Everything You Wanted to Know About Psychedelics but Were Afraid to Ask with Dr. Julie Holland

Summary

Episode Summary: "Everything You Wanted to Know About Psychedelics but Were Afraid to Ask with Dr. Julie Holland"

In this insightful episode of "My So-Called Midlife", host Reshma Saujani delves into the transformative world of psychedelics with renowned psychiatrist and psychopharmacologist Dr. Julie Holland. The discussion centers around the potential of psychedelics as tools for emotional and mental healing, especially pertinent to individuals navigating midlife challenges.

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1. Reshma's Journey and the Rise of Psychedelics in Healing

Reshma opens the conversation by sharing her personal evolution from a "drug virgin" influenced by the anti-drug campaigns of the 80s to witnessing a growing trend among her peers using psychedelics like ayahuasca, MDMA, and psilocybin. She observes that many are turning to these substances not for recreation but as avenues to address deep-seated trauma and foster genuine emotional healing.

Key Quote:

"So because of all that, this phenomenon has made me really curious. So I wanted to have this conversation about psychedelics today." ([00:57])

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2. Understanding Microdosing and Its Benefits

Dr. Holland introduces the concept of microdosing, explaining it as the practice of taking sub-perceptual amounts of psychedelics—about 1/10th to 1/20th of a recreational dose. She outlines two primary protocols:

• Stamets Protocol: Five days on, two days off (commonly with mushrooms).
• Fadiman Protocol: Once every third or fourth day (typically with LSD).

Dr. Holland shares her personal experience, noting how microdosing has helped her uncover minor traumas and gain clarity without the overwhelming intensity of a full-dose psychedelic experience.

Key Quote:

"Microdosing does allow you to kind of pick off some of the small traumas, the microaggressions, the places where you screwed up." ([08:28])

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3. Deep Dive into Psychedelics: Psilocybin, MDMA, and Ketamine

The conversation shifts to specific psychedelics:

• Psilocybin (Mushrooms): Dr. Holland describes psilocybin's ability to disrupt the brain's default mode network, fostering increased communication across different brain circuits. This can lead to seeing the world with fresh eyes, akin to a child's wonder.

  Key Quote:

  "Everything has the sort of more importance. Everything deserves as much scrutiny as anything else." ([10:26])

• MDMA (Molly/Ecstasy): Distinguished from classical psychedelics, MDMA is noted for its capacity to enhance clarity and openness, making it effective in treating PTSD by allowing individuals to process trauma with reduced fear.

  Key Quote:

  "MDMA allows the person to be open enough that you can get in there and really dig out these horrible malignant things that happened." ([14:05])

• Ketamine: Initially an anesthetic, ketamine has gained attention for its antidepressant effects. While it presents a higher risk of abuse compared to other psychedelics, regulated forms like Spravato offer controlled therapeutic benefits.

  Key Quote:

  "Ketamine does seem to be more sort of ... has a very low risk of addiction or abuse in the way that most people would think about it." ([18:52])

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4. Legal Landscape and Accessibility

Dr. Holland outlines the current legal status of psychedelics in the United States:

• Legal with Prescription: Ketamine is legal when prescribed for medical purposes.
• Illicit: Substances like psilocybin, LSD, and MDMA remain illegal federally, though some states like Oregon and Colorado are pioneering medical programs.

She emphasizes the importance of set and setting—the psychological state and physical environment—in ensuring safe and beneficial psychedelic experiences.

Key Quote:

"Set and setting are very important. Setting is obviously what's around you. ... you're going to need someone checking in on you, somebody making sure you're safe." ([25:40])

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5. The Psychedelic Experience and Integration

Reshma inquires about the nature of psychedelic journeys and the crucial process of integration—the reflection and application of insights gained during the experience.

Dr. Holland explains that:

• Ayahuasca: Typically involves group retreats with sessions often accompanied by purging (vomiting), facilitating intense emotional release.
• MDMA and Psilocybin: Offer varying experiences but generally require careful post-session integration lasting days to weeks to internalize and apply revelations.

Key Quote:

"If you don't have a lot of chaos ... it's good to check them out against somebody who really does know you and know what is typically true for you." ([39:48])

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6. Mental Health Implications and Future Vision

The discussion culminates with Dr. Holland's vision for psychedelics in mental health care. She advocates for:

• Education and Open Dialogue: Reducing stigma and increasing awareness about the therapeutic potentials of psychedelics.
• Comprehensive Care Models: Combining psychedelic sessions with professional therapy for optimal outcomes.
• Accessibility and Regulation: Ensuring safe access through medical channels to prevent the dangers of underground usage.

She highlights the cultural shift towards embracing mental health as a universal concern, further fueled by positive media coverage and emerging scientific research.

Key Quote:

"My hope is just more talk, more education. ... less shame talking about that." ([45:28])

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7. Conclusion and Takeaways

Reshma and Dr. Holland conclude by reaffirming the potential of psychedelics as powerful tools for healing and personal growth. They stress the importance of responsible use, professional guidance, and ongoing integration to harness the benefits while mitigating risks.

Key Quote:

"It is a very great conversation. Thank you so much. I feel like I learned so much and I really, I really appreciate you kind of breaking it down for everybody and for all of our listeners." ([48:00])

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Final Thoughts

This episode serves as a comprehensive introduction to the complex and evolving field of psychedelics in mental health. Through Reshma's compelling personal narrative and Dr. Holland's expert insights, listeners gain a nuanced understanding of how these substances can facilitate profound emotional healing, especially during the introspective journey of midlife.

