This episode is sponsored by Transcend, a veteran
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company that I introduced recently as a sponsor
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Now, as I mentioned before, the other side of
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808 with the founder, Ernie Colling. or go to
transcendcompany .com. Welcome to the Behind
the Shield podcast. As always, my name is James
Gearing, and this week it is my absolute honor
to welcome back onto the show psychiatrist and
MDMA -led psychotherapy researcher, Dr. Ben Sessa.
Now, if you haven't heard my first conversation
with Ben, it was episode 156, and I highly recommend
you listen to that first. In this second conversation,
we discuss a host of topics, from the continued
success of using MDMA for trauma and alcoholism,
ketamine, psilocybin, ibogaine, the psychedelic
renaissance, his new book, and so much more.
Now, before we get to this incredible conversation,
as I say every week, please just take a moment,
go to whichever app you listen to this on, subscribe
to the show, leave feedback and leave a rating.
Every single five star rating truly does elevate
this podcast, therefore making it easier for
others to find. And this is a free library of
well over 1100 episodes now. So all I ask in
return. is that you help share these incredible
men and women's stories so I can get them to
every single person on planet Earth who needs
to hear them. So with that being said, I welcome
back onto the show Dr. Ben Sessa. Enjoy. Well,
Ben, I want to start by saying, firstly, thank
you so much for coming back onto the Behind the
Shield podcast. We spoke on episode 156 and now
up to over 1100. So that was a long time ago
in the end of 2018. So firstly, I want to welcome
you back. Thank you for coming on. Well, brilliant.
Thank you, James. I remember fondly the last
session we did. And obviously so much has happened
since then. So I'm thrilled to be back here again.
giving you and the world a bit of an update on
where things are from my perspective. And yeah,
what great success on your podcast that we're
over 1100 episodes in now and it's still going
strong. So it's a great privilege to be here.
Thank you. Well, we're going to get into that.
I think there's a huge amount of success on your
end as well. And we'll talk about obviously the
kind of revolution that's happening in some of
these other modalities that are helping in mental
health. I think a good kind of... Jump off point,
though, would be to talk about the pandemic.
The reason being, whatever people's stance was
at that moment in time, there were a few truths
that were in the middle, that the healthier the
human being, the better the outcome. And then
also some of the choices that were made as far
as isolation had a ripple effect on society and
mental health. And sadly, I don't know if it's
the same in the UK, but here. As we rounded off
the end of that, it was all kind of swept under
the rug and no one wanted to talk about it anymore.
And I think it does a disservice because people
are still dealing with the ripple effects today.
So with that being said, what through your eyes
was that pandemic experience like yourself? And
then talk to me about what you've seen personally
as far as the ripple effect of that. Yeah, I
think it's really good to talk about the pandemic
because... as you said, its effect is still huge.
And although it may not be so much in the news
these days, the devastation that the pandemic
caused globally and to individuals is still very
much being felt on so many levels. On a societal
level, and particularly an economic health level,
it was obviously absolutely devastating. The
incredible amount of money that was spent on
the health care, how that stripped resources
that were already threadbare in the UK mental
health services, diverting money into treating
COVID. The money that the government spent on
the furlough scheme, which all came out of the
public purse, again, which has cut to the bone
even further the resources available for mental
health care. And on an individual level, people
are still reeling with a kind of global PTSD
from that experience of social isolation, losing
their work and their jobs and their businesses,
many of which never came back. Particularly in
areas like the hospitality sector, they're still
crippled. We changed our whole way of life. One
of the good things that came out of it were so
many podcasts and so many people moving from
office work based environments to home based
environments. I was actually doing telemedicine
five years before the pandemic. So I was very
much used to doing telemedicine on Zoom and other
platforms. And then since then, it's just become
very commonplace for mental health care personnel.
to work from home um now there's there's there's
pros and cons of that i mean i remember when
the telemedicine and psychiatry started i was
i was one of the people saying that's absurd
it can never work you need that personal face
-to -face contact with a patient in the room
um you couldn't possibly do it by zoom but actually
there are pros and cons yes you do lose that
personal touch to some extent but there's gains
as well um You know, if a patient has an appointment
with their psychiatrist and they've waited months
and months and it's a one hour appointment, they
have to take the whole day off work. They have
to drive somewhere. They have to park. It's very
expensive. And a lot of patients really prefer
jumping on a Zoom call for their psychiatric
assessment. And although there are bits missing,
I think on balance, it's increased accessibility
to many patients. So it's now very commonplace
for mental health professionals to do. on remote
assessments and evaluations and monitoring of
patients. And I think that does work. But it's
not a complete substitute for the level of care
that a psychiatric patient needs. So we're still
reeling from that. And we also see a large proportion
of patients who are reeling from the physical
effects of COVID. And we're learning more and
more about the mental syndromes that accompany
long COVID. But I think the biggest thing is
just the effect economically. And the mental
health issues as an epidemic were already on
the rise. They have been for decades. But since
so many people lost their work and their income,
and with that, their resources and their self
-esteem and their accessibility to getting help,
it's just gone through the roof. You know, so
many of the patients that I see in my private
practice now, the first thing they say when they
sign up is, I tried to go to the NHS, but it
just doesn't exist. There, of course, is an NHS
mental health care service, and it's very good
in some places, but it's very patchy. And obviously,
with the high level of resources, demand rather,
and the low level of resources, the bar is set
very high. to get into nhs mental health care
services so really you have to be psychotic and
suicidal to get through the door um which is
very frustrating you know when i trained as a
doctor and then as a psychiatrist getting on
30 years ago the whole model and standard of
care was just different from what you do now
um there's no way you'll you'd get through the
door in nhs services with just low or moderate
levels of anxiety or depression. You have to
be very severe to even get through the door.
So for me in private practice, this has opened
up a lot more patients. But it's very sad that
so many people can't get the care and support
they need. And of course, it's a double whammy
because there's a much higher mental health care
need amongst people in lower socioeconomic groups
with lower incomes. And so they can't afford
to go private. So they just don't have health
care at all. And I think you're in the States,
aren't you? So, you know, you know more than
pretty much any other nation on the planet what
it's like to live in a nation that doesn't really
have a public health care system. I think in
the UK, we have one better than America. I think
Malawi has a better public health care system
than the United States, with some 71 million
people with no access to any health care at all,
is a headline I read the other day about the
States. But yeah, just to bring us around to
psychedelics, this is where faced with these
kinds of challenges in mental health care, we
need to be thinking outside the box about what
can we do differently? What can be a game changer
in improving the nation's mental health? And
I hope we're going to get on to talking about
psychedelics in that respect. Yeah, absolutely.
Just before we do, though, firstly, the telehealth
element. This obviously really was something
I think from what I was told by a lot of people,
a lot of the red tape around telehealth was cut
around COVID. So people have said this was one
of the good things that came out of it. And now,
even from 911 or 999, you know, you have the
abuse of ambulance, fire, you know, police, you
have the ability now to integrate into the dispatch
system. where someone calls with a low acuity
cord or a low acuity mental health issue you
know that's not you know a psychotic episode
or something that would warrant us to really
go there and medicate whatever it is that we
have to do and now that person can sit in their
home and they can speak to uh an er you know
nurse or whatever the person is and then that
will be a kind of treat at home element but also
when i look now at all the incredible conversations
i've had 95 of them have been exactly how we're
doing it now because i always say i don't let
geography get in the way of a good conversation
yeah the depths of some of these people go to
via this screen and a number of times i've been
told that was like a therapy session thank you
but it is it's through the screen but if you
can connect and you can stay engaged it is i
mean the gold standard obviously is sitting in
a desk in sorry in a room across from each other.
