The Machine Elf will see you now: DMT in clinical Medicine
Hello and welcome to The Trip Report Pro dispatch for Monday, May 11th, 2020.
I hope you had a nice weekend and Happy belated Mother’s Day!
Today we’re looking at DMT related news and the challenge of integrating it (and psychedelics in general) into a clinical setting. It wanders a bit into strong feelings about how I think about traditional knowledge systems and stress physiology.
As always, if you agree, if I am missing something or you think differently I would love to hear from you.
Is Medicine Ready for ‘Entity Encounter Experiences’?
Last week the Johns Hopkins team published Survey of entity encounter experiences occasioned by inhaled N,N-dimethyltryptamine: Phenomenology, interpretation, and enduring effects
“Among the most vivid, intriguing, memorable, and sometimes disconcerting experiences that people report after taking a high dose of inhaled or intravenous DMT are those of encountering seemingly autonomous entities or beings… Strassman (2008) estimated that at least half of the participants in his studies of high doses of intravenous DMT reported experiences of journeys to invisible or alternative worlds, and that contact with alien beings or entities were a variant of this category.”
Also last week:
A molecule that induces entity encounters “more real than life” and converts atheists into believers is heading towards clinical trials.
What a time to be alive.
Is there a dose-response relationship between the significance of the entity encounter and clinical endpoint as there is with the mystical experience?
Are contraindications to DMT different than other psychedelics?
What does a go-to-market strategy for a drug that induces entity encounters? Is this a selling point or will it detract from efforts to legitimize psychedelic medicine? I can’t wait to see Entheon’s marketing material;
Will attempts be made to engineer out the entity encounters?
Finally, there is understandable concern about removing certain aspects of the psychedelic experience as it enters mainstream medicine.
Chief among the watering-down concerns is the elimination of a “vessel” from the psychedelic experience.
Set, Setting, and Vessel
A promise of psychedelics is accessing untapped emotional and conceptual muscles that have atrophied for many of us. The atrophy of trust, love, connection, empathy is what some call trauma, depression, addiction.
As a kid, you learned to read. It took time and effortful engagement on your part and instruction from parents, teachers, etc.
Just like reading, developing emotional and conceptual tools requires effortful engagement and guidance. But it’s way more complex. The learning is never over. If it is, it’s a problem. The learning progresses and regresses, it sometimes gets stuck in a deleterious pattern. Engaging with one’s own consciousness is hard work.
Psychedelics offer a glimpse without the default mode network’s protection.
But not without an appropriate set and setting.
Spiritual communities and traditional lineages occasionally invoke the term “vessel” as a related feature of set and setting.
From the Council of Spiritual Practices:
“There is traditional wisdom and logic (but nothing like adequate empirical evidence) behind the notion that the existence of a social "vessel" to contain the experience – a group of people with some shared understanding of what the experience means and what is to be done with it – increases the chances that a given experience will lead to lasting benefit.”
The fascinating aspect of a molecule that invokes encounters with entities, aliens, deities is how the set, setting, and understanding might need to change in comparison to say MDMA or psilocybin.
Heart opening, non-duality, and alien encounters might each best be prepared for, anticipated, and integrated somewhat differently.
How do psychedelic clinicians, therapists, and the systems that support them address this diversity?
Most psychedelic research to date has chosen the patient-therapist alliance as the “vessel”. This is probably more reassuring for regulatory agencies and appeals to current modes of therapy, but it is optimal?
Is there an argument to be made for different vessel types for different molecules? Are a shaman and a group a more effective vessel for some molecules compared to others? If so, how should traditional strategies compare to modern methods of evaluation?
(I have strong feelings on the Traditional Wisdom-to-Science equation. I encourage you think about traditional practices not as superstitious and naive on the one hand and infallible and absolute truth on the other— but as heuristics, guidelines, and mental models based on close observation of a phenomenon for a long period of time. They are what Nassim Taleb calls Lindy. They have stood the test of time, they are helpful but they’re not necessarily prescriptive. But there are ways to use this way of knowing in coordination with scientific process. I am convinced that the way to connect Traditional Wisdom systems like shamanism, or indigenous traditions, Acupuncture, etc. to modern science is through the framework of Hormesis, aka a biphasic-dose-response. Most of the tools of traditional systems are physiological ‘loads’; needling, pungent herbs, fasting, thermal conditioning, intense focus, emotional challenges—all create a response from the tissue repair, regeneration, and rebuilding systems. More on this another time, this has been a long enough tangent.)
Should Entheon and others seeking to develop DMT into approved medicine consider alternative formats for therapy to account for the unique feature of entity encounters during DMT trips?
Artificial Intelligence as a Vessel
CEO Tim Ko from the Press Release:
"We are also in preliminary discussions with a Palo Alto based artificial intelligence company, about developing a home-based and hospital-based AI protocol. This would allow Entheon Biomedical to create AI driven psychedelic assisted therapies, that includes facial recognition and mood analysis software. This would greatly enhance the success of the treatments, while decreasing the cost and making the treatments more accessible to the public.”
Tech proponents point to access and cost advantages of tech-enabled therapies. Classicists point to the human-to-human therapeutic alliance as the key ingredient to this kind of work.
AI-enabled systems will be useful for data collection but what is lost when AI-driven psychedelic-assisted therapies are the norm?
Eventually, research will start looking at how these molecules, settings, and protocols affect things like shame. This is where I think the “tech first” approach will fall short.
On the other hand, there are some pretty creepy people out there. One participant at the recent digital event lamented the extent of regrettable behavior among many therapists that she was aware of.
Tech evangelists in psychedelic-assisted therapies would be smart to study other areas in healthcare where promising technology has failed to live up to the hype. The one example that comes to mind is electronic medical records, often invoked as a primary culprit in physician burnout.
There’s no doubt a lot of promise in technology-enabled treatments and exciting innovation to be explored but we should not lose sight of the “vessel” through which these experiences are mediated. Especially with aliens involved.
Tomorrow at 11 am US Mountain Time, 5 pm GMT Unlimited Sciences hosts the next Unlimited Voices with a focus on Business. Guests include ATAI’s Christian Angermeyer and MindMed’s JR Rahn.
Alright, thanks for reading, and see you on Wednesday.