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Note: This summary excludes commercial advertisements and non-content segments to focus solely on the informative dialogue between Reshma Saujani and Dr. Julie Holland.

Transcript

[Reshma Sajani]

The first 100 days of a new presidential administration have the potential to be the most impactful. Campaign promises and concepts of plans begin to take shape and become reality. I'm Sarah. And I'm Beth. Together we host Pantsu Politics, a podcast where we take a different approach to the news. Join us for this different approach where we ask questions, resist hot takes, and have fun no matter what the world serves up. We'll get you through the first 100 days and beyond the new Trump administration. Stay informed without all the anxiety. Join us for new episodes every Tuesday and Friday. Wherever you get your podcasts.

[Dr. Julie Holland]

Hi, Georgia.

[Reshma Sajani]

Hi, David. What do you think the world needs more of?

[Dr. Julie Holland]

Well, the world always needs more podcasts.

[Reshma Sajani]

Didn't you used to have a podcast?

[Dr. Julie Holland]

Not only did I used to have a podcast, Georgia, it's coming back. David Tennant does a podcast with season three. It's coming at you.

[Reshma Sajani]

Okay, and who are your guests? Who are my guests? What about Russell T. Davis?

[Dr. Julie Holland]

What about Jamila Jamil? What about Stanley the Tooch Tucci?

[Reshma Sajani]

So it's really just you hanging out.

[Dr. Julie Holland]

With your mates then?

[Reshma Sajani]

Yeah.

[Dr. Julie Holland]

Come join me. David Tennant does a podcast with.

[Reshma Sajani]

Bye, Lemonade. Is there anyone out there who still isn't clear about what doing drugs does?

[Dr. Julie Holland]

Okay, last time. This is your brain. This is drugs. This is your brain on drugs.

[Reshma Sajani]

Any questions? Welcome to my so called Midlife, a podcast where we figure out how to stop just getting through it and start actually living it. I'm Reshma Sajani. So I'm a drug virgin. I grew up in the 80s, completely influenced by that ad and by the DARE program. Just say no, remember? Yep, no problem. I definitely said no all the time. I didn't even consider doing drugs. I missed out on all of it. And honestly, not only did I miss out, but I just had a lot of judgment around drugs, even until recently. Lately, though, I literally can't go a week without hearing from friends or strangers mention ayahuasca, mdma, mushrooms. Suddenly it's like, amazing. Everyone around me is using psychedelics. Everyone but me. And here's the thing. They're not using drugs to be rebellious or edgy or for recreation. They're using them to get shit done, to deal, finally deal with real trauma, to actually heal themselves. So because of all that, this phenomenon has made me really curious. So I wanted to have this conversation about psychedelics today. Because, let's face it, midlife is when we realize we're not invincible. We have literally carried the weight of our past, our trauma, and the stresses of just living every day for decades. This is the point in our lives when we want to explore talk therapy. We dabble in a little bit of meditation. Maybe we call our mandalas to chill the fuck out. What if, though, there was something else? What if there were alternative ways to heal? What if psychedelics, when used in the right context, could help offer a real path towards emotional and mental renewal? What if it could help you heal all those years of emotional trauma? So much of midlife, for me, and I know for you, midlifers is about questioning what we think we know. It's about rediscovering who we are and maybe who we can become. So I knew the perfect person to talk about psychedelics. Dr. Julie Holland is a psychiatrist, a psychopharmacologist, and one of the leading voices in the field of psychedelics and mental health. She has literally spent decades researching how substances like MDMA and psilocybin can be used to treat trauma, anxiety, depression, and other conditions. In this episode, she shares not just her clinical insights, but also her personal perspective and how these substances can be a game changer, especially for women in midlife. And the other thing is, she just tells you play by play how it works, just in case you want to try. Let me tell you, she completely blew my mind. You'll hear us dive deep into the hard science and the real data behind psychedelics and the risks and benefits about how these tools can lead to just profound healing. And plus, Julie offers a lot of great takeaways for anyone who's curious or maybe wants to make this part of their journey. So sit back, relax, and enjoy the conversation with Dr. Julie Holland. I promise you one thing. It's gonna probably change the way you think about something you thought you knew about. And it may even open you up to a new experience. Who knows? Happy, listen. So Dr. Holland, who I'm now going to call Julie, we talk a lot on this show about midlife mindset and how it literally varies for everyone. Where do you land? What's your midlife mindset?

[Dr. Julie Holland]

I think I mostly land on this idea of, like, the best part of the movie or the book or the play is the third act. Um, it's where the conflict is getting resolved. It's where you strive for a happy ending. It's where the growth has happened, where the learning has happened. So I, you know, third act. If without a third act, it's. It's not finished, it doesn't have a message, you know, you're left hanging. I mean, this is the time of my Life to sort of put everything together that I've learned, capitalize on my gains, you know, fix the stuff I screwed up. So it's. It's mostly opportunity.

[Reshma Sajani]

Is it turning out that way for you? Like, are you feeling that way right now?