But it's not that far down as far as being present
via a screen and being able to listen. And like
you said, I think you offset that with the ease
of access. We jumped on this and then the moment
we hang up, we're both going to go and do something
else now. It really does illustrate how powerful
this medium is. And again, as far as the finances
attributed to it, it's cutting a lot of costs
just to be able to sit in your office and for
me to sit here. And whether it's an interview
or a counseling session, both of us, it makes
it affordable from that point of view. Yeah.
And, you know, as you said, that's a benefit
of using this technology. And I think it's taught
us all a lot because I suppose we were all quite
Luddite about it in thinking it could never possibly
work. And actually, we've all surprised ourselves
to find it does work. In fact, it's sometimes
superior for all the reasons you mentioned. So,
yeah, that's the world in which we live. That's
not an excuse to keep cutting mental health services.
You know, people with severe mental health problems
require holistic care, multidisciplinary holistic
care. People in their local area, a community
nurse, a consultant psychiatrist, a general practitioner,
a community day hospital, as well as inpatient
services, that whole cluster of multidisciplinary
inputs. And of course... Remote sessions like
this can be part of that, but it's not a substitute
for all those other parts of care for those patients
with severe mental health problems that really
need all those other parts as well. Well, before
we go into the world of psychedelics, one more
area, because I mean, you and I grew up in the
same area or you're in the same area now. I was
from Bath originally and we're about the same
age. And I talk very fondly about the NHS, the
NHS that we grew up in the 70s and the 80s, and
the philosophy that a nation would band together
and take care of anyone who needed help at that
moment, whether it was a pregnant family or whether
it was someone that was hit by a car, whatever
the thing was, we all take care of everyone.
I think that's the ultimate, you know, it takes
a village mentality. But what I've seen now,
you know, as I sit here, 51 years old with, you
know, fire experience and all these other things
that I've done. And you see the NHS picked apart.
The only way that that system is going to work
well is, as you said, holistic, proactive, preventative
practices. So you keep the nation healthy so
they don't need the NHS until absolutely necessary.
But I've seen the opposite. And when I go home
now, it's heartbreaking. Not only the mental
health elements, but also the obesity that's
crippling our nation now as well. So through
your lens. You know, how has this devolution
happened? And if you were king for a day, how
can we reverse it? Because I would argue it's
the, at its core, the best healthcare system
on the planet when it was originally conceived
and fully funded. Yeah, that's a really good
question. And I don't pretend to be an expert
in this. Obviously, as a consultant with 30 years
experience in medicine, I've got a pretty good
opinion on it. um but i'm not an expert in health
economics it's quite clear that it's not working
at the moment i guess one way of looking at the
nhs and what went wrong and why we're in this
position is actually really simple when the nhs
was set up in 1948 medicine was a far simpler
place than it is today you know we only had two
or three um antibiotics we had two or three painkillers
we had a bunch of operations surgical operations
which which you could have a long rehab process
for and stay in hospital for 12 weeks you know
to have your leg mended it's changed beyond recognition
with technology that's very expensive pharmacology
that's very expensive you know some oncology
treatments are 1800 pounds per pill you know
none of that existed it was it was affordable
to provide the healthcare for the nation in 1948,
based on simple taxes. The cost of medicine now
is infinite. We can keep people alive indefinitely,
depending on how much money we want to pump into
them. So this makes me sound very non -socialist,
because I'm very much a socialist, but there
is a real argument for... In today's consumerist,
very expensive, complex society, there simply
is no room for free, universal, unlimited health
care. It just doesn't work as a commercial model.
Now, that makes me sound very unsocialist and
that kind of comment would make me very unpopular
with the basic narrative of the NHS, which is
free, universal health care to everyone at the
point of need for their whole life. no matter
what they do with their life. And here's an even
more contentious thing. Should the NHS be lifestyle
means tested? I'm asking you this. Should it
be fair that one person can smoke 80 cigarettes
a day and drink two litres of vodka a day, eat
lots of fatty food, become obese and never go
to the gym, develop hypertension and obesity
and diabetes by the age of 50? and then expect
free, unlimited health care for those conditions
for the next 30 or 40 years. And another person
meticulously decides not to smoke, not to drink,
go to the gym, eat all their vegetables and salads,
and doesn't require any health care really at
all until they're in their late 80s. What do
you think? That's a very un -socialist thing
to say. But is it a realistic thing to say? Should
there be a lifestyle means test for access to
health care? Now, the socialists would say absolutely
not. It doesn't matter if you smoke and drink.
You should still get free health care because
that's what the NHS is. But I don't know. What
do you think? So it's interesting because I'm
person B in that example. So aside from drinking
once in a while in the evenings, the rest of
the stuff is me. I don't ever see a doctor. I
have blood work done frequently. I adjust my
nutrition accordingly. But I use this as a comparison
a lot because this is something that people talk
about. Well, who deserves the health care versus
who doesn't? I grew up on a farm outside Bath.
And, you know, we had livestock on the farm that
we would eat. You know, we had a vegetable garden.
We had an orchard. My day comprised of, you know,
mucking out stables and herding geese and all
these other things. So my baseline was forging
health. You know, the activity level, understanding
where the food came from, cooking whole food,
basically almost never had any sort of fast food
whatsoever. And then you compare someone who
grew up in inner city London. grew up in a flat,
you know, their local food was probably fish
and chips or whatever it was. You know, their
parents smoked, so they passively became addicted
and they became smokers themselves, yada, yada,
yada. So you have two children on two different
paths. So I think that, you know, with this one
or the other conversation always, you know, ends
up with no resolution versus they're both correct.
100 % is on the ownership of the individual,
but what is the environment like? In America,
everything's fast food, everything on every corner,
drive -through everything. Even the PE programs
at school have been sliced and diced. They serve
processed food in school cafeterias. Yeah, there
is no simple answer. It's not either or. And
of course, when it comes to that question of
who deserves healthcare, Obviously, everyone
deserves health care. Also, another way of looking
at this is that lifestyle is already taxed. When
you buy alcohol, you're paying for liver units.
When you buy cigarettes, you're paying for respiratory
services. So I don't know whether when you buy
fried chicken at McDonald's, you're paying for
obesity and diabetes care. I'm not sure how that
would work. Yeah, we're in a very difficult position.
And I think going back to mental health care
specifically, if you don't have an acute service,
if you can't catch people early on, it's almost
not worth having something at all. If you go
to your GP and you're complaining of depression
and anxiety and you're miserable and you've lost
your partner and your children and your job and
you're told, yeah, that's fine, I'll get you
an NHS appointment, it'll be three years. You
know, that's almost there's no point because
all of those acute things will have passed. You
need the help when you need it. And I think this
is why we are spiraling downwards in terms of
our management of the health of the nation in
terms of mental health. Which is why we need
something innovative and effective. fast working
and efficient and financially efficient and psychedelics
do bring us all of that well let's take a deep
dive then the first time obviously we spoke about
some of these areas but so much has changed now
so many more studies so much you know so much
more uh Even just advocation, I guess, is the
best word since the last time we sat down in
seven years. I think it's been a real kind of
renaissance since then. So talk to me first.
Let's start with MDMA, because obviously that
was the one that we really honed in last time.
That's ironically a compound that I have used
recreationally in the past and is something that
I actually want to do. pursue myself as far as
the MDMA counseling, just to see if there's anything
underlying. There's nothing that really troubles
me specifically, but knowing the life that I've
had, I got a funny feeling there's probably some
boxes in there that are still locked tight. So
let's start with MDMA. What's been the kind of
evolution since the last time we spoke seven
years ago? Well, it's an interesting question
and it's a sort of both a positive and a not
so positive answer. In terms of MDMA being a
licensed prescribable medicine, it's still not.
