A Pioneer of Ketamine Psychotherapy on Psychedelics’ Future
An interview with psychiatrist Phil Wolfson; also 2 Vanity Fair essays on psychedelics; plus, a video of me giving a talk and a reading of “Stolen Words: COVID, Ketamine, and Me”
Phil Wolfson leading a training session on Ketamine-Assisted Psychotherapy.
In this issue of FUTURES
Theme: Psychedelics
New Essay: A Pioneer of Ketamine Psychotherapy on Psychedelics’ Future, by David Ewing Duncan.
Q&A: Phil Wolfson, MD
New Commentary in Vanity Fair: “Ketamine’s Long, Strange Trip” (Excerpt)
Essay from my archives: “Stolen Words: Covid, Ketamine, and Me,” by David Ewing Duncan, Vanity Fair, 30 May 2022 (Excerpt)
Video: Video of my CureX talk on psychedelics, and my reading of “Stolen Words”
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FUTURES is a column and a newsletter about possible futures at a pivotable moment in history, where the future could turn out wondrous—or not. We’re seeing a flurry of innovations and fresh ideas in technology, health, science, art, policy, and matters of the heart even as we face existential threats like climate change, authoritarianism, misinformation, and anxieties about powerful new technologies like AI. I’m asking the most interesting people I can find what they are most excited about and most afraid of for the future, and why.
For more check out my website: www.davidewingduncan.com
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New Essay
A Pioneer of Ketamine Psychotherapy on Psychedelics’ Future
An interview with psychiatrist Phil Wolfson—also an update of my journey since I wrote in Vanity Fair about using K to help me overcome a long haul COVID depression
By David Ewing Duncan—July 12, 2024
Note: This story stands on its own but also is a supplement to an article appearing today in Vanity Fair titled “Ketamine’s Long, Strange Trip.”
Lying on a plush red couch in San Anselmo, California, I’m about to don a Mindfold blackout mask. Ethereal music pulses softly. It’s been almost three years since I took my first journey using ketamine, and now I’m back again with Phil Wolfson, psychiatrist and warrior of K-assisted psychotherapy, about to go under again.
In Wolfson’s living room, I’m surrounded by the artifacts of a life devoted to healing and the transcendental. The furniture feels old-world parlor meets Zen. Lots of leather and dark-stained wood; Tibetan prayer flags dangle near floor-to-ceiling shelves overflowing with hardcover books. A statue of Buddha sits cross-legged on the floor, his chiseled face blissful. Outside a large picture window, beyond a lush garden with tall cypress trees, a series of ridges ripple off into the distance like green-skinned waves heading towards a blue-sky horizon. Wolfson himself, age 80, sits across the room, his white, curly hair thick and short, his eyes empathetic but world-weary. He’s watching over me as we both wait for the 130mg of ketamine he just injected into my shoulder to kick in.
Back in 2020, I was with Wolfson in his nearby office supine on a different couch (black leather), bracing myself for a K injection to rev up my mind for the very first time. It was Christmas Eve, and I was depressed, having spent most of that terrible coronavirus year trying to clear my head and to catch my breath after the ravages of long haul Covid had, among other things, stolen my ability to write.
I had met Wolfson socially a few weeks earlier when he pulled me aside and asked if I was okay. When I admitted “not really,” he offered to help me like he had helped thousands of others for 30+ years who had been struggling with depression and other neural maladies—or that just needed a break from life. Back then he had explained the ins and outs of Ketamine Assisted Psychotherapy (KAP)—the three-hour sessions that began with an hour of shrink talk and preparation for the psychedelic journey to come. Then came the trip, which he said would last about an hour—unlike other psychedelics like psilocybin and MDMA. They last for many hours. Finally, as I was returning to Earth after my trip, we would debrief on my experience.
What happened on that Christmas Eve, 2020, was the subject of my Vanity Fair essay “Stolen Words: Covid, Ketamine, and Me,” published in 2022. In the story I describe that after a mind-bending trip and therapy-talk my mind surprisingly and astonishingly had cleared, and I could think straight again. I needed a few more sessions, but soon I was more or less cured.