[Dr. Julie Holland]

You know, I. I don't want to sound too crunchy granola, but I'm. I really have been in a place of gratitude for a while. My husband and I have been doing this, like, gratitude practice where we email each other things we're thankful for.

[Reshma Sajani]

Oh, every day.

[Dr. Julie Holland]

Just three things, you know, not every day, but I. You know, one of the things that I. That I wrote about in Moody Bitches is that you can't clean something unless you see where the dirt is. And I think that most of our mindset is to look for what's broken, what's missing, what's dirty, how do we fix this? What's the problem? And at some point, you have to, you know, look slight, just pull, you know, widen the aperture enough to see that what you're working on is beautiful and that you've got this great opportunity to work on something. So it is a shift in mindset, but it is. I accept that my brain naturally goes to, what's wrong? What isn't working. Yeah, I was. I was babysitting my God children the other night, and she's playing this beautiful song on the piano, and I'm like, oh, that's supposed to be an F sharp, not a B, you know? And this morning I was like, what. What's wrong with me that I'm just not like, oh, my God, you can play piano.

[Reshma Sajani]

How beautiful is that?

[Dr. Julie Holland]

I mean, and I will go back and make it up to her and say something about how, you know, my brain works this way, but that's not fair to you. So it is a shift in perspective, I think.

[Reshma Sajani]

It's really hard. It's really hard. I mean, one of the things why I'm so glad we're having this conversation is, like, I realized in midlife, I needed to go in, understand my trauma. And what I found is that I wasn't the only one, that there were a lot of my friends in midlife that were also so desperate to kind of go in. And a lot of them, in order to do that, were using ayahuasca or mdma, right? Or using psychedelics. Because what they found is that it was much easier to get at that trauma. It was easier to get there, and they got there quicker.

[Dr. Julie Holland]

Well, there's a lot to unpack there. I barely Know where to start? I think I'm actually going to start with microdosing.

[Reshma Sajani]

Okay.

[Dr. Julie Holland]

Because I would argue, and it has been my personal experience that you can actually unpack a lot of trauma just with microdosing.

[Reshma Sajani]

Now, what is a microdose?

[Dr. Julie Holland]

So the idea with microdosing is that you're not taking a big trippy dose of a psychedelic. You're taking 1/10 or even 1/20 of what would make you trip. So, for instance, let's say 100 micrograms of LSD is sort of a traditional dosage. So you would take 10 micrograms or even 5 of LSD. And if 3 or 4 grams of dried mushrooms would make you trip, then you would take like 300 milligrams or 200 milligrams or even 100 very small, sort of a taste of a psychedelic. And there's, there's two quickly. I will just say there's two schedules for microdosing. There's what's called the Stamets protocol, which is five days on, two days off, traditionally done with mushrooms. And then there's the Fatiman protocol of once every third or fourth day, typically done with lsd. I have patients who microdose. I have friends who microdose. I personally have microdosed. I do find that during the day, or even the day after I microdose, I am uncovering little traumas and just little pearls of, oh, you know, that did happen to me when I was 12. And actually I'm remembering something kind of terrible when I was 8 that I never thought of before. And isn't that interesting? But it's not like you're spending six hours digging into the core primary trauma that made you who you are. But the microdosing does allow you to kind of pick off some of the small traumas, the microaggressions, the places where you screwed up. So I'm very interested in microdosing for personal growth.

[Reshma Sajani]

So I was one of the child of the 80s. You know, this is your brain on drugs. I have never done psycho. I've never done drugs. Right. So I'm a super newbie. I don't know the difference between Molly and Ecstasy and da da, da, da. So I want to talk about this in a simple way. So let's start with psilocybin. Psilocybin is mushrooms, Right?

[Dr. Julie Holland]

Psilocybin is the active ingredient in mushrooms.

[Reshma Sajani]

Okay. How does it work in the brain?

[Dr. Julie Holland]

Well, that is a really complicated question. I mean, if you look at it in terms of here's A metaphor that I really love. Say you're in a classroom and the same five kids are always interacting with the teacher. The teacher's always calling in the same five kids and the other 20 kids are just kind of sitting there doing nothing, not talking. If you take those five kids out of the room or at least just tell them they can't talk for the rest of the class, the teacher realizes that there's some other kids in the class and the other kids realize that there's other kids in the class and they start talking to each other. That's kind of like what happens with psilocybin that the. The usual default circuitry of how am I doing? What do I have to get done today? How, how am I compared to everybody else? And separate from everybody else that goes offline. And all the different parts of the brain can sort of be heard and also communicate with each other. Right? So there's more cross communication between other circuits when this default network quiets down and you just hear from more parts of the brain. And also importantly, there is kind of like a filter that decides what's important and what gets in. And the brain spends a lot of time sort of dismissing things like, okay, I know what a flower looks like, I know what this corner of the room looks like. I don't need to explore it in depth. The brain already knows it. If you turn that filter off, the brain is like, oh, a flower. Like, I've never really fully seen a flower before. Do you look at things with fresh eyes, with a childlike wonder, without the been there, done that sort of brain mechanism? So everything has the sort of more importance. Everything deserves as much scrutiny as anything else. And you are a little bit like a toddler. And if somebody is trying to get you from point A to point B, they're going to have to be a lot more patient because you're going to be fascinated by everything along the way.

[Reshma Sajani]

So who do you normally recommend psilocybin to or in what circumstances?

