How to Change Your Mind

by Michael Pollan

  “The psychedelic journey may not give you what you want,” as more than one guide memorably warned me, “but it will give you what you need.” I guess that’s been true for me. It might have been nothing like the one I signed up for, but I can see now that the journey has been a spiritual education after all.

  Coda: Going to Meet My Default Mode Network

  I got the opportunity—a non-pharmacological opportunity—to peer into my own default mode network soon after I interviewed Judson Brewer, the psychiatrist and neuroscientist who studies the brains of meditators. It was Brewer, you’ll recall, who discovered that the brains of experienced meditators look much like the brains of people on psilocybin: the practice and the medicine both dramatically reduce activity in the default mode network.

  Brewer invited me to visit his lab at the Center for Mindfulness at the University of Massachusetts medical school in Worcester to run some experiments on my own default mode network. His lab has developed a neural feedback tool that allows researchers (and their volunteers) to observe in real time the activity in one of the key brain structures in the default mode network: the posterior cingulate cortex.

  Until now I have tried to spare you the names and functions of specific parts of brain anatomy, but I do need to describe this one in a bit more detail. The posterior cingulate cortex is a centrally located node within the default mode network involved in self-referential mental processes. Situated in the middle of the brain, it links the prefrontal cortex—site of our executive function, where we plan and exercise will—with the centers of memory and emotion in the hippocampus. The PCC is believed to be the locus of the experiential or narrative self; it appears to generate the narratives that link what happens to us to our abiding sense of who we are. Brewer believes that this particular operation, when it goes awry, is at the root of several forms of mental suffering, including addiction.

  As Brewer explains it, activity in the PCC is correlated not so much with our thoughts and feelings as with “how we relate to our thoughts and feelings.” It is where we get “caught up in the push and pull of our experience.” (This has particular relevance for the addict: “It’s one thing to have cravings,” as Brewer points out, “but quite another to get caught up in your cravings.”) When we take something that happens to us personally? That’s the PCC doing its (egotistical) thing. To hear Brewer describe it is to suspect neuroscience might have at last found the address for the “But enough about you” center of the brain.

  Buddhists believe that attachment is at the root of all forms of mental suffering; if the neuroscience is right, a lot of these attachments have their mooring in the PCC, where they are nurtured and sustained. Brewer thinks that by diminishing its activity, whether by means of meditation or psychedelics, we can learn “to be with our thoughts and cravings without getting caught up in them.” Achieving such a detachment from our thoughts, feelings, and desires is what Buddhism (along with several other wisdom traditions) teaches is the surest path out of human suffering.

  Brewer took me into a small, darkened room where a comfortable chair faced a computer monitor. One of his laboratory assistants brought in the contraption: a red rubber bathing cap with 128 sensors arrayed in a dense grid across every centimeter of its surface. Each of the sensors was linked to a cable. After the assistant carefully fitted the cap onto my skull, she squirted a dab of conductive gel beneath each of the 128 electrodes to ensure the faint electrical signals emanating from deep within my brain could readily traverse my scalp. Brewer took a picture of me on my phone: I had sprouted a goofy tangle of high-tech dreadlocks.

  To calibrate a baseline level of activity for my PCC, Brewer projected a series of adjectives on the screen—“courageous,” “cheap,” “patriotic,” “impulsive,” and so on. Simply reading the list does nothing to activate the PCC, which is why he told me now to think about how these adjectives either applied or didn’t apply to me. Take it personally, in other words. This is precisely the thought process that the PCC exists to perform, relating thoughts and experiences to our sense of who we are.

  Once he had established a baseline, Brewer, from another room, led me through a series of exercises to see if I could alter the activity of my PCC by thinking different kinds of thoughts. At the completion of each “run”—lasting a few minutes—he would project a bar graph on the screen in front of me; the length of each bar indicates to what extent the activity in my PCC had exceeded or dropped below baseline, in ten-second increments. I could also follow the ups and downs of my PCC activity by listening to rising and falling tones on a monitor, but I found that too distracting.