An excerpt and link to “Stolen Words” is included below, along with a video of me reading part of the essay at a CureX salon held last year in New York City.
Also below is a Q&A with Wolfson, who has been at the forefront of psychedelics as therapeutics for 40 years and has been an unconventional psychiatrist and therapist after going to medical school and finishing his training in the early 1960s. He first encountered the use of ketamine as a therapeutic in the 1990s, when scientists were realizing that psychedelics were more than just party drugs; that they also seem to help clear the heads of some people with depression.
Research in the late 90s and early 2000s helped to confirm these earlier observations, which led the psychiatric community in the 2010s to embrace psychedelics as a new line of therapeutics for people in mental distress, particularly patients who didn’t respond to traditional antidepressants like Prozac. In 2016 Wolfson edited a collection of essays titled The Ketamine Papers and a year later founded the Ketamine Research Foundation, a nonprofit that conducts research and trains caregivers in KAP.
Wolfson describes below how he has lived through the remarkable journey of psychedelics from the hippie experimentation of the 1960s to the war on drugs in the 1970s and 1980s to the renaissance of psychedelics as therapeutics in the 2010’s. Now Wolfson and others are seeing a bit of a backlash to ketamine and psychedelics that has recently emerged as the flush of rediscovery and excitement around these meds gives way to anecdotes of bad trips and addiction; to the death of Friend’s actor Matthew Perry while on ketamine; and to stories about K not working or worsening someone’s depression. (Check out “Ketamine’s Long, Strange Trip,” excerpted below).
Wolfson is clear that K is a powerful drug, and that for some people it can either fail to work, or, in rare cases, cause harm. “This needs to be used carefully and with intention,” he said. “It helps most people but not everyone.”
Back on Wolfson’s living room couch, it didn’t take long for the K to kick in. We had just had an hour or so of psycho-talk about my life since I last saw him, and to prepare me for my upcoming journey. Being no longer depressed, this journey was more along the lines of a plunge into checking in on my mind, what Wolfson calls “taking a break from your brain,” which he encourages healthy people to do every so often.
This was a very different journey than the one I took in 2020. That earlier trip dropped me into a whirlwind of movement and hallucinations that came fast and furious. It included people important to me in my life and even advice from the hero of a novel I was writing who made an appearance at the end of the journey to tell me everything was going to be okay. This time there were no swirls or drama. It was serene, with gentle and muted colors. For a long time, I was just hovering above a river that looked vaguely like the Amazon. Later I was floating in outer space. I woke up feeling calm and happy, and honestly there wasn’t much to discuss with Wolfson afterward other than him saying that he was pleased that I was no longer depressed.
Not long after this deliciously uneventful journey I interviewed Phil Wolfson; our discussion is slightly edited and shortened for clarity and space. As always, I start with my question about Wolfson’s hopes and fears for the future.
Q&A: Phil Wolfson
What are you most excited about and what are you most worried about or afraid of for the near future?
I am most excited about those people who turn to love, kindness and sharing—of which there are many, but far too few. Being in that realm and attempting to support that realm and support it in my own life, in my own way of being and my connection to others, that’s what I'm doing in my remaining days.
What are you most afraid of?
What I'm most worried about is the immensity of control in the world in the hands of a very few who are usually men, and how some of them behave in ugly ways. They have their fingers on the button they have their hands on AI. And the opposition to them is minimal.
These are starkly different views of the future. How do you sync these up, or is this possible?
I am pessimistic, frankly. War seems to be growing, and opposition to the climate debacle is minimal. Add AI to that, and you have a lot that’s unknowable in terms of whether it will be used for good or not for good.
Is there any glimmer of optimism here?
