Show Notes

• Tania de Jong AM – Previous Unstress Episode
• Trip of Compassion documentary
• Dr Mark Horowitz – Unstress Episode to be released June 2024
• NIgel Denning – Previous Unstress Episode
• Stanislav Grof – Holotropic Breathwork
• Admiral Chris Barrie – Previous Unstress Episode
• Mind Medicine Australia website

Timestamps

• [00:00:00] Introduction by Dr. Ron Ehrlich, acknowledgment of traditional custodians.
• [00:00:45] Dr. Ehrlich discusses the gravity of mental health issues globally and introduces the main topics of the episode including PTSD, chronic depression, and the role of psychedelic-assisted therapies.
• [00:02:15] Introduction of Dr. Eli Kotler, his background, and his innovative approach to mental health.
• [00:02:33] Dr. Kotler shares his journey into the field of psychedelic-assisted therapy.
• [00:04:26] Discussion on the differences between psychotherapy and psychiatry.
• [00:06:07] Dr. Kotler explains psychodynamic therapy and its impact.
• [00:10:01] Debate on the DSM-5 and the concept of normalcy in mental health.
• [00:15:30] Dr. Kotler critiques the biological model of mental disorders.
• [00:20:36] Discussion shifts to the treatment approaches and their societal impacts.
• [00:25:40] Dr. Kotler elaborates on the systemic issues in psychiatric diagnosis.
• [00:31:47] Introduction to psychedelic-assisted therapy and its paradigm.
• [00:37:30] How traumatic experiences are processed differently in adults and children.
• [00:41:00] Overview of the process and model of psychedelic-assisted therapy.
• [00:48:15] Dr. Kotler describes the typical session of psychedelic therapy.
• [00:51:20] The risks involved in psychedelic-assisted therapy.
• [00:56:10] Importance of therapist’s experience in the therapy process.
• [01:01:55] Dr. Kotler shares a powerful patient story illustrating the impact of therapy.
• [01:06:12] Dr. Ehrlich summarizes the discussion and the promising future of psychedelic-assisted therapy.
• [01:08:30] Closing remarks and takeaways from the episode.

Dr Eli Kotler: Psychedelic-Assisted Therapy 

Dr Ron Ehrlich [00:00:00] Hello and welcome to Unstress. My name is Doctor Ron Ehrlich. Now, before I start, I would like to acknowledge the traditional custodians of the land on which I am recording this podcast, the Gadigal people of the Eora nation and pay my respects to their elders, past, present and emerging. And when I say past, I’m talking about the longest surviving culture in human history 65,000 years. We have a lot to learn about connection and respect with people and country. Well, today we are exploring mental health and as we know and are constantly told, mental health is a huge and growing problem world. Today we explore not just diagnosis and specifically the diagnosis, Diagnostic and Statistical Manual. The fifth volume, the DSM five as it’s called. But how intractable problems like post-traumatic stress disorder, PTSD, intractable chronic depression, addictions and other complex medical issues are managed. Now, a recent podcast I spoke to Tania de Jong, who is the co-founder and executive director of Mind Mid Medicine Australia, who have advocated for the use of psychedelic assisted therapies in Australia. This was approved in July 2023. My guest today is Doctor Eli Kotler. Now, Eli is a psychiatrist and psychodynamic psychotherapist who sees things a little differently. And let’s face it, if the evidence is anything to go by seeing things a little differently in the world of mental health in general, and as a psychiatrist in particular, is refreshing and arguably never been a more important time for that. Ellie is medical director of the Melbourne Private Hospital, a trauma and dynamically based hospital helping those with addictions. He is also a lecturer at Monash University in Melbourne and involved in psychedelic research. He’s the independent medical expert for the historical use abuse cases, historical abuse cases and the Australian director of the Certificate in Psychedelic Assisted Therapies. He’s actively treating patients in Australia with MDMA assisted and psilocybin assisted therapies. I hope you enjoyed this conversation I had with Doctor Eli Kotler. Welcome to the show, Ellie.

Dr Eli Kotler [00:02:33] Thanks so much for having me.

Dr Ron Ehrlich [00:02:35] Ellie, we were just and will, thank you. And I really appreciate your time. And we were just reflecting before we came on. On what what first introduced us both to the world of psychedelic assisted therapy. And you, as a psychiatrist, would have had a bigger moment than me. But but, why don’t we share that? Because it’s the same story you can’t tell.

Dr Eli Kotler [00:02:57] It’s funny, but it was. Yeah. You did a synchronicity. Yes. Yeah. So it was of also about five years ago. But in Melbourne, not Sydney. I went to a viewing with a friend of mine of an Israeli documentary called Trip of Compassion, and it was a documentary about MDMA assisted psychotherapy for people with intractable post-traumatic stress disorder. And I was blown away, I really was. What really hit me was that. So I’ve always predominantly been a psychotherapist. I’m a psychiatrist, but I have always been much more connected to the sort of therapy realm of things. And what I saw in that documentary was sort of like, like what I do in therapy for people. I do think it can help people, but it takes a long time. Like years of weekly, you know, at least weekly therapy for years. And I saw in that documentary the same sort of processes that my patients go through, but happening in months rather than years. And I was absolutely blown away by that. And so I from that point, I got, you know, I was in I was like, you know, this is this is something that could really breathe some new life into the somewhat stagnant mental health field.

Dr Ron Ehrlich [00:04:27] Yes. Well, I can just imagine. And actually, it’s interesting to even ask the question what the difference between psychotherapy and psychiatry is. People may just think on decision that would a psychiatrist do?

Dr Eli Kotler [00:04:42] Yeah. It’s a really interesting question. I guess as a psychiatrist, you are in many ways fortunate because you have the ability to practice, you know, in different paradigms. So as a psychiatrist, you can work predominantly with medication. You can work with both medication and therapy, or you can just be a therapist. And even within those who choose to practice a lot of therapy, there are different, very different paradigms within therapy that you can choose to go down. So if you know, the word therapy hides much more than it reveals, because there are actually many, many different types of therapies with different goals, different focuses. And they can be, you know, poles apart in terms of how they actually function. But as a psychiatrist, you can essentially choose to practice in, you know, all of those three domains or one of those three domains, whatever you whatever you want, really.

Dr Ron Ehrlich [00:05:41] But, you know, I know that. Well, it’d be interesting to ask you what your who who inspired your approach to psychotherapy, sort of laying a foundation for what we’re going to be talking about. Who’s been a major influence or what kind of psychotherapy would you give me? The elevator pitch or no longer than an elevator? It’s a tall building. So let’s imagine we’re in the elevator for a bit longer. What’s the psychotherapy that you practice?

Dr Eli Kotler [00:06:07] So I’ve always been attracted to what’s called psychodynamic or psychoanalytic thought. And it is. It can’t be an elevator pitch, for better and for worse.

Dr Ron Ehrlich [00:06:18] Okay, that’s. I was being facetious.

