Around five years ago, a young man went to the emergency room in Manchester, England after taking a combination of drugs, and met Gregory Yates, an emergency physician on call. Yates learned the man had mixed a synthetic psychedelic drug, 2CB, with monoamine oxidase inhibitors, drugs that can intensify psychedelic effects.

But it was another drug the patient had taken that surprised Yates: a common antihistamine that he had bought in advance to act as a “trip killer,” in case the experience became too overwhelming. The antihistamine works, in part, by blocking serotonin, and the man said he had hoped it would stop the effects of the psychedelic drugs.

Yates became interested in whether people who take psychedelics recreationally, outside of medical contexts, were turning to other drugs for similar trip-ending purposes. Very little academic research on trip killers has been done; one 2022 study found that a blood pressure drug, ketanserin, could reduce or reverse the effects of LSD, potentially because the drug also interacts with serotonin receptors. But online, people were suggesting many more options. In 2024, Yates and a co-author published a paper in the Emergency Medical Journal that scoured Reddit posts to find what substances people regularly turned to when a trip doesn’t go as planned.

Yates said the doses mentioned on Reddit were sometimes dangerously high, and many of the “trip killers” listed didn’t necessarily work as intended. The Microdose talked to Yates about what substances people are using as they attempt to end a trip early. (As a medical professional, Yates does not endorse the use of any illicit drugs.)

What is a trip killer, and how did you first come across the concept?

There is no agreed definition. People have been doing this for ages, but there hasn’t been any sort of academic interest in trip killers to the point where somebody’s come up with an official definition.

A definition that I would use is: any pharmacological agent that has been employed by an individual to prematurely terminate the effects of psychedelic drugs or reduce their intensity. A lot of what you see is trip killers being used because people are freaking out or experiencing physically unpleasant effects of the drugs. But that’s not necessarily always the case. I’m aware of some cases where individuals have used trip killers to shut down a trip because they’ve got to go to work. The trip was going on longer than they expected. I’ve read one instance of an individual just getting really bored of a really long LSD trip, and using a trip killer to prematurely end it. They weren’t particularly distressed. They were just bored.

My interest in trip killers came from a patient that I saw in the emergency department five years ago. I was asked in the middle of the night to see this young male student who had taken a load of and, I quote from the nurse, “complicated sounding drugs,” who now had a high temperature.

The combination of high temperatures after recreational drugs can be a red flag for a life-threatening problem called serotonin syndrome. I came to see him, and he was all right. He was just quite twitchy and anxious. We got to talking, and he told me that he had taken a combination of drugs, which is quite unusual. He’d had two monoamine oxidase inhibitors, and he’d taken a hefty dose of 2CB— a fairly potent drug seen as similar to mescaline. His trip had become more potent than he had anticipated, probably because of the MAO inhibitors.

To shut it down, he took a dose of cyproheptadine, which he’d bought in advance. It’s just an antihistamine, actually, with some anti-serotonin properties. Today it is a mostly hospital-used drug, and it is a serotonin antagonist, so it blocks serotonergic activity. He bought it legally from an online pharmacy and had it ready as an escape if he had a bad trip. He calmed down a wee bit, but he decided to go to hospital anyway to get checked out. But by the time he’d arrived at triage, I think he mostly treated himself to be honest.

Your subsequent 2024 paper tried to find out what people were saying about trip killers online. Where did you look to find that information?

I co-authored this with Dr. Emily Mellon. I’ll tell you where we looked unsuccessfully first: we tried traditional academic methods. We did a review of medical databases to try and find any reports in the medical literature about trip killer usage, and we found the sum total of one paper which had used olanzapine, an antipsychotic, for this purpose. But we didn’t find anything else.

We fished around a bit on the internet, we found a few case reports on Erowid and blue light, which are legacy drug websites. But they were pretty sparse and they didn’t answer the questions that we were trying to ask. We used Reddit in the end, which is a massively publicly accessible database for illicit drug use.

We got about 700 relevant posts which were generated from 128 threads. Most of them were about LSD, mushrooms, and MDMA, but there were some occasional references to other psychedelics. The users mostly described or recommended use of prescription drugs, but there was some mention of herbal remedies as well.

What were the most commonly mentioned drugs?

In terms of drug classes, those were benzodiazepines, antipsychotics, and antidepressants. We would use the generic names for them; the three most common were alprazolam, diazepam, Quetiapine. Your American readers might recognize Xanax, Seroquel, and Valium. They absolutely dominated the results. Everything else was footnotes.

Did people recommend these because they had tried it before and it helped? Or was it based on a chemistry-based hypothesis, like that the active ingredient would block or counter a psychedelic drug?

I wanted to write about this in the original paper, and we did actually collect some data on it. A lot of comments did express a rationale and I divided it up into three groups in my head.

Number one, there were people who were quite aware of either medical guidelines or what they would likely be receiving should they go to hospital. These were people who’d been through, for example, the psychiatric system before, and were well aware that benzodiazepines and antipsychotics are the absolute mainstay of treatment for agitation. They were emulating what they had been through in the past, or what they had read in medical guidelines.

There was a second group of people for whom it was purely experiential. They had done it before, because they were either recreationally already using something like Xanax, and were aware of its downer effect, or were aware of friends doing the same thing.

And then the third group of people were—I need a better term for this—psychonauts or sort gentlemen scientists types who had read the pharmacology. A lot of the users who were bringing up Quetiapine were aware that antipsychotics have powerful serotonin antagonist side effects, and therefore were using them as 5-HT2A antagonists. They had read about the pharmacology of the drug, and therefore felt it was the theoretically appropriate drug to use, and got hold of it for that reason.

What are some of the risks or red flags that came up to you when you saw the drugs that people were using as trip killers?

There’s quite a few risks. Benzodiazepines have a load of uses in medicine. If you’re an emergency care doctor, these are the mainstay of treatment for a lot of agitated patients. But if overdosed, they can put you in a coma. They can make you stop breathing, they can tank your blood pressure. They can do quite a lot of bad things, and actually, you see more of these harmful effects in people who have never used a benzodiazepine before. The actual doses recommended by some of the users on Reddit were pretty wild. Even if I had a patient in a hospital setting, I’m not sure I’d be giving some of these doses. And if I was, they would be heavily monitored.

Antipsychotics and antidepressants have a different set of risks to benzodiazepines. An example would be life threatening heart arrhythmias, particularly with antipsychotics. That’s the boring risk that your readers are probably well aware of anyway.

A more interesting risk, in my view, is if you have an individual who’s taking, for example, MDMA that they’ve mixed with other drugs, and they’re trying to use a trip killer because they’re worried about the physical effects of what they’re taking. One of the dangers is that it just doesn’t work. And instead of reaching for actual medical help, what you’ve tried to do is self-treat unsuccessfully, and now your runaway train problem has got even worse. Self-treatment can distract from actual medical treatment, or it can delay actual medical treatment.

The other thing is a trip killer might be completely ineffective because you don’t know what’s in it. A lot of the users on Reddit were buying their benzodiazepines from the street. And one thing that we know from the toxicology literature is that street benzodiazepines are terrible. They’re often misdosed. They often contain research benzos, not actual alprazolam, and often they contain other narcotics. They can either be too effective or completely ineffective, and you wouldn’t really know until you used it.

I don’t know massive amounts about psychedelic culture, but I do talk to a lot of patients who use psychedelic drugs. If you think there’s a possibility you might have to shut this trip off pharmacologically, are you really dosing safely? Are you really confident in this drug that you’re about to use? Part of me thinks that the feeling that you need to have a benzodiazepine sat next raises the question: are you really comfortable using this LSD? I don’t know.

Psychonauts are a fascinating group of people for us in emergency medicine, because they are different from our other drug users. But it can be a mixed bag. I was talking about this with one of the emergency medicine doctors that I work with, and our overall feeling is that psychonauts are often the most proactive in harm reduction and safety behaviors. These are usually the patients who paid attention to things like trip sitters, low and slow dosing, things like this. But there’s also the potential for big crises because these are the patients who are ordering obscure Russian research pharmaceuticals and they can fly too close to the sun.

This interview has been edited and condensed for clarity and length.

From 1953 to 1973, the CIA ran a program called MKULTRA. Its goal was to find ways to control people’s behavior against their will, or force them to tell the truth. In practice, the CIA experimented on thousands of people who didn’t know they were subjects.. Doctors were paid to try out hypnosis, extra-strong electroconvulsive therapy, or put people in drug-induced comas while playing repeated recordings of spoken phrases and noises. The program also made liberal use of a recently discovered psychoactive molecule: LSD.

CIA agents were given LSD so they could experience its effects, sometimes without their knowledge. In 1953, Gottlieb organized a retreat for CIA officials and scientists in Western Maryland, and one scientist who was dosed with LSD mysteriously died falling from a New York City hotel 10 days later. At CIA-funded safehouses in New York City and San Francisco, unsuspecting people were dosed with LSD to see “whether we could elicit more information from informants,” as Gottlieb recalled in later testimony. In San Francisco, for Operation Midnight Climax, federal agent George White set up a lavishly decorated bedroom with a two-way mirror, and hired sex workers to bring men there to surreptitiously give them the drug while he and others watched.

In the 1970s, congressional hearings aired MKULTRA’s dirty laundry, using financial records and interviews to expose what had occurred during the program. But a lot of information was still missing, said John Lisle, a historian of science at University of Texas, Austin.

Lisle wrote his doctoral dissertation on an earlier generation of scientists in the U.S. intelligence community like Stanley Lovell: a biochemist in charge of the research and development branch of the The Office of Strategic Services (OSS), the precursor to the CIA. During World War II, Lovell created deadly gadgets, forged documents, and disguises for undercover agents, as Lisle described in his first book, The Dirty Tricks Department. Lovell’s interest in truth serums led Lisle to MKULTRA.

In his book from last year, Project Mind Control: Sidney Gottlieb, the CIA, and the Tragedy of MKULTRA, Lisle found never-before-seen depositions that reveal the motives and thoughts of Sidney Gottlieb, head of MKULTRA, as well as the project’s victims. (David Chase, creator of The Sopranos, is making an HBO television show based on his book.) The Microdose talked to Lisle about the new documents, where he got them, and what was uncovered about MKULTRA.

When Sidney Gottlieb retired, he threw all of his files into an incinerator. Who was he, and how was our knowledge of MKULTRA limited by what documents survived?

Sydney Gottlieb was the head of MKULTRA. He had gotten his PhD in bio-organic chemistry from Caltech, and after that, he worked various government jobs. He tried to volunteer for the Army during World War II, but he was born with club feet, and his limp prevented him from joining into service.

Gottlieb was looking for a way to pay back the debt that he felt that he owed to his country. His parents had been immigrants, and they had gotten a better life here, so he wanted to contribute something to the United States. Eventually he applied for a job at the CIA. He was a brilliant chemist, and this is right after World War II when they were looking for scientists to help discover the next weapons or tactics that could help the United States defend itself in another war. The CIA was eager to take Gottlieb on.

His first job within the CIA was working in the chemical service; he was working on methods to do secret writing. Not long afterwards, MKULTRA was created in 1953 and he was appointed to be its head. This was a program, basically, to develop methods of mind control. The fear was that communist countries, like the Soviets or the Chinese, might have developed mind control techniques. Therefore we should know those techniques and develop them on our own.

Before my book, most of the stuff that we knew about Gottlieb came from congressional committees that did investigations of past abuses of the intelligence community. Through those investigations, a lot of documents came out—the ones that survived Gottlieb’s purge.

He burned thousands of files. The head of the CIA at the time was Richard Helms. Richard Helms had been a big sponsor of MKULTRA throughout its entire existence, and in 1973 both Gottlieb and Helms were retiring. Gottlieb went to Helms and asked him, “Hey, what should we do about all these files?” Helms agreed that they should destroy them. Gottlieb took them to a record center and had them incinerated. But he forgot that he had already sent several boxes to that record center years before: the financial documents of MKULTRA. Those are the boxes that survived. It’s not the reports of the MKULTRA’s subprojects, but the financial records about who was getting paid, and an overview of what they were supposed to do. That’s how this originally came out, and that’s what we knew before my book.

What are the new depositions you found, and where did they come from?

The basis of my book is a series of depositions that mostly occurred in the 1980s. After the congressional committees, many of the victims of MKULTRA realized that they were indeed victims. Beforehand, a lot of them thought that they had received poor treatment at the hands of these doctors. They didn’t know the CIA was sponsoring the doctors to do certain experiments.

Many of these victims sued the CIA. As part of those lawsuits, the attorneys representing the victims took the depositions of several people who were involved, including Sidney Gottlieb, Richard Helms, and others. That’s the origin of these depositions; they come about as part of the lawsuits that the victims launched against the CIA.

The main case where these depositions occurred was called the Orlikow case; Velma Orlikow was a woman who was a victim of [the Canadian psychiatrist] Donald Ewan Cameron. His experiments in Montreal were sponsored by MKULTRA. It got settled out of court; it never went to trial, so these depositions wound up in the hands of the main lawyer who was representing the victims, a guy named Joseph Rauh. They just sat in his papers. When he passed away, his papers were donated to the Library of Congress.

When I was investigating MKULTRA and trying to look for new documents, I went to Rauh’s papers, because I knew he had represented the victims of MKULTRA. It turns out, in these boxes are the depositions that never got submitted to court. There were thousands of pages of Gottlieb, his right hand man, Robert Lashbrook, Richard Helms, and others being grilled about what they did.

This is great for the historian, because with history, you rarely have verbatim quotes. Most of the time, historians summarize. The great thing about this book is that I have dialogue. There’s a literal court reporter in the room recording the back and forth between attorneys and the victims, or Gottlieb and the perpetrators.

They were sworn in, but they could still lie, or tell untruths. I try, in the book, to compare the depositions of different people to say, Okay, they’re contradicting each other here. We know at least one of them has to be lying. In general, I did get the impression that Gottlieb was fairly truthful. I got the impression that Robert Lashbrook, his right hand man, was not. He really did not like talking under oath. He put up a lot of fuss about it.

What do the depositions tell us about Gottlieb’s motives, or what was going on in his head?

I think Gottlieb was honest in saying that he had joined the CIA, and was happy to go along with MKULTRA, because he thought it was in the service of national security. He really thought that this was in the interest of the country, and it was an ends-justify-the-means situation.

Gottlieb seems like he had a hard time afterwards coming to grips with the fact that he had done something so unethical. It took him several decades to reach that realization. You can see this especially when Joseph Rauh, the attorney, confronts Gottlieb about why he destroyed the files.

If you think about it, those files are classified anyway. It’s not like the CIA is going to release them to the public. Why would you destroy them? Gottlieb goes through several explanations before he reveals his main motivation. One explanation is that the CIA had so much paper, and there just wasn’t any room in the headquarters anymore. He’s just making this up, and that’s not convincing at all. Another explanation is that he was worried that the names of these people would get out somehow, and it would undermine the CIA’s credibility if it couldn’t keep secret the names of the people that it had been experimenting with. Finally, he breaks down during one of these depositions, and he says, I destroyed these files because it was embarrassing. I didn’t want people to know what we had done, and so we destroyed them.

Another thing he admits in the depositions: we didn’t really get anything out of this. We spent millions of dollars on hundreds of different researchers, and we didn’t learn anything that was actionable. We couldn’t use it in some kind of covert action type operations. He was embarrassed by it. Imagine the amount of mental and physical toll that you’ve taken on people over all these years through MKULTRA, and it amounted to basically nothing.

Another important thing that Gottlieb reveals in the files, for the first time, is that when Gottlieb was within the CIA, he was assigned to figure out a way to assassinate Patrice Lumumba, the Prime Minister of the Congo. It’s been long known that Gottlieb was involved in this, but nobody ever knew exactly how Gottlieb was doing it. They knew that he had some kind of chemical or biological agent that he wanted to slip to Lumumba. In the depositions, Gottlieb for the first time reveals what it was. It turns out to be anthrax. He was trying to slip anthrax to Lumumba in his toothpaste, or by some other means.

MKULTRA lasted such a long time, even though, as you say, it wasn’t very successful. Do the depositions indicate why it lasted so long, or how they got away with it when so much of what they did was illegal?

There were some people in the CIA, including the Inspector General, who said in his own words that this was both illegal and unethical. Why is it that no one ever tried to put a stop to it? A couple of main reasons are that the Inspector General of the CIA didn’t have much power, and could be fired on a whim. Therefore, he was incentivized to not ruffle people’s feathers so that he wouldn’t get in trouble, and he could keep his job.

