Freeing the Mind. With Micha Lerner, psychologist. How do the law, new therapies, and drug reform fit together - from the war on drugs to better wellbeing?
A Personal Note
I have never taken ketamine but know all the other well known ‘drugs’. For me it was always pretty pointless hedonism. I am a bad hippie, a child of inner city pub rock and sketchy adventuring. I prefer - or preferred - uppers if you must know. I’ve had Valium a few times to get to sleep. In my 20s for a couple of weeks I used SSRI anti depressants - but they got me down! In a medicated world I am clean as a whistle these days. Confession: I have never really understood pot. Oh, how I have tried. My lack of interest in pot taught me long ago that drugs are a very personal, nuanced biochemical experience. Words and images, nature and humans, sport and music are my drugs now. Yet so many friends of mine have explored ayahuasca and other plant medicines, or extreme meditation and other questings. I watch with love and interest. I see friends and clients suffer with life, and see the relief that drugs can provide - in therapy and escape; and I see all the negatives of the downside of drugs, especially in my work. But the thirst for enhanced consciousness, the better ways of being and seeing, for liberation from suffering, is part of what humans are and always will be.
I am for the legalisation of all drugs. I encourage the use of alternative therapies to help human beings enjoy their lives and improve their mental health. I support people exploring the limits of consciousness and experience, provided we take the risks seriously. My views are grounded in a combination of human rights discourse, utilitarian harm minimisation and a Buddhish sense of do the least harm. I also think science matters - hard science, peer reviewed, properly put to the test. The law has a role, but the law has always been heavy handed when it comes to drugs and that should shift.
Recent developments - TGA Approval and SCU Trials!
In Australia we are seeing some movement, certainly in therapies for mental health. In 2023 the federal government agency, the TGA (Therapeutic Goods Administration) surprised many by approving psychedelics and MDMA for use in treating depression and other conditions. From July 2023 psychiatrists have been able to use - after authorisation - MDMA to treat PTSD - and psilocybin for depression where other treatments did not work - all on the proviso that the psychiatrist would observe the patient. The approvals are, ‘naturally’, tightly controlled and the therapy is very expensive, well out of the reach of most people. The TGA decision also arrived without extensive guidelines, protocols or funding. But perhaps that is now changing a little. For more on the TGA approvals: https://www.tga.gov.au/news/blog/understanding-changes-mdma-and-psilocybin-access#:~:text=For%20this%20reason%2C%20the%20TGA,treat%20post%2Dtraumatic%20stress%20disorder.
Recently Southern Cross University obtained significant funding to conduct trials exploring new therapies for people experiencing PTSD in the wake of the 2022 floods. The trials will cover at least 200 people recovering from their flood experiences. Step 1 involves a series of sessions of self-compassion focussed art therapy and then in Step 2, if PTSD symptoms continue, people may move on to MDMA. The trial is for 4 years with almost $4m in funding. The project is a huge credit to the team at SCU led by Dr James Bennett-Levy, and reflects our need for a clinical, therapeutic response to natural disaster as well as the best traditions of our region in exploring new, non-conformist ways of living this brief life. For more on the SCU project: https://www.scu.edu.au/news/2024/ptsd-clinical-trial-funding/
Reflection on Regulation and Working in Mental Health
The TGA and the SCU trial are high-end formal activities, all framed by and working within the law. At the same time, the law remains hostile to drug taking and focussed on criminalisation, which is often at odds with evolving community views. We still struggle to see movement on pill testing at festivals or safe injecting spaces. We have drug driving laws that do not reflect the demonstrated lower safety risk of cannabis use. The law needs to catch up. Politicians could, as ever, be braver. The experience of Portugal - and the net positive results in decriminalising drugs - treating people at least at patients not criminals is preferable to what we have in Australia. Our courts and jails are full of people whose drug abuse is a symptom of underlying health and trauma that is criminalised at great expense. Our jails also have many ‘difficult’ inmates whose mental health issues are not properly dealt with - they should be in hospital not jail. Criminalisation to me is a lazy response. The hard work is to get to the cause and to see what we are really dealing with - human suffering, much of it an inevitable consequence of inequality, disadvantage and bad life experiences.
