A New Paradigm of Mental Health Care: The Preventative Potential of Psychedelics
A New Paradigm of Mental Health Care: The Preventative Potential of Psychedelics
Dr. Sherry Walling - 0:00:09
Hello Mind Curious listeners. September is Suicide Prevention Awareness Month. In the U.S. and this is a subject that warrants our time and attention because the suicide rate in the US has increased 35% between 1999 and 2019. This of course did not include any increases that may be associated with the mental health toll and loneliness and isolation that has gone along with the COVID-19 epidemic. On today's show, I want to talk a little bit about suicide and psychedelics.
Dr. Sherry Walling - 0:00:38
And I'm going to do this by talking through my own story of losing my own brother to suicide about two years ago and I'll unpack how that loss has led me toward this emerging field of psychedelics as both an advocate and clinical psychologist. So I will be talking a lot about suicide today and about the toll that mental health and addiction can have on a family. I'll trust you to discern whether a conversation about suicide is in alignment with your own mental well being at this point. If you think that that might be triggering for you, then do feel free to skip this episode and come back next week. Another reminder that I'm going to talk about my own experiences and those of my family.
Dr. Sherry Walling - 0:01:21
I'm drawing some conclusions about what I think would have been helpful to my brother, but my statements are not intended to be medical or therapeutic advice. They represent my own personal and professional opinions. Thanks so much for tuning in. I want to tell you why I'm here. To be honest, I'm a very unlikely advocate for psychedelic supportive therapy or psychedelics in general.
Dr. Sherry Walling - 0:01:48
I grew up in an evangelical family in which the only conversation about non ordinary states occurred in the context of prayer and worship and my religious upbringing meant no alcohol, no dancing, no card playing, and definitely no drugs. I was a product of the religious right and Nancy Reagan's "Just Say No" campaign. Fast forwarding past my early life experiences. I've spent my professional career as a clinical psychologist, helping people work through the aftermath of trauma. I trained at Fuller Theological Seminary, where I earned a PhD in clinical psychology, as well as a Master's degree in theology.
Dr. Sherry Walling - 0:02:30
And then I went on to the division of Community and Prevention research at Yale University School of Medicine and did my postdoc at the National Center for PTSD, which is housed at the VA in Boston, and is affiliated with Boston University School of Medicine. So I've spent a lot of my professional life thinking about how to help people recover from hard things. Because of my seminary training, I've been able to engage with that from a spiritual perspective as well as a more traditional psychological perspective. I've been peripherally aware of the research related to PTSD and MDMA for at least 15 years. I've closely followed the work of Bessel van der Kolk and have had the opportunity to do some training with him and I think it was in one of his seminars that I initially saw some early clinical videos of what is now the MAPS protocol using MDMA to treat PTSD.
Dr. Sherry Walling - 0:03:15
But I'll be honest, it wasn't until the deaths of my father and brother that I became absolutely intrigued with psychedelics and convinced that they are an essential option for those who are seeking healing in the areas of mental health and addiction. Of course, I want to take a moment to acknowledge that people use psychedelics and have used psychedelics for many years for many different reasons that can include spiritual growth, intimate connection, just plain old recreation and fun and I acknowledge those uses, but I'm going to focus on the therapeutic uses of psychedelics because that's been my entry point in driving curiosity in this world. My brother Dave started drinking when he was a teenager. It felt like it began fairly normatively. A beer after a hike.
Dr. Sherry Walling - 0:04:05
Some beers with his buddies and his band. But for some reason, alcohol took a hold on him from quite a young age. He never really made college plans. He kind of barely graduated from high school. When he was twenty, he decided to leave our hometown in Northern California and ride his bike to Montana, where he had this kind of wonderful wildlife doing seasonal jobs like running a ski lift in the winter.
Dr. Sherry Walling - 0:04:29
Working as a river raft guide in the summer, he would text me amazing pictures of grizzly bears that he'd seen in the woods or beautiful mountains at sunrise. I suspect that he was pretty deep in his addiction during that time during his 20s, but he was also really loving his life and created this really interesting outdoor adventuree Montana wild life. It was around when he turned 30 that he began to have some significant consequences from his alcohol use. He developed pancreatitis and some other medical complications. We got together for my other brothers wedding around his 30th birthday and he just didn't look well.