Another reason Gottlieb talks about when he’s mentioning destroying the files, is that the record keeping in the CIA wasn’t that good. You could destroy files and face zero repercussions for it. There was a degree of plausible deniability that was baked into these people’s rationale. They knew if anything ever went south, they could at least destroy the files and have plausible deniability about being involved in something so sinister.

Did you include or highlight the voices of victims of MKULTRA experiments?

In the first half of the book, I explain the origins of MKULTRA, what MKULTRA was, and the details of its subprojects. I dedicated the entire second half to the fallout, how it was revealed to the public, and what happened afterwards when the victims found out that they had been victims of CIA experiments.

Many of them sued the CIA, and I spend a lot of the book talking about these lawsuits, and giving descriptions of what happened to them. One of them is Mary Morrow; I probably spend more time on her than any of the other victims. She was a victim of Donald Ewen Cameron in Canada. The ironic thing about her story is that she had been one of Cameron’s assistants at the Allen Memorial Institute, but she had a mental breakdown, and she ended up being one of the victims. She received many of the so-called treatments [like a ‘de-patterning’ treatment of a combination of electroshock and barbiturates] that she had been doling out beforehand. She realized how terrible and nefarious these treatments actually were.

I spend a lot of time telling the stories of the victims. There’s many good depictions of them that lay out their own stories in their own words, that give a lot more detail to what they went through, rather than just the perspective of someone like Sidney Gottlieb, who’s on the other side of it.

This interview has been edited and condensed for clarity and length.

In the 1992 video game Ecco the Dolphin, a dolphin tries to find his lost pod, but along the way, gets abducted by aliens. A 2025 documentary, John Lilly and the Earth Coincidence Control Office, opens with images from the game, in part because it succinctly captures the interests of the film’s protagonist: dolphin intelligence, extraterrestrial life, and submersion in water.

John C. Lilly was an American scientist who invented the sensory deprivation tank, studied cetacean communication, and experimented with LSD and ketamine—sometimes all at the same time. The documentary follows Lilly’s journey from young scientist to countercultural icon. He’s infamous for flooding a Saint Thomas, U.S. Virgin Islands house for a female researcher to live alongside a young male dolphin, and inspiring Hollywood movies like The Day of the Dolphin and Altered States as well as a nascent marine environmental movement.

The film was made by Michael Almereyda and Courtney Stephens, and narrated by Chloë Sevigny. Stephens studied medical anthropology while an undergraduate at University of California Berkeley, and said that she tends to work on subjects that move between fantasy and reality. “John Lilly was a great candidate for that,” she told me. The Microdose talked to Stephens about her and Almereyda’s approach to the film and her takeaways from Lilly’s life.

How did you pick John Lilly as a documentary subject?

I came across Lilly back when I was an undergrad, and I used to see his books floating around in used bookstores. I knew him more from his psychedelic writing, so his later books: Programming and Metaprogramming in the Human Biocomputer and The Center of the Cyclone.

I was fascinated by his public persona as a kind of renegade scientist. What was interesting about him, from the perspective of making a film, is the way that he circulates as a set of ideas, not unlike a musician or William Burroughs character. There’s a lot of tension between that and rigorous science. It was interesting to think about a figure who had that cipher quality.

He was involved in a lot of different things: dolphin communication, sensory deprivation tanks, psychedelics, coincidences, aliens. Did you want to foreground one of them, or explain how they interweaved with each other?

We wanted to try to tackle the entire thing.

For Michael and I both, the idea that there were two Hollywood movies about this person that had nothing to do with each other was really interesting. I think his interests are connected through the question of consciousness, and also water. What was really interesting was not just the ideas, but also the full arc of a life that had light and dark. He was really a figure of his time. He’s in military science in the 1950s, he’s in experimental work in the 60s. He’s at Esalen in the 70s.

We show some of those ideas, not just in the moment that Lilly was in control of them, but as they spread through the culture, and took on other shapes—through other people’s work, environmental movements, and the new age. We all share this idea that whales and dolphins are complex, intelligent beings. That’s just become a basic cultural belief that we don’t even really think about where it came from, but Lilly was a major part of that.

That’s the ripple effect of Lilly. The film is about Lilly, but it’s really a cultural history of the late 20th century, and how some of these ideas impacted and changed American culture.

He’s also a receiver of a lot of cultural shifts, specifically the idea of the rights of nonhuman entities. The huge paradox is, of course, that his early experimentation with dolphins is conducted in ways that we would frown on. At the same time, his books influence a lot of people to go into marine mammal science.

There’s so much amazing archival material in the film, from Lilly’s childhood into his later years. Where did it come from?

Some of it came from Lilly’s archive at Stanford University in the library. Some of it is public materials: TV show appearances and things like that. Over time, a lot of stuff came to us that we weren’t initially aware of: his appearance on different shows, later conferences that he attended. We also looked at stuff that Lilly’s not in: archives of Esalen workshops, media involving dolphins. We were interested in the way that some the iconography around Lilly spreads beyond Lilly.

Through a series of strange coincidences, we met somebody who had known Lilly’s son, and he was in possession of not only the home movies that John Lilly had shot of his kids, but also his own home movies from when he was a kid that his dad had shot. Those are in the movie, and have never been featured in anything before. That was exciting. In the movie we see him from probably age ten to his early 80s.

The story around Lilly is so complicated, and there’s really a lot to be written about it. But what you can do with a film that you can’t do in a book is expose people to a person and allow an audience to just sit and witness someone: the energy and information that’s transmitted through being present with somebody.

Lilly really was a showman at some level. He knows how to—I don’t want to say work the camera—but enter people’s fantasy worlds. I think that that suited him to work with the media. And he was present in all kinds of media towards the end of his life, including weirdo tech magazines, all kinds of things

His beliefs about dolphin language didn’t pan out scientifically, and as you mentioned, dolphins suffered under his care. His other views on drugs or aliens pushed against the boundaries of the rational mind. How did you cover his more fringe attitudes or actions?

That was one of the big challenges. And why it was also valuable to have two directors on the film. We had our own internal conflicts around how to represent some of these things; how much to humor Lilly with his self-mythologizing, and how much to come down harder on him when we had information that was contrary to his narrative.

Like, everything concerning his lab in the 1960s. Why people left. How the dolphins suffered. There’s a kind of narrative that Peter [the dolphin] committed suicide out of heartbreak after a kind of love affair [with a female researcher]. We say in the film that it’s more likely that he died of neglect and mistreatment, as did other dolphins in that facility.

It gets into these philosophical questions around documentaries. What is the responsibility of the filmmaker to show versus tell? Our approach was to give the audience the information we had and not guide their hand overly.

But another angle on this entire thing is that we live in a country where our culture has been magnetized by charismatic and irresponsible men, and continues to be. Some of the more megalomaniacal parts of Lilly, we saw as relevant and part of an archetype of the wizard figure that was worth exploring.

I’m also interested in failure, and I’m interested in people who change a lot. I think the Internet creates a kind of virtual space where people can become static figures, just names. I’m really interested in lifetimes where people go through huge shifts. It’s nice to rescue Lilly from just being a weird cult figure who is only tanks ketamine, dolphins, and LSD.

After spending so much time with him, did you take any personal lessons from Lilly’s life?

I still find Lilly vexing and fascinating, and I don’t think that we’ve escaped the cult of Lilly-esque characters. What else would I say? I guess, be careful getting high on your own supply.

This interview has been edited and condensed for clarity and length.

John Lilly and the Earth Coincidence Control Office recently played at BAMPFA in Berkeley, California as part of the Psychedelia & Cinema festival running March 1–May 10, 2026.

Last summer, the Food and Drug Administration (FDA) announced that it was creating a new program to fast-track the review of drugs that met the agency’s criteria for urgency. If a company receives one of these Commissioner’s National Priority Vouchers, it would be reviewed in one to two months, compared to the usual 10 to 12 months.

In February, the first nine recipients of the vouchers were announced, and one name was notably absent. Compass Pathways, which is running clinical trials with psilocybin for treatment resistant depression, was on a shortlist of ten companies to receive the voucher. According to a Stat News investigation published earlier this month, when FDA Commissioner Marty Makary showed that shortlist to others within the Health and Human Services Department, “his superiors shot it down” and Compass Pathways was removed.

The voucher program is already controversial since it was implemented without any input from Congress, said Daniel Eisenkraft Klein, a postdoctoral research fellow at The Program On Regulation, Therapeutics, And Law (PORTAL) at Brigham and Women’s Hospital and Harvard Medical School. “There are a good number of legal experts who have questioned whether the FDA even has the statutory authority to do this,” he told me. The Microdose talked to Eisenkraft Klein about what the voucher program is, what it offers to companies, and what it means when psychedelic companies do—and don’t—make the cut.

What is the Commissioner’s National Priority Voucher program?

We can start with what it is on paper. The basic idea is that companies receive a voucher to have their final drug application reviewed in one to two months, instead of the standard 10 to 12 months. That really speeds things up; even the FDA’s existing priority review only gets you down to six months.

It is organized around what’s considered by the administration to be five national priorities: Addressing U.S. public health crises, delivering innovative cures, meeting unmet medical needs, on-shoring drug manufacturing as a national security measure, and increasing drug affordability. I would note that two of those five priorities—manufacturing on-shoring and affordability—actually have nothing to do with the medical merits of the drug.

Companies apply with a 350 word statement explaining how their drug addresses one of those priorities, which is a very short statement for something that’s so important. Also the FDA drug review divisions can nominate candidates without an application.

It’s worth naming what this program does structurally, which is it gives the administration a powerful piece of leverage and negotiations with industry, because the selection process runs through both the FDA and the White House. These become quite valuable for the administration to give out—without a lot of oversight—to companies that they’re trying to curry favor with, and that are trying to curry favor with the administration.

How are the vouchers different from other FDA programs that speed up review?

The voucher program is promising review within one to two months, which has not existed previously.

There was already a voucher system that Congress did authorize before this, which was earned by bringing rare pediatric or tropical disease drugs to the market. Some other programs like Fast Track, give you more frequent FDA interactions and rolling reviews. There’s Breakthrough Therapy, which adds more FDA guidance and organizational commitment to companies. There’s Accelerated Approval, which allows you to get approval through surrogate endpoints. Being generous, if the administration is very concerned about priorities outside of medical criteria, the Commissioner’s National Priority Voucher does explicitly address domestic manufacturing and affordability, which aren’t medical judgments.

The problem is that that is not how the FDA works, right? The agency’s role is not around security or around pricing. It’s about safety and efficacy. You can maybe make the case more broadly that this is something that we societally should care about, but that is not what the FDA’s job is.

How many of these vouchers have been awarded, and have any of the drugs been approved?

16 companies have received them as of now. They range from Sanofi for Type 1 diabetes, to US Antibiotics, for a domestically made generic antibiotic. Only one voucher has produced approval so far, which was Augmentin XR, a well known generic antibiotic. It’s a pretty easy one to move forward quickly, but for now, only that one of 16 has gotten approval.

I saw that Reuters reported that FDA scientists had delayed reviews of several of these drugs after concerns about safety and trial data. It seems like the most serious concern was Sanofi’s, which is for Type 1 diabetes; internal documents had cited seizures and blood clotting issues. These delays are kind of reassuring, because FDA scientists are maintaining safety standards despite the political pressure. The question is, to what extent they’ll be able to maintain those standards and stand up for science despite that pressure.

One of the new voucher recipients was a ketamine company called Phlow. Stat News reported that Compass Pathways was supposed to receive a voucher, but it was pulled from the list at the last minute. Can we interpret who gets vouchers —and who doesn’t—as signals of how the administration feels about certain kinds of interventions?

To clarify, Phlow received the Commissioner’s National Priority Voucher not for a new drug, but for domestic manufacturing of ketamine’s active ingredient. The innovation here is manufacturing infrastructure, not pharmacology. Does that signal something about the administration’s posture towards ketamine as a therapeutic intervention? Probably not.

But for Compass, yes. Internal data is hard to come by, but according to the Stat News investigation, Compass’ psilocybin treatment, which is for treatment-resistant depression, was on the initial list of the 10 Commissioner’s National Priority Voucher candidates. Apparently when Makary presented the list to HHS and the White House, the administration officials vetoed it just hours before the recipients were announced. As far as we know, that was the only drug cut from it.

Practically, the rejection probably doesn’t change that much for Compass. It already has that Breakthrough Therapy designation and rolling review; it has accelerated timelines. In terms of what it tells us about the way the administration is viewing psychedelics, and wants to position themselves in relation to psychedelics, it does actually give us quite a bit of insight. As Psychedelic Alpha has rightly noted, there’s a real tension between MAGA and MAHA here. I think the broader MAGA political coalition views psychedelic drugs as a bit of a liability, especially heading into the midterms.

Christian Angermeyer, the CEO of ATAI Life Sciences, wrote on X that it was a “blessing in disguise” that Compass’ voucher was canceled, because people wouldn’t question its data later. Do you agree there are public opinion risks associated with these expedited approvals?

I totally agree, not only for public opinion, but expert opinion. This trial data is so complicated and dense, the idea that you can truly review it in one to two months is a bit silly. A thorough and rigorous review process is always going to do more for the long term credibility of these drugs, especially if it looks rushed or politically motivated, and particularly as this Commissioner’s National Priority Voucher program keeps getting more scrutiny.

That logic applies to any novel therapeutic with a lot of skepticism, but with psychedelics, the historical stigma, the concerns about the Lykos trials—you put all that together and psychedelics face an even higher kind of burden of proof. It would be a real shame if the first psychedelic that made it to market was one that was so obviously politically influenced. That could mean that payers restrict coverage or physicians hesitate to prescribe. It’s counterintuitive, but I think the rejection actually could be an advantage long term.

This interview has been edited and condensed for clarity and length.

When Nikolas Francis listens to music, he knows how the sounds are being processed by his brain. As an auditory neuroscientist at the University of Maryland, he specializes in how neurons respond to pitches and tones. Francis is also a musician who plays the drums, with a focus on jazz and improvisation. He became interested in studying how the brain hears because he knew that listening to music didn’t lead to the same experience as hearing other noises, like a car driving by or a fire alarm. Those sounds are processed by the auditory circuits in the brain too, but when we hear music, “suddenly, we have this emotional reaction,” he says.

When people take psychedelic drugs, they can have even stronger responses to music. In one paper from 2020, researchers reviewed psychedelic therapy participants’ responses to songs, and found that, “music could convey love, carry listeners to other realms, be something to ‘hold,’ inspire, and elicit a deep sense of embodied transformation.” Research institutions including Johns Hopkins University and Imperial College London have their own song playlists that they rely on during therapy. (Francis is a fan of Imperial’s, in part because it includes the musician Laraaji.)

In his Maryland lab, Francis is using mice to understand exactly how psychedelic drugs such as psilocybin, affect neurons in the brain’s auditory cortex. The Microdose talked with Francis about what mice can teach us about humans’ experience with music while on psychedelics.

Your recent study was on mice that were given psilocybin. What can you learn using mice rather than people?

It’s an important question. The goal here is to improve human health, and so the most relevant species to study would be humans. Why would we study how a mouse hears?

The important thing is that a lot of the underlying neurophysiology, like the way that the brain is structured in its sensory systems, is conserved across species—particularly across mammals. And the real benefit of mice is that we can study neurons at the single cell level.

In humans, we’re largely limited. If you want to study neural activity, we’re limited to non-invasive methods such as fMRI and EEG, where we can’t really resolve activity of individual neurons. If we want to understand the neural basis of psychedelic experience, we need to link behavior and perception to the way that individual neurons process sound, not just whole brain signals.

How do you see what’s happening in individual neurons?

Mostly we use two-photon imaging. This is a laser imaging method where we have a high power laser that scans some region of the brain. Then, these particular mice are genetically modified such that when their neurons are active, they give off a little bit of light. We scan the brain and when those neurons are active, we record that light. That tells us how active an individual neuron was, and we can do that for many hundreds of neurons simultaneously.

Ultimately, everything that we perceive and understand about the world comes from the processing and the interaction of individual neurons. Mice give us access to these individual neurons, and different types of neurons. We can manipulate those and see how they affect perception and behavior. And we can do things like look at, for example, the differences between neurons. This is a potential future direction: How do neurons that have 5-HT2A receptors change their activity versus those that don’t?

What sounds did you play the mice that were on psilocybin, and what did you observe in their brains?

Since this was the first study that we decided to do in this area, we chose the most simple sound that we could think of which is called a pure tone. A pure tone has only a single frequency. It’s basically the simplest sound that you can produce, but it’s a really good sound for studying the auditory system.

If you play a single tone, a particular region in the auditory system will become active. If you play a different frequency of a pure tone, you’ll get a different region active. You have these very reliable spatial structures in response to tones that you can use to calibrate how much has the system changed. We play these tones at the roughly human conversational level. Our goal here is to ask the question: How much does a single neuron change its response to different frequencies of sound?

