Michael Pollan
Penguin Press
New York
2018
452 pages
According to the Art:
Michael Pollan, a journalist who is known for his work on food, takes on mind-altering drugs, or more specifically, psychedelics. From his research, interviews, and personal experiences, Pollan is enthusiastic about the potential benefits psychedelics offer individuals who are healthy or sick, and societies that are stable or fractious. But, how is this to be done?
Synopsis:
Michael Pollan, a journalist who is known for his work on food, takes on mind-altering drugs, or more specifically, psychedelics. According to Pollan, “after several decades of suppression and neglect, psychedelics are having a renaissance.” (p. 3) His aim is to tell “the story of this renaissance.” (p. 4)
Pollan pegs the beginning of the renaissance to three events in 2006. The first was the symposium surrounding the one–hundredth birthday celebration of Albert Hoffman, who is credited with discovering LSD (he was in attendance and lived for another two years). The symposium put a spotlight on a few studies of psychedelics that inspired other researchers and practitioners to enter or stay in the field. The second event was a U.S. Supreme Court decision permitting importation of a banned psychedelic substance for religious purposes, which effectively reanimated federal government recognition of psychedelic drugs. The third event was the publication of a well-received study showing the psychological effects of certain psychedelic drugs, and in so doing, conferred some credibility and encouragement for further study (and use). Psychedelics were beginning to inch their way from counterculture to mainstream culture.
Before Pollan picks up on what happens after the eventful year of 2006, he goes back to the early 1950s when psychedelics first attracted attention as treatment for “addiction, depression, obsessive-compulsive disorder, schizophrenia, autism, and end-of-life anxiety.” (p. 141) He quotes researcher Stephen Ross, who asserts that during this time, “there had been forty thousand research participants and more than a thousand clinical papers!…Some of the best minds in psychiatry had seriously studied these compounds in therapeutic models, with government funding.” (pp. 142-143) The trajectory towards therapeutic uses would come to an end in the 1960s when “a moral panic about LSD engulfed America, and virtually all psychedelic research and therapy were either halted or driven underground.” (p. 185) Pollan identifies several contributing factors to the precipitous reversal in the status of psychedelics. Among them were their associations with Timothy Leary (“Turn on, tune in, drop out”) and with counterculture movements that were seen as threats to mainstream society in general. The era ends in 1970 when psychedelics were made illegal in the U.S., after which they were largely forgotten. They began to reappear in the 1990s, which rekindled an interest in them that would reach an inflection point in 2006.
Bridging the mid-twentieth-century history Pollan provides with the era commencing in 2006 he describes in detail later, is a chapter reporting on his own experiences with psychedelics. Pollan arranged three separate “trips” with three individual psychedelics: psilocybin, LSD, and the little-known 5-MeO-DMT, or “The Toad.” He carefully chose a tour guide for each one. Pollan experienced what he interpreted as a dissolution of his ego, which made more room for his consciousness: “I was present to reality but as something other than my self.” (p. 264) He also reported spiritual and mystical experiences, which surprised him because he is not religious in much of any way, and he found others who had similar experiences.
Even the most secular among them come away from their journeys convinced there exists something that transcends a material understanding of reality: some sort of a ‘Beyond.’
p. 85
The term “spiritual” for Pollan became “a good name for some of the powerful mental phenomena that arise when the voice of the ego is muted or silenced.” (p. 288)
In another chapter bridging the past and the present, Pollan covers the neuroscience of psychedelics and the current understanding of how the brain works. The chapter will appeal mostly to neuroscientists, pharmacologists, and clinicians. It’s not required to appreciate what the book offers on the whole.
Pollan devotes a chapter to ongoing investigations into clinical uses for psychedelics in near death, addiction, and depression. These investigations had moved into mainstream biomedical research institutions. Results were encouraging enough to generate additional studies, expand treatment programs, and motivate the U.S. Food and Drug Administration (FDA) to push researchers for more information on depression in particular. Pollan also reports that “dozens of medical schools have asked to participate in future trials, and funders have stepped forward to underwrite those trials.” (p. 350)
In the final chapter, Pollan recognizes that despite the momentum behind mainstream biomedicine interest in psychedelics, established clinical and regulatory frameworks pose daunting challenges for broad-based adoption anytime soon. That aside, Pollan argues for the use of psychedelics in situations that are not limited to health problems per se, but also for “the betterment of well people,” which was also an interest of early researchers. To Pollan, the betterment comes from the effect of psychedelics to expand consciousness.
