:57.289 --> 01:05:00.369 dollar industry with millions of people on SSRIs. 01:05:01.329 --> 01:05:03.769 I don't think that big pharma are suppressing 01:05:03.769 --> 01:05:05.969 psychedelics because they just don't fear any 01:05:05.969 --> 01:05:08.130 competition. They just don't see them as a competitor. 01:05:09.170 --> 01:05:11.110 The main reason they're not putting money into 01:05:11.110 --> 01:05:12.570 it is because they don't see them as a money 01:05:12.570 --> 01:05:15.510 spinner. In a way, psychedelic medicine is a 01:05:15.510 --> 01:05:18.710 marketing nightmare. it's it's it's a terrible 01:05:18.710 --> 01:05:22.090 idea you only need to use the drug two or three 01:05:22.090 --> 01:05:25.590 times and then you're better it's it's a marketing 01:05:25.590 --> 01:05:28.269 nightmare psychedelics and this is if we get 01:05:28.269 --> 01:05:30.269 on to talking about the contemporary psychedelic 01:05:30.269 --> 01:05:32.550 industry and what's happened in the last five 01:05:32.550 --> 01:05:34.550 ten years part of the reason why we saw this 01:05:34.550 --> 01:05:38.590 big peak about five seven years ago loads of 01:05:38.590 --> 01:05:40.789 money came pouring into psychedelics ironically 01:05:40.789 --> 01:05:43.710 most of it from the canadian and californian 01:05:44.079 --> 01:05:46.380 cannabis industry people who'd made their money 01:05:46.380 --> 01:05:48.820 in cannabis medicine decided to turn turn their 01:05:48.820 --> 01:05:50.940 attention to psychedelics thinking they would 01:05:50.940 --> 01:05:54.199 make billions psychedelics and cannabis could 01:05:54.199 --> 01:05:56.340 not be more different i mean they get put in 01:05:56.340 --> 01:05:57.880 the same box because they're both recreational 01:05:57.880 --> 01:06:00.639 drugs but from a medical practitioner point of 01:06:00.639 --> 01:06:03.159 view they couldn't be more different cannabis 01:06:03.159 --> 01:06:05.760 is a daily maintenance drug that has to be taken 01:06:05.760 --> 01:06:08.619 every day day out day in day out you get someone 01:06:08.619 --> 01:06:12.289 onto cannabis as a medicine You're going to make 01:06:12.289 --> 01:06:13.889 millions because they're going to carry on using 01:06:13.889 --> 01:06:17.429 it. Who's going to spend $150 million on getting 01:06:17.429 --> 01:06:19.929 MDMA over the line as a licensed medicine when, 01:06:19.989 --> 01:06:23.929 A, it's off patent. Nobody owns MDMA. No one 01:06:23.929 --> 01:06:28.949 owns MDMA or psilocybin or LSD or 5 -MeO -DMT 01:06:28.949 --> 01:06:31.409 or DMT. These are not patented drugs. These are 01:06:31.409 --> 01:06:33.750 not molecules that are owned by anyone. Who's 01:06:33.750 --> 01:06:36.730 going to put $150 million into all of that research 01:06:36.730 --> 01:06:39.829 to then come up with a licensed drug that's free 01:06:39.829 --> 01:06:43.730 anyway? um and you only have to take it once 01:06:43.730 --> 01:06:45.750 or twice or three times and then never again 01:06:45.750 --> 01:06:51.710 and you're better um and so it's not that i don't 01:06:51.710 --> 01:06:53.550 think it's this is i don't think it's that the 01:06:53.550 --> 01:06:55.530 pharma industry fear psychedelics i just think 01:06:55.530 --> 01:06:57.409 they they can't be bothered there's no money 01:06:57.409 --> 01:06:59.929 to be made in them um it's a waste of money to 01:06:59.929 --> 01:07:01.329 put all that money into something that they're 01:07:01.329 --> 01:07:03.869 not going to reap back their r d costs on you 01:07:03.869 --> 01:07:07.789 know when you make a new prozac or or cannabis 01:07:07.789 --> 01:07:11.000 product or i don't know uh viagra or one of these 01:07:11.000 --> 01:07:14.059 wonder drugs that you use frequently you reap 01:07:14.059 --> 01:07:17.659 back your 150 million dollars of r d costs um 01:07:17.659 --> 01:07:19.940 because you've got patients on maintenance drugs 01:07:19.940 --> 01:07:22.780 psychedelics are not maintenance drugs they're 01:07:22.780 --> 01:07:25.159 they're a marketing nightmare and that's why 01:07:25.159 --> 01:07:27.820 we saw this peak of all sorts of clinics like 01:07:27.820 --> 01:07:29.880 the one where i worked in in the uk we opened 01:07:29.880 --> 01:07:32.619 the uk's first medical