0:00

Hey everybody, welcome to

0:02

Dr. Drew Podcast. I appreciate

0:04

you guys being here supporting

0:10

this

0:13

podcast. We have some great guests and very

0:15

interesting interviews. I hope, if you have any suggestions, by

0:17

the way, send them over to contact at drdrew.com

0:20

and head over there also for After Dark and

0:22

Adam and Drew and other things we're doing over there. And do

0:24

not forget that streaming show, drdrew.tv.

0:27

There's

0:28

no doubt this audience would find

0:30

that material very interesting. It's very different

0:32

than all this. We're sort of meeting

0:35

Dr. Kelly Victory on Wednesdays. Again, it's

0:37

three o'clock Tuesday, Wednesday, Thursday, Pacific, are

0:39

interviewing some of the people that have not

0:41

been heard to see what we can learn from them. Sometimes

0:44

over their skis, sometimes I learn something. But

0:46

as always, that's the process. You

0:49

put thump on things and take a look at

0:51

what people are thinking and what the data suggests

0:53

and go from there and

0:56

be very, very cautious and skeptical

0:58

as you move forward. Today, I have Dr.

1:00

Dave Rabin. He is a psychiatrist.

1:03

He's got lots of interesting things he is working

1:05

on. And he and I have shared our

1:07

love of interpersonal neurobiology and all

1:10

the neurobiological correlates with addiction

1:12

and situations like that. He has

1:14

a very interesting instrument

1:17

called Apollo. You can follow him

1:19

on Twitter and Instagram at,

1:21

Dave, am I get this right? Dr. David

1:23

Rabin, am I getting that right? Yep. And

1:26

Dr. is DR Dave Rabin. And

1:30

Apollo neuro under, Apollo underscore

1:33

neuro on Instagram and Twitter. Apollo underscore

1:35

neuro. So today I want to get

1:38

into some of the newer stuff that

1:40

psychiatry is looking down

1:42

the barrel of. I

1:44

have some really fine colleagues

1:46

who are extraordinarily

1:49

excited, particularly by psilocybin

1:52

and some of these hallucinogens and some of the

1:54

data that's out there. I,

1:56

as someone that has worked in the world where

1:58

I've seen lots of.

1:59

injury from these things.

2:02

They scare me until we know for sure the

2:05

risk benefit ratios. And

2:07

so I get worried about it. I

2:09

know for sure there will be therapeutic

2:12

use for sure. I just

2:14

don't know when to pull the trigger and how much

2:17

and when and this sort of thing. So

2:19

let me just ask this just general question

2:21

to start out with.

2:23

Is academic psychiatry on

2:25

board with all this or is

2:27

it all sort of rogue? Not

2:29

rogue. Because psychiatry

2:31

has always been, I worked on Psych Out to Council

2:33

for 35 years. Psychiatry has always been because

2:36

it's such a, people don't understand it's relatively

2:38

new science psychiatry in terms

2:41

of how we practice it. Especially

2:45

the biological understanding. Well, that's what I'm meaning

2:47

when I say that. I mean, people don't

2:49

realize that psychoanalysis had a grip

2:51

on American psychiatry for like 50 years

2:54

and we didn't return to medicine until the 80s

2:56

really. And as such, I

2:58

noticed that

2:59

psychiatrists are usually very aggressive

3:01

with new therapeutics. That's just generally

3:04

their sort of orientation. Is

3:06

the academic infrastructure behind

3:09

some of these things? Yeah,

3:10

it's a great question. And thank you so much for

3:12

having me back, by the way. It's always a pleasure

3:15

to chat with you because you've

3:18

really been, I always admired your approach

3:20

to the way that you translate some of

3:22

these really interesting and complex

3:25

medical terminology information to your

3:27

audience. So really appreciated that.

3:30

And yeah, I think the, in short,

3:33

the academic

3:34

field is coming along because

3:37

of people like Rick Doblin and Roland

3:40

Griffiths and Matt Johnson and Robin

3:42

Card Harrison, these great folks at Hopkins

3:45

and Yale, Ben Kelmendy and Rachel Yehuda

3:47

at Sinai. All of these people who are

3:50

world-renowned scientists, who originally

3:53

came from, and physicians, psychiatrists

3:55

who came from a non-psychadelic

3:58

background often. and

4:00

now have spent

4:02

the last 30 years pioneering these

4:05

treatments in Western medical paradigms,

4:08

not just in nature and

4:10

not just in the indigenous tribal cultural

4:12

setting. And what we've

4:14

seen now is fast forward

4:17

to where we are today, ketamine is

4:20

the only legal psychedelic medicine

4:22

that's available for use in clinical practice. It's

4:24

an anesthetic and it's been used for 60

4:27

to 70 years as an

4:29

anesthetic for children, women, evacuating

4:32

soldiers from battlefield, animals

4:34

that can't tolerate anesthesia well like horses.

4:37

And so ketamine was

4:39

just by chance discovered to have psychedelic

4:41

properties, but it actually is

4:44

very effective at helping people recover

4:46

by when using the proper

4:48

setting, as you kind of alluded to, it amplifies

4:52

the patient or

4:53

client sense of safety that

4:55

is facilitated by the, you

4:57

know, what you and I described as like the doctor patient

5:00

relationship, right? Like one of the

5:02

biggest challenges with trauma.

5:04

And I think, you know, the caveat is these medicines

5:06

need to be used respectfully and properly. And according

5:08

to guidelines, and I think your hesitance is in

5:11

the right place because we don't

5:13

have guidelines yet that are. And by the

5:15

way, when I talked to Rick Doblin, I think I talked to you right

5:18

after Rick last time, and he is extremely

5:21

cautious and, you know, he only,

5:23

you

5:24

know, concludes

5:26

and uses what he knows in

5:29

evidence has great good evidence, some

5:31

strong evidence basis for it.

5:34

Yeah, absolutely. And we're the

5:36

same way. You know, I think if we don't, if we don't look

5:38

at the evidence and read our history,

5:40

right, and know what's worked in the past and know what

5:42

hasn't, we're doomed to repeat it. So

5:44

the goal is how do we, how do we

5:46

learn what everybody's done before, so

5:49

that we can understand, you know, what's worked, what hasn't

5:51

worked, you know, did massive dissemination

5:54

of psychedelics in the 1670s work

5:56

on a without education,

5:58

right? People get.

5:59

accidentally hurt because

6:02

I didn't understand what they were doing. I saw lots

6:04

of that. I literally, I had patients

6:07

that were chronically, psychiatrically

6:09

ill, but it was of a quality that was so

6:14

disabling. Many of them ended up in nursing

6:16

homes. It was sort of neuropsychiatric,

6:18

you know, and these people

6:21

were backup singers in rock bands that toured

6:23

around and did their psychedelics.

6:25

And they were so cool in the sixties, not

6:28

so cool in the eighties when they're, when

6:30

the, the biology came to roost.

6:32

Right. And I, and I think that's an interesting,

6:35

you know, a lot of these folks were talking

6:37

about in the sixties and seventies, especially the backup singers,

6:39

the

6:40

front line singers and the performers. A

6:42

lot of these people were doing a lot more than just

6:44

psychedelics, right? So there's, there was a huge

6:46

party culture. Yeah. Yeah. But, but

6:49

I only saw the, you know, I saw lots of drug

6:51

addicts, lots of drug use. The ones that ended up in nursing

6:54

homes had a big psychedelic LSD

6:56

particularly. That's the drug that scares me. I've

6:58

never seen any, I've never seen real

7:00

injury from psilocybin, for instance. Yeah.

7:02

Definitely never seen injury from ketamine. Never

7:05

seen, I've seen some

7:07

stuff from really heavy MDMA

7:09

use, like

7:10

really heavy, like not something you would use in a therapeutic

7:12

context. Yeah.

7:14

But just to echo what you're saying, I've

7:17

seen all of it. I see about 50% of

7:19

my practice is taking care of people who have had challenging

7:22

unresolved or what we call bad trips, right?