  I began by trying to meditate, something I’d gotten into the habit of doing early in my foray into the science and practice of psychedelic consciousness. A brief daily meditation had become a way for me to stay in touch with the kind of thinking I’d done on psychedelics. I discovered my trips had made it easier for me to drop into a mentally quiet place, something that in the past had always eluded me. So I closed my eyes and began to follow my breath. I had never tried to meditate in front of other people, and it felt awkward, but when Brewer put the graph up on the screen, I could see that I had succeeded in quieting my PCC—not by a lot, but most of the bars dipped below baseline. Yet the graph was somewhat jagged, with several bars leaping above baseline. Brewer explained that this is what happens when you’re trying too hard to meditate and become conscious of the effort. There it was in black and white: the graph of my effortfulness and self-criticism.

  Next Brewer asked me to do a “loving-kindness” meditation. This is one where you’re supposed to close your eyes and think warm and charitable thoughts about people: first yourself, then those closest to you, and finally people you don’t know—humanity at large. The bars dropped smartly below baseline, deeper than before: I was good at this! (A self-congratulatory thought that no doubt shot a bar skyward.)

  For the next and last run, I told Brewer I had an idea for a mental exercise I wanted to try but didn’t want to tell him what it was until afterward. I closed my eyes and tried to summon scenes from my psychedelic journeys. The one that came to mind first was an image of a pastoral landscape, a gently rolling quilt of field and forest and pond, directly above which hovered some kind of gigantic rectangular frame made of steel. The structure, which was a few stories tall but hollow, resembled a pylon for electrical transmission lines or something a kid might build from an Erector set—a favorite toy of my childhood. Anyway, by the odd logic of psychedelic experience, it was clear to me even in the moment that this structure represented my ego, and the landscape above which it loomed was, I presumed, the rest of me.

  The description makes it sound as though the structure were menacing, hovering overhead like a UFO, but in fact the emotional tone of the image was mostly benign. The structure had revealed itself as empty and superfluous and had lost its purchase on the ground—on me. The scene had given me a kind of overview effect: behold your ego, sturdy, gray, empty, and floating free, like an untethered pylon. Consider how much more beautiful the scene would be were it not in the way. The phrase “child’s play” looped in my mind: the structure was nothing more than a toy that a child could assemble and disassemble at will. During the trip the structure continued to loom, casting an intricate shadow over the scene, but now in my recollection I could picture it drifting off, leaving me . . . to be.

  Who knows what kinds of electrical signals were leaking from my default mode network during this reverie, or for that matter what the image symbolized. You’ve read this chapter: obviously, I’ve been giving a lot of thought to the ego and its discontents. Here was some of that thinking rendered starkly visible. I had succeeded in detaching myself from my ego, at least imaginatively, something I would never have thought possible before psychedelics. Aren’t we identical with our ego? What’s left of us without it? The lesson of both psychedelics and meditation is the same: No! on the first count, and More than enough on the seco
nd. Including this lovely landscape of the mind, which became lovelier still when I let that ridiculous steel structure float away, taking its shadow with it.

  A beep indicated the run was over. Brewer’s voice came on the loudspeaker: “What in the world were you thinking?” Apparently, I’d dropped way below baseline. I told him, in general terms. He sounded excited by the idea that the mere recollection of a psychedelic experience might somehow replicate what happens in the brain during the real thing. Maybe that’s what was going on. Or maybe it was the specific content of the image, and the mere thought of bidding adieu to my ego, watching it float away like a hot-air balloon, that had the power to silence my default mode network.

  Brewer started spouting hypotheses. Which is really all that science can offer us at this point: hunches, theories, so many more experiments to try. We have plenty of clues, and more now than before the renaissance of psychedelic science, but we remain a long way from understanding exactly what happens to consciousness when we alter it, either with a molecule or with meditation. Yet gazing at the bars on the graph before me, these crude hieroglyphs of psychedelic thought, I felt as if I were standing on the edge of a wide-open frontier, squinting to make out something wondrous.