Dr Eli Kotler [00:06:22] So psychoanalysis started with Freud a long time ago. It’s come a long way. And about in the 50s or 60s, I think it was the 50s. The notion of psychodynamic psychotherapy and psychodynamic thought came in, which was based on a lot of Freud’s ideas and the people that came after him. But somewhat more general, probably less dogmatic about certain aspects of the psyche and human experience and, you know, built on what Freud and his, friends and associates brought into the world. Well, they didn’t necessarily bring it into the world, but at least they brought it into, I guess, a medical framework. You know, really, it’s an ancient all all that Freud did was bringing the ancient idea of knowing, you know, know thyself. And he brought that into a medical framework. And so it’s really not him. It’s just he brought it into the medical framework. And it was changed over the years to be a bit broader, less dogmatic. But essentially at its root is this is the notion that human suffering comes from, first of all, our experiences in the world. And through gaining awareness of ourselves, the pain that we carry with us, how our minds distort that pain, and try and avoid that pain through understanding and re-experiencing those aspects of ourselves. Our suffering will be less, at least to the point that we can live fulfilling lives, you know, be somewhat free, use our creative capacities, our imagination. So I was always, attracted to those types of thinkers, including Freud and Carl Jung, who I’m sure many people, many of your listeners will know, but also, you know, through the 50s and 60s and 70s, people, such as Karen Horney, Frieda from Rockland, Erich Fromm, and, you know, a lot of Nancy McWilliams is a. Three, psychologist and psychoanalyst who. I’m a big fan of. So these are the types of people, who I read and who inspired me.

Dr Ron Ehrlich [00:08:38] Well, sounds some of those names are very familiar to me in my early time, you know, and while I was at uni reading, you know, Hermann Hesse and Erich Fromm and Krishnamurti anyway. But but, it’s interesting in the preparation for this podcast because I was really I’ve really been looking forward to talking to you. You know, I’ve noticed that you use the term psychic suffering paradigms, too. We used to understand psychic suffering, and I think, well, I now know why you use that term, because it’s quite a different paradigm to an imbalance in brain chemistry. And, we recently had a conversation with doctor Mark Horowitz, who’s very, I’m sure you know Mark. Yes. And Mark is very passionate about the overuse of anti-depressants. And I asked him, you know, the DSM one, for example, was something like, I mean, I know that was 1952, 32 pages, had a couple, you know, 100 conditions. By the time we got to DSM five, we’ve got 1100 pages and over 3 or 300 odd conditions. And the question I asked Mark, having had a little bit of a look at that, is, is anyone normal? Number one. And if brain chemistry is the issue, how do we measure that imbalance in brain chemistry? How do we measure that in this world of evidence based medicine?

Dr Eli Kotler [00:10:02] Yeah. So I haven’t seen what what Mark say. He’s it’s my best friend. You say there you go. I’m a proper psychiatrist, you see, with notes. Simple.

Dr Ron Ehrlich [00:10:11] Yes. This in five.

Dr Eli Kotler [00:10:13] That’s just to prove I’m a proper psychiatrist.

Dr Ron Ehrlich [00:10:16] Yeah, I was I was okay, I believe that right from the word go.

Dr Eli Kotler [00:10:19] You told me. Yeah. So. This is fundamental. Absolutely fundamental. And my take, for what? It works, for what it’s worth, is. I mean, it’s quite lengthy. If I took the elevator pitch. The elevator.

Dr Ron Ehrlich [00:10:39] Who am I? Ella, please. Forget I even said elevator pitch. Because this is a podcast and we’re not on a time restraint. So, you know, I.

Dr Eli Kotler [00:10:47] So.

Dr Ron Ehrlich [00:10:48] I kind of don’t hold back.

Dr Eli Kotler [00:10:50] I mean, I always hold back a little bit because I’m, you know, worried that people are going to want to fire me and, and, cancel me, but, yeah, I don’t I’ve never been struck by the notion that, these conditions, due to brain chemistry, as in fundamentally the cause of these conditions is brain chemistry. I don’t believe that to be true. I obviously believe that the brain is there, and it’s important. But at most, I would suggest these findings, correlations, they’re not causative. It makes sense to me that if I’m feeling something awful that that will be there will be a correlate in my brain for that. Of course there will be, because our brains and our experiences or our minds are obviously connected. But two things. One thing is that we don’t actually know what the correlates of our difficult experiences are. There are plenty of theories. There’s a serotonin, there’s dopamine, and these are theories. There’s lots of holes in the theories. So, you know, I work in addiction, and I can point out the holes very easily in the theory that addiction is about dopamine. There are lots of holes with that theory. But even if the theory were true, even if we did have really good correlations in terms of what’s going on in the brain, in someone with an addiction, it still would not prove that the brain changes caused the addiction because they are correlated. And science 101. We know that when two things are correlated, it’s not necessarily causative. So just because there’s a brain, something in the brain and that’s correlated with my experience or particular behaviours, does not mean that my brain caused those experiences. And, you know, this brings us to the most important question or issue, which is the paradigms that we use in our society for suffering. And we use particular paradigms, which I think have problems. I’m not suggesting that, you know, I’m not like an anarchist. I’m not suggesting that we throw away what we’ve developed with our paradigms. But I do think that the paradigms are misunderstood. And I can and talk about, I’ll talk about how I think the misunderstood and potentially even misused, at times. So, so the current paradigm. So let’s say take a diagnosis of depression. So all of, all of the current diagnoses have particular properties. So one is that they disagree. So there’s depression and it’s seen as a discrete entity. You know, to the point that, for example, if someone has an addiction, someone is addicted to alcohol and they have a major depressive disorder, it’s termed dual diagnosis. You know, as if they’ve got two things and the two things are separate. And this current system encourages discrete entities rather than a systemic understanding of what’s going on for the person. So if I see someone with addiction, depression, my sense is that they’re going to be related. It’s one person with two manifestations. Of some problems, but they’re both happening in the same person, so undoubtedly they’re going to be related. It’s not like two separate things. It’s one person with multiple manifestations of whatever’s going on for them. And so one issue with the current diagnostic, approach, which we use, is that it encourages discreet packaging of human suffering, rather than looking at people as a systemic whole within their history and their culture and their personality. So that’s the first issue that I see as a problem. The second issue is that often so all psychiatric diagnoses, pretty much 98%, including depression, we’re using depression as an example. Now that is a descriptive diagnosis. It’s not it doesn’t explain anything. So if you can care if you compare it to something like appendicitis, appendicitis is an explanatory diagnosis in the sense that it explains to you why you have certain symptoms. So my tummy’s, you know, very sore. I’m vomiting, I’m sweating. I go to the emergency department, a doctor, a nurse comes up to me. They poke my tummy, they order some blood tests. They come back to me and they say, you have appendicitis, which is a very useful type of diagnosis because it explains to me why I have the symptoms that I have. It’s like, oh, that’s why I’m vomiting. And I feel terrible and my tummy is killing me because I have appendicitis. So that explains to me my symptoms. Depression for you as an example of a psychiatric diagnosis is purely descriptive. So to be diagnosed with depression, you literally have to have certain symptoms. It’s a checklist. So, you know you feel terrible or you’re numb and you can’t sleep properly, and you think you’re a terrible person and you want to kill yourself. You can’t eat properly. You can’t sleep properly. If you have those symptoms, you get diagnosed with depression. And what seems to happen in our society is that we relate to these descriptive diagnoses as if they explain something. So, you know, it’s as if it’s like the appendicitis diagnosis. It’s like, oh, that’s why I’m feeling awful, because I have depression as if it explains something. But really, all the diagnosis of depression is, is a description of someone that feels awful. So basically what we’re saying is I feel awful because I feel awful. So because there is no explanatory power to a psychiatric diagnosis. But in our society, it’s very clear that we don’t relate to psychiatric diagnosis as descriptions. We relate to them as explanation. So I can’t concentrate because I have ADHD. My emotions are all over the place because I have borderline personality. I’m feeling awful because I have depression, you know that really, I think it’s called a tautology. Or, you know, it’s like I feel awful because I feel awful. But so there’s an error in how our society relates to these diagnoses. So that’s another very significant issue. And that’s a really significant issue. And they’re all significant issues. Should I keep going in terms of.

