An Interview with Psychologist Albert Garcia-Romeu
Albert Garcia-Romeu, Ph.D. is an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. He's a founding member of the Johns Hopkins Center for Psychedelic and Consciousness Research and the International Society for Research on Psychedelics. His work specializes in the clinical applications of psychedelics, particularly as it applies to addiction treatment.
Sara Wilson: Hi everybody. Thank you for joining us today for this installment of The Seattle Psychiatrist Interview Series. My name is Sara Wilson, and I'm a research intern at Seattle Anxiety Specialists. We're a Seattle-based psychiatry, psychology, and psychotherapy practice specializing in anxiety disorders.
Today, I'd like to welcome with us psychologist Albert Garcia-Romeu, PhD. Dr. Garcia-Romeu is an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. His research examines the effects of psychedelics in humans, with a focus on psilocybin as an aide in the treatment of addiction. His current research interests include clinical applications of psychedelics, real world drug use patterns, diversity in science, and the role of spirituality in mental health.
He's a founding member of the Johns Hopkins Center for Psychedelic and Consciousness Research and the International Society for Research on Psychedelics. He serves on the board of directors for the College on Problems of Drug Dependence (CPDD), and is an associate editor for the journal Psychedelic Medicine.
So before we get started today, could you please let us know a little bit more about yourself and what made you interested in pursuing psychedelic research as it relates to the study of consciousness, selfhood, and therapeutic development?
Albert Garcia-Romeu: Yeah, absolutely. So thanks for the intro. My name is Albert Garcia-Romeu. I'm a researcher here at the Johns Hopkins School of Medicine. And let's see. I mean, it's a long story in terms of how I got involved here. I've been doing this work here at Hopkins for over 11 years. And so before that even, I became interested in this area.
But initially, my work in graduate school was not even focused specifically on psychedelics. It was really much more driven by curiosity about the intersection of spirituality and mental health, and also how certain types of spiritual experiences could interact with mental health in both positive and negative ways.
And so I think a really good example of that is that people can have spiritual, or transcendent, or other types of peak experiences that can be tremendously helpful for them in a developmental state, in terms of how they developmentally are able to move throughout the lifespan and help them build resilience against difficult life events that they may face.
But other people have really powerful, intense experiences that sometimes have more negative repercussions. Things like developing psychotic and delusional states and sometimes dealing with persisting mental health challenges.
And so that was the starting point for me. My undergraduate work, I had been exposed to both eastern religion and spirituality, and philosophies like Buddhism, Taoism, and Hinduism. And that also came along with practices like meditation that I found very compelling. And I had some very powerful experiences in the meditation club that I joined during my undergraduate when I was studying philosophy and psychology at Tulane University.
But that really translated later into a curiosity about where the overlap and where the divergence was between all these spiritual and philosophical schools and what they thought about in terms of mind and selfhood, and all of the Western psychology that we learned. Including things like neuroscience and behavioral and other paradigms of psychology.
So that kind of led me into studying other schools of psychology, including humanistic and existential psychology, which Maslow was a big proponent of. And one of his areas of studying self-actualization specifically also brought in this concept of peak experiences and the idea that people could have peak experiences that help them become more self-actualized.
And so that was really a jumping off point for me in graduate school to start studying these types of experiences that some people might consider altered states of consciousness, and that they have some relationship to things like psychedelics or meditation practices.
Sara Wilson: Yeah, thank you. I think that it's really interesting, this intersection that you've achieved in your research among existential philosophy, and therapeutics, and spirituality. I think that it's very, very good work that you do.
So now, arguably there is no single thing that is more real and immediately known than our own consciousness. However, the specific constituents of this sense of self and sense of conscious experience remains highly elusive, even among the seemingly intuitive conviction that we all have. So I was wondering before we get into the nitty-gritty, what is meant by the term consciousness, and how is this distinguished from the brain?
Albert Garcia-Romeu: Yeah, that's a great question. I would say I don't have a good answer for you. And that was something that I was very interested in early on in my research and studies when I was in undergraduate and even in graduate school. I was really curious about consciousness and what does that mean, and where does it come from?
I've gotten a little bit more frustrated with the field over the last 10 years or so, feeling like in many ways you're kind of stuck because... And we've talked about this I think in our prior email conversations, but the idea of this hard problem of consciousness is one that we're kind of at an impasse perhaps in terms of what we're able to observe, measure, and study in an empirical manner.
But consciousness is hard to define, and it's a very slippery term. But I tend to think of it as a sort of sum of all of the things that we're aware of, both internally and externally. And so we're aware of what's going on around us in the environment, and we're also often aware of what's going on in our bodies if we're feeling certain sensations or we have emotional states that we're going through. And so this is a sort of immediate first person experience that we're living in. So that's typically what many of us think of as consciousness. And of course, that's changing from moment to moment, and that can also be altered by using certain practices like meditation or psychoactive drugs.
But there's probably not one definition of consciousness that everybody would agree on. And that also makes it really hard for us to find meaningful ways to study that phenomenon. Because when we're talking about consciousness of certain stimuli, for instance, we can start to look at what are the component processes that the brain is going through to be aware of, say something like a sound, or something that we're seeing visually.
