In this episode, I am speaking with David Rabin, MD, PhD, renowned neuroscientist, and inventor who has been studying the impact of chronic stress in humans for more than a decade. He specializes in the treatment of PTSD, Post-Traumatic Stress Disorder, depression, anxiety, and substance use disorders, and he’s the inventor of the Apollo Neuro device.
We are going to talk about Psychedelic-Assisted Psychotherapy, and how they may be the greatest breakthrough in modern medicine.
In this podcast, Dr. Rabin and I will discuss:
- Are psychedelics safe?
- Why psychedelic-assisted psychotherapy is a major breakthrough in mental health
- Why current psychotherapy methods are failing in treating the most common psychological conditions
- The science on psychedelics
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Ari: Hey there. Welcome back to The Energy Blueprint podcast. I’m your host, Ari Whitten. With me now is my friend, Dr. David Rabin, who I recently did a webinar with on his device, the Apollo Neuro, which is an amazing new technology. We won’t be talking about that here. We’re going to be talking all about Psychedelic-Assisted Psychotherapy specifically, Ketamine and MDMA, but maybe we’ll touch on some other compounds.
A little bit about him, he’s an MD and a Ph.D. which is a whole lot of years of studying. He is a neuroscientist and a board-certified psychiatrist. He’s a health tech entrepreneur and inventor who’s been studying the impact of chronic stress in humans for more than a decade. He specializes in the treatment of PTSD, Post-Traumatic Stress Disorder, depression, anxiety, and substance use disorders and like I said before, he’s the inventor of the Apollo Neuro device.
He’s also an expert in MDMA and Ketamine Assisted Psychotherapy. With all that said, Dr. Rabin, I’m super curious to hear your personal story of how you got interested in, I guess, psychiatry more broadly and neuroscience, the brain, and then more specifically, how that evolved into an interest into Psychedelic-Assisted Psychotherapy.
Dr. Rabin: Well, I guess starting at the very beginning, I think that my interest originally was just in understanding consciousness better. I think that we have had– There’s a lot of confusion about what is reality, what is this world we’re living in. Philosophers and scientists, and many others have been talking about this for hundreds if not thousands of years. It’s been a question that I don’t think has ever been answered.
As a kid, I used to have these really vivid dreams that– This was probably starting as early as three years old. It was as long ago as I can remember where I would have very vivid dreams that were so vivid that I could not tell whether they were based in my reality or not. What would happen was I would have these dreams. They weren’t all bad. Some of them were nightmares, but most of them were neutral or positive.
I would find myself later, in my day-to-day life, having a conversation with someone– This is again between the ages of– My conversations were limited at this point, but this is between the ages of like 3 and 10 years old. I would have conversations with people and I would be referencing something that happened and they would be like, “I have no idea what you’re talking about.”
I would instantly have a recognition that this is something that happened in a dream, in my sleep, not in my real life. That was pretty astonishing to realize at first as a child when we’re first starting to understand what life is and what all these things around us mean and what is experience and seeing how subjective that really is. I asked my parents, my parents are Western-trained physicians, and I was very lucky to have them around particularly when I was growing up.
On the weekends, in particular, we could spend time together and I could ask them things about my experience. They said, overwhelmingly, which is the most common answer people get, I think, as kids is, “Don’t worry about your dreams. They’re not real. Don’t be scared about them. They’re not real. Don’t worry about it.”
Ari: Secondary to that, they’re like, “We got to get you to a psychiatrist to get you on some-“
Dr. Rabin: Well, luckily it never went that far. I think deep down, to me, what that seated inside of me was a slight bit of distrust, which is that, “Hey, my parents are telling me this because that’s what they know and that’s how they know to explain this to me. Clearly, that’s not the whole story because when I went through these experiences, they seemed quite real.”
After that, I just went through my regular schooling. I was always interested in resilience, chronic stress and consciousness and dreams, I think, dreams and dream theory and Jungian psychology and psychiatry. Those were all things that always stood out to me, but I never really knew how to study them mainly because they’re just really hard to study.
I started talking to people, my dad encouraged me and just said, “Hey, if you’re really interested in this, just reach out to people. Talk to them and see people who work in this space, read about people who work in this space.” I started reading into it and I was like, “This is impossible study. There is no way that I’m going to be able to make a career for myself studying consciousness by studying people’s dreams and have that be any kind of rapid discovery process”, right? Because dreams are so hard to study.
People have spent their lives studying these phenomenon and not really coming to any significant realizations at all that they could easily pass on to society at large. I basically pushed that aside and said, “All right, I’m just going to focus on my interest in chronic stress, resilience and growth and then with a focus on illnesses that don’t typically get better with Western treatment.”
I originally started this at my training at Albany Medical College in Rensselaer Polytechnic Institute, looking at dementia and aging disorders of dementia and neurodegenerative disorders, and also aging disorders of blindness, which are very similar to neurodegenerative disorders and why some of us get these illnesses and others don’t because we don’t really have good treatments.
Then, from there, I was wrapping up that research and this must’ve been in– I can’t remember exactly the date, but it was sometime around 2012 that one of my colleagues who was very interested in psychiatry from the beginning reached out– Well, we were hanging out and she said, “Have you ever thought about being a psychiatrist?” I said, “One of my–” Because we always had very mindful conversations and we always talked about consciousness together.
I was like, “Oh, yes. Whatever, I thought about it.” I had a mentor in psychiatry who said, “You’d be a great psychiatrist,” but I always blew it off because psychiatry had such a crappy reputation in Western medicine. Legitimately, it did because it wasn’t doing a very good job of treating and healing people at that time. Still, we struggle with that. She said, “If you’re interested, check out these papers.”
She sent me all of these articles that were publishing mainstream, incredibly rigorous peer review journals on Psilocybin for treatment-resistant depression and MDMA for treatment-resistant PTSD, research in Ketamine and all of this stuff that was going on at groundbreaking institutions currently all over the world. I saw that research and I really was just blown away by how high quality it was and what good science it was.
Then, it was better science than a lot of the studies I was seeing on the Western side with SSRIs and other medicines– or at least as good. I said, “You know what? This is it, this is the time.” I immediately made the decision within that 24-hour period of diving into all that research to re-explore psychiatry and then ended up connecting with some mentors in that space that I could work with in the research capacity who were open to new ideas on the field.
Then, everything just came together from there. I spent the next several years really studying chronic stress with respect to treatment-resistant mental illnesses like PTSD and depression and how to basically modulate or alter our emotional states to be aligned with our goals. If you have a goal, it’s not about why can’t I get there. It’s what can I do in this moment to increase my chance as much as possible of getting to that goal and accomplishing it successfully.
That became the path of study that I focused on predominantly at the University of Pittsburgh and where Apollo ultimately came out of.
The most common treatment-resistant psychological conditions and why they are difficult to treat
Ari: Excellent. You’ve made a reference in passing to a number of treatment-resistant conditions and to the idea that psychiatry as a whole didn’t have a great reputation for helping people with mental illness. Talk to me just a bit about that. This is a bit of a vague question. I’ll let you answer it however you want to answer it but your sense of psychiatry as a whole and what they’re good at or not very good at and what are the key conditions that conventional psychiatry is not very effective at treating.