psychedelic clinic lots 01:07:32.619 --> 01:07:35.039 of money came pouring in and then it just wasn't 01:07:35.039 --> 01:07:38.480 possible to make any revenue because it's very 01:07:38.480 --> 01:07:42.079 expensive to deliver psychedelic therapy and 01:07:42.079 --> 01:07:46.400 so far nobody really has come up with a decent 01:07:46.400 --> 01:07:50.059 viable economic model that makes it worth spending 01:07:50.059 --> 01:07:52.619 money on setting up psychedelic therapy clinics 01:07:54.119 --> 01:07:56.119 It's so funny because this brings us right back 01:07:56.119 --> 01:07:57.679 to the beginning of the conversation with the 01:07:57.679 --> 01:08:00.760 NHS and how expensive it is for medicine. Well, 01:08:00.840 --> 01:08:03.340 if you have, for example, MDMA, where you have 01:08:03.340 --> 01:08:06.199 three sessions with it and you just keep seeing 01:08:06.199 --> 01:08:10.699 healing progressing or Iboga or whatever the 01:08:10.699 --> 01:08:14.719 thing is, then that's a patient -centric model. 01:08:14.940 --> 01:08:17.279 But as you said, you can't get rich out of that. 01:08:17.439 --> 01:08:19.739 So how do we fix the healthcare systems of the 01:08:19.739 --> 01:08:23.430 world? You know, we bolster the proactive elements 01:08:23.430 --> 01:08:26.170 and then you're left with pediatric cancer and 01:08:26.170 --> 01:08:28.829 trauma medicine and these areas that do need 01:08:28.829 --> 01:08:31.569 a lot of research and funding. So this is great 01:08:31.569 --> 01:08:34.489 that we've come around to this because we've 01:08:34.489 --> 01:08:36.590 come around to me completely contradicting myself. 01:08:36.729 --> 01:08:38.649 And I'm glad because this is where I wanted us 01:08:38.649 --> 01:08:43.409 to land. Whilst there's no money to be made from 01:08:43.409 --> 01:08:47.210 a profit driven business of psychedelic provision. 01:08:48.270 --> 01:08:50.590 What we do know, and I say this in my talks all 01:08:50.590 --> 01:08:52.930 the time, there is nothing more expensive than 01:08:52.930 --> 01:08:55.829 the untreated psychiatric patient. Psychiatric 01:08:55.829 --> 01:08:59.350 patients cost millions over a lifetime. If you 01:08:59.350 --> 01:09:02.350 allow that person in their teens with mild anxiety 01:09:02.350 --> 01:09:06.649 and depression or PTSD to germinate into a full 01:09:06.649 --> 01:09:09.670 blown psychiatric patient, they will cost millions 01:09:09.670 --> 01:09:12.350 over a lifetime. Every time they go into hospital, 01:09:12.390 --> 01:09:15.829 it's 10 ,000 pounds a week. They offend. They 01:09:15.829 --> 01:09:17.850 go to prison. They don't work. They're on disability 01:09:17.850 --> 01:09:20.890 benefits. The family law courts take away their 01:09:20.890 --> 01:09:23.189 children. They don't work. Transgenerational 01:09:23.189 --> 01:09:26.510 unemployment because of sub -treated or untreated 01:09:26.510 --> 01:09:30.289 transgenerational mental illness. So we know 01:09:30.289 --> 01:09:33.229 it's very, very expensive to not treat mental 01:09:33.229 --> 01:09:36.970 health properly. So this is where you look at 01:09:36.970 --> 01:09:39.970 then psychedelics. So suppose a course of MDMA 01:09:39.970 --> 01:09:42.840 therapy cost, I don't know, suppose it costs 01:09:42.840 --> 01:09:45.960 40 ,000 pounds, 30 ,000 pounds. That's a lot 01:09:45.960 --> 01:09:48.340 of money and a hell of a lot more money than 01:09:48.340 --> 01:09:50.659 a packet of Prozac, which is like two pounds 01:09:50.659 --> 01:09:55.939 80 for 30 tablets. So we're not, so, so then 01:09:55.939 --> 01:09:57.439 that makes people think psychedelics are too 01:09:57.439 --> 01:09:59.659 expensive to deliver. We, you know, psychedelic 01:09:59.659 --> 01:10:01.979 therapy doesn't work. We can't afford to pay 01:10:01.979 --> 01:10:05.600 for these expensive two therapists, 12, 16 weeks. 01:10:06.920 --> 01:10:10.710 But It's preventative medicine, because if that 01:10:10.710 --> 01:10:16.489 30 ,000 pounds halts that 20 year old from becoming 01:10:16.489 --> 01:10:19.949 a lifelong psychiatric patient, you will reap 01:10:19.949 --> 01:10:24.189 back that 30 ,000 pounds very quickly. So the 01:10:24.189 --> 01:10:25.890 answer, going back to the beginning of our conversation, 01:10:26.069 --> 01:10:28.069 what's our magic wand to fix the mental health 01:10:28.069 --> 01:10:31.310 care system? It's people with very far reaching. 