Dr. Sherry Walling - 0:05:11
He was yellow and jaundice and had this sort of puffy belly that didn't look like someone who spent most of his life on a mountain bike or a pair of cross country skis. So I knew there was trouble. I knew that he was ill and I talked a lot with him about how worried I was about him, but it wasn't until our father was diagnosed with terminal cancer, about two years after that, that he really plummeted into the ugliness and desperation of an addiction. A few days following my dad's diagnosis and the clarity that my dad's life would be significantly shortened by oesophageal cancer. Dave drinks so much that he ended up in the ICU in Kalispell, Montana for almost two weeks, really fighting for his life.
Dr. Sherry Walling - 0:06:00
I sat beside him while he was intubated. I played him music while he was in a medically induced coma. And cheered him on when he was using a walker to get down the hallway of the ICU. After he recovered for long enough to leave the hospital, he began his first experience with inpatient treatment for excessive alcohol use, alcohol use disorder. He came back to Minnesota where I live to do this course of treatment because Minnesota has some of the most flexible, highest quality substance abuse treatment sort of programs in the U.S. So when Dave began treatment he had no time limits, you know it wasn't like he had six weeks or the insurance would kick him out.
Dr. Sherry Walling - 0:06:41
He had extensive support and he did really well in treatment. He found a new sense of sobriety and health and began the hard work of putting his life back together. But for some reason, probably beyond what I will ever understand. My dad's illness and eventual death was so disruptive and so hard for Dave. It was almost like their life lines were tied together.
Dr. Sherry Walling - 0:07:08
About a year into Dave's sobriety, my dad took a major turn for the worse. The cancer moved into his brain and he really lost the ability to move around very well or to engage with us in any meaningful way. He was incredibly fatigued and really was quite close to death. Seeing him like that seemed to be more than my brother could handle, and he relapsed and began this months long period of being in and out of the emergency room. Different injuries, bike accidents, a head injury here and there.
Dr. Sherry Walling - 0:07:41
This went on until he was court ordered to stay in treatment. So restricted from leaving the hospital because his physicians were so worried that he in his addiction presented such a risk to himself that they were worried that he would die. So he stayed in the hospital and went back to treatment until it became immediately obvious that my dad would die, and then I asked that he be permitted to leave the hospital to come to California and be with my dad in his last days, which he was allowed to do. And we gather together my two brothers and I with my mother, and kind of walked my dad right up to the door. We held him and talked to him until he died.
Dr. Sherry Walling - 0:08:24
So for me it was actually a beautiful and sacred profound experience to be present at my dad's death. But for my brother, it must have been too much. He seemed OK. He seemed present, he seemed engaged. He was incredibly tender and loving towards my dad, but once again, within a few hours of my dad's death, he relapsed and ended up in the county jail after having crashed the car.
Dr. Sherry Walling - 0:08:48
You can imagine the amount of like chaos and turmoil that our whole family was in. We managed to get him back into treatment. He missed the memorial service, but he stayed in treatment for almost three months and once again had this new, very fragile sobriety. He was in deep depression and deep grief, but was finding the strength, at least it seemed to put his life back together. So he finished treatment and was discharged to a sober house.
Dr. Sherry Walling - 0:09:18
Sober houses are sort of these low income places for people who are in transition, who are coming out of treatment and not yet well established enough to get a traditional apartment. The sober house that Dave lived in was pretty terrible. He felt extraordinarily unsafe right away, and he had to get out of there. So he left the treatment community. He left. His therapist he left all of the support that he had built up, bought a train ticket back to Montana and he died two weeks later.
Dr. Sherry Walling - 0:09:51
My brother was 33 when he died and he was tall and handsome and made the world's best salsa. He loved to play Frisbee with his nephews. He loved dogs and paddle boarding and being outside. He loved wild adventures in the mountains and I promise you, the world is a little bit worse. Because he's not here, so I tell you this story, not just to make you sad, although I'm sure you can hear in my voice that as I tell it, I am also sad. I tell this story because there are thousands of people like Dave. People who are loved and people who get caught in some kind of trap of addiction or illness and just can't get themselves out.
Dr. Sherry Walling - 0:10:37
And I believe both as the survivor of someone who is dead by suicide and as a clinical psychologist. I believe that there are so many problems with our current treatment systems and I do believe that there is much that we could do better and that psychedelic supported therapies specifically offer different kinds of interventions that can be more integrated and more effective in preventing suicide. So, just to recap some of the problems with the current mental health treatment system, as I've observed them with my brother and with my own professional life. Number one is that our current interventions, whether that's therapy, medicine, the combination. They take too long to create a new kind of feeling. They take too long to instill hope.