  EPILOGUE

  In Praise of Neural Diversity

  IN APRIL 2017, the international psychedelic community gathered in the Oakland Convention Center for Psychedelic Science, an every-few-years-or-so event organized by MAPS, the Multidisciplinary Association for Psychedelic Studies, the nonprofit established by Rick Doblin in 1986 with the improbable goal of returning psychedelics to scientific and cultural respectability. In 2016, Doblin himself seemed stunned at how far and fast things had come and how close to hand victory now seemed. Earlier in the year, the FDA had approved phase 3 trials of MDMA, and psilocybin was not far behind. If the results of these trials come anywhere near those of phase 2, the government will presumably have to reschedule the two drugs, and then doctors will be able to prescribe them. “We are not the counterculture,” Doblin told a reporter during the conference. “We are the culture.”

  What had been as recently as 2010 a modest gathering of psychonauts and a handful of renegade researchers was now a six-day convention-cum-conference that had drawn more than three thousand people from all over the world to hear researchers from twenty-five countries present their findings. Not that there weren’t also plenty of psychonauts and legions of the psychedelically curious. Between the lectures and panels and plenaries, they browsed a sprawling marketplace offering psychedelic books, psychedelic artwork, and psychedelic music.

  For me, the event turned out to be a kind of reunion, bringing together most of the characters in my story under one roof. I was able to catch up with virtually all the scientists I’d interviewed (though Robin Carhart-Harris, with a baby on the way, had to skip), as well as several of the underground guides with whom I’d worked.

  Everyone, it seemed, was here, scientists rubbing shoulders with guides and shamans, veteran psychonauts, a large contingent of therapists eager to add psychedelics to their practice, plus funders and filmmakers and even a smattering of entrepreneurs sniffing out business opportunities. And although I picked up snippets of concern about the new attorney general’s efforts to rekindle the drug war, on the whole the mood was unmistakably celebratory.

  When I asked conferencegoers which session they deemed most memorable, almost invariably they mentioned the plenary panel called “Future of Psychedelic Psychiatry.” What was most noteworthy about this panel was the identity of the panelists, which, at a psychedelic convention, was cause for cognitive dissonance. Here was Paul Summergrad, MD, the former head of the American Psychiatric Association, seated next to Tom Insel, MD, the former head of the National Institute of Mental Health. The panel was organized and moderated by George Goldsmith, an American entrepreneur and health industry consultant based in London. In the last several years, he and his wife, Ekaterina Malievskaia, a Russian-born physician, have devoted their considerable energy and resources to winning approval for psilocybin-assisted therapy in the European Union.

  It was clear to everyone in the standing-room crowd exactly what the three men on the panel represented: the recognition of psychedelic therapy by the mental health establishment. Insel spoke of how poorly the record of mental health care stacks up against the achievements of the rest of medicine. He pointed out that it has failed to lower mortality from serious psychiatric disorders and spoke of the promise of new models of mental health treatment such as psychedelic therapy. “I’m really impressed by the approach here,” he told the group. “People don’t say, simply, we’re gonna give psychedelics. They talk about ‘psychedelic-assisted psychotherapy.’ . . . I think it’s a really novel approach.” Insel tempered his enthusiasm, however, by noting that such a novel paradigm may bedevil regulators accustomed to evaluating new drugs in isolation.

  George Goldsmith asked both men what advice they would give to the researchers in the room, men and women who have been working diligently for years to bring psychedelic therapy to patients. Without hesitating, Insel turned to the audience and said, “Don’t screw it up!”

  “There may be lots of promise here,” Insel said, “but it’s really easy to forget about issues related to safety, issues related to rigor, issues related to reputational risks.” He suggested that psychedelics would probably need to be rebranded in the public mind and that it would be essential to steer clear of anything that smacked of “recreational use.” He and Summergrad both warned that a single sloppy researcher, or a patient with a disastrous experience, could poison the well for everybody. Nobody needed to mention the name Timothy Leary.