01:10:31.770 --> 01:10:34.590 understanding of preventative medicine that yes 01:10:34.590 --> 01:10:37.729 psychedelics are an expensive upfront cost but 01:10:37.729 --> 01:10:39.590 there's been some recent good health economic 01:10:39.590 --> 01:10:42.470 analyses done with MDMA and psilocybin and they 01:10:42.470 --> 01:10:47.029 are hugely beneficial and value for money hugely 01:10:47.029 --> 01:10:50.770 value for money because if you prevent that trajectory 01:10:50.770 --> 01:10:54.890 into a lifelong mental health psychiatric career 01:10:54.890 --> 01:11:00.170 patient you will more than mop up that expensive 01:11:00.170 --> 01:11:02.850 upfront cost. And it is expensive. And when a 01:11:02.850 --> 01:11:06.149 GP's got a queue of people with depression and 01:11:06.149 --> 01:11:10.329 anxiety, and he or she is endlessly writing scripts 01:11:10.329 --> 01:11:13.909 for Prozac for three pounds a shot, to get that 01:11:13.909 --> 01:11:16.390 GP to put his or her hand into their pocket to 01:11:16.390 --> 01:11:20.050 spend 40 grand on MDMA therapy, it seems like 01:11:20.050 --> 01:11:22.329 they're not going to do it. But then if you... 01:11:22.510 --> 01:11:24.369 If you ask that GP, what will happen with these 01:11:24.369 --> 01:11:26.449 patients who are being fobbed off with Prozac 01:11:26.449 --> 01:11:29.329 scripts, and they've been in mental health services 01:11:29.329 --> 01:11:32.970 for 40 years, they will have cost millions, millions 01:11:32.970 --> 01:11:38.529 and millions. So the answer is an enlightening 01:11:38.529 --> 01:11:42.510 look at the economic value of psychedelics, an 01:11:42.510 --> 01:11:44.810 appreciation that they are an expensive upfront 01:11:44.810 --> 01:11:48.210 cost. They are an invasive upfront cost. And 01:11:48.210 --> 01:11:49.970 that the pharma industry are probably not going 01:11:49.970 --> 01:11:51.930 to meet those costs because there's no pharma 01:11:51.930 --> 01:11:55.329 money to be made in it. So who's going to meet 01:11:55.329 --> 01:11:57.470 those costs? Who's going to pay that £40 ,000? 01:11:57.930 --> 01:12:00.970 It has to be public health care systems, really. 01:12:01.329 --> 01:12:03.609 It has to be public health care systems because 01:12:03.609 --> 01:12:05.289 they're the ones that are going to reap the benefits 01:12:05.289 --> 01:12:09.489 of bringing down that epidemic of mental illness 01:12:09.489 --> 01:12:12.149 that not only is morally, ethically, clinically 01:12:12.149 --> 01:12:15.590 wrong, but is also economically wrong for the 01:12:15.590 --> 01:12:18.899 public purse. There's an interesting comparison 01:12:18.899 --> 01:12:23.159 that I talk about a lot here. We have devolved 01:12:23.159 --> 01:12:26.779 as a profession, a lot of us in the US are firefighters 01:12:26.779 --> 01:12:29.399 and also paramedics. So we, you know, jack of 01:12:29.399 --> 01:12:31.920 all trades, master of none. These men and women 01:12:31.920 --> 01:12:34.439 are running, you know, 24 hours straight, usually 01:12:34.439 --> 01:12:38.779 on. everyone's worst day and the work week initially 01:12:38.779 --> 01:12:41.720 is 56 hours a week so you do a 24 hour shift 01:12:41.720 --> 01:12:44.340 and a 48 hour period off and then rinse and repeat 01:12:44.340 --> 01:12:48.000 for 10 20 30 years and there's obviously you 01:12:48.000 --> 01:12:51.460 know illustrate this too much. Over time, we 01:12:51.460 --> 01:12:53.619 have seen this just completely fall apart. The 01:12:53.619 --> 01:12:55.460 mental health crisis, physical health crisis, 01:12:55.619 --> 01:12:59.399 recruitment crisis, financial crises. As people 01:12:59.399 --> 01:13:01.340 don't want to do this anymore, there's more overtime. 