But when it comes to the whole gestalt or the whole first person experience that we're going through in a subjective experience at any point, there's really not a good explanation for the mechanics of that, how that comes to be, where it comes from, and why it even is that we have the type of experience that we have. And so that then makes it very difficult for us to be scientific about studying it, although there are lots of folks who are working on in that area, many of whom are very interested in brain related mechanisms and processes. But eventually, I sort of veered away from that and much more towards clinical work.
Sara Wilson: Right. Yeah. I remember you saying in an interview with the American Psychological Association, that many of these trials with psychedelics, for example, are focused on how the brain is responding to these drugs. And you say that it's more of a question of how the mind is responding to these drugs, which I think is definitely conversant with the hard problem of consciousness, because that's where you start to see changes in self-identity in a way that allows someone to fully live their life. And maybe that can manifest itself in measurable behavioral changes or brain functioning, but it is hard to clinically measure. So I guess that's an enduring problem in both psychology and philosophy, I guess, and many other disciplines.
Albert Garcia-Romeu: Yeah, yeah, I agree with you. We kind of run up against a limitation of what we're able to observe, because consciousness is in many ways, a first person phenomenon. So even the idea of whether or not other people around us are conscious, or whether the kind of consciousness that they experience is similar or not to what we experience is hard to say. I mean, we can't really tell that for certain. And so that makes it a sticky problem for something like empirical hard sciences to wrap our collective minds around.
Sara Wilson: Yeah. So you already touched on the hard problem and the problem of other minds, so I think it's fair to move on. I was just curious, why do you enjoy studying consciousness through catalysts such as meditation and psychedelics? Why is this research important in a therapeutic context?
Albert Garcia-Romeu: Yeah. To me, that was a really important jumping off point just because the idea that there's a sort of baseline state of consciousness as people like Charlie Tart have posited, and that we're kind in this baseline state of consciousness much of the time without knowing that, that we flip channels between being awake, being asleep, sometimes dreaming, and then that there's these other channels or modes of consciousness that we can enter, really became clear to me when I started practicing meditation initially when I was in undergraduate, and having specifically a really powerful experience practicing a meta loving kindness meditation, and having this feeling of... I don't really even know how to explain it, but there was this strong feeling of love radiating out of me all throughout the entire universe. And also just sitting there, and then all of a sudden opening my eyes when the bell rang, and just having tears streaming down my face, and a lot of really intense emotions coming along with that.
And realizing, "Wow, the way that I'm walking around most of the time doesn't mean that that's the way that I always have to be feeling and experiencing the world," and that there are these very powerful tools that we have at our disposal, these techniques or these practices, to change that way that we're experiencing things.
And that was an important realization for me that led to an ongoing fascination with what is consciousness and what are altered states. And eventually, really zeroing in on how we can use these in a way that's pragmatic and helpful.
Particularly for things like mental health conditions like major depression, anxiety, substance use disorders, where you might even think of the actual condition as almost a state of stuckness of consciousness to certain patterns. Getting trapped in these loops over and over again, thinking about oneself, thinking about negative things that could happen or that have happened, or being constantly focused on certain compulsive behaviors, or obsessive thinking about whatever it might be. Substances, for instance, is a great example. And how do we shake one out of those dysfunctional loops, so that they can get back on with their lives?
And so that was eventually where I landed. It took quite some time from initially being interested in what are these altered states and how do we elicit them, to finally getting to a point of saying, "Well, now I know more about what they are, but now we need to understand, how do we use them?" And that's kind of where I've landed most recently.
Sara Wilson: Right. Yeah. I think that you touched on a lot of very interesting points in that response, particularly ramifications of being conscious with your sense of self and a sense of agency over self. I feel like humans have a tendency to think of the world and think of self as fixed entities that we don't have much agency over.
So I guess bringing the conversation more towards selfhood, in your article “Self-Transcendent Experience: A Grounded Theory Study”, you discuss self-transcendence. What is self-transcendence, and how do participants describe a self-transcendent experience?
Albert Garcia-Romeu: That is difficult to pin down, because just like consciousness, the idea of what the self is isn't really any... There's no conclusive sort of definition that everyone's going to agree on throughout different disciplines and psychology and philosophy. But there is, again, a very intuitive sense that many of us have that I am this self, I am this person, and that's a collection of memories, and experiences, and also behaviors and habits that we kind of grow into and develop over time. And of course, that also encompasses our bodily sense of self, us being this being in the world that's moving around in space and time.
So the idea of that self then becoming enmeshed with or entangled with something greater than itself. So connecting with something bigger. And that's often a theme that you find in things like spiritual experiences, for instance, or these types of peak or mystical type experiences. Where the feeling of selfhood is temporarily almost offline, such that the boundaries between what I thought of as in here myself and out there, everything else, are very blurry.
And then all of a sudden, there's this sense of interconnectedness between what's inside and outside, or even this sense of non-duality that there is no inside or outside, that there really is just one entire organism or process, if you will, that's happening, and that you're just one part of that process.
And losing that sense of selfhood can both be frightening and overwhelming. And that can often happen to people when they're having experiences both in meditation and using psychedelics. But that can also be a very ecstatic type of experience, and it can lead to a lot of positive emotions, and potentially, I think psychological healing.
And that's really become one of the main areas that we've been focusing on specifically with therapeutic use of psychedelics, because these self-transcendent experiences outside of psychedelics and psychedelic research, they tend to be difficult to elicit. We can't make them happen when we want them to happen. They tend to occur spontaneously a lot of the time. When I was doing that small study that was part of my graduate dissertation work, I had interviewed a number of people about experiences that they considered transcendent, where they felt like they were in touch with something larger than their normal sense of self.