We played these sounds for the mice, and we did it in three different contexts. One was before we administered psilocybin. The second was immediately after, and then 30 minutes post-administration. When we look at the neural activity, we see some pretty striking results. Of course, before we give the psilocybin, everything looks normal. We get tuning as expected. The neurons are responding to sound. And then immediately after we inject the psilocybin, what we see is an increase in activity, bigger responses to sound than before the treatment. And then roughly 30 minutes later, what we see is hypoactivity. In other words, the neurons are responding much less to the sound, and also in a much more variable way.

There were two other findings. First, tuning is important for the way that we distinguish sounds in the environment, and that remains unchanged. You can relate this to hearing two different voices. They sound different because they contain different amounts of energy at different frequencies. How well tuned neurons are, and how well they select for different frequencies, affects how well we can select out a particular voice from a crowd. Neurons in the mice were just as well-tuned immediately after the psilocybin treatment— they remained perfectly well-tuned as if nothing had changed. We have these neurons which are responding less to sound 30 minutes later, but remaining equally selected to the environment.

Second, we also saw that these neurons started communicating more. There was a greater functional connectivity between these neurons, which suggests that there’s some change in the brain that involved the way that either other areas are communicating with neurons in the auditory cortex, or the way neurons in the auditory cortex are communicating with each other.

People speak about how strong their responses are to music while on psychedelics in both therapeutic and recreational contexts. Are there any lessons from your findings that explain why that might be?

There are maybe some basic lessons. One of the major findings from my study was the stability of auditory responses. Granted, they were lower, they were sort of quieter, but the complexity of the response, in terms of their selectivity, was the same.

What this means is that tonality might be preserved. Our perception of notes might remain fairly stable. It’s a reliable scaffolding, which I think is interesting in how it relates to how the field has thought about this. Psychiatrist Bill Richards mentions the idea of music being a safety net: You might not even notice it while you’re having the psychedelic experience. But then, if need be, it can provide the structure that you might need under that emotional vulnerability.

I just got a grant to do another study, in animal MRI. We want to look at how these effects that we observed in the auditory cortex are related to what’s going on elsewhere in the brain. The auditory cortex is connected to the whole limbic system, the amygdala, and can modulate the thalamus. When we think about musical chills and interception in the insula, all these areas are connected to the auditory cortex. If we have this stable representation of sound, that’s going to influence all these other structures that change the way that we feel about music, in terms of interoception and also our emotional state.

It seems like every therapist, institution, and retreat center has their own playlist. Can your findings help clinicians pick the music that they should play for their tripping clients?

In our study, sound sensitivity varied over time. While the neurons may maintain their selectivity to sounds, they become less sensitive to those sounds. I think that’s something important for clinicians to consider. Maybe early on in the session, the auditory cortex might be more sensitive and respond more. You might not want to play sounds that have so much influence.

I have listened to some of these playlists. The Hopkins one is really biased towards classical music, although there’s some other stuff towards the end. And then the Imperial College has some ambient music—I saw Laraaji on there. From the science perspective, my data is showing that there is a heightened amount of intracortical functional connectivity in the auditory cortex, which means that it’s the endogenous aspects of experience that are dominating. I think that makes it important to consider the individual. Not everyone is going to have the same reaction to the same song. I think it’s probably important to consider the pacing, the predictability, and the tonality of the music, as opposed to focusing on a particular genre.

This interview has been edited and condensed for clarity and length.

In the summer of 2022, a 57-year-old woman went to Stanford Health Care for breast cancer surgery, and was given anesthesia. She’d had several grueling years leading up to her diagnosis. Her 18-year old son died by suicide, and she had frequent nightmares of trying to save him from falling off a cliff or being kidnapped—and failing.

While under anesthesia, the woman had a different kind of dream. She re-experienced the joy of her son’s birth, and watched as he played with her dog that he had never gotten to meet. After the surgery was over, she tearfully thanked her anesthesiologist, Harrison Shong-Wen Chow, a clinical associate professor of anesthesiology at Stanford Medical School, for the experience. She stopped having nightmares, and months later no longer met criteria for PTSD.

Chow had seen his patients have dreams starting around 2007 when he was working in private practice. He is an expert in regional anesthesia techniques that use lighter doses of a drug, often propofol, which helps people wake up gradually, and have a faster recovery time. Patients liked that they didn’t feel groggy, and they also started telling Chow that they could remember having dreams. Some were related to traumatic incidents from their past, and after dreaming about them, they felt better. Chow and his colleagues reported such cases in 2022 and in 2024.

Since 2020, Chow has been tracking anesthesia dreams in people who come in for surgeries in collaboration with other researchers at Stanford. The Microdose talked to him about how dreaming might be reducing mental distress.

When you heard that your patients were dreaming, what were your first reactions?

At first it was a source of mirth, in the sense that both patients who were reporting dreaming and practitioners around them could all have a laugh about it. It seemed to make patients pretty happy, and that was the extent of it. There’s nothing better than a smiling patient being discharged, telling you about dreams.

During that time, a major publication came out in Anesthesiology by Kate Leslie from the Royal Melbourne Hospital. In about 350 patients under anesthesia, she reported about 22 percent of them had dreams. There were two things that were different from what I was seeing in practice. First was the dream rate. I was seeing dream rates of about 50 percent.

The second thing is that she was reporting that patients were having very mundane kinds of dreams, with no particular pattern. That was different from what we were seeing here. We were seeing patients reporting dreams that seemed related to their lives, and specifically to anxiety in their lives. It was to the point where you could—and not only myself but recovery nurses—pretty much identify what was on the patient’s mind in terms of what they were anxious about. A really typical dream was, “I was dreaming I was supposed to be at work,” or “I was dreaming that I was supposed to pick up my child.” And then, they successfully picked up the child, or had gone to work in the dream. We used to laugh about that, it was such an obvious pattern to us.

When did you first encounter someone who dreamed about something with more traumatic content, rather than everyday anxieties?

In 2009, a patient hadn’t had anesthesia with me, but a similar kind of anesthesia with a different anesthesiologist in our group. She reported that her PTSD symptoms were getting better after repeated foot surgeries. I told her we’re going to do similar anesthesia as the previous anesthesiologist did, and I’ll ask you about your dreams.

I was a little concerned, actually. This was getting a little bit over my skis as an anesthesiologist. I’m just trying to do surgical anesthesia. Her PTSD diagnosis was 30 years long, related to chronic sexual abuse as a child by her mother’s boyfriend. She suffered severe nightmares, and was afraid of being in the open; she suffered from severe agoraphobia too.

She reported a dream afterwards in which she escaped her attacker in her house, she went outside, and she was gardening. Just like before, symptoms got better—according to her. She was able to go outside and have Starbucks. She was able to open her windows again. Just like before, the symptoms eventually came back after several days. But she did get better for a couple days.

I went to some sleep conferences and anesthesia conferences to talk to people, and nobody had ever heard of this before. Everybody treated anesthesia dreams just like an observational wonder.

Do you think people get a therapeutic benefit from the anesthesia drug, or the experience of the dream?

We have a pretty educated guess on this. Before, I definitely thought it was the anesthesia medication. Over time I came to believe it was actually the dream content. There are multiple anesthetics that generate what we call this pre-emergent dream effect: propofol, dexmedetomidine, ketamine, sevoflurane, midazolam. There’s probably way more at this point.

What I’m suggesting is that in the right conditions, almost any anesthetic can generate a pre-emergent state of anesthesia that is associated with patients reporting dreaming, with a specific EEG frequency wave signature. The brain is very active. They’re not externally conscious, they won’t respond. But there’s some kind of thalamus, amygdala, and hippocampus activity—so emotional processing, fear resolution processing. And of course, the hippocampus is the storage of memories.

What is happening to the patient? We believe the patient is going through a processing of their fear based on memory. On a clinical level, they’re going through some kind of fear extinction. The memory no longer triggers them. It no longer provides a stress response. A psychiatrist would call this extinction rehearsal. In normal PTSD therapy, you slowly expose a patient over multiple sessions to their trauma, and eventually, slowly, there’s accommodation. The patient is replaying the trauma in their dream, but they’re doing it in a kind of rapid and profound fashion.

In 2020, you started to work with collaborators at Stanford. What are you doing there, and have you continued to observe dreams?

In 2020 I started, and by 2021 we were seeing lots of dreaming with Stanford patients. We’re doing a protocol very similar to what I was doing in private practice, where we are creating the conditions where patients can remain in the light anesthesia at the end of the surgery. We look at post-operative outcomes that include dream surveys, and look at whether they are aware under anesthesia. One of the biggest fears of anesthesiologists is that the anesthesia is too light. Fast forward to today, we’ve done light sedation to reduce postoperative nausea and faster recovery around 2,000 times, with 1200 reporting dreams. Thinking back to the 22%, we’re now at roughly 65%.

We are also using EEG, which is a pretty expensive machine that isn’t widely used in the community, especially not in surgery centers. We’re working on identifying the brain signatures for these dreams. When patients are in this pre-emergent state, we have a signature we associate with this dream consciousness.

We also now have an investigational dream emergence anesthesia lab. We’ve run through a number of volunteers, most of them psychology graduate students, who seem happy to sign up for dosing studies. We are underway with a PTSD trial using a propofol dream protocol, using EEG guidance very much like in surgery; these patients will obviously not be having surgery. They’re prospective PTSD patients with blinded controls. That’s underway and there will be around 55 patients.

Other drugs have been used for treating symptoms of PTSD, notably MDMA. Do you think anesthesia dreams are similar to a psychedelic experience?

Almost all of us who are involved don’t think this is really fitting a psychedelic picture. Psychedelics all have different effects, but in general, there’s a lot of distortion of reality. Things are bent, things are new, new images are created. The biggest difference is the psychedelics seem to create a third-person perspective, almost like a third-person shooter game. You’re coming from an above position, and seeing yourself below.

[Anesthesia dreams] are very different. This is new. They are really coming from a first-person perspective. There is some overlap, but by and large, people are having first-person experiences, and there’s no new data being created. In other words, everything is from memory. Nothing new that gets created. We really think this is some form of consciousness.

This interview has been edited and condensed for clarity and length

In The Doors of Perception, the author Aldous Huxley writes that taking mescaline had a weakening effect on his ego. “In the final stage of ego-lessness there is an ‘obscure knowledge’ that All is In all—that All is actually each,” he wrote. Many people, after taking psychedelic drugs, find that their individual self disappears. The boundary between who they are, the “I” that is separate from the rest of the world, gets fuzzy. This experience has been called ego dissolution, and often results in a sense of unity with others or the universe.

But in some cases, psychedelic substances can lead to an over-involvement in the self and one’s perspective and to narcissism—a personality trait where people have a high level of self-importance, and consider themselves to be special, and superior to others.

The MIND Foundation, a European non-profit based in Berlin, is involved in psychedelic medical research and offers a 15-month training program, the Augmented Psychotherapy Training (APT). “Psychedelic narcissism” is one the program’s subtopics, and a critical subject to alert future therapists to. “We consider it an important area of self-reflection,” said Henrik Jungaberle, a medical psychologist and the founder and CEO of the MIND Foundation. The Microdose talked to Jungaberle about what psychedelic narcissism is, and how it can affect both clinicians and patients alike.

Narcissism is a popular word right now. It has left the confines of psychology, and is often used conversationally. How do you define narcissism? Aren’t we all narcissistic sometimes?

Almost any of the DSM-5 disorders, it’s not a clear yes or no, but there is a progression into a disorder. For narcissism, a sense of grandiosity, a constant need for admiration, and a lack of empathy are the most important signs for a narcissistic personality tendency.

Very often people who have these traits, or have developed these traits, do not necessarily suffer. The suffering comes from social feedback to narcissism, which can be very strong if somebody is fully immersed into grandiosity, lack of empathy, or this constant need to be admired.

There is an interesting discourse in literature that in phases of falling in love, the first phase of our love relationships, we all have these feelings of being enlarged, and feeling that we are experiencing something very special that almost nobody else could ever experience. But humanity would not exist if this was true.

The MIND Foundation training, called APT, includes a subsection on psychedelic narcissism. What’s the distinction between psychedelic narcissism and regular narcissism?

With psychedelics, there can be an instantly-initiated narcissism that did not appear, or did not seem likely before. For some people, something flips over.

There’s a subphenomenon that is therapeutic narcissism, which can be easily triggered by psychedelics. These are therapists who believe that their own understanding of healing, of the world, and of the therapeutic process is the thing that they need to communicate to their patient—which is actually against what psychotherapy is. You’re working towards understanding what creates suffering in another person with a lot of empathy. You’re trying to support the other person in better behaviors, and other ways of experiencing themselves. Stabilizing them, instead of preaching to them. It does not only happen in psychedelic therapy, but it’s common in psychedelic therapy and very common in underground [psychedelic-assisted] therapy.

How do we deal with it in our APT training? We have a lot of conversations about differentiating three kinds of experiences. One is professional self experience. When people go through this 15-month training, they get some amount of breathwork and ketamine self experience. The goal of the professional experience is to be a better therapist. To see how you, as a therapist, experience this altered state of consciousness in which ideas, attitudes, impulses, emotionalities come up. But you do that to investigate how to be a better therapist.

The second is, of course, the experience of the patient. We really nail down that these are two different things. Other people experience the same substance, sometimes in the same spot, sometimes in the same scenario, very differently. That doesn’t come naturally to everybody, not even to trained psychologists or medical doctors.

Then the third is the private self experience of many psychedelic professionals. Private self experiences are something very different. Nobody engages in a private self experience with their partner, in a party setting, or even in a meditative setting to learn about how to help others better. The set and setting is not shaped in order to be able to support another person or a group.

For this part of the training, you’re actually addressing the risk of narcissism in the practitioner, rather than in the patient?

That’s where we start. We also talk about narcissism as a trait in patients. When I’m teaching, I often begin with the case study of a person that I got to know in 2017. This was a person who addressed us with the goal of finding out if he could invest in us. He turned out to be the most complete—and also interesting, but also strange—immoralist I have ever met.

When he talked about his few psychedelic experiences with psilocybin, the core insight that he had, and one that was very much emotionally and bodily rooted, was: When you take a psychedelic, you find out that you can do anything. I asked him, “You can do anything, can you explain that a little bit?” He said, “Well, when you take a psychedelic you find out that all the morality and ethical thoughts that people create are just an illusion. You can actually do anything. You can murder people. You can exploit them, and there is no reason why we should not do that.” That was his way of interpreting something that can also be a therapeutic insight: A complete resetting of his relationship to the world. In his case, he suddenly became the central God-like figure that could decide about death and life. It ticked the box of lack of empathy. That’s what I mean with an instant narcissism that can develop in some people, and can stay with them for years.

How could a therapist help in a case like that?

It starts with preparation. We give people literature about what’s called the noetic experience. What is a noetic experience? An experience that feels more real than anything that people experienced lately in their everyday life. We talk with people about how this could happen, and that’s the first step in making it less likely that they get stuck with rigidity in those states. It’s not happening a lot in psychedelic therapy, it’s not a very common thing that happens all the time. But yes it can happen.

Having prepared the patient, having built an understanding of the noetic experience, say that the patient shows these features directly after a psychedelic experience. We would reframe it, and point the patient to the goals of the psychedelic dosing session. Remind him of this phenomenon—that you can feel through this psychological process, that you’re now a keeper of truth. There is almost a religious feeling.

There are other techniques, like helping the patient look at herself himself from an outside [perspective] in the therapeutic session. Like, let’s do this technique that everybody knows, of talking to themselves in an empty chair. Very early on, when something like that happens getting some information into the system that is contradicting that “one truth” perspective.

Another thing is to bring people together with others who have gone through a psychedelic experience. That helps a lot. Building empathy through commonness with others.

With psychedelics, there’s often this idea that you will experience ego loss or ego dissolution. Does it surprise you that people can have that experience, and then for others, the opposite experiences can occur?

Not at all. I come from a tradition in psychotherapy where all neural cognitive representations are considered to be on a continuum. And very often things are flipping. And so, it’s almost to be expected. If you are in contact with a person doing it, it can also be an interesting therapeutic insight.

But there’s another component of the psychedelic therapy space that seems to enable sticking with the psychedelic narcissism perspective. When psychedelics entered the West, the first generation was bringing in concepts and interpretations that came from religion. We have this idea: Oh, this is about the truth. Now we found we have that enlightenment. Now we are going beyond reality. It’s a social cultural development in the West. If you’re searching for yourself and for a positive way of reinterpreting yourself, this religious offering is very attractive to people. People reading the history of the psychedelic movement are offered these big philosophies, reinterpreting everything that we are the chosen people.

