How to Change Your Mind

by Michael Pollan

  It was Ross who first told me the story of Bill W., the founder of AA, how he got sober after a mystical experience on belladonna and in the 1950s sought to introduce LSD into the fellowship. To use a drug to promote sobriety might sound counterintuitive, even crazy, yet it makes a certain sense when you consider how reliably psychedelics can sponsor spiritual breakthroughs as well as the conviction, central to the AA philosophy, that before she can hope to recover, the alcoholic must first acknowledge her “powerlessness.” AA takes a dim view of the human ego and, like psychedelic therapy, attempts to shift the addict’s attention from the self to a “higher power” as well as to the consolations of fellowship—the sense of interconnectedness.

  Michael Bogenschutz put me in touch with a woman I’ll call Terry McDaniels, a volunteer in his alcoholism pilot study in New Mexico—a surprising introduction, I came to think, because hers wasn’t the kind of unqualified success story researchers like to give journalists. I spoke to McDaniels by phone from her trailer park outside Albuquerque, where she lives on disability a few trailers down from her daughter. She hasn’t been able to work since 1997, when “my ex-husband beat my head in with a cast-iron skillet. Since that occurred, I’ve had a real problem with my memory.”

  McDaniels, who was born in 1954, has had a tough life, going back to her childhood, when her parents left her for long periods in the indifferent care of older siblings. “Even to this day I have a hard time laughing.” She told me she spends many of her days mired in feelings of regret, anger, envy, self-loathing, and, especially, a deep sense of guilt toward her children. “I feel very bad I haven’t given them the life I could have if I had stayed away from drink. I think about that other life I might have had all the time.”

  When I asked McDaniels how long she had been sober, she surprised me: she wasn’t. She’d actually been on a bender just a few weeks earlier, after her daughter “hurt my feelings by asking for money I owed her.” But the binge lasted only a day, and she had only had beer and wine to drink; in the years before her psychedelic session, she would binge on hard liquor for two weeks at a time, the drinking interrupted only when she blacked out. For McDaniels, a one-day binge now and again represents progress.

  McDaniels read about the psilocybin trial in the local alternative weekly. She had never before used a psychedelic but felt desperate and willing to try something new. She had made many attempts to get sober, had been in rehab, therapy, and AA, but always fell back on the bottle. She worried that her head injury might disqualify her from the trial, but she was accepted and in the event had a powerful spiritual experience.

  The first part of the trip was unbearably dark: “I saw my children and I was bawling and bawling, for the life they never had.” But eventually it turned into something awe inspiring.

  “I saw Jesus on the cross,” she recalled. “It was just his head and shoulders, and it was like I was a little kid in a tiny helicopter circling around his head. But he was on the cross. And he just sort of gathered me up in his hands, you know, the way you would comfort a small child. I felt such a great weight lift from my shoulders, felt very much at peace. It was a beautiful experience.”

  The teaching of the experience, she felt, was self-acceptance. “I spend less time thinking about people who have a better life than me. I realize I’m not a bad person; I’m a person who’s had a lot of bad things happen. Jesus might have been trying to tell me it was okay, that these things happen. He was trying to comfort me.” Now, McDaniels says, “I read my Bible every day and keep a conscious contact with God.”

  By her own lights, McDaniels is doing, if not well exactly, then somewhat better. The experience has helped her begin to rethink the story of her life she tells herself: “I don’t take everything so personally, like I used to. I have more self-acceptance, and that is a gift, because for a lot of years, I did not like myself. But I am not a bad person.”

  That one’s perspective could shift in such a way in the absence of any change in circumstance strikes me as both hopeful and poignant. I was reminded of an experiment that several of the addiction researchers I interviewed had told me about—the so-called rat park experiment. It’s well known in the field of drug abuse research that rats in a cage given access to drugs of various kinds will quickly addict themselves, pressing the little levers for the drug on offer in preference to food, often to the point of death. Much less well known, however, is the fact that if the cage is “enriched” with opportunities for play, interaction with other rats, and exposure to nature, the same rats will utterly ignore the drugs and so never become addicted. The rat park experiments lend support to the idea that the propensity to addiction might have less to do with genes or chemistry than with one’s personal history and environment.

  Now comes a class of chemicals that may have the power to change how we experience our personal history and environment, no matter how impoverished or painful they may be. “Do you see the world as a prison or a playground?” is the key question Matt Johnson takes away from the rat park experiment. If addiction represents a radical narrowing of one’s perspective and behavior and emotional repertoire, the psychedelic journey has the potential to reverse that constriction, open people up to the possibility of change by disrupting and enriching their interior environment.

  “People come out of these experiences seeing the world a little more like a playground.”

  * * *

  • • •

  ONE GOOD WORD to describe the experiences of both the Apollo astronauts and the volunteers on their psilocybin journeys is “awe,” a human emotion that can perhaps help weave together the disparate strands of psychological interpretation proposed by the psychedelic researchers with whom I spoke. It was Peter Hendricks, a young psychologist at the University of Alabama conducting a trial using psilocybin to treat cocaine addicts, who first suggested to me that the experience of awe might offer the psychological key to explain the power of psychedelics to alter deeply rooted patterns of behavior.