Dr Ron Ehrlich [00:17:32] Well no, no. Let me just stop you for a moment because, you know, you’ve said so much there. I mean, that kind of description, a diagnosis satisfies two things. One, for the doctor, it makes him feel good because you’ve given the patient a diagnosis. You know, they’ve come to you with a problem and the patient has come to you with the problem. And hey, I’ve got a diagnosis. So we’re really this is good, this is happening. And the next part of that, of course, is what do we do about it? And and often because of imbalances in brain chemistry still being the major theory that seems to be driving, you know, mental health diagnosis, the obvious answer to that is the prescription of medication. And when we read that 1 in 6 Australians are on antidepressants, and once you have a label, you really do have a label. This is what I love about your framing. It understands psychic suffering because it immediately empowers the patient to a journey that they might be that that is, you know, that you’re willing to help them along with, which is quite different from an imbalance in the brain that I’m giving you a prescription with. And just come back in the six months and I’ll give you a repeat.

Dr Eli Kotler [00:18:47] Yeah. So what you’re pointing out is very important that so there are two assumptions that have occurred. One is that what I have diagnosed you with is an excellent. But I’ve got this. I just got an apple. I just got a I just got a mac. And all these things are happening and I don’t know, I know how to use a mac.

Dr Ron Ehrlich [00:19:07] So all these weeks okay, I enjoyed that. Some are very that emphasised your point.

Dr Eli Kotler [00:19:13] I’ll try not to use my hands so much, but it’s hard. I’ll talk with my hands. Okay. So there are there are two assumptions there. The first is that I’ve diagnosed you with an explanation. That’s the first assumption. The second assumption is that the explanation is biological. So there are actually two assumptions that have been made in that process without anyone actually discussing the assumptions. And you also mentioned something very important, which is that the assumptions actually have really significant consequences in terms of treatment. Because if I believe and these assumptions are often implicit, they’re not explicitly stated. Which is potentially even more dangerous. But if I believe that I am suffering because I have some type of imbalance in my brain, that will lead me on one course of action in terms of trying to get better. Whereas if I am open to the sense that, well, maybe this isn’t due to a chemical imbalance and maybe this diagnosis doesn’t actually explain anything, then that might lead me on a very different trajectory in terms of how I might try and help myself. So there are really significant practical differences. You know that we’re talking about. This is not a theoretical discussion.

Dr Ron Ehrlich [00:20:36] No, no. And and it’s borne out in the impact that it’s having on millions of people.

Dr Eli Kotler [00:20:43] Yeah. And I do suspect I don’t know this. You know, this is just my suspicion. I might be I may be wrong, but I suspect one of the reasons why we have so many people with mental health disorders that are chronic is because of these issues. Because. If I see my depression as an explanation for my suffering, then and I have some sense that it’s something in my brain, it’s not something to do with my experience or my feelings. And, you know, and if that is wrong, then of course I’m going to get stuck in my suffering because there’s no way out of it, because I’m looking in the wrong place for the answers. So of course I’m going to suffer forever because I’m not looking in the right place to find the answers.

Dr Ron Ehrlich [00:21:39] I mean, it’s interesting that you also are involved so much in addiction because we’ve also recently done a podcast. It hasn’t come out yet, but on addiction, and we referenced the DSM five and went through the ten or 11 or 12 criteria for addiction that you require only two or 3 or 4 of those to be ticked. And hey, guess what? You’re addicted. And hey, in this world that we live in where addictions could be technology, it could be drugs, it could be alcohol, it could be pornography, it could be a whole range of different things. It’s not hard to imagine that most of the Western world, as we look around, may well be addicted. Would you agree with that?

Dr Eli Kotler [00:22:22] Yeah. I mean, I mean, yes, a lot of people have compulsive behaviours that may fit into the DSM criteria. Absolutely. Which speaks to some of the issues. Around DSM diagnoses. Yeah.

Dr Ron Ehrlich [00:22:45] I mean, Mark had an interesting perspective on this, and I’ll share it with you. He said, that the turning point came in DSM three, where up until then, the the line between psychologists and psychiatrists were ill defined. And, the what to the things DSM four and beyond was about was identifying this many illnesses to define the different real illnesses, not just reactions. That, that that was the driving force behind DSM four and five, that it it was drawing a line between psychiatry and psychology. What do you think of that?

Dr Eli Kotler [00:23:23] Yeah. Well, DSM three was a turning point. And it’s important to, I’ll add to what Mark was saying. DSM three from DSM three, what the authors focussed on was something called reliability. So they realised that up until DSM three, there were all these conditions and there were interesting descriptions of the conditions, but they were not reliable diagnoses. And you can’t research diagnoses that are not reliable. In other words, if I’m a psychiatrist in Melbourne and you’re a psychiatrist in Sydney, we need to ensure that when I diagnose someone with depression and you diagnose someone with depression, they actually look similar. We need that. We need to ensure that we also need to ensure that May is a psychiatrist diagnosing people with depression. All the people that I diagnosed with depression actually look similar as well, because if you don’t do that, you can’t research conditions because you’re getting people that look potentially very different from each other, and they’ve all got something called depression. So what they did was made they made these lists and criteria to ensure, or I should say to maximise reliability so that patients actually look the people actually look the same that have the same diagnosis. And this is another era that we make when we, you know, in our current sort of paradigms of psychiatry, we can think that psychiatric diagnoses are valid in the sense that they actually represent something in nature. But that is not what a psychiatric diagnosis is. A psychiatric diagnosis like depression is only reliable. It doesn’t know it’s not valid. It doesn’t necessarily actually represent a particular disease entity. You know. And one way to think about this idea is that, again, we can compare it to and contrast it to something like appendicitis. In something like appendicitis, the world or nature dictates to us what the condition is. You know, you can have ten different surgeons all discovering what appendicitis is, and they’ll all discover the same thing because they’re looking the body and it’s there. And then they’ll take, you know, they’ll take a little biopsy and put it under a slide and they’ll see an infection. So in other words, we look at nature, and nature dictates to us what appendicitis is with psychiatric diagnoses. Humans dictate to nature what’s going on. We vote on what we think is going on for people and what, what, what a disease is. So humans come together and we vote, and we vote to create a category called depression. And now we’ve imposed that on nature. But nature never told us that that exists. That came from our assumptions about human suffering. We looked at human suffering and we said, we’re going to create a category called depression. You know, that’s a human creation. It’s almost like a metaphor is a borders of countries, you know? So, you know, any area of the world, you know, India, Bangladesh, Sri Lanka, you know, at some point humans came and we drew lines on the map and we imposed our borders on to nature. And when those borders have been there for a long time, you can start to think that those borders really mean something. But then you meet people who live on either side of the border, and you walk along the border and you realise. It’s just a human creation. There’s nothing actually here that separates what’s going on. And it’s similar with psychiatric diagnoses. We have imposed particular borders and constraints around human suffering, but that’s our creation. Nature never told us that. So, you know, the fact that we create diagnoses in the first place, the fact that we create categorical boxes to fit human suffering into this box and this box in this box, that’s our creation. And there’s nothing to suggest that that’s a valid. Well, it’s not nothing. But, you know, that is not necessarily the correct way to understand human suffering. That’s our creation. I wanted to make some sense.