7:25

Just can't come back on their own and they don't

7:27

have support to help them and they don't know where they are,

7:29

what's going on anymore. And so it's

7:31

borderline psychotic, right? Yes. That's

7:34

actually the single biggest risk

7:36

that we take when we're using psychedelic

7:38

medicines as a, as a culture is

7:41

that when we, if we don't understand

7:43

that they amplify all parts of us,

7:46

not just the pleasant parts and not just the

7:48

unpleasant parts, but they're nonspecific amplifiers

7:50

of awareness as Dr. Stan Groff, famous

7:53

psychiatrist described in the fifties

7:56

and sixties that they amplify what we

7:58

bring in. And so

7:59

if we,

7:59

we're bringing in disorganized thinking,

8:02

if we're bringing in lack of

8:04

confidence and self-esteem, fear or threat,

8:07

and our environment is encouraging of those

8:09

kinds of feelings and not supportive, then the

8:11

medicine can actually amplify that and

8:13

it can dissociate us further and make us feel

8:16

less connected to the world and ourselves and

8:18

worsen what we call the delusion

8:21

or like the delusion that I am not okay,

8:23

right? And I am not worthy in this world or

8:25

worthy of love. And if you transition

8:28

that into an approach where you come in with gratitude

8:29

and safety, where the clinician, patient

8:32

or guide-patient relationship is the ultimate

8:35

safe role model, then the

8:38

client can remember, the patient can remember, hey, this

8:40

is what it feels like to feel safe and trusting, when

8:42

I might have trusted myself in years, which is,

8:45

you know, at the root of addiction and trauma, as you all know,

8:47

and then we can role model trust for the client

8:49

and then the medicine amplifies the trust and safety

8:51

and that's what results in the long-term therapeutic

8:54

benefit. Yeah, I

8:56

always saw my job,

8:58

you know, my specialty was, you

9:00

know, the early part of treatment with,

9:02

you know, polydiagnosis, medically

9:04

and psychiatric severe drug addicts. And

9:07

in addition to getting them medically and psychically squared,

9:10

my other job, as I saw it, was to get

9:12

them into the frame of a relationship,

9:14

to teach them that they could be felt,

9:17

they could be saved, it's possible

9:19

to be in this frame.

9:21

And I got so many things

9:24

I want to talk to you about, but I'll just go down this path

9:26

for a second. And one of the ways that I

9:28

got good at getting them in

9:31

was responding

9:33

to whatever came out of my body. In

9:36

other words, I would say

9:38

things without thinking about it. And

9:41

they were never wrong. They would just, I

9:43

just got so used to attuning deeply,

9:45

because the addict was blah, blah, blah, blah,

9:47

blah, blah, blah, blah. And I just

9:49

wouldn't listen, I would just, I would listen, I would get

9:52

the, you know, what they were saying, but

9:54

I would just respond with whatever came out. And

9:57

what came out oftentimes was, you know,

9:59

well, that's...

9:59

That's bullshit or you're so full of shit or give

10:02

me a, you know, how about, what

10:04

about that? That's you just, you glossed

10:06

over that. Let's go down that path. And

10:09

that ability to respond

10:12

body to body, which is what harkens

10:14

back to our

10:16

mother child system that

10:19

builds our emotional regulatory system in the first place,

10:22

just touching that teaches them

10:24

that somebody can do that. And

10:26

I always felt that was very important. I love the idea that

10:28

ketamine is expanding on that now. Is

10:31

that accurate?

10:32

Yeah, you nailed it, right? I think that's exactly

10:35

what it is that we're doing for people. And ketamine

10:38

is the first that's entering into, to answer

10:40

your first question, entering into the Western

10:42

medical, clinical,

10:44

what we call interventional psychiatry environment.

10:47

So applying a medicine and therapy

10:49

together. Right. We used to just give the

10:51

ketamine in six sessions, right? That

10:53

improves mood too, just that.

10:55

It does, but it seems like

10:57

what we're seeing now in the literature. And by

10:59

the way, still, I think 90% of ketamine

11:01

providers are still just providing medicine only

11:04

without therapy. I think as

11:06

we're seeing in the therapy field, as we're doing more

11:08

studies of therapy plus the

11:11

medicine and seeing that if you prepare

11:13

somebody, even if it's just for an hour or two before,

11:15

and then you sit with them during, and then

11:17

you prepare that, and then you integrate or you unpack

11:20

what comes up after that they're actually

11:22

able to get, require less medicine long-term

11:25

and sustain

11:25

the benefits. And we just published

11:27

a really interesting article, review

11:30

article in Journal of Effective Disorders that came out a couple

11:32

of months ago by the board

11:34

of medicine and Ali Fadusha,

11:37

who's a very well-regarded MDMA researcher

11:39

and neuropharmacologist who, you know,

11:41

really calling for a gold standard of care, best

11:44

practices in psychedelic medicine and

11:46

reviewing, presenting a review of all the evidence that says,

11:48

look, whether we're looking at SSRIs for depression

11:50

or anxiety, or whether we're looking at antipsychotics

11:52

for psychotic disorder,

11:54

or whether we're looking at psychedelics for

11:56

PTSD and depression and anxiety, psychotherapy.

12:00

invariably always makes

12:02

the outcomes better. It's so weird. We have to say it again. Right.

12:08

Why would psychedelics be any different? You know,

12:10

the challenge we're facing as a medical field right

12:12

now is that the financial models that

12:15

models of air don't align

12:17

with an outcomes driven focus, which is

12:19

what actually gets us to a healed community.

12:22

Right. I'm also looking at a study that you

12:25

sent me ketamine matches, ECT efficacy

12:27

for treating major depression. And I just

12:30

want to say, you know, people think shock therapy.

12:32

Oh my God. Shock therapy is a very effective

12:34

therapeutic. It's only obviously reserved

12:37

for very severe cases where people's lives are

12:39

in danger, but it works. And

12:41

putting ketamine against ECT is a pretty powerful

12:44

statement. I was that with therapy in this study?

12:46

No. So that's what's interesting, right? So ECT

12:49

typically in most electroconvulsive

12:51

therapy, electroshock therapy studies.

12:54

And by the way, two of our most tried and true technologies

12:56

in psychiatry that work or

12:59

tools that work to treat things better than

13:01

anything we've ever seen evidence wise,

13:03

not to mention that there are

13:05

side effects, but those two things are electroshock

13:07

therapy. It's been around for over a hundred years.

13:09

I think it was co-invented by like Michael

13:11

Faraday who invented the original capacitor that

13:13

allowed for us to shock ourselves

13:16

enough to kind of like reset

13:18

the brain. And then the other one is

13:20

lithium, which is, you know, a natural organic

13:23

compound that's used mineral that's in

13:25

the soil that's used for

13:26

bipolar disorder and mood stabilization.

13:29

So electroshock therapy in particular is

13:32

very interesting because it's inducing

13:34

a state in the brain that causes

13:36

what we call like a dissociative. So

13:38

a separation of mind and body through

13:40

seizure. So you're reducing

13:43

a seizure in a controlled setting, which

13:45

causes a period, a very temporary

13:47

period of hyperactivation in the brain, which

13:50

then is followed by a period of under activation

13:53

that allows people to sort of regain perspective,

13:55

but it has a lot of side effects. It has memory

13:58

issues that follow short, especially short.

13:59

short-term memory issues that are really disturbing

14:02

for people. And it has a lot of stigma

14:04

from the past that we are well aware

14:06

of and it's not particularly soothing.

14:09

And so ketamine is really interesting because ketamine and electroshock

14:11

therapy are both used for treatment resistant depression

14:14

and suicidal depression. It's

14:16

probably their major indication. Ketamine

14:19

is soothing. It

14:21

doesn't have the stigma. It makes

14:24

people feel

14:25

better and the effects can

14:27

last longer, especially

14:29

when combined with psychotherapy and you don't necessarily

14:32

need it for life. And we haven't answered all of those questions

14:34

yet, but it's really exciting as a field

14:37

to have and paradigm shifting to have tools

14:39

that we can start to bring in that really change

14:42

the way we think about approaching mental illness by

14:44

not just distracting or numbing

14:46

people to their feelings, but getting

14:49

to the core, right? How do we help people feel

14:51

safe enough to reevaluate what it means to be me

14:54

and to be okay with that?