Before the psychedelic renaissance started, and more science-based people got involved, I think this was more common. Now we have more differentiated voices in the field.

This interview has been edited and condensed for clarity and length.

(Editor's note: The title of this post has been changed from "Psychedelic narcissism: 5 Questions for medical psychologist Henrik Jungaberle" to "Psychedelic narcissism: 5 Questions for psychotherapy researcher Henrik Jungaberle." This change makes clearer Jungaberle's academic history and clarifies that he is not a clinical psychologist.)

You’ve likely heard of Albert Hoffman, Timothy Leary, Aldous Huxley, and Humphrey Osmond as important figures in the psychedelic scene of the mid-20th century. Perhaps the names Sidney Cohen and Walter Pahnke, the therapist and researcher, are familiar too. What about Margot Cutner? Betty Eisner? Joyce Martin? In the 1950s and 1960s, these three women treated thousands of people, usually with LSD, and revolutionized the way psychedelics were administered. Yet their names have been largely forgotten.

Zoë Dubus, a historian at the French National Institute of Health and Medical Research in Paris, is trying to change that. Her research focuses on charting the medical uses of psychoactive substances over time. One of the women Dubus has been tracking is Margot Cutner, a psychoanalyst and philosopher who started doing LSD therapy at Powick hospital in Worcestershire in the 1950s. Yet it wasn’t until this month, seven years into studying her, that Dubus managed to source her photo from a man who responded to an ad that Dubus placed online, while searching for anyone who had known her.

Among the other women Dubus is trying spotlight is Joyce Martin, a Freudian psychoanalyst and early LSD therapist at the Marlborough Day Hospital in London. Another is Betty Eisner, an American psychologist who practiced in Los Angeles, and who is often credited with developing the guidance that both a man and a woman therapist should be in the room with a tripping patient.

The Microdose talked to Dubus about the rich and complex legacy of these three women psychedelic practitioners, how their work led to the creation of “set and setting,” and changed ideas about therapists touching clients.

We’re going to talk about the therapeutic techniques of some lesser known women psychedelic therapists: Joyce Martin, Margot Cutner, and Betty Eisner. First can you give us an idea of what psychedelic therapy was like before they started working?

A lot of the methods developed by these therapists have been adopted without ever crediting their names. For example, Better Eisner was the first to say that patients should never be left alone, that sessions should take place in a space that feels warm and welcoming, that music should be used, and so on. These women contributed a great deal to psychedelic therapy and have been completely erased from this history. It’s rare to see them quoted in clinical trials involving their techniques.

To really understand the process and the importance of what these women brought into the history of psychedelics, we have to go back to the period before psychedelics were used—the 1930s. It was a time when psychiatry didn’t have any medication to relieve mental illness, and in this context, doctors came up with the idea of what they called shock therapy.

It followed an observation made during the First World War that when some soldiers came back from the battlefield, they were completely traumatized. Sometimes, if they were exposed to a shock, they would recover. Techniques were developed, like electroshock therapy, putting patients into comas and waking them up, and even lobotomies, for instance. These were really violent techniques, but they did work in some cases. It was the only thing that a psychiatrist had at the time.

When mescaline and LSD started to be used in psychiatry, they were initially used as a shock method. They would take the patient, not explain anything about the drugs’ effect, inject them with very high doses, and leave them in the empty room with bright light for several hours.

Very quickly, many doctors in England and Canada, and throughout the western world, stopped doing this. They didn’t want to traumatize their patients. They realized that the method didn’t actually work, and they started looking for something else. In 1954 in England, the psychiatrist Ronald Sandison was the first to propose a method of psychedelic-assisted psychotherapy. It was no longer about shock at all. The method, on the contrary, was to try to encourage and to support the patients to develop what we now call set and setting, the technique to reassure the patients.

In this new therapy, the person who was responsible for reassurance, for instance, putting the hand on the forehead of the patient or taking their hand, it wasn’t the doctors who had this responsibility. It was a nurse. At that time, physical touch was completely taboo between doctors and patients, and on top of that, the nurses were women. They were seen as naturally suited to this role. Doctors, who were mostly men, had to have a very distant attitude towards the patients.

Women like Betty Eisner and Margot Cutner were the practitioners themselves. How did they bring into their practice these ideas about reassurance and touch?

For these women, the work was based on their own self-experimentation of the substance. That was something that was completely normal and even expected from the medical profession. You shouldn’t administer LSD before you have self-experimented multiple times.

They self-experimented, and they understood that it was really important to respond to the patient’s request for physical contact. Very often the patients were explicit in asking to have their hand held, to be hugged, or to be cuddled. The doctors wouldn’t respond to that. Unlike their male colleagues, these women, they agreed to touch. They didn’t just agree to the request of touch, they actually turned touch into a therapeutic element in itself. In their view, responding to the need for physical contact during a psychedelic-assisted therapy could repair something, often a lack of love in early childhood, and this would help patients to heal more effectively from their trauma.

In some cases, this created somewhat controversial therapeutic techniques, like those used by Joyce Martin. How did she use touch?

Joyce Martin and her colleague, Pauline McCririck, were two London-based psychoanalysts. Martin was also a psychiatrist, which means that she was able to prescribe LSD. She’s said to have treated somewhere between 1000 to 3000 patients with LSD over a period of about 15 years. She worked at an [English] hospital and in her private practice, located in her own home.

For a small portion of patients, not every patient, but those who had suffered deeply from a lack of maternal love, Joyce Martin and Pauline McCririck invented a method that they called “fusion.” After several sessions, once trust and a strong therapeutic alliance has been established between the therapist and the patients, the patient was familiar with the effect of LSD, and had given verbal consent—which at that time basically never happened—they would gradually move closer to the patient, session after session. First to the bed where the patient was lying, then they would sit next to them, and eventually they would lie down fully with them, holding them. Sometimes they would give them warm milk. There is a very strong maternal imagery, as you can see.

The idea was that for about an hour to an hour-and-a-half, depending on what the patient wanted, over one, two, or three sessions—again, depending on the patient’s need—the patient could experience a feeling of unconditional maternal love. After that, in the following session, the intense and intimate physical contact was stopped, and the therapy would move to other stages.

Today, the question of whether therapists should touch their patients at all during psychedelic sessions or during regular therapy sessions is controversial and hotly contested. When you look back at these techniques—even ones that we would be uncomfortable with today—what lessons do you take from them?

We’re uncomfortable thinking of Joyce Martin lying in a bed with a patient for an hour and a half. But what is interesting is that at that time, it was not seen as so controversial. A lot of different doctors came to the hospital to follow the training of this woman. They published a lot, and they would speak about her techniques at conferences. There was even a movie made about Joyce Martin’s techniques that have been lost, unfortunately.

Another thing is that these women emphasized that LSD is not for everyone. Patients needed to be really selected very carefully, and this was very new. At that time, doctors would give LSD to anyone. For these women practitioners, only some people can actually benefit from it, and according to them, it’s also absolutely crucial to explain everything clearly before the session. What is the substance? Why is it being used? What is expected from the effect? What might happen, and what are the rules? How should you behave when you are under the effect of LSD? In their clinics, patients could be touched if they asked for it, but they were also allowed to touch the therapist themselves. That was really revolutionary, but it required very strict rules to be put in place.

Another thing that was absolutely central for them was putting the patient at the heart of the treatment, listening to what they ask for, understanding what they need, and acting accordingly. That meant that it was impossible to have standardized rules. You had to be able to adapt to every situation, and this required a very intense level of involvement from the therapist.

Today in clinical trials, doctors are much more restricted in what they can do, because sessions need to be reproducible in order to be evaluated as objectively as possible. But what we see in Switzerland, for example, where for more than 10 years now doctors have been legally allowed to use LSD, MDMA, and psilocybin in their private practice—outside clinical trials—is that if they have a government authorization, there is an incredible diversity of practices. There are some doctors who have a garden, and take patients outside. There are some doctors who run group sessions. Others allow relatives to be present during the session. The doses are chosen jointly by doctors and the patients. Basically, there is a lot of freedom, and it’s the same when it comes to touch. Doctors work based on their training and on the patient’s needs. For now, it seems to be working quite well.

People worry about touch in part because of known instances of sexual assault and problematic touch in psychedelic-assisted therapy. Given that, how do you think we should view the legacy of Eisner, Martin and Cutner and the techniques they pioneered?

These substances became prohibited for decades. It was the underground scene that kept alive the knowledge of some of the methods of Eisner, Martin, Cutner, and many other therapists. Many of the people practicing this therapy illegally were very committed, well intentioned, and deeply dedicated to their patients.

The problem is that some of the methods developed by these women were taken up by certain underground therapists as self-evident practices without having had the time when it was legal to properly evaluate their safety, their effectiveness, and also their risks. In a context where there was no official training available it was often underground therapists who ended up training. As a result, some potentially dangerous methods were transmitted into official practices. Today, unfortunately, there are cases of sexual assault or abuse coming to light in psychedelic-assisted therapy, sometimes in the underground, but also in clinical trials.

This is a very serious issue, but thankfully, the psychedelic field is actively confronting it. So there are many conferences, articles, even special issues in scientific journals addressing the problem and trying to offer ways forward.

This interview has been edited and condensed for clarity and length.

Olivia Marcus, a medical anthropologist with training in public health, grew up in the Bay Area with parents who meditated every day. Family vacations often involved going to silent retreats. She noticed the tactics that retreat centers used to market themselves: they promised enlightenment and well-being.

Her academic work has focused on how people seek out healthcare, and how clinics integrate different therapies. She was recently a post-doctoral fellow at NYU in Behavioral Sciences Training in Drug Abuse Research, and worked on the Ayahuasca Treatment Outcome Project (ATOP), a study of an addiction rehabilitation center in Peru. But her early interest in how medicine and healing gets advertised never went away.

Psychedelic drugs and services used to be on the fringes, but they’re now widely marketed on social media and even on billboards, sometimes using similar catchphrases and buzzwords that Marcus saw when she was younger. Now, she is researching the language and themes in direct-to-consumer advertising of psychedelic treatments and services, alongside the ads on social media that are algorithmically delivered to consumers. She presented on the topic of the ethics of direct-to-consumer advertising at the Hopkins-Oxford Psychedelics Ethics (HOPE) conference in the summer of 2024, and is currently working on an academic paper on psychedelic marketing.

The Microdose talked to Marcus about how psychedelic advertisements fit into the legacy of pharmaceutical marketing, and the repeating themes she sees in psychedelics ads.

You did your doctoral fieldwork in Peru in 2015, a time when many ayahuasca retreat centers were opening up to foreigners there. When did you first start to pay attention to the ways psychedelics were being advertised?

Definitely early on. It was a lot of word of mouth hyperbolizing—people trying to get people into their retreats by talking about how ayahuasca was like meeting Jesus and the Buddha in the same three to five hour experience. There were these very big claims about what was going to happen, how it was going to be so beautiful, and you were going to heal all your wounds and your traumas.

Those are the things that I remember as far back as 2015 from my field work. From the beginning, there were the claims that ayahuasca was worth 10 years of therapy in one night. By 2015, people were starting to put that on their websites.

I also noticed in that time span of that year, 2015 to 2016, a lot of the websites started to get updated and modernized. You had people who would come to retreats, have a really good experience, and they had web design skills. They created websites for local practitioners who didn’t have much of a media presence.

Before, a lot of centers and people offering services had these rudimentary websites, looking like the late 1990s and early 2000s; I found them very charming. I liked that basic look. The websites began changing, getting updated by foreigners with web design skills. Or, new centers emerged that had a design focus from the beginning. They would add in these very, to me, bland, cookie-cutter statements.

What are the common themes or catchphrases that you see in the psychedelic marketing landscape as it exists now?

To back up a bit, in the mid-2000s there were already a few really promising early studies that got people excited. You had the MAPS psychedelic science conferences that started, and the Horizons conference. At those conferences, there were always booths with people selling stuff, selling ideas, or advertising psychedelics for this and that. But it all felt very cottage industry. And it all felt very contained.

Then around 2015 to 2017, a lot of organizations began to up their game with brochures, modernized web design, and more proactive marketing techniques on social media—which brings us up to today. Now we have social media targeted advertising. We have templated patterns of websites. In these, people are smiling really brightly while getting a ketamine IV, or jumping in the air—the same kind of stuff you see in other pharmaceutical advertisements. They look meditative, they have a peace of mind, or they’re pensive.

They’ll use buzzwords targeting the kinds of things people are concerned about: trauma, PTSD, burnout, being stuck in your life, conquering feelings of helplessness, pursuing your goals, clarity, reclaiming your life, moving beyond your path, breaking the cycle, and rediscovering joy.

A lot of these advertisements, whether they’re physical media or social media, use the same word clouds: breakthrough, empowerment, mind-altering, innovative, neuroplasticity, revelation, and empowerment. Experience healing beyond the surface, go deeper, go to the root. A lot of my participants in my research—that’s what they wanted to do. They wanted to go to the root causes of their issues. That’s a very reasonable thing to want to do, but it’s used as part of the marketing allure.

Every country in the world prohibits direct-to-consumer prescription pharmaceutical advertising with the exception of the U.S. and New Zealand. There is a long, and sometimes sordid history in America of marketing drugs to treat mental health issues. If the Food and Drug Administration were to approve a psychedelic drug, consumers will likely see ads for that drug. How do you see psychedelic advertising fitting into this larger history of drug marketing?

I like to look at older advertisements. Some of them are just from 20 to 30 years ago. Like, imagery of the housewife being imprisoned and needing something to feel free, while advertising Serax. Going back even further there’s all sorts of perfumes and medicinal waters that were advertised as being able to help animate the spirit and ward off infections.

[Psychedelics] have become an industry with corporations and businesses, and we know that the commercial and corporate determinants of health are extremely deleterious. From formula milk companies derailing progress on breastfeeding education, to the opioid epidemic, tobacco industry, and alcohol industry. If we want to be responsible, we have to really consider: are we developing anything good here if we’re engaging in this form of misleading information, or are we just outright snake oil salesmen?

This idea that there’s some paradigm that we’re changing, whereas, we’re really squarely fitting psychedelics into an existing paradigm. The “paradigm shift” is a marketing technique.

I find social media ads the most unsettling. How do you think direct-to-consumer advertising influences what people do or don’t know about psychedelics?

This might sound extreme to some people, but I think it’s incredibly toxic. Marketing is all about behavioral economics, right? You’re trying to get someone’s attention and keep it. The one that really got under my skin was this Field Trip advertisement, where they do the unboxing of Field Trip’s at-home ketamine kit, and they had a cute white girl, young with a beanie. She’s so stoked to get her box, and she’s doing an unboxing video.

It’s like she’s opening up shoes. It’s uncanny that we’re talking about unboxing something in the way that you might unbox a new toaster, but it’s a potent substance that people tend to not know anything about.

I’ve spoken with people who used ketamine companies where they got mailed stuff. They didn’t really know what it was. They were just desperate for something to help with their depression. The only instructions were to take this with a friend nearby your first couple times.

What is your prediction for the next five years of advertising and marketing of psychedelics?

In some ways, we already have the future mapped out for us in terms of what we’ve seen in any other pharmaceutical or health or wellness industry domain. A lot of current proponents of psychedelic want it to be more like pharma. They want to be normalized in that way, so that it can become accessible. There’s another interesting phenomenon that’s happening, which is that the wellness industry is trying to emulate the pharmaceutical industry with “evidence-based” claims and similarly, the pharmaceutical industry is trying to pick up on the cache of the wellness industry by saying a pharmaceutical will bring you a sense of peace and wellness. There’s a lot of cross-contamination going on, and maybe one day it’ll all just be the same thing. To think that psychedelics may play out any differently would require, I think, a monumental shift in priorities on multiple levels within our country.

There was a 2022 study of marketing strategies by cannabis companies in four U.S. states, and they demonstrated that businesses do not comply with regulations. To no surprise, they’re aggressively using social media to target younger and more vulnerable populations, as well as sharing misinformation and not reporting risks or contraindications.

Another study by a group in 2023 was on news media reporting about ketamine. A lot of the positive aspects were being reported, and there was an underreporting of risks, and making unsubstantiated claims about ketamine—which we see is rampant on almost every ketamine or esketamine website.

All of this is, unfortunately, the proverbial race to the bottom. Everyone is trying to stay afloat in their business and their practice, and if they need to say the things that get people in the door, then that’s what they say.

That’s what I saw in my experience in Peru among ayahuasca retreat centers. I would look at these websites, and I would be horrified by what people were saying. I would go to talk to the owners, and ask, “Why are you saying this?” And they would say, “We know it’s ridiculous, but that’s what people expect us to say.” They may have good intentions, but still feel like they need to play into this economy of lies or misinformation.