And what struck me is that there were a number of different triggers or catalysts that seemed to help people get there. And some of those included taking psychoactive substances like psychedelics. But also, others included engaging in spiritual practices, meditation, going on retreats, having different types of fasting or prayer practices that they were engaging in.
For other people though, this seemed to happen much more spontaneously. I mean, it would just come out of the blue. There wasn't necessarily any intentional practice to get there. And that was also something that maybe was elicited by something like being in nature or being around something that could be awe-inspiring like a waterfall or the Grand Canyon.
So the idea that we can't necessarily have these transcendent types of experiences happening when we want them make them very hard to study, we kind of have to do it retrospectively and try to put the pieces together.
But the exciting thing about the research with psychedelics over the last few decades has been specifically that in many people, it seems like we can, by using both careful preparation and then high dose psychedelic administration, help people get there in a much more reliable fashion. And then that allows us to study these types of experiences in a way that's much more convenient and easy to do, even in a laboratory setting.
So that's I think one of the major ramifications of the work we're doing, is that it allows us to really put these experiences under a microscope. Whether we're putting people in brain scanners, or we're just having them on the couch and then asking them about what it is that they're going through.
Sara Wilson: What are the perceived therapeutic outcomes of having a self-transcendent experience?
Albert Garcia-Romeu: That can be really hard to say, because it varies so widely between people. And for some people, this can be a short-lived just moment of “Aha”, this feeling of insight or realization, and going back to the way they continue to operate for some time.
For other people, it can actually sometimes be not so therapeutic, and it can be distressing, and it can lead to some destabilization, I would say. And even for some folks, in extreme cases, they can end up having delusional thinking or psychotic types of symptoms, which can be short-lived or sometimes persisting. So obviously, that's something to keep an eye on and to be concerned about.
But for other folks, there's definitely what you would consider benefits, therapeutic types of effects. So I'm just coming out of a room from a session where we're doing here for one of our studies, and the person really describing to me that the experiences that they've had here with psilocybin, which really were a powerful altered space, were really helpful in a lot of ways for them outside of the session room and in real life.
For instance, one thing that I was just told was - it was feeling that oftentimes, when people are treating her in a way that's not healthy or positive, that her gut reaction was just to let it slide, not to say anything, and just to kind of move on and suck it up. And that since she's had the experiences here in the study that she's been in, she's been much more forthright about the fact that it's not okay with her to be treated that way, that she's not comfortable with certain things, just being upfront and honest about it.
And so changing that pattern of communicating and socially interacting with people in a different way, which she also felt has been much better for her in terms of her mental health and feeling like it was really nice to get that off my chest. And that when I responded in that way, people also responded in kind and said, "I'm sorry. I shouldn't have been acting that way. That was a misstep, and I apologize."
So there's often shifts that can come along with these types of transcendent experiences that people can have, where it kind of shakes them out of some of their old patterns. And some of those old patterns might be behaving in ways that are not healthy. And if you can help instill in a person this movement in the right direction, then these experiences can be very therapeutically helpful to overcome some of those negative past patterns, and to put in place things that we hope are healthier and more adaptive.
Sara Wilson: Yeah, I think that you definitely bring awareness to the fact that we need to be aware that not everybody is ready for these catalysts of self transcendent experience. So to be aware of important markers of when somebody might be ready to transcend the boundary of self.
And I think it definitely also speaks to the importance of acknowledging a person as a being that goes through stages of development. So I know that in major depression or the dissociative disorders, maybe schizophrenia, it's characterized by a lack of a foundational sense of minimal selfhood. So maybe in order to transcend self, it's important to still have an effective sense of self before you can get to that next stage.
Albert Garcia-Romeu: Absolutely. And so we think about that. In different terms, you can talk about, for instance, having sufficient ego integrity. But yeah, having that sense of self that's stable enough that it can be shaken up a little bit, or that some of those boundaries can get blurred without necessarily leading to adverse reaction, or a feeling of total destabilization, or getting immersed in chaos.
I think it was... Gosh, I forget who said it, but I think it was Joseph Campbell who said, "The person who's going through psychosis is drowning in the same waters that the mystic is swimming in."
And so it's this idea that for some people at certain times in their lives, they can go into these transcendent or peak experiences and lose their sense of self, and it can be therapeutic or it can be beneficial for them in the longer term. And for others, they may not be in a place where having that kind of experience is a positive one, and it can actually lead to more disorientation, distress. And so that's something you have to be mindful of, certainly with psychedelic therapies. But even with things like meditation, where you've seen that certain folks can have difficult experiences that can sometimes lead to ongoing problems.
Sara Wilson: Right. Yeah. One question that came to mind from an evolutionary perspective was, how could it ever be adaptive to lose ourselves? How could it ever be adaptive for any organism to overcome self-interest?
Albert Garcia-Romeu: Well, you can think of the evolutionary purview in many ways for us to survive, procreate, keep the organism alive, basically. And so that means find food, find safe shelter, safe haven, avoid things that are trying to harm you, and find potentially a mate and procreate, and then keep the biology going. And on very simple terms, that's what we're programmed to do.