[Dr. Julie Holland]

Well, I'm not officially recommending anything and I'm not your doctor. But what the clinical research is showing is that high dose psilocybin sessions with psychological support are good for treating depression or what's called treatment resistant depression, which is basically, you've tried a bunch of antidepressants and you've tried a bunch of therapies and you're still kind of miserable. Mushrooms might be for you. And then you mentioned Molly or Ecstasy. So Molly is a.

[Reshma Sajani]

That was my next question. What about etiquette, man?

[Dr. Julie Holland]

So Molly is a nickname for mda. Ecstasy is a nickname for mdma. My very first book is called Ecstasy the Complete Guide. I was really fascinated by MDMA and its capacity to be used in psychiatry. So back in 2001, I edited a book and all the proceeds from that book, by the way, funded clinical research, which I'm very proud of.

[Reshma Sajani]

Yes.

[Dr. Julie Holland]

So anyway, so MDMA is being studied again with a lot of psychological support before, during and after. And after is the most important part. It's being studied to treat post traumatic stress disorder. So officially, the FDA looked at MDMA for treating ptsd. The FDA will look at psilocybin for treating either depression or treatment resistant depression. You know, psilocybin is a classical psychedelic the way that LSD is a classic psychedelic like mescaline. MDMA is really, it's not a classical psychedelic, but MDMA really allows you to see things very clearly with just a lot less fear. So you can.

[Reshma Sajani]

So it's like, it's like clarity.

[Dr. Julie Holland]

It's much more about clarity, I would argue, and about open, just being open, open minded, open hearted. You know, one thing that happens when people get traumatized is they really close down. You know, they get tight, they have scarring over where they've been wounded. It's hard to get to. You know, it's almost like surgery where MDMA allows, allows the person to be open enough that you can get in there and really dig out these horrible malignant things that happened. You can look at them, you could talk about them without the person being so defended or afraid to talk about the trauma. You really, you know, to, to fully process a trauma, sometimes you got to go back there and, and also like, forgive yourself for whatever you did and forgive the other person for whatever they did. MDMA is good for like that 3,000 yard view. You know, the overview, the, the macro of the playing field.

[Reshma Sajani]

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[Dr. Julie Holland]

Yes, it's going to temporarily alter your brain and alter the way that the circuitry connects or is quieted or is activated. So temporarily, you know, MDMA is maybe 4 to 6 hours mushrooms, pretty much 6 hours LSD much closer to 10 or 12 hours. But for that period of time, yes, your brain is altered, but then it leaves your system and your brain does not stay there. Your brain goes back to your normal waking consciousness later that day, certainly by the next day. Some people have a real sort of afterglow. The day after mdma, they, they still feel pretty great. Likewise, I would say the day after ayahuasca, a lot of people still feel very clear and quiet in their head. But it is not a situation where your brain is going to be stuck in that trip mode or that, that ayahuasca or MDMA mode. So it's not permanent in terms of addiction. You know, I would argue that ketamine is probably the most likely to be abused of all these drugs we're talking about.

[Reshma Sajani]

What is ketamine?

[Dr. Julie Holland]

So ketamine is, is not a classic psychedelic, but it gets lumped in with psychedelics. It's officially an anesthesia and it's, it's what's called a dissociative anesthetic that it sort of separates your mind from your body. Officially, ketamine is used, it can be used during surgery. Like if you're a medic in the war and you have to do some surgery in the field, you would give ketamine because that person would be anesthetized enough to do a minor procedure, but they wouldn't need any support with breathing. They wouldn't need to be intubated. So this anesthesia turns out is very useful for treating depression. So a brand name of ketamine called Spravato got FDA approved for treating depression originally as an add on medicine with other antidepressants. And then very recently it got FDA approved just to be used on its own to treat depression. But ketamine does seem to be more sort of. Some people really like the way it feels. Some people self administer ketamine repeatedly. That doesn't happen very often at all with the classical psychedelics. The classical psychedelics have a very low risk of addiction or abuse in the way that most people would think about it.

[Reshma Sajani]

So what's legal and like, where do I get this stuff?

[Dr. Julie Holland]

Right. So ketamine's totally legal by prescription, but still sort of illegal if you're using it as a recreational drug. So you can get IV ketamine infusions legally. You can get a doctor to prescribe a ketamine nasal spray legally. There is the brand name Spravato, which is not only legal, but sometimes your insurance will pay for it, sometimes they'll pay for IV ketamine drip. So that's all legal. But right now, pretty much everything else we're talking about is illegal. I mean, I'm going to leave out cannabis. Everybody kind of knows what the rules are. It goes state by state. Some states have medical, some states have legal. Cannabis is sort of like a mild psychedelic. My husband Jeremy likes to call it the people's psychedelic because it's very available. But so the issue of, of legality and whether whether something can be used medically, whether it can be used recreationally, our country has sort of decided that some of this is going to go state by state. Right. So we've got Oregon and Colorado who are interested in making psilocybin with psychological support a legal option. But federally these things are not, are not legal yet. MDMA definitely illegal. LSD mushrooms, illegal. But there are some states where they've got sort of medical programs in play.