This interview has been edited and condensed for clarity and length.

Scroll through the Instagram account Healing From Healing, and you might see an influencer explaining that vegetables are toxic, or an entrepreneur describing how taking ayahuasca increased their earning potential. Healing from Healing captures the wildest and weirdest corners of the internet wellness world. In reposted memes and screenshots from across social media, people eat raw meat, cleanse their bodies from parasites, go into trances, drink urine and discuss astral projection.

The page is curated by Adam Aronovich, a previous psychedelic facilitator and medical anthropologist with Universitat Rovira i Virgili in Catalonia, who says he’s using the account to offer a kind of ethnographic account, albeit a snarky one, of modern day healing culture. Healing from Healing has nearly 90,000 followers.

Starting in 2016, Aronovich spent about five years in the Peruvian Amazon completing field research at an ayahuasca retreat center for his dissertation. While there, he saw first-hand what he now calls “healing culture“—a movement focused on betterment of the individual at the expense of a view of health that considers society at large. The phenomenon troubled him. The Microdose talked with Aronovich about using humor to critique society, and how he wields social media to keep wellness culture in check.

What does the name Healing from Healing mean? What kind of healing would someone need healing from?

During the time that I worked in the jungle, the place I worked at focused on personal healing and transformation as the best gift that you can offer the world. When you’re in it, it sounds right, it sounds true, and it sounds like a good thing. If each individual does their own work, and they heal themselves, they work on their own personal awakening—then that ripples outwards.

I call this trickle-down healing, or trickle-down spirituality. This is a very common idea within the wellness world: that if you heal and transform the people at the top, this spirituality will trickle down as if it’s some sort of trickle-down economic policy.

The gist is that healing culture as a whole is extremely focused on the individual. The individual is the only agent, as Margaret Thatcher used to say. Society is an abstraction; the only thing that exists is an individual. Healing culture is attached to that hyper-individualist ideology in the sense that the only place for spiritual transformation, for healing, for awakening, is the inner space.

Healing culture fosters and encourages not only a culture of self-absorption and navel gazing, but an ongoing consumerism. The so-called healing journey becomes a journey of consumption: more retreats, more ceremonies, more supplements, more coaching sessions, webinars, and so on. This has been more or less the main critique of Healing from Healing: that what we consider healing culture is really a culture of individual consumption.

Are we supposed to be laughing with, or laughing at the people in the videos you post?

We are to some extent making fun of individual people, at least laughing with individual people, because the content comes from, or is produced by, individuals. But I am trying to use individual examples to illuminate structures—that’s the most important thing, right? We want to avoid individualizing blame, or ridiculing one particular person, but understanding how particular structures create experiences that compel people to put out these videos in order to achieve some goals. Those goals are based on the consumerism aspect, on the precarity of our contemporary economic systems, and the stress that many of us feel to constantly monetize every aspect of our lives to create a personal brand.

Humor oftentimes can function as a Trojan horse for landing difficult messages. If a critique is just a critique, as intellectually sound as it may be, it will only appeal to a very small group. My goal has never been to preach the choir. Critique should reach the people who actually need that critique. Healing From Healing is an attempt to reach a much wider audience.

I have received throughout the course of the last few years hundreds of messages from people who say, “Thank you for for saying that in that way, because I was very deep into this particular belief,” or, “I was very deep into that particular pipeline and the humor of it allowed me to listen, and brought me back.” A lot of people credit the page with allowing them to rethink the path that they were on, and that’s something that always makes me happy, because that’s exactly the goal.

What are some common ingredients you look for in videos that you include in your posts?

Nowadays, I don’t look at Instagram myself for the most part. Almost everything is user submitted, and then I curate it.

Some of the galleries are themed, for example, like I will do a gallery of healing as spectacle. I will do some gallery that has more psychedelics. Or, one based on the primacy of trauma in the healing sphere. The spectacle is an important aspect. Some of the videos that I like the most are, for example, life coaches or integration coaches that model authenticity by setting up a camera and pretending to cry in their cars because they’re broken-hearted. It’s very easy to get lost in a performance of it and say, “Oh, like this person is really very vulnerable.” But then when you take a step back and remember that they had to set up the camera, and they had to make a couple of takes. What actually is happening is that they’re sacrificing that authenticity at the altar of the stress of monetization and personal brand.

Psychedelics are now a big part of the mainstream wellness world, in a way they weren’t say, ten years ago. What do you see as the risks of introducing psychedelics into this “healing culture” ecosystem?

One of the main things that psychedelics do is that they create a space where a person is able to question assumptions that perhaps they haven’t questioned in the past. Psychedelics can bring a person to ask deep questions about ontology and epistemology, which is to say, they question basic assumptions about what the world is, who exists in the world, and how to gain information and process knowledge about the world.

The need for sense-making and meaning-making often becomes heightened when a person is first engaging with psychedelics. This is a moment where people are very vulnerable to be infected with what I call epistemic malware, or conspiracies. We’re going through a massive moment with wellness to right-wing pipelines, wellness to populism pipelines, and wellness to fascism pipelines. All of these come from similar places: epistemic vulnerability and then epistemic malware that is used to hijack people’s needs for new sense-making and meaning-making frameworks.

We’re also experiencing a massive religious revivalism: the New Age to Jesus pipeline is a huge thing right now. A lot of people in wellness and spirituality are veering back towards organized religion. It’s interesting to see how these processes happen. A lot of them have psychedelic [experiences] at their core.

You were a psychedelic facilitator. How did you think about offering people healing that isn’t so individualistic and narcissistic? The kind of healing that maybe won’t land them on a Healing from Healing post?

When I facilitate the retreats, what I used to teach the participants is that there has to be an equal consideration on our personal process, and on engagement with the world at large.

I will illuminate with examples, some of them are very basic. When I lived in Peru, people travelled from all over the world and came to Iquitos to pay thousands of dollars to do ayahuasca in the jungle. They often don’t know that the five main rivers feeding the Amazon basin in Peru are basically dead rivers that have been declared national catastrophes.

You came here all the way and you don’t know that these rivers are polluted, that the Indigenous people and the Mestizo people that live all over the Amazon are dying from diseases because of oil extraction that pollutes these rivers. These are examples that are very easily illuminating how environmental health impacts individual health, but that oftentimes we have the privilege of not engaging with.

It’s great if you want to do retreats. It’s great if you want to do psychedelics. It’s incredibly important that you do therapy, and you do all the things to heal your trauma and grow. But at the same time, what I would say to my participants would be, “I encourage you to keep one eye inwards, looking at your own biography and your own personal drama, and keep one eye outwards,looking at your own relationship with your community.”

When we talk about depression or anxiety, we can’t talk about those things without also talking about loneliness and alienation. We’re also talking about how societies and communities are unraveling, and atomization is making us all lonely and miserable. We want to talk about mental health; it’s not only about doing therapy and healing trauma and so on. It’s also about creating stronger communities. It’s making an effort to transcend that loneliness, to connect more deeply with people. Nobody can be fully healthy and happy unless we’re all healthy and happy. And that’s always going to be true.

This interview has been edited and condensed for clarity and length.

In Yunnan, China, people know that if they eat a local wild mushroom known as “jian shou qing,” they might start to see a particular hallucination: “xiao ren ren,” or little people. The mushroom’s scientific name is Lanmaoa asiatica, and it provokes “lilliputian hallucinations,” named after the mischievous Lilliputians in the novel Gulliver’s Travels, who are tiny people around 6-inches tall.

According to hospital records from Yunnan Hospital, 96 percent of people who sought medical help after eating this mushroom said they have seen “little people” who might be dancing or climbing up furniture. One professor in the region told Colin Domnauer, a PhD candidate at the University of Utah and the Natural History Museum of Utah, that after eating stir-fried mushrooms, he lifted the tablecloth and saw “hundreds of xiao ren ren, marching like soldiers.”

Domnauer has been tracking this ethnomycological mystery in different cultures around the world. He’s found that the same species induce these little people hallucinations in China, Papua New Guinea, the Philippines and elsewhere. The Microdose talked to him about his attempts to identify the psychoactive chemicals within Lanmaoa asiatica.

Tell me about the mushroom itself, Lanmaoa asiatica. How did you come across it, and is it related to other magic mushrooms, like those that contain psilocybin?

I first heard about it during a class taught by mycologist Tom Bruns. It was a course on fungi and society, and he mentioned this report from China of a weird type of bolete mushroom—which is completely different from magic mushrooms. Locals were saying it caused hallucinations, but no one had really studied it. He mentioned it as a mystery waiting to be solved.

When I first heard about it, it was not known exactly what species was responsible. Many different, unrelated species of bolete mushrooms were attributed to this effect. Boletes are a term mycologists used to describe a family of mushrooms that is pretty well distinguished from most other mushrooms. They have pores on the underside of their cap rather than gills, and they’re a very distinctive group.

They’re very distantly related from the magic mushrooms, which contain psilocybin, as well as the psychoactive Amanita mushrooms, which is the other currently known group of psychoactive mushrooms. They belong to completely different orders of fungi. The two groups actually diverged about 150 million years ago. Evolutionarily speaking, psilocybin mushrooms and boletes are about as related to each other as we are to a platypus.

When were the hallucinations of little people first reported?

Reports of the bolete mushrooms causing hallucinations were first reported in the 1930s from the first missionaries to embark into the highlands of Papua New Guinea. They reported that the native people were consuming a type of wild mushroom which made them temporarily “insane,” as they called it.

Gordon Wasson and Roger Heim went to Papua New Guinea in the 1960s just a few years after they had discovered psilocybin mushrooms from Mexico. They made collections, spoke with local people, and determined through that process that it was six or 12 different species of mushrooms they attributed these effects to—they were all bolete mushrooms. They sent samples of these to Albert Hoffman and he, in the same way he attempted to isolate the chemical psilocybin, worked on these bolete mushrooms, but was unable to produce anything. They concluded it was merely a cultural drama, or that there wasn’t a physical explanation for what’s happening.

Starting in the 1990s, the first publication came out of China reporting on a very similar phenomenon: in Yunnan province in southwest China, folks were consuming a type of wild bolete mushroom and reporting the same exact types of hallucinations. This was interesting that two completely independent cultures reported a remarkably consistent effect. To my mind, that gave credence to the fact that there might be some chemistry involved that could explain this. It’s not merely a cultural fabrication.

Can you describe the hallucinations?

The hallmark symptom of these mushrooms are Lilliputian hallucinations. This is a clinically defined psychiatric condition characterized by the perception of numerous tiny human, animal, or fantasy-like figures in one’s environment. They’re often very realistic, three dimensional figures said to be colorfully dressed, very mobile, and interacting with the physical world—like climbing up chairs or tables, or clinging to surfaces.

This is a very unique and distinctive type of hallucination, and it’s been reported across history and cultures. The common causes are delirium, alcohol withdrawal, or macular degeneration in old age, and the prevalence has always been very low—under 1 percent of clinical cases. The mechanism of what’s responsible for this effect remains unknown by neurologists.

Up until recently, mushrooms had nothing to do with this syndrome. Now it seems this mushroom has some compound that reliably elicits this exact effect. If we are able to isolate or understand the compound responsible that could give us great insight into the underlying neurological mechanism, and perhaps novel pharmacology.

Have you heard about hallucinations that are often associated with DMT, where people see “elves” or encounter entities? Do you think these hallucinations are similar?

I’ve read up on some of the literature describing Lilliputian hallucinations from psychiatrists writing about them, and they seem categorically different from classical psychedelic hallucinations. The primary difference is that Lilliputian hallucinations inhabit and interact with the world according to physical laws. They’re very three-dimensionally grounded perceptions.

Of course, there is something to what you’re saying. The perception of tiny, diminutive figures is a similarity and has been reported from things like DMT around different cultures. Perhaps that is highlighting some similar mechanism, neurologically speaking. There must be something in our minds that’s producing these sorts of visions of tiny figures. I don’t think they’re exactly the same, but perhaps sharing something or highlighting something shared.

What work are you doing now to isolate the chemical in the mushroom that could be triggering these hallucinations?

We genuinely don’t know what the active compound is. That’s one of the main things I’ve focused on researching right now. My approach has been to use both comparative genomics combined with doing pharmacological assays testing the mushroom extract.

I have samples of specimens of this mushroom that I collected through field work, and I’m generating chemical extracts and testing those. I’m both doing chemical tests as well as pharmacological assays, in vivo and in vitro testing, to narrow down on the bioactive components involved. We’ve made great progress with this, so hopefully soon we can get to an isolated compound.

Also, I’ve completed whole genome sequencing for all the species in this group, and then we can search for the presence of genes that we know are involved in making traditional psychoactive compounds, like psilocybin or ibotenic acid. After doing that search, I found that there’s no trace or evidence that those are present. We’re confident that it’s something different or new in this bolete mushroom, which isn’t surprising, given their distant evolutionary tracks and ecology.

Once we have a compound involved, then we can start doing more interesting work, understanding the evolution and distribution of the species. Given our genomic data set, we now have an understanding of the genes involved and can look at how those genes evolved, how they’re shared across species. Is it only this species that has it? That would be unique because, you know, in the case of psilocybin, it’s found in hundreds of species of mushrooms.

This interview has been edited and condensed for clarity and length.

Serotonin is a rockstar in the neurotransmitter world. You don’t need to be a scientist to know that the “happy” molecule, as it’s known, is involved in regulating our moods. People have tattoos of serotonin’s chemical structure, and there are plenty of serotonin necklaces and earrings available to buy online. So-called classic psychedelics, including LSD and psilocybin, interact with serotonin receptors in the brain.

But Patricia Whitaker, a neuropharmacologist and a professor emeritus at Stony Brook University remembers training as a neuroscientist in the 1970s when serotonin was still novel—only recently understood to be important in how the brain functions. Her career was spent mostly studying the relationship between autism and serotonin, though her 1979 doctoral thesis compared LSD to other psychedelics, such as DMT, ibogaine and psilocybin, examining how they affected serotonin receptors. She and other early neuroscientists saw a connection between serotonin and psychedelic compounds, and believed that understanding serotonin could someday lead to better mental illness treatment options. The Microdose talked to Whitaker about the discovery of serotonin and how the neurotransmitter in many ways gave rise to the modern field of neuroscience.

Who discovered serotonin?

It’s hard to say what discovery means. Let’s say discovery is the moment you give something its name. That would be Maurice Rapport and Irvine Page who discovered serotonin in blood [in 1948]. They worked at the Cleveland Clinic, which was known as a cardiovascular research center. They were focused on the problem of hypertension, or high blood pressure. They knew that when blood vessels were cut, they would spasm and constrict, and they were trying to identify what substance caused that—because they thought maybe that’s why people have high blood pressure. They isolated gallons and gallons of blood, and they found something that caused constriction of blood vessels. They called it serotonin, because sera is serum or blood, and tonin is tension.

At the same time they were doing that, Vittorio Erspamer in Italy was looking at substances in the gut that would cause constriction. He found a substance that he called enteramine. Both Vittorio Erspamer and Irvine Page carried on doing their work for around 10 years before they both realized it was the same thing, when they finally isolated the chemical structure.

Was serotonin ever used to treat high blood pressure? How did serotonin break out of the hypertension box and be understood to be important for the brain?

No, the serotonin that gets in the bloodstream is largely regulated by platelets. If platelets are damaged, if there’s a cut, then the serotonin comes out and constricts blood vessels. It’s only there as a defense mechanism.

The person most responsible for the next step was Betty Twarog, who really thought, let’s look in the brain. At the time, [scientists] were just classifying neurotransmitters. Work with the heart had found adrenaline and acetylcholine—one chemical that sped it up, one that slowed it down. The general attitude was, ‘Why would you need any more?’ In the brain they thought if they found adrenaline and they found acetylcholine, that was enough. Now, we know there’s hundreds of other neurotransmitters.

Betty Twarog was interested in marine animals. If you eat mussels, sometimes you can see there’s a little leg that comes out that attaches to the rock. She was studying what causes it to constrict. When others started talking about serotonin she thought, maybe it’s serotonin. And then she wanted to look for it in the brain, and found it [in the early 1950s]. Everybody, as I said, thought, ‘We don’t need anything more,’ so she had a long, hard time getting her finding published [in 1954].

LSD and serotonin have a similar chemical structure—who noticed that similarity?

D.W. Woolley gets most of the credit for that. He was an amazing guy. By the time he went to Rockefeller University [in 1939] he was blind from diabetes. It is known that he liked to build elaborate visuals in his mind when he couldn’t see. He knew when he was going blind, and he had a couple of years when he traveled across America to really look at things.