So in some ways, we're no further ahead now than
we were 20 years ago or 30 years ago when the
research started. In order to get a drug licensed
as a medicine with a capital M. So this means
a legal licensed medicine. I'm not talking about
underground or illegal use here because that's
just a different kettle of fish. But for a drug
to be a licensed legal medicine, it has to jump
through a whole bunch of hoops. And these hoops
are not specific to psychedelics. They're the
same for painkillers and antibiotics and cancer
drugs. The same same set of research hoops. It
has to jump through all those hoops. And then
you have to submit to, in America, the FDA. And
then they accept the drug or not. And it becomes
an approved medicine. Until it's an approved
medicine, it can only be used in a research setting
under research protocols, which is a very small
number, a couple of dozen of patients, very expensive
to run research studies. The leading organization
in the world for MDMA research is called MAPS,
as you know, the Multidisciplinary Association
of Psychedelic Studies. And they've been carrying
out all of these research protocols, jumping
through all these hoops. And then last year in
2024, they submitted all of their data to the
FDA. and it was turned down. So that was after
20, 30 years and $100 million plus of research
costs, the FDA turned it down on, quite frankly,
rather spurious criteria. And so as we're sitting
here today, MDMA is still not over the line as
a licensed legal medicine. And that's true throughout
Europe. throughout the States, Canada, United
States, South America, anywhere. Anyone that
says they are legally prescribing MDMA, they
are not. It is illegal unless they are a researcher
and they're doing this under research and the
patients are participants in a research trial.
Now, there is a slight caveat to that in that
what's happened a couple of years ago in Australia
is that MDMA and psilocybin were given a special...
Not a full medical license, but an approval to
be used in large numbers of people. And so in
Australia, MDMA is available in a number of clinics.
And I was very privileged a couple of years ago
to go out to Australia on two separate occasions
for about 10 weeks each to take part in training
schemes. So there's a furious rush in Australia
to get lots of people trained, doctors, nurses,
therapists, to deliver MDMA therapy. in Australia
for Australian nationals. So it's really moving
ahead in Australia, which is kind of ironic because
Australia has always just been a backwater in
terms of psychedelic research, but it suddenly
leapt into front position with this government
initiative. But in the United States and Europe,
MDMA is still not a licensed legal medicine.
Now, the setback that MAPS had in summer 24 It
means they've got to retake, redo some of their
studies. And I think that's I think the last
I heard from Rick Doblin was it's going to be
another two or three years and another however
many tens of millions of dollars to then get
that data again, then resubmit and hopefully
get approval. And then once it gets approved
as a medicine, then practitioners with the appropriate
training and support and facilities can use it
as a medicine, not just as a research. investigative
tool. So in answer to your question, in some
ways, we're no better off now than we were when
I last spoke to you. In other ways, an awful
lot has happened. And there's an awful lot more
people trained to deliver MDMA therapy now. And
certainly, the public perception is further along
positively. There's much less stigma. There's
much more public acceptance. And there's much
greater need. We are more than ever. in need
of MDMA -assisted psychedelic therapy than we
were back then. We're just waiting for that green
light from the approval services to start opening
clinics and delivering the treatments. It's funny
you say that because I have literally about to
interview an Australian firefighter who did MDMA
in Australia and had incredible results. And
funnily enough, we were talking, and I'll get
to this in a minute, but you hear the... Some
of these places that offer these treatments,
as you said, whether it's legally or illegally,
ketamine is a good example. Obviously, it's legal
here. And every time I've heard someone say with
ketamine, oh, it didn't work, usually they were
hooked up to an IV and the person walked out.
They weren't doing any sort of kind of guiding
or counseling alongside. But his experience with
MDMA, he was extremely well -researched. I mean,
he's doing a master's on this at the moment,
I believe. So had an excellent grasp on all these
therapeutic modalities, went in thinking, OK,
my relationship with the counselor is strong.
This is what's going to be the winning factor.
And actually, he said the medicine was actually
really what did most of it. He was quiet and
in his own head for most of the time. So I'm
actually going to be able to storytell an Australian
firefighter success story with MDMA literally
in a few weeks. Yeah. And, you know, there's
a real debate raging at the moment in psychedelics
in terms of. The narrative has always been it's
a combination of the drug and the psychotherapy
and the drug opens the door, primes the brain,
a process called neuroplasticity or neuroflexibility.
And then when the brain is in that neuroplastic
or neuroflexible state, you throw the psychotherapy
at them and that's where you get the great results.
And that's always been the model. We're starting
also to challenge that. And more and more people
are finding, certainly with neuroscientific studies,
that simply taking the drug without psychotherapy
is also highly beneficial because of that neuroplastic
effect that it has. And we've learned a lot of
this from ketamine, interestingly. So, I mean,
we can certainly talk about ketamine because
you're quite right. So ketamine, as you know,
is a licensed medicine. It doesn't have to go
through that approval process of becoming a licensed
medicine. It's been around since the 1970s as
a anesthetic. And it's a very, very important
and useful anesthetic. It's used all over the
world. In fact, it's on the World Health Organization,
their list of top 10 essential drugs that every
country must have up there with morphine and
penicillin. It's a very useful anesthetic. And
then around about 2001, it was serendipitously
found to be that it also worked to reduce depression.
It was found by an anesthetist who was prescribing
it for his anesthetic, for his surgical patients.
And he found that those with depression had a
better mood for a week afterwards, after this
infusion of ketamine. And so we then saw this
springing up of its use in psychiatry. And yeah,
the beginning of these so -called ketamine clinics,
it was just getting the infusion. You would go
along to the clinic. There'd be no psychotherapy.
You would have an IV drip. It would last a couple
of hours. The practitioner would say to you,
oh, I'm really sorry. You're going to feel a
bit weird for a couple of hours, but don't worry,
it'll pass. And then the antidepressant effects
will start in a few hours later and it'll last
a week or so. So that's what most of these ketamine
clinics were. But then what we've seen in more
recent years is using MDMA like we would use
psilocybin or MDMA, not considering the intoxication
as just an irritating side effect of feeling
a bit weird, but actually a positive mental state
that we can work in and alongside. So combining
that with psychotherapy like we would for MDMA
and psilocybin. And this is called CAP, ketamine
-assisted psychotherapy. as opposed to just what
we would call RAAD, rapid acting antidepressant
effects. And more and more, we're seeing CAP
being used. But I think you're right. I think
the vast majority of so -called ketamine clinics,
even today, are not doing CAP. They're just giving
the infusions. Now, it's not a bad thing. It's
a good antidepressant. The trouble is you have
to keep doing it. It's a maintenance therapy.
You might do it once a week, once a fortnight,
once a month. But you have to keep topping up
in that way. It's a bit like dialysis for the
brain. Whereas when you combine it with psychotherapy
in the form of CAP, the hypothesis is that like
MDMA and psilocybin, you make important realizations,
reflections on aspects of your psychology that
were stuck. And the psychotherapy is much more
effective and long lasting without having to
repeat it. So it's really ironic that right now,
when most people think of psychedelic therapy
they probably think of ketamine therapy because
it's by far the most used it's the license and
it's used all over the world um but if you take
those three psychedelics ketamine psilocybin
and mdma i would argue that ketamine is the poor
cousin of mdma and psilocybin when it comes to
agents to assist psychotherapy it's good ketamine
therapy it's better than no ketamine but it's
no mdma and it's no psilocybin but ironically
it's the one everyone's got So, you know, if
if we could have made that choice, you know,
20 years ago, which of those three should we
have? It wouldn't be ketamine, but it is ketamine
because it's already licensed. And so we're honing
ways to do ketamine assisted psychotherapy better
and better and make it more effective. But like
you said about your your patient who who is a
firefighter, a lot of people come out of the
ketamine experience saying it's all right. But,
you know, it wasn't mind blowing. Whereas with
MDMA or psilocybin, they pretty much all, without
exception, say that was profound and mind -blowing.
And with MDMA particularly, it was also very
pleasant and tolerable. And they immediately
talk about the amazing gains they've made. So
now there are no magic wands in mental health
at all. But if there was one, it would be MDMA.