  * * *

  • • •

  HOW CLOSE ARE WE to a world in which psychedelic therapy is sanctioned and routine, and what would such a world look like? Bob Jesse was in the audience when the former head of NIMH took his swipe against “recreational use,” and though I didn’t see it, I can picture his grimace. And what exactly is wrong with re-creating ourselves? Bob Jesse worries that the “medicalization” of psychedelics these men were advocating as the one true path would be a mistake.

  Not that medicalization will be easy. Several steep regulatory hurdles will first need to be overcome. Phase 3 trials involve multiple sites and hundreds of volunteers; they can cost tens of millions of dollars. Normally Big Pharma foots the bill for such trials, but thus far the pharmaceutical companies have shown scant interest in psychedelics. For one thing, this class of drugs offers them little if any intellectual property: psilocybin is a product of nature, and the patent on LSD expired decades ago. For another, Big Pharma mostly invests in drugs for chronic conditions, the pills you have to take every day. Why would it invest in a pill patients might only need to take once in a lifetime?

  Psychiatry faces a similar dilemma: it too is wedded to interminable therapies, whether that means the daily antidepressant or the weekly psychotherapy session. It is true that a psychedelic session lasts several hours and usually requires two therapists be present for the duration, but if the therapy works as it’s supposed to, there won’t be a lot of repeat business. It’s not at all clear what the business model might be. Yet.

  Several of the researchers and therapists I’ve interviewed nevertheless look forward to a time, not far off, when psychedelic therapy is routine and widely available, in the form of a novel hybrid of pharmacology and psychotherapy. George Goldsmith envisions a network of psychedelic treatment centers, facilities in attractive natural settings where patients will go for their guided sessions. He has formed a company called Compass Pathways to build these centers in the belief they can offer a treatment for a range of mental illnesses sufficiently effective and economical that Europe’s national health services will reimburse for them. Goldsmith has so far raised three million pounds to fund and organize psilocybin trials (starting with treatment-resistant depression) at multiple sites in Europe. Already he is working
with designers at IDEO, the international design firm, to redesign the entire experience of psychedelic therapy. Paul Summergrad and Tom Insel have both joined his advisory board.

  Katherine MacLean, the former Hopkins researcher who wrote the landmark paper on openness, hopes someday to establish a “psychedelic hospice,” a retreat center somewhere out in nature where not only the dying but their loved ones can use psychedelics to help them let go—the patient and the loved ones both.

  “If we limit psychedelics just to the patient,” she explains, “we’re sticking to the old medical model. But psychedelics are more radical than that. I get nervous when people say they should only be prescribed by a doctor. I imagine a broader application.”

  In MacLean’s words it’s easy to hear echoes of the 1960s experience with psychedelics—the excitement about their potential to help not only the sick but everyone else too. This kind of thinking—or talking—makes some of her mainstream colleagues nervous. It’s exactly the kind of talk that Insel and Summergrad were warning the community against. Good luck with that.

  “The betterment of well people” is very much on the minds of most of the researchers I interviewed, even if some of them were more reluctant to discuss it on the record than institutional outsiders like Bob Jesse and Rick Doblin and Katherine MacLean. For them, medical acceptance is a first step toward a much broader cultural acceptance—outright legalization, in Doblin’s view, or something more carefully controlled in MacLean’s and Jesse’s. Jesse would like to see the drugs administered by trained guides working in what he calls “longitudinal multigenerational contexts,” which, as he describes them, sound a lot like churches. (Think of the churches that use ayahuasca in a ritual context, administered by experienced elders in a group setting.) Others envision a time when people seeking a psychedelic experience—whether for reasons of mental health or spiritual seeking or simple curiosity—could go, very occasionally, to something like a “mental health club,” as Julie Holland, a psychiatrist who used to work with Stephen Ross at Bellevue, described it. “Sort of like a cross between a spa/retreat and a gym, where people can experience psychedelics in a safe, supportive environment.”*