Dr Ron Ehrlich [00:27:50] Yeah. No, it does. And, you know, I mean, it’s one of the things that I’ve often said and and that is that our current healthcare system is it channels people into a diagnosis which often requires lifelong medication to manage. And that is a great economic model. I mean, you wouldn’t have a $1.5 trillion pharmaceutical industry. That’s US dollars. You know, you wouldn’t have that unless we had that kind of system. So it’s an incredible economic model. Just doesn’t happen to be a very good health model, which ultimately is what we as individuals, we’re all patients, but also as practitioners should be focussed on. Which brings me to this back to where we were at the beginning, and we were going to talk about and, and what distinguishes this psychedelic assisted therapy, understanding psychic suffering, is that this is not just palliative, this is curative. And this is what the power of this is, is so great. I wonder if we might just talk about the difference in paradigm between approaching things from this perspective, as opposed to the more traditional approach to mental health, particularly intractable conditions in mental health where it’s applicable.

Dr Eli Kotler [00:29:05] Yeah. So to to review some of the differences in the paradigms and I’ll use some things I’ve already mentioned. So first of all, psychedelic assisted therapy is not discrete. It’s systemic. So in other words, you know, I don’t think psilocybin cares if you have major depression or obsessive compulsive disorder or what type of anxiety disorder you have, or is it bipolar two or is it borderline personality disorder? Because psychedelics work in a very systemic way. They just work on the human and their personality and the inner world, and the discreteness of the diagnoses fall away because it’s not about that. So that’s one difference in the paradigm. Another difference in the paradigm is that it focuses and this is another whole conversation. But I’ll keep it reasonably brief. It focuses on what’s unique to the person rather than what’s in common with other people. So one of the other issues with our current diagnostic approach is that it focuses on what’s common between me and everyone else. So yes, I can’t sleep properly. I can’t eat properly. I have thoughts of killing myself. So does everyone else with depression. But you could argue, as Carl Jung did, very strongly and explicitly, that focusing on what is common amongst people is not going to help people. What people need to do is focus on their own idiosyncrasies. You know what or what. Why? Why can’t I sleep? You know, what about my relationships? What about my childhood? What about my emotional dynamics? What am I defence mechanisms and coping mechanisms and etc., etc. and so psychedelics help people focus on what’s unique to them, their own experiences and their own difficulties rather than what’s in common. And that’s what we tend to do with current treatment models. So if someone is depressed so they’re feeling sad and they can’t sleep properly, current models often will focus on exactly that. Well, let’s get you sleeping better. Let’s get you feeling better. And that is, that is a focus on what is in common amongst everyone rather than the unique what what’s unique to the person. And so that’s a very significant difference between, psychedelics and a lot of the current models.

Dr Ron Ehrlich [00:31:47] Yeah.

Dr Eli Kotler [00:31:48] And I think the goal of treatment as, as you suggested, the goal I think is, is different. And I’m not going to use the word cure, but I will use the term integration, but in sort of a classic psychoanalytic or psychodynamic sense of the word and what that means. INS is that it aims to help the person be able to integrate or to sit with everything that is inside them. So everything that the world has put in them, you know well, the world combined with their own unique genetics and character, whatever is inside the person that is awful or distressing or upsetting, it helps the person be able to sit with whatever is inside themselves and to be able to sit with reality, the reality of the world, which can often be awful for many, many people. And in that sense, it’s integrative. So it tries to encourage people to face themselves, to face their world, and to be able to sit more and more with reality and what reality triggers in us, which is often very awful. And so in that sense, the aim of the treatment is integrative rather than symptom control, which again, is very, very different goals.

Dr Ron Ehrlich [00:33:11] Yes. I mean, one of the most compelling. It’s interesting because we’ve looked at drawing on a lot of, information about, you know, trauma I’ve heard once described as one of my guest. I think it was Nigel Denning once described. I don’t know, Nigel. Yeah, well, Nigel was Nigel was talking about trauma as being something that just circles around in your head, and I’m pointing to the back of my head, because that’s probably where a lot of it happens in that survival primitive mode, part of our brain. And it just cycles and cycles and cycles around repeating itself, repeating itself, repeating itself. And one of the most compelling images I’ve seen in this field of psychedelic assisted therapy. And it’s so interesting to hear you use the word integration is the, the image of a functional MRI of the brain and the effect that the psychedelic assisted therapy has on the default mode network, and the way trauma is integrated into different parts of the brain. Yeah.

Dr Eli Kotler [00:34:12] So. Well, I’ve got a lot of things, coming to my mind. So I want to add to what Nigel said. Well, he said he’s absolutely 100% true. I just want to add something. Okay, so there’s a very stark difference. And this is true in general. It’s not always true, but it is generally true. There’s a very stark difference between how people present to me as a psychiatrist. And an adult that has had trauma. So let’s say an adult that goes to war and has to kill people and sees people killed and all this awful stuff. They will come to me generally and say, look, I can’t get this stuff out of my head. I can’t. It’s in my dreams. It’s when I’m awake. It’s when I hear a noise. I can’t get it out. Which is what Nigel is referring to. And that is absolutely true. It’s interesting to contrast that to people who were traumatised as children and present to me as adults. So people that were traumatised as children and present to me as adults do not come to me and say, Ellie, I was, I’ve got this trauma. I can’t get it out of my head. What they present me with is an addiction, an eating disorder. Chronic depression. Obsessive compulsive disorder. Self-harm, etc., etc., etc.. And why that happens is because when our personalities quote unquote. Developing throughout our, you know, childhood and teenage years. But the mind seems to do is adapt to the trauma. When we have trauma as young people. And it creates compulsive patterns. In order to fail to split off or dissociate or repress whatever word we want to use, the traumatic events and emotions connected with that trauma. And so by the time the person is 20 or 30 or 40, what they’re presenting with is the compulsion. They’re presenting with the compulsive thought patterns, emotional patterns, behavioural patterns which are covering over the trauma rather than the actual trauma.

Dr Ron Ehrlich [00:36:37] A sort of a sort of a dysfunctional pattern here.