But you can also think of all of the culture, and language, and stuff that we built up in the history of humankind. And obviously looking at things like social media, or how many followers do you have, we can get very entrenched in this tunnel vision. And I think that's something that we've seen ever since post industrialization for sure, but maybe even earlier on, is that people get sucked into certain things that they're very perhaps over-concerned with. And that may be things like status, it may be things like social standing, how other people perceive us. And that can potentially lead to this ongoing over concern or rigid pattern of really reifying these things, these constructs, whatever they may be.
And so when we get stuck in these patterns and we potentially end up in pathological or unhealthy ways of being and thinking and feeling, so exactly that is when the idea that you could get outside of those loops or those patterns, I think is when we'd be able to potentially have a therapeutic intent to go in there and then shift those patterns, get somebody out of these maladaptive ways of thinking about themselves or the world.
So you can think in a very basic sense, if somebody's got just a very negative view of themselves in the world, and that's the way that they see things, and that's the way they sort of have landed in terms of their worldview and their way of thinking about things, then that would be a really nice thing to be able to transcend out of, to then potentially see other ways of seeing the world in themselves and say, "Oh yeah, I've gotten really stuck, entrenched in thinking about things this way. But there are other ways of thinking and seeing things, and maybe I can practice some of that, and maybe I can become part of my repertoire that could then lead to a healthier mental mindset."
Sara Wilson: Yeah. I think it's very hard to extricate ourselves from a lot of our daily practices once we become so entrenched in them, and not even fully comprehending what it's doing to us, to what it's doing to our ability to interact with others, and perceive our world, and how we perceive ourselves. And I think the importance of having an existential experience related to a core selfhood is maybe one of the only ways to really get out of those patterns, of those maladaptive patterns.
Albert Garcia-Romeu: Yeah. And sometimes, something that's adaptive at a time, at a certain stage or phase of our life or of our existence, may not be later on down the line. And so in order to get from point A to point B, we may need to transcend ourselves multiple times over time, the lifespan.
And just thinking about something as simple as object permanence or conservation from Piaget in development, when children go through these stages of not knowing that when you're playing peekaboo, that you're not disappearing, that you're still there. And then all of a sudden, having this kind of transcendent realization that, "Yes, even when I can't see them, they're still there." And then moving on up through that.
Those are in ways, key developmental milestones where all of a sudden, we've shifted the way that we understand the world around us. And so I think it's kind of inbuilt in us in many ways to continue to transcend.
However, it's also extremely common nowadays, I would say, for adults to sort of get to where they're at in perhaps their twenties, thirties, and so on, and stop developing in some ways, and becoming stagnant.
So it can lead to what my mentor and professor at graduate school, Jim Fadiman used to call this psychosclerosis, this hardening of the attitudes where we just kind of like, "Well, I know everything I need to know. I'm a fully formed person, so what else is there to do or to learn?" But if you keep having this idea in the back of your mind that there is more growth and there is more development, then that allows us to keep visiting that transcendent territory, and hopefully becoming a better version of ourselves.
Sara Wilson: Yeah, for sure. Yeah, I love that. So we've already touched on this quite a bit actually, but could you explain to our audience what psychedelics are, and what specific altered states of consciousness can occur with psychedelic interaction?
Albert Garcia-Romeu: Yeah. Psychedelics are a fascinating class of substances. And I even hesitate to use the term drug. I mean, you can say drug because some of them are molecules that were made by humans, but many of them are just these naturally occurring, found in nature molecules. And psilocybin is a great example.
It's something that is an alkaloid that's produced by over 200 different species of mushrooms. Why exactly do mushrooms make this specific chemical? We don't know. But for whatever reason, it interacts with our brain's serotonin receptors. And specifically what we call the classic psychedelics, including substances like LSD, psilocybin, DMT, mescaline. Many of these are occurring in nature, and then they're something that people have had a longstanding relationship with, have used for a long time. These mushrooms, for instance, that are containing psilocybin, because of their psychoactive effects. And so in terms of how they work, we believe that the serotonin 2A receptor is a big part of the puzzle in terms of the neurotransmitter, the pharmacology of the drug.
There's more to it than that. And we're slowly unlocking these mechanisms as we do more science to really drill down on what's happening in the brain when people and animals are exposed to these substances. But they have these really profound psychoactive effects, which I think is one of the reasons why people have taken them for so long.
And so for instance, we know that for thousands of years now, people have made artifacts around these types of mushrooms, showing that they have a sacred status in ancient and indigenous cultures. And the Aztec people, for instance, called the mushrooms teonanacatl which roughly translates to the divine flesh.
So for a long time, people have known about these substances, they've used them. And in terms of what they're doing, they can produce changes in our perceptions, and changes in our cognitions, the way that our mind is working and that we're thinking, and intense changes in our emotional state. And when that's happening, people are under the influence of psychedelics. It can last, depending on the substance, six hours, eight hours, or even longer.
And during the drug effects, people feel these altered states of consciousness. So their brain and their mind is working quite a different way from their normal sense of self.
But what's also very interesting and what we found in more contemporary research over the last 20 years or so, is that those temporary altered states of consciousness also seem to have an association with or can be linked to altered traits or altered ways of being in the world, and altered ways of experiencing ourselves and the world.
And that from a psychotherapist standpoint is very exciting, because one of the key things that people come to therapy for is because they want to find some way to change something that's not working for them, or somewhere where they feel stuck.
