The show, which boasts Oscar-winning documentarian Alex Gibney as one of its executive producers, presents psychedelics as a potential game changer in the treatment of mental illnesses such as anxiety, depression, post-traumatic stress disorder, and obsessive-compulsive disorder. This may come as a surprise for those who mostly know about these drugs from America’s drug wars of the 1960s, 1970s, and 1980s, in which psychedelics were criminalized and characterized as dangerous and devoid of medical benefit. However, it turns out that before that, medical research had already demonstrated psychedelics had powerful therapeutic benefits. Today, that research has resumed, and the show covers recent studies and clinical trials whose results indicate that psychedelics, which research suggests are non-addictive and non-lethal, could help many people improve their lives. Here’s an overview of what we can learn from each of the series’ four episodes, followed by additional information not covered by the show about the potential risks of psychedelics.
LSD
The first episode in the series focuses on LSD, or acid, a substance that’s most often associated with the 1960s and hippie culture. But it turns out before it left the lab, LSD had a long history. Discovered in the 1930s by the chemist Albert Hofman while he was working for a pharmaceutical company, LSD sat on the shelf until Hofman accidentally came in contact with it several years later and realized it had hallucinogenic and mind-altering properties. In the 1950s it was marketed as a psychiatric drug, which was given to researchers for free so they could conduct their own studies with it. One of those researchers, psychiatrist Humphry Osmond, even coined the term “psychedelic.” Things changed when Timothy Leary, a psychologist at Harvard University started studying LSD. He discovered that people’s experiences with LSD varied based on the external setting and their internal mindset when they take it, but eventually his work got sloppy and he was fired. After that, Leary became a major—and very vocal—proponent of letting everyone take LSD and it became a widely used recreational drug. Teenagers’ and young adults’ behavior concerned the authorities, especially after many refused to fight in the Vietnam War. It was at this point that President Richard Nixon started speaking out against LSD and the media started to demonize it. Then in 1970, America labeled LSD a Schedule 1 substance, stopping any research on its clinical uses in its tracks. Research remained dormant until 2006, when a group of scientists at a conference wrote an open letter to the world’s health ministries asking them to once again allow studies involving LSD. Only Switzerland responded, but it was enough to ensure research resumed. The episode also briefly covers the popular trend of microdosing, or taking a low dose of LSD for help with everything from boosting creativity to easing depression. According to How to Change Your Mind, approximately 80% of those who have tried microdosing have claimed it helps them differently than antidepressants, with the most common observation being it helps people feel like themselves again. In particular, if those predisposed to serious mental health issues, such as schizophrenia, having a bad psychedelic trip, could trigger their first psychotic break. That said, in the controlled environment in which psychedelic studies are conducted, these risks are minimized.
Psilocybin
The series’ second episode explores psilocybin, the chemical produced by magic mushrooms, which like LSD, was classified as a dangerous Schedule 1 substance in 1970. Yet, according to the docuseries, many people believe psilocybin has the potential to revolutionize the field of mental health. Studies that have been going on since the late 1990s have shown that psilocybin can help with all kinds of issues, including substance use disorders, depression, anxiety, and anorexia. For example, one study found that after a single high dose of psilocybin people with cancer no longer feared death. In the episode, one participant confesses that she still experiences depression and pain because of her cancer, but that following the study, she feels like things are okay overall. Another study found that people who had never taken psychedelics before and were given a high dose of psilocybin had highly mystical experiences, with 30% claiming it was the most spiritually significant experience of their lives. Moreover, the more mystical a participant’s experience with psilocybin, the more likely they maintained positive outcomes a year later including positive changes in mood, attitudes, and behavior. These studies are undertaken in a lab under the supervision of a doctor and seem to demonstrate that under these circumstances, psilocybin can have a positive impact. As Dr. Cargart-Harris explains in the episode, mental illnesses appear to be a defensive reaction to uncertainty. For example mental health problems like eating disorders and substance use disorders are an attempt to restore control in one’s life, even if it’s a dysfunctional attempt. Psilocybin seems to break down the self and therefore the defenses the self has built, creating an opportunity to see things differently. Taking psilocybin seems to allow people to see through those stories. As a result, taking psilocybin can lead to deeply personal experiences that often have a spiritual component and enable people to put things in perspective.
MDMA
How to Change Your Mind’s third episode focuses on MDMA, which is commonly known as ecstasy or molly. Recreational use of MDMA spread in the 1980s, drawing the attention of the DEA, which eventually banned it in 1985 over concerns about neurotoxicity. However, before it was outlawed many people, including the man who discovered and started experimenting with it in the 1970s, the chemist Alexander “Sasha” Shulgin, felt it could be used for therapeutic purposes. Today, MDMA is the psychedelic closest to being legalized for medical use. That’s largely due to the work of the Multidisciplinary Association for Psychedelic Studies (MAPS) and its founder Rick Doblin, who’s spent years researching MDMA and advocating for its use. It’s this work that the documentary spends the most time profiling in this episode. MDMA seems especially good at treating trauma, and MAPS’ research has had remarkably good results in this area. Their clinical trials have explored the impact of psychedelic psychotherapy in people with PTSD. In each trial session, participants take MDMA under the supervision of a doctor and talk with a therapist throughout the session. The studies have shown that just three doses of the substance seem to help participants. In fact, in MAPS’ first large-scale clinical trial, two-thirds of participants no longer qualified as having PTSD after taking MDMA. Moreover, even many of those who haven’t gone into remission have had life-changing improvements in their PTSD symptoms after taking MDMA. It’s this combination that seems to be especially helpful for people with PTSD. In PTSD, the amygdala, the part of the brain that’s involved in our fight or flight response, is hyperactive, while the part that controls rationalization is less active. Taking MDMA essentially reverses this, opening patients up to heal. It also increases the release of oxytocin, elevating feelings of empathy and connectivity, while also providing a motivational component that helps people engage in therapy. According to medical psychedelic therapist Ben Sessa, who’s interviewed in the episode, unlike traditional psychiatric pharmacology that only treats the symptoms of trauma, using MDMA in the context of psychedelic psychotherapy gets to the root cause, the actual trauma.