It's interesting because someone asked me the
other day. um you know something to do with psychedelics
and i had this realization because on this journey
that i'm on and i'm you know advocating for all
these things when it comes to you know the physical
health the mental health one of the questions
is well why am i not struggling i'm no more you
know No different a human being than all of the
men and women I know that have been suffering
alcoholism, they've taken their own lives, et
cetera, et cetera. Now, part of it is definitely
my upbringing, going back to that farm. I was
surrounded by a lot of things that we know are
very healing. But there was a lot of trauma.
I almost died in a house fire when I was four
years old. Parents had a horrible divorce. There
was another near -death incident. So there's
a lot of compounding things, big T's and little
t's. But when I lived in Japan, mushrooms were
legal. So, and then MDMA wasn't, but we did it
anyway. But it was in a kind of, you know, the
rave setting as it were. So legalization aside,
I was exposed to MDMA and psilocybin during those
times. And it wasn't specifically to deal with
trauma, but I wonder again, if, you know, just
by osmosis, there was a healing element of that.
So you've got the holistic healing. that offset
the childhood, then you've got exposure to these
two compounds that we're talking about today,
which ironically, when I was honest about my
very first firefighter application, which I hadn't
done them for years, I was, I basically had the
application screwed up and thrown in my face.
And now here we are talking about how effective
they are to heal first responders. It was kind
of ironic, but I wonder if, you know, that was
one of the reasons why after a 14 year career.
With arguably a decent amount of trauma that
I was able to be in a slightly better place than
some of my peers. Well, I don't want to take
the wind out of your sails with that idea, James.
But I would say what we know about the etiology
of mental health problems and the prevalence
of mental health problems amongst different groups
and what are the big causative factors. By far,
the two biggest factors are probably initially
genetics. which of course you have no control
over it's the genes you're given and the other
is your very early attachment experiences so
you know what happens in your first 48 months
of life um in terms of that nurturing experience
with your primary caregiver um so if you get
that right and you've got good genes The likelihood
of you having a resilient adult mental health
for the rest of your life is by far the biggest
factors. It's a nice romantic idea to think that
your exposure to recreational MDMA and psilocybin
later in life has had a bolstering effect. And
maybe it has. And, you know, of all people, it
should be someone like me who would say that's
true. It certainly could have had a positive
effect and to continue to do so and to continue
to use it in a. in a healthy facilitated way
is a healthy thing to do um but when you actually
look at the prevalence and etiology of mental
health disorders i think those those other two
factors genetics and very early attachment are
the biggest protective factors get those right
and we are resilient to adult mental health problems
far more so than people who don't have those
parts which is why you know we can't do much
about genetics um at least not not easily or
ethically um But we can certainly do something
about attachment. And often I say in my talks,
we could close half of the prisons and half of
the hospitals tomorrow if we had really good
care for single mothers with children under five.
Because get those early attachment years right.
Attachment becomes this blueprint for the rest
of your life. The experiences you have in those
pre -verbal years become the blueprint, the benchmark
for... every aspect of our psychology um trust
love fear acceptance violence aggression addiction
all of those things are very very early imprinted
in in that pre -verbal child and we can do something
about that with really really good public health
care and support for single single parents not
not just mothers usually mothers but single parents
and children um But yeah, ongoing adult support
with psychedelics is another great way of mopping
up some of the difficulties when you haven't
got those kind of resiliences. Well, when you
say genetics, there's more and more discussion
now of epigenetics. And again, before we hit
record, I was talking about the book I just wrote
and the multigenerational trauma. One of the
very snide comments that you hear now is, well,
the problem today is these broken families. And
it's like, yes, it is. But what are we going
to do about that? This is a generational issue,
as you said, whether it's addiction, whether
it's incarceration, there are a lot of families
that that's already happened to them. But I believe
that if we start healing these households with
all these initiatives that we're talking about,
whether it's taking care of... The households
that need more care, the Norwegian prison model
where we're truly rehabilitating people so they
come back and become functioning members of society,
the Finnish education system, the Portuguese
decriminalization system, where you're holistically
healing a nation. I believe that... epigenetics
will be where now you have the opposite effect
and you start, you know, reducing the amount
of people that have prevalence for, you know,
addiction, alcoholism, et cetera. Yeah. No, I
mean, absolutely. There's no doubt that maximizing
all of those social measures improves outcome
for mental health and physical health illnesses.
There's no question. All of these illnesses cluster
in the lower socioeconomic groups, whether it's
epigenetics or just episocialization. I think
is I mean, I think if you if you live in poverty
and you don't go to and you don't have further
education and you can't find employment and nor
could your father and nor could your grandfather
or his father. Is that epigenetics or is that
just transgenerational? poor social conditions.
I think it's probably the latter. Whether that's
imprinted into the genetic code or not is almost
irrelevant. I think the effect of that would
be tiny compared to the very obvious in -your
-face issue of we live in poverty and all these
generations have. And I don't know that there's
much of genetic tweaking that needs to be done
there. You just need to... look after these groups
from a social and economic perspective. But yeah,
I mean, epigenetics is a field that is fascinating
to study and understand. Personally, my understanding
of it is that the effect is not nearly as great
as some of the things we actually know loads
about, which is the social situation and the
effect that that has on transgenerational populations.
of children becoming adults, having children,
et cetera. So epigenetics is an interesting field,
but not as interesting as good education and
employment and tackling poverty on a social level,
I think. That's my personal opinion. Yeah, no,
I agree. I mean, the statement about which label
is irrelevant, if we find solutions, proactive
solutions, and I think this is underlined, ironically,
circling around to the FDA. who approved OxyContin,
where we saw the highest prevalence of addiction
were places where there used to be a high level
of industry. And then it was taken away, whether
it was mining towns or the steel industry or
the auto industry. So was it an addictive hook
that those people all had genetically or was,
as you pointed to, a lack of community, a lack
of stability financially that then created this
void that then... you know they were far more
susceptible to this fda approved painkiller and
then ironically mdma is is not approved yeah
i mean it's actually both because what we see
in genetics is what's called a genetic drift
of the genes are not equally spread amongst the
environment um the the genes for depression anxiety
personality disorders addictions um psychosis
ptsd all of these genes cluster in the poor areas
um because over the generations you slip off
that social ladder and find yourself living in
the ghetto and so it would you know all the nice
posh kids that go to the posh schools and have
the wonderful parenting and all the money and
the jobs and the university and the and the brilliant
support systems they've got all the best genes
in that part of town, in the nice part of town.