15:01

This is Walk-Ins Welcome with Bridget Phetasy.

15:04

I love hearing people's stories of resilience

15:06

and grit. This is why I created this

15:08

podcast. We are very excited to

15:10

welcome Jim Gaffigan, Yasmin

15:13

Mohammed, Glenn Beck, Tim Dillon, Abigail

15:16

Schreyer, Jeff Garland, Ayan Hirsiali,

15:19

Sam Harris, Heather Hying, Jonah

15:21

Goldberg, Ben Shapiro, Glenn Greenwald,

15:24

Sarah Shahi, Colin Quinn. There's

15:26

a culture of victimhood, then let's tell

15:28

stories of grit and survival. Subscribe

15:31

and listen

15:31

now on Apple Podcasts, Spotify,

15:33

or wherever you get your podcasts.

15:43

It's interesting when I hear you talk that

15:45

you combine, and I'm

15:48

wondering if this is common in psychiatry

15:50

right now, you're combining a

15:53

psychological frame with a biological

15:55

frame. That

15:57

is a relatively new thing I would

15:59

say.

15:59

say. Am I right

16:02

about that? Yeah, that's but

16:04

that's where the field's going right now. So

16:06

I mean, it's called it's called integrates called using

16:09

everything we know and integrating it. Exactly.

16:11

Because I'm not used to my psychiatric colleagues speaking

16:14

quite I've always personally, you

16:16

know, I worked in addiction and you have to

16:18

master all that stuff. You have to have family systems,

16:20

you have to have all everything. Yeah, you've

16:22

got to have familiarity with all of it. And

16:25

so I, I, you know, I had to, I

16:27

had to cherry pick who I had to bring the psychiatrist

16:30

in just for the med manager, I'd bring a psychologist

16:32

in for or the therapy. And it always

16:34

seemed odd to me.

16:36

Yeah,

16:37

no, it's I mean, it's not the best model, right? I think

16:39

I'm, I'm a particularly unusual psychiatrist,

16:42

because I do predominantly psychotherapy. So

16:44

I'm a general adult psychiatrist, I write prescriptions,

16:46

I do psychedelic assisted therapy

16:49

and medication assisted therapy. But

16:51

I do holistic integrative therapy,

16:53

because what we realize is that what

16:55

are the things you know, what are the things that make people

16:57

better fastest, and help

17:00

people actually take what

17:01

they're learning in therapy

17:04

and then make it stick. And it's

17:06

the same things that we that you're

17:08

talking about that everybody's talking about that helps our bodies

17:10

get into a state of healing, which is good quality,

17:13

restful sleep, daily,

17:16

daily, like health and wellness practices, like mindfulness,

17:19

meditation, yoga, breath work, soothing,

17:22

touch, soothing music, healthy amounts of movement

17:24

and good nutrition, right? But sleep

17:27

is at the fake at the core foundation

17:29

of all of that, because sleep is

17:31

where we re consolidate

17:33

and store and organize all of our memories. And

17:35

so if we're not getting good deep restful sleep, a lot

17:38

of that stuff we're learning during the day is just like

17:41

not sticking, right? And so then, no,

17:43

how do we create a foundation where

17:45

the body effectively is ready

17:48

to learn? And neuroplasticity

17:51

is the norm,

17:53

right? Learning neuroplasticity are the same

17:56

thing. How does the brain continue to develop

17:58

over time? And what we've seen from the

18:00

last 20 years of neuroscience research is really

18:02

exciting is as above,

18:04

so below, right?

18:07

When we have a change in the brain, a change in our

18:09

thinking process, there is a change in

18:11

the brain and then a change in the cells that interact

18:13

in the brain and a change in every organ

18:15

system in the body and the way we function because

18:18

our thoughts and our minds

18:20

and our bodies are intimately connected. And

18:23

that separation that I think started

18:25

with maybe Descartes in the, you know,

18:28

1800s is actually caused a lot of confusion

18:30

in the field and it's caused us to separate

18:33

therapy and biology and separate

18:34

psychoanalysis and biological

18:37

psychiatry. It's caused a lot of rifts.

18:40

If you're physically ill and you don't treat it, you get mentally ill.

18:42

And if you're mentally ill and you don't treat it, you can get physically

18:44

ill and we know that. So that's really

18:47

the direction the field's going. Yeah. We, you know, well,

18:49

we start with our patients hungry, angry, lonely,

18:52

tired.

18:52

That's just where you start and just deal with

18:54

that stuff first. And by the same

18:57

token, I, to your

18:59

point about the getting sick, if

19:02

your brain's not right or vice versa, for

19:05

the first 10 years I worked in psychiatric

19:07

hospital, I was doing medical services where I would

19:10

do, you know, everyone has to get a medical

19:12

evaluation because I would

19:14

say 30% of the time there

19:17

was a medical problem undiagnosed

19:20

that was underneath causing the depression

19:23

or causing it because somehow there was a medical issue

19:25

or there was a medical issue caused

19:28

by the psychiatric state

19:29

or the medication. That was a common thing too. Oh

19:31

yeah. The medication was often a problem.

19:35

Especially back, this is like 80s and 90s when I was really

19:37

doing that stuff actively. Still is. Yeah,

19:39

I'm sure. I'm sure that like I was saying at the outset

19:42

psychiatry is aggressive with the medication.

19:45

And so you have an instrument, the Apollo

19:47

instrument that helps with sleep, right?

19:50

That part that people really struggle

19:52

with very often. Yeah.

19:54

It helps with sleep at the foundation, but it really helps

19:56

with getting ourselves in

19:58

a place to feel.

20:01

our feelings because when we feel

20:03

our feelings, then we

20:05

are able to adapt to stress

20:07

and adjust to sleep and change

20:09

states more easily. It's when, and

20:11

this goes back to ancient Hippocrates,

20:16

as you know, or the founding

20:18

father of Western medicine, but also ancient Buddhist

20:20

and yogic philosophies, which is that

20:23

resistance to what is creates

20:25

suffering. And that includes

20:28

our feelings. We are feeling machines,

20:30

right?

20:31

Why do people abuse substances?

20:33

Oftentimes when we see in our practice, it's to avoid

20:36

or distract from feeling because it's uncomfortable.

20:40

And so, or they remind us of something really

20:42

uncomfortable. So studying

20:44

all of that and recognizing the power

20:46

that our

20:48

clinician patient doctor patient relationship

20:50

has on people's healing and our empathy and

20:53

recognizing that psychedelic medicines actually

20:55

amplify that process. And we've been studying, I've

20:58

been studying the mechanism of MDMA and ketamine

21:00

for the last several years and

21:02

actually had some great findings to show

21:05

that MDMA consistent with what

21:07

others had found is actually

21:09

reversing the epigenetic

21:12

markers of trauma on our DNA in

21:15

the safety and fear response pathway, the cortisol

21:17

pathway, right?

21:19

And so that has given us a ton

21:21

of evidence that says, okay, well maybe

21:23

the drug, the medicine like MDMA is

21:26

amplifying safety. Maybe ketamine is amplifying

21:29

the safety of this relationship so you can trust

21:31

yourself again, but maybe it's

21:33

not required, right? MDMA

21:36

is going to cost 10 to $14,000 for one round of treatment over 12 weeks. And most

21:41

people can't afford that. And it's not for

21:43

everyone. And it's, you

21:46

know, not going to be reimbursed by insurance for

21:48

a while and it's hard to access. So we

21:50

thought, well, if we can figure out how MDMA

21:52

works on the brain, what

21:54

pathways is it targeting? What's being activated?