Dr Eli Kotler [00:36:41] 100%. It’s a compulsive, impulsive, repetitive pattern of thoughts, feelings, behaviours that somehow the personality has adept, has, has created in order to protect the person from the intolerable trauma, and at the same time comes at a cost and is harmful for the person with the, with the probably best example being in addiction, which is exactly that. It’s a compulsive impulsive pattern that the person cannot control. It’s repetitive, but it’s helping the person deal with something else. And that pattern, even though it’s helping the person dealing with something else, has become destructive in and of itself.

Dr Ron Ehrlich [00:37:30] Yeah.

Dr Eli Kotler [00:37:31] Yeah. So I just wanted to just add that aspect of trauma. The trauma often leads to split off. And this goes back to the idea of integration. Because trauma splits, it causes splits inside us. It causes repression, splits dissociation. You know, this is like the body keeps the score. You know, it’s in there. It’s just that my mind doesn’t connect to it anymore, you know. So it’s it’s it’s split. And what psychedelic assisted therapy tries to do is help integrate. So this it lessens the degree to which I’m internally split.

Dr Ron Ehrlich [00:38:09] Yes. I love that word. You using that word integration particularly as that image of functional MRI. It’s a beautiful way of describing that functional MRI.

Dr Eli Kotler [00:38:22] Yeah. So that functional MRI is quite awesome. I know the picture you’re thinking of. Yes. You know and again, that but I do want to make one point, which may be somewhat controversial, but, you know, I think it’s important that these, the neural correlates of. So something happens on when we use psychedelics, which we can talk about hopefully. And that thing that happens, you know, there’s something going on in the brain when that happens and that looks like something there are, in other words, you know, in scientific jargon or philosophical jargon that would be called the neural correlates of the experience. So there’s the experience that the person has. And then there are the neural correlates of the experience. That’s what’s going on in my brain when I’m having that experience. But I want to emphasise that to me, what is healing is the experience itself. It’s not what’s going on in the brain. And, you know, we will be able to to prove this one way or another. So I might I might be wrong. And that’s okay if I’m wrong because people are trying to develop psychedelics, that when you don’t have the experience, you know, where things are happening in the brain, where you don’t actually have the experience is connected to that. And if they are successful in creating those compounds, we will know, because a lot of those compounds will work or they won’t work. I suspect they won’t work because I think it’s the experience that people have when they’re on psychedelics that help. And it’s not the it’s not what’s happening in the brain per se. Obviously, they there’s a correlation there happening together, but it’s the experiences that people have which are healing.

Dr Ron Ehrlich [00:40:17] From for me. But but for somebody that yes, I can imagine that being the case because for somebody that would have had this trauma experience, whatever going on in their head or have developed a dysfunctional pattern to deal with something that they weren’t even aware of, just this expansive experience, which I’d like to be talking about. We will talk about this expansive experience must be so wow, you know, like what? This is all going on in my head. In my own head. This is going on. I must open up all my all sorts of possibilities, you know, to deal with it. Let’s talk about the psychedelic. Let’s talk about this psychedelic weed. Like the foundation say, like we’ve laid the foundation.

Dr Eli Kotler [00:40:59] Yeah.

Dr Ron Ehrlich [00:41:00] Tell us, tell us about. Tell us about the. Psychedelic assisted therapy, what it is and what you why you are so excited about. Well, clearly excited about it with good reason. Tell us about.

Dr Eli Kotler [00:41:10] It. So first I’ll explain the model and then maybe we can talk about the experiences people have. So the model is a new model in psychiatry. In mental health there’s nothing like it because what this is doing you know traditionally there’s been medication and therapy. But this is medically facilitated therapy. So it is called psychedelic assisted therapy. So it’s primarily a therapy. And the medicine is there to facilitate a therapeutic process which you could call integration. So as to the medicine is used to facilitate therapy. So this is a new paradigm. We haven’t had this before. And what tends to happen I should also preface this by saying it’s in its infancy. Psychedelic assisted therapy in these Western sort of models. Obviously it’s been used by other cultures for thousands of years in our sort of Western paradigms. It’s very new. So what I’m saying now could be very different in five years. But at the moment, what tends to happen is that I’ll meet someone and there’s a preparation phase, which basically means I try and get to know them as well as I can. You know, there are technical things like inclusion and exclusion criteria. Those are, you know, technical, medical and psychiatric issues. But assuming someone, fulfils those criteria and is eligible for the treatment, what essentially happens is I try and get to know them as best as I can. That includes what difficulties they’ve had, what traumas they’ve had. I try and get a sense of the structures that their mind might use to protect them from what’s underneath, how they process feelings, how they don’t process feelings, their life histories, the significant people in their lives, their childhoods. All of these things try and get a good sense of who they are as a person. We also prepare them for the actual day. So the dosing day, because when people have MDMA or psilocybin, which are the psychedelics available at the moment in Australia, they take it in the morning and the experience lasts all day. So it’s a full day where the person sits, and takes the medicine. So we prepare them for that experience. That includes what they want the room to look like. We try and make it as non-medical as possible. They can bring things in if they want. It means meeting the second therapist, because there’s always two people sitting in on the on the medicine day and the.

Dr Ron Ehrlich [00:43:41] Second not two psychiatrist.

Dr Eli Kotler [00:43:43] It can be two psychiatrist it can be a psychiatrist and a psychologist can be a psychologist and a therapist. And it can potentially even be two therapists and two psychologists.

Dr Ron Ehrlich [00:43:52] Right.

Dr Eli Kotler [00:43:54] Generally it’s a man and a woman. And that’s a lot about that, that that’s about the psychological aspects. But it’s also just about mitigating the risks, that there should always be a female and male sitting in with the person. And so, yeah, the preparation also talks about the risks. So there are significant risks.

Dr Ron Ehrlich [00:44:18] Can you. Oh, I was going to I was going to ask you two things before we get on. One is what are some exclusions. And secondly, what are some risks.

Dr Eli Kotler [00:44:27] The important psychiatric exclusions at the moment, basically people have had to have experienced some type of psychosis. So people with schizophrenia, even bipolar type one, going back to our friend the DSM and the diagnoses, people that have experienced significant amount of significant amounts of drug induced psychosis, you also have to be and that might it’s just interesting to note also that that may not always be an exclusion. That’s an exclusion at the moment because. It’s in its infancy. We’re being cautious. There are also, you know, the person really has to be stable at the moment. The person should have good support around them. They should not be acutely suicidal. They should be in a point of their life, whether with a with a container. They’re in a safe enough container to really do some intensive psychotherapeutic work. And if people are unstable. You know that can be risky. So the person should generally be stable. And there are some issues with medications that can interact. And sometimes, you know, the, the, the most significant thing there is that with MDMA, MDMA causes a massive release of serotonin. And so if people are on certain antidepressants and anti-anxiety medications like SSRI and scenarios, like fluoxetine of effects, you know, things like that, those medications actually have to be weaned and stopped, before. So there are these sort of medical and psychiatric issues and risks. Risks. So I mean, physically these compounds seem to be really pretty safe. They’re the they’re actually very safe relative to some of the other medications that psychologists prescribe.