Dr. Rabin: That’s a great question, broad question. I think that when we really think about what Western medicine– Even taking another step back, what Western medicine a practice or strategic healing approach, how that’s different from Eastern medicine or tribal medicine. The major difference that we see is that Western medicine, to include our approach to mental health, is really, really good at treating emergencies.
And treating things that we need to tackle right away or someone could either hurt themselves, hurt someone else or die or become severely injured from an infection or injury, emotional, mental, or physical. That is the stuff that Western medicine excels at. We have the best surgeons. We have the best-trained doctors who have developed incredible antibiotics to treat terrible infections that used to kill many, many, many hundreds of thousands, if not millions of people.
Western medicine really has a place in what we call the acute phase of illness. What we can do right now, if somebody is having a life or death emergency situation, whether that’s mental health, physical health, emotional health, what have you. However, when it comes to treating chronic illness, chronic inflammatory diseases, autoimmune diseases, chronic metabolic syndrome, and obesity.
Many people consider a mental health diagnosis like schizophrenia, bipolar disorder, depression, anxiety, PTSD to be life sentences and that we don’t have good treatments for them because our treatments resort or rely around basically taking what we would do in an immediate term situation and immediate emergency when someone is acutely unstable and then prescribing that to them, to take every day for the rest of their lives.
That is not necessarily the first best step, that is maybe down the road something we can do that can help if we’ve tried everything else, that doesn’t have any risks but those medicines that we use acutely when use long-term can actually pose great risk to patients.
Ari: If you don’t mind me interjecting. My understanding of the field of psychiatry is that it used to be much more psychotherapy-focused many decades ago and then slowly in the last, I don’t know if it’s two, three, four decades, it’s almost spaced out the psychotherapy element almost entirely and it’s become very drug-focused. Is that accurate to say that way?
Dr. Rabin: I’m glad you brought that up. It’s mostly accurate. What’s really interesting is that psychiatry used to be, as you said, almost entirely psychotherapy based and it was really based in these foundational principles of Freudian psychoanalysis, which came from Sigmund Freud and an earlier and then his disciples later that then ultimately formed our practice of psychiatry, which was psychoanalysis-focused.
All psychiatrists for many decades had to spend four to five days a week in psychoanalysis with a psychoanalyst during their training every week. It’s incredible how much time you imagined this would take and then interestingly enough, a psychiatrist named Thomas Detre, who was very successful at the Yale Psychiatry Program, ended up leaving Yale and coming to Western Psychiatric Institute and Clinic at the University of Pittsburgh where I trained.
Which was predominantly a psychotherapy-based talk therapy-based program and transformed that program into one in which the psychotherapists and the psychoanalysts were no longer as welcome and really spearheaded this movement towards a nearly purely biological approach to psychiatry which was then referred to as biological psychiatry, which UPMC and Western psych are known for, for really, really pushing forward in the development along the way.
Ultimately, that results in the development of many, many new drugs, many of which are useful for certain things, but not necessarily blanket use for everything. Those medicines are interestingly enough, now shown in many cases, particularly PTSD, which I think is the most astonishing case population because there’s so many vets that have this and non-vets now because of COVID that have PTSD, where our remission rates with these medicines are less than 50%.
That means that if you get two full doses of an SSRI and you take them for the full course, like an SSRI, like Prozac, Zoloft, Paxil, these kinds of medicines that are gold standard and described in the DSM, the Diagnostic Statistical Manual of Mental Illness, which also came out of Western Psychiatric Institute and Clinic, then you will find that almost 50%, sometimes more, sometimes a little less, of people do not achieve the remission rates in terms of symptom relief that the book says they should.
Then the question becomes, what do we do then? This whole movement between Yale and Western Psych and UPMC started in the 70s and 80s and now that has expanded. Then basically almost all the psychotherapists left because it was inhospitable for them in the institution and most psychiatrists just started prescribing medicines. Very frequently.
Prescription medicine became the first line go-to, which I think really was a very dangerous move for our specialty but what’s very promising about this now is that Western Psych amongst other institutions that have recognized that perhaps they went a little too far down the biological psychiatry path and they are now reintegrating psychotherapy into practice to the point where I think we’re finding something very interesting, that we’ve learned, which is ultimately that psychotherapy alone is very good.
It requires motivation. It requires a lot of effort from the client or the patient. Drugs alone, they’re okay. Probably they work a bit less effectively than psychotherapy alone. However, the one caveat is when you combine psychotherapy and medicine in this form of what we call medication or medicine-assisted psychotherapy, which is the way that we practice psychedelic medicine, we see tremendously improved results. That is where the future of mental health is really going.
Ari: Very interesting. Okay, one quick point of clarification before we go into psychedelic stuff. The way that you just described medicine-assisted psychotherapy– I’m familiar with MDMA or Ketamine Assisted Psychotherapy or psilocybin assisted psychotherapy where someone is actually using that compound in an altered state of consciousness while doing the psychotherapy.
But the way you just used it almost implies like one could use, SSRIs and do the psychotherapy in tandem with that. Is that a thing? Is that what you’re referring to or am I misinterpreting that?
Dr. Rabin: I was referring to the fact that that’s possible. I think it’s clear that there’s certain medicines that work better in psychotherapy than others. SSRIs are not one of the medicines that works particularly well to augment psychotherapy, however, medication-assisted psychotherapy started with going way, way back to doctors using benzodiazepines and sedative drugs barbiturates to sedate patients who were very, very sick, who were really uncontrollably mentally ill, who couldn’t function at all and couldn’t interact with other people.
They would give them sedatives, calmed down for a period of time and then conduct psychotherapy over that time to try to help reach them when they were settled. However, that didn’t work very well because we know that sedatives and hypnotic medications, like the ones I mentioned and to include opioid narcotics actually impair our ability to engage with each other.
They impair our ability to feel empathy and to look inside ourselves, to feel our bodies, to introspect, to self-reflect. All of those things are critical for the practice of psychotherapy to get anything out of it. It was very quickly realized that this was not the best approach and then ultimately, now we’re moving forward to a new direction where I would say it’s more about– For one, not all medicines are created equal.
So not all medicines are going to go well with psychotherapy and not all medicines are going to go well individually. That being said, it’s really about a complementary intervention that’s connected to psychotherapy. What is one of the oldest ways that we’ve done this? It’s hypnosis. Hypnosis is combining a mental technique of hypnotizing someone with a psychotherapy technique. That would be an old way of doing this.
Another way is touch therapy, bodywork. Combining a massage technique with talk therapy, sound healing. Thousands of years old, combining sound with talk therapy where you either interact with an individual or a group in terms of the community afterwards and talk about what came up. We know that touch and sound and hypnosis, vibrations in general when delivered properly– and medications, biochemical, inducers are very effective when used properly at inducing these powerful altered states of consciousness that create windows for self-reflection and growth.
That’s really what we’re talking about when we bridge the gap from where we’ve been to where we’re going.