01:13:01.560 --> 01:13:03.420 And now these men and women are working 80 hours 01:13:03.420 --> 01:13:04.800 a week because they're forced to stay another 01:13:04.800 --> 01:13:11.020 shift. And what has emerged from this as a huge 01:13:11.020 --> 01:13:15.239 solution, as it were, one of the solutions is 01:13:15.239 --> 01:13:16.899 to simply say, all right, we're going to invest 01:13:16.899 --> 01:13:19.899 and put a fourth shift. And we're going to bring 01:13:19.899 --> 01:13:22.720 it down to a 42 hour work week. And there's been 01:13:22.720 --> 01:13:25.180 a revolution here in Florida where in the last 01:13:25.180 --> 01:13:27.680 two years, nine departments have gone to this 01:13:27.680 --> 01:13:29.380 because they realize all the money that we're 01:13:29.380 --> 01:13:32.319 losing in overtime, in training people who then 01:13:32.319 --> 01:13:35.260 leave, in lawsuits from mistakes, et cetera, 01:13:35.319 --> 01:13:37.600 et cetera, et cetera. Why don't we just front 01:13:37.600 --> 01:13:40.979 load that money, fill all those vacancies, and 01:13:40.979 --> 01:13:43.579 now we'll actually be saving money. It's the 01:13:43.579 --> 01:13:46.000 same exact thing, not even just in the mental 01:13:46.000 --> 01:13:49.100 health, but I see in the NHS. If you did these 01:13:49.100 --> 01:13:52.039 mental health treatments, what would be the impact 01:13:52.039 --> 01:13:55.159 on obesity? Knowing that people, that's a way 01:13:55.159 --> 01:13:57.600 of filling the void is food. What about cancer? 01:13:57.640 --> 01:14:00.220 Knowing that stress is related to cancer. So 01:14:00.220 --> 01:14:02.779 even all the other ailments that are crippling 01:14:02.779 --> 01:14:07.140 the NHS, so many of those would be improved as 01:14:07.140 --> 01:14:09.159 well if we were able to move the needle on the 01:14:09.159 --> 01:14:12.760 British mental health. Yeah, absolutely. I mean, 01:14:12.760 --> 01:14:15.739 and this is not new, the idea of prophylactic 01:14:15.739 --> 01:14:19.060 medicine or... Public health care that is preventative 01:14:19.060 --> 01:14:21.260 rather than just firefighting and mopping up 01:14:21.260 --> 01:14:23.939 the problems later. This is not new as a concept, 01:14:24.159 --> 01:14:28.859 but we've dug ourselves into such a hole now 01:14:28.859 --> 01:14:33.300 with the epidemic crisis that psychedelic medicine 01:14:33.300 --> 01:14:35.119 is finding it very hard to get off the ground 01:14:35.119 --> 01:14:38.960 because you have to be very far reaching and 01:14:38.960 --> 01:14:43.119 creative to spend that 40 grand on an MDMA patient. 01:14:46.159 --> 01:14:48.739 If we kept spending it on lots of people in their 01:14:48.739 --> 01:14:52.159 early years, we would save lots of money further 01:14:52.159 --> 01:14:55.159 down the line and everyone would be happier too. 01:14:55.819 --> 01:15:00.680 But going back to the finances of this, usually 01:15:00.680 --> 01:15:02.939 we'd look to the pharma industry for this because 01:15:02.939 --> 01:15:06.079 they've got millions and they produce the product 01:15:06.079 --> 01:15:08.939 and they're more than happy to produce the product 01:15:08.939 --> 01:15:10.880 because they're going to reap back their R &D 01:15:10.880 --> 01:15:13.340 costs. If they're not going to reap back their 01:15:13.340 --> 01:15:15.460 R &D costs, why would they bother producing the 01:15:15.460 --> 01:15:16.979 product? And the answer is they wouldn't. And 01:15:16.979 --> 01:15:19.439 the answer is they haven't. And that's why we've 01:15:19.439 --> 01:15:22.060 seen this kind of rise and then collapse of a 01:15:22.060 --> 01:15:25.520 psychedelic industry. And I'm not quite sure 01:15:25.520 --> 01:15:28.340 what the answer is to bring it back. Because 01:15:28.340 --> 01:15:33.939 I know as a socialist and certainly as a hippie, 01:15:33.960 --> 01:15:36.739 I shouldn't have to care about commercialization. 01:15:37.159 --> 01:15:40.619 But as a realist, you do. if something's not 01:15:40.619 --> 01:15:43.840 profitable and commercially viable it's just 01:15:43.840 --> 01:15:48.960 not going to happen in this world um so we talk 01:15:48.960 --> 01:15:52.579 about the evils of satisfying shareholders etc 01:15:52.579 --> 01:15:55.180 but if we don't satisfy shareholders then the 01:15:55.180 --> 01:15:57.439 company collapses and that's that's that you 01:15:57.439 --> 01:16:00.619 know so whilst you know the psychedelic world 01:16:00.619 --> 01:16:02.939 and certainly my world of socialism and being 01:16:02.939 --> 01:16:06.479 a hippie it revolves around shunning those things 01:16:06.479 --> 