Dr. Sherry Walling - 0:11:22
If someone begins a new course of SSRIs, which is the most commonly prescribed medication for depression, it's weeks or months before working out the exact dosage that will help to create a new emotional experience. And although I am a big believer in psychotherapy, it is what I practice and what I have trained in. For people who are really in the midst of desperation, it takes too long to reset the neurological system. Another major, major problem with the current treatments is that they are very fragmented, so you go to one physician for your medicine. You go to your therapist for your talk therapy.
Dr. Sherry Walling - 0:12:07
You go to your spiritual leader for the existential conversation about death and grief. If you've listened to the other episodes of this season of the podcast, you've heard these themes. You've probably heard some of my frustration in my questions at the lack of integration or the siloed nature of mental health and addiction care as it currently exists. A third concern that I have about commonly prescribed treatments is that some SSRIs or some people experience not only a reduction in depression symptoms, which is fabulous, but also a reduction in the spectrum of positive emotions. So there's sort of a decrease in joy.
Dr. Sherry Walling - 0:12:47
While there's also a decrease in depression. Kind of in a narrowing of the emotion range altogether. And while this is of course functional in reducing depression, it is, I think, pretty problematic in helping people connect with joy with hope with the kinds of experiences that really can be life giving. For someone who is trying to work their way out of addiction or depression or grief. Number four problem is that these inpatient programs, while they are helpful in taking people out of their context and giving them the space and the time to really focus on healing.
Dr. Sherry Walling - 0:13:19
They also create these really risky transition periods. We've long known that suicide risk goes up during transitions that bring a lot of stress that are accompanied by significant changes and support system. In my brother's case, he was sort of jumping from one community to another and ultimately ended up in this home where he felt really unsafe at a really, really vulnerable time. Living for months and months within one treatment facility and then trying to reintegrate into the community is problematic in that it undoes so much of the stability that is built up during this treatment program. The fifth thing that I want to mention is accessibility.
Dr. Sherry Walling - 0:14:03
Many programs that are high quality have really long waiting lists. And are hard to get into, and so people kind of languish in an in between phase for months and months. Fortunately for Dave, he was able to get right into treatment each time that he really needed it, but there was considerable variability in the quality of the programs that he was part of. So not everyone has access to programs in a timely manner and certainly not access to high quality programs that are really supported by highly trained, compassionate staff and informed by science. So I know I just scratched the surface in terms of problems with the mental health system.
Dr. Sherry Walling - 0:14:41
I've not addressed quality of care access, particularly for BIPOC or LGBTQ individuals. The hard truth is that from where I sit now, I really believe that psychedelics could have been helpful to my brother. I was vaguely aware of them as an option at the time, but there was no easy way into a clinical trial. There was no access, and I'll confess I wasn't brave enough to a sweep him off to the jungle myself. In my family, because of their history, were certainly not supportive of trying to access any kind of underground treatment or anything like that.
Dr. Sherry Walling - 0:15:14
But here's why I think that psychedelics could have been helpful. Last week we brought you an episode all about Ibogaine and the Iboga plant, and some of the really dramatic early research that shows of its power to alleviate opioid addiction. There's also clinical research to support the use of MDMA, LSD, ayahuasca and psilocybin as tools to help alleviate substance use disorders. It's hard to overstate how important this is. How many people have died, or how many people are suffering or their families are suffering deeply because of the biological, social, and psychological entanglements that people have with addictive substances?
Dr. Sherry Walling - 0:15:57
Addiction aside, the research from the phase three clinical trial of MDMA shows the MDMA helped to reduce suicidal ideations and among the participants in the phase three trial. A recent article in the New England Journal of Medicine, authored by Robin Carhart-Harris and his team found that psilocybin was effective in reducing depression symptoms without reducing capacity for positive emotions. So that intervention was more targeted to the depression end of the spectrum, without reducing the capacity for joy and delight. Functionally, although they are not easy, and they don't happen overnight, psychedelics work faster than traditional interventions. Or at least there's a shorter time period from the beginning of treatment to a new emotional experience.
Dr. Sherry Walling - 0:16:42
That doesn't mean that people don't have to do the years long work of integration and of rebuilding their lives, so I would never advocate for psychedelics as sort of some fast easy drive through solution. But there is a tighter timeline between utter hopelessness and new experience, and that I think, is what my brother was so desperate for. And one of the important things about psychedelics, the thing that I think is really a game changer for anyone who's pursuing mental health treatment is that psychedelics are a multimodal, integrated approach to care. So there's biochemistry in the substances being ingested. But there's also this therapy component that addresses emotion and cognition and provides support for a relationship.