The way psychedelics affect our physiology and consciousness
Ari: Got it. Okay, you just alluded to my next question in your answer there, but I want to talk about psychedelics and we can be very specific and talk specifically about ketamine or ketamine and MDMA, I’ll let you decide where we go, but on a fundamental level, what are these substances doing to our physiology and to our brain, to our consciousness? There’s two things I want to mention here as a context for this.
One, personal experiences of my own. I’ve had of course, in perfectly legal international scenarios, some amazingly profound life-altering experiences using some of these compounds. I’m coming to it with a reverence for these compounds, given my own personal experiences. On the other end of the spectrum, there’s a segment of people listening to this who might think this is nonsense.
I have, for example, family members who think this is nonsense, “These are just “drugs.” Anybody who does this stuff is just trying to get high and escape reality using these dangerous drugs.” There’s this semantic issue of lumping these compounds, which are much better referred to as plant medicines, most cases, into this semantic category of drugs. Since we all know, of course, drugs are bad, therefore these compounds are bad.
There’s a mental block that a lot of people have to wrapping their heads around what these are and what they do to us and why it’s different from like cocaine or heroin or something like that. Talk to me about just what you perceive is the fundamental thing that these compounds are doing to our bodies, our brains, our consciousness.
Dr. Rabin: Sure. The first thing I’ll say again is that not all drugs are created equal. Almost every single medicine that we use in Western medicine came from a plant or a fungus. It’s not unique, even opium and cocaine, which are used clinically come from plants and aspirin comes from plants. What we think about a particular drug says a lot more about us than the drug.
If people are anti-drug, then you should also think about how your antibiotics and painkillers because ultimately, antibiotics cause a lot of– they help our society quite a bit by treating life-threatening infections but when used improperly, they cause other infections to arise that threaten our survival as a species that are resistant to set antibiotics which has been happening a lot.
We’ve been hearing talk about that a lot and opioids, which come from plants, but are also one of the most commonly prescribed drugs worldwide are probably one of the most dangerous medicines that are prescribed worldwide and they’re legal in every state and in almost every country. If anything, psychedelic medicines are actually safer than a lot of these other medicines that we currently use when used properly.
But again, of course the caveat is when used properly, which to that knowledge has not been readily available to a lot of Western medicine practitioners or to the public for a long time. I think the first place to start once we’ve gotten that under out of the way is, what is psychedelic? What does that word even mean? We spend a lot of time thinking about that word, talking about that word and that word often has this connotation of crazy 70s dance party.
But that name, that word, that just description or connotation, it couldn’t be further from the truth because what psychedelic really means in, I believe Latin is mind-manifesting. Psyche is mind, Delos is manifest. What that really means is to take things out of our psyche, out of our subconscious, the part of our lives that we are typically unaware of, what Freud always called the subconscious and what many of us call the subconscious and to become aware of that space.
When you think about what you’re listening to right now, you’re hearing Ari and I have a conversation about medicines and all these different ways to think about them and you’re probably focused on that right now, just like we’re focused on each other and hearing what each other’s saying and not focused on anything else, but there’s a million, billion other things going on around us at this time.
We have families and friends around us. We have people maybe in our home, we might have bugs squirming around underground. There’s animals walking around. There’s people driving around outside, there’s all this stuff happening around us that is going on that’s not immediately within our realm of awareness. All of that stuff still is happening.
It just falls into a part of our minds called the subconscious because if we were aware of all that stuff all the time, we couldn’t focus on being productive. We couldn’t get anything done in our day-to-day. We would be constantly distracted. However, we can access that material with ancient techniques like mindfulness, meditation, breathwork, yoga and then modern techniques like biofeedback, float tanks, soothing touch is a very old way to access the subconscious, music, sound baths.
All of these things are tools that allow us to effectively blur this boundary a little bit between our subconscious, what’s normally stored beneath our awareness so that we can maintain our survival and our conscious, which is within awareness, everything that’s within our awareness at any given time so that we can dive into our subconscious, dive beneath our awareness for a moment and then pull out things that we want or that we might’ve forgotten that we want to manifest in our day-to-day lives.
For example, one of the most common things that I see in my practice is a young boy experiences trauma, because something bad happens. Think about X bad thing that could happen when they’re a kid and they’re told to just suck it up and not show that they’re sad and that it’s not okay to show that they’re sad.
Ari: Oh, that’s all too familiar for me.
Dr. Rabin: For most of us. Most of us, especially as men growing up in this world have had this experience. What ends up happening is we tell ourselves at that young, vulnerable age to say, “Okay, it’s not okay to the people I respect as my role models to express this part of myself. When I express this part of myself, they tell me it’s wrong so I sequester that part of myself away in my subconscious. And that part of myself is a part of myself that not just feel sadness.”
It’s a part of ourselves that is vulnerable in general. It’s a part of ourselves that express a sensitivity, connection, empathy, all of these things that we’ve been talking about that allow us to connect more deeply with ourselves and with other people. What happens is we start engaging in this pattern of behavior, where we present a version of ourselves to the world that is different than the version of ourselves we actually know ourselves to be, which as Gabor Matteo describes, this is the original source of trauma in our most of our lives.
When we can get to the heart of it using any of the meditation techniques or breathwork natural techniques I already talked about or using things like [unintelligible] or using psychedelics, which biochemically blur that boundary between the subconscious and our conscious or between our beneath awareness information and our within awareness information, then that allows us to go back down within there, find that part of ourselves that we buried away in sequester way and told back then in our child, that it wasn’t okay to be there. Then let that part of ourselves know that it’s safe to come out.
The role of microtraumas in mental health
Ari: If I can rephrase, you’re saying the fundamental trauma and these are like, microtraumas that accumulate over time is when there is a mismatch between what we feel and what the outward world says is okay for us to be or to express, is that accurate to phrase it that way?
Dr. Rabin: It’s by no means the only trauma that we face, but that is a big part of the theme of trauma that we commonly experience and that I commonly see in my clients regularly.
Ari: Got it.
Dr. Rabin: I can say I’ve experienced that myself as you said, you’ve experienced yourself. I think I do not know a single person who has not had an experience like that.
Ari: At least one, if not maybe hundreds or thousands. You’re saying, psychedelics now fit into this by bringing some of those things to the surface, is that a good way of understanding it?
Dr. Rabin: Yes, but I think there’s an important caveat here, which is, that there’s a reason why all of that subconscious material is stored beneath our awareness on a regular basis because our ego, the part of ourselves we do present to the outside world, it’s very concerned with our day-to-day survival, doesn’t have time or resources to pay attention all that stuff under there.
It is only concerned about survival and so all of the stuff that’s not directly related to survival gets shoved beneath awareness. What psychedelic medicines do just like breathwork practice and just like meditation, what psychedelic drugs do is they biochemically shift the filter just like Aldous Huxley talks about, the reducing valve of consciousness. All consciousness is coming in.
We have a filter that keeps only the survival parts of it within our awareness. Everything else is stored beneath. What psychedelic drugs do, what breathwork does, what meditation does, what all these other techniques do is they gently adjust that reducing valve or the filter to allow us to now become aware of what has beneath our awareness typically, so that we can work with that material in a meaningful way. That’s why the intention is so important.