  “People who are addicted know they’re harming themselves—their health, their careers, their social well-being—but they often fail to see the damage their behavior is doing to others.” Addiction is, among other things, a radical form of selfishness. One of the challenges of treating the addict is getting him to broaden his perspective beyond a consuming self-interest in his addiction, the behavior that has come to define his identity and organize his days. Awe, Hendricks believes, has the power to do this.

  Hendricks mentioned the research of Dacher Keltner, a psychologist at Berkeley who happens to be a close friend. “Keltner believes that awe is a fundamental human emotion, one that evolved in us because it promotes altruistic behavior. We are descendants of those who found the experience of awe blissful, because it’s advantageous for the species to have an emotion that makes us feel part of something much larger than ourselves.” This larger entity could be the social collective, nature as a whole, or a spirit world, but it is something sufficiently overpowering to dwarf us and our narrow self-interest. “Awe promotes a sense of the ‘small self’ that directs our attention away from the individual to the group and the greater good.”

  Keltner’s lab at Berkeley has done a clever series of experiments demonstrating that after people have had even a relatively modest experience of awe, such as looking at soaring trees, they’re more likely to come to the assistance of others. (In this experiment, conducted in a eucalyptus grove on the Berkeley campus, volunteers spent a minute looking either at the trees or at the façade of a nearby building. Then a confederate walked toward the participants and stumbled, scattering pens on the ground. Bystanders who had looked at the trees proved more likely to come to her aid than those who had looked at the building.) In another experiment, Keltner’s lab found that if you ask people to draw themselves before and after viewing awe-inspiring images of nature, the after-awe self-portraits will take up considerably less space on the page. An experience of awe appea
rs to be an excellent antidote for egotism.

  “We now have a pharmacological intervention that can occasion truly profound experiences of awe,” Hendricks pointed out. Awe in a pill. For the self-obsessed addict, “it can be blissful to feel a part of something larger and greater than themselves, to feel reconnected to other people”—to the weave of social and family relations that addiction reliably frays. “Very often they come to recognize the harm they’re doing not only to themselves but to loved ones. That’s where the motivation to change often comes from—a renewed sense of connection and responsibility, as well as the positive feeling of being a small self in the presence of something greater.”

  The concept of awe, I realized, could help connect several of the dots I’d been collecting in the course of my journey through the landscape of psychedelic therapy. Whether awe is a cause or an effect of the mental changes psychedelics sponsor isn’t entirely clear. But either way, awe figures in much of the phenomenology of psychedelic consciousness, including the mystical experience, the overview effect, self-transcendence, the enrichment of our inner environment, and even the generation of new meanings. As Keltner has written, the overwhelming force and the mystery of awe are such that the experience can’t readily be interpreted according to our accustomed frames of thought. By rocking those conceptual frameworks, awe has the power to change our minds.

  Three: Depression

  Something unexpected happened when, early in 2017, Roland Griffiths and Stephen Ross brought the results of their clinical trials to the FDA, hoping to win approval for a larger, phase 3 trial of psilocybin for cancer patients. Impressed by their data—and seemingly undeterred by the unique challenges posed by psychedelic research, such as the problem of blinding, the combining of therapy and medicine, and the fact that the drug in question is still illegal—the FDA staff surprised the researchers by asking them to expand their focus and ambition: to test whether psilocybin could be used to treat the much larger and more pressing problem of depression in the general population. As the regulators saw it, the data contained a strong enough “signal” that psilocybin could relieve depression; it would be a shame not to test the proposition, given the enormity of the need and the limitations of the therapies now available. Ross and Griffiths had focused on cancer patients because they thought it would be easier to win approval to study a controlled substance in people who were already seriously ill or dying. Now the government was telling them to raise their sights. “It was surreal,” Ross told me, twice, as he recounted the meeting, still somewhat stunned at the response and outcome. (The FDA declined to confirm or deny this account of the meeting, explaining that it doesn’t comment on drugs in development or under regulatory review.)

  Much the same thing happened in Europe, when, in 2016, researchers approached the European Medicines Agency (EMA)—the European Union’s drug-regulating body—seeking approval to use psilocybin in the treatment of anxiety and depression in patients with life-changing diagnoses. “Existential distress” is not an official DSM diagnosis, the regulators pointed out, so the national health services won’t cover it. But there’s a signal here that psilocybin could be useful in treating depression, so why don’t you do a big, multisite trial for that?

  The EMA was responding not only to the Hopkins and NYU data but also to the small “feasibility study” of the potential of using psilocybin to treat depression that Robin Carhart-Harris had directed in David Nutt’s lab at Imperial College. In the study, the initial results of which appeared in Lancet Psychiatry in 2016, researchers gave psilocybin to six men and six women suffering from “treatment-resistant depression”—meaning they had already tried at least two treatments without success. There was no control group, so everyone knew he or she was getting psilocybin.

