TEDx - Insights from the Frontlines of Psychedelic Medicine

So, I make my living administering psychedelics to people suffering from anxiety, depression, and PTSD. The purpose of this talk is to share with you that, in my experience, drugs are not the answer. Now I'm going to share three insights with you that are born from spending the last several years of my life on what I consider to be the front lines of the psychedelic medicine movement. I am blessed in that I have really found my mission in life, and I work with an amazing group of people, including my good friend and partner Adam Tibble, who is not only an excellent human being but also a wonderful physician. Over the past six years, we have literally administered thousands of treatments to veterans and civilians, patients as young as 18 and as old as 80.

Now, I didn't used to do this work; I sort of stumbled my way into it. As Rune (Rune Toms, MD) mentioned, I was a mindfulness-based leadership facilitator. So I'd travel the world and work with Fortune 500 companies or nonprofits, taking me to places as far-flung as Pakistan and even South Sudan. On one hand, I loved my work, but it was also incredibly stressful. The travel schedule was really hectic, and I remember waking up one morning in a hotel room in Seattle. I caught a glimpse of myself in the mirror and just looked tired; I looked exhausted. I remember leaning on the counter and getting closer and looking deeper and deeper, having the sense that I couldn't keep doing this.

Now, I'm no stranger to anxiety and depression; I've experienced it pretty much my whole life in and out. Like most of my patients that I work with now, I had also had a fair amount of experience being on a cocktail of all kinds of pharmaceuticals—SSRIs, SNRIs, MAO inhibitors, benzodiazepines—you name it; I kind of cycled through them, and nothing was really working. The part that bugged me the most was the labels. I had amassed a bunch of labels: generalized anxiety disorder, major depressive disorder, post-traumatic stress disorder. I was looking at this person in the mirror who was just this embodiment of these disorders and these labels. Deep down, I knew I was starting to slip right back into one of those dark, murky, sticky places that probably wasn't going to end well. In that moment, I sensed that I was going to have to do something different here.

This leads me to the first insight I'd like to share with you: if we're not careful, these labels we give to people—especially in a mental health context—can have real consequences. Many patients that I work with now are convinced that they are those labels, which generates some degree of hopelessness. Conversely, if we can help our patients reframe their relationship to anxiety and depression—if we can help them shift from viewing these as diseases or disorders or pathological states to understanding them as explainable symptoms of some underlying untreated PTSD—we really give them a gift: the gift of agency. It gives them a sense of motivation and purposefulness to say, "Okay, I can embark on this healing journey; I have the power to do something about it."

So I came back to San Francisco feeling pretty motivated. I thought: "Okay, you're not going to slide down your usual path to depression; you're going to do something different." Of course, the obvious conclusion was psychedelics—right? Not for everyone! I'm joking here; it seemed like something drastic needed to happen for me to shift this. So I found a ketamine clinic; I wanted to do this legally. While I'd never really explored psychedelics in a therapeutic context before, I'd had some experience with them.

I found a clinic in San Francisco that was sort of this interesting mix of a high-end dentist's office and a surgery center—it was trying to be comfortable and groovy while still being very clinical with lots of beeping machines and white coats. Nonetheless, there I was in a chair with an IV in my hand. About 90 seconds later—boom!—I was gone. There was this swirling experience of lights and movement—this eternal expanse. Now I'm starting to do what all patients try to do: explain and describe their psychedelic experience—which is really boring for everyone else! So I'm not going to do that.

Having said that though, I did experience something best described as an out-of-body experience. I felt like an observer looking into life and myself; I saw that little kid inside me. There was an overwhelming sense of compassion and love—and even joy—at this whole enterprise of being human and being alive. In that moment, I knew he was going to be okay; The Observer watching all this knew that everything would be fine for me too. For the first time, it felt like we were ready to begin healing together.

I felt enthusiastic about these ketamine experiences; it felt like someone had given me the keys to a shiny new car! But there was a problem: I had no clear destination in mind—I had no map or GPS—and didn't even know what the roads were supposed to look like where I was going! Although I had an amazing therapist whom I saw for 50 minutes a week—what about the other 10,030 minutes of the week? What was I supposed to do with that?

I realized that in order for me to figure out how to take this beautiful vision from my experience and convert it into something useful for me, I'd need to take a step back and determine what my destination would be. At CIT Clinics when a new patient gets onboarded, we conduct a thorough clinical intake for safety—to understand what's clinically going on for the patient—but we also ask two specific questions: First: if you had a magic wand and could change three things about your life overnight, what would they be? Second: how would making those changes change your experience of life?

