Why are we doing this? 5 Questions for doctor and MDMA researcher Sylver Quevedo

Quevedo discusses incorporating Western medicine and Indigenous ways of knowing into the psychedelics world.

In the 1960s, Sylver Quevedo was in an undergraduate biochemistry course at U.C. Berkeley when he learned about the similarities between serotonin neurotransmitters and tryptamines. This is really interesting — why aren’t people studying this? he wondered. A few years later, in medical school, Quevedo worked with researchers studying MDA, an analog of MDMA that was legal at the time, to enhance therapy sessions. But his interest in psychedelics was put on the backburner for the next few decades as his medical career bounced him around the world; he  worked in family medicine clinics in the southwestern U.S.; at Stanford’s nephrology department; with ayahuasca shamans in the Amazon and medicine healers in China; and alongside Massai and Indigenous healers in Kenya. 

In 2015, Quevedo finally came back around to psychedelics. His son had returned from a decade and a half in the Navy traumatized and disillusioned. Quevedo asked his colleagues about PTSD, hoping he’d find a way to help his son, and learned that MAPS was looking for researchers to serve as principal investigators in phase 3 clinical trials studying the use of MDMA-assisted therapy to treat PTSD. He co-lead the study’s San Francisco arm. The Microdose spoke with Quevedo about his sprawling career bookended by psychedelics projects, and how to incorporate Western medicine and Indigenous ways of knowing into psychedelics work.

You’ve been interested in psychedelics for six decades now. What’s changed in the world of psychedelics over that time?

A consistent theme is: how can we improve the discourse on psychedelics? In this second renaissance, how do we not make the mistakes of the sixties? We’re thinking about how to talk about these drugs responsibly, how to distill the real lessons and innovations out from the hype, and what cautionary notes there should be. There's so much hype; it's a growth industry, and the venture capital people are all over it. 

What’s happening feels very similar to what’s happened with mindfulness, which had its origins in Vipassana and Buddhism, but it got disconnected from its ethical, spiritual, and doctrinal roots. Mindfulness became a tool to do better at some task; there's a famous story about that, where a famous teacher was asked to teach mindfulness to military snipers to make them better shots, and they refused to do it because it wouldn't work, because mindfulness is a way that one approaches the principles of right livelihood, and cannot be disconnected from that. That's where psychedelics are headed. 

There's a lot that we can glean from the discourse and dialog about psychedelics that has relevance to our general lives, and as a cultural commentary on where we are. Recognizing that nature is sacred may be a turning point for our generation, in the sense that it allows us to approach issues of climate catastrophe and climate justice in a more unified, collective way, and with a different orientation: not economic or extractive, but relational and sustainable. 

There are lots of attempts underway to scale these drugs for widespread treatment for specific ailments, like PTSD or depression. Is it possible to do that without going the way of mindfulness, without losing sight of the fact that the spiritual or cultural aspects of these drugs are also important? What should the field be thinking about at this moment?

I was once asked, Wouldn't it be better if everybody was using psychedelics? And really, I don't know. The casual use has a lot of ways to potentially go wrong, and this gets us to this question: Why are we doing this? It's important for us to rediscover the intentionality and culture of psychedelics. These are consciousness enhancing agents that work primarily on subjective experience. People have profound experiences with them, and that’s not true with many other drugs.

William James wrote about the notion of radical empiricism: it’s the idea that any scientific account of human experience which does not include the subjective is, by definition, insufficient or inadequate. Does that mean that I think that all research should look at everything? That’s difficult, and the funding isn't there. Our MDMA trial is about as conventional as you can get, which ironically is one of the reasons it's being taken so seriously. 

It does seem like a double-edged sword that this work must be packaged in a specific way for it to be taken seriously. You’ve thought deeply about the importance of holistic and integrative medicine, and at the same time, you’re leading some very classical clinical trial studies – why did you feel like this was the path forward for you?

The short answer is that I know how my academic physician colleagues think. Conventional academia and U.S. medical centers are, in general, still quite reductionistic. People think in terms of singular causes and models. If you want the outcome of improved scores on your depression inventory, like Beck’s depression scale, you don't think the peak experience has much to do with it. [Editor’s note: Psychologist Abraham Maslow used the term “peak experience” to reference euphoric moments of awe in a person’s life; psychedelics can elicit these, but so can playing music or rock climbing.] But psilocybin data shows that that's not the case; peak experiences do have predictive power and may be important.  

Should we do this kind of clinical trial medical research? I think the answer is “both and”: we need to do this kind of research, but also ask deeper questions about what it all means. 

You’ve spent time with traditional healers who use psychedelic drugs, and seem to have a healthy respect for the subjective, spiritual aspect of these substances, and you’ve also spent your career working in Western medicine. What do you see as the breakdown between how much work the substance itself is doing, versus the context in which it’s taken, like the set and setting, or guides’ or therapists’ direction?

I’ve thought about this for years. If I push myself hard, the answer would be both. The medicines are medicines; they do things in your body. But do we know how? Not really. There's definitely a physical part, but because we're dealing with consciousness as opposed to, say, cardiac output, it’s tougher to measure. We have a narrow definition of what cardiac output is, but what's our definition of consciousness? It’s the pressing scientific issue of our time. 

The interesting thing is you see this in other aspects of medicine, too. I used to see a lot of dialysis patients who were essentially dying, and then they would get a transplant. At one point, I was reading the Tibetan Book of the Dead and there was a statement about how the best preparation for living is dying, and I thought, Hmm, that's a little bit hard to do. In the clinic, I saw a patient who had just had a transplant, and she was really happy, doing well, thrilled to be off dialysis. A nephrologist would say that the euphoria was not real; rather, she was high on steroids because they're on high dose steroids. That kind of peak experience changes meaning in people's lives and re-orients them to things that are larger than themselves; it’s a spiritual experience. 

In your work around the world, you’ve brokered conversations between two groups of people who are often presented as coming from opposite poles: traditional Western public health and medicine officials and people with expertise in Indigenous or traditional ways of knowing. What have you learned in brokering those conversations?

People on both sides of my family were Indigenous to the American Southwest, primarily Mescalero Apache and Pueblo people. As I received my education, I felt like I had a foot in two different worlds, which sometimes communicated with each other, and other times felt very much like discordant opposites. I grew up with a sense of being between worlds.

When I was in Africa, we were planning curriculum for a medical school, and we did a lot of focus groups. We quickly realized that the groups’ worldviews were so different, and we created a little aphorism for ourselves: the dialog itself may be the epistemology of our time. We're facing issues of identity and community in a historical period of unparalleled and new pluralism. There is a pluralism to our experience that people have not had before. We had people from the UK and Europe, as well as Africans who were educated at Oxford or Harvard. But, given the history of Africa, and the colonial period being so recent, these individuals spoke Indigenous languages alongside English.

Communicating with people in order to create a shared sense of reality is really important. That's very much a traditional Indigenous perspective, where beingness is primarily relational. Our relationship to the Earth is one of relationship, whereas in Judeo-Christian culture it's dominion over the Earth. The whole planet is going to rediscover the importance of the relationship to nature, just out of necessity. If we take purely extractive, utilitarian approaches to nature, it's going to come back to haunt us. 

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