Dr Ron Ehrlich [00:46:23] Yes.

Dr Eli Kotler [00:46:24] The risks tend to be around the experiences the people will have and those and which speaks to really the dosing day. So I’ll, I’ll, I’ll join the two conversations. That’s the two ideas. So you do the preparation which is about risk which is about consent and about understanding the person and about educating the person what’s going to actually happen. Then you have a dosing day. So the person comes in early in the morning. The two therapists are there. The person comes to a room which is hopefully, hopefully quite a nice and relaxing environment. There’s a bed. The person sits on. The bed lies down on the bed. The two people are there with the person. The person takes the MDMA or psilocybin and that goes for many hours. So the medicine starts to work. There’s usually music which can be discussed before. So music can really help the journey, the the experience and enhance the experience and also direct the experience. In some ways, the person there’s a blindfold. Sometimes people are encouraged to use blindfolds to sort of, you know, go inwards more than the ad in the world. You know, things like blood pressure and heart rate a monitored a few times throughout the, the, the day. But it’s literally the person sitting on on the psychedelic for many, many hours. And really the job of the therapist is to keep the person safe. There is some therapy that happens over the day, but generally the sense is to let the psychedelic and the person’s mind go where it needs to go and do what to do, what it needs to do. And it generally does that, which is fascinating and mysterious and awesome. You know, we’re taking a, you know, a compound from a mushroom should do that in the human mind.

Dr Ron Ehrlich [00:48:15] He’s a I think it’s I think it’s an issue that has fascinated humans for tens of thousands. Well, certainly thousands of years and probably tens of thousands of years. So it’s it’s been and it’s probably what attracts people. This altered state of reality is something that humans find remarkably appealing, isn’t it?

Dr Eli Kotler [00:48:35] It’s awesome. You know, I mean that in the true sense of the word awesome. And it’s mysterious. But this brings me to the risks. Because you mentioned risks so often, the experience is actually quite difficult. So there may be experiences of, you know, ecstatic feelings and beautiful feelings of oneness and connection, which I’m sure your listeners can imagine. For someone that’s been struggling with depression for maybe 30 years to all of a sudden feel beautiful, ecstatic, connected to other people and the world, you know, so much of depression is disconnection. And terrible loneliness. And for people who have been suffering with that for so many years, to all of a sudden feel connected and open is remarkable. But the experiences are often difficult and which speaks to the integration aspect because people often do face their demons, their trauma. Reading Stan Groff, who was one of the psychiatrist who, worked with these compounds before they were outlawed in the 60s and 70s. He has spoken of people literally becoming devils. You know, almost like you might see in The Exorcist movie or something. You know, like they, you know, they’re those devils that they carry inside them. You know, they embody that for some of the time during the experience. So the experience is really can be quite scary. And which is in a way the point, you know, it’s kind of the point of the therapy is to face the parts of ourselves that we’ve been running from. So it’s almost the point of the therapy, you could argue, or at least 50% of it, to to face these difficulties. And the risk is that if the therapists are properly trained and they’re not properly, you know, they’re not, I guess, ready for it in themselves, that experience. Could be retraumatizing for the person. You know, the person really needs to be held in that experience. And over the coming weeks, which is the integration phase, which is, you know, so so there’s the preparation, then there’s the medicine session on the day, and then there’s the integration phase where whatever comes up for the person is integrated. It’s spoken about, it’s felt, it’s understood, you know, with the help of a well, hopefully appropriately trained person to do that. And so the risks the biggest, you know, the biggest risk for me when I think about it is that difficult experiences come up for the purpose, for the person, that the people there are adequately trained to help them through that.

Dr Ron Ehrlich [00:51:20] But and, well, let’s just talk about, g there’s already a few quite a few questions I got there, but but, let’s talk about the training, because I can imagine, you know, this is such a different approach. I mean, you’ve, you know, you preparing your offering, you know, a mechanism for doing it. You’ve got two practitioners looking after you, to guide you through this and then to talk to you about it with a sense of familiarity, of what you may or may not have gone through, but at least open to the experience. Tell us about the training.

Dr Eli Kotler [00:51:56] Yeah, it’s really interesting question that I’ve thought a lot about. So, just so people are aware, aware of any, potential conflicts. I’m the Australian director of one of the training programs, which is the certificate of psychedelic assisted therapy run by Modern Medicine Australia. So I’ve thought a lot about and we’re not met with people that are trying to, design this program about how to train people for this. And what we’ve basically come to is the. Conclusion that. So you know, our course runs for its run between 4 to 6 months. The information. He’s excellent. I think, you know, world experts discussing, you know, everything from the medicines to the reactions to the integration, to the preparation. So all the knowledge is there. So. The student gets the knowledge. But what’s surely more important is who the therapist is rather than what they know so clearly they have to know some things. I have to know some things. In order to do psycho psychedelic assisted therapy. Like, literally, I need to know the dose and I need to know the risks, and I need to know the exclusion criteria, and I need to know the process. But what’s more important, ultimately, is who I am as a therapist. And I think that is true in therapy in general. And it becomes particularly important in psychedelic assisted therapy. And what’s interesting to me, and sad at the same time is that, you know, for example, I was just looking at a book by Frida from Reichman, who was a psychoanalyst decades ago. It’s probably written in the 60s, the book even maybe 50s or 60s. It’s a book on psychotherapy. Literally. The first half of the book is about the person, as a psychotherapist, the personality of the therapist. That’s the first half of the book. If you look at a contemporary book on psychology or psychotherapy, how much of the book emphasises? The person you know. So in other words, psychotherapy has really shifted from who the therapist is to what the therapist knows. Interesting and and I think that’s an era. I think that’s not good. And and so just to finish that thought. Yeah. Yeah. So what we’re trying to get across to people is yeah, there’s knowledge and we’ll give you all the knowledge that you need. But what what we’ve done is we’ve built into the course a personal journey for, for each person doing the course to have their own journey, because it’s really about that. It’s about the person becoming the type of human being that can sit with someone else, who has had a lot of trauma and has very things inside of very scary things inside of them.

Dr Ron Ehrlich [00:55:11] But for you who have been a psychiatrist for some years now, two and having been through the psychotherapeutic approach, psychodynamic approach, this is like putting this is accelerating, breaking through so many barriers that in the past must have taken you months, years, or maybe never to get through. Is that how you’ve perceived it? Yes. And tell me this. Tell me this as a I mean, you know, we don’t usually ask brain surgeons to go through brain surgery, and we don’t use heart surgeons to go through open heart surgery to fully understand what it is they’re doing, although it be an interesting, exercise in itself. But but this particular form of health care of particularly dealing with mental health, it would seem to me that it would be absolutely critical. And I guess that’s what you’ve been saying, that the the therapist in the training experiences this themselves.