And so there's something about the altered consciousness that psychedelics can bring about that seems to lend itself to helping people make these longer term trait changes, which is fascinating because there's not a lot out there that we know of that can really do that in a reliable way.
Now, in terms of what kinds of altered states that people experience, it really runs the gamut because people can have... And it depends on the dose, which is very true in pharmacology in general. If you have a little sip of wine, it's going to be a very different experience than having a whole glass or a whole bottle of wine. And so the dose definitely affects the way that the drug is experienced.
But on lower doses, people often are having visual perceptual changes. It also depends on the drug, because they all have a slightly different pharmacological profile the way that they work and bind to different receptors.
But generally, these serotonin 2A agonist classic psychedelics are causing both these visual and perceptual changes, which are reminiscent of the types of tie-dye and paisley art and imagery that we see from the 1960s when psychedelics were a big part of the counterculture.
But then there can be certain characteristic types of experiences that people have when they're under the influence. And some of these can include autobiographical content that can come up.
I've talked to people, for instance, who have said they've taken ayahuasca, which is a DMT containing psychedelic mixture that's used in Amazonian cultures in Central South America. And what they've said about their experiences, it was almost like their brain was playing a highlight reel for them of all the terrible things they ever did in their lives, all of the things that they regretted, they felt bad about. And that in through going through, that they were also in a way able to go back and come to terms with and forgive themselves for having gone through that, and realizing maybe I knew better, and I needed to learn from that experience. Or maybe I didn't know any better, and that was just an honest mistake that I made.
But by going through that process, it can be very helpful, or at least people have told me that can be very helpful for letting go of some of these feelings of guilt and shame about things that have happened in the past.
Besides autobiographical content, though, people can have all sorts of really unusual content. Whether they feel like they're seeing imagery. And some of that imagery may be very basic geometric shapes and colors. But other times, people can find themselves in whole alternate dimensions where they see themselves in outer space, underwater, seeing themselves interacting with other creatures or beings. Some that might be experienced as having sentience or consciousness of their own.
Sometimes, people feel as though they're having encounters with higher power of some sort, and that may be a deity like Jesus Christ or some sort of incarnation of a Buddha, for instance, or saints, or visions of other types of spiritual figures.
Sometimes, people talk about having experiences where they're in contact with lost relatives and loved ones that they're no longer with us, but that they're able to re-contact during their experience.
Sometimes people can also have very challenging and frightening experiences where they feel paranoid, they feel strong anxiety, they feel a lot of disorientation. So that's something that we have to work with acutely when people are here in the dosing sessions. And it's also something that we see obviously, when people are using these substances recreationally. And sometimes they need to be cared for either by medical or psychological people, or by friends and loved ones who happen to be there.
And another big experience that we see and that we've spent a lot of time studying is this what we call mystical type experience. But I think that can really be interchangeably called a number of different things, whether we're talking about a unit of experience, or a spiritual or transcendent experience.
And really, there the key is just this sense of oneness with everything around us or with the universe. And I think that sense of unity is one of the key features that people will often describe when they go through these high dose experiences.
Sara Wilson: Yeah. In your article “Clinical Applications of Hallucinogens”, you find a meaningful interaction between mystical experience and the big five personality traits, particularly increased levels of openness to experience. And I was wondering if you could explain these findings a little bit for our audience.
Albert Garcia-Romeu: Sure. And so that's from some early work that was published out of this lab here at Hopkins. And what I think is more interesting now is that we've seen a shift in the data. So they're not all consistent, and that's not uncommon in science.
But what I would say is that really, the initial cohort that went through some of the early studies with psilocybin here at Johns Hopkins, this was work that was conducted by Roland Griffiths and Bill Richards, and others who were here at the time, Mary Cosimano.
And what they found though, was they took a bunch of healthy people. So they weren't people with any particular mental health condition like depression, but they actually had a clean bill of mental health. And they volunteered to join the study where we would give them a high dose of a psychedelic drug. Many of them had never taken any type of drug like that before.
And what they found in these early studies were that those people were coming in with a high level of baseline openness, higher than your average, at least average college student, which is what a lot of these data come from with psychological tests and inventories.
However, what they also found was that the greater mystical type experience they had under the influence of psilocybin, then those individuals were having increases in their personality openness, which is one of the five domains that's been proposed within this model of five factor model personality. There's openness, conscientiousness, extroversion, agreeableness and neuroticism.
And so what we found with healthy people is that when you get people who have mystical type experiences with psychedelics, that increases their personality openness. And that's actually quite interesting, because personality openness has got a number of little subdomains or factors. But that includes things like aesthetic appreciation for art and music, and also open-minded tolerance of others' viewpoints. And so by being more open to others' views, that's something that could really be helpful in a lot of ways, if you think about what we find ourselves in contemporary culture.
Now, that data though, now that we've kind of zoomed out... And I recently came back from the Psychedelic Science conference in Denver where I went with a group of my colleagues here from Hopkins, and one of them, Nate Sepeda, was presenting on some data that we'll publish soon.
But he looked at data from hundreds of people that have gotten psilocybin in these different studies. And what he was finding was that there wasn't one clear path in terms of how high dose psilocybin was affecting your personality. But that for instance, different groups of people were showing different patterns.