  After a week, all of the volunteers showed improvement in their symptoms, and two-thirds of them were depression-free, in some cases for the first time in years. Seven of the twelve volunteers still showed substantial benefit after three months. The study was expanded to include a total of twenty volunteers; after six months, six remained in remission, while the others had relapsed to one degree or another, suggesting the treatment might need to be repeated. The study was modest in scale and not randomized, but it demonstrated that psilocybin was well tolerated in this population, with no adverse events, and most of the subjects had seen benefits that were marked and rapid.* The EMA was sufficiently impressed with the data to suggest a much larger trial for treatment-resistant depression, which afflicts more than 800,000 people in Europe. (This is out of a total of some 40 million Europeans with depressive disorders, according to the World Health Organization.)

  Rosalind Watts was a young clinical psychologist working for the National Health Service when she read an article about psychedelic therapy in the New Yorker.* The idea that you might actually be able to cure mental illness rather than just manage its symptoms inspired her to write to Robin Carhart-Harris, who hired her to help out with the depression study, the lab’s first foray into clinical research. Watts guided several sessions and then conducted qualitative interviews with all of the volunteers six months after their treatments, hoping to understand exactly how the psychedelic session had affected them.

  Watts’s interviews uncovered two “master” themes. The first was that the volunteers depicted their depression foremost as a state of “disconnection,” whether from other people, their earlier selves, their senses and feelings, their core beliefs and spiritual values, or nature. Several referred to living in “a mental prison,” others to being “stuck” in endless circles of rumination they likened to mental “gridlock.” I was reminded of Carhart-Harris’s hypothesis that depression might be the result of an overactive default mode network—the site in the brain where rumination appears to take place.

  The Imperial depressives also felt disconnected from their senses. “I would look at orchids,” one told Watts, “and intellectually understand that there was beauty, but not experience it.”

  For most of the volunteers, the psilocybin experience had sprung them from their mental jails, if only temporarily. One woman in the study told me that the month following her session was the first time she had been free from depression since 1991. Others described similar experiences:

  “It was like a holiday away from the prison of my brain. I felt free, carefree, reenergized.”

  “It was like the light switch being turned on in a dark house.”

  “You’re not immersed in thought patterns; the concrete coat has come off.”

  “It was like when you defrag the hard drive on your computer . . . I thought, ‘My brain is being defragged, how brilliant is that!’”

  For many of the volunteers, these changes in the experience of their own minds persisted:

  “My mind works differently. I ruminate much less, and my thoughts feel ordered, contextualized.”

  Several reported reconnecting to their senses:

  “A veil dropped from my eyes, things were suddenly clear, glowing, bright. I looked at plants and felt their beauty. I can still look at my orchids and feel that: that is one thing that has really lasted.”

  Some reconnected to themselves:

  “I had an experience of tenderness toward myself.”

  “At its most basic, I feel like I used to before the depression.”

  Others reconnected to other people:

  “I was talking to strangers. I had these full long conversations with everybody I came into contact with.”

  “I would look at people on the street and think, ‘How interesting we are’—I felt connected to them all.”

  And to nature:

  “Before, I enjoyed nature; now I feel part of it. Before I was looking at it as a thing, like TV or painting. You’re part of it, there’s no separation or distinction, you are it.”

  “I was everybody, unity, one life with 6 billion faces. I was the one asking for love and giving lo
ve, I was swimming in the sea, and the sea was me.”

  The second master theme was a new access to difficult emotions, emotions that depression often blunts or closes down completely. Watts hypothesizes that the depressed patient’s incessant rumination constricts his or her emotional repertoire. In other cases, the depressive keeps emotions at bay because it is too painful to experience them.

  This is especially true in cases of childhood trauma. Watts put me in touch with a thirty-nine-year-old man in the study, a music journalist named Ian Rouiller, who, along with his older sister, had been abused by his father as a child. As adults, the siblings brought charges against their father that put him in jail for several years, but this hadn’t relieved the depression that has trailed Ian for most of his life.

  “I can remember the moment when the horrible cloud first came over me. It was in the family room of a pub called the Fighting Cocks in St. Albans. I was ten.” Antidepressants helped for a while, but “putting the plaster over the wound doesn’t heal anything.” On psilocybin, he was able for the first time to confront his lifelong pain—and his father.

  “Normally, when Dad comes up in my head, I just push the thought away. But this time I went the other way.” His guide had told him he should “go in and through” any frightening material that arose during his journey.

  “So this time I looked him in the eye. That was a really big thing for me, to literally face the demon. And there he was. But he was a horse! A military horse standing on its hind legs, dressed in a military outfit with a helmet, and holding a gun. It was terrifying, and I wanted to push the image aside, but I didn’t. In and through: Instead, I looked the horse in the eyes—and promptly started to laugh, it was so ridiculous.

  “That’s when what had been a bad trip really turned. Now I had every sort of emotion, positive, negative, it didn’t matter. I thought about the [Syrian] refugees in Calais and started crying for them, and I saw that every emotion is as valid as any other. You don’t cherry-pick happiness and enjoyment, the so-called good emotions; it was okay to have negative thoughts. That’s life. For me, trying to resist emotions just amplified them. Once I was in this state, it was beautiful—a feeling of deep contentment. I had this overwhelming feeling—it wasn’t even a thought—that everything and everyone needs to be approached with love, including myself.”