01:16:10.649 realistically If the business doesn't work, you 01:16:10.649 --> 01:16:14.369 don't get the treatment. So it has to be profit 01:16:14.369 --> 01:16:17.329 driven. It has to be profit driven. I mean, Rick 01:16:17.329 --> 01:16:19.609 Doblin's used up all the philanthropists now. 01:16:19.710 --> 01:16:22.069 There's no more donors left. People don't want 01:16:22.069 --> 01:16:25.829 to donate anymore. They want to invest. And so 01:16:25.829 --> 01:16:28.649 we need to make it so it's investable. We need 01:16:28.649 --> 01:16:30.510 to get the people with the big bucks to give 01:16:30.510 --> 01:16:33.090 us $10 million. And you're only going to do that 01:16:33.090 --> 01:16:35.630 if you can give them back $12 million in five 01:16:35.630 --> 01:16:37.880 years time. They're not going to donate anymore. 01:16:38.539 --> 01:16:41.779 And so to do that, we need to create viable economic 01:16:41.779 --> 01:16:44.380 industries with psychedelics that make money 01:16:44.380 --> 01:16:49.899 so we can do good. Or conversely, I mean, again, 01:16:49.939 --> 01:16:52.500 if you have nations that are bleeding trillions 01:16:52.500 --> 01:16:55.079 of dollars because of health care costs, do we 01:16:55.079 --> 01:16:57.539 need to make money or can we actually proactively 01:16:57.539 --> 01:17:00.439 invest? I mean, we have no problem sending weapons 01:17:00.439 --> 01:17:02.779 overseas for all kinds of horrible things. What 01:17:02.779 --> 01:17:04.899 if as a nation we band together and say, all 01:17:04.899 --> 01:17:07.800 right, we will. you know, invest X amount in 01:17:07.800 --> 01:17:10.760 creating these treatments for our people, knowing 01:17:10.760 --> 01:17:13.020 that our healthcare costs are then going to start 01:17:13.020 --> 01:17:16.020 shrinking dramatically. So rather than making, 01:17:16.039 --> 01:17:18.880 do we always have to make more money or can we 01:17:18.880 --> 01:17:21.020 be more efficient, you know, and fiscally sound 01:17:21.020 --> 01:17:24.359 and proactively invest at the front door, which 01:17:24.359 --> 01:17:26.239 will save us, you know, for years and years and 01:17:26.239 --> 01:17:27.420 years. Because if you look at the healthcare 01:17:27.420 --> 01:17:30.060 costs when we were children compared to now, 01:17:30.140 --> 01:17:32.279 I guarantee you, they were, you know, a fraction 01:17:32.279 --> 01:17:34.899 of what people pay today. Yeah, which is what 01:17:34.899 --> 01:17:36.579 we talked about at the beginning, the complexity 01:17:36.579 --> 01:17:39.960 of today's technological healthcare system. I 01:17:39.960 --> 01:17:41.600 mean, and there are certain nations that seem 01:17:41.600 --> 01:17:43.699 to be doing this better than others. And a lot 01:17:43.699 --> 01:17:48.279 of the Nordic nations have a much more creative 01:17:48.279 --> 01:17:52.260 and aspirational understanding of this. And as 01:17:52.260 --> 01:17:54.359 a result, they have very high taxes. You know, 01:17:54.399 --> 01:17:56.739 you pay a lot of tax, but they're investing it 01:17:56.739 --> 01:17:59.119 in the future in ways that other nations are 01:17:59.119 --> 01:18:06.119 not doing so much. Yeah. It's going to be really 01:18:06.119 --> 01:18:09.359 interesting to see how the psychedelic renaissance 01:18:09.359 --> 01:18:11.539 is going to play out in the next five years. 01:18:11.699 --> 01:18:15.760 Because just to plug my book for a second, I 01:18:15.760 --> 01:18:21.819 first wrote the book in 2012 when there was research 01:18:21.819 --> 01:18:24.579 going on around the world and there was university 01:18:24.579 --> 01:18:27.420 departments and small pockets of academic research. 