The way he did it with LSD is by making a molecular model. When we were undergraduates, we all had kits that you could make models to understand bonds, and that’s what he did. He did it by feeling the LSD model, and feeling the serotonin model.

When you look at LSD, you can see the serotonin molecule when you’re told it’s there. But he must have spent a great deal of time feeling around, because you’d have to find and feel the bonds.

He knew about the effects that LSD could have on the brain, perception, and hallucinations from reading Albert Hoffman’s writing, the inventor of LSD. What did Woolley make of the chemical similarity between LSD and serotonin?

Woolley was interested in diseases that influence agriculture and plants. Like, he worried about this black tongue disease that was in cows. So he developed the idea that there are some little tiny molecules that can cause disease. He wanted to understand why some people got mental illnesses, and he decided—and he was right, of course— that it involved molecules.

It was so completely different from what anybody else thought. Woolley went to international psychiatry symposiums when they’re all still talking about Freud. All the Freudians were like, ‘No, it’s your mother.’

In his book [The Biochemical Bases of Psychoses or the Serotonin Hypothesis about Mental Illness], he really thought it out; he talks about what could serotonin’s role be in schizophrenia. LSD doesn’t cause auditory hallucinations, which is a hallmark of schizophrenia, so maybe serotonin was just one part of schizophrenia. It goes back to his idea that little molecules can do so much, that they can actually make your brain work completely differently. Humphrey Osmond and Albert Hoffman also spent a lot of time taking hallucinogens seeing if they could find out what it was that caused schizophrenia.

All us old serotonin researchers, and I’m in my 70s now, we all joked about getting interested in serotonin because we were so amazed by LSD. I really think that’s true. LSD was a big influence on a lot of research ideas, and what a lot of people thought would be interesting ways to study the brain.

If something could change the brain drastically, the brain must be something that is very finely tuned to function properly—to have the right perception of things, to have the right emotion, to have the right cognition. It must be very, very highly managed. LSD did so many things that at first people thought, well, that’s too many. But now that we know serotonin has so many different receptors and it’s so regulated in so many different ways, it makes sense to have that many effects.

There has been a lot of focus for decades on the role of serotonin deficiency in causing depression. But increasingly people have begun to question that theory of depression. Where do you stand?

Today people throw the word serotonin around, like, ‘Is your serotonin not high enough?’ It’s so annoying how people just write it off, like it’s a boring chemical. But it’s not, it’s so sophisticated in so many ways, in so many brain regions, and developmentally.

I think we got carried away with the SSRIs. Everybody seemed to think you could just take it and that’ll make you better. It’s interesting, it goes along with what I think about psychedelics. I’m a big believer in the role of psychedelics, historically, in religious ceremonies and spirituality. In the same way, you can’t take LSD, MDA, or ayahuasca and all of a sudden believe in God. You can’t take a pill to believe in God, you still have to work at it, study about it, think about it, question yourself.

That’s the same with taking a drug for depression. You can’t take a drug and you’re all better. You still have to work on it, and think about it, do psychotherapy. There isn’t a pill that can change your brain permanently, that quickly.

This interview has been edited and condensed for clarity and length.

Jillian never liked to drink alcohol. But two years ago, when she first started to confront her addiction to ketamine, Alcoholics Anonymous seemed like the only support group option that was available. “I wasn’t really interested in AA,” the 23-year-old said. “I thought, ‘This doesn’t have anything to do with me.’”

Ketamine was popular in her social circles in Los Angeles, and she began using it every day. A year ago, she went to rehab, but still wanted to find a community of people who had managed the same addiction as she did. It was hard to find. When you search online for ketamine addiction, you’re more likely to find advertisements for ketamine clinics than support groups.

In March of this year, Jillian founded Ket-a-Grip, a 12-step program meeting specifically for people struggling with ketamine use. They meet weekly in person at The West Hollywood Log Cabin, a wooden house surrounded by restaurants and yoga studios. The cabin was built in the 1920s as a women’s temperance movement club, and after World War II, became a home to dozens of addiction recovery groups. The Microdose talked to Jillian about her experiences with ketamine, and what Ket-a-Grip uniquely offers to its members. We are using Jillian’s first name only, in keeping with 12-step programs’ commitment to anonymity.

How did Ket-a-Grip get started?

A year ago I went to rehab for ketamine. Long before I got sober, I thought, “One day we’re going to need a support group for ketamine.” My friends and I would do so much ketamine together, and the way that we used, I just knew it wasn’t sustainable. I would make jokes that, “One day we’ll have a Ketamine Anonymous.” When I got sober, I heard a woman talking about how starting a meeting really helped her sobriety. That inspired me.

In NA [Narcotics Anonymous] they have Crystal Meth Anonymous, and I couldn’t find anything for ketamine. My friend helped me talk to the person who runs West Hollywood Recovery Center, we pitched the idea, and they approved it.

The first few meetings, we didn’t really have speakers. It was a round robin meeting, which meant we went around in a circle and everybody shared. There were a lot of people recently in recovery. We didn’t have a lot of advice or wisdom to share with each other yet. We were just relating to how hard it was. It’s definitely grown a lot. We have some core members now, and it’s been growing ever since.

In your experience, how do people first start using ketamine?

When I first started doing it, it was like the perfect drug from heaven. When I moved to LA, I did ketamine with my ex-boyfriend, and was like, “Wow, there’s no hangover.” I had heard of people who were addicted to it, many years ago. I thought, how could you be addicted to a horse tranquilizer? But it was considered really cool in the circles I hung out with. It was extremely popular. Hardly anybody did not do ketamine.

I’ve had several people come to the meeting who started doing ketamine through ketamine therapy. They started out by injecting it, and then they’ll start injecting it themselves. One man told me he did 28 grams in one weekend. He’s sober now, but he started out doing ketamine therapy for his other addictions.

What do people get out of having a ketamine-only focus? What can they share that is specific to ketamine?

In a lot of meetings, you’re not supposed to really mention drugs other than alcohol. Sometimes you’re not supposed to talk about being high at all, which is understandable, because it can be triggering. But I think it’s important for us to talk about the reality of it. When I went to rehab, there were a few other people who were addicted to ketamine, and it was really nice to be able to talk, and relate to them.

Last week, a speaker was talking about how he’s never met a ketamine addict who struggles with the idea of a higher power. Everybody in the meeting believes in a higher power, and doesn’t struggle with that because I’m pretty sure I’ve met god on ketamine. We all are pretty spiritual.

We sometimes talk about how our mental health could actually be better during addiction versus being sober. I didn’t feel very depressed when I was on ketamine, but then when I would run out, that was when I would feel terrible.

And a lot of people can relate to the ketamine cramps, the horrible, horrible stomach pains, the pelvic floor issues, the incontinence. I peed myself multiple times towards the end of my addiction. One person peed blood for a while. I never got there, but many bladders will never be the same.

How do you feel about ketamine being used to treat depression symptoms in some people, while also being addictive for others?

For me, it is complicated because I’ve done ketamine, and I can understand. I feel like it did help me in ways. It’s a very slippery slope, because your tolerance goes up fast. I used to say that I did bumps of ketamine and lines of ketamine as often people hit their vape. I did it throughout the day, like smoking a cigarette or something. It can really destroy your life, and I don’t want that to happen to more people. This is an intense drug.

I think these treatment places can be so predatory. They’ll even go into rehabs and offer treatment to people for like $500. But I was talking to a fellow [member] about this last week, and she reminded me: her brother is a Marine, and there are many people with PTSD who say that psychedelic treatment has completely changed their life. It made it easier for them to live, and I want them to be able to access that and to do that.

Do you think there’s a big need for ketamine support groups? Have you heard of any others?

I post on Reddit sometimes, and I get so many comments. Not everybody actually joins, but when I post, “contact me for the meeting info,” I then get flooded with DMs asking for help. In person it’s 15 to like 30 people. Some weeks are a lot bigger than others. We’ve had people join from all over the world on Zoom.

Two girls in Bushwick just started [a group] in New York, and it’s called Out of the Hole, which is such a good name, I love it. They reached out to me and asked about our meeting format, and I shared that with them.

I think programs like 12 Step are really important. I wouldn’t be able to be sober without it, and if I was, I think I would just be a lot more miserable and lonely. It’s nice to have a support system that’s always there, with people who don’t want anything from you except that they want to help. Having the responsibility I feel to show up for the group has helped me a lot.

This interview has been edited and condensed for clarity and length.

Close your eyes and imagine a red apple. How vivid is the image? Can you see the bright red skin, possibly even a stem? Or is it more blurry? For people with aphantasia, an absence of mental imagery, they see nothing at all.

The neurologist Adam Zeman began publishing scientific papers in the 2000s on people who had lost—or never had—mental imagery. It prompted thousands to reach out to him to share that they too only saw darkness in their minds. It’s now estimated that aphantasia affects 3 percent of all people.

A few of them have claimed that an experience with psychedelics gave them the ability to mentally visualize. In one 2018 case report, a man with self-diagnosed aphantasia started to see images of his hometown and father 30 minutes after consuming ayahuasca. He continued to have mental imagery after the drug wore off. “It feels like this experience…has slightly opened up my mind’s eye and allowed me to experience internal images like I have never had before,” he told researchers. “Ayahuasca turned on my mind’s eye, even if it is faint.”

Such stories are rare but intriguing. The Microdose talked to aphantasia researcher and neuroscientist at the University of New South Wales, Joel Pearson, about the experience of aphantasia, and the potential consequences if psychedelics could actually switch on a film reel in the mind.

I have aphantasia, and yet I find it hard to explain. How would you describe the experience of having aphantasia?

I have imagery, so I can’t give a first-person description of it. The best analogy I have is that I have trouble packing when I’m going from a cold climate to a hot climate, or vice versa. I pack for where I am at the moment, so I suffer from this presentism. If it’s winter [in Australia] and I’m going to a conference in Florida where it’s going to be really hot, I think I’ve got to bring long pants and sweaters and jackets. I have a lot of trouble imagining that change in temperature. That’s the closest I can get to capturing a glimpse of what it might be like to have aphantasia.

What I hear from the other people I talk to ranges. They see black on black; black velvet on black velvet is one description I’ve heard a lot of times. There’s a shadow experience—where it’s almost something, but not. It’s almost a black thing on a black background, but not.

The black object can maintain some spatial representation of an object despite not being able to generate an image of an object, the colors, or the surface. People have won memory competitions who have aphantasia, and instead of a mind palace, they use a mind-spatial layout of their neighborhood, where they have spatial representation, but no objects in that space. That’s hard for me to understand.

People will often try to visualize apples or red stars to self-diagnose aphantasia. How do researchers determine who has it?

The most popular way to assess imagery is the Vividness of Visual Imagery Questionnaire. You can do it very quickly, but it has some downsides. It assesses two different things simultaneously: someone’s vividness of their imagery, but also their criteria for how they decide their vividness number. Me and you could have the exact same mental image, but give it very different numbers because of our criteria for how to make that decision. It relies heavily on the word vividness, and some people have different interpretations of that word. They might interpret it to be an emotional thing. Some people take it to just be a visual, sensory thing.

We have developed a number of different, more objective techniques to assess visual imagery in the lab. The binocular rivalry method uses a visual illusion as a measurement tool to measure the sensory strength of visual imagery. Another method we use capitalizes on the emotional content of imagery. You can ask people to imagine emotional scenarios while they’re connected to a thing around their finger which measures changes in micro-levels of sweat, a proxy for emotional arousal. People who have aphantasia, when they read these emotional scenarios, their skin response was pretty bumpy and more or less flatlined. Those with imagery had an increase. More recently, we’ve developed a way to use pupil response. It turns out if you can imagine bright objects versus dark objects, your pupil will constrict or dilate in response to that, just like if you look at a bright object or a dark object. Of course, there’s fMRI, where you could scan blood oxygen levels in the visual cortex, but that’s very expensive.

When did you first hear that some people with aphantasia were able to visualize things in their mind’s eye after taking psychedelics?

I have heard people say that they have had an imagery experience from different kinds of meditation and also from taking psychedelics. I’ve also heard from plenty of people that have tried psychedelics and not had any visual experience.

There’s big variation in the reports I’ve heard anecdotally from people, which makes me think that psychedelics are not going to be a way to give every person imagery who doesn’t have imagery. There are a few case study reports that were done retrospectively, which means no one gave them a questionnaire or measured imagery beforehand. We’re relying on their memory, and comparing that to some period later in time.

We don’t want to throw these stories out, but there are a lot of unknowns there. I’m also hearing anecdotal reports that people have tried [psychedelics for aphantasia] after they saw these reports, and it didn’t move the needle for them. It makes me think that this is going to be for only a subset of the population. We have no idea what the percentage is. If we tested 100 people, how many would this work for?

If psychedelics can bring back visualization in some rare cases, what do you think is happening in the brain? Can we learn about aphantasia from psychedelics?

There might be two things going on. If you have some conscious visualization experience while the [psychedelic] molecule is active, having a flash of that shows you what it can be like, and it can teach you what to pay attention to. We also know that psychedelics put the brain in a very plastic state where it can speed up brain changes that would normally take much longer.

Aphantasia itself is very heterogeneous. There’s all different types: pure visual, pure auditory, full multi-sensory. It’s not one shoe that fits all. If we zoom in on visual aphantasia, it may be that there are different types. There could be one subtype where people have unconscious imagery; there are still images being formed in the visual cortex, it just remains unconscious for some reason that we don’t yet know. Another type, call it 100% pure aphantasia, could have no unconscious image.

It could be that if you have unconscious imagery, taking psychedelics may make that conscious, help you pay attention to it, and amplify that, combined with the brain plasticity. Psychedelics would shed light on that theory of unconscious imagery as a subset of those with apantasia. From that point of view, psychedelic studies could be really interesting for the study of mental imagery.

People with aphantasia might be curious about “switching on” mental imagery, but you have recently written that caution is needed. Why?

There are psychedelic studies happening for mental health reasons around the world, and this should be mentioned in the ethics declarations before people take part in the study: it is a possibility that if they don’t have imagery, that may change afterwards.

While the psychedelics might be used to treat PTSD, increasing imagery may counter that. Strong imagery, generally speaking, is associated with worse experiences of anxiety, neurological diseases, and mental health. There have been associations between imagery and strong thoughts, and an emotional amplification of those thoughts because they become an image in your brain.

That’s one of the things that’s held us back from doing a big study on this. If you gave a large number of people imagery who had never had it before, and it was basically irreversible, what if half of those people then had trouble sleeping? If they had intrusive thoughts? They would not have had the years of practice to learn the strategies to deal with these thoughts, and we’d be in a sticky situation.

I’m not trying to be alarmist or freak people out, but from all the data we have, there is probably—everything else being equal—more downside to having very strong imagery than upside. People who don’t have imagery often think that getting imagery would solve a lot of problems in their lives, but we don’t see a lot of data to support that.

This interview has been edited and condensed for clarity and length.

At the end of 2018, Pedram Dara participated in a clinical trial for MDMA-assisted therapy for PTSD in Canada. The treatment had a profound impact on him, yet once the trial was over, there wasn’t a way for him to share how he was continuing to process. He had no one to talk about the aspects of his experience that were specific to him that he felt researchers might learn from. For example, clinicians often play music during psychedelic dosing sessions, and they often pick songs without lyrics so that people won’t get distracted by the words. But Dara’s playlist included a song in Farsi—which he understands. Rather than being a hindrance, the song was a pivotal moment in his session, and a moment he credits with being the catalyst to positive effects.

Since then, Dara has wanted people’s lived experiences to be more central in psychedelic conferences, research, and discussions. Some may have messier experiences not easily classified as good or bad. People can have psychedelic trips that are disappointing yet neutral, scary yet beneficial, or positive yet short-lasting, as Dara found while interviewing past clinical trial participants for an upcoming event he is organizing: The Psychedelic Lived Experiences Summit. The Microdose asked Dara about the summit, and what’s missed when lived experiences are ignored.

How did your focus on individuals’ lived experiences with psychedelics begin?

I was a participant, a research subject. After attending a few conferences, I quickly realized how invisible voices like mine were when it came to how the experts were designing and delivering these treatments. I participated in an MDMA-assisted therapy trial in late 2018 and I finished that by mid 2019. The experience was profound, but when it ended, there was no aftercare, and I was left on my own. There was no infrastructure for me to provide feedback in any way, and I couldn’t make a difference in broader scientific or policy narratives.

When I started speaking more publicly about my own experiences with other patients, caregivers, practitioners, I saw that there were clearly frustrations from others who also felt like their voices were not being treated properly. They were treated like anecdotes or testimonials, but not like evidence. If this lived experience input is not built into the feedback, the system stays blind to what helps or harms.

