WEBVTT

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It's easy to be captivated
by the world out there.

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It's a fascinating place.

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It's deserving of this attention.

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But what if we were to invert
our focus and look inside?

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What would we find?

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I study psychedelic drugs for a living,

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and the reason why I do this -

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apart from good fortune -

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is because I think they're special.

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And the reason why I think they're special

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is that I believe
they have a unique ability

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to reveal to us
the very depths of our minds.

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Dreams and perhaps
a select few other states

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may hint at what lies beyond the reaches
of normal consciousness,

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but psychedelics, in my view, are really
unrivaled in their ability to do this.

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Now, many of you will be familiar
with the word "psychedelic,"

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but I doubt so many of you are familiar
with its origins or what it means.

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So, psychedelic was a word
that was coined in the 1950s

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by the British psychiatrist
Humphry Osmond,

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with reference to this class
of drugs that I study,

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and it combines two Greek words,
"psyche" and "delos,"

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which, when put together,

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mean "to make the mind manifest"
or "to reveal the soul."

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Now, I've been fascinated by psychology
for most of my adult life,

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but one question that has always bugged me

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is why can't it prove the existence
of the unconscious mind?

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Is it because it doesn't exist?

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Or is it because it
is especially difficult to see?

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Now, I've come to believe
quite strongly that it's the latter,

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but then the key question is

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how could we make it easier to see?

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Freud famously told us about dreams,

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how they're a window in
on the unconscious, a "royal road."

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But the problem is
dreaming happens while we're asleep,

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and then when we wake up,

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all we're left with is this flimsy memory
of what we actually experienced.

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So it's while I was studying
for my Masters

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that I found myself asking
whether a drug exists

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that could facilitate
access to the unconscious mind.

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I did a brief library search,
and I came across this book:

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"Realms of the Human Unconscious:
Observations from LSD Research,"

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written by the Czech psychiatrist
Stanislav Grof in 1975.

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So I swiftly took this book
out of the library;

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I brought it back to my room;

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I opened it and I read:

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"Many of the phenomena
in these LSD sessions

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could be understood in psychological
and psychoanalytic terms;

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they had a structure
not dissimilar to that of dreams.

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And Freud once said of dreams

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that they are a royal road
to a knowledge of the unconscious mind,

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but to an even greater degree,

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this seems to be true
for the LSD experience."

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And finally: "The capacity
of psychedelic drugs

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to exteriorise otherwise
invisible phenomena

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and make them the subject
of scientific investigation

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gives these substances

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a unique potential as research tools
for the exploration of the human mind.

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It does not seem inappropriate
or an exaggeration

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to compare their potential significance
for psychiatry" - and for psychology -

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"to that of the microscope for medicine
or the telescope for astronomy."

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So, as you can imagine,
after reading these things,

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I was filled with a very strong sense
of purpose and direction.

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I wrote to Professor David Nutt, 
then at the University of Bristol,

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and I told him I wanted
to study the brain on LSD

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and to see whether it looks
like the dreaming brain.

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Anyway, David was kind enough
to allow me to join his team,

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and then four years later,
I completed my PhD with him.

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Soon after that,

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I was lucky enough to begin
some quite exciting brain-imaging research

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with psychedelic drugs.

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First with psilocybin, which is
the active ingredient in magic mushrooms,

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and more recently with LSD.

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Now, it's quite difficult
to explain to people

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how psychedelic drugs work in the brain,

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and it's harder still
to do that in 18 minutes.

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So instead what I'm going to do

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is show you a few pictures and
give you a few analogies to think about.

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So what we're looking at here
are communication pathways in the brain.

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Each line is a communication pathway

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between two different
regions in the brain.

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And believe it or not,

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there's actually an equal number of lines,
or pathways, in these two circles,

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yet they look very different, don't they?

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Essentially, what we're seeing
is the normal brain on the left,

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where communication is confined

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to particular communities,
or cliques, in the brain.

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So, for example,

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visual regions are talking
mostly with other visual regions;

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this is what happens ordinarily.

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Then we look at the psychedelic
brain on the right;

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there's much less of this cliquing,

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and much more of an open,
freer conversation

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going on across the brain.

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Another useful way to think
of how psychedelics work in the brain

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is to think of what
it's like to be an infant:

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Experiencing everything is novel;

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feeling emotionally labile -

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one minute you're laughing
and the next you're crying;

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having a wildly overactive imagination;

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being mesmerized by the likes
of Iggle Piggle or Makka Pakka.