21:57

And how is that facilitating change for people? Then

21:59

And perhaps we can tap

22:02

into that same safety cascade with

22:04

other things. And it turns out that soothing

22:06

touch is by far the

22:09

fastest way for us to get into

22:11

a safe state in our bodies. And

22:13

by safe, I mean physiologically safe. So when our

22:15

stress response system turns down or off

22:18

and our recovery parasympathetic vagal

22:20

system turns on, our heart rate slows down,

22:22

our blood pressure comes down, our breath rate comes

22:25

down, and our digestion and

22:27

our immunity and our reproduction all go up

22:29

because our bodies

22:29

are recognizing that they're safe enough to

22:32

prioritize things that are not required for

22:34

survival. And so we figured

22:36

out how to effectively tap into that

22:38

pathway to understanding safety and what

22:41

MDMA is doing. And then we created this

22:43

tool, Apollo, that I'm wearing on my chest that

22:46

you can wear anywhere on your body that delivers soothing vibrations

22:48

to the skin that are felt like a

22:50

hug or felt like a purring cat

22:53

on your body or somebody holding your hand on a bad day

22:56

that is like a song for your nervous system. And it helps

22:58

to tone the vagal system and remind

23:00

us that we're safe enough

23:02

to maybe take our time and

23:04

make better decisions and fall

23:07

asleep because sleep is also a very vulnerable place

23:09

to be for us.

23:10

Does it help the sleep hygiene, the

23:12

sleep cycling?

23:14

We

23:16

developed it originally at the University of Pittsburgh for people

23:18

to use during the day, originally working

23:20

with vets with PTSD and addiction disorders.

23:23

But interestingly enough, when we, like

23:25

many products, you release them to the world and they're used differently

23:27

than you thought originally. And people

23:29

started using Apollo for sleep more than anything else.

23:31

And so they'll use it to, it has eight vibes.

23:34

So you can choose from energy, creative,

23:37

social, flow, deep focus,

23:39

then recover, which is like five minutes of moderate

23:42

breathing, calm, which is like 20

23:44

minutes of deep breathing, relax,

23:46

which is kind of like a deep unwind.

23:49

It's unwind like cannabis, indica, or a glass of whiskey,

23:51

and then sleep. And so people will

23:53

schedule those throughout the day and they'll

23:55

schedule it to wind them down and

23:57

put them to bed to wake them up in

23:59

the morning. of an alarm clock and then to keep them

24:01

energized during the day so they drink less coffee

24:03

and rely on less substances. And

24:06

that regulates your circadian cycle for you.

24:09

And that ultimately we've seen improved

24:11

sleep up to 30 minutes a night and people use it

24:13

regularly over three months and improves

24:16

deep and REM sleep significantly as well, which is

24:18

very, very interesting. So,

24:20

you know, we've mentioned several times

24:23

trauma now today. And

24:25

it's, you know, finally, the other thing

24:27

that

24:29

mental health and medicine has caught up

24:31

with is the impact of trauma, particularly childhood

24:33

trauma. You

24:35

know, I don't know if people remember, but in

24:37

the 1990s, that was the decade

24:39

of the brain. And we got much in

24:41

a very Descartian style or Cartesian

24:44

style, we got very hooked, you know, very focused

24:46

on the thing in the cranium.

24:49

The thing in the cranium is embedded in a body.

24:51

We sort of left that behind in this instrument

24:53

you're talking about is the bodily based component

24:57

of

24:58

what our central nervous system is doing. And,

25:02

you know, we still don't know, we

25:04

know, you know, we have these people call them chakras

25:07

or solar plexus or whatever these,

25:09

we have these rest of nervous tissue in our body,

25:11

we still don't know what they're doing. They're like little mini brains

25:13

throughout our body that process the

25:15

autonomic nervous system, the automatic part of

25:18

our nervous system.

25:20

And, and that's what you're talking

25:22

about attuning to. And there's

25:25

a lot of stuff out there. You know, obviously,

25:27

we've said the Apollo, ketamine, we're talking about entering

25:31

the frame of relating and all these things that

25:33

you and I are very dedicated to. But

25:35

people are doing other things too. And I just want to get some

25:38

input from you about some of these other therapeutics. For

25:40

instance, I interviewed a guy that's doing stellate ganglion

25:43

blockade for resistant PTSD.

25:46

And he claims 100% efficacy.

25:48

I don't know. But there's

25:51

that I wonder if you have anything to say about that. And then two

25:54

things like EMDR,

25:55

which Apollo to me seems sort of

25:57

like tapping into that same kind of mechanism.

26:00

you know, um, work around, let's

26:02

say, but those two things, what do

26:04

you say? Yeah, that's, that's,

26:06

those are great questions. So I think

26:09

I'll take EMDR first. So the way to think

26:11

about treatment for trauma is that trauma

26:13

to give you a modern definition

26:15

for everybody, right?

26:17

A modern updated neuroscience based evidence

26:20

based definition or description. So

26:23

trauma, the way to think about it is one

26:26

or multiple intense,

26:27

high density stimulation. Lots

26:30

of stimulation, meaningful, meaning

26:32

self-referential means something to me.

26:35

Experiences that we have over time

26:37

that are perceived as

26:39

threat, actual or perceived, but

26:42

doesn't matter if they're actually threatening, they're perceived as threatening

26:44

to us for which we are

26:46

not given adequate support after. Right?

26:49

So one or multiple intense,

26:51

meaningful experiences that

26:54

we interpret or perceive as threatening for

26:57

which we are not supported after. And

26:59

to me, the threat part, I

27:01

mean, I kind of turn up the volume on that part. It's like,

27:03

you know, really threatens your

27:05

beingness in, in whether psychic

27:08

or physically. Yeah, absolutely.

27:10

And that's why it's really important to

27:12

reconceptualize the modern definition

27:15

or description of trauma, because we also need

27:18

a modern description and definition of healing because

27:21

with psychedelic medicines, we're actually seeing people

27:23

get better long-term with just a few doses of

27:25

medicine and therapy, and they don't have

27:27

to continue treatment forever like our current

27:29

paradigm. So we need another

27:31

definition when we're seeing trauma

27:33

reversed. Right?

27:34

Yes. Oh, if trauma can

27:37

be reversed, which we've never actually thought

27:39

that it was possible other than an extinction,

27:41

fear extinction animal models, right? Then

27:43

can we track that, which we

27:45

now know we can, and

27:48

does that give us a new modern definition of healing, which

27:50

is maybe one or multiple intense,

27:53

meaningful experience we perceive

27:55

as safe

27:56

where we have support, but they're still challenging. Both challenging

27:58

can be changed. challenging experiences,

28:01

one is perceived as threatening without support and one

28:03

is perceived as safe with support. Right?

28:06

Challenging with support.

28:08

Challenging with safety and support.

28:10

Yes. Challenging with safety and support versus

28:12

challenging without safety and

28:15

without support. Right. And

28:17

I think that is the

28:20

key because when that though,

28:22

when that trauma happens, when that negative or that,

28:24

you know, intense, meaningful threatening experience

28:26

happens and we don't have support, two

28:29

things go on in our bodies. Number one, our

28:31

bodies immediately learn to

28:34

divert all resources, all blood,

28:36

oxygen, waste removal, et cetera, to

28:38

our skeletal muscles, our heart, our lungs, our

28:40

motor cortex of our brain, our fear center, all

28:43

the parts of our brains and bodies that are to get

28:45

us out of a immediate life threatening

28:47

situation because our bodies don't know the difference

28:49

between too many emails

28:50

and our kids screaming and too many responsibilities

28:52

in the news than a bear chasing

28:54

us in the jungle. Our bodies are just responding

28:56

to perceived threat.

28:58

So that is

29:00

why stelaganglion block works because

29:03

stelaganglion block is the

29:05

stelaganglion in the back of the neck is literally

29:07

the part of the

29:09

core of the sympathetic fight or flight nervous

29:12

system, the stress response survival system that

29:14

is outside of the brain. So when you

29:16

block that

29:18

with anesthetic or an injection of some

29:20

sort, then you're just preventing

29:22

the stress response system from activating,

29:25

which has side

29:27

effects. It's not without side effects because you're not going to be able

29:29

to respond to threat adequately in

29:31

a real situation. If you block the part of your

29:33

body and brain that is responsible for transmitting

29:36

those survival signals

29:38

in people who can't feel anything or

29:40

don't remember how to feel safe and they can't feel anything

29:42

but survival signals for those

29:45

kinds of people

29:46

blocking the stelaganglion can give

29:49

them one to three months of relief

29:51

and then they have to go back and do it again.