My working life as a lawyer intersects with mental health in a variety of ways. I often deal with psych reports in criminal law sentencing to reduce penalties or in family law parenting cases to understand adult behaviour and impacts on children (they are often used as weapons, of course). I have regularly appealed for clients whose mental health has meant that they should be dealt with as patients rather than as ‘criminals’. It is also very satisfying to get a ‘Section 32’ or now ‘Section 14’ for someone who is suffering. I have also acted for clients who have contested community treatment or involuntary patient orders. In one case I have worked for years for a woman who has wanted to be free from electro-convulsive therapy (‘ECT’) - an extreme and extremely sad case. ECT has demonstrated success in limited circumstances but my experience in that case shows the huge challenge of ‘pushing back’ against the weight of a risk-averse mainstream clinical system.
To me, mental health is a broad, community experience and collective responsibility. So much mental illness is about disconnection - from others and self. Those connections are fundamental human rights issues. The crime of indefinite detention, for example, is ultimately the infliction of deliberate disconnection - a fundamental abhorrent breach of the simplest concept of human rights. As was the crime involved in the history of the stolen generations - and its ongoing resonance in our bureaucracies. Reconnection or the strengthening of connection is a key objective of any effective and ethical approach to mental health. It is about human rights - always - our inherent shared humanity.
About Micha Lerner
This week’s guest is Michael ‘Micha’ Lerner is a psychologist with the Mudita Holistic Collective in Byron and long-time local. He has researched the use of psychedelics in health care since the 90s. Micha worked at The Bay Retreat and The Sanctuary and has vast knowledge in drugs and alcohol treatment and recovery. His new venture Go Flow Consultancy aims to help people post recovery to sustain well-being and reach flow states of consciousness. Micha is a very interesting man and I cannot wait to talk about the new therapies now available in Australia, especially the ground-breaking work at SCU on post flood PTSD and the whole crazy world of the ‘war on drugs’ and what mental health means for democracy.
To learn more about the research in this field, Micha provided me with some key articles to help orient the debate. Some excerpts from two key papers…
The frontiers of new psychedelic therapies: A survey of sociological themes and issues. Timothy Andrews & Katie Wright (Sociology Compass, Wiley, 2022)
Psychedelic compounds are on the cusp of being approved by medical regulators for treatment-resistant mental health disorders. Following promising clinical trials, and as rates of mental ill health rise globally, psychedelic medicine presents a new paradigm for treating depression, anxiety, addiction and post-traumatic stress disorder. The novelty of psyche- delic therapies, the cultural stigma they elicit, and the chal- lenges of regulation and implementation urgently call for a sociological lens onto this emerging field of psychiatry. This article identifies key sociological issues related to the med- icalisation of psychedelic-assisted therapies. It begins with a brief overview of the field's history and current treatment approaches. We then identify and critically examine three areas of sociological interest: the of role advocacy in the ad- vancement of scientific research and the destigmatisation of psychedelics; issues related to the medicalisation and phar- maceuticalisation; and integration into healthcare systems. The challenges and affordances of psychedelics to existing therapeutic models, regulation and monetisation are high- lighted, and the socio-political context of the pharmaceu- tical industry, research, investment and implementation is examined. Drawing on health science literature in this field, the article offers a sociological lens on clinical psychedelic
What to do about the woo? Philosophy and Psychedelics. Frameworks for Exceptional Experience. Edited by Christine Hauskeller and Peter Sjöstedt-Hughes (Bloomsbury (2022).
In a landmark paper from 2019, Robin Carhart-Harris and Karl Friston lay out their theory for what happens to the human brain under the influence of psychedelics: their so-called REBUS (RElaxed Brain Under PsychedelicS) model (Carhart-Harris and Friston 2019). Towards the end of the paper, and after some heavy-duty neuroscience, the authors change tack to ask an unexpected question: ‘What to do about the “woo”?’ (335). For, if psychedelics have great therapeutic potential – momentarily loosening the brain to shake it free of depressive, obsessive and other related cognitive rigidities – they often occasion strange and, for the authors, unwelcome ideation. It’s all very well healing people, but not if it comes at the cost of their entertaining ‘bizarre beliefs or poorly understood platitudes’ (336). The authors suggest psychiatrists and researchers steer patients away from any lurid conclusions. ‘Combining psychedelic therapy with a secular wisdom teaching, such as can be found in nonreligious Buddhism for example ... as well as depth psychology ...[will help]...to ground psychedelic science and medicine, while inoculating against evangelism’ (336).