01:18:27.579 --> 01:18:30.840 I then did a second edition in 2017 where that 01:18:30.840 --> 01:18:33.329 had moved on to... more and more academic departments 01:18:33.329 --> 01:18:35.890 but then the reason i've done this third edition 01:18:35.890 --> 01:18:38.010 which is coming out next month the third edition 01:18:38.010 --> 01:18:41.390 of psychedelic renaissance is so much has happened 01:18:41.390 --> 01:18:44.010 in the last eight years beyond recognition from 01:18:44.010 --> 01:18:47.489 2017 we didn't have a psychedelics industry we 01:18:47.489 --> 01:18:50.729 just had a academic university -based research 01:18:50.729 --> 01:18:55.130 program um which was doing well but as i said 01:18:55.130 --> 01:18:57.550 all this money came pouring in and all these 01:18:57.550 --> 01:19:00.989 clinics opened all sorts of new ventures And 01:19:00.989 --> 01:19:04.729 a lot of them have collapsed or merged or are 01:19:04.729 --> 01:19:09.210 struggling. Because I think from my understanding 01:19:09.210 --> 01:19:12.489 of it is the investors who'd come from cannabis 01:19:12.489 --> 01:19:16.069 suddenly realized that it's not like cannabis. 01:19:16.989 --> 01:19:19.489 It's really a lot more expensive to deliver. 01:19:19.630 --> 01:19:24.670 And the outcomes are a lot slower because you 01:19:24.670 --> 01:19:27.770 don't have to do so much. It's not a maintenance 01:19:27.770 --> 01:19:34.020 treatment. And so you need people to invest economically 01:19:34.020 --> 01:19:37.119 and also in terms of resources now so that we'll 01:19:37.119 --> 01:19:40.220 save money in 20 years. Now, that's always a 01:19:40.220 --> 01:19:45.539 hard sell to investors, but it's doable. It's 01:19:45.539 --> 01:19:48.800 doable with certainly with health care systems 01:19:48.800 --> 01:19:51.579 for whole nations who can see that wider picture. 01:19:51.760 --> 01:19:54.859 But I'm interested to see how it's going to happen 01:19:54.859 --> 01:19:57.840 in the next. five years i mean one of the things 01:19:57.840 --> 01:20:00.560 that we've seen growing a lot in the last five 01:20:00.560 --> 01:20:04.380 years since the clinic system kind of collapsed 01:20:04.380 --> 01:20:06.939 to some extent is we've seen loads of psychedelic 01:20:06.939 --> 01:20:09.460 education psychedelic training and education 01:20:09.460 --> 01:20:11.779 is where people are making some money at the 01:20:11.779 --> 01:20:14.319 moment so that's that's been promising and uh 01:20:14.319 --> 01:20:17.840 loads people are offering treat um how to become 01:20:17.840 --> 01:20:19.819 a psychedelic therapist and all the training 01:20:19.819 --> 01:20:23.399 centers um another thing that's grown hugely 01:20:23.399 --> 01:20:27.810 is The underground and then a gray area, which 01:20:27.810 --> 01:20:31.130 we call the sort of wellness industry in which 01:20:31.130 --> 01:20:34.970 drugs like psilocybin or ayahuasca or ibogaine 01:20:34.970 --> 01:20:41.409 or indeed MDMA are offered under the radar for 01:20:41.409 --> 01:20:43.989 for in retreats. Now, one of the difficulties 01:20:43.989 --> 01:20:46.470 with this is because they're not on the public 01:20:46.470 --> 01:20:48.609 health care system and they're underground, literally 01:20:48.609 --> 01:20:52.750 they're off the radar. They tend to be very expensive 01:20:52.750 --> 01:20:55.939 and exclusive. One thing I've said in talks recently 01:20:55.939 --> 01:20:59.640 is we will have failed with the psychedelic renaissance 01:20:59.640 --> 01:21:02.500 if after all this time, all these decades, all 01:21:02.500 --> 01:21:07.319 we're doing is providing exciting trip experiences 01:21:07.319 --> 01:21:11.180 for tech billionaires in Jamaica and Costa Rica 01:21:11.180 --> 01:21:15.520 in luxurious yurts. That would be a failure of 01:21:15.520 --> 01:21:18.479 the psychedelic renaissance, in my opinion. It's 01:21:18.479 --> 01:21:20.439 not bringing the medicine to the people who need 01:21:20.439 --> 01:21:23.880 it. Those huge swathes of low social economic 01:21:23.880 --> 01:21:27.500 status groups with, as we discussed at length, 01:21:27.600 --> 01:21:29.699 with all of the mental health problems, the high 01:21:29.699 --> 01:21:33.939 prevalence of mental health problems. So have 01:21:33.939 --> 01:21:35.840 we failed? I don't think we failed. It's all 01:21:35.840 --> 01:21:38.939 part of the journey. But until we get psychedelics 01:21:38.939 --> 01:21:43.060 free for the public in nationally approved public 01:21:43.060 --> 01:21:46.680 health care. we will not have achieved the goal 01:21:46.680 --> 01:21:50.420 of a psychedelic renaissance. Winston Churchill 01:21:50.420 --> 01:21:52.520 once said, you can measure the greatness of a 01:21:52.520 --> 01:21:54.920 nation by the health of its people. And I think 01:21:54.920 --> 01:21:57.079 when you look at Scandinavia, they might have 01:21:57.079 --> 01:22:01.100 a higher tax requirement, but it's a very healthy 01:22:01.100 --> 01:22:03.060 nation. And we talk about their education, their 01:22:03.060 --> 01:22:06.060 prison systems, their resilience to COVID. I 01:22:06.060 --> 01:22:08.159 mean, so many areas where they're just doing 01:22:08.159 --> 01:22:10.800 things really well. And I think it comes to humility. 