29:58

They're facing massive

30:01

problems that are widely ignored by governments

30:03

and the media. Like personal space

30:05

invaders. Had it with these couples that

30:07

sit on the same side of the booth. Yak mouths.

30:10

Stupid stick figure bumper stickers. Almond

30:12

milk. You cannot milk an almond. Hi,

30:15

I'm Jennifer. And I'm Angie. We call her

30:17

Pumps. And we're the hosts of I've Had

30:19

It. Pumps, tell the listener where they can find us.

30:22

Apple, Spotify, Amazon, or wherever

30:24

you get your podcasts. Nailed it. See

30:27

you next Tuesday.

30:35

Back to the the body keeping the score

30:37

as we say the famous book,

30:39

I believe it was. Vessel

30:42

Vandacol. Vandacol. How

30:45

does that happen? What's the current thinking

30:47

about how the both two things fascinate

30:49

me. The recurrent

30:52

body, you know, experiencing

30:54

of trauma and then repetition

30:57

compulsion. Those two things seem

31:00

non adaptive evolutionarily. So

31:02

they intrigued me.

31:04

Yeah. I. So I think

31:06

what's interesting is so you remember, as I said earlier,

31:08

we're talking about as above so below. Yeah. Right.

31:12

So this is a phrase that I love because it comes from Pythagoras

31:14

who discovered the circle of fifths,

31:17

the modern way that we make music. And

31:20

he also discovered a lot

31:22

of the ways that we that sounds interact

31:25

with each other by looking at

31:26

the relationships between the stars and the planets. Very

31:29

very interesting fellow. Very

31:31

famous mathematician. And

31:34

so what is happening if you

31:36

think about this this phrase as above

31:38

so below when we experience

31:40

a powerful,

31:42

intense experience like a trauma.

31:45

What Dr. Rachel Yehuda showed was

31:47

that the who's the director

31:49

of trauma and psychedelic research at Sinai now

31:52

is that when we experience these traumatic

31:54

events, there are changes. The

31:57

learning doesn't just happen in our brains

31:59

in terms of the way.

31:59

our neurons are talking to each other. And

32:02

that does happen. Our neurons from

32:04

our fear center are now talking more probably

32:06

to our identity center, which is talking

32:09

more towards our emotional brain,

32:11

which is saying, Hey, don't be empathetic

32:13

right now. You could be in danger. You don't want to empathize

32:16

with your enemy, right? You want to get out of

32:18

here, get to safety, right? So that process

32:20

is going on on the neural neuronal level

32:23

in terms of the way that they're talking to each other.

32:25

But the, what Eric Kandel found,

32:27

who won the Nobel prize in 2000 for

32:29

discovering the origins of learning and memory is that we

32:32

learn the same way as ancient sea snails, which means

32:34

that when we experience fear and threat

32:36

or safety,

32:38

we're building these new neural connections.

32:40

And as the neurons get tighter, they

32:42

actually have to make more

32:45

protein to build the scaffolding,

32:48

the infrastructure that allows them to talk. So

32:50

just like building a new building or building a new room

32:53

in your house, you have to actually add

32:55

things,

32:56

structural components like drywall

32:58

and maybe some wood framing and things like that

33:00

to get that part of the, of

33:03

the room to look and

33:05

act and function the way you want it to. So the brain is

33:07

actually doing the same thing. And to

33:09

do that, it has to change its DNA

33:12

expression patterns. And Rachel

33:14

and Eric found this in different

33:16

studies. And Rachel found it studying

33:18

Holocaust survivors showing that as

33:21

you track these folks over time, their

33:23

offspring were known to have increased

33:25

risk of PTSD

33:26

and depression and mental illness, even though

33:28

they lived and grew up safely in America

33:30

or other places. Why? Turns

33:32

out because they have

33:35

markings on their DNA that

33:37

tell their cortisol receptors, amongst other

33:39

things, their stress response system to function

33:42

differently

33:43

because their ancestors who were

33:46

in the Holocaust were exposed

33:48

to such severe and significant threat that

33:51

they passed that down across

33:54

generations to

33:56

their offspring. Right? So it's actually

33:59

not just on

33:59

in the neural wiring, it gets passed down

34:02

onto the DNA and then tells the DNA, hey, if

34:05

I am under threat and I have children

34:08

in a situation under threat and

34:10

austerity or where there's not enough to go

34:12

around, perhaps it's

34:14

very likely nature says, well, your

34:17

offspring are probably going to grow up in a similar environment,

34:20

right? So they need to be protected and we're

34:22

going to protect them by passing

34:24

on these epigenetic markings, which is

34:26

the markings on the DNA that tell cortisol

34:28

receptors to go up

34:29

or go down that changes the way we respond

34:32

to threat. So we just showed in

34:34

short, to bring it full circle, we just

34:36

showed for the very first time that

34:38

based on this theory, which has now been replicated

34:41

in mice and it's shown to be causal and Rachel may

34:43

very well win the Nobel prize for it. We

34:46

just showed with a study with Rachel and a number

34:48

of others at Yale and maps that

34:51

MDMA assisted therapy in the highly controlled

34:53

setting of the FDA space three trial

34:56

is actually statistically

34:59

and clinically significantly reversing

35:01

these epigenetic markers

35:03

on the cortisol genes that are telling our bodies

35:06

to store the memory of the trauma it seems,

35:08

right? So the memory stored all the way

35:11

from the top to the bottom,

35:12

all the way from the cells to the DNA and

35:15

that powerful safety experiences

35:17

like that of MDMA assisted therapy are actually

35:20

capable of reversing it and reversing

35:22

it in a way that's clinically significant, which is really

35:25

fascinating and we can track it.

35:27

How does it get, or maybe we don't know

35:29

the answer to this from neuronal

35:31

DNA to something

35:34

like a non-dividing egg cell? How

35:37

does that happen? That makes no

35:40

intuitive sense to me. So I think

35:42

that this is a big question that I don't think we

35:44

know all the answers to, but I think

35:46

in short,

35:47

it sounds like it's a DNA methylase

35:50

situation, right?

35:51

In other words, the only

35:53

hypothesis I come up with is that the

35:57

thing that causes the methylation

35:59

and

35:59

regulation of the neuronal cells

36:02

must affect all cells, including

36:06

non-dividing cells. Right. Sequoiacin

36:08

cells, senescent cells, and dividing

36:10

cells, and German egg cells.

36:13

Because DNA methylase

36:16

and some of the other proteins that regulate the turning

36:18

up and turning down of our genes are

36:21

in all cells. Yeah. But

36:24

it must be something ubiquitous,

36:26

but it just has an expression in the neurons.

36:29

So that's kind of interesting. Very

36:32

interesting. So- And that

36:34

paper, I'll send it over. That paper came out in

36:36

February of this year, which

36:39

is the first paper showing that MDMA-assisted

36:41

therapy, these powerful safety states, are actually

36:43

acting like

36:43

a reverse trauma and reversing

36:46

these epigenetic changes, which then is directly

36:49

correlated with clinical outcome. So the more reversal

36:52

on this cortisol receptor gene you have, the

36:54

more people get better,

36:57

which is really, really interesting. So there's actually

36:59

a relationship now where we can start to track

37:02

healing from mental illness in a more

37:04

objective way. Again, getting back to the biology

37:06

and Apollo is just a more accessible tool

37:09

that's tapping into the same pathway that people can start

37:11

to access when you can't get access to some of

37:13

these other techniques. And just to be fair,

37:15

if anybody's skeptical, yeah, of course

37:18

an environmental hit can cause those

37:20

same biological changes and those biological

37:22

changes can still be used

37:25

as a marker for improvement, whether they are intrinsic

37:28

to a reproductive biology or not. Just

37:32

playing the odds,

37:35

everything I've seen in neuropsychiatry,

37:38

about 60% is accounted for in

37:40

the basis of biology alone. You know

37:42

what I mean? So it's always

37:45

in there. So to say that it's both

37:47

is like, yeah, that's pretty much, that's a lot of things in

37:50

neuropsychiatry. Is EMDR something

37:53

that's by itself efficacious, do you think? Or

37:55

is it, I've

37:57

seen some good results.