And that difficult part of town with transgenerational
drug misuse, addiction, poverty, unemployment,
poor education, that's where depression, anxiety,
PTSD genes cluster over the generations because
you slip down. That's called genetic drift. Yeah,
I mean, this is highly unethical. But one way
of tackling this is to have this kind of eugenics
scheme where you get all the nice, posh people
to mate with all the poor people in the difficult
part of town and spread the genes around. Now,
of course, that's an absurd idea. But yeah, what
this conversation is pointing out is the double,
triple, quadruple whammy that comes when you
look at risk of mental health prevalence. It's
not ever as simple as... Just the genes, just
the childhood, just the environment. Most of
the patients that I would see in secondary or
tertiary mental health services have multiple
risk factors. They've got the poor genes, the
poor environment, the poor parenting, the poor
childhood, the trauma, all of those things. Because
any one of those getting it right acts as a very
strong protective factor. um against the developing
the end phenotype which is the mental disorder
so you know you can protect against it so we
have to do what we can do and we can't do much
about the genetics at this stage but we like
you said i think we both agree the things we
can do something about is where we should be
targeting our resources i don't know if i asked
you this back in 2018 so i will again because
this is again when you've done over a thousand
interviews the venn diagram intersects pretty
profoundly. And you see these truths really arise
because these people are from, you know, all
walks of life all over the globe. But, you know,
the conversation around that time in my profession
was we've got to smash the stigma. It's, you
know, it's okay not to be okay. All these kind
of, you know, buzz phrases. But one of the ones
that I saw or heard over and over and over again
that I just don't hear discussed and I feel like
it needs to be front and center was the feeling
of burdensome. And when, just as you alluded
to, these first responders have that perfect
storm from their early life, the trauma that
we see, the sleep deprivation, the organizational
betrayal, the side effects of alcohol, psych
meds, et cetera, et cetera, et cetera. And they
get to this point, the voice in their head has
literally distorted their reality. to the point
where they truly believe that if they just took
themselves out of the equation, that their family
would be better off, that that would solve the
problem. And you have, you know, a profession
where we train diligently not to die. And I always
say, if you stand on the top of us, you know,
a high rise building and go near the edge as
an invisible hand, like pushing you back. I feel
like through this change of, you know, brain
chemistry, you know, psychology. That hand almost
goes behind you and is pushing you towards the
edge now. So in all the people that you hear
that are really getting close to that suicidal
point, talk to me about that distorted reality
and that. belief that they are the problem and
if they just take their own life everyone will
be better because we've talked about suicide
being cowardly and selfish but when you hear
these people some of whom have survived survived
their attempts that have been on the show you
realize at that moment in that distorted mind
it was actually a courageous and selfless act
even though to a healthy mind it made no sense
yeah it's such a difficult subject to talk about
um And especially if somebody's lost a loved
one to suicide themselves. And of course, in
some ways, it's a moot point because we don't
know the psychology and the cognitions of a person
who completes suicide. We can't. We can know
those that attempt suicide and don't complete
it. And then indeed, they say the things like
you're saying. They may do it to escape their
own pain. And the commonest thing you hear is
I just want the pain to stop. And this will make
the pain stop. And again, another reason you
might say is not just for me, but I want the
pain to stop for those other people because I'm
also causing them pain. But of course, as you
rightly say, when a person dies from suicide,
that causes immense pain to all these people
they were hoping to protect. So it's very hard
to know what's actually happening. I think the
other side, the sort of existential philosophical
side is, I suppose everybody does have that option
to live or die by their hand. And in some strange
way, we have to almost respect that decision.
How ghastly though it is when someone is in such
a position that they take that decision. And
we're mental health workers because we don't
believe that is ever the right decision. And
there has to be an alternative to that. But there
is also that in the mix, that it is a philosophical
decision for a person to make. And of course,
not all people who take their lives. have mental
illness. Some people do decide to make that decision
in a degree of clear consciousness. I think it's
relatively rare. And of course, we wouldn't be
doing our jobs as psychiatrists if we believed
that that was a reasonable way out. But yeah,
when you look at society, and particularly post
-COVID, and then really sadly, you throw in the
fact that people are not getting resources and
not getting access to support and care. more
and more people are thinking that that is a valid
way out to end their pain and to end the pain
of others. And it's tragic. That's tragic. Yeah.
I mean, you just alluded exactly to the point
that I'm hearing is the people that actually
went through with it. Kevin Hines, when he left
the Golden Gate Bridge, Emma Benoit, when she
pulled the trigger, immediately there's this
kind of return to... to the original state, to
their healthy mind state. And it's like, no,
I don't want to do this. And thank God they survived.
But you hear, especially with the use of alcohol
as well, there's that blurring of consciousness
by that point. So yeah, if you've got someone
who's got ALS and they're end stage and they
choose euthanasia. With a healthy mind, absolutely,
that should 100 % be everyone's choice. But it's
when the unhealthy mind is telling them lies
that I think that your profession and the other
world of psychology and psychedelics, that's
where we're able, I hope, to pull the people
back from the edge, restore their original frame
of mind, and then hopefully they'll be like,
oh, thank God I didn't do that. That would have
been amazing. Like you say, the acute event itself.
is very, very often associated with alcohol or
other drugs because of their disinhibiting effect.
So not just having an addiction to those substances
and all of the destruction that that causes,
but the acute event, the disinhibition. I mean,
we've all said and done things when drunk that
we wouldn't have done when sober. And that also
accounts for self -harm and completed suicide.
I'm not sure what the figure is. I think it's
something like 90 percent of suicides that the
patient is intoxicated with alcohol. Don't quote
me on that, but it's very high. Yeah. But then
we all get drunk and we don't all try and kill
ourselves. So it's not that the two go together.
It's obviously rooted in longer term mental health
problems and strife. And that's where we can
intervene. I think one thing that I've just reminded
of in what we're talking about here is. You talk
about those people who came back from an almost
completed suicide with a new life or a new lifestyle
or a new reflection. I've always been sort of
cautious about that narrative that somehow awful
trauma makes you stronger. I hate that phrase,
that that doesn't kill me makes me stronger.
It's not true. In the majority of cases, that
that doesn't kill me. gives me ptsd and heroin
addiction you know um it's a bit of a romantic
idea that when we're stressed and we're pushed
and we lose our jobs and we lose our money and
we lose our family and we lose our hope that
somehow there's this amazing ray of sunshine
that comes out of such adversity and means oh
now we're going to be okay because we've experienced
such lows That's not what the statistics show
us. Adversity causes pain. It's a very Hollywood
Disney idea that extreme adversity turns you
into a strong fighter. It usually doesn't. It
usually kills you. You know, why do we avoid
adversity? Because it kills us. And I think going
back to what you said about, you know, the idea
of reducing stigma. Part of that is being able
to say, I am really, really unwell and really
unhappy. And no, I haven't been made stronger
by losing my job, my money, my family. It hasn't
turned me into this, wow, everything's going
to be great now. It's actually killing me and
I might die from it. And I think sometimes sufferers
of PTSD, they see that sort of Hollywood Disney
message that... adversity will make you strong.
It doesn't usually. It usually kills you. That's
why it's adverse. I don't know what you think
about that. Do you get what I'm saying there?
I think so. Those events, it was immediately
like the split second after the suicide attempt
that they had this no moment. So it wasn't like
they suddenly were stronger. Where I see the
strength, and I've talked about this a lot, and
I think this is what we need from the mental
health conversation now, is where that strength
is gained is that journey. you know, MDMA, whatever
the toolbox that you choose, that healing journey,
that growth journey, because yeah, the adverse
event, I agree with you 100 % was horrible. That's
why it's a trauma. But doing the work then, and
obviously, ultimately, you're going to unpack
in my profession, well, it's not just that horrible
car crash that we went to. It's actually This
happened when I was a child and this relationship
issue and this financial issue. And you start
addressing the laundry list of other things that
you've kind of buried down in the past. So I
think that's the hope of post -traumatic growth
is the journey that you go, the healing journey.
And then being James 2 .0, not like I'm 18 -year
-old James or 12 -year -old James. I'm a totally
different person. But I think then seeing those
people that have gone through it. the empathy,
the compassion, you know, it's not that they're
bulletproof anymore. It's just that they've been
there. It's kind of that analogy with the man
in the hole, you know, the man jumps down. He's
like, why did you jump in with me? He said, because
I've been here before. I know how to get out.
That to me is the kind of post -traumatic growth.
Not as you said, oh, because I lost my child.
Now that was a gift from God. And now I'm going
to have this superpower. I think it's just these
traumas send us on this healing journey. And
that's really what the superpower is. You're
absolutely right. The adversity and the trauma
itself is not inherently strengthening. It's
inherently damaging. But what you do with it
afterwards can result in this kind of epiphany
of new direction in life. I mean, you know, I
mean, we're in agreement here. And we take these
things for granted now with our understanding
of trauma. But it wasn't that long ago that even
science didn't see things like that. You know,
the Victorians talked about tough love. It's
good to beat children. It's good for them. It
makes them strong. And that's where this phrase,
that that didn't kill me, made me strong. This
is where that phrase came from. The idea that
adversity is somehow good and to be welcomed.