01:22:11.390 --> 01:22:14.810 The places like the UK, the USA need to be going 01:22:14.810 --> 01:22:17.630 to those nations. Portugal, what are you doing? 01:22:18.270 --> 01:22:20.750 It's not apples to apples. Your country is the 01:22:20.750 --> 01:22:23.229 size of one of our states. But how can we apply 01:22:23.229 --> 01:22:25.649 this? How can we take this blueprint and use 01:22:25.649 --> 01:22:29.069 it in our system too? Because if in the UK and 01:22:29.069 --> 01:22:31.869 the US, if we look and our nation has got fatter 01:22:31.869 --> 01:22:34.510 and sicker and the mental health is getting worse. 01:22:35.269 --> 01:22:37.529 insanity is doing the same thing, expecting different 01:22:37.529 --> 01:22:39.989 results. So we need to do something differently 01:22:39.989 --> 01:22:43.890 and proactively investing, whether it's MDMA 01:22:43.890 --> 01:22:46.550 -led therapy or whether it's simply putting real 01:22:46.550 --> 01:22:48.909 food back in schools or ideally all of these 01:22:48.909 --> 01:22:52.130 things simultaneously. We were a healthy nation 01:22:52.130 --> 01:22:56.029 for millennia until modern society came around. 01:22:56.170 --> 01:22:58.069 So we can take the good things from technology, 01:22:58.369 --> 01:23:01.069 apply it with some of this ancient wisdom and 01:23:01.069 --> 01:23:03.869 create an even better system moving forward. 01:23:04.619 --> 01:23:07.439 Yeah, it's absolutely doable. And, you know, 01:23:07.460 --> 01:23:10.140 in many ways, we don't need any more psychedelic 01:23:10.140 --> 01:23:13.960 research. We don't. We've demonstrated the safety 01:23:13.960 --> 01:23:16.979 and efficacy of MDMA and psilocybin and DMT and 01:23:16.979 --> 01:23:21.220 5 -MeO -DMT and ketamine. And, you know, we don't 01:23:21.220 --> 01:23:22.979 need to do the safety and efficacy studies anymore. 01:23:23.159 --> 01:23:26.340 We just need really good PR. We just need to 01:23:26.340 --> 01:23:29.600 sell this to the people who can make the decisions 01:23:29.600 --> 01:23:31.859 about implementing public health care systems 01:23:31.859 --> 01:23:37.029 that use these. And that's what is happening. 01:23:37.189 --> 01:23:38.890 And, you know, going back to the beginning of 01:23:38.890 --> 01:23:40.770 this interview, you know, what's changed. There 01:23:40.770 --> 01:23:43.170 are a great many positives that have happened 01:23:43.170 --> 01:23:48.430 since 2018, since we last met, in terms of tackling 01:23:48.430 --> 01:23:50.229 that stigma and bringing this into the public 01:23:50.229 --> 01:23:53.310 consciousness. But in terms of us being there, 01:23:53.430 --> 01:23:55.970 I would love for us now, you know, seven, eight 01:23:55.970 --> 01:23:59.010 years after the first. session that we had for 01:23:59.010 --> 01:24:00.989 me to be saying, Oh, it's fantastic. You can 01:24:00.989 --> 01:24:03.770 now get MDMA on the NHS. You know, we're not, 01:24:03.789 --> 01:24:06.329 we're not there. I would love it if in five or 01:24:06.329 --> 01:24:08.810 eight years we come back and that is the case, 01:24:08.810 --> 01:24:12.390 then we really will have, have moved forward. 01:24:12.430 --> 01:24:16.029 We really will. Absolutely. Well, your book, 01:24:16.130 --> 01:24:18.029 the third edition, the psychedelic Renaissance. 