Am I optimistic? Well, I started out feeling that way in the sixties. I was a revolutionary. I still am in my way, although it's turned from a sense of a revolutionary struggle, possibly armed, to advocating for love; to sharing and community as a counter-availing force to greed and domination. But this isn’t feeling like a very strong impulse right now.
As a mental health professional, how are you seeing people react to this world you’re describing?
People are living in existential anxiety more and more, and people's hopes for steady income are in decline. People feel left out and they can’t find housing and childcare, and homelessness seems worse. People have a sense of an economic crisis looming and authoritarianism, and with that comes uncertainty.
Are people getting the help they need?
No. Mental health is obscure. It's mostly privatized. The public sector is dysfunctional. There's almost no support for the vast numbers of people who need mental health support. It's been eroded over time. It's very poorly paid for by insurance companies. Practitioners are discouraged from taking insurance because the payoff is so small.
Mental health services are lacking. Hospitals can hold people for three to five days for an evaluation, which isn’t very helpful, and we haven't had much in the drug front that's of use for a long time, except psychedelics, with ketamine being the only legal one. So you see a mental health absence—a treatment absence, an availability absence, an accessibility absence—which has grown and grown and grown, this is happening when you have 103,000 people a year dying of fentanyl overdoses.
What are you specifically working on with ketamine assisted psychotherapy to fight this?
I'm working on using ketamine for people with acute trauma. I have my patients in the US, and we’ve trained about 900 people so far, therapists of all sorts. We're doing a training in Barcelona that is bringing people from South Africa, Chile, from all over Europe. We're working on getting into Latin America.
I’ve also been working with people in war zones. I wrote a protocol for therapy after the Hamas attack on October 7, for treatment of PTSD using ketamine. This is leading to a group of us trying to set up an international consultation group to help people with an acute trauma treatment profile use ketamine at low doses. We’ve been working to do this in the Ukraine and Israel. I can't get into Palestine. It's too hard, but I’d like to do it there, too.
I meet with front line people who are damaged emotionally or wrecked by death and disaster and amputation and all the rest, and it’s so terrible. But I think we have some tools and not just ketamine. We have tools of consciousness, tools of love and caring and tools of altered consciousness that opens doors that we could give to these people. And we're certainly trying, but there are obstacles to that. We were supposed to go to Israel, but we ran into bureaucratic issues. Nonetheless, I think we're trying to build consciousness unity worldwide.
This is all ketamine based?
The only other available and mostly legal substance that can be augmenting for ketamine if we're talking about substances, is marijuana, which goes well with ketamine. I did a study of MDMA in life-threatening illness, and we're doing research with ketamine. We’re doing training in how to do KAP, it’s mostly on methodology, focusing on the people who are going to administer mind-altering substances.
I was about to ask you about the intentionality, the spiritual component. You have training in Buddhism—how does that play into what you’re doing?
Really, the question is about the nature of consciousness and what moves us, right? We're so absorbed with this society of consumption that the spiritual and sacred dimension of our lives can be very slight. We have very little ritual left. If you look at your life, my life, I have put ritual in and I put meditation in it, and not just sitting on the cushion, but devotion to it and being conscious of that element of who I am and trying to move the use of psychedelics. It’s a wonderful way to deepen our connection to being alive, something we often don't appreciate.
We know that most humans in the past, indigenous peoples, had rituals involving psychoactive substances and plants. In my experience with you, there was a certain ritual, not super heavy, in how you conducted our sessions.
I'm a public practitioner, so I have to be careful about injecting dharma, anything suggesting dharma But it's not hard to use symbols and meditation practices and guided meditation to invoke a deeper sense of being without getting caught in ritual madness. But I live in a very pluralistic community here in California. This isn’t going to work everywhere.
Let’s talk about your own story growing up in Queens, and how you came to be this person who is excited and fearful about the future.