And we have thankfully moved on from that, you
know, because most of the time it doesn't result
in good outcomes. It results in poor outcomes.
so we have moved on by far the best way to to
make a strong a child strong is to love them
and cuddle them and praise them and and give
them a nice warm gentle life that's the way to
make a child strong not to hurt them and humiliate
them and and beat them up to make them tough
but you know like i said it wasn't long ago in
society and in psychiatry that we didn't see
things like that I use that example of Victorian
times. That's when we used to have children in
factories and going up chimneys at five years
old. So just because that's the way they used
to do it doesn't mean it's right. But, you know,
if you look at it the other way, paradoxically,
look at the high levels of mental illness that
we seem to have. Well, with that being said,
what about the prevalence in... Knife crime and
those kind of things that we're seeing. What's
your perspective through a psychiatrist lens
as far as the root cause of this violence that
our children are seeming to lean into now? I
think, again, it's multiple factors. I would
say it's probably more than anything, it's psychosocial
factors of just economics and poverty and poor
education and lack of opportunity. Knife crime
exists amongst richer kids, but it's much, much
smaller. And then you've got the internet, the
media, the glamorization of that. It's really
scary for young people. You know, I've got teenage
children and it's really scary to think that
they could be involved in, you know, a skirmish
on the street at night. and could be stabbed.
I'd like to think that, you know, my children
wouldn't instigate such a thing, but they could
be a victim of it, you know? But of course it
could be anybody. So yeah, these things seem
to, they go hand in hand with social deprivation
and social stress. And I think, I don't know
enough about this in terms of the clear data,
but I think that from what I understand, issues
like the glamorization in certain aspects of
the media. and the access to the internet augment
the problem, as far as I can understand. But
that's kind of a lay opinion. Shifting back to
MDMA, and then we'll get to the book. I remember
in our first conversation that it was originally
a marriage counseling style drug. So I'm assuming
back then there was a level of approval. So how...
is a drug that was for a while actually approved
to being used then demonized to the point where
even in 2025 you guys can't get that it regulated
again well it was never approved it's never been
approved it's just it wasn't an illegal substance
on the list of banned substances so mdma therapy
came to the fore in the sort of mid to late 70s
And it was taken up particularly by a group of
psychotherapists who had been LSD therapists
in the 60s. So, of course, LSD psychotherapy
became a relatively big thing in psychiatry in
the late 50s and early 60s. And it was being
used on tens of thousands of patients. And it
was it was effective and it was safe and it was
doing well. And then, of course, the 1960s. drug
revolution happened and Timothy Leary and psychedelia
and the rest of it. LSD was banned pretty much
everywhere by the end of the 60s. And the doctors
and the therapists stopped using it. Of course,
the banning did nothing to stop the recreational
use, which kind of spiraled ever since. So banning
things doesn't make them go away, but it does
make respectable people like doctors not use
them if they're told they're not allowed to.
So MDMA came in in the late 70s. It had been
around since 1912, but it wasn't really a recreationally
used drug. It was pretty much unheard of until
it was rediscovered, if you like, by a chap called
Sasha Shulgin, who introduced it to another psychotherapist
called Leo Zeff. And he was using it. He was
previously an LSD psychotherapist and he'd stopped
using LSD when it was banned. But then when he
was introduced to MDMA. It wasn't a banned substance.
It wasn't even a known substance. So it wasn't
that it was licensed. It's just that it wasn't
banned. And then lots of success with thousands
of patients. But then MDMA went broadly the same
direction as LSD had done 10, 15, 20 years earlier.
It leaked from the medical community, started
turning up in nightclubs and police seizures.
And then it became banned in 1985. And then since
then, that's when Rick Doblin set up MAPS in
1985, 86. And since then, he and MAPS have been
working to unban it, if you like, and get it
licensed as a medicine. That's where we are today.
It's still not quite over the line. There's been
lots and lots of research over the last 20, 30
years. Hundreds, thousands of patients have been
treated legally with MDMA in research settings,
but it's still not over the line as a licensed
medicine. What are you seeing as far as the resistance?
For example, I've had a few guests on when it
comes to CBD, literally hemp -based therapeutic
plant medicine, no kind of real psychoactive
effect whatsoever, and they've had such resistance.
Now, my perspective is obviously there's so much
money in other drugs, you can see that there
would be pressure from markets that would be
threatened if... addiction mental health were
vastly improved in a much smaller amount of you
know therapeutic applications from behind the
scenes why is there so much resistance to you
know whether it's iboga mdma psilocybin these
compounds that are clearly having a lot of effects
as you said you know whether it's a hundred year
of the drugs being here or in some of these plant
medicines even thousands of years yeah i mean
My sense is there isn't actually lots of resistance.
It just simply hasn't jumped through the hoops
and got the approval. Yeah, sometimes people
say, hey, man, the reason governments ban LSD
and mushrooms is because they know that if people's
eyes were opened and they became enlightened
by these compounds, they would rise up against
the governments and be free. I just don't believe
that for a second. I think that is massively
flattering. the intelligence of governments that
they have that kind of a narrative going on.
You know, I would be incredibly impressed if
there's members of the government saying that
we can't let psychedelics become legal because
then everyone would rise. That's absurd. The
reason psychedelics are not legal is because
the governments have no idea about their benefit
and potential. The reason they're illegal is
because they think of them as crack and heroin.
They think that magic mushrooms, MDMA and psilocybin.
are the same as crack and heroin. They're killer,
dangerous, addictive drugs. And that's why they're
not being used. It's not because they're trying
to save themselves from the magical therapeutic
properties of these drugs. If only they were
so bright and astute to be banning them for that
reason. So the reason they haven't got over the
line is they simply haven't jumped through the
hoops that are required for licensed medicines.
It is more complex than that. Why have they not
jumped through the hoops? Because they haven't
had the money spent on them to jump them through
the hoops. It's incredibly expensive to get a
drug to market, whether it's an antibiotic, an
analgesic, a cancer drug or a psychedelic. It
doesn't matter. It's the same rules for all of
those. There's not extra rules for psychedelics.
All of those different compounds of drug have
to jump through the same hoops. to get licensed.
And it costs loads of money. It costs $150 million
and it takes 15, 20, 25 years. So we're just
on that journey. Now, it's certainly, on the
other hand, arguable that because there is a
stigma around these drugs, perhaps getting licenses
to do research studies is harder. Certainly because
they're scheduled drugs, Schedule 1 drugs, it
costs a lot of money and it's difficult and complex
to get. permission to do research on them but
it's not impossible and it's not blocked because
of stigma at least not that's not the main reason
if we had the money they would be over the line
if now then that goes back to the other part
of the question why would we not have the money
why are big pharma not spending money on psychedelics
i again i think it's a bit of a urban myth amongst
the psychedelic community that big pharma are
suppressing it because they're They're terrified
of the competition. We are nowhere near psychedelics
being a competition for SSRIs. It's a multi -trillion
dollar industry with millions of people on SSRIs.
I don't think that big pharma are suppressing
psychedelics because they just don't fear any
competition. They just don't see them as a competitor.