01:24:18.170 --> 01:24:20.289 So you've got multiple other books as well. Where 01:24:20.289 --> 01:24:22.850 are the best places to find that book? And what 01:24:22.850 --> 01:24:26.510 is the exact release date as well? So it's on 01:24:26.510 --> 01:24:31.270 a publishing, a publisher called Aeon Books or 01:24:31.270 --> 01:24:36.270 Aeon, A -E -O -N, UK based publisher. It's a 01:24:36.270 --> 01:24:40.270 terrific book. I'm really proud of it. I've been 01:24:40.270 --> 01:24:42.750 writing this for about a year and a half. It's 01:24:42.750 --> 01:24:45.529 a big, thick textbook. It's going to hopefully 01:24:45.529 --> 01:24:47.909 be in every university department on all the 01:24:47.909 --> 01:24:51.750 curricula for medical students and trainee psychiatrists 01:24:51.750 --> 01:24:56.920 as the go to book. on psychedelics because a 01:24:56.920 --> 01:24:59.779 lot of books have got the history of albert hoffman 01:24:59.779 --> 01:25:01.699 and timothy leary and a lot of good books have 01:25:01.699 --> 01:25:04.739 got the pharmacology um how the drugs work a 01:25:04.739 --> 01:25:06.960 lot of the books have got the culture indigenous 01:25:06.960 --> 01:25:10.199 uses and historically how these drugs have impacted 01:25:10.199 --> 01:25:12.199 on culture and music and art and all of that 01:25:12.199 --> 01:25:14.539 and the psychedelic renaissance book has that 01:25:14.539 --> 01:25:17.159 but i don't think there's any other book that 01:25:17.159 --> 01:25:21.260 documents the industrial changes of the last 01:25:21.260 --> 01:25:25.069 15 20 years um as this book does so you really 01:25:25.069 --> 01:25:29.670 do learn about these ups and downs of legalization 01:25:29.670 --> 01:25:34.170 uh legislation approvals um and it's a kind of 01:25:34.170 --> 01:25:37.130 work in progress and you know it's already out 01:25:37.130 --> 01:25:39.250 of date because it's not even published but it's 01:25:39.250 --> 01:25:41.449 already out of date because every week every 01:25:41.449 --> 01:25:44.869 day i'm seeing more and more studies coming in 01:25:44.869 --> 01:25:48.569 clinics opening clinics closing new retreats 01:25:48.569 --> 01:25:51.920 starting retreats shutting you know it's it's 01:25:51.920 --> 01:25:54.060 such a dynamic business and as i said it's going 01:25:54.060 --> 01:25:56.119 to be really interesting to see see what what 01:25:56.119 --> 01:25:58.939 it's like in another five years um i'll have 01:25:58.939 --> 01:26:01.079 to write another one god i don't don't don't 01:26:01.079 --> 01:26:04.539 um look forward to that um but no i'm really 01:26:04.539 --> 01:26:06.180 really proud of it and it's going to be coming 01:26:06.180 --> 01:26:09.439 out in hardback on eon books um i've got a sub 01:26:09.439 --> 01:26:13.220 stack um group about it called the psychedelic 01:26:13.220 --> 01:26:16.180 renaissance um and i've been posting regular 01:26:16.180 --> 01:26:19.170 excerpts from all the chapters over the last 01:26:19.170 --> 01:26:24.010 few months. I'm speaking at the Hay Book Festival 01:26:24.010 --> 01:26:27.649 on psychedelics in a couple of months. And yeah, 01:26:27.689 --> 01:26:29.449 this is a very well -timed interview because 01:26:29.449 --> 01:26:33.020 it's just about to come out. Brilliant. Well, 01:26:33.140 --> 01:26:35.340 Ben, I want to thank you so much. Another incredible 01:26:35.340 --> 01:26:37.739 conversation and exciting conversation. I think 01:26:37.739 --> 01:26:40.399 the renaissance that I've talked about, I think 01:26:40.399 --> 01:26:42.920 is coming as one of kindness, compassion, empathy, 01:26:43.079 --> 01:26:45.319 and community. And this is part of this entire 01:26:45.319 --> 01:26:47.680 conversation. The way we bring people together 01:26:47.680 --> 01:26:50.060 is we get them to heal. I really believe that. 01:26:50.079 --> 01:26:51.439 And this is going to be one of the most powerful 01:26:51.439 --> 01:26:54.359 tools. So I want to thank you so much for coming 01:26:54.359 --> 01:26:56.840 back onto the Behind the Shield podcast and being 01:26:56.840 --> 01:26:59.340 so generous with your time today. Well, thank 01:26:59.340 --> 01:27:02.539 you, James. As usual, lots of difficult and penetrating 01:27:02.539 --> 01:27:06.680 and stimulating questions and probably developing 01:27:06.680 --> 01:27:09.760 more questions than answers between us. But it's 01:27:09.760 --> 01:27:11.840 really, really important to thrash these things 01:27:11.840 --> 01:27:14.560 out, isn't it? And let's hope that next time 01:27:14.560 --> 01:27:16.960 that I come back and talk to you, we've got some 01:27:16.960 --> 01:27:19.520 really positive things to talk about in terms 01:27:19.520 --> 01:27:21.659 of what we've achieved with psychedelic medicine.