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It's no coincidence, therefore,

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that if you look at how the brain develops
as we develop from infancy into adulthood

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and you compare that with how the brain
changes under a psychedelic,

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what you see are kind of mirror opposites.

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So instead of a brain becoming
more sophisticated as we develop,

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more finessed,

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but also more constrained,

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you have a brain that is simpler
and freer in its functioning.

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The third useful way to think
of how psychedelics work in the brain

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is to think of the dream state.

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Here we're looking at the effects
of LSD on the brain,

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and what we're seeing
is that much more of the brain

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contributes to the visual experience
under LSD than it does ordinarily.

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And this effect correlated very strongly

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with the dreamlike visions
that people reported under LSD

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when their eyes were closed.

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So we could think of both these states,
the dream state and the psychedelic state,

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as conditions where the brain
becomes untethered, or unanchored,

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from incoming sensory information.

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And then in this state,

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it can operate in a more anarchic,
freewheeling kind of way,

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conjuring up imagery from the very depths
of the mind and the brain

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rather than relying on sensory information
coming into the brain.

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Perhaps the most important thing

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to have come out of our research
with psychedelics

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isn't the knowledge
of how they work in the brain

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but rather some idea
of how they may be useful

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or how they can be applied.

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So, we've recently completed

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the first phase of the first step
of clinical trial,

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looking at psilocybin, magic mushrooms,
as a treatment for major depression.

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Now, it's important that I make you aware

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of the magnitude
of the problem of depression;

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it really isn't something
that should be swept under the carpet

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although, unfortunately, often it is.

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It's a leading cause
of disability, worldwide.

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It actually affects
some 350 million people.

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To put that in perspective,

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that's more than the total population
of the United States.

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And if you care about money,
it's also especially costly.

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It's the most costly
brain disorder in Europe,

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and it's annual cost to the U.S. alone
is 200 billion dollars.

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That's roughly the GDP
of the Republic of Ireland.

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And depression is quite
an insidious disorder;

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it's often evident
by the absence of something.

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That might be the absence of pleasure,
or positive mood more generally,

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or it could be the absence
of the individual themselves;

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they may simply not get out of bed
in the morning and make it into work.

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The depression is the leading cause
of absenteeism in the workplace.

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But depression can also
be more stark in its presentation

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and often, tragically, when it's too late.

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Some 15% of patients with major depression
will take their own lives,

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and it's a frightening statistic now
that suicide is the leading cause

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of death among males
under the age of 45 in the UK.

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So what can be done about these things?

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How effective are current treatments?

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Well, the good news
is that they're not ineffective.

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This chart here shows
the relative effect size

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of different treatments for depression.

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Just to give you some perspective on it,

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it's convention to consider
that an effect size of 0.8 -

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which is where the line is - as large.

NOTE Paragraph

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So you can see

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that antidepressant medications,
psychotherapy and placebo

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all have pretty large
effect sizes in depression.

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But even so, around about 50% of patients

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won't respond to the antidepressants
that their doctors prescribe them,

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and as many of 20% fail to respond
to any treatment at all.

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And it's these particularly refractory
treatment-resistant cases

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that we're seeing in our current trial.

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But before I tell you about our results,

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I think it's important
that I emphasize to you,

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especially to those of you who are naive
to the effects of psychedelics,

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that an experience with one of these drugs

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can be among the most profound
of the whole of your life.

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So evidence suggests
that in terms of meaningfulness,

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it can be up there
with pretty much anything:

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facing death,

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falling in love

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or bringing in new life.

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So the key point is that these
are not party drugs;

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they're incredibly powerful substances
that should be treated with respect,

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as they have been by certain cultures
for hundreds, if not thousands, of years.

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It's also important to emphasize that
when we give psilocybin to our patients,

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we do so with full legal
and ethical approval,

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and we simply don't tell them

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to chuck a bunch of magic mushrooms
down their necks and hope for the best.

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We carefully prepare them
for their experiences.

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They're looked after
by a trained team of therapists.

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They have two sessions
with the psilocybin;

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they're looked after throughout,

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and the therapists help them
make sense of things afterwards.

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So, here we can see
the magnitude of the effect

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that we're seeing with psilocybin so far.

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Psilocybin is shown in blue,

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and you can see the data
at two weeks post-treatment

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and three months post-treatment.

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Now, I should caution
that it's early days yet;

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we had 12 patients
in the trial at this stage,

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now, actually, we have more data
and the effects look even better.

