In this episode, Thomas Kim, MD joins to discuss ketamine-assisted psychotherapy for anxiety. Dr. Kim is the Chief Medical Officer of Noma Therapy, which is a ketamine-assisted psychotherapy program available via telehealth and in-person with licensed therapists. He has devoted 20 years of his professional life to realizing a value-based approach to healthcare through telehealth.

In this conversation, Dr. Kim shares his journey of working in early telehealth contexts to now working with ketamine. He discusses the research on ketamine treatments for anxiety and explains the significant comorbidity of anxiety, depression, and PTSD, stressing that anxiety is best understood from a more holistic perspective that considers the social determinants of health. Dr. Kim also emphasizes the importance of psychotherapy alongside ketamine dosing sessions, explaining that therapists have a window of opportunity in the days following the ketamine dose to best take advantage of the state of ketamine-induced neuroplasticity the patient is experiencing. In closing, Dr. Kim shares his philosophy of prescribing the least amount of medicine which produces the largest impact for the patient to ensure that side effects are mitigated and financial burdens are reduced.

In this episode you'll hear:

• Balancing maximal safety and maximal accessibility in medicine
• The research on ketamine treatments for anxiety
• How psychotherapy fits with ketamine treatments
• The neuroscience of why patients can have strong emotional reactions following ketamine sessions
• Stories of success from Dr. Kim’s practice
• The importance of understanding how adverse childhood experiences and social determinants of health significantly contribute to mental health struggles
• Collaborative ketamine-assisted psychotherapy with a patient’s existing therapist

Quotes:

“Over time, continued effort in the field [of telehealth] has led to cost-effective, scalable solutions that can reach more people. I’m really hopeful that we can find solutions in the psychedelic and ketamine landscape to do a similar thing.” [5:36]

“A thing that I say routinely to patients is ‘there is no cure in the bottom of the pill bottle—ketamine included.’ They are all incredibly useful and, when used effectively, can provide you meaningful relief from your psychological distress but make no mistake, there is not a cure—which is why I’m such a huge advocate of therapy and which is why ketamine-assisted psychotherapy also needs to be distinguished from ketamine therapy.” [14:21]

“[We created] an intentionally time-limited plan which places the emphasis on the fact that, one day, you’re going to drive your own bus and you’re not going to need me. It’s a terrible business model—in fact it’s a wonderful business model because it gives us an opportunity to take care of more people because we set the intention of ‘Ketamine is not forever. You’re not broken. You’re struggling and we’re going to get you to a place where you might not need us.’” [34:04]

Links:

Dr. Kim on LinkedIn

Noma Therapy website

Psychedelic Medicine Association

Porangui

In this episode, Joseph Holcomb Adams joins to discuss the important topic of guruism and cult dynamics in psychedelic communities. Joseph is an ethicist who specializes in issues related to psychedelics, altered states, and transformative experiences.

In this conversation, Joseph introduces the concepts of a guru, guruism, and cult dynamics. He describes the social-psychological mechanisms behind the devotee-guru relationship and the development of ideological conformity in cults, explaining how the heightened states induced by psychedelics can contribute to these dynamics if participants and facilitators are not aware of these dangers and vigilant in guarding against them. Joseph explains that psychedelic experiences can lead to “experiential verification,” where the participant’s sense of the facilitator as a wise spiritual guide can seem to be confirmed through the intense mystical nature of the experience, which in turn can feed into a guru-disciple power dynamic where the participant feels reliant on the facilitator for their healing. In closing, Joseph focuses on the profound importance of education on these topics. He emphasizes that these potentially harmful dynamics will always be present, so raising awareness is crucial as psychedelic healing continues to become more mainstream.