Ari: Say more on that. I was going to ask you a question, but that’s more interesting, rabbit trails go down.
Dr. Rabin: Thinking about what you were talking about, I think you alluded to this earlier, which is that you’ve had extremely powerful experiences in a safe environment with these kinds of medicines. Other people, I don’t know if you notice that, but there are over a million new users of medicines like MDMA and psilocybin in the US every year. Over a million new users every year.
All of these people for the most part are recreational users who don’t know anything about what they’re doing in medicine. When you think about those people, how many of those people– Many of those people have positive experiences. Many of them have negative experiences, but very few of those people cure their PTSD. Very few of those people cure their depression long-term from just a few doses of medicine because they’re using it unintentionally.
They’re using it to party. They’re using it to escape or numb themselves or distract themselves from life or the difficulties of life that we face on a regular basis, which are painful and challenging and can cause suffering but I can tell you one thing, which is that there is no escape. If we attempt to escape and we resist working through some of the challenges that we face or the challenges that we face on a regular basis and we use the medicine to escape rather than to engage with what’s challenging us, then we will increase our suffering dramatically.
Because the suffering comes from resisting the challenge. If we embrace the challenge, then we figure out how to deal with it. We identify what it is, we process it and then we figure out how to tackle it and we overcome it and then we feel stronger afterwards for working our way through and growing as a result.
When I mentioned intention, the intention is, what we’re paying attention to in our lives multiplied by time, that then is amplified by the altered state of consciousness, or what Terrence McKenna called the ecstatic experience, whether that’s access with the assistance of medicine or whether it’s access completely without the assistance of medicine.
Either way you’re accessing a state that is guided by the intention that we bring into the experience, which is effectively, “What do I want to get out of this? Do I want to party for six hours and wake up feeling like I just partied for six hours and stayed up all-night with my friends and had a good time, because I was feeling crappy about what happened at work this week?”
Or, “Do I want to figure out why I’m unhappy with what I’m doing every day at work and how to be more grateful for my time?” It’s the same problem you’re solving. It’s just one of them takes into account the short, mid and long-term goals by focusing our human energy on how to actually get to the root of a problem and solve it.
Whereas the other way, the distraction numbing way or the escape is literally just distracting and numbing us from something that will come right back as soon as the experience is over. Does that makes sense?
What the science tells us on the use of psychedelics
Ari: Yes, that’s a beautiful way of phrasing it. This intention thing is fascinating to me and there almost seems to be some magic to it. You go into one of these kinds of experiences and you set an intention beforehand and it is remarkable how, what happens on the journey depends on that intention. The way you explained it just now is so beautiful but I feel almost still– I almost– and I’m a very science guy like you are, but I still almost feel like there’s some magic at play with that intention aspect of things. Do you agree with me or?
Dr. Rabin: Magic is one word to describe it and unfortunately, it’s one of the only words that we have in English to describe mystical experiences. A lot of other languages actually have many, many more words to describe mystical experiences than English but I feel like magic is okay to use, it does– I feel like, again, there’s a lot of stigma around magic and that if it’s magic, it’s not real, it’s not science, but I think there is a science of magic and there’s a magic of science.
There are things that happen like quantum stuff. Stuff that happens on the quantum level that we cannot see except with very, very delicate machinery that’s very expensive, that for all intents and purposes is magic. Quantum entanglement is like a magical principle that we don’t necessarily understand exactly how it works.
But we understand that if you take two atoms and you fire them at each other at the speed of light and they hit each other and explode in opposite directions, that if you make a change to one electron fly off, it will create a similar change in the other electron flying off another direction. How does that happen? We have no freaking idea, so it does seem like magic.
But I think magic is also another way of saying that it’s okay to know that something exists and that we can tap into it without having a full understanding of it. One of the things that I think psychedelic medicine and my trainings have taught me more than anything is this idea that it’s okay to know without knowing. It’s that we know, but we don’t necessarily know how or why we know.
This is a tribal principle going back to tribal plant medicine practice that believes that all the knowledge of the universe is stored within our DNA or on our DNA. It’s stored within us at any time and that when we don’t have an answer to something, by looking inside ourselves and learning, which is why it’s so important to learn how to trust ourselves, then when we learn how to trust ourselves with practices, like the four pillars of South American medicine, self-gratitude, self-forgiveness self-compassion and self-love.
Then that trust opens up a channel to our intuition, which then allows us to ask ourselves questions that can then be answered by ourselves without necessarily having to look elsewhere. Of course, it’s a good to ask other people, of course, but it’s also good to be able to have that own trust ourselves, to trust our gut feelings, trust what our body tells us.
This whole idea of interoception feeling our body is literally hard-wired from our emotional cortex throughout our entire body. It’s there. The wires are late– if we don’t choose to use it, that’s on us but the wires are late.
Ari: Let me ask you this, just out of curiosity, why is it important to learn to trust ourselves, to open up that more intuitive capacity? What does that grant us in our life? Or what does somebody who doesn’t have that, how do they pay a price for not having it?
Dr. Rabin: I think the simple answer to that is if you don’t trust yourself, you will always have trust issues with others. Always. We often try to play tricks on ourselves to make us think that we can trust others when we don’t trust ourselves but ultimately, what that results in is poor decision-making where we trust people we shouldn’t trust and we don’t trust people we should trust and it creates barriers in relationships of letting people close to us.
Ultimately, these ideas, which are not unique to South American tribal medicine, by the way, they actually– I think what’s so fascinating and if anybody’s interested in this, please read Jeremy Narby’s book, The Cosmic Serpent, which is one of my favorites and it is about a skeptical Western-trained anthropologist who goes back to study South American tribal culture to save the Amazon rainforest.
He gets a whole education that he writes about in this book and what it’s really so important about trust is that if we can build a foundation of trust in ourselves, then we can allow ourselves to access what could be our full potential. Ultimately, our full potential is locked away in us somewhere. The Buddhist believe this, the ancient Yogi Hindus believe this, the Ayurvedic believe this, the South American tribal people that believe this, the African and Australian tribes believe this.
Even dating back to ancient Judeo-Christian religions, they all convey on these ideas of spiritual self. The path to access our true selves or our true potential is stored within us and the South American tribes who believe that trauma is effectively an energetic block. Every time we experienced a trauma that’s unresolved, it basically puts the block in our energy flow. Then our energy has to get around that block or it gets stunted.
What’s really interesting is when you talk to people who have been through those tribal ceremonies or the shamans themselves, and as skeptical as they might’ve been walking in, they feel that the singing of the shaman combined with the medicine in this case, Ayahuasca, in the tribal setting, literally is clearing the blockages of their trauma and helping to alleviate their trauma in certain ways to process it.
Not just to make it disappear, but so that they can work through it and recognize that it’s not their fault, that there’s no reason to feel shame or guilt or resentment or jealousy, it’s just what happened and we did the best we could at the time and that this is an opportunity to rebuild a foundation of trust upon which our full potential becomes a seed that can be nurtured.