I was born in '43. My parents came out of the Great Depression. They were very confused by the Great Depression, and they were confused about being Jews and what it meant to be American Jews. I graduated high school in 1960 and here was no radicalism in my high school. I guess I was an intellectual with a sense of fairness and social justice that kind of erupted around 1962, when I was at Brandeis, and I led this lecture series where we brought in Martin Luther King and Malcolm X and people like that. Brandeis was fairly supportive of consciousness in a broader sense; we had access to psychotherapy, which helped me figure a few things out and led me to become a psychotherapist. In medical school, I started doing therapy in the basement of Bellevue Hospital, because I wanted to learn about people's consciousness and my own.
In 1965. my experimentation led me to become an activist andI went to my first demonstration, and there were 5,000 people, including two guys from medical school who were professors of physiology, and they welcomed me. So suddenly the boy from Queens became a citizen of the world, and a revolutionary.
When did you first use psychedelics?
I started in '64 with an acid experience in med school, and then marijuana, which was really very helpful to me that same year. I did this as a psychotherapist and as a radical and revolutionary, which was amazing. In the seventies this all kind of jolted to an end when the drugs were abused and you had a lot of superficial, unhelpful nonsense happening that wasn’t about healing, and that destroyed the movement.
But formally, I became deeply involved with psychedelics through Sasha Shulgin [chemist and rediscoverer of MDMA Alexander “Sasha” Shulgrin] in 1983. This was in the wonderful legal period until MDMA got scheduled [made illegal] in 1986. And a lot of the people I know from that time helped organize a new movement, including Rick Doblin, [founder of the Multidisciplinary Association for Psychedelic Studies (MAPS)].
Even back then, you were in favor of using psychedelics for healing, not for recreation, right?
Right. The recreational, casual use led to troubles. You watched some great activists and the flood of LSD that ruined them, stoned out of their minds. I never thought that psychedelics in and of themselves were liberating. I thought they had to be contextualized. They may have a vector in a positive direction, but you have to capture that by being intentional and deliberate, or you could use it very negatively. Then I had kids, and my first kid was born in 1971. I always wanted to be a father. I was young, 27. And that was another major part of my evolution, was loving being a father. I had two kids, two boys. I lost one. Noah was 12 when he got leukemia, and four years later he died. And that was pivotal in my life, in so many ways, including trauma.
If you put yourself back in the sixties, would you have predicted that the future around psychedelics would've played out the way it has?
You could see the thunder of liberalization and then the Richard Nixon shit coming down, and the anti-radicalization reaction forming. I saw protesters getting beaten, and it was pretty vicious, but I think we were all optimistic. There was hope until the mid-eighties for psychedelics, 'that’s when there were breakthroughs for using psychedelics with psychotherapy that helped people. ‘84 and '85 were seminal years—then the crunch came down. You already had seen LSD scheduled [in 1968], but then the crunch got really, really, heavy by '86, when MDMA was scheduled. Everything got scheduled, and you couldn't breathe. So everything went underground. But really, most of the therapeutics we learned in the period when it was legal are the therapeutics of today, there've been no major surprises other than neuroscience verifying what we already could see happening clinically.
This “future” we’ve been living for the past few years seems to have shifted from those dark days in the eighties when everything was scheduled and repressed to psychedelics being embraced as therapeutics. Does that bring you some hope?
People are fascinated by doing psychedelic medicines, not always to their betterment, but often to their betterment. That stream is the overwhelming stream that's now occurring, and is occurring right now very rapidly. If you look at the ketamine situation, it's out of control. Companies are selling drugs online, legally selling drugs online with minimal support or coverage. Also, most psychedelics are still scheduled, and it’s difficult and expensive taking a psychedelic medicine out of Schedule 1. We started working on making MDMA legal in 1999. It's 25 years later and we're still not there. I think we’ll get it, but it's going to be tightly controlled. So it’s not yet a happy future for using most psychedelics for medical or psychiatric use.
What I'm getting at is the mentality seems to have changed—for instance, in 2018, there was Michael Pollan's book, How to Change Your Mind, that seemed to shift things.
I think Michael Pollan's book was a hit because the situation had already shifted. But why did it get such sales? Only because people were ready to buy into the quality of psychedelic medicine.