The main reason they're not putting money into
it is because they don't see them as a money
spinner. In a way, psychedelic medicine is a
marketing nightmare. it's it's it's a terrible
idea you only need to use the drug two or three
times and then you're better it's it's a marketing
nightmare psychedelics and this is if we get
on to talking about the contemporary psychedelic
industry and what's happened in the last five
ten years part of the reason why we saw this
big peak about five seven years ago loads of
money came pouring into psychedelics ironically
most of it from the canadian and californian
cannabis industry people who'd made their money
in cannabis medicine decided to turn turn their
attention to psychedelics thinking they would
make billions psychedelics and cannabis could
not be more different i mean they get put in
the same box because they're both recreational
drugs but from a medical practitioner point of
view they couldn't be more different cannabis
is a daily maintenance drug that has to be taken
every day day out day in day out you get someone
onto cannabis as a medicine You're going to make
millions because they're going to carry on using
it. Who's going to spend $150 million on getting
MDMA over the line as a licensed medicine when,
A, it's off patent. Nobody owns MDMA. No one
owns MDMA or psilocybin or LSD or 5 -MeO -DMT
or DMT. These are not patented drugs. These are
not molecules that are owned by anyone. Who's
going to put $150 million into all of that research
to then come up with a licensed drug that's free
anyway? um and you only have to take it once
or twice or three times and then never again
and you're better um and so it's not that i don't
think it's this is i don't think it's that the
pharma industry fear psychedelics i just think
they they can't be bothered there's no money
to be made in them um it's a waste of money to
put all that money into something that they're
not going to reap back their r d costs on you
know when you make a new prozac or or cannabis
product or i don't know uh viagra or one of these
wonder drugs that you use frequently you reap
back your 150 million dollars of r d costs um
because you've got patients on maintenance drugs
psychedelics are not maintenance drugs they're
they're a marketing nightmare and that's why
we saw this peak of all sorts of clinics like
the one where i worked in in the uk we opened
the uk's first medical psychedelic clinic lots
of money came pouring in and then it just wasn't
possible to make any revenue because it's very
expensive to deliver psychedelic therapy and
so far nobody really has come up with a decent
viable economic model that makes it worth spending
money on setting up psychedelic therapy clinics
It's so funny because this brings us right back
to the beginning of the conversation with the
NHS and how expensive it is for medicine. Well,
if you have, for example, MDMA, where you have
three sessions with it and you just keep seeing
healing progressing or Iboga or whatever the
thing is, then that's a patient -centric model.
But as you said, you can't get rich out of that.
So how do we fix the healthcare systems of the
world? You know, we bolster the proactive elements
and then you're left with pediatric cancer and
trauma medicine and these areas that do need
a lot of research and funding. So this is great
that we've come around to this because we've
come around to me completely contradicting myself.
And I'm glad because this is where I wanted us
to land. Whilst there's no money to be made from
a profit driven business of psychedelic provision.
What we do know, and I say this in my talks all
the time, there is nothing more expensive than
the untreated psychiatric patient. Psychiatric
patients cost millions over a lifetime. If you
allow that person in their teens with mild anxiety
and depression or PTSD to germinate into a full
blown psychiatric patient, they will cost millions
over a lifetime. Every time they go into hospital,
it's 10 ,000 pounds a week. They offend. They
go to prison. They don't work. They're on disability
benefits. The family law courts take away their
children. They don't work. Transgenerational
unemployment because of sub -treated or untreated
transgenerational mental illness. So we know
it's very, very expensive to not treat mental
health properly. So this is where you look at
then psychedelics. So suppose a course of MDMA
therapy cost, I don't know, suppose it costs
40 ,000 pounds, 30 ,000 pounds. That's a lot
of money and a hell of a lot more money than
a packet of Prozac, which is like two pounds
80 for 30 tablets. So we're not, so, so then
that makes people think psychedelics are too
expensive to deliver. We, you know, psychedelic
therapy doesn't work. We can't afford to pay
for these expensive two therapists, 12, 16 weeks.
But It's preventative medicine, because if that
30 ,000 pounds halts that 20 year old from becoming
a lifelong psychiatric patient, you will reap
back that 30 ,000 pounds very quickly. So the
answer, going back to the beginning of our conversation,
what's our magic wand to fix the mental health
care system? It's people with very far reaching.
understanding of preventative medicine that yes
psychedelics are an expensive upfront cost but
there's been some recent good health economic
analyses done with MDMA and psilocybin and they
are hugely beneficial and value for money hugely
value for money because if you prevent that trajectory
into a lifelong mental health psychiatric career
patient you will more than mop up that expensive
upfront cost. And it is expensive. And when a
GP's got a queue of people with depression and
anxiety, and he or she is endlessly writing scripts
for Prozac for three pounds a shot, to get that
GP to put his or her hand into their pocket to
spend 40 grand on MDMA therapy, it seems like
they're not going to do it. But then if you...
If you ask that GP, what will happen with these
patients who are being fobbed off with Prozac
scripts, and they've been in mental health services
for 40 years, they will have cost millions, millions
and millions. So the answer is an enlightening
look at the economic value of psychedelics, an
appreciation that they are an expensive upfront
cost. They are an invasive upfront cost. And
that the pharma industry are probably not going
to meet those costs because there's no pharma
money to be made in it. So who's going to meet
those costs? Who's going to pay that £40 ,000?
It has to be public health care systems, really.
It has to be public health care systems because
they're the ones that are going to reap the benefits
of bringing down that epidemic of mental illness
that not only is morally, ethically, clinically
wrong, but is also economically wrong for the
public purse. There's an interesting comparison
that I talk about a lot here. We have devolved
as a profession, a lot of us in the US are firefighters
and also paramedics. So we, you know, jack of
all trades, master of none. These men and women
are running, you know, 24 hours straight, usually
on. everyone's worst day and the work week initially
is 56 hours a week so you do a 24 hour shift
and a 48 hour period off and then rinse and repeat
for 10 20 30 years and there's obviously you
know illustrate this too much. Over time, we
have seen this just completely fall apart. The
mental health crisis, physical health crisis,
recruitment crisis, financial crises. As people
don't want to do this anymore, there's more overtime.
And now these men and women are working 80 hours
a week because they're forced to stay another
shift. And what has emerged from this as a huge
solution, as it were, one of the solutions is
to simply say, all right, we're going to invest
and put a fourth shift. And we're going to bring
it down to a 42 hour work week. And there's been
a revolution here in Florida where in the last
two years, nine departments have gone to this
because they realize all the money that we're
losing in overtime, in training people who then
leave, in lawsuits from mistakes, et cetera,
et cetera, et cetera. Why don't we just front
load that money, fill all those vacancies, and
now we'll actually be saving money. It's the
same exact thing, not even just in the mental
health, but I see in the NHS. If you did these
mental health treatments, what would be the impact
on obesity? Knowing that people, that's a way
of filling the void is food. What about cancer?
Knowing that stress is related to cancer. So
even all the other ailments that are crippling
the NHS, so many of those would be improved as
well if we were able to move the needle on the
British mental health. Yeah, absolutely. I mean,
and this is not new, the idea of prophylactic
medicine or... Public health care that is preventative
rather than just firefighting and mopping up
the problems later. This is not new as a concept,
but we've dug ourselves into such a hole now
with the epidemic crisis that psychedelic medicine
is finding it very hard to get off the ground
because you have to be very far reaching and
creative to spend that 40 grand on an MDMA patient.
If we kept spending it on lots of people in their
early years, we would save lots of money further
down the line and everyone would be happier too.
But going back to the finances of this, usually
we'd look to the pharma industry for this because
they've got millions and they produce the product
and they're more than happy to produce the product
because they're going to reap back their R &D
costs. If they're not going to reap back their
R &D costs, why would they bother producing the
product? And the answer is they wouldn't. And
the answer is they haven't. And that's why we've
seen this kind of rise and then collapse of a
psychedelic industry. And I'm not quite sure
what the answer is to bring it back. Because
I know as a socialist and certainly as a hippie,
I shouldn't have to care about commercialization.
But as a realist, you do. if something's not
profitable and commercially viable it's just
not going to happen in this world um so we talk
about the evils of satisfying shareholders etc
but if we don't satisfy shareholders then the
company collapses and that's that's that you
know so whilst you know the psychedelic world
and certainly my world of socialism and being
a hippie it revolves around shunning those things
realistically If the business doesn't work, you
don't get the treatment. So it has to be profit
driven. It has to be profit driven. I mean, Rick
Doblin's used up all the philanthropists now.
There's no more donors left. People don't want
to donate anymore. They want to invest. And so
we need to make it so it's investable. We need
to get the people with the big bucks to give
us $10 million. And you're only going to do that
if you can give them back $12 million in five
years time. They're not going to donate anymore.