Dr. Sherry Walling - 0:17:29
Of course, many people with psychedelics report a sense of spiritual experience. A deepening existential clarity about how they're connected to those around them, often a very extensive experience with confronting one's mortality and struggling with an awareness and sense of peace related to death. If my father hadn't died, it's possible that my brother would have kept marching along in his addiction, but would have been alive living in Montana, playing in the mountains. But the loss of our father and his deep grief around that was some kind of spiritual crisis that traditional therapy and medical interventions just didn't seem to touch. So while we can understand the biochemistry and the neurological mechanisms of psychedelics, there is some mystery. There is some spiritual component that maybe isn't quite yet measurable, but is extraordinarily important to people's healing, especially when it comes to matters of end of life and grief and loss.
Dr. Sherry Walling - 0:18:32
When added benefit of psychedelics is that although they are intensive and often require that people kind of step out of their day-to-day life for a while, they don't require months and months of removal from one's community and one's family in ways that creates significant vulnerability when those transitions have to be reversed. Psychedelics allow the possibility of going through deep level intensive work without having to leave home for long, long periods of time. The steps that lead someone towards suicide are many and are complicated. So I'm sure that this conversation is largely oversimplified, because there's no way to cover all of the complexity in the time allowed. And of course my own grief and loss and sense of responsibility about my brother's death contribute to me doing that intellectual work of "what could we have done differently?
Dr. Sherry Walling - 0:19:23
What would have helped? What could have changed the course of this story?" My deepest truth is that Dave didn't have to die, that there were ways out of the trap that he found himself in. That there were ways to grieve better or to recover from addiction. The gentlest statement would be to say that I do believe that psychedelics could have been helpful and that they should have been a treatment option for him. The less gentle, harder line statement is that the stigma around psychedelics and the slow pace of legalized access to these therapies could have contributed to his early death.
Dr. Sherry Walling - 0:19:58
One of the painful stories, the painful realities that I will carry with me for the rest of my life, is that I didn't do more or fight harder. To try to get him access, I fought for high quality treatment for him, but in the end it wasn't enough. I watched his life unravel in front of me alongside the death of my dad and there was very little that I could do. Very little that I could do to instill real hope or change the conditions. Changed the way that he was feeling. Changed the neurochemistry in his brain.
Dr. Sherry Walling - 0:20:34
Very little that I could do to help him grieve with more empathy for himself. Ironically, in the time since his death, I've had the opportunity to do some of my own work with psychedelics supported psychotherapy and in one healing journey my mind returned to that moment of my dad's death and I observed that scenario from a different perspective, not from the way that I saw it as it unwrapped before me in real life, "real life", but I saw it as like a third party observer. When it was happening in real time, my focus was so much on my dad, on my desire for him to feel comfortable as he was leaving this life and my desire for him to know that he was loved. But in my journey work I saw from this different vantage point a daughter who is losing her father. Not a psychologist, not a doctor.
Dr. Sherry Walling - 0:21:31
Not all the titles. Not all of the accolades that I've accumulated over my life, not all of the ways that I had taken responsibility, but simply as a daughter who was losing her father. And of course felt such deep empathy and compassion for that version of myself. And that's the thing that I most wish could have happened from my brother. That sense of deep empathy, which is so very healing and accepting even of very painful and hard realities.
Dr. Sherry Walling - 0:21:56
My impression is that he could never find any gentleness within this loss. He could never regard his own broken heartedness with tenderness. I can't do anything to change the story for my brother, for my family, but I can tell his story. And I can put my energy towards having conversations about how to make mental healthcare better. So although I'm a clinician and a researcher, I come to this conversation and Mind Curious.
Dr. Sherry Walling - 0:22:28
I come to the conversation around psychedelics as a grieving sister. As someone who watched a battle that didn't have to be lost. So if you have your own story around mental health and psychedelics, feel free to reach out via our social media platforms or the Mind Cure website. Mindcure.com. And if you have some curiosity about my unfolding story, I wrote a book about the loss of my dad and my brother called "Touching Two Worlds" which will be published next spring by Sounds True. If you want to get on the list for the pre release, feel free to follow me on Instagram or find my pre launch information at sherrywalling.com.
Dr. Sherry Walling - 0:23:04
As always, thanks so much for listening and stay curious.