Most of the time, it is normal waking consciousness that best serves the interests of survival—and is not adaptive. But there are moments in the life of an individual or a community when the imaginative novelties proposed by altered states of consciousness introduce exactly the sort of variation that can send a life, or a culture, down a new path.
p. 407
His conclusion is that without the assistance of psychedelics, the vastness of the mind and the mysteries of the world can never be known. Psychedelics for everyone!
Analysis:
From his research, interviews, and personal experiences, Pollan is enthusiastic about the potential benefits psychedelics offer individuals who are healthy or sick, and societies that are stable or fractious. But, how is this to be done? As he says,
This is a very different kind of therapy than we are accustomed to in the West, because it is neither purely chemical nor purely psychodynamic—neither mindless nor brainless. Whether Western medicine is ready to accommodate such a radically novel—and ancient—model for mental transformation is an open question.
pp. 367-368
Pollan is getting at structures, laws, practices, traditions, and dogmas of contemporary Western health care systems that could impede mainstream adoption of psychedelics. He is right. Even therapeutic breakthroughs can have difficulty breaking through some or all of these barriers.
Administering psychedelics requires different arrangements than what is available through conventional health care. As leaders in the field told Pollan, the use of psychedelics is closer to a form of “applied mysticism” or a “shamanic concept” than to typical medical treatment protocols. Where they are administered, how they are administered, and who administers them are important determinants of effective experiences.
Under that paradigm, the shaman/therapist carefully orchestrates ‘extrapharmacological variables’ such as set and setting in order to put the ‘hyper-suggestible properties’ of these medicines to best use. This is precisely where psychedelic therapy seems to be operating: on the frontier between spirituality and science that is as provocative as it is uncomfortable. (p. 334)
p. 334
This means treatment facilities will have to accommodate set and setting for administration of psychedelics, which are in many ways antithetical to conventional structures, and their provider base will need experts in psychedelic administration. Both of these adaptations could face staunch resistance.
Researchers and practitioners in the field are aware of this challenge. Pollan reports on George Goldsmith’s response to it. Goldsmith, an entrepreneur and health care industry consultant, created a company called Compass Pathways to develop “a network of psychedelic treatment centers, facilities in attractive natural settings where patients will go for their guided sessions…for a range of mental illnesses” (p. 402). The company has attracted financial support from venture capitalists and scientific support from prominent leaders in mental health. Field Trip Ventures, a Canadian company, is also setting up clinics for psychedelic treatment and research.*
Current methods of acquiring and administering psychedelics will not conform well to the assessment frameworks regulators use. Is a “good experience” through applied mysticism or through shamanic concepts enough to warrant regulatory approval? These obstacles are made all the more challenging because they are embedded in laws and regulations. Nevertheless, late in 2018, FDA granted Compass “breakthrough” status for psilocybin in treatment–resistant depression even though the drug is still illegal (Schedule I). Breakthrough status means FDA will give psilocybin priority among other drug applications for approval.
Pollan only gestures at payment coverage issues related to these treatments. Once “medicalized,” he expects psychedelics to be “accessible to everyone with health insurance” (p. 402) By “medicalized,” he means to convey that these agents have been adopted at some minimum level of accepted medical practice. Health insurance plans in Western, industrialized nations can require higher standards, and they make their decisions on health outcomes in forms that may not be available for psychedelics. Measuring blood pressures, cholesterol levels, and blood sugar, and linking their importance to health is one thing, but measuring mystical experiences and to what end is quite another.
Then there is the matter of how psychedelics would be produced and distributed. The pharmaceutical industry is an obvious source. Pollan knows that this industry may not be so fast to jump on the psychedelic bandwagon.
Thus far, pharmaceutical companies have shown scant interest in psychedelics. For one thing, this class of drugs offers them little if anything in intellectual property: psilocybin is a product of nature, and the patent on LSD expired decades ago. For another, Big Pharma invests in drugs for chronic conditions, the pills you have to take everyday. Why would it invest in a pill that patients might only need to take once in a lifetime?
p. 400
Whether psychedelics will ever be of interest to Big Pharma is thus an open question. Medical marijuana didn’t attract its attention, and yet ways to produce and distribute it came about. Big Psychedelic could be in the offing.
The pendulum swings. For psychedelics, it has swung from a time when they were promising for a variety of purposes, to a time when they were made illegal, and then back to a time when clinical investigations are funded, regulators are encouraging them, and opinion leaders in psychiatry are interested and supportive. People demanding access to psychedelics launching campaigns as has been seen with medical marijuana, HIV, rare diseases, and various cancers among many others is not hard to imagine. If the pendulum swings far enough, fast enough, and soon enough, Pollan will have more to report on the renaissance of psychedelics.
*The Economist Oct 19, 2019
Also:
A version of this review is posted at the NYU Literature, Arts and Medicine Database