So one of the things that's been found is that, for instance, people with depression, they tend to come in with higher baseline levels of neuroticism. And that tends to be something that comes down after treatment with psilocybin. And for some people, there's also increases in things like extroversion. Or basically, the ability and the desire to be social with other people.
So I guess the story here in terms of impact of psychedelics on personality is still taking shape, and it's still a little unclear. But depending on where you start, we can say that there's potentially some type of response that you may have in terms of your personality possibly being changed after these experiences. And for some people, the mystical type experience, certainly for healthy people, can lead to increases in openness. And for other people, we can see different changes like reductions in neuroticism or changes in some of these other factors like extroversion.
And so there's still a lot more to study there. But I think one of the takeaways there is that it sort of depends on what your personality is like when you go into that, which is a big maximum of psychedelic research, this idea of set and settings. So the person that's going into it is going to be impacted differentially because of who they are when they show up to that experience.
Sara Wilson: Yeah. Okay, yeah. This leads us really nicely actually into my next question, which is, are the changes in personality elicited by psychedelics encouraging or bringing out traits that were already in the person?
Albert Garcia-Romeu: So that's a difficult question to answer. We can't really say yay or nay on that, because it's kind of unclear where a person's, what their inherent tendencies are. You can say psychedelics are really uncovering who a person was all along, but it's hard to say yes, that's who the person was all along, in any sort of authoritative way.
But there's an idea in psychedelic therapy, this idea that psychedelics can kind of help people get in touch with parts of themselves that perhaps have been obscured or maybe covered over by life experience. And by getting back in touch with those parts of ourselves, they can help us get to where we're supposed to be going or develop more towards our true self, whatever that is, leading us towards more authenticity. So I think that that's certainly a working hypothesis that many people have brought to this psychedelic therapy and research space.
Sara Wilson: Yeah. I guess regardless of whether it's helping us get in touch with our true self or helping us get to where we ought to be going, I think it definitely does illustrate the positive, powerful potential in the human brain as something that we can unlock certain things, whether that's who we are or where we should be going.
Albert Garcia-Romeu: And really, what I think is more pertinent is that if you think about people, a lot of who we are is predicated on what we experience and what we're taught. And so for instance, a person who's raised in a certain family, and culture, and environment may take on lots of ideas and beliefs that they may not have chosen. They're just what were thrust upon them as they were children and then growing up.
And so what's really nice about psychedelics is that it seems like it can help people to take a step back, and reexamine those beliefs and those ways of thinking about the world and themselves and say, "Now how much of this is actually true? How much of these are beliefs that I want to hang onto and that I feel are authentically a part of who I am?" And how much of this can I say, "You know what? That was stuff that other people basically spoon fed me, and I don't think I need to be this way, feel this way, think this way anymore." So you can think of lots of examples.
But being raised in a xenophobic, or racist, or homophobic type of situation I think is a great way to think about when we're spoon-fed some perhaps not particularly healthy ways of thinking about the world, and we're able to step back and say, "Is this really who I am or who I want to be?" And then making a more conscious, informed decision as an adult.
Sara Wilson: Why do you think it's difficult for people to address deeply rooted issues naturally, and how might psychedelics help facilitate getting in touch with our subconscious?
Albert Garcia-Romeu: That's a great question. I think it really depends. But oftentimes, just like what we're just talking about, when we have big experiences, traumatic experiences even, they can be so overwhelming that, again, the ego integrity, our ability to really process those experiences just isn't there yet.
And so it may be something that we just don't know what to do with. It's almost like you're handed this big experience that is really powerful, and intense, and disruptive in a way to one's worldview and one's sense of self and saying, "I don't know what to do with this. I have to put it somewhere where it's out of sight and out of mind," so it can stay there for many years for lots of people.
And I should say I'm talking more now from clinical and lived experience and less from empirical data here. But it seems to me that when we go through these types of really difficult experiences... And it can happen at any time of our life. It might be childhood, but it could be in adulthood, it doesn't matter. It can be so frightening, powerful, or overwhelming.
And you can think of, for instance, a veteran who's in a combat zone and is in an experience where their life is in danger. They may see other people that they're with being harmed or killed. And again, their number one priority at that point is survival, make sure I get through this. So they may not have time to even then as adults, process that experience then and there. And it may be so unpleasant and so intense that again, it kind of gets swept under the rug.
So we have a tendency to often have these big experiences and try to get past them, move beyond them, but perhaps not really deal with them to the level that they need to be processed for us to make sense of them and to come to terms with them.
And I think psychedelics have a really powerful way of sweeping out whatever's under the rug for us to see and say, "Hey, this was important." Whether you were able to deal with it or not, now is a time for us to go back to this and look at it, and try to put this together with the rest of the life experience in a way that is cogent and makes sense, and that we can also come to some sense of acceptance or at least acknowledgement that yes, this is something that occurred. This is a part of my life story, whether I would've chosen it or not. It is there. It is what it is. And from there, I think you can get to a place where from a therapeutic standpoint, people can engage in some healing around that.
Sara Wilson: Yeah. What would the introduction of psychedelics look like in therapy, and why is it important to couple talk therapy with the psychedelic sessions?
Albert Garcia-Romeu: So because of the powerful alter state of consciousness, I think it's really important to have some level of psychological support around that. And it may not necessarily be a formal psychotherapy, like cognitive behavioral therapy, or ACT, or motivational interviewing, but it could be. And that's something that we've used. We've used these types of therapeutic modalities successfully in different studies here, and other labs across the country, and even overseas. And what we're doing there is a couple of things. And they're very basic, but at the same time complicated in many ways.