[Reshma Sajani]

Walk me through how this happens. If I like, walk me through what a journey is, I have a sense of heard. With ayahuasca, you're often in a retreat, you're with a group of people, you know, and then you're. It's like a long period and you feel, and I've heard about feeling sick and throwing up and all these things happening. And then you have. Right, so that's. What's the journey like with, you know, psych. And then how do you do the integration? Like when you, if it's, you said, I think you said it's a four to six hours. You have your, you know, your revelations or your awarenesses and then you talk to somebody like, tell me how it works.

[Dr. Julie Holland]

Yeah, well, you're right about Ayahuasca is often done in Groups, and it often is like a weekend retreat. And you may drink the ayahuasca at night, and then the next morning, everybody comes together and they talk about their experience, and they have all day to sort of chat and process, and then they may have another session of drinking the tea that night. And yes, ayahuasca does typically cause purging, at least from above, sometimes from below. It's very, very common to vomit with ayahuasca. It is less common, but also happens that you will have, like, watery diarrhea or stomach cramps. You know, the. The sort of joke I make about ayahuasca is that at some point during the night, you are going to be curled up in a fetal position. You are either going to be going, sounds like fun with your GI tract, or you're just going to be going through it psychically and, you know, begging for forgiveness. And. And it can be. I've seen people look pretty blissed out and, you know, beatific, but more often than not, like, it's a struggle, it's a hard night. People are crying, they're moaning. You know, they're asking for help. There's usually people in the room who are helping, sitting with people, helping them, singing to them, you know, breathing with them. It's pretty intense. I remember the next morning, somebody. I was at a circle, and somebody said, well, what's MDMA like? And I was like, remember last night? MDMA is the exact opposite of last night.

[Reshma Sajani]

It's like, so why do ayahuasca. That doesn't sound pleasant, or.

[Dr. Julie Holland]

I would argue you should never start with ayahuasca. That if you've never had any altering experiences, it's nice to start with something that's a little more gentle and pleasant. And mdma, for most people, they feel less anxious, more of a sense of peace or satiety and more confidence, sort of looking at the traumas. And then mushrooms are somewhere in the middle. Like, sometimes. Sometimes you have bliss and unity and feelings of love, and then other times you are terrified or you're deeply saddened by something, and so you're kind of all over the place. You're laughing, you're crying again. You know, the medical model for all of these is that you are. You are given a known quantity of a known drug in a safe environment with people you trust, where you've talked ahead of time about what to experience. They're going to be there with you during, before, during, and after. They're going to help you integrate everything. That's the optimal experience. But not everybody's doing that. Obviously, some people are tripping on their own or they're tripping with a small group of friends. And, you know, it may be the case that the more trauma you have to process, the more you really need a lot of support around you.

[Reshma Sajani]

Yeah.

[Dr. Julie Holland]

That it may be for the average person who doesn't, you know, have complex post traumatic stress disorder. It may be harm reduction enough that you are with friends and that you are in a safe setting. You know, set and setting are very important. Setting is obviously what's around you. You know, it's not really great to be tripping in the subway or in Times Square, I would argue. So setting is just somewhere safe where you're not going to hurt yourself and you don't necessarily need a babysitter, you know, keeping you away from sharp object. And then your set is your own personal frame of mind going into the event. Like the first time I was invited to have an ayahuasca session, I declined because I was just learning to be a psychiatrist, and I had had, like, a very hard case of a patient who did not do well. And I. And I was afraid that it would just.

[Reshma Sajani]

Yeah. Alter. Like, change your perspective.

[Dr. Julie Holland]

If I were preoccupied with it, that I couldn't get past it, I would feel trapped by it.

[Reshma Sajani]

All right, I want to talk about mental health. I loved your book Good Chemistry. And it really blew my mind because I realized. So, you know, one of the things I took away is, like, we are all constantly living in this fight or flight. We are, you know, getting all these kind of dopamine hits. Forget about what's happening in the world, like, the past two weeks. Oh, my God. Right. Forget about what's happening in the world. But between that and social media and our jobs and our responsibilities like we are. And. And I realized after rereading your book, like, I am constantly in fight or flight. I am anxious. I cannot sleep. And what blew me away, you said, you know, people's normal state of mind should be, like, the way that you feel when you're, like, standing and looking at the Grand Canyon or, like, petting your dog. Right. Or playing with your kids.

[Dr. Julie Holland]

Yeah. I mean, look, that the. The Grand Canyon thing is specifically about awe. And awe is a unique state. And awe is a. Is a state of deep learning. Deep learning is possible when you are. That opened up. Right. Openness helps you to change. And if you think about fight or flight, there's no openness there. You're. You're defensive, you're shut down. You're Ready to attack or run away. You're not staying and working your shit out.

[Reshma Sajani]

So how does psilocybin open you up? How does it biologically do that?

[Dr. Julie Holland]

Well, I think that it has something to do with oxytocin. You know, as much as adrenaline and cortisol. Run, fight or flight, oxytocin is part of what runs the parasympathetic system, which is the opposite of fight or flight. Right. I mean, Brene Brown talked about it as like, tend and befriend. What I learned in medical school was that it was rest, digest, and repair. It's the parasympathetic, the opposite of fight or flight. That's when we sleep. That's when we're just kind of zoned out and we're relaxed. It's when we can digest our food. It's also the only time that the body really runs any kind of repair protocols, right? So when you're in fight or flight, your body is just kind of like burning, burning fuel and keeping your immune system at bay, because the priority is to get blood to your muscles in case you have to beat somebody up or run away. And your stomach doesn't get the blood and your sex organs don't get the blood. You know, there's no priority for sexual pleasure in fight or flight. So you get over to parasympathetic. Rest, digest, repair. That's also where you have sex. It's also where anything social is going to happen. Your social skills suck when you're in fight or flight.