Yet you have major medical centers that wouldn't have had anything to do with psychedelics not long ago.
It's still pretty tepid. There's still highly academic neuroscience that emphasizes the mechanistic and is very anti-therapy. There are very few people developing the therapeutic skills of working with the medicine. In part this is because the academics are locked into their own programs and funding. That's why our foundation [Ketamine Research Foundation] is so different and important in a sense, in that we're the only freestanding research organization of its kind, other than MAPS, but they're not doing research as we are. We're doing broad scale because ketamine is such a flexible substance compared to MDMA.
I'm getting a lot of people who ask me after writing about my experience with ketamine: does it really work?
Yes. You know this. You were depressed back in 2020. Now I think you take things more in stride. I think you're still worried about some things, but you're not depressed.
Let’s go back to the future. What's your assessment for the future of psychedelics? Is it going in the right direction, or is it still a struggle?
It's a mixed bag. It's going in the right direction in terms of people's consciousness; it’s really opening doors of mind and perception, and people working together and using it to help. But its medical use is floundering in the control issue of legalization, and in the application in a mental health system. But I think it's coming eventually.
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Commentary on Ketamine Just Out in Vanity Fair
Ketamine’s Long, Strange Trip
The cred of this miracle med has gotten murkier and, somehow, more promising. An assessment of K by a science writer who has used the drug to combat depression and long-haul COVID
By David Ewing Duncan, Vanity Fair, July 12, 2024
K is a wonder drug. K is addictive. K is transcendental. Beware the K-hole. Matthew Perry drowned in his hot tub while on ketamine.
Six years ago, Michael Pollan wrote How to Change Your Mind, a brain-bending bestseller (and a recent Netflix series) about how scientists have been using psychedelics to heal depression and mental trauma. For many, the book was a shocker after a half-century of LSD, magic mushrooms, and MDMA being vilified as corruptors of youth—not to mention targets of the “war on drugs” declared by the likes of Richard Nixon and Nancy Reagan. This “war” included an infamous 1987 TV ad that showed a dour man holding an egg and saying: “This is your brain.”
He cracks the egg and the insides drop into a hot frying pan. “This is your brain on drugs,” he intones as the egg sizzles.
Subtitled What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, Pollan’s book captured a growing movement among psychiatrists, therapists, and scientists that psychedelics—besides being party drugs—were fast becoming potent remedies to treat various mental maladies. For some patients, they work more quickly and decisively than traditional antidepressants such as Prozac, Pollan reported, with fewer troublesome side effects…
Seemingly overnight, these trippy molecules went from being Nancy Reagan’s worst nightmare to miracle meds…
Now has come the inevitable backlash…
Read the rest of this commentary here.
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From My Archives: Vanity Fair on my first ketamine journey
Stolen Words: Covid, Ketamine, and Me
A Vanity Fair contributor’s encounter with psychedelics helped him emerge from a pandemic brain fog that had snatched away his ability to write.
By David Ewing Duncan for Vanity Fair, May 29, 2022
One day you realize that you’ve lost your mind.
One day words are lost, and you search for them but there is a hole in your brain where the words used to be.
You struggle to breathe.
I scribbled these words during 2020’s pandemic spring when I realized I had lost the ability to write. Not to physically jot down words. Those came in a profusion that tumbled out everywhere, like raindrops. The issue for me, as we moved into summer, was not being able to focus and write something coherent.
When autumn came, with a second surge of anguish, I dared to whisper a word that was new to me: depression.
Winter promised to be worse. Until one day my fog-addled brain was rescued by something unexpected, a compound known to chemists as C13H16CINO. Also called ketamine, Special K, or just K, the substance took me on a psychedelic journey into the shadow architecture of my mind…
For the rest of the essay, click here.
From My Video Archives: A Reading of “Stolen Words: Covid, Ketamine, and Me”
View the video here.
My talk and reading were part of a CureX on mental health last year in New York City.