So the basics are that first, before there's even a real therapeutic process, we're often screening people just to assess their level of physical and mental safety to undergo this type of experience. I think this is a really important part of the process that doesn't get talked about enough, because people often want to jump right to the drug experience or to even the therapy.
But before we start the therapy, it's kind of like when people are coming in for any sort of medical procedure, we want to make sure this person is going to be able to go through this safely. And that could both mean looking at their liver and kidney function, looking at their cardiovascular function, but also looking at their past history of mental health and their family mental health history.
Because sometimes, there's clues there that perhaps this person may have an adverse reaction. And obviously, you typically are trying to avoid that, specifically in cases where you think you might trigger something like a latent psychosis or a potential bipolar mood condition. So those are the types of things we're doing before we even get started in the process.
But when we get into the actual psychedelic therapy, we're often starting with several weeks of just rapport building. Meaning if I'm sitting in the sessions with somebody, before we give them the drug, we're going to spend six to eight hours with them over the course of several weeks, getting to know more about them, making sure that they feel comfortable with us, getting a good sense of their life story. Particularly formative events.
And that can mean anything from their childhood and family history, growing up, going to school, important relationships, friendships, mentors, romantic relationships.
And then going from there, to just develop a sense that you're safe here with us. You're in a place where you can be yourself and be honest and open with us. And then developing that I think is really one of the first steps to doing psychedelic therapy safely so that even if people encounter these really scary or difficult parts of an experience, that they can work together with the facilitators to make it through that in a way that's not harmful.
The other big piece of this preparatory process is twofold. The one is explaining to people what it is that they're going to be potentially experiencing, because it is a very strong altered state of consciousness that includes intense emotions, changes in perception and thinking. That can be disorienting and frightening.
And so giving people a lowdown and saying, "This is what sometimes happens. And we don't know what's always going to happen, but we want to give you a sense for where we're at and what could occur." And finally, setting some form of therapeutic intention. Specifically when we're doing this as part of a therapy package, that typically is going to come along with some sort of therapeutic target or indication. Major depression, tobacco use disorder, existential distress related to illness.
And so part of understanding the person's life and their life story is where they're at now, and what's brought them here to us, and what is it that they're dealing with, and what does that look like in daily life when you're depressed or when you're struggling with an addiction.
And then that then sets the stage for saying, "Well, this is where I'm at." And then kind of determining, so where do you want to be? Or what would you like to get out of this process? How can we help support that? And what would life on the other side of a successful treatment look like to you?
And so really helping the person envision that, and also come up with strategies. Because it's not just a matter of, bam, take the pill and all my problems are gone. But it's really about on the ground, how do you make this something that's a sustainable change that's for the better for this person?
So that's really I think what the whole supportive therapeutic process is about, is getting somebody ready to go through the experience, providing the safe container for them to have the experience during the drug session or sessions. Sometimes, we'll go up to three sessions or more. But then also afterwards, providing a supportive process for integration where if there were insights, if there were difficult memories or difficult parts of the experience, or really anything that came up during the sessions, that you're able to work together to make sense of it, and take away anything valuable or useful from that. And put it into practice, so that it's more of a long-term change and not just, "Wow, I had this realization. But now I'm going to go right back to the way I was beforehand."
Sara Wilson: Yeah. Okay. So in your article “Clinical Applications of Hallucinogens”, you claim that it is a moral responsibility of biomedical researchers to explore every possible treatment, which I think is very interesting. Could you talk about this a little more for our audience?
Albert Garcia-Romeu: Yeah. Well, my main thrust there is that there was good research in the 1950s and '60s and '70s to show that when used responsibly and carefully, that psychedelics would be really potentially useful for a number of different types of mental health conditions, including things like alcohol use disorder.
Now, the data weren't always consistent. Part of the problem there being the early research, they didn't necessarily have a good grasp on what the proper model was to use these types of tools. They were very new at the time. LSD was not even really discovered until 1943, psilocybin not until 1958. And so when using these new tools, there were different results in early research, but there was still an underlying thread there that this could be helpful.
And unfortunately, this really got wrapped up in a lot of politics, the counterculture. And I wrote a little blog for Psychology Today about this as well called “Psychedelics Reconsidered”, where I really talk about more of the historical arc of this culturally.
Because at the time, psychedelics and cannabis got really associated with the counterculture, and the counterculture was seen by the powers that be at the time, and certainly the Nixon administration, but just conservative politicians in general as a real threat to the status quo.
And so as a result, there was a huge amount of energy put into stigmatizing this idea that these were dangerous, that they're going to destroy your children's lives, and that they're something that need to be banned, put under lock and key. And as a result, it became very taboo to think about doing the type of research that we're doing now from 1970 on.
And so it took several decades until you finally start to see that thaw, where scientists like Rick Strassman, Roland Griffiths, Franz Vollenweider and others begin to set the modern era of research underway, Dave Nichols. And they're really starting to bring it back to, "Okay, let's see, can these things be useful? Or are they just these dangerous drugs of abuse, like many people have been saying for years?"
And come to find now that absolutely, there are ways that we can use these therapeutically, and they seem to hold a great deal of potential. And there's a lot there that we don't know yet, but there's been studies from various labs around the world showing robust, rapid acting antidepressant effects.