[Reshma Sajani]

That's right.

[Dr. Julie Holland]

You know, and, and, and, you know, like, if you're, like, really freaked out about something, you kind of end up, like, you know, being a little bit of a. Like, you know, you're not that pleasant, right? So the repair, it's not just bodily repair. I would argue that parasympathetic is about social repair. It's when you call your friend and say, oh, my God, I'm so sorry I was short with you. I was really freaking out. You know, that's a repair. That's a social repair. And you also do social repairs on your own with yourself. And, you know, I was so hard on myself and I should have, you know, loved my inner child. So parasympathetic is where you want to be. It's where you can sleep. It's where you can lose weight. It's where you have orgasmic sex. It's where you can learn and grow and change. None of that shit's gonna happen when you are running away or attacking people.

[Reshma Sajani]

Now Is there a particular age where you are more open to this? Like you're like, I think you've said your brain isn't fully function until mid-20s. Like is there? Because I wanted, why I'm asking you. This is like, like it is wild. How many people in my age group are really going to psychedelics right now? And it's not necessarily for recreation. It's really about getting at their trauma. So is, are we at the right age to be exploring this?

[Dr. Julie Holland]

Yeah. So I do want to go back for one second to this idea of like what the brain looks like, you know, the. I, I am an adult psychiatrist. I don't treat people younger than 25 because the brain, it's functional, it's just not soup yet, you know, like you can eat it, but, but the zucchini is still very crunchy. You know, it like it needs time to fully mature and the brain is fully sort of cooked by 25. And so I personally don't want to do too much mucking around in something that isn't even done yet. And impulse control is one of the things that really doesn't fully come online until later on in the twenties. And, and you know, if you think of like a tree that's growing or a bush and it gets bushier and bushier and bushier and then at some point you have to prune it back. Right. Late teens, early 20s is all about this pruning. But the practical reality is that adolescents experiment, adolescents feel invincible. They, they tend to make riskier decisions than people in their 40s or 50s. It may be that, you know, middle age is the perfect age to finally unpack some of this stuff. But I would argue that if you're, you know, addicted to something or you've got a self harm or you're suicidal, you're not going to wait till you're, till you're middle age to process a trauma. So, and I certainly know underground therapists who are working with kids in their late teens, early 20s, because a lot of what psychiatry preaches is that early, early treatment is best.

[Reshma Sajani]

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[Dr. Julie Holland]

Yes, it is. I mean the scientific trans. The explanation is what I said earlier about this default mode network going on offline. You know, this, the basic part of your brain that is constantly like, this is me, this is who I am, this is what I do, this is what I need to do tomorrow. And what I did yesterday and all that sort of me, me, me quiets down. And when it quiets down enough, that really is the sort of ego disintegration or ego death that people experience. And so, you know, in a classic mystical experience after the ego death comes this sort of merging with everything. Okay, if you are not just this tiny little insignificant thing, then. And where do you end and everything else begins. I mean, if you know anything about physics or atoms, you know, I have atoms. This thing has atoms, like in between there's atoms. Like where is the cutting off point? And when you have an intense ego death experience, you often have this. The flip side, the, the dark. You know, the scary part of ego death is that it's just black and nothing. And I've had 5 Meo DMT once. It's a very potent psychedelic. I don't recommend it for any sort of beginners. But it, it was that, that not existing.

[Reshma Sajani]

Like you do it and then like everything goes black.

[Dr. Julie Holland]

It was, it was absolutely like being in a void, a complete void. And the void is scary. You know, the music slowed down and stopped. I slowed down and stopped. Your brain will sort of be like, I guess I must be dead. I guess this is death. But then what happens after the void is the light and the fusion that if I don't exist anymore, then I am everywhere and I am everything and I am the universe and the universe is me. And it's all. And, you know, and that kind of thinking, you know, part of the psychedelics, they make you think that everything is important and everything is true. And that's why it's really good to have other people around to be like, I know you think that right now, but, you know, you can't fly. And you, you know, you will. You are not merging with the sun. You know, it's good to have some reality.

[Reshma Sajani]

That's. I wanted to ask you. So how important is to have a trip sitter? Right. And. And should that person be a professional therapist or a psychiatrist with you who. That you already have an established.

[Dr. Julie Holland]

Well, it is. I would say it's a spectrum. Right. And if you are taking a very heavy drug to tackle some very heavy things, you're gonna need somebody around you or, you know, somebody checking in on you, somebody making sure you're safe, and certainly people to talk to you afterwards about what you came up with and the next day about what you're gonna do about what you came up with. So the stronger the medicine, the more you're gonna need babysitters, right? And the more incapacitated you are, the more you're gonna need babysitters. Like, you know, there are people who take ketamine just lying on their bed on their own. You don't want to be in a hot tub. You don't want to be in a bathtub. You know, I. I would assume it goes without saying, but if you can't keep your wits around you, you need to be somewhere where you have constant supply of oxygen, you know, so, you know, there's a great book coming out by Joe Dolce about sort of how to safely use recreational psychedelics. There's another book by Jim Fadiman about the same psychedelics, Explorer's Guide. So there are books, and they're not long books. I mean, these people are really trying to make just like 200 pages of here's Gotta Know. And, you know, I would argue even good chemistry gives you a lot of.