When you went to conferences, you most likely saw researchers presenting trial findings using various depression or trauma measurements. Why didn’t you feel like those results reflected lived experience?

It’s not the full experience if you’re only looking at the clinical scales. Let’s say somebody’s life is like an onion—it’s just one layer. You’re looking at that one layer, which makes sense to experts, but not to the individual. Nobody tracks their depression based on a clinical score. Nobody wakes up and says, “Today I’m five points better on my BECK depression score.”

I have recordings of all my sessions. But then, I also recorded videos every day after my dosing session for 45 minutes for how I was making sense of all of it. Nobody watched them. They only saw what happened in the dosing, not how I personally reflected on it to my wife, my kids, to people around me. I watch those myself, and I’m like, “Wow there’s so much more here.” It’s essentially uncaptured and unmeasured data, and we’re just missing out on it.

There are a lot of psychedelic experiences portrayed in the media, and they can tend to be very good or very bad. How are lived experiences that you’ve encountered different from that?

My story doesn’t fit those extremes. There’s a group called the middle majority, and the extremes are in the minority. It’s rare that someone has just one MDMA session and is cured of their PTSD. There are people who describe their experiences as, “This saved my life, but it nearly killed me.” Nuanced, right? I’ve been doing interviews with people where within one minute what they say is contradictory.

People have contradictions within their own experience, but also with others. What do you make of lived experiences that directly contradict each other?

I think we need to treat contradictions as data. It’s still data, it’s not a threat to legitimacy. Let’s not skip the data that doesn’t make sense. Psychedelics are not like regular medicine, they amplify subjective experiences, so even more divergent experiences aren’t really noise, they are signals. Some people call the experiences healing, others may say harm or confusion, but all of these realities must still inform practice. In quality research, the way they look for truth is that it emerges from patterns across differences. We have to respect the contradictions.

It’s human transformation, for better or worse. Someone I’m interviewing who described their psilocybin experience within a clinical trial in Canada has been in hell for the last three years. That’s transformation, right? In a very negative way. This person no longer feels their old self. They’re fully transformed, but for worse, not for better. What happens to that data?

What prompted you to create the Lived Experiences Summit?

I’ve been in this field six years, and I organized the very first panel at ICPR (Interdisciplinary Conference on Psychedelic Research) with trial participants in 2022. I organized the first panel with MDMA therapy trial participants at the past Psychedelic Science conference. Then, I thought it was finally time to have a dedicated event. I wanted to make it global. I wanted to keep it grassroots, patient-led. I wanted to bridge clinical science with lived experience, nuance, and wisdom. Clinicians are doing their own thing, researchers doing their own thing. We need bridges.

I invited 27 people with lived experience, on top of 27 professional researchers and therapists together to really share these raw stories and expert insights with treatments—all legal treatments above ground, across the world, with MDMA, psilocybin, LSD, ketamine, DMT, and Ibogaine for various health indicators. We have no funding. It’s 100% independent.

I decided to do [the summit] back on the day of the MDMA FDA advisory meeting. I spoke, and when I walked out I realized how much these voices were missing and how much we were stuck between a hype and fear narrative. It wasn’t representing the real world complexity of healing. I wanted to replace the feeling of expert versus subject. I wanted the insights to feel mutual, and to treat these experiences as evidence that needs to be captured, measured, and understood properly.

It’s not about worshipping psychedelics or being against it, it’s about listening to the people who risked the most to bring the field forward to where we are now.

This interview has been edited and condensed for clarity and length.

A psychedelic experience can change a person’s beliefs about the nature of reality. One study from 2021 found that after using psychedelic drugs, some people shift away from materialist beliefs and start believing in panpsychism or animism.

A philosophical reminder: Materialism is the idea that matter is just matter, and the world around you is made only of such inert physical stuff. Consciousness might emerge from matter, but isn’t a given, or universal. Materialists usually don’t believe in entities like spirits or gods either. A panpsychist or animist worldview is a bit different. In panpsychism, mind or consciousness is everywhere, imbued in everything, and is fundamental to how the universe is.

Animism is a broad category of beliefs and practices that assumes the “animation of all nature,” and that other living things (animals, plants) or places (mountains, rivers) are spiritual, powerful, subjective beings. Animism is a common belief system in Indigenous cultures and while it is undergoing renewed interest in Western society in psychedelic circles, it can be misunderstood, says Justine Quijada, an anthropologist of religion at Wesleyan University whose field work is in Buryatia, an Indigenous republic inside the Russian Federation. The Microdose talked to Quijada about how a shift towards animism might impact a person, and where psychedelic-induced animism differs from Indigenous animist beliefs.

Animism encompasses a huge range of practices and beliefs. How would you go about describing or defining it?

When I talk about defining animism, it’s important to briefly think about where the concept comes from, because the origin of the term carries baggage with it. The term was coined by Edward Tylor, an anthropologist back in the 1870s. Like most Victorians, he had a very hierarchical sense of how the world worked. Animism was a term for belief systems that, in effect, were mistaken. They were people who believed that things had souls and spirits that modern people, who had science, knew were inanimate. It’s not a wrong definition, but it was a definition that was coined in contrast with an inanimate, scientific way of thinking.

I tend to define animism a bit differently. Ideas about souls and spirits, and what it means to be animate, an agent or subject in the world, can vary from one culture to another. I define animism as worldviews or belief systems that extend social relationships beyond the human. A river isn’t just a thing out there in the world that you can measure, it is a person or a being that you have a relationship with.

In psychology, people think about how narcissists think about other humans as objects versus subjects. This is a worldview within which things that science considers objects are subjects in their own right. The degree to which they have a personality, will, desire, or power over other people varies. But you relate to entities and animals in the world around you as subjects rather than as objects, and you have social relationships with them. There was an anthropologist in the 1940s named Alfred Hallowell, who coined a phrase, “other-than-human person”—and I think that’s a useful term.

What’s the relationship between animism, shamanism, and altered states of consciousness?

Animism and shamanism are two sides of the same coin. We think of them sometimes as being separate systems, but Caroline Humphrey, who writes about animism, coined this, which I like: animism describes the worldview or belief system within which it makes sense to have a shaman.

If the world is a community of beings that all exist in this space, we need certain specialists who are able to communicate with beings that don’t necessarily communicate in a way that humans can easily understand. The shamans are the specialists that help intervene, that help mediate, that help communicate with these other beings and solve problems when they come up and also heal people. Altered states of consciousness can be induced with psychedelics or not. Even when they’re induced with psychedelics, there’s almost always some sort of music to help facilitate it. Often, spirits will give people the song that they need to communicate with them.

Rituals and making an offering are also forms of communication. You can read landscape signs. You can read the way the water rises and falls in the river. Those are all ways of communicating. The way shamans communicate more directly through altered states of consciousness are for when you really need to fix things.

What do you make about the research findings showing that people with materialist beliefs sometimes shift towards animism or panpsychism after a psychedelic experience? Does this seem different from the animism you have studied in Indigenous groups?

With shamans, only specific people have a calling to become a shaman. It is a process that often begins in suffering, in unexplained illness symptoms, fevers, tremors, seizures, and depression. That helps to break down the life you had before, and then you rebuild yourself into being a shaman. There are moments where you have these revelations and these experiences where your ancestors come and tell you that you’ve been chosen. Then the question is, how do you rebuild your life into a life based around the idea that you have these obligations to these ancestral spirits.

There’s a difference between having a one-time realization, and building that realization into your everyday life. I think in the West, we have a more Christian way of thinking about how you’re saved through one salvational experience—you’re saved, and then that’s it. [For shamans], it’s more like a person would have this revelation, but then build it into a life that’s based on this new system. That’s a little bit harder.

Another thing that I’ve noticed as a trend, though certainly not universal, that often turns up in western psychedelic or neoshamanic approaches is that the beings that are encountered—spirits of animals, places, and nature—are presumed to be generally helpful, well intentioned, and exist in order to help human beings. In most Indigenous contexts, these other-than-human-persons are incredibly powerful. Powerful beings are not necessarily easy to interact with, and if they’re powerful enough to help you, they are powerful enough to harm you. That element of danger and needing to be careful and respectful, is often missing. Not always, but there does often tend to be this assumption that engaging with these beings is always beneficial. Any Indigenous practitioner would be terrified by that approach.

Why do you think some people on psychedelics assume the natural beings they encounter are there to help them? Is it that they’re otherwise detached from the natural world? Do they think it will be like Cinderella being dressed by birds in the morning, while forgetting the powerful and sometimes violent qualities of nature?

It’s very anthropocentric. It’s interesting you go to Cinderella as the metaphor because in Edward Tylor’s original text, he also includes European peasants; Cinderella and other fairy tales are old folk tales from Europe. If you read the original Grimms stories, Cinderella’s birds are not kind, gentle, chirping happy birds. They actually go to peck out her stepsisters’ eyes. Even in the original Cinderella, animals used to be a little bit more powerful and scary, and they’ve been tamed and domesticated.

I think part of why people are newly attracted and drawn to ideas of animism is because we’ve reached a point in the climate crisis where we can’t ignore the fact that nature does have power over us. The modernist 20th century technological progress narrative was about subduing nature, and we’ve hit a point where we realized that all of that subduing has actually made it more dangerous. Look at hurricane Melissa that’s going on right now. That’s terrifying. This is a power that is greater than us. There’s something in traditional animist systems that acknowledges that power.

If someone’s beliefs do shift after taking psychedelics, would that change them in everyday life? Do you have any words of advice or caution for someone undergoing that shift?

Going back to my original definition, animism is about extending social relationships beyond the human so I think it can have tremendous impact in terms of relationships and obligations to the world around us. When you look, for example, at the protesters against the Keystone XL pipeline, the water protectors talked about how the water was their relative. They could no more sell out the land than sell their grandmother for profit. That’s not a metaphor, right? This is a person in their world that they have obligations to, and that is an intensely felt emotional tie that can motivate tremendous action and commitment.

But they live in a social context that values that, reinforces it, and when people say things like, “I have an obligation to protect my grandmother, the river,” people around them say, “Yes, this is good. You have to do that.” It goes back to what I was saying: Can you incorporate this into an everyday life in which that worldview is built into the way in which you interact with the world? That’s difficult for people who have a one-time psychedelic experience, and then go back to their office job in Brooklyn.

Because psychedelics were effectively illegal in the United States for so long it also creates a field, like shamanic tourism, where it’s easy for people to be exploited. I would tell people to be cautious, to think critically, and to think carefully about what kind of an environment you’re engaging in these practices. Think about how your presence, and your money impacts the community that you’re engaging with. This is someone’s religion, right? This isn’t just going to a clinic and picking up some pills. You are, in effect, going into someone else’s church and participating in their services. That should be done with a certain amount of care and respect, not just for them, of course, but also for yourself.

This interview has been edited and condensed for clarity and length.

Editor’s Note: We’re thrilled to announce that Shayla Love is joining The Microdose as a contributing writer. She’ll be working on 5 Questions. This is her first post. Shayla is a science journalist based in Brooklyn who writes about psychology, history, social science, wellness trends, and the shifting ways we understand our bodies and minds. She also covers research on psychedelics for the treatment of mental illness, and the sociocultural impacts of the psychedelic renaissance. Shayla has a master’s degree from Columbia University, and was previously a staff writer at The Atlantic, Vice, Psyche, and The Guardian. Her work has also appeared in The New Yorker, The New Republic, Scientific American, Wired, Esquire, The New York Times, Nautilus, and more. Now over to Shayla.

In the late 1950s, the American psychologist Betty Eisner gave a drug to some of her patients in psychotherapy. She didn’t know exactly how it worked, but Eisner found the drug could “enhance verbalization, facilitate the expression of anger, and sometimes lead to explosive catharsis.” One 18-year old girl burst into tears shortly after the injection. “A session was held with real affect and insight on her part,” Eisner wrote in her unpublished autobiography.

While Eisner was an early pioneer of LSD-assisted psychotherapy, the drug she gave the 18-year old girl, the one eliciting catharsis, wasn’t a psychedelic. It was methylphenidate, known by the brand name Ritalin and used today mostly for the management of ADHD symptoms. Compounds like MDMA or psilocybin take up much of the spotlight when it comes to drug-assisted mental health treatments, but there’s a more varied history of substances that have been paired with therapy. The Microdose spoke with Lucas Richert, a historian of medicine and pharmacy at the University of Wisconsin-Madison, about other drugs that have made their way onto the therapist’s couch.

Many people know of psychedelics being combined with therapy, yet there have been other drugs too. What are some examples?

The one that immediately comes to mind had to do with Freud. When he published Über Coca in 1884, he was praising cocaine as a magical drug. He was using it for treating melancholia and depression, and also enhancing mental clarity and energy. Besides that, you had barbiturates, amphetamines, and sodium amytal. Of course, you already referenced psychedelics, like mescaline and LSD. So, this isn’t the first time that you’ve got a pairing of some sort of psychoactive agent with psychotherapy.

How did psychologists like Betty Eisner use Ritalin? How was it different from the other drugs you mentioned?

When Eisner came across the use of Ritalin in psychotherapy, there were reports in the Los Angeles area that Ritalin, when paired with psychotherapy, helped patients to communicate more effectively, demonstrate empathy, and possibly temporarily break down ego defenses. The quotation that I’ve read is that they experienced “explosive catharsis.” Drugs like sodium amytal or pentothal induced a sort of sleepiness, and trace-like states. Ritalin, by contrast, was a stimulant based approach—same with MDMA, also used in psychotherapy—meant to increase alertness, or increased cognitive engagement during the session.

In early advertisements for Ritalin, the drug was even marketed as a psychotherapeutic tool. One ad promised the drug would make an alcoholic patient “more accessible to psychotherapy” by releasing subconscious material, if administered 10 to 15 minutes before a therapy session. Yet today, when people take this drug for ADHD, they may not associate it with unearthing subconscious material. How can both of these experiences with Ritalin occur?

This gets at some of the social and institutional forces which shape the way drugs are used in therapeutic settings, and what becomes legitimate and illegitimate. When you look back on the use of Ritalin and psychotherapy, that goes back to the mid-1950s before it was associated with ADHD, before it was paired up with that particular therapeutic category. Ritalin was marketed as something of a magic bullet at the time, promising all sorts of fixes, in particular, in children, which led to use in the clinics and schools. Drugs and disease categories co-evolve, and that’s essential when considering why we have these therapy-drug pairings.

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If Ritalin-assisted therapy worked for some people, what does that say to you about the use of altered states in combination with psychotherapy?

You only have to go back to the 1920s, when alcohol was prohibited, to get therapeutic prescriptions for alcohol. Altered states of consciousness, whether induced by psychedelics, sedatives, or stimulants, have developed a long history as gateways to therapeutic insight. The idea of an altered state of consciousness producing some sort of breakthrough or therapeutic effect is long standing, so that’s not particularly new.

In the future, do you think that people will use a drug-assisted therapy that would surprise us? A drug that we use for a different purpose right now?

I don’t think I’d be overly surprised by any novel emerging substance being paired in that setting. What history shows us is that there’s essentially a revolving door of different types of brain altering drugs that are in that space. What we’re talking about here is both a drugs’ direct impacts on the body, but also these other extra-pharmacological issues: the preparation, the situation itself, and also the therapist’s skill, the therapist’s intention. Those are extremely important elements of the process that sometimes get lost when we’re thinking too much through the lens of the drug itself.

This interview has been edited and condensed for clarity and length.

A week into his freshman year at Harvard, Sam Suchin got bad news: his father, a brilliant doctor, had been diagnosed with dementia. Suchin tried to push down his feelings about it, concentrating on school, but he always felt a heaviness from the knowledge that his dad’s days were limited, and that he was far away. It wasn’t until his junior year that a friend suggested he try psychedelic-assisted therapy to work through his grief over his dad. During a guided session, Suchin felt a comfort he hadn’t found elsewhere, and the ability to confront some of his feelings head-on. Beyond that, he saw the substances as a tool to help him connect with others.

Suchin had always been a tinkerer. At 15, he designed and 3D printed maps for people who were visually impaired. He went on to design a 400-part artificial coral reef project, and during his senior year, he built gaming apps with Rus Yusupov, co-founders of HQ Trivia and Vine, and Daniel Greenberg, founder of the art collective MSCHF. A month before Suchin graduated, his dad passed away, and Suchin found himself wondering what he wanted to do next.