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But even so, there was several
hundred patients in these other studies.

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Also, all of our patients knew
that they were going to receive psilocybin

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whereas these other studies
had a placebo-control element -

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that's actually what we
are going to be doing next.

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Even so with these caveats,

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you can see that the magnitude
of the effect that we're seeing so far

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is pretty considerable,

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even at the three-month
post-treatment period

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where they haven't received any treatments
from us for that duration of time.

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Also remember that our patients
had treatment-resistant depression;

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many of our patients reported

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having had their depression
for most of their adult lives.

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The average duration of the illness
in this sample was 18 years,

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yet all of them showed some improvement
in their depressive symptoms

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for at least three weeks
after the treatment.

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Some two-thirds, 67%, met criteria
for remission one week post treatment.

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Remission means they
are essentially depression free.

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And 42% maintained that status
of being depression free

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for three months after the treatment.

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So to finish, I'm just going
to read you a short case report

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written by one of
the patients in our trial.

NOTE Paragraph

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He's male, age 52,

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has a very long history of depression,

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quite severe depression
stretching back to his 20s.

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He's tried a number
of different medications,

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all of which haven't worked for him,

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and also psychotherapy.

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So about his baseline state before
the treatment, he says the following:

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"For decades, I've battled depression.

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The awful feeling that you don't matter,
you're not making a difference,

00:13:33.878 --> 00:13:36.907
that everyone else
is having a better life.

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The utter pointlessness of it all,
getting no real enjoyment from anything."

00:13:42.738 --> 00:13:44.559
Then about the experience, he says:

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"There simply aren't words to describe it,

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but I can say that the usual
negative self-narration that I have

00:13:51.500 --> 00:13:53.776
had vanished completely.

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It was replaced
by a sense of beautiful chaos,

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a landscape of unimaginable
color and beauty.

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I began to see that all of my concerns
about daily living weren't relevant,

00:14:07.416 --> 00:14:11.249
that they were a result
of a negative spiral.

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I also felt like I was learning
without being taught;

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that intuition was being fed.

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The fleeting feelings
from my past came back,

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memories too,

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both of which had seemed long forgotten."

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Then about the outcome;

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this was written a couple of weeks
after he completed the trial.

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He says, "Although it's early days yet,
the results are amazing.

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I feel more confident and calm
than I have in such a long time.

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My outlook has changed significantly too.

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I'm more aware that it's pointless
to get wrapped up in endless negativity.

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I also feel as if I've seen
a much clearer picture.

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Another side to this is that I feel
like I've had a second chance,

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like a survivor.

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I can enjoy things now the way I used to

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without the cynicism,
without the oppression.

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At its most basic, I feel like I used to
before the depression."

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If you're curious how this patient
is doing in the longer term,

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we've collected his six-month
follow-up data now;

00:15:18.319 --> 00:15:21.377
I'm pleased to say
that he's still in remission.

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You can see his data
highlighted here in blue.

00:15:25.604 --> 00:15:28.557
Of course, I've cherry-picked
a particularly good example here,

00:15:28.557 --> 00:15:30.916
and you can see from
other patients on this chart

00:15:30.916 --> 00:15:33.037
that at the three-month follow-up period,

00:15:33.037 --> 00:15:35.978
they're showing some signs of relapse.

00:15:35.978 --> 00:15:40.168
So this is an important opportunity
to say that this isn't a magic cure;

00:15:40.168 --> 00:15:44.148
it's not a golden bullet
that's going to help everyone;

00:15:44.158 --> 00:15:46.237
there's much more work
that needs to be done

00:15:46.237 --> 00:15:52.514
to learn how to optimize this treatment
and further test its effectiveness.

00:15:52.954 --> 00:15:56.598
But hopefully you've got a sense
from that case that I reported,

00:15:56.598 --> 00:16:00.427
and I can tell you from many
other cases I've sat with now

00:16:00.427 --> 00:16:02.917
that when this is done properly -

00:16:02.917 --> 00:16:05.237
with the right level of preparation,

00:16:05.667 --> 00:16:08.088
good drug effects working in synergy,

00:16:08.088 --> 00:16:09.867
with good therapy -

00:16:09.867 --> 00:16:14.628
to lift the veil on the mind
and exorcise what lies beneath,

00:16:14.628 --> 00:16:17.767
it can truly work like a dream.

00:16:17.767 --> 00:16:19.097
Thank you very much.

00:16:19.097 --> 00:16:20.671
(Applause)