[Reshma Sajani]

I thought good chemistry was great for, like, again, like a beginner. Here's what you need to know. One of the things you talk about in good chemistry is again, the integration experience, right? And for our listeners, you know, so how long does the integration last? How long do you have to, like, again, make sure, like, what you learned from your trip, that you're integrating it into your life? Is it immediate or do you have to constantly kind of do that work?

[Dr. Julie Holland]

It's, you know, it's days or weeks at least. And again, the more trauma you're trying to process, the heavier the drugs you're taking, the more you're gonna need to do integration. If you don't have a lot of cha. I mean, some people who are using ketamine to treat depression, they go and get an IV infusion and nobody even talks to them. And then they just walk out and go home and go back to their lives. And I would argue, and many people would argue that's not the best use of ketamine, that if you're stumbling across upon sort of things that are true for you, it's good to check them out against somebody who really does know you and know what is typically true for you. So in a perfect world, you have a therapist who knows you're doing this stuff and you go do the stuff and then you see the therapist the next day and they help you process it. Or you've got somebody with you a whole weekend and you're having one or two drug sessions with, with integration going on before, during and after. I mean, there's a lot of underground therapists who offer like a package where they'll meet with you a couple times before, they'll sit with you during and they'll do sessions with you after. And then there are some people who just do the integration work. They don't, they don't want to be involved with anything illegal. They're like, I'll talk to you before and I'll talk to you after, but you have to. Do you have to work with someone else during.

[Reshma Sajani]

Now how do you vet these people? Because when, the minute you say like underground, it's like, yeah, how do you vet them?

[Dr. Julie Holland]

Yeah, well, that, you know, as long as things are illegal, it's going to be hard to have anything be sort of regulated, you know, or there's going to be any sort of safety check. So it's a lot of caveat emptor. There are some, I think more and more there are people kind of putting together websites or repositories for information, but because it's illegal, it's really hard to. Like, for instance, there's a lot of people who want to do this work, who want to work with an underground therapist. And there's a lot of underground therapists who are very, very busy and have like 3 month, 11 month waiting lists. But wouldn't it be amazing if there were some site where these people could all get together and like you would find somebody who is vetted in your, in your region? Like, yes, it would be great. We do you know it's illegal, so we don't have that, you know, because it is illegal, it is more dangerous. Our drug policy is making these sort of experiences for now more dangerous. And the first level that's happening is going to be medical use, not recreational, which means the recreational is going to stay dangerous the longest for a long time.

[Reshma Sajani]

I mean look how long, look how long marijuana pot has taken. It's still, you know, I want to ask you, why do you think this conversation is happening right now? What I mean by that? Why is there so much interest? Interest?

[Dr. Julie Holland]

Yeah, well, you know, it's been building. I mean like I've been involved in sort of learning about psychedelics or you know, try and teach other people about it since like the 80s, right? So that's like 40 years now. So to me it's like it's just been naturally slowly building up over like 40 years, you know, and I, and obviously the build up to, to Lycos presenting to FDA to get MDMA approved for ptsd. I know it's a lot of letters. I just said this summer was a really shitty summer for people who were paying attention because we thought that MDMA was going to get FDA approved and it didn't. But over the course of the summer, because that got so much press, just psychedelics started getting more press and the New York, the New York Times like leading up to FDA decision, the New York Times published like so many different articles about psychedelics and they kept painting them in a pretty positive light over and over and over again. I was like, what is going on with the New York Times?

[Reshma Sajani]

Who was there someone doing a lot of psychedelics, that's who.

[Dr. Julie Holland]

That's still going on. I mean even, even just the other day they did a really great piece explaining like who torpedoed the FDA approval process. And it was a really thoughtful article. So the, the media coverage of psychedelics has been more and more sort of glowing and attentive. And then microdosing I think did bump it up a level, you know, that.

[Reshma Sajani]

People started realiz changing for sure.

[Dr. Julie Holland]

You don't need to have, you know, this big eight hour intense experience. You can just take something and go about your day and just have, as Ayelette Waldman called it, a really good day. So I think that's happening more. I'm getting more and more questions about microdosing. Also Spravato became FDA approved, right? So this is like a brand name version of ketamine that got FDA approved. And Johnson Johnson is not going to be quiet about that. So you See ads for Spravato everywhere. There's ketamine clinic clinics cropping up everywhere. You know, during COVID the ketamine sort of craze that happened during COVID it was, it was like a lot of bushwhacking. It got a lot of infrastructure in place. People got used to the idea that they can have an altered state of consciousness for a couple of hours that can have an impact on how they feel for weeks afterwards. So. And actually ketamine is a good business model because it doesn't last and people have to go back for boosters every couple weeks, every couple months. So, you know, I, you gotta, I mean, the other thing I'll say is like capitalism is involved here. That there, you know, there's gold in them dar hills. There are more and more companies coming.