37:59

works great. Again, it's about how

38:02

you use it, right? So a lot of people

38:04

have side effects from ketamine because it's not delivered properly.

38:06

The dose is too high, it's too frequent, and there's

38:08

no therapy, and so they're not getting long-term benefit,

38:11

and they have more side effects. EMDR,

38:13

similarly, it has to be delivered properly.

38:16

So EMDR is a bilateral

38:19

stimulation that can use vibration,

38:21

visuals or sound or all three that

38:24

alternate between sides of the body

38:26

that create similar to ketamine

38:29

therapy, not quite as powerful, but

38:31

it creates what we call a dissociated

38:33

state

38:34

that allows us to kind of

38:36

look under the hood, right? Become aware

38:39

of things that have happened to us and things that we've experienced,

38:41

that we might have forgotten about, and ways

38:43

of thinking about ourselves we might have forgotten about, and

38:46

that is all well and good. That helps to

38:49

create fertile ground for the therapeutic process

38:51

to unfold. However, if

38:53

you don't have somebody there to guide

38:56

you through that process who's trained that

38:58

you trust and to unpack what comes up,

39:01

then EMDR can often be very overwhelming

39:03

for people because stuff comes to the surface

39:06

from underneath, and you're like, well, what do I do with

39:08

that now? And so I think we see

39:11

a lot of people at home trying to do EMDR

39:13

with these at-home techniques and tools,

39:15

but they don't have the support, and so

39:17

they struggle quite a bit, and they don't get

39:19

the outcomes they're looking for. But then when people

39:21

use it in practice in the clinic with a trained

39:24

guide therapist,

39:26

they can get really fantastic results. Fundamentally

39:29

brains heal other brains,

39:31

fundamentally. And I have

39:33

certainly noticed that EMDR in therapy,

39:38

fortunately or unfortunately, there's

39:41

the people that are talented and people that are not

39:43

when it comes to this stuff. And it's

39:45

not just a skill, it's a talent to really

39:47

do well. And I've certainly seen that with the EMDR, a

39:50

really talented therapist has great outcomes

39:52

and not as talented. And

39:55

what is that thing that it's

39:57

that ability to be

39:59

fully present in an attune to

40:02

another human. I think something

40:04

like that and be highly skilled highly

40:06

trained.

40:07

Yeah, I think it's a lot of that. We joke

40:09

around a lot about you know, using the phrase like leave

40:11

your baggage at the door. Yeah. Before

40:14

you walk into a patient encounter. Yeah. We're gonna

40:16

be helping that person carry their own bags and

40:18

you don't need them to you don't want them to carry our bags.

40:21

So leave your bags at the door. But if you don't

40:23

realize or you're not aware of

40:25

what you're carrying when you walk into an encounter

40:28

person, then they will accidentally wind

40:31

up carrying your bags and they won't know it and then you're gonna

40:33

have a problem on your hands. Yeah. And it's

40:35

gonna have like mixing going

40:37

on. It's not exactly good

40:39

for you or the client and so and blurring

40:42

of boundaries that doesn't actually result in healing. It is

40:44

usually a boundary thing. It is usually you

40:46

know, the patient activating something in the therapist

40:49

without them being aware of it. Right, which

40:51

is totally normal. And it's okay. It's just that

40:53

we have to expect and anticipate

40:55

that's where the training comes in. You know, people

40:58

aren't born being good therapists, but we are

41:00

born knowing how to listen. And

41:03

we're taught not to listen. So if we practice

41:05

listening, I think that's the thing that's really interesting

41:08

about therapy is it's really like

41:09

this conversation you and I are having right now

41:11

we're making eye to eye contact doesn't matter. It's

41:13

over zoom. Or if it's in person, we're making eye

41:16

to eye contact. We're clearly listening

41:18

to what each other saying. We're clearly expressing

41:20

and validating that we're hearing each other. Right.

41:23

And there's a back and forth dynamic where

41:25

there's no judgment. And we're just kind of getting into it. And

41:27

that

41:28

is what sets that frame for the client

41:31

to just be able to kind of dive

41:33

in and unpack stuff. And if they don't feel safe

41:35

coming in, or they feel judged, or they feel like,

41:38

I'm not sure what's mine and what's okay. And what's not

41:40

okay, that creates barriers to the

41:42

process that just prevent us from doing

41:44

the good work. Yeah, when I was teaching,

41:47

I

41:47

thought in terms of I

41:49

know you appreciate this. It's not just

41:52

listening. It's listening with your whole body,

41:54

something that people are not accustomed to doing.

41:56

So things may occur to you

41:58

smells, thoughts. things, feelings

42:01

in your body that are not

42:03

yours. You can identify them

42:05

as not you because you've never really experienced that

42:07

before. And they'll say, Hmm, I wonder where that's coming from? And just

42:10

listen to all of that. In addition

42:12

to the words and what's going on in everybody's faces

42:14

and body, you know,

42:17

you have to be open to the whole thing to

42:19

do it properly.

42:20

Absolutely. And

42:21

one of the things that reminds me of that

42:24

I've always thought fondly about is that

42:26

Apollo, traditionally

42:28

Apollo was the Roman and Greek

42:31

God of the Sun who gave the gift of medicine

42:33

and music to humanity. And

42:35

the temples of Apollo

42:38

in ancient Greek and Roman culture are some

42:40

of the most holy and

42:42

ancient temples that still stand. And

42:45

one of them, the temple of Apollo at Delphi

42:47

has inscribed on it maxims

42:50

of how to live a good life. And

42:51

the first one, very

42:53

first and know thyself, know thyself,

42:56

right? Know it is know thyself.

42:59

It means knowing what's me and what's not me. Right?

43:02

People don't appreciate that. That is a really,

43:04

and frankly, I had to be a patient

43:06

in therapy to really get it. You have to experience

43:09

it a bit if you have boundary stuff, which I definitely

43:11

did. And my thing was

43:13

when I'd see a patient in pain, I'd want to make

43:16

it stop, not realizing

43:18

that I

43:19

was motivated, like strongly

43:22

motivated because they were mobilizing my pain,

43:25

but I couldn't differentiate it at that point

43:27

in my life. And that's a hard,

43:29

it's a subtle thing. It's like you

43:32

gotta bring, you gotta be the object of

43:34

scrutiny to really get it. You can't,

43:36

it's hard to do by yourself. I had a fair

43:38

bit of childhood trauma stuff myself. And if

43:41

you have that stuff, you gotta

43:44

take care of your baggage before

43:46

you can help somebody else. Same thing, you know, put

43:48

the mask over your face before you put the

43:50

mask on the children. But I want to go back

43:52

to, we're kind of running low on time. So

43:54

I'm anxious to finish some of these other topics. I

43:56

want to go back to repetition

43:59

compulsion.

43:59

I don't know what that

44:02

is. You may have a theory, but the one

44:04

thing I've noticed is people

44:06

do very little

44:10

analysis or thought about what

44:12

causes attraction, right? Because

44:15

I've noticed that people do repetition compulsion. They're not

44:17

so much repeating the behavior as

44:19

they are attracted to people and circumstances

44:22

that are identical to the traumatizing

44:25

circumstances. And of course,

44:27

everything will happen again because that person

44:30

they were attracted to, motivated

44:32

towards, will oblige them because

44:35

they're that kind of person. And because that person's

44:37

body is a perfect instrument, I

44:39

know that that attraction is to

44:42

someone like the, whether it's an abuse of alcoholic

44:44

abandoning father, whatever it is, there

44:46

it is over and over and over again. Any thoughts

44:49

about where that's wired and what's going

44:51

on with that? Yeah, we see that all the

44:53

time. And I think the best

44:56

way that we found to understand it, and again,

44:57

I don't think we understand everything about it, but the

45:00

best way to understand it is that

45:02

the amygdala in the fear

45:04

center of all of our brains, we call it the reptilian

45:06

brain that detects threat, we just think of it as taking

45:08

threat and safety

45:10

is really detecting contrast.