In this episode you'll hear:

• The spectrum of cult dynamics
• How guruism and cult dynamics can become amplified in psychedelic practices
• How psychedelics influence suggestibility, transference, and projection
• Why it can be easy for psychedelic facilitators to unintentionally fall into guruism
• Ego inflation following psychedelic experiences
• How ecstatic ritual experiences promote group cohesion
• What can be done to address the risks of guruism and cultic dynamics in psychedelic practices
• The importance of informed consent

Quotes:

“[During a psychedelic experience] it can be very easy for the participant to basically associate and identify this mind-opening experience, this earth-shattering spiritual experience, with this person who facilitated it for them, who is right there, who seems to know all about this space of consciousness that they’re experiencing.” [13:22]

“If the facilitator… already has a big, inflated sense of their spiritual knowledge and ability, then that’s already right there, pushing them to step into that guru role and this can happen from their own psychedelic use.” [30:06]

“When we’re engaging in psychedelic-enhanced ecstatic group rituals, what we’re doing here is we’re basically using powerful neuropharmacological tools to help us really powerfully tap into these potentialities that are in our primordial nature as social, instinctively religious beings… That’s what we’re messing around with here.” [38:23]

“The most important risk mitigation factors—really it’s education and the awareness that comes from it.” [43:52]

Links:

Joseph’s website

Joseph on LinkedIn

Joseph’s chapter, “Guruism and Cultic Social Dynamics in Psychedelic Practices and Organisations” co-authored with Jules Evans in Current Topics in Behavioral Neurosciences

“Oxytocin modulates charismatic influence in groups” by Ilanit Gordon and Yair Berson, 2018

Psychedelic Safety Flags: A Color System to Help Assess Practitioner Ethics and Safety

Previous episode: The Challenging Psychedelic Experiences Project with Jules Evans

Previous episode: Avoiding the Traps of Psychedelic Self-Absorption with Adam Aronovich PhD(c)

Psychedelic Medicine Association

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In this episode of the Psychedelic Medicine Podcast, Adam Aronovich, PhD(c) returns to discuss issues of psychedelic self-absorption—and how to avoid these traps. According to Adam, he is a PhD candidate in medical anthropology, the creator and curator of Healing from Healing, a trophy husband and dad.

In this conversation, Adam revisits his previous discussion of psychedelic narcissism and explains why he’s now somewhat more critical of the term. However, Adam still sees issues around cultivating epistemic humility and acknowledging the political dimensions of healing in psychedelic contexts. He explains the issues he takes with forms of New Age, Neoliberal spiritual perspectives he sees as pervasive and typically unacknowledged amongst many engaging with psychedelics. He also discusses how some pop psychology terms have worked their way into the psychedelic realm and what impacts that has had.

In this episode:

• The “spectacle” of filmed psychedelic experiences on social media
• The intersection of medical and spiritual cultures in psychedelics and how this can create issues of access
• The cheapening and overuse of the idea of “trauma” in popular discourse and the birth of “traumadelic” culture
• Why approaches focusing on excavating supposed repressed traumatic memories from childhood should be approached with a degree of skepticism

Quotes:

“One of the main things with plant medicine—particularly when people are sharing about it—is that people want to be really vulnerable and people want to be very authentic… But at the intersection with the spectacle, that vulnerability and authenticity become part of the spectacle in the sense that they become 100% performative.” [19:01]

“The people who don’t have that modicum of self awareness and epistemic humility to really understand, with intellectual honesty, the scope of their understanding and knowledge, then it is very easy to overdo it. And then we do a disservice, not only to the actual traditions that we purport to be portraying, but also to the people that we’re working with.” [37:56]

“If you don’t understand that your healing is political, because individual health, and individual happiness, and individual everything is intrinsically related to collective health, and social health, and cultural health, and environmental health, then you need to go back to square one because you haven’t understood anything. ” [40:02]

“If we can’t even fathom that perhaps my own wellbeing is in constant dialogue with the wellbeing of a society, and the wellbeing of a culture, and the wellbeing of an environment—that nobody can be healthy and happy unless everybody else is relatively healthy and happy—then we are in big trouble and we haven’t really learned everything.” [40:20]

Links:

Healing from Healing website

Healing from Healing on Instagram

Healing from Healing on Facebook

Adam on Instagram

Society Of The Spectacle by Guy Debord

Wikipedia entry on the Satanic panic

Previous episode: Navigating Psychedelic Narcissism with Adam Aronovich

Previous episode: How Western Medicine and Indigenous Traditions Differ in their Approach to Mental Health and Healing with Adam Aronovich

Psychedelic Medicine Association

Porangui