His first thought was using the skills he’d gained from his year of app-building to create an app for himself. Every time Suchin experienced an altered state, whether from psychedelics or cannabis, he took copious notes about his thoughts and feelings, which he found helpful when trying to make sense of things later on. So, a couple months after graduating, Suchin, now 23, built ALTERD, a journaling app for altered states. He launched it on Reddit. The Microdose spoke with him about the making of the app and how users are employing it.

How does ALTERD work?

I describe it as a journaling app for altered states. You can choose your state of mind — for instance, baseline sobriety, meditation, or exercise — and you can record details about your session, like how long you meditated, who you’re with, or if you took a substance, which one and what dosage. Then, you can just write your thoughts, whether that’s one liners, big ideas, brainstorms, or poetry. It’s all rooted in the ideas of intentional use and harm reduction.

Then, once these thoughts are in the app, it uses integrated AI tools to analyze them. Hours after your session, it’ll send you a summary, even recommending music and movies to check out based on your thoughts — it’s kind of like Spotify wrapped.

There’s also the community aspect of the app. You can keep your posts private by default but you can also choose to post them to the wider community. So far I’m discovering it’s an incredible, supportive community where people are talking about philosophy, spirituality, consciousness, and life. People seem to really like that there are no “likes” on the app; there’s no clout-chasing.

What do you know about your users?

In 6 months there are now tens of thousands of users who have signed up. I’ve made friends with some of them just from DMing; at this point I’ve spoken with hundreds of people on the app, which makes sense from a product development standpoint but I’m also just enjoying learning about people and hearing about their perspectives. There are people who are primarily interested in the science aspect, while others are more interested in exploring psychedelics from a spiritual lens. And then there are even people who have never even touched a psychedelic, but they are using it as a dream journal, or people who aren’t using it as a journal at all, but enjoy the social aspect of the app, like scrolling through other people’s posts.

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The app has a distinctive design — what were your influences in creating it?

There are so many different ways to make an app. You can do market research and target a specific avatar of user. Or you could build something for yourself, the way musicians make music they like — and that’s really what I did. The basis of it was just me writing in my phone’s Notes app, and I would always do it in dark mode because when you’re in an altered state, whether that’s cannabis or psychedelics, a white screen can be kind of jarring. So the background of the app is black, and I use colors to represent a different state of consciousness.

I studied computer science in school but I love design and art, and almost wish I’d studied that instead. I think a lot about Virgil Abloh who was a huge streetwear designer; he merged art and fashion in a way that made it accessible to the mainstream.

Can you say more about how the app uses AI? Given all the talk right now about how AI apps can lead people into harm, what safeguards do you all have in place to ensure your users in vulnerable states stay safe?

AI can be misused just as psychedelics can be taken in the wrong context, and I take that really seriously. The way I think about it is that AI, like psychedelics, is a tool: if you use it the right way, it can help people make new connections between their unstructured thoughts. The way AI is used on ALTERD is not like a tripsitter or chatbot; you don’t talk to it while you’re in an altered state. You don’t need to be taken out of that moment. The AI comes in post-session, roughly eight hours later, to send you insights. But if, while you’re using the app, we detect suicidal thoughts, there’s a pop up with info about a suicide hotline as well as a link to The Fireside Project. [Reporter’s note: Fireside Project offers a psychedelic peer support hotline; for more, read our interview with co-founder Hanifa Nayo Washington.] So far, we’ve been lucky to have no issues, though some people have complained that there are too many safeguards.

This app is fairly new, and you’ve just graduated from undergrad. What plans do you have in the future for the app, and for your own interests in the psychedelic space?

In the short term, I want to concentrate on making the product as good as it can be and making sure it’s safe, private, and secure. I just love building things, and I never wanted to raise venture capital funding and go down that path, and having to do things with investor profits in mind.

In the longer term, I think about my dad a lot. A week or two after he died I ended up learning about the potential applications of psychedelics for neurodegenerative diseases, like the one he died of.I think it’d be great to be able to get involved with that kind of research — maybe even using the app for that in some way. Around sixty percent of our users have opted into allowing their deidentified data to be used in research so far, so I think it’d be great to partner with researchers. It also would be really fun to lean into the people aspect of the app; as it grows, I would love to do events, whether that’s a conference or even an ALTERD concert. But so far this doesn’t feel like a business, but art, and being able to talk to people and hear that the app has helped them has been incredible.

This interview has been edited and condensed for clarity and length.

The rainy season is underway in southern Mexico, which means the mushrooms are pushing up through the soil. Filmmakers and producers Mónica Álvarez Franco and Tatiana García recently returned from their first film shoot in the mountain communities outside Oaxaca where they are working on a feature-length documentary film called “Voices from the Earth.” Their project received a 2025 Mycoskie - UC Berkeley Psychedelic Documentary Fellowship.

Álvarez has written and directed several short films showcased at festivals across Mexico. Her debut documentary feature, “Bosque de Niebla,” premiered in 2017 at FICUNAM, the International Film Festival of UNAM, where it received an Honorable Mention. The film later won awards and made the rounds at film festivals including South by Southwest, Margaret Mead New York Film Festival and Rio de Janeiro International Film Festival. The film is currently available on Amazon Prime in over 20 countries.

García is a producer on “Voices from the Earth.” She’s worked at the Tribeca Film Festival and Cinema Tropical and produced award-winning documentaries, features, and digital content for companies including Netflix and NBC. The Microdose spoke with Álvarez and García about their psilocybin film.

You recently went on a shoot in the mountains of Oaxaca. Tell me about your film and about your experience there. What was it like?

Tatiana García: “Voices from the Earth” is a documentary about psychedelic tourism and gentrification in this little town in the Oaxacan Sierra. This project explores the tradition of the psilocybin mushrooms that are grown there, the Zapotecorum mexicano, or derrumbes, which means landfall in Spanish, because they grow on landslides in the mountains. Our approach to the film is having an intimate lens on one family that survives gentrification and psychedelic tourism, and, of course, how mushrooms have been a main compass of their lives and their visions.

We met with our main participant Ariadna Pinacho and her family. Ariadna studied gastronomy and came back home because after working in hotels, she was like, ‘What am I doing when I have an amazing thing to go back to? When I can grow my community through my experience and raise up what mushrooms mean to us as a Zapotec community?’ Ariadna’s little cabins are where many scientists stay when they come and study mushrooms in these mountains, which is beautiful. We really got a sense of them becoming stronger as a community, defending their land, defending the mushrooms. They are also very experienced in having psilocybin trips. They’re very proud of being part of a mushroom community. ‘We are from the mushrooms’ is a phrase that Ariadna always says. We had a wonderful walk with a lady who showed us all the different mushrooms they consume there, what they call the “holy children.” For them this is a natural part of their life and not ‘Let’s just get high and have fun.’ It’s part of who they are from when they are born all the way to when they die.

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Why did you choose to focus on the Zapotec community specifically?

Tatiana García: The Zapotec community has lived alongside mushrooms all their lives throughout generations and have survived many, many, things including gentrification and other struggles. I had knowledge about their community because I was close to a family there. So I think it was kind of like going back to a place that was home for me in a way.

It just made sense to go to a place like that, especially because the landslide mushrooms, Zapotecorum mexicano, is a very peculiar kind of mushroom that doesn’t grow any other place in the world. It only grows there. So that also made the experience very interesting, having one type of mushroom that is very protected by the community. San Jose del Pacifico is the highest point in the mountains of Oaxaca and it’s so high that you can actually see the Pacific Ocean from there. It’s a beautiful place. One minute it’s cloudy, it’s foggy, you cannot see 2-feet in front of you. Then it starts to rain, and two seconds later it’s bright and blue skies. I think all those elements create the perfect environment for these mushrooms to survive.

Why are you interested in telling this story?

Mónica Álvarez Franco: I think this project is trying to understand how things like tourism cause changes socially and anthropologically. And in this case, it was the mushrooms that brought the tourists. The use of the mushroom for this community is not just a recreational act, it’s an act of healing. They consume mushrooms at least once a year, or when they’re having personal, psychological conflicts. So these mushrooms symbolize one thing for the people, but at the same time you see graffiti in the streets about mushrooms in languages that are foreign to the community itself. That culture shock is really interesting.

Monica, how do you see this new project in conversation with your previous work “Bosque de Niebla”?

Mónica Álvarez Franco: I like to think that each project has its own feeling, its own soul. I see similarities in “Bosque de Niebla” and this project because of the communities. Even though they seem to be very sociable, they work from the inside. It’s difficult to break those barriers of intimacy. I think the key in both projects is the observation and being very close to those intimate spaces, and being able to capture the beauty of that authenticity of the population, of how it is organized, of how it understands itself. That part is mystical.

Why do you feel that it’s important for this story to be told to an international audience?

Mónica Álvarez Franco: I think that, like “Bosque de Niebla,” these are stories that kind of solve questions of our human experience, or how we relate with other humans. Through that lens, we can identify each other and have this hunger to seek who we are, and it can relate to any audience on the planet.

Tatiana García: Filmmaking is not separate from the scientific world. It’s a beautiful bridge between art and science in that sense. By relaying information through art and looking humanly to, in this case at mushrooms, we can speak about the scientific world through human experience.

Mónica Álvarez Franco: I think that also happened with “Bosque de Niebla.” If it had been a documentary that talked about permaculture or climate change, a very specific audience would have arrived. But to talk about it in this human, narrative way, that opens up that audience.

This interview has been edited and condensed for clarity and length.

Are you a documentary maker with a project that in some way relates to psychedelics? Applications for the next round of Mycoskie - UC Berkeley Psychedelic Documentary Fellowships are due October 30, 2025.

The 2025 legislative session saw dozens of psychedelics-related bills across the U.S., with nearly half of U.S. states introducing dozens of laws proposing to study, decriminalize, or even state-legalize psychedelic substances. In January of this year, we reported on Colorado’s House Bill 1063, which proposed making COMP360, the psychedelic company Compass Pathways’ proprietary formulation of psilocybin, legal at the state level should the U.S. Food and Drug Administration approve it as a drug. The bill eventually passed, and over the next few months, several similar bills popped up in Virginia, Kansas, Pennsylvania, Arizona, Iowa, and Georgia as well.

Some of those bills also specify COMP360, while others use the term “crystalline polymorph psilocybin,” which also refers specifically to Compass’s formulation. (The Microdose has reached out to Compass several times in the last few months about their legislative efforts, but we have not received a response.) In June, the British company announced preliminary results for their Phase 3 clinical trials using COMP360 to remedy treatment-resistant depression; in 2021, the company came under fire for its patent claims to protect COMP360. Groups like Porta Sophia, a non-profit known for their work challenging patents, called the patent overly broad. (For more about Porta Sophia, read our interviews with founder David Casimir and our earlier interview with Shahin Shams.)

Jeremy Rolquin and Shahin Shams, analysts at Porta Sophia, noticed these recent trigger laws as well, and The Microdose spoke with them about the potential implications of passing these Compass-specific trigger laws and what the organization is doing to address them.

How did this issue get onto your radar?

Jeremy Rolquin: I used to work at the Virginia Commonwealth University School of Medicine in a lab that studied psychedelics — that’s where I got my master’s in medicinal chemistry studying psychedelics. One of my co-workers there reached out to me in May, and she said she’d been invited to a meeting about psychedelics in Chesterfield County, the county directly south of Richmond, Virginia’s capital. And I was like, “Oh, that’s interesting. What about?” And she said that it was in relation to this bill, SB-1135, which was put up for a vote in the last legislative session, and had to do with polymorphs of psilocybin.

That term is something that I see a lot in the patents that we examine here at Porta Sophia. It’s becoming increasingly prominent, so we as a team have been quite familiar with it. When I heard that, I was, first of all, shocked that I hadn’t heard about it, but then I became super curious as to why this was coming up now.

That co-worker invited me to the hearing, so I immediately said yes and asked if I could bring Shahin. Since then, we’ve found bills in 10 other states that all describe the same thing as SB 1135: a “crystalline polymorph” of psilocybin. Three have passed; others have been put up for vote, or are in a pre-draft period.

You mentioned that this term “crystalline polymorph psilocybin” is familiar to you. Can you say a bit more about why it’s important?

Shahin Shams: Crystalline polymorph psilocybin isn’t scientific language — it’s a patent portfolio or marketing term for COMP360.It is still very restrictive and would likely lead to court challenges to see if any other providers would be able to enter that state.

There are about a dozen Phase 3 clinical trials for psilocybin in motion from a variety of sources: for-profit companies like Compass and Cybin, and the non-profit Usona. [Reporter’s note: Porta Sophia was co-founded by Usona’s founder, and has received funding from the organization.] And then you have a lot of different universities that are using other versions or just public domain versions of psilocybin as well. If approved by the FDA, those wouldn’t have the proprietary upcharge that you usually see in the pharmaceutical world.

According to the executive director of Virginia’s Board of Pharmacy, who we’ve met with, this is the first time a company seeking to legalize just its product has put forth a bill in the state legislature. This has not happened before for them. Their role is to be a regulatory body that aligns the state of Virginia with federal guidelines; they generally meet once a quarter. The fact that they’ve never seen something like this before suggests this could be a new tactic, and because this is such a unique field of medicine, it could be ripe for exploitation. We want to make sure that this doesn’t become a trend.

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You spoke with legislators while you were in Virginia for that bill hearing. What were their thoughts on this issue?

Jeremy Rolquin: Dealing with lawmakers is very interesting; they’re often very to-the-point. I had one lawmaker call me personally from his cell phone after I called his number; I’d left him a voicemail that laid out the issues that we had with this bill. When he called me back, he said, “I’ll never legalize an addictive drug like psilocybin.” Talking to someone like that brought me back to earth; it made me realize that this is still the general consensus on these compounds. Since we work in this psychedelics-focused field, it’s easy to believe that everybody thinks that these substances should be legalized and that they have great therapeutic potential. But we still have a long way to go in terms of catching the general public up to that way of thinking.

Shahin Shams: Oh, and it’s important to note that this individual was also a pharmacist. It was incredible to still see that even someone as educated as a pharmacist with a doctorate in pharmacy still had this resistance.

Several lawmakers we’ve spoken to disclosed that the reason why they voted for the Virginia bill was that it had the “right” guardrails in place. There have been at least four other Virginia bills within the last couple of years that have proposed decriminalization, legalization, or rescheduling of psilocybin, but they did not get a lot of support because lawmakers didn’t have what they thought was the right approval system in place. So when these lawmakers saw the stipulation that this would be triggered by FDA approval, they thought okay, that should be a little bit safer; giving the individuals a therapeutic product and monitoring them would be safer than just access to a drug. But they didn’t know that the bill approved psilocybin made by just this one company; what they thought they were greenlighting was FDA-approved psilocybin access.

Beyond talking with Virginia legislators, are you all planning additional work around these trigger laws?

Shahin Shams: We’re proposing language changes that would be more inclusive of the totality of therapeutic options that are currently in Phase 3 clinical evaluation; we want to change the language so it isn’t so company specific. We’re not trying to prescribe to the lawmakers what the best version of their bills are going to be, but rather trying to identify what they thought was valuable about a bill — for example, psilocybin access that is FDA approved — and suggesting something that is in line with what they were hoping to accomplish. In many cases change can be made with just a sentence. In Virginia, we’re proposing changing the phrase “crystalline polymorph psilocybin” to any version of psilocybin approved by the FDA and rescheduled by the DEA. We’re also beginning work in Pennsylvania, Georgia, and Colorado. Colorado already passed their version of this law, but we’re trying to seek an amendment.

We’re also trying to rally and gather advocacy groups within those states as well; we’re connecting with doctors groups, veterans groups, and patient groups that have previously spoken out in support of expanded access to psychedelic therapy options to inform them of the current limitations this bill poses and how a simple language change would be able to benefit not only the subpopulations they represent, but also the broader totality of constituents in their state.

Jeremy Rolquin: We’re trying to position ourselves in time for the beginning of the legislative cycle. Most states’ sessions open at the same time and we’re trying to get ahead of the potential deluge. We’re a small team and there will be who knows how many of these bills; many could get reintroduced from last session, or new ones could be introduced.

Porta Sophia’s work so far has focused on patents, and interfacing with the U.S. Patent and Trademark Office. Is policy making now a focus for the organization too?

Shahin Shams: I’m a scientist, and Jeremy is a scientist; the policy world is completely new to us. We never thought we’d be involved in policy. It’s just that we’ve seen these bills gain such momentum, so we’re trying to figure out the nuances of each of these states’ regulations, and at least in the case of Virginia, it was concerning that the legislators we talked to were completely unaware that the bill they were considering used such product-specific language. So far it’s been an on-the-fly learning experience for us; we’re just trying to get in front of the committees that are putting these bills forward and trying to educate them on the current restrictions that this language poses.

This interview has been edited and condensed for clarity and length.