The trust in ourselves is effectively having a nutritious nitrogenated soil that we can put our seeds in with confidence when we want to grow vegetables or plants in our garden so that they actually have the best shot at yielding what we want them to yield when they grow.
Ari: Love that analogy, that’s great.
Dr. Rabin: It’s literally no different than that. The belief in our ability to heal is so critical. I think going back to the idea of magic, what’s really magic when you break it down is belief. Belief is magic. If we believe in our ability to heal from something, whatever the intervention is, particularly in mental health, it increases our chances of getting positive results, 30 to 50% of the time– sorry, 30 to 50% more we increase our chances of getting positive results.
That’s called the placebo effect. Similarly, if we believe that an intervention or a treatment or something will not help us, particularly with a mental illness, that it decreases the chances of that treatment or intervention working by 30 to 50% and that’s called the nocebo effect. What could be more magic than that? That is magic.
Ari: Yes, absolutely. Well said. It really is because we still don’t understand that all that well and we see examples of placebo-based healings that are miraculous healings from actual, like full-blown biological medical conditions, not just this more nebulous mind stuff. That we intuitively feel is more susceptible to belief-based influence. The way we’ve discussed this or you’ve discussed this so far is very– what’s, I don’t know the right word, abstract. It’s very conceptual.
What I would like to do is for anybody who’s listening to this who haven’t read anything about psychedelic-assisted psychotherapy. They don’t know anything about it. For those people I would like to ask this, is there any research on psychedelic-assisted psychotherapy? And can you speak a bit about the science on this subject?
Dr. Rabin: Sure. Oh, yes there’s tons. For those who don’t know this work has been ongoing since the 1940s when LSD was first discovered by Albert Hofmann when he was working for Sandoz, I think in Switzerland and this has been going for a long time. We actually discovered as a scientific community, I don’t think we would have discovered many of the antidepressants that we have today without the discovery of LSD first, which is really interesting. Albert Hofmann is credited with quite a bit.
Ari: Because it helped us uncover a lot of the different neurotransmitter systems and receptor systems in the brain?
Dr. Rabin: Yes, particularly the serotonin receptor system. The discovery of LSD, which binds directly to the 5-HT2A serotonin receptor, which is one of the most important ones for our understanding of meaning and interpretation meaning from our environment is likely also one of the most important receptors in the psychedelic pathway in our brain is also important for the way the SSRIs like Paxil and Zoloft work.
And also tricyclic antidepressants, MAOI inhibitors where the old antidepressants, all of those were developed based on the learnings from the effects of LSD on the serotonin system which is really interesting. Anyways, with respect to the research, there’s no shortage of research out there that unequivocally states that these medicines, when used properly induce radically transformative healing experiences for people with just a few doses when combined with psychotherapy.
There’s a lot to talk about with respect to the research. I think one of the studies that I think is most fascinating that really helped me understand what was going on in the field with these medicines. I’ll talk about this one is the MAPS FDA trial with MDMA. For those who don’t know MDMA, which is an extract actually comes from sassafras originally. If anyone’s heard of Sarsaparilla which is one of my favorite root beverages and this MDMA comes from that plant as a concentrated extract that is manipulated slightly in the lab.
It is very powerful. It’s from the amphetamine family-like Adderall, but it directly stimulates the emotional cortex of our brains, these part of our brains that interpret and perceive safety. When this medicine and psilocybin from mushrooms, which probably is the oldest psychedelic known to humanity, which has probably been around for tens of thousands, if not years, if not more, these two medicines are currently in breakthrough status with the FDA, which means that they are on a fast track to commercialization for medical use.
Psilocybin is in phase two FDA trials, MBDA is in phase three FDA trials, and the results have been outstanding so far. I think what’s really interesting and what is really highlighted by the MDMA studies, which is similar for psilocybin and ketamine and other psychedelic medicines that have been studied is this idea that you can administer in the case of MDMA three doses of medicine with 12 weeks of psychotherapy and then no more therapy and no more medicine and people continue to get better consistently over time.
This is paradigm-shifting for psychiatry. Typically, we prescribe one or multiple medicines, one or multiple times a day to be taken on a continuous basis, indefinitely to hold symptoms off. With MDMA and psilocybin, particularly with MDMA, we see that three doses of medicine, just three doses spaced out two to four weeks apart with 12 weeks of psychotherapy can result with people who have had PTSD, post-traumatic stress disorder for an average of 17.6 years, that after the treatment is over, after that 12-week treatment session is over with three doses of medicine, something like 54% of people are no longer meeting diagnostic criteria for PTSD.
Compared to the placebo group, which is something like 27% or something, or no longer meeting diagnostic criteria for PTSD. The therapy is doing something alone, but the therapy plus drug is getting nearly double the response rate. However, that’s just 12 weeks. Let’s look at five years out.
That’s the really interesting data. Following these people from the phase two MDMA trial, five years out with no additional intervention, no additional medicine, no additional therapy.
What we see is that five years out, the people who actually got real MDMA in psychotherapy, 67% are now no longer meeting diagnostic criteria for PTSD whereas many of the folks who received placebo relapsed and still meet diagnostic criteria for PTSD.
Ari: My understanding is this is pretty much the most effective treatment for PTSD that has ever been discovered. Is that accurate to say?
Dr. Rabin: It’s by far the most effective treatment for PTSD that’s ever been discovered or for any mental illness for that matter and it’s the closest thing to a cure for a mental illness we’ve ever had. I say cure carefully because as a psychiatrist, we’ve never been able to use that word with our clients until recently. What we’re seeing is that and why we think we can start to use this word is because we’re teaching people how to heal themselves.
If more people are better five years out after the intervention is over, then there were right after the interventions over. The only explanation for that is that during the intervention time, that 12 weeks in those medicine dosing experiences that were– and this is the protocol of the MAPS therapy, by the way, which is also the protocol for Ketamine Assisted Psychotherapy is that we’re helping the client or the patient recognize that they have the ability to heal themselves.
Once they’ve realized they have the ability to heal themselves, they can believe and know that they have the ability to heal themselves and then start to tap into this in every waking moment of their lives and then that cumulatively compounds over time to the point where they don’t need us anymore. [crosstalk] on their own.
Ari: This is one of the key questions I had for you is, there are these results, like the ones you just described with MDMA and PTSD, I’ve seen at least one study on psilocybin and depression having remarkable results, I think with just one dose.
Dr. Rabin: Yes, very similar results with one dose.
Ari: Then obviously, ketamine, which is now your specialty and you haven’t mentioned that, but there’s the– I’m sure we can talk about the research on that and treatment-resistant depression and amazing effects of ketamine but you see these kinds of results from one session, three sessions, something like that, that are
persistent for very long periods of time. I also know from my own personal experiences and studying this topic that these are, and this isn’t the understatement of the century, but these are massive regulatory experiences where you have profound new insights into yourself, into your path in the world, and so on. Actually, just as a personal aside, I was actually in a PhD program in clinical psychology.
I went through all three years of coursework but, at the end of it, decided that I didn’t want to become a psychotherapist. I probably would be different now if the psychedelic aspect of things was possible back then but part of the reason why is because while I was in that three-year program, I had several experiences with psychedelics and I was also doing psychotherapy as part of the program.