And so to do that, we need to create viable economic
industries with psychedelics that make money
so we can do good. Or conversely, I mean, again,
if you have nations that are bleeding trillions
of dollars because of health care costs, do we
need to make money or can we actually proactively
invest? I mean, we have no problem sending weapons
overseas for all kinds of horrible things. What
if as a nation we band together and say, all
right, we will. you know, invest X amount in
creating these treatments for our people, knowing
that our healthcare costs are then going to start
shrinking dramatically. So rather than making,
do we always have to make more money or can we
be more efficient, you know, and fiscally sound
and proactively invest at the front door, which
will save us, you know, for years and years and
years. Because if you look at the healthcare
costs when we were children compared to now,
I guarantee you, they were, you know, a fraction
of what people pay today. Yeah, which is what
we talked about at the beginning, the complexity
of today's technological healthcare system. I
mean, and there are certain nations that seem
to be doing this better than others. And a lot
of the Nordic nations have a much more creative
and aspirational understanding of this. And as
a result, they have very high taxes. You know,
you pay a lot of tax, but they're investing it
in the future in ways that other nations are
not doing so much. Yeah. It's going to be really
interesting to see how the psychedelic renaissance
is going to play out in the next five years.
Because just to plug my book for a second, I
first wrote the book in 2012 when there was research
going on around the world and there was university
departments and small pockets of academic research.
I then did a second edition in 2017 where that
had moved on to... more and more academic departments
but then the reason i've done this third edition
which is coming out next month the third edition
of psychedelic renaissance is so much has happened
in the last eight years beyond recognition from
2017 we didn't have a psychedelics industry we
just had a academic university -based research
program um which was doing well but as i said
all this money came pouring in and all these
clinics opened all sorts of new ventures And
a lot of them have collapsed or merged or are
struggling. Because I think from my understanding
of it is the investors who'd come from cannabis
suddenly realized that it's not like cannabis.
It's really a lot more expensive to deliver.
And the outcomes are a lot slower because you
don't have to do so much. It's not a maintenance
treatment. And so you need people to invest economically
and also in terms of resources now so that we'll
save money in 20 years. Now, that's always a
hard sell to investors, but it's doable. It's
doable with certainly with health care systems
for whole nations who can see that wider picture.
But I'm interested to see how it's going to happen
in the next. five years i mean one of the things
that we've seen growing a lot in the last five
years since the clinic system kind of collapsed
to some extent is we've seen loads of psychedelic
education psychedelic training and education
is where people are making some money at the
moment so that's that's been promising and uh
loads people are offering treat um how to become
a psychedelic therapist and all the training
centers um another thing that's grown hugely
is The underground and then a gray area, which
we call the sort of wellness industry in which
drugs like psilocybin or ayahuasca or ibogaine
or indeed MDMA are offered under the radar for
for in retreats. Now, one of the difficulties
with this is because they're not on the public
health care system and they're underground, literally
they're off the radar. They tend to be very expensive
and exclusive. One thing I've said in talks recently
is we will have failed with the psychedelic renaissance
if after all this time, all these decades, all
we're doing is providing exciting trip experiences
for tech billionaires in Jamaica and Costa Rica
in luxurious yurts. That would be a failure of
the psychedelic renaissance, in my opinion. It's
not bringing the medicine to the people who need
it. Those huge swathes of low social economic
status groups with, as we discussed at length,
with all of the mental health problems, the high
prevalence of mental health problems. So have
we failed? I don't think we failed. It's all
part of the journey. But until we get psychedelics
free for the public in nationally approved public
health care. we will not have achieved the goal
of a psychedelic renaissance. Winston Churchill
once said, you can measure the greatness of a
nation by the health of its people. And I think
when you look at Scandinavia, they might have
a higher tax requirement, but it's a very healthy
nation. And we talk about their education, their
prison systems, their resilience to COVID. I
mean, so many areas where they're just doing
things really well. And I think it comes to humility.
The places like the UK, the USA need to be going
to those nations. Portugal, what are you doing?
It's not apples to apples. Your country is the
size of one of our states. But how can we apply
this? How can we take this blueprint and use
it in our system too? Because if in the UK and
the US, if we look and our nation has got fatter
and sicker and the mental health is getting worse.
insanity is doing the same thing, expecting different
results. So we need to do something differently
and proactively investing, whether it's MDMA
-led therapy or whether it's simply putting real
food back in schools or ideally all of these
things simultaneously. We were a healthy nation
for millennia until modern society came around.
So we can take the good things from technology,
apply it with some of this ancient wisdom and
create an even better system moving forward.
Yeah, it's absolutely doable. And, you know,
in many ways, we don't need any more psychedelic
research. We don't. We've demonstrated the safety
and efficacy of MDMA and psilocybin and DMT and
5 -MeO -DMT and ketamine. And, you know, we don't
need to do the safety and efficacy studies anymore.
We just need really good PR. We just need to
sell this to the people who can make the decisions
about implementing public health care systems
that use these. And that's what is happening.
And, you know, going back to the beginning of
this interview, you know, what's changed. There
are a great many positives that have happened
since 2018, since we last met, in terms of tackling
that stigma and bringing this into the public
consciousness. But in terms of us being there,
I would love for us now, you know, seven, eight
years after the first. session that we had for
me to be saying, Oh, it's fantastic. You can
now get MDMA on the NHS. You know, we're not,
we're not there. I would love it if in five or
eight years we come back and that is the case,
then we really will have, have moved forward.
We really will. Absolutely. Well, your book,
the third edition, the psychedelic Renaissance.
So you've got multiple other books as well. Where
are the best places to find that book? And what
is the exact release date as well? So it's on
a publishing, a publisher called Aeon Books or
Aeon, A -E -O -N, UK based publisher. It's a
terrific book. I'm really proud of it. I've been
writing this for about a year and a half. It's
a big, thick textbook. It's going to hopefully
be in every university department on all the
curricula for medical students and trainee psychiatrists
as the go to book. on psychedelics because a
lot of books have got the history of albert hoffman
and timothy leary and a lot of good books have
got the pharmacology um how the drugs work a
lot of the books have got the culture indigenous
uses and historically how these drugs have impacted
on culture and music and art and all of that
and the psychedelic renaissance book has that
but i don't think there's any other book that
documents the industrial changes of the last
15 20 years um as this book does so you really
do learn about these ups and downs of legalization
uh legislation approvals um and it's a kind of
work in progress and you know it's already out
of date because it's not even published but it's
already out of date because every week every
day i'm seeing more and more studies coming in
clinics opening clinics closing new retreats
starting retreats shutting you know it's it's
such a dynamic business and as i said it's going
to be really interesting to see see what what
it's like in another five years um i'll have
to write another one god i don't don't don't
um look forward to that um but no i'm really
really proud of it and it's going to be coming
out in hardback on eon books um i've got a sub
stack um group about it called the psychedelic
renaissance um and i've been posting regular
excerpts from all the chapters over the last
few months. I'm speaking at the Hay Book Festival
on psychedelics in a couple of months. And yeah,
this is a very well -timed interview because
it's just about to come out. Brilliant. Well,
Ben, I want to thank you so much. Another incredible
conversation and exciting conversation. I think
the renaissance that I've talked about, I think
is coming as one of kindness, compassion, empathy,
and community. And this is part of this entire
conversation. The way we bring people together
is we get them to heal. I really believe that.
And this is going to be one of the most powerful
tools. So I want to thank you so much for coming
back onto the Behind the Shield podcast and being
so generous with your time today. Well, thank
you, James. As usual, lots of difficult and penetrating
and stimulating questions and probably developing
more questions than answers between us. But it's
really, really important to thrash these things
out, isn't it? And let's hope that next time
that I come back and talk to you, we've got some
really positive things to talk about in terms
of what we've achieved with psychedelic medicine.