Dr Eli Kotler [00:56:10] Yeah. So I and I actually think it’s different than brain surgery or other areas of medicine. I think that everyone that does therapy should have their own therapy. And that’s because it actually makes a difference. You know, you could argue probably very successfully that a brain surgeon. Will be just as good doing brain surgery if they themselves have had that surgery or not. However, I could argue very strongly and probably successfully that a therapist will not be as good unless they’ve really done a lot of work on themselves, whether that’s through therapy or some other work. I actually think it makes a significant difference. So as a general comment, I think in therapy it’s important for a therapist to have had their own therapy. And I think in psychedelic assisted therapy, that becomes even more pronounced because the, you know, what’s called the sort of the transference, kind of transference, the interactions between you and the person and what the person is, what’s coming up in the person becomes even more intense. And so I do think it’s, important. I do also think it’s important, though not absolutely necessary, that the therapists have had a psychedelic experience. You know, I think it’s wonderful if people can find ways to do that and if they choose to do that. I actually think it’s more important for the person to be a good therapist and have therapy themselves then to have had a psychedelic experience, per se. Yeah.

Dr Ron Ehrlich [00:57:51] Because there’s something quite safe, almost, for a therapist. In a slow reveal, isn’t it? There’s something quite safe for them, because it’s kind of coming out in dribs and drabs, and you’re kind of experiencing it and processing it yourself as a therapist. But here. Wow. I mean, what you may end up dealing with is coming at you very quickly after the session.

Dr Eli Kotler [00:58:14] Yeah, I think that it’s a really important point, and I think it’s, quite an insightful point that you make because therapy is scary for the therapist. Yeah, it really is, because you have to explore. Things like rage, violence. You know, in, in the person that you’re working with. And those things are scary. And so if I am not equipped to hold that in myself, then I’m going to put stumbling blocks and roadblocks in front of my patient. Even if I don’t realise I’m doing that. It could be unconscious. I might just change the topic, or I might choose to ground the person in front of me, rather than allowing the person to fully experience what’s going on for them. Not not to help them, but just because of my own anxiety about what’s going on in the room. Yeah. Yeah. And so. Yeah. Absolutely. And like, like you suggest that these things can be even more intense in a psychedelic session. So.

Dr Ron Ehrlich [00:59:10] Because I often say that health care is really straightforward apart from two minor variables, and that is that the patients are only human and so are the practitioners. But apart from that, it’s apart from that it’s very straightforward.

Dr Eli Kotler [00:59:24] Exactly what could be complicated about two people sitting in a room together. That’s three people sitting in a room together. Tell me you.

Dr Ron Ehrlich [00:59:31] Mention I just. Look, we could keep on talking. I just want to ask you a couple of other things. You mentioned Stanislas Graf Groth, who I’m very familiar with and has done the whole of Tropic well since he stopped doing therapy with psychedelics, transitioned into Holy Tropic Breathwork. Which you know what? What do you know much about how the traffic breath work?

Dr Eli Kotler [00:59:53] Yeah. So when I did the CPAp program, I did the first iteration of the CPAp program. And, as part of that program, because it’s obviously illegal for us to take psychedelics in Australia. What they used as an analogue for that was holographic breathwork, although I don’t think they called it that. Whatever. I won’t get into the intricacies, but I did, you know, an equivalent of holographic breathwork. I can say that for me, at that point, I’d probably done four years of weekly therapy, and I found that experience of the breathwork extremely profound and useful, and it took me to places inside myself that I had not been able to access before. You know, I’m sure that having done the therapy myself allowed me. To use the Holy Tropic Breathwork to use that breathwork, you know, more constructively. But I found it extremely, extremely profound, to the point that, you know, thought about trying to bring it into the hospital in terms of a treatment. I found it wonderful. And it definitely gave me an experience of an altered state of consciousness. It took me right into my body, into my emotions, into my past. My imagination was flying. It was.

Dr Ron Ehrlich [01:01:17] And for those I know, for those that haven’t heard of it, what very quickly is the difference between normal breathing and hollow tropic well, breath, that kind of breathwork.

Dr Eli Kotler [01:01:29] It’s essentially it sounds ridiculously simple, and it is actually, all I did was over breathe for about 20 minutes. Like, literally, I was. I mean, you know, there was a whole ceremony. I’m not saying like, you know, and it was with a lot of other people and there was a cedar with me. So it was all safe and everything, but I literally just breathed deeper and faster than I usually do for about 20 minutes. And I was off with the fairies.

Dr Ron Ehrlich [01:01:55] For how long?

Dr Eli Kotler [01:01:57] Three hours.

Dr Ron Ehrlich [01:01:59] Really? After that? After that initial thing? Yeah. Interesting. Because he come in, he transitioned from psychedelics. He wasn’t able to into that. And now I know runs courses on it of which I’m signed up to do one. But, that’s a whole other story.

Dr Eli Kotler [01:02:14] Oh, I’m excited for you.

Dr Ron Ehrlich [01:02:15] Yeah. No, I mean.

Dr Eli Kotler [01:02:16] It was. Yeah.

Dr Ron Ehrlich [01:02:18] How the professional bodies, approach this. I mean, I mean, the TGA is approved, which is incredible to think. I think they came under a fair bit of pressure from that and. Good, good to and congratulations to Mine Medicine Australia and the 13,000 people that made submissions to the TGA to encourage them to do it. How have the rest of the profession, embraced this or approached this? What’s your sense?

Dr Eli Kotler [01:02:47] Very mixed and actually quite strong opinions. So you know me, for example, I’m a psychiatrist. I’m a member of the college. I mean, I’m not particularly a vocal person in terms of publicly, but I would be an example of a psychiatrist that’s really, you know, quite strongly for the introduction, in very controlled circumstances, compassionate use, etc.. And I know that there are some psychologists that are very vocally against the introduction. And that’s how it is. And, you know, that’s psychiatry in a nutshell. Psychiatry is conceptually complicated. And because of that, you’ll have very different ideas on what’s going to work. What’s not going to work has to be best help people. But, there’s definitely a significant, you know, there are significantly differing opinions, strong opinions, differing, you know, strong, differing opinions about it.

Dr Ron Ehrlich [01:03:47] I mean, I know that, you know, I think ignorance. Well, I think firstly, the difference between recreational use of these kind of things and therapeutic use need to be really highlighted to the people because it’s, I don’t think, addictive, this kind of experience, although although there are very few therapies where I believe four out of five people come out of it saying it’s one of the five most meaningful experiences of their lives. I doubt whether you’ve ever prescribed an antidepressant to somebody and two months later, come back and told you that. But I guess I guess ignorance is is is a powerful driver here. I mean, I practice ignorance every week. That’s why I have a podcast and I get to ask people like you questions and and they answer them and I learn. But I guess when ignorance is mixed with ego and arrogance, of which there may be a bit of that in the medical profession, I guess there’s kind of some constraints there.

Dr Eli Kotler [01:04:44] Yeah. So I’m not, I’m not going to.

Dr Ron Ehrlich [01:04:48] I don’t want to put you on the spot.