I was having to do my own personal psychotherapy sessions and what immediately became apparent to me was that, and this is how it felt subjectively to me is, I could accomplish more in one night of a psychotherapy session than 10,000 hours of typical psychotherapy. That was actually, ironically, it was part of the reason I decided not to become a conventional psychotherapist is because I felt that this stuff was just orders of magnitude more powerful and-
Dr. Rabin: A very common report, actually.
Ari: My question is, the way we think about conventional psychiatric drugs is like you take antidepressants and they alter the serotonin levels in your brain and the degree of re-uptake and so on. They’re creating this biochemical new you that is different and, therefore, that is altering your symptoms. This is something that seem– Let me phrase it this way, is the effects, these amazing persistent benefits, are they the result of that one experience rewiring the biochemistry of your brain in some profound way or are they the result of the revelations that one gets in the experience?
Dr. Rabin: It’s a little bit of both. I should say it’s both of those for sure plus what you do after the experience and how prepared you are going into the experience. Mostly what you do after. I think the main place to start is the way we go into these experiences with the plan to engage with ourselves is really important and the plan to have an intention that we spend time thinking about, which is basically the goal of what we want to get out of that experience.
It doesn’t have to be specific and it doesn’t have to be intense, but it does need to be something that is related to an intentional, meaning we’ve spent time thinking about it. With the understanding that the medicine is a teacher, just like depression as a teacher, but in this case, the medicine is a teacher that helps us overcome something that we’re challenged with or help us see things in a new way that we can then with practice, after the session, get insight to change the way that we act or think or do things in whatever way we do them to be more consistent with our goals and our intention because oftentimes, we end up doing a lot of stuff in our day-to-day lives that isn’t actually aligned with our goals because we’re not conscious of it.
Again, it’s beneath our awareness because they’ve been taught to us. These behaviors have been taught to us for so long, first, by so many other people who did them before us. It gives us perspective during the experience and then that perspective gets concreted afterwards. One of the best analogies that I think of how this works is actually provided by Tim Ferris when we interviewed him on The Psychedelic NewsHour on Clubhouse, which was this idea of our minds or our sense of self-being like clay.
We’re like a clay pot and that clay pot is used to pour water, in the same way, every single day for years and years and years. Then all of a sudden, we start to realize that, hey, maybe I want to interact with water in a different way. Maybe this old way of pouring water just isn’t doing it for me and so you take the clay pot and you put in heat and then you soften the clay.
Now, in the psychedelic medicine or the meditation experience or the breathwork or whatever the intervention is, the Apollo that helps to soften the clay so that we’re able to understand that it can be reshaped and then once we understand that it can be reshaped and that it can look different, then how it looks is guided by our intention. Then whether it– How well it stays in that new shape that is more consistent with the way we want to be shaped and want to be in the way that we see the world has to do with how well we help it keep its shape afterwards by practicing what we’ve learned.
Then we practice what we’ve learned, we’ve integrated what we’ve learned from the medicine, then, that allows the clay to now harden into the new shape that is more consistent with the way we actually see ourselves to be and that is a dynamic process. It can change. We can have many experiences like that, where we heat and reshape and heat and reshape and heat and reshape. It’s not set in stone. It’s a dynamic modifiable experience that can be shifted over time and guided by the preparation and the intention and then guided even more so by the integration thereafter. Does that answer your question?
Ari: Yes, it does. You actually just made me think of the visual of in Japan when they make swords like Samurai swords. They stick it in the fire, they take it out, they hit it with a hammer, flatten it, and they fold over one of the pieces of metal on the other. They hammer it down, they stick it back in the fire, hammer it more and then fold it again and they fold it. They keep doing that back in the fire, fold it again. By doing that, you actually end up with metal that is way, way harder and more resilient, way stronger than it was just as the raw metal piece.
Dr. Rabin: Right. That’s a great analogy as well. I like that. My point is, and to finish that up is, that it’s not the medicine. It’s not just the medicine. The medicine is great. The way we access these altered states of consciousness is great. It’s really important. It’s like another, whether it’s Apollo or breathwork or psychedelics or whatever, soothing touch music. Those are tools in our toolbox to alter our state of consciousness, to blur that boundary so that we can reach down into our subconscious or beneath our awareness and pull out stuff that’s meaningful and helpful to us when we need it.
However, the actual change that’s meaningful, that lasts for a long time, that actually concretes and rewires our neural networks in our brains and our thought patterns is from the integration thereafter. It’s the integration and the change in behavior, which is why the connection to psychotherapy is so important because we really guide the integration process and help people understand how to do that. That is where the real magic happens. That’s where we manifest the desired outcomes to achieve our goals.
How psychedelics can alter your state of consciousness and how it relates to psychotherapy
Ari: Beautiful. My next question is a bit out there, but I want to ask it given that you have a lot of expertise and you’ve facilitated a lot of these kinds of experiences for people. The way we’re talking about things now is very scientific, and yet, the actual subjective experience that a person may have in one of these states is often if they try to communicate it to the average person who has no experience with these kinds of things, it sounds crazy and yet we know simultaneously, as you’ve said, that these kinds of experiences, as crazy as they may sound to the outside observer with no experience, are profoundly healing and have amazing, massive effects in terms of healing, things like PTSD and depression and so on.
I am curious. I’ve had experiences that feel to me as having conversations with God, like some kind of intelligence that seems far beyond my own, that is communicating certain things to me. If it unquestionably feels 100% real in that moment, there is not any shred, even a 1% of doubt as to what is happening and the wisdom of what is being communicated in that moment, and then after, as a very evidence-based guy, I then reflect on those experiences in a certain way where I look at them in a very agnostic way.
I don’t create a lot of supernatural belief systems around them. I say, well, “Yes, they were profound experiences. Yes, I do treasure the wisdom that I’ve gleaned from those experiences” and I’ve listened to it also I’ve actually changed my life course based on some of those experiences. Yet, there’s also a piece of me that’s like, “Well, I don’t really know what that was. I don’t know if that is just some weird state of altered brain activity or if it really is some kind of supernatural phenomenon.”
Obviously, you’re a science guy, you have to talk about the research, but I’m curious just on a personal level. What is your personal perception of the sort of magicalness or supernaturalness of these experiences or do you think that they can be reduced down to just, oh, this is just altered activity in certain parts of the brain and they’re just our human brains producing these experiences?
Dr. Rabin: Asking all the tough questions today, aren’t we?
Well, I think– Altered States of consciousness are certainly not just chemical alterations in our brains. There is something else going on that involves a connection to material that is typically stored in that subconscious space in our minds that’s beneath awareness. The best way to think about it is in dreams because in dreams we have these experiences often. People have lots of times where they’ve had dreams interacting with real people, people they don’t know or they can’t recognize, people that they would consider to be Jesus, God, figures, prophets, things like that.
They’re all perceiving these experiences in similar ways when they have them. Then the question is, how do you integrate that experience into your version of society that we’re in right now when you come back to your normal survival ego mode, conscious regular mind state? What neuroscience refers to as our default mode. When we get back to default mode, how do we put all this together?