45:14

So it's detecting familiarity and

45:16

it's detecting unfamiliarity, newness

45:20

and familiar. New things, when

45:23

we are stressed out, become very scary

45:26

because they bring uncertainty.

45:29

And so repetition of things that

45:31

give us instant gratification or relief

45:34

from discomfort, even though

45:36

they don't serve us in the long run, like

45:38

everything from heroin and cigarettes to

45:40

the Haggadah's Netflix. We

45:43

know that those are not healthy coping

45:46

strategies to rely on in any way.

45:48

And yet

45:49

we tend to

45:51

repeat them because

45:53

they're familiar. That's all

45:56

it seems to be is familiarity.

45:59

safe even though it could be destructive.

46:02

Right. So then- Let

46:05

me ask this. This is something- ... the cycle is embracing the unfamiliarity.

46:08

Let me ask this. I've never really thought about

46:10

this, but it just occurs to me the way you framed it.

46:13

Oftentimes, not

46:16

always, but oftentimes in these repetition

46:18

interpersonally, something

46:21

we would call love figures into

46:24

it. Is that just

46:26

a separate motivational system that gets enlisted?

46:29

Thinking for that safety and connection. You

46:31

know what I mean? Because that's their only model of

46:33

it in the past is the person that was the perpetrator typically,

46:36

oftentimes. Are you talking about love or the

46:38

lust?

46:40

Well both figure in, right? I'm

46:43

thinking it's love more than lust, I

46:45

think. Like a true affection

46:47

and a trust kind of. No, because

46:50

all that is sort of broken down

46:52

by the trauma in a weird way. That's

46:54

why I'm using love sort of in quotes. Oh,

46:56

I get what you're talking about. Yeah,

47:00

maybe it is that closeness and familiarity

47:02

and that the child

47:04

was looking for that was ruptured and

47:07

they're still looking for it. That sort of has, there's

47:09

a system in there

47:10

called, I think we call it love.

47:13

Yeah, and it's also what

47:15

we often forget is that

47:17

we are often seeking what we perceive

47:19

to be love. Absolutely, 100%. But

47:23

it's a motivational system, I think, that gets

47:25

a lot. I never see much literature on this. Yeah,

47:28

absolutely. Yeah, we see this a lot

47:30

in the psychedelic space because oftentimes when

47:32

people take an MDMA or ketamine in

47:34

a safe therapeutic setting for the first time,

47:36

they turn to us and they're like, especially

47:39

severely traumatized folks, they say, Doc,

47:41

is this what love feels like? Oh,

47:44

interesting. So interesting. Oh

47:46

my goodness. Think about that,

47:47

it's powerful. Right? And our intuition

47:49

because these people haven't felt safe in years.

47:52

Maybe they've never felt true love because again,

47:54

true love, real love, the love that

47:57

we know is real compared to the love that might

47:59

be confusing.

47:59

it is you know uncertain is

48:02

that true love is safe. Yeah,

48:04

that's part that's part of the the feeling

48:07

right and I'm thinking about really

48:09

physically safe, yeah, yeah,

48:13

yeah, no I get it.

48:19

and

48:30

I'm thinking about the you know the other substances

48:56

that

48:59

people use and what they're going for like you

49:02

know heroin they're going for they will talk

49:04

about a warm blanket and maternal

49:06

feelings you know, not really love

49:09

but that sort of sort of

49:12

safety meets comfort meets

49:14

no more pain. Exactly.

49:17

And then three bliss. Yeah,

49:19

and then weed weed now particularly

49:22

the concentrations that we're seeing these days is doing

49:24

some of the same stuff and

49:27

activating that saliency meter

49:29

in the in the amygdala so everything looks more

49:31

salient and new and then but

49:34

over time that sort of flattens out doesn't

49:36

it when you're using a substance?

49:38

It does and I think and but I think

49:41

there are different ways of it happening if

49:43

we use substances habitually that's what

49:45

I'm talking about where we're relying on it. Depending.

49:47

Oh, no, yeah, absolutely. They that effect fades

49:49

but when we use them in the psychedelic paradigm

49:51

where it's use this every few

49:54

days or every couple weeks highly

49:56

intentionally not every day. We

49:58

actually see this sensitivity.

49:59

to the effects grow. How

50:03

is the regulatory landscape responding

50:08

to all this? Are they ready to let us do our thing?

50:10

Are they resistant? Is it impossible?

50:13

What's going on there? It's coming along.

50:16

I think people are, the FDA is moving

50:18

along. It looks like the MDMA phase three

50:20

trials were just completed. We'll

50:22

be releasing a really nice special on

50:24

that with Rick Doblin next week

50:27

for psychedelic science. The FDA trials

50:30

did very, very well. There was

50:32

an 88% response rate. Wow.

50:35

Crazy. It was a treatment resistant PTSD. So

50:37

this is really incredible. It doesn't mean 88% got

50:40

better long-term, but there's 88% responders. I

50:43

think 67% got into

50:45

remission after just 12 weeks. So that's really

50:48

astounding, even better than their prior

50:51

findings. So now it's analysis,

50:53

it's data preparing and processing, paper

50:55

writing, and the FDA are doing all

50:57

of that for approval and clearance,

50:59

which will hopefully be available for MDMA in 2024,

51:02

early 2024. Psilocybin

51:05

will probably be 25. Although

51:08

a lot of people are rushing with decriminalization

51:10

to improve access to care. There are obvious

51:13

challenges that because a decrim

51:15

is fantastic and then it prevents the

51:22

unjust incarceration of people who

51:24

should not be in prison for drug crimes. At

51:26

the same time, it also prevent, it doesn't

51:29

account for the needs of legalization.

51:32

And it doesn't allow people like me who

51:34

are some of the most highly trained providers to actually deliver

51:37

care with psilocybin or any of these other

51:39

plant medicines because the licensing boards don't

51:41

respect decriminalization.

51:43

Only unlicensed medical providers

51:45

and therapists can actually provide

51:48

psychedelic care with things like psilocybin, which

51:51

actually create a lot of risk and

51:53

exposure because those people don't have a license

51:55

to jeopardize so they can do whatever

51:57

they want and don't have to have training even.

51:59

So we really need to make sure we're careful

52:02

and not rushing too much. And we actually

52:04

keep our eye on the prize of

52:06

let's get this to patients. Let's get this

52:09

over the hump. We can still mess it up by

52:11

rushing. Rushing is how we make all our mistakes.

52:13

So let's like really focus on getting

52:16

this through the FDA, getting it to patients and

52:18

getting it out in the safest possible way, like

52:20

we didn't do in the sixties and seventies. And

52:23

if we do that, then we could

52:25

see rapid adoption where it's

52:27

not going to slip back. But until we

52:29

get FDA clearance for for MDMA

52:31

or psilocybin and it's really

52:34

through the, through the other side,

52:36

it

52:36

can still slip back and we can, you

52:39

know, we could still fall back into a paradigm where

52:41

we don't have access to these tools anymore because people

52:43

are using them. Yeah. This

52:45

is a muddy, muddy

52:47

landscape. So, um,

52:49

I want to just

52:51

dial back something that, uh, you

52:54

touched on so briefly and I want to get

52:56

in a little deeper from the remaining minutes is

52:59

I forget the words you used, but I think

53:01

you used something like traditional medicine

53:03

or, or, um, medicines practiced

53:06

by indigenous people or something such as that. That

53:08

is something that fascinates me greatly. And

53:11

I've been trying to, uh,

53:13

help create

53:15

programs, particularly on the alcoholism front,

53:18

um, where the indigenous

53:20

practices are upfront

53:22

and the Western practices are sort of, we're

53:25

sort of following along for safety

53:27

and, you know, understanding of whatever else.

