Abstract
In Michael Pollan's newest book, How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, the author takes the reader on a journey through the history of psychedelic drugs while also recounting his own experiences with this class of drugs. Although psychedelics often conjure visions of long hair and flowing robes, a quick Google search will dispel any notion that Mr. Pollan is a seasoned user of lysergic acid diethylamide (LSD) or psilocybin (the active ingredient in magic mushrooms). Rather, Pollan admits that “the only way [he] was going to get to Woodstock was if [his] parents drove [him].” And in many ways, his distance from the counterculture movement gives him greater credibility as an historian and traveler into the world of psychedelics.
He begins with a captivating historical tale of the accidental discovery of the LSD molecule, which was initially touted as a potential cure for a variety of psychiatric diagnoses, including addiction, anxiety, and depression. But by the 1970s, LSD had fallen from grace as the result of a prominent researcher's efforts to “change the country one brain at a time” by promoting the drug outside the context of clinical research. LSD and other psychedelic drugs were quickly outlawed and research went dormant.
Decades later, LSD is making a comeback. Over the past several years, researchers have quietly begun re-examining LSD's role as a therapeutic agent. For example, Pollan interviews New York University (NYU) psychiatrist, Stephen Ross and his colleague Tony Bossis, who directed a trial to see the effect of a single dose of psilocybin on alleviating anxiety and depression after a life-threatening cancer diagnosis. Bossis, who is a palliative care psychologist, explains that “people don't realize how few tools we have in psychiatry to address existential distress… so how do we not explore this… if it can recalibrate how we die?”
As a palliative care provider, I was intrigued by this research. Our current arsenal of benzodiazepines and opiates may temporarily mask symptoms but to have a drug that could dramatically impact or even eliminate the existential crisis that often accompanies dying would transform the practice of palliative care. Throughout his interviews with cancer patients enrolled in the NYU trial, Pollan found that most “described an encounter with their cancer (or their fear of it) that had the effect of shrinking its power over them” after a psilocybin trip. Several participants described “edging up to the precipice of death,” and one explained how being able to “travel” and encounter death alleviated the fear and anxiety of the unknown.
Although most practitioners are unlikely to consider suggesting LSD as a treatment, the parallels to medical marijuana cannot be ignored. Like LSD, marijuana gained notoriety during the Summer of Love but quickly fell from grace with the rise of the moral crisis of the 1970s—a backlash to the counterculture movement. Today, marijuana is legal for medicinal use in many states and is a still under-researched yet widely accepted drug for a wide range of symptoms including pain, nausea, and anxiety. But LSD likely has a much steeper uphill battle before the general public accepts it for its therapeutic potential.
One of these challenges is that psychedelics—LSD in particular—have been feared to induce psychotic breaks and lifelong insanity. Pollan notes that Dr. Ross of NYU utilizes psilocybin rather than LSD because it “carries none of the political baggage of those three letters.” Although Pollan assures the reader that “since the revival of sanctioned psychedelic research…nearly a thousand volunteers have been dosed, and not a single serious adverse event has been reported,” he alludes to “bad trips” and warns that “no one with a family history or predisposition to mental illness should ever take [psychedelics].” Unfortunately, he spends little time examining the potential harms or side effects of these potent drugs. Rather, the book reads as an advocacy piece for further psychedelic research and use instead of a balanced evaluation of the pros and cons of these powerful drugs.
“How to Change Your Mind” offers its readers an engaging narrative that provides a broad overview of an unfamiliar psychoactive substance and its related research. For those interested in the interplay between psychoactive substances, consciousness, and suffering, it provides an entertaining overview of psychedelics past, present, and future and a springboard for further research into the topic.