Here, almost unnoticed, hard science has slipped into making normative and somewhat defensive theological (‘atheism’) and metaphysical (‘physicalism’) statements. That defensive- ness is perhaps understandable if we remember the long shadow cast by scandals of the 1960s, where, most famously, Timothy Leary metamorphosed from buttoned-down Harvard psychologist to rogue priest, shaking the establishment with his call to ‘turn on, tune in, and drop out’. Sobriety is now the order of the day and, to be taken seriously, one has to distance oneself from the excesses of the past. Nonetheless, an obvious answer to the question, ‘what to do about the woo?’, is to give it some more thought, for just as we might want to probe the more extravagant claims made by psychedelic enthusiasts, we might also want to probe the philosophical and implicit theological assumptions1 that underpin the great explosion in scientific interest in psychedelics occurring on both sides of the Atlantic: the so-called ‘psychedelic renaissance’.
Whatever it is that psychedelics do, they indubitably do so through physical alterations to the brain’s chemistry: Carhart-Harris, Friston and their contemporaries remain on firm ground here. It’s just that those minute chemical tweaks cause disproportionate upheavals in cognition, perception, memory, affect and understanding – the whole trippy phantasma- goria, so familiar even to the uninitiated. Carhart-Harris and Friston may be keen to contain the surfeit of meaning that erupts in psychedelic phenomenology, but in doing so they might be accused of rather missing the point. Psychedelics remain interesting pre- cisely because they open up a plethora of metaphysical, ethical, aesthetic, psychological, sociological, anthropological, cultural, political, not to mention theological, questions. Perhaps this is why psychedelic experiences have always prompted Western intellectuals to speculate – think William James, Aldous Huxley, Henri Michaux, to name just three – but as psychedelics move from the margins to the mainstream, driven by this explosion of big science, these questions cannot simply be sidestepped or shut down.
Talking with Micha
Here are the questions we will try to explore on the night …
How did you come to psychology? What drew you to that way of being in the world?
Let’s talk about where we are at in Australia, can you explain in simple terms what the TGA approvals of psychedelics and MDMA for treatment mean for mental health care?
What is the background research supporting the approval? I know you’ve worked in the area since the 90s.
Are other countries following suit? Who is doing the most interesting stuff?
How do you see the formal approval against the informal use? Around the world there is a spectrum of use from fun or hedonist to therapeutic or ritual use.
What are the shown benefits of the treatment? Short term long term? How are they measured / assessed?
Do you have thoughts / concerns about the unregulated sector? Other plant medicines and illegal drugs?
Do you have thoughts / concerns about the regulated sector?
Where is the field heading overall?
How will you develop your own practice? Where do these therapies fit into your approach? Are psychiatrists excited about the possibilities?
What can we say about the SCU trials which combine art therapy for self compassion and psychedelics of MDMA for post floods PTSD?
What country gets regulation right in your view?
What do you make of the Portugal experience with decriminalisation of illicit drugs?
What can we learn from what I would call the failed ‘war on drugs’?
Where does addiction fit into your practice? (Addiction is loss of agency to me and an acute form of atomisation).
How do you see the use of ECT which is also primarily for treatment resistant patients? (One of my key recent cases involved the long term use of ECT).
Do you buy into the concept of a mental health epidemic? The bookshops are full of this idea!
Do you see capitalism as a machine for producing mental illness? (I do).
How do you see countries where psychology is not established or pervasive, or the different cultural place of psychology?
What is the link for you between human rights and mental health?
How does a democracy promote mental health?
In what sense is mental health a community responsibility?
What philosophy can help us move towards maximum mental health and human flourishing?
Can you let us know a little about your work on flow consciousness?
What would you most like to see happen in mental health right now, if you had a magic wand?
I am so looking forward to this conversation and where it leads.
Mark Swivel
3 June 2024