Dr Eli Kotler [01:04:50] You know, potentially why people have their opinions. People have their opinions and they have their opinions. You know, I do know that in general I’m an outlier in psychiatry. I generally have more critical views, like like I’ve discussed before on the paradigms we use on the diagnoses. And so in general, I’m an outlier in psychiatry. So I’m not surprised at all that there’s a lot of psychologists that, you know, would disagree with me. And and I’m like, you know, I’m okay with that. And yeah, you know, I’m not sure exactly why, but it probably has something to do with, you know, how I conceptualise psychiatric issues, you know, that, you know, and how maybe other people conceptualise psychiatric issues? You know, because for me, if psychiatric issues are based in splits and repressions and associations within the person, and this is a treatment that helps integrate, you know, then, you know, obviously for me that’s going to look like, well, that’s awesome. But, you know, maybe other people have different understandings of, you know, and I can’t prove I’m wrong. That’s just what my gut says based on my experiences. So I think, you know, maybe, maybe some of the differences comes down to how I conceptualise psychiatric disorders and how other people conceptualise them.

Dr Ron Ehrlich [01:06:12] Like you are one of the first. You are, in fact, the first therapist in Australia doing this kind of treatment. And so it’d be really fascinating, interesting for you to share with us a patient experience.

Dr Eli Kotler [01:06:24] So yeah, so obviously while I can’t share patient experiences, I do have permission. So I have a friend. Who has been part of a trial for MDMA assisted therapy for post-traumatic stress disorder. And he gave me permission to use his story. I won’t use any identifying information, obviously, but he did give me permission to use this story. And I think it’s a great story because it speaks to the mystery and the wonder of it all. And it also speaks to the power of the experience that people have, as opposed to what’s going on in the brain, which is obviously important. But there’s something about the experience which can be quite healing. So this excuse me, this person, is currently older, and when they were in their late teenage years, they. Had to, go fight in a war. They didn’t want to. But they were some scripted and they had to go. So after, you know, a few months of basic training, they were thrown out, you know, into war. And what happened to this person is that they were driving and the car exploded and awful, awful, awful things happened, including terrible injuries to this person themselves, terrible, terrible injuries, awful injuries. So this was in the late teens and that was the end of the Army service. And so this person has had a number of issues throughout their lives as, as you as you would. And the person went into their first MDMA session and after about one hour, they just went straight back there. And let’s say this person is 70 now. So but when they went back there, there were two of them. There was the 18 year old them and the 70 year old them, and they were both of them at the same time. And the 70 year old them was having a discussion with the 18 year old them. So they, you know, and this is while the person was lying there injured when they were 18. And so the 70 year old goes back there and they start a discussion between the two of them. And this discussion, you know, who knows how long it goes for because time becomes little bit, vague in these, in these experiences. But essentially they have this discussion whereby they reassure each other. So the 70 year old person looks at the 9 to 18 year old person and says, I don’t remember this. Like, this is awful. Like, this is terrible. You know, saying the injuries and all the carnage. And the 18 year old says back, well, yeah, because your mind protected you. You’re not supposed to remember this. You know, you can be here now, but your mind has protected you. And and that’s why you haven’t remembered it. You know, the 70 year olds like. Oh, okay. Sure. That makes sense. And then the 70 year old reassures the 18 year old and tells him, you know, like, it’s okay. Like, this is awful. But, you know, don’t worry. Life gets better. You know, you heal. You have a family, you get married, you have kids. It’s like it’s going to be okay, you know? And the 18 year old teams like grow, you know, amazing. Like that’s that’s so great. And you know, so they have this like, in interactions. You know, and then all of a sudden it disappears. You know, and he’s he’s back. He’s back, you know, and he’s real tough. And I saw him a few weeks after this experience, and he told me that some amazing things have happened. So, for example, he said he’s sleeping the best he’s ever slept since that happened. And he realised. So he had an insight that the reason he hasn’t been able to sleep is that he was scared, that in his dreams, he would be taken back there and he wasn’t ready to go back. There was too scary. But now, because he’s been back there. And he knows it. And it doesn’t scare him anymore. All of a sudden, he’s sleeping fantastically because he’s not scared of sleeping anymore. He’s not scared of the dreams. And, you know, I think that’s a beautiful example, of what can happen, in these experiences. Because, you know, we can try and explain this. You know, I’ve got I could speak for hours about the neuroscience behind psychedelics and the default mode network and, you know, all these things. But ultimately that that experience is just awesome and mysterious and can only be explained by the experience itself is, you know, how do you explain that? You know, I don’t know.

Dr Ron Ehrlich [01:11:15] Incredible. I mean, sends a shiver down my spine just hearing the story. And we also did a podcast with, Rear Admiral Chris Barrie, who who has his feel is.org group. And, you know, it’s sobering to know that, 50 servicemen have died in Afghanistan and Iran, but, Iraq, but, 600 or so have committed suicide since coming back. And that is post-traumatic stress happening. Well, you know, it’s happening all the time in different ways. Yeah. Amazing story. Hmhm. Listen, this has been terrific. And I knew it would be. I just want to ask you one last question very quickly, taking a step back from your role as a psychiatrist. We are all, as individuals on a health journey through this modern world. I’m wondering, what do you think one of the biggest challenges is for us on that journey?

Dr Eli Kotler [01:12:07] I think that, we do not. And I include myself in this. We do not take time to be with ourselves. And I don’t mean meditation. I don’t mean focus, breathing, things like that. I mean actually sitting with myself and looking, what’s coming up for me? What am I feeling? What am I thinking like, without controlling it, without focusing on anything in particular focus. So without focusing on something like breathing, I mean actually just to be with my feelings. So just to state that a bit differently, I think that we don’t take enough time to be with ourselves and in particular what we’re feeling. I think we are very, very disconnected as a society from our emotional worlds. And if there’s one thing I think which creates a lot of problems for us humans, is that we are disconnected from our feelings and our emotional world.

Dr Ron Ehrlich [01:13:01] Hayley, what a what a great note to finish on, and thank you so much for sharing your knowledge and wisdom with us today.

Dr Eli Kotler [01:13:08] Thank you so much. It’s been a pleasure. So thank you.

Dr Ron Ehrlich [01:13:12] Well, isn’t it exciting to hear of a psychic, of a psychotherapy or, or a treatment for mental health, which actually has a positive outcome. It’s. Well, to use the word cure is perhaps not perhaps the right word, but certainly going far, far beyond, long term management through medication. And as we’ve listened to, recent episode with doctor Mark Horowitz, who, who shared with us the personal and professional experience of the use of, antidepressants. This is, unfortunately, a therapy that is, very difficult to remove yourself to get off. But there are very few therapies in, in the world of mental health where people will describe the psychedelic assisted therapy session as one of the five most meaningful experiences in their lives. I dealt with anybody after a month of being on antidepressants would describe that, that being how they feel. So there is so much here. I encourage you to explore and support Mind Medicine Australia. This is a turning point in mental health in Australia. We will of course have links to that site. I also invite you to join the Unstressed Health Community, a community that is focussed on just one thing and that is good health without any influence from any industry. No chemical, food or pharmaceutical industry. Just what is good for health. And as I’ve often said, as the world we live in becomes increasingly more complicated. So many of the solutions are remarkably simple. Accessible, sustainable, cheap, and most importantly, effective. Join the community at, Stress Health. Until next time. This is doctor Ron Erlich. Anywho, this podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice, or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions experienced. And conclusions.