Again, I think this is why evolutionarily, there is such a strong emphasis on that filter, barrier between our ego, within our consciousness, within our awareness, and what’s beneath because all of that stuff, all of that content, all the things that you talked about accessing, these experiences are extremely personal. They’re extremely personal. Your experience may have similarities to other people, but it is super personal to you and it’s not going to be replicated exactly by anyone else and the nature of what comes to you during those experiences is very much personal to you.
It’s very hard for me to tell you without knowing the specific details of how to help interpret the experience, what does all of it mean and how does it fit into our regular society? The easiest way to think about it is that there is a whole lot more out in the universe that we don’t know than what we know. For us to say that I know what is, whether it’s talking about myself, I know what I’m capable of, I know what this world is capable of, I know what humanity’s capable of, to say that we know things like that is fundamentally lying to ourselves.
Unfortunately, when we say, I know what I’m capable of, we’re fundamentally putting ourselves into a box that creates boundaries for our own potential to grow, because we’re already telling ourselves we know what our potential is. If we say that about the world and we say, “Okay, I know what the potential of the world is. I know there’s no, God. I know there is a God.” What about it being okay to say, I don’t know? Which is a big part of these altered state experiences, is that the Yogis and the ancient Buddhist have talked about quite a bit, is going into these states with the acceptance that not knowing is knowing and that not knowing is okay. It’s not only okay. It’s like our baseline state is not knowing.
What we do know is great, fantastic, wonderful. That’s a prediction based on our past, but what we don’t know is most everything else. I think when we try too hard to analyze our experiences that are very personal and oftentimes very difficult to put into words because they come to us as feelings and then try to put those into words in the context of what we are told we’re supposed to know about ourselves and about the world, it creates a hell of a lot of confusion about what it is we’re actually experiencing.
What I would say we’re experiencing is when we have these peak states is we’re experiencing a connection to the source energy of where all of this consciousness thing comes from in the first place. It’s a connection to the energetic source of where all of the universe and human life comes from through accessing it in whatever way we know how. Whether it’s chemical, whether it’s vibrational, whether it’s through chanting, singing, breathwork, meditation, yoga, whatever, the point is, we access that, that source of the universal consciousness.
Whether you believe that to be God, or whether you believe that to just be energy, or whether you believe that to be part of our soul, you would still be right, no matter what picture you try to fit that into. I think the hardest part for us as humans is to take a step back and say what we were talking about earlier, which is that it’s okay to not be able to fit this experience into a box. That’s often when we ultimately get the most out of it.
I know that was a roundabout way of answering your question, but it’s a really hard question to answer because these experiences are truly so personal to us. The universal source consciousness, whatever it is, that’s created the universe and the earth and all of us has a way of coming to us in the way that it feels we need it most.
How ketamine can be used in psychotherapy
Ari: Beautifully said. I want to be respectful of your time, Dave. I know there is– We haven’t touched on– Here’s my wish. If you had unlimited time, I would just say the two things I feel like we need to touch on are just ketamine briefly and what that sort of experience is like and what it’s good for. Then I know you wanted to touch on safety.
Dr. Rabin: Sure. We can talk about ketamine very briefly. Ketamine, even though it’s the only– It’s the only legal psychedelic medicine, which is the most important thing to know about it. It was discovered in the 1950s, I believe, as an anesthetic. It was used in anesthetic and as a pain-relieving agent for a long time, it’s very well studied. It’s used in children, it’s used in pregnant women for surgery and it’s very safe and very gentle for the most part medicine that has the side effect of being of inducing a very potent, spiritually powerful altered state of consciousness that oftentimes can be associated with what we call ego death or the temporary dissolution of that part of our survival ego-self.
That is always talking in the back of our minds, telling us that we need to be afraid of something around us, that part of us, or that we need to preserve our self-identity or something like that. That part of us gets dissolved temporarily. Which happens with a lot of the other psychedelic medicines as well that we’ve been talking about, but it helps us to then blur that boundary between our subconscious and our conscious by dissolving the ego to go down into that subconscious space and do work with some of that stuff that we’ve been not necessarily paying attention to for a while.
It’s very similar to all the other medicines in that way. The main positive things about it are number one, it’s very short-acting. It only lasts 45 minutes to an hour and a half. Number two, totally legal in every state of the US, and also legal in almost every country, which means as a psychiatrist, I can deliver this medicine to people from the pharmacy to their homes directly.
The main reason I practiced ketamine-assisted psychotherapy is because it’s the only legal psychedelic therapy that I’m allowed to practice by my medical board. It’s FDA approved for depression. It’s very, very powerful for depression and PTSD and for breaking or interrupting negative thought loops in our minds. That’s the gist of it. It is practiced all over the country, but most of the people who practice ketamine work don’t practice it with psychotherapy associated. They do IV injections or intramuscular injections.
However, I would say to date, most of the evidence about best results that people get from the practice comes with psychotherapy along with the administration of the medicine, not just the medicine alone, as we mentioned earlier.
Ari: Is that during the session itself?
Dr. Rabin: No, that’s a caveat also. Thank you for bringing that up. Ketamine sessions are so short and so out of body, basically, that people can’t really talk much. Sometimes they do, but most of the time, most people don’t talk much during the experience. You lie there without interacting for a while. Sometimes you’ll talk a little bit, but not much. Most of the therapy with ketamine happens before and after.
Ari: Interesting. There’s some research on this in the context of depression, right?
Dr. Rabin: There’s a ton in the context of depression. That’s what it’s FDA approved for. There is also a ton in the context of PTSD and there’s more coming out in other areas of mental health, but we frequently use it for PTSD, substance use. We call it off-label use, but we use it for PTSD and some anxiety disorders, mostly PTSD, depression, substance use disorders, and some other things like chronic pain disorders, but mostly the former of what I mentioned.
Are psychedelics safe?
Ari: Got you. The last thing that I know you made a note of that you wanted to make sure we touch on is just the safety aspect of this. You did this in passing earlier differentiating between use in a recreational context. Somebody just partying or trying to escape the unpleasant aspects of their lives versus using it in an intentional way, in a psychotherapeutic way.
Dr. Rabin: Safety is the single most important thing to focus on and understand when coming into these experiences. It is the number one. We talk about set and setting, curating our mindset to be ready and have thought about and prepared an intention for the experience and then there’s also our physical setting, which all need to be focused around safety. If we feel unsafe in these experiences, then we will not be prepared for what’s coming up from our subconscious and we will be more likely to judge it than to accept it and work with it. There’s no room for judgment in the psychedelic experiences because we’re free and open in those experiences.
Judgment can be very detrimental and can set people on what others have described as bad trips are really hours of unpleasantness. These are manageable, it’s just not desirable, and they’re certainly not very fun if you wind up in one of those situations unintentionally. One of my favorite anecdotes that I’ve heard many times is from people who have gone through the clinical trials with psilocybin and MDMA and people who have also used psilocybin and MDMA recreationally.