When asking patients that question most immediately say: "Of course I'd get rid of my anxiety and depression—that's obvious!" To which I respond: "I know what you don't want; what do you want?" There's usually a long pause; they get fidgety until eventually looking up saying: "I have no idea—I don't know! No one's asked me that question in a long time." Some will eventually say: "I just want to feel normal and peaceful." To which I'll say: "Great! Now we're getting somewhere!" But we're still missing details: What does a normal Thursday morning look like for you? What does a peaceful Monday evening look like? Who are you with? What have you done all day? How many hours did you sleep last night? Are you living alone? Do you have pets? How clean is your house? What's your credit card debt? Are you working? If so where? With whom? Doing what? Do you like the people you work with? The list goes on!

The point is: if we don't know where we're trying to go, there's no amount of ketamine or other medicines that'll magically get us there! We have to engage in this conversation with patients. My second insight is that the destination matters! We can glimpse this beautiful opportunity—the sense of wholeness or joy—but if we can't convert that into an actual roadmap or plan then it's going to be an uphill battle—we're missing out! So both destination and details matter.

Now we've established you've got to be willing to start this journey—you need agency—and also need clarity regarding what your destination looks like! The question remains: how do we proceed from here? Do any of you know what the Adverse Childhood Experiences (ACE) Questionnaire is? It's an amazing tool—a simple questionnaire consisting of ten yes-or-no questions where scores are generated by adding up yes answers. It was developed back in the late '90s by Kaiser researchers/physicians trying to understand developmental trauma or childhood trauma.

It turns out that scoring four or more indicates significant childhood trauma correlated with various health issues—for example: scoring four or more indicates a 500% increased risk of depression—a 1200% increased risk of attempting suicide—it doubles your risk for stroke/heart disease—and triples your risk for obesity! This is just naming a few health impacts. Half our clinic's patients score four or higher; 30% score five or higher—so you see where I'm going with this!

When we're young our nervous system develops like sponges soaking up our environment—that's how we make sense of our world!... If growing up in violent/unpredictable environments—what does that do for our ability functioning later on? It has massive impacts! Part of our job as mental health providers isn't just pumping people full of ketamine hoping for the best; it's actually helping them learn how to cope with forms of arrested development!

This leads me into insight number three: there are ten non-negotiables for well-being—foundational skills needed for functional adulthood! If we're missing one or more non-negotiables—it'll have repercussions—so rather than attaching labels/disorders let’s figure out which skills are needed! Now—I don't have time now go into all ten—that's another TED Talk—but here's something illustrating these non-negotiables:

Think about habits/behaviors not serving you well now ask yourself: can you imagine thriving over the long run while continuing this behavior into the future? For example: let's say the behavior is smoking a pack of cigarettes daily? Can you imagine thriving; being well over the long run while continuing smoking a pack daily? Obviously no! What about taking frustration/anger out on kids/not expressing gratitude/appreciation for your spouse?

They're subtler issues where actual rubber meets road regarding skills—they're non-negotiable because we know the outcomes if we continue these behaviors! The good news is that the inverse is true too! What if behavior/habit practicing self-care/self-compassion? Can I imagine thriving/being well over the long run practicing self-compassion/self-care? Obviously yes!

So the answer regarding ten non-negotiables is ensuring that we are helping patients achieve actual day-to-day behavioral change alongside any pharmaceutical interventions offered!

To summarize these three insights I've shared using another example: let’s say I wake one day and come tell you all “I’m running the Boston Marathon." It’s happening a few months from now and I'm running it!” 

Based on the insights I've shared with you today, you might think his agency/motivation seems pretty clear. Check! 

Also, Oli seems to have a clear destination in mind. Check!

But now back to the third insight: “Okay Oli, HOW are you going to get there?” To which I respond, “Well I've started supplementing electrolytes, doing a protein shake every morning, taking ibuprofen prophylactically for inflammation, watching YouTube videos, joining an online chat group with other runners and we’re talking every day!”

The obvious follow-up question should be “Okay Oli—is THAT all you're doing?” And I'd say “Yeah—you know, I'm starting there and waiting to see how it goes!” At this point my guess is that your confidence in my ability to run the Boston Marathon plummets right? And for good reason.

The true question that needs to be on the table is: “Oli, what's your training schedule? How will you build your training volume day-to-day? Week-by-week?” In other words, are you doing the important stuff that actually makes a difference?

If I sit there saying “Nope. I'm trying all these other things out first," then it tells you something. It’s a metaphor for what often happens in mental health! Yes—we’re doing things that are helping patients a little bit here and there. We’re even starting to see an abundance of ketamine clinics where you just get dosed… but receive no additional support.

In my experience, that's just not going to work! Ketamine is wonderful. It changed my life, and I see on a daily basis how impactful it is. But it really just hints at possibilities; it shines the spotlight on where things could go and how life could be—but the hard work still needs to happen, day-in and day-out!

I hope this talk provided some useful insights into this new world of psychedelics and hopefully serves as a good pitch for the importance of comprehensive care space! 

Thank you very much!