Mescaline
In the docuseries’ final episode, the psychoactive molecule mescaline, which is the active ingredient in peyote, is covered. However, the nature of the information in this chapter is a bit different because peyote is deeply important to Native Americans and a cornerstone of their religion. As a result, the Native Americans interviewed in this episode are against others using peyote. Their concerns are valid. After all, Native Americans were using mescaline in their religious ceremonies well before Europeans settled in North America. Mescaline is produced in only two kinds of cacti that we know of, one is the peyote cactus, which grows on both sides of the Rio Grande River in America and Mexico, and the other is the San Pedro Cactus, which grows in the Andes. Native Americans harvest their mescaline from the peyote cactus. However, when the conquistadors came in 1492 and learned about peyote, including that it was said to enable users to talk to God, it threatened the Catholic priesthood, leading the Spanish to try to suppress and eliminate it. This didn’t wipe it out. In fact, Native Americans still use it today, considering it medicine that can heal both their generational trauma from the repression they faced at the hands of European settlers and for individual issues such as drug and alcohol addiction. However Native Americans have had to fight to use peyote. It was listed as a Schedule 1 substance and caught up in events like prohibition and the drug wars of the 1970s and 1980s. However, through Native American’s advocacy, a law was finally passed in 1994 that allowed the use of peyote as a religious sacrament. Today, peyote is under threat from a variety of sources, including the construction of mines, bad harvesting practices, wind turbines and the roads created to reach them, and more. This is especially concerning for Native Americans because not only is the peyote cactus endangered in America and Mexico, it also take it approximately 15 years to grow from seed to edible plant. Native Americans’ advocacy has once again ensured peyote is being left out of many city’s bills to decriminalize psychedelics. And Native Americans encourage those who want access to mescaline to take it from the San Pedro Cactus or to get it from synthetic mescaline, which can be extracted and made in a lab. While wrapping up the series, Pollan comes to the conclusion that as a non-Native American he shouldn’t try peyote. However, he also believes that the Native American religion can serve as an example of how psychedelics can be used to solve problems in socially conscious ways.
Are There Risks to Psychedelics?
There’s a warning at the beginning of each episode of How to Change Your Mind that tells viewers the show is intended to be informative and entertaining but not to be seen as medical advice. Still, after watching four hour-long episodes that provide an almost entirely positive perspective on the potential of psychedelics to help people with mental illnesses, it’s understandable why some viewers might be tempted to seek out psychedelics for personal use. After all—considering how many people suffer from various mental health ailments today—the idea that just one or two doses of psilocybin or MDMA could help makes it seem like a miracle cure. Of course, all the studies and clinical trials covered in the docuseries involved controlled settings and protocols ensuring that adverse effects are less likely and, if they do, a medical professional is there to help. This strongly suggests that using psychedelics to heal mental health issues should be done under the supervision of a doctor. The biggest risk is a bad trip, which can induce distressing feelings of fear, paranoia, and anxiety, but these appear to be fairly rare. In addition, bad trips seem to have only short-term effects and don’t require any drugs to treat them, although without interpersonal support to help manage a bad trip, it has the potential to lead to erratic or dangerous behavior. Moreover, while psychedelics appear to help with a wide range of mental illnesses, in their guidelines for safe hallucinogen research, Johnson, Richards, and Griffiths recommend excluding people who meet the criteria for schizophrenia, bipolar disorders, or any other psychotic disorders, as well as those with relatives with these issues, from studies. This is out of concern that taking psychedelics could trigger prolonged psychosis, although this risk is probably small. Still, this indicates that those who suffer from these issues shouldn’t take psychedelics.
Details the Show Overlooks
There are also some things that the show fails to mention that make some of the evidence presented seem less promising. For example. MAPS, which was covered in the show’s third episode, has been plagued by multiple scandals recently, but the one that might change viewers’ perception of the results of its MDMA trials involves its failure to document that several study participants experienced worsening suicidal thoughts following the trial. This has led the Canadian health regulator, Health Canada, to launch a review of all MDMA trials in the country. Furthermore, a recent study on microdosing, the first to compare those microdosing LSD to a placebo group found both groups experienced the same level of improvement after four weeks. This suggests that the benefits of microdosing may simply be the result of the placebo effect. Still, while more research remains to be done, and not everyone who participated in the studies covered on the show benefited from taking psychedelics, in the right doses and clinical settings, these drugs may eventually make a meaningful difference in the lives of many people suffering from mental illnesses.