What I’ll tell you is that these people who have used the medicine both recreationally and clinically as patients, many of them firmly believe that after the in-person clinical session with one or two therapists with the clinical grade medicine, that they believe that it’s a different drug because the effect is so radically different for them. Based on the safety of the set and setting that’s been curated for them, that they believe that they have been administered a different drug and lied to. Seriously, this is a very common thought, which is incredible. That you could take the same drug in two separate settings and have such a radically different experience.
It’s all based on safety of the set and setting. There are certain tools that we can use now that are available to enhance safety. Soothing touch or vibration and music are critical, particularly in the ketamine experience in or in psilocybin and MDMA experiences. Music, soothing touch that we apply to ourselves or that we have a loved one apply to us that we trust is an automatic, almost instant safety stimulus to our bodies that almost instantly brings us back into our bodies, back into the moment and does something very important, which is, restore a sense of agency and control to us at any time we feel stressed out or overwhelmed or uncomfortable.
Apollo was a tool we created to facilitate that as well because lots of people use psychedelics recreationally that don’t know what they’re doing. This is common. Over a million people in the US alone are doing this every year who are new users. These people aren’t necessarily going to go and do all the research in advance. Can’t blame them. Not everybody takes this that seriously or knows they even should.
Using the tools that we have available, the soothing music, soothing touch, and vibration, with technologies like Apollo, people can basically set up their set and setting to make their psychedelic experiences more safe. That could not be more important right now when these medicines are starting to be decriminalized and legal in all these different places where the education isn’t quite there yet as to how to use them safely. We now need to make sure that we educate people on the tools and how to use them safely.
Apollo was one of those tools. There are lots of other tools out there but most of the best tools stem from the tribal origins of using soothing loving touch and soothing music to help ground us and bring us back into our core central sense of self, where we have agency and control over the situation and where we know we can control our breath and be present in the moment.
Ari: Beautiful. Dave, thank you so much for spending all this time with me. This has been brilliant stuff. Fascinating stuff. I feel like I just want to wrap up with just a few words to communicate fundamentally who this is beneficial for and what kinds of changes can happen. In my personal observation, I’ve experienced my own personal transformations from this. I’ve seen other people have absolutely life transformative experiences and even health transformative experiences.
Then if you just consider some of the research that we’ve talked about here, if somebody has been struggling with depression for a long time or PTSD, to have something that can reverse that or “cure” it can absolutely completely transform a person’s life from being miserable to having a good life. I think it’s hard to understate the potential benefits from this. Can you just briefly describe your perception of who this is for and what someone might experience as far as the kinds of benefits that you’ve seen?
Dr. Rabin: Sure. I will first say that I don’t believe that psychedelic medicines, in the way of what we’re talking about here, the molecules like MDMA, psilocybin, LSD, and ayahuasca, I don’t believe that these are for everyone. Everyone’s different and everyone will resonate with different interventions to achieve what we call the psychedelic state. If we think about the psychedelic state, the state of mind-manifesting.
Whether you get there with medicine or you get there with breathwork, I think that state of mind is critical for all of us to learn how to access and we should be teaching it to kids when they’re very young, because when you teach the kids when they’re young, then it’s very easy for them to learn and to access it with breathwork alone, which is the most powerful and easy way to access altered states of consciousness and the most powerful way to access our own internal ability to heal ourselves.
I think what these states are for, are for helping us recognize how good we can feel when we have dealt with and processed all of the trauma in our lives. When we’ve figured out where our trauma is coming from, why it’s there, that it’s not our fault, we did the best we could, and that we are now here, it’s time to figure out what we’ve learned from it so we can move on and make the best lives we can for ourselves and our friends and family and our communities. That’s what this is about.
It’s not about shaming or guilting ourselves in the past, it’s not about embarrassment, it’s not about remorse and it’s certainly not about regret or resentment. These experiences are about self-gratitude, self-forgiveness, self-compassion, and self-love, which all also happen to be the four pillars of tribal medicine. South American medicine formed the foundation of trust in ourselves.
The psychedelic state and this is talked about, again, by MAPS and by the Multidisciplinary Association of Psychedelic Studies that funds most of this research in the US and around the globe, then also by the ketamine psychotherapy folks and by the psilocybin folks, is this idea that the medicine is a catalyst. Whether MDMA, psilocybin, et cetera, it’s a catalyst that chemically–
Like a chemical catalyst speeds up a chemical reaction, this is a chemical catalyst that biochemically binds to our serotonin receptors in our brains, particularly this 5-HT2A receptor that’s known to be associated with meaning, and then allows us an opportunity that’s a time-limited opportunity to have a new look at our lives, a new look at how we got to this point, and then take a fresh approach to how we’ve got here, what we’ve been doing to get here, what we’re still doing, even though we’ve already gotten here, and how we want to then get where we’re going.
It allows us to basically take a bird’s eye view out of our lives to really step outside of ourselves and look back across our lives from a different perspective and see, what have I been doing? Is it working for me? Is it working to get to accomplish my goals? What are my goals? If this isn’t working, what can I do better? Right. That’s all it is and so by whether we access it with medicine that really can rapidly speed up the process or where they access it the traditional ways of breathwork, meditation, chanting, music, touch, and these things, or whether we use technology like Apollo and float tanks and biofeedback and all those other stuff, they all take us to the same place and that place is a place where we feel safe enough to allow our inner healer to really turn on and take its course.
This is a part of ourselves that we’re born with. It’s built into all of us. The sooner that we can nurture that– Allow that seed of healing in ourselves to nurture, then the sooner it can grow into a full plant that can heal ourselves on a continuous basis without constantly having to remind ourselves to do the right thing all the time. That’s really how the that’s really how I think everybody can tap into this. It doesn’t require a drug, which is really important.
Ari: Beautifully said. Dave, this has been phenomenal. Really, really loved it. You’re brilliant. I want to just say, first of all, thank you, but also mentioned that you facilitate ketamine-assisted psychotherapy. Where can people contact you if they’re interested in working with you in that capacity? I assume it’s only in the US or is it only in certain states?
Dr. Rabin: Right now, it’s in certain States. I believe we work– Let me think. We have a team of people and we work in California, New York, Connecticut, and Pennsylvania, although we are expanding. If you would like to learn about or get connected to ketamine-assisted psychotherapy providers, and you don’t find one of our states, you’re in a state that we can’t provide ketamine, I’m happy to try to refer you to someone. If you want to learn about my clinical practice and the team I work with and get in touch, please go to drdave.io and you can email us at email@example.com.
Our team will be happy to work with you if you live in our state, if not, I’m happy to work with you to find someone near you. We do traditional mental health practice too for adults. Whatever you’re looking for, feel free to check out drdave.io and reach out to us and we’re happy to help.
Ari: Beautiful. Thank you so much, my friend. This was one of my favorite conversations. Really, really enjoyed it.
Dr. Rabin: Likewise, thank you so much for having me. It was a pleasure.
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The role of microtraumas in mental health (34:32)
What the science tells us on the use of psychedelics (40:10)
How psychedelics can alter your state of consciousness and how it relates to psychotherapy (1:05:05)
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