53:30

And so do you have any expertise in

53:32

this area? Can you talk about that a little bit? Because it's a very interesting

53:35

thing to, to try to connect people

53:37

to, you know, the

53:39

traumas of the past, the heritage

53:42

of healing, connecting to a cultural

53:44

milieu that they may have lost track of that

53:46

can be deeply meaningful for people and

53:49

then do some psychotherapy and some kind of being on

53:51

top of that. Or maybe, maybe the, you

53:53

know, maybe the indigenous practices include some

53:55

able gain or something. And, uh, you know, we

53:57

sort of learn how to, um,

53:59

and help in that area without

54:02

interfering with it. How's that all gonna work, do

54:04

you think? It's a great question.

54:06

I think we have some examples of

54:09

it where the MAP's MDMA

54:11

protocol is very heavily inspired

54:13

by indigenous community and indigenous

54:15

culture and the way that indigenous people think

54:18

about trauma. It's different. You

54:20

have to be in that framework, right? It's

54:23

a framework of its own. And

54:26

that's why it has to be kind of upfront.

54:28

Absolutely. I totally agree with you. And

54:30

I think that's what we do in our practice actually.

54:32

In our practice, we put all the indigenous traditions

54:34

up front. It's a very, because they've

54:37

been doing this for thousands of years. People

54:39

are not new to this. Like we are in Western

54:42

medicine, which is only, Western psychiatry

54:44

is what, 150 years old? So,

54:47

these folks have been doing this for

54:49

a long time. And while we in Western psychiatry

54:52

are focused on how do we stabilize people

54:54

after they're totally decompensated and messed up,

54:57

indigenous cultures take a different

54:59

approach, which is very preventative. It's how

55:01

do we understand when we're starting to notice

55:03

imbalances or when you're starting to not feel

55:05

good before you meet diagnostic

55:07

criteria for an illness, before things really

55:10

down a hard path, how

55:12

do we sense that early and identify it

55:15

and then give you the support you need to overcome the

55:17

challenges

55:17

you're facing, looking at challenge

55:19

very clearly as a path to growth

55:22

and self actualization, self-realization,

55:24

not a, oh God, why me?

55:26

Why do I have to do that today? And

55:29

it's that little simple, those kinds of simple

55:31

changes in our

55:32

framework and the way that we look out at the world

55:35

and ourselves that make the biggest difference

55:37

in the healing process because it empowers

55:39

us to learn how to heal ourselves. Where-

55:42

And yet not a particularly popular

55:44

kind of psychological frame

55:46

these days. How do we get a, let's just end with

55:49

this. How do we get the

55:51

health, the overall health of,

55:53

well, I'm not gonna lay that on you, but how do

55:55

we move the frame a little bit back for everybody

55:57

in that direction? No, it's a great

55:59

question.

55:59

And you can go big with these questions. I

56:02

love it. You know, topics. I think

56:05

the main thing is we have to let everybody

56:07

know. So indigenous culture treats

56:10

trauma as universal,

56:13

right? We all, by nature

56:15

of being birthed out of our mother's

56:18

womb, have experienced the trauma

56:20

of separation.

56:22

Right? There's a whole lot more that comes from that

56:24

too, right? But by the way, that's fascinating

56:26

to me that you can say that with that kind of

56:29

certitude, because I've often thought

56:32

that that was intrinsic

56:34

in the human experience. I'm sure the psychoanalyst

56:37

had some of them. Let's

56:39

be fair for her, but a psychoanalyst has broken into 30, 50, 100 different

56:43

kinds of frames, but I'm certain that

56:45

many of them believe this or had

56:47

evidence for this. Absolutely. And a

56:50

lot of the psychedelic studies since then and

56:52

reports have confirmed these theories.

56:54

And it's not to say there's only one way to think about it, but this

56:57

is just one example is that in

56:59

indigenous cultures and eastern tribal,

57:01

eastern cultures, they all look at us as

57:04

all having had trauma and challenging

57:06

experiences where we were not adequately supported

57:08

after. And that that is left in mark

57:11

or an impact on the way our nervous

57:13

system and our body functions in

57:15

conjunction with our brains and our emotional health. And

57:17

so what they say is trauma

57:19

is the norm,

57:20

right? Whether it comes from your parents or your grandparents,

57:23

or whether it comes from something you experienced in this life,

57:25

trauma is the norm. Let's not stigmatize

57:27

it. Let's not tell you that you should be ashamed or guilty

57:30

or sad because victim. Yeah, because

57:32

you're a victim and life happens to you, right?

57:34

Let's not talk about it that way. Let's

57:37

use our words thoughtfully and respectfully, and

57:39

let's talk about it from the standpoint of we've all

57:41

had struggles and challenges. How do

57:43

we work together as a community

57:45

to help us all accept that that's

57:48

the case? Like Carl Rogers said, you

57:50

can't make actual change in your life until

57:52

you've accepted where you're at at this moment,

57:55

right? Deeply, really exactly.

57:59

Like I know where I

58:02

am right now. I couldn't be any other place because what

58:04

is, is. As much as I might regret

58:07

certain things or want things to be different, what is, is. Here's

58:09

where I'm at. And if I can accept where I'm at, then

58:11

I can understand where I want to go and how to get there.

58:14

That is indigenous culture wrapped

58:16

up and it's not stigmatizing.

58:18

It doesn't make people feel bad about being unwell

58:20

or sick or being lesser than everybody else

58:22

or second class citizens. It doesn't separate

58:25

mental health and physical health and emotional

58:27

and spiritual health. It calls it health,

58:30

right? That's actually what Hippocrates

58:33

said. That's what Hippocrates said thousands

58:35

of years ago. That's what Maimonides said thousands

58:38

of years ago. That concept

58:40

has been lost in Western medicine because

58:43

the financial incentives around healing are not aligned

58:46

with the actual process of healing. I

58:48

think that if you want to know what I, you

58:50

know, how we get to the next stage and we

58:52

embrace

58:55

what we can learn from Eastern and tribal preventative practices

58:58

at, with the stabilization, incredible

59:01

stabilization techniques we have in Western practice,

59:03

then we will actually be healing people on mass.

59:06

Dr. David

59:08

Rabin, thank you so much for spending time with us. Where

59:11

should people go to hear more? You

59:13

want to hear more? Come find me on socials at

59:15

Dr. David Rabin on Instagram and Twitter.

59:18

You can find me on Clubhouse. We do some live

59:20

Clubhouse radio shows and love to have you on

59:22

to join us. Dr. Dave Rabin

59:25

on Clubhouse. And if you want to learn more about

59:27

our Apollo, ApolloNero.com

59:30

or WearableHugs.com and

59:32

you can find me on The Psychedelic

59:34

Report, which is your single source of truth

59:36

for psychedelic news

59:39

on Apple and Spotify. There

59:41

you go. Thank you so much. Oh, and there's a

59:43

podcast there, right? Is that the podcast? That's

59:45

the podcast. Yeah. Say

59:47

it again. It's ThePsychedelicReport.com,

59:49

your single source of truth for psychedelic news.

59:53

And you can find that on Spotify and Apple

59:55

iTunes podcasts. Please everyone check that out. Thanks

59:57

Dave. We'll see you next time, everybody. Thanks so much, Dr. Rabin.

59:59

All conversation and information exchanged during

1:00:02

the participation in the Dr. Drew podcast is intended for

1:00:04

educational and entertainment purposes only. Do not confuse

1:00:06

this with treatment or medical advice or direction. Nothing

1:00:08

on these podcasts supplement or

1:00:09

supersede the relationship and direction of your medical caretakers.

1:00:12

Although Dr. Drew is a licensed physician with specialty board certifications

1:00:14

by the American Board of Internal Medicine and the American Board of Addiction

1:00:17

Medicine, he is not functioning as a physician in this environment.

1:00:19

The same applies to any professionals who may appear on the podcast

1:00:21

or drdrew.com.