And when you're dealing with a large number of people who are struggling with major depression, and a not inconsequential number of people who are refractory to treatment, meaning that we give them the best medications and talk therapy that we have, and that they're not getting much better, then I think it is our moral responsibility to explore all the avenues available. And psychedelics represent one area of that, but there's lots more going on.
So it's a pretty exciting time, I think, for mental health research. And we're seeing a lot more outside the box thinking, which is I think a good thing.
Sara Wilson: Yeah, certainly. So I don't think that there's an obvious answer to this question, but feel free to postulate. Your studies really illustrate not only what consciousness is and the current metaphysics of mind, but also what consciousness can be, and what it can mean to be human. Based on the research you've pursued, do you think that there's a higher level of consciousness that can be achieved, and maybe what might this look like?
Albert Garcia-Romeu: Yeah, that's a really interesting question to sit back, and ponder, and hypothesize about. Lots of different people are going to have different answers to this question.
I think one of the most compelling accounts that I've seen of this type of thinking of higher levels of consciousness is really from philosophers like Ken Wilber, and others whose work he based his work on, like Jean Gebser. Beck and Cowan who did Spiral Dynamics.
So these thinkers have sort of postulated that just like a regular single human being is going to go through different phases of development in the lifespan, and just like we're talking about with cognitive development and Piaget, and this idea of developing object permanence or getting to a level of understanding conservation.
As we move through these stages, one might say that it's a higher level of consciousness, or one might say simply it's a different level of consciousness, where we've reached a different level of understanding, again, of ourselves in the world. Now what's higher or lower, what's better or worse? Some of that can be relative. And certainly, there's also cultural differences that come to play here.
But I do think if you want to step back and look at us as a species of creatures that live on a planet with finite resources and other creatures on the same planet, that there are certain things that work better than others. And if we're going around, for instance, killing off all the other species, or even harming each other, whether it be across racial boundaries, or across territorial or religious boundaries, those are not necessarily outcomes that are desirable.
And so many thinkers like Wilber and others have seen that as humans develop over time and go through different phases and stages of development, that perhaps cultures also do the same thing. And that in that regard, perhaps higher states of consciousness and cultural development as well are those that are leading us to live in more peace and harmony with ourselves and with other cohabitants of the planet where we are.
And so that's probably my best answer, my best guess as to an answer is really anything that leads us towards having a more peaceful and harmonious existence with one another and within ourselves. And so coming back to the individual level is, how do we get to this state of optimal well-being? And how do we then put that into practice by hopefully having positive and peaceful interactions with the people and creatures around us?
Sara Wilson: Yeah. So as this very stimulating conversation is now coming to a close, I wanted to ask you, is there anything else you would like to share with our audience about avenues of research you are finding most exciting right now, or just more broadly?
Albert Garcia-Romeu: Yeah. I mean, there's a lot going on with the field of psychedelic research, which I'm heavily involved in. But I find it really exciting to see both this area of clinical and therapeutic research is really taking off, both doing bigger and more well controlled studies and conditions like depression and substance use disorders.
But also starting to explore new conditions. Alzheimer's disease, chronic Lyme disease, different areas that we're starting to dip our toes in the water to see, can we use psychedelics for these populations? Can we help people with end of life existential distress? Can we help people with chronic illnesses?
So that's a really exciting area. And we're seeing more and more research too on the mechanisms of, how in the world do these drugs exert these long-lasting changes and benefits that people are reporting? So brain research, neuroimaging, animal research, cellular molecular research is elucidating the mechanisms of how these drugs work, which is, I think, really exciting.
And then the other stuff that I think is also really important and is a little bit outside of the medical arena is the idea that we can also use psychedelics in other areas. Not just for people with mental health conditions or with physical illnesses, but also with people who are healthy and who are wanting to have spiritual or different types of altered states that may be helpful for their development.
And so as Bob Jesse puts it, for the betterment of all people, using psychedelics for people who are healthy in ways that have nothing to do with illness. But are really about promoting health, wellbeing, and even creativity.
And this was something I was just talking about a little while ago with a reporter from Scientific American. But this idea is not a new one, which is that in the 1960s, they were studying psychedelics as agents to enhance creative problem solving. And lots of people like Steve Jobs, Kary Mullis, and others, who have talked positively about the impact of psychedelic experiences on their own innovative ways of thinking, and the products that then led to down the line for them.
And so it's, I think, really exciting to think about using psychedelics outside of the medical model. But for people who are wanting to connect more with their spirituality or people who are wanting to change the way that they're thinking, or view themselves, or different problems that they're working on from a different perspective, which could potentially then lead to some new ways of approaching some of the big problems that we're facing now. Whether we're talking about climate change, ecological crises, etc., there's a lot of problems that need to be solved. So anything that we can use as a tool to help us solve those more quickly or more efficiently, I think is welcome.
Sara Wilson: Yeah, thank you. Well, thank you so much for joining us today. This was such a cool discussion. And I really think that every human being, no matter your discipline, can learn something incredibly valuable from your practice. I think that this has major promising implications not only for personal well-being, but as you were speaking about, societal harmony, and how we treat each other, and our environment more broadly. So thank you for having this conversation with me.
Albert Garcia-Romeu: My pleasure. Thanks for having me on.
Sara Wilson: Of course.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.