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How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence

2021; Lippincott Williams & Wilkins; Volume: 132; Issue: 3 Linguagem: Inglês

10.1213/ane.0000000000005349

1526-7598

Peter G. Brindley,

Psychedelics and Drug Studies

It is tough to write about psychedelics without a few gratuitous puns. Regardless, Michael Pollan’s “How to Change Your Mind” is definitely “mind expanding” and deserves my “highest” recommendation. Published in 2019, this book comprehensively and presciently covers a topic of increasing interest: whether psychedelic agents can revolutionize mental health. Pollan is not a Medical Doctor but is a celebrated New York Times bestselling author, journalist, and professor at the University of California Berkeley. He was also named one of the world’s top 100 most influential people by Time Magazine. I have enjoyed each of his engaging popular science books, including a subsequent audiobook about caffeine. But this book is my favorite: Its 480 pages took me on a very pleasant “trip.” Pollan interests center on the sociocultural aspects of food, plants, and fungi. As such, this book is a logical progression. He focuses on lysergic acid diethylamide (LSD), psilocybin/psilocin (magic mushrooms), and dimethyltryptamine (ayahuasca, 5-MeO-DMT, “the toad”). In the first 3 chapters, he covers natural history, pharmacologic discovery, commercial and synthesis, and legal status and cultural understanding. He adds color via myriad characters, including Swiss chemist Albert Hoffman, the “Johnny Appleseed of LSD” Al Hubbard, and Timothy Leary: the love-him-or-loath-him psychologist-turned guru. Pollan covers research ranging from remote 1950s Saskatchewan to modern day Johns Hopkins and Imperial College. Pollan offers convincing arguments as to how psychedelics have influenced spirituality, environmentalism, counterculture, and even Silicon Valley. In chapter 4, Pollan gets personal. Under supervision, he ingests LSD, psilocybin, and DMT. This is candid, insightful, and even emotional. It is also without the new age prose that might turn off readers of this journal. In chapter 5, he pivots back to neuroscience. He covers serotonin pharmacology, plus the neuroanatomy and neuropsychology of consciousness, attention, synesthesia, and memory. He also summarizes the Default Mode Network, and its role in daydreaming and mind-wandering. I enjoyed every amuse bouche, but, the main course, for clinicians at least, is chapter 6. This chapter covers psychedelic-assisted therapy for dying, addicted, and depressed patients. The proposed psychological mechanisms are plausible and include feeling less separated from nature and therefore less scared to rejoin it; better able to restore connections that addiction has severed and stepping outside of your dysfunctional story or tyrannical ego. Pollan argues that supervised use of these “ego-lytic” drugs can offer a control-alt-delete, or reboot: especially if conventional therapies have failed, and especially because a psychedelic experience can help long after the drug has gone. Psychedelics may reconnect us with a sense of awe, empathy, connectivity, childlike openness and equanimity, and in a way that traditional approaches do not. Careful use of psychedelics may make us better able to give and receive love, better able to accept that there is more than our selfish self, and better able to overcome existential crises. I have not taken psychedelics, but I fully relate to all these challenges. I believe just reading this book nudged me toward where I want to be. For that, I am uncharacteristically grateful. A book review usually includes criticisms. In the early days, at least, psychedelic research suffered from excessive exuberance and insufficient engagement with the scientific method. To Pollan’s credit, he does not proselytize, even if he is a convert. He calls out crackpots even while embracing mysticism. The problem is that, through no fault of his, psychedelic studies cannot be adequately blinded, and their effect (both good and bad) is greatly influenced by set, setting, and expectation. To paraphrase Pollan, we are left struggling to explain transcendence because we don’t have enough crayons to paint that rainbow. In the meantime, we may need to get more comfortable talking about “active-placebo” and accept that there are worthwhile lessons beyond the “arrogance of science.” Traditionalists may be twitchy by the extent to which Pollan has embraced psychedelics, and the prospect of white-coated shamans: but not me; not after reading this book. After all, if Pollan is right, psychedelics are no more harmful, and no less successful than our current armamentarium of pills and talk therapy. Moreover, why not leverage set and setting in our clinics. Obviously, we need to be cautious, but job one is to help patients, rather than to be certain about mechanism. Given the enormous burden of mental health, it’s a propitious time to explore new ideas, albeit prudently and gradually. If psychedelics really can change the mind for the better, then it is likely time that doctors opened ours. Thank you, Mr Pollan for opening mine.