[Reshma Sajani]

Online, there's money to be made. People, you know, you know, demand there. And so that, that's a huge. Yeah, there's a, there's. I mean, I think the culture is changing. Like, I, I absolutely think the culture is changing. And I also think what's interesting, I wanted to hear your thoughts on this as we close. Like, it's. Many of this conversation is tied to mental health and I think there's a lot of focus on our mental health. What is your vision for psychedelics and mental health care? Big picture?

[Dr. Julie Holland]

Well, I think one of the reasons why people are focusing on mental health also is just social media has really grabbed onto this as like a universal bipartisan issue. You know, it's not just the veterans who are traumatized. Everybody's been traumatized. Everybody has trauma to unpack. And I think it's good in general that more people are talking about mental health. I don't love that everybody is like really into these labels and I have OCD and I'm on the spectrum. And you know, I feel like everyone is sort of identifying too much with, with these diagnostic categories and labels. And the truth is that everything is a spectrum. You know, I think ADD is a spectrum as much as autism is a spectrum, as much as sexuality and gender is a spectrum. And so, so everybody falls somewhere. But, you know, my hope is just more talk, more education. I think people still have a lot of puritanical, I don't know, queasiness about talking about like sex and sexual health and sexual pleasure. I think women still deserve more of all of that. And I wish that we had less shame talking about that.

[Reshma Sajani]

Well, we're trying to change that here at my so called midlife. Yeah, yeah, that's right.

[Dr. Julie Holland]

Good. Thank you. Thank you for your service.

[Reshma Sajani]

And I think this conversation too is a big part of that because again, this could this point about I think being open to women, to pleasure, to your desires, to your needs, and getting something to help you open up. Cause you're right. I do think we live in a puritanical society that's just teaching us to cross our arms and cross our legs and just be quiet.

[Dr. Julie Holland]

Yeah. And I guess it is worth saying as long as we're talking about the risks. I mean, unfortunately, one of the risks of doing underground work with somebody is that you are going get a bad actor who does not respect boundaries or who convinces you of things that you should not be convinced of. So, you know, that is like a, a very huge sort of caveat emptor when you're looking for a quote, air quote shaman. You know, some of these shamans behave very badly and take advantage of you when you are completely vulnerable. So it is probably better to do things in groups just because there's sort of more eyes watching you and, and potentially more reporters if somebody does something inappropriate. But it is a very real risk because you're, especially women, you're really in a vulnerable state. And some of these drugs, like 5 Meo DMT, you leave your body for 20, 30 minutes, like you are not there to make sure your body's okay. And ketamine too, you know, you're really sort of out there.

[Reshma Sajani]

This is a really great conversation. Thank you so much. I feel like I learned so much and I really, I really appreciate you kind of breaking it down for everybody and for all of our listeners. I loved your book Good Chemistry. So everyone who's listening in our community, go get it.

[Dr. Julie Holland]

Thank you.

[Reshma Sajani]

All of them are good. Moody Bitches. They're all good.

[Dr. Julie Holland]

Thank you. I'm glad you like them.

[Reshma Sajani]

Dr. Julie Holland is a psychiatrist, a psychopharmacologist, and one of the leading voices in the field of psychedelics and mental health. She's written five books including Moody Bitches and Good Chemistry. A huge thank you to Dr. Holland for joining me today. Thanks so much for listening to my so called midlife. If you haven't yet, now's a great time to subscribe to Lemonada Premium. You'll get BONUS Content like Dr. Holland's take on using MDMA in couples therapy. Just hit the subscribe button on Apple Podcasts or for all the other podcast apps, head to lemonadapremium.com to subscribe. That's lemonadapremium.com thanks and we'll be back next week. I'm your host Rashmi Sajani. Our producer is Claire Jones. Our Associate producer is Isara Aceves. This series is sound designed by Ivan Kurayev. Ivan also composed our theme music and performed it with Ryan Jewell and Karen Waltock. Our senior Supervising Producer is Kristen Lepore and our senior producer is Chrissy Pease. Our VP of New Content is Rachel Neal. Special thanks to our development team, Oja Lopez, Jamila Zara Williams and Alex McGowan. Executive producers include me, Reshma Sajani, Stephanie Whittles Wax and Jessica Cordova Kramer. Series consulting and production support from Katie Cordova. Help others find our show by leaving a rating and writing a review. And let us know how you're doing in Midlife. You can submit your story to be included in this [e-mail] midlife follow my so called Midlife wherever you get your podcasts or listen ad free on Amazon Music with your prime membership. Thanks so much for listening. See you next week. Bye. Foreignada Media Podcasts While supporting the shows that help make life suck less, subscribe to Lemonada Premium today. As a subscriber, you'll unlock exclusive bonus content like never before heard interviews, behind the scenes moments, bonus episodes, and so much more. It's easy to sign up no matter what podcast app you use on Apple. You can just click the Lemonada logo in the Apple podcast app and hit subscribe. For all other podcast apps, head to Lemonada supportingcast FM to subscribe. That's Lemonada supportingcast fm. People love to pretend that there are simple formulas for living your best life. Now eat this and you won't get sick. Manifest it and everything will work out. But there are some things you can choose and some things you can't. And it's okay that life isn't always getting better. I'm Kate Bowler and on Everything Happens I speak with kind, smart, funny people about life as it really is. Beautiful, terrible, and everything in between. Let's be human together. Everything Happens is available wherever you get your podcasts.