E176 | LSD, Narcissism & the Science of the Self (w/ Dr. Anjali Bhat)

Dr Anjali Bhat is a neuroscientist, therapist and writer. Today we discuss the science of the self, the future of therapy, and what altered states of consciousness can teach us about the mind. Anjali explains her work in psychedelics research, including an upcoming study that involves giving people high doses of LSD in a high-resolution brain scanner. 

We also talk about the promises and limitations of psychedelic-assisted therapy,  ADHD, productivity culture, burnout, and why slowing down can be psychologically transformative. We also discuss what makes therapy effective, why the therapeutic relationship matters so much, the risks of AI therapy, and how to think more clearly about narcissism.

You can find out more about Anjali's work here: https://www.anjalibhat.org/

Interviewed by Dr. Alex Curmi. Dr. Alex is a consultant psychiatrist and a UKCP registered psychotherapist in-training. Website: alexcurmitherapy.com

Check out The Thinking Mind Blog on Substack: https://thinkingmindblog.substack.com/

If you would like to invite Alex to speak at your organisation please email alexcurmitherapy@gmail.com with "Speaking Enquiry" in the subject line.

Alex is not currently taking on new psychotherapy clients, if you are interested in working with Alex for focused behaviour change coaching , you can email - alexcurmitherapy@gmail.com with "Coaching" in the subject line.

Give feedback here - thinkingmindpodcast@gmail.com Follow us here: Twitter @thinkingmindpod Instagram @thinkingmindpodcast

Transcript

SPEAKER_01 0:00

What we're doing is uh giving people high doses of LSD and putting them in a high-resolution brain scanner and uh mapping their subjective experience over time. There's something about the intensity of the psychedelic experience and all of this evidence that we're having about a very different way of treating mental illness that is forcing us to question assumptions, particularly around the separation of the mind and the body. To put it very simply, I would say that we connect with each other by feeling together. People first kind of discovering the concept of narcissism. One of these ways in which the word is used, I think it correctly, is just to simply mean someone who loves themselves. Actually, underpinning all of it is actually quite a profound self-loathing or self-abandonment.

SPEAKER_00 0:46

Today I'm so happy to be speaking with Dr. Anjali Bhatt. Dr. Barth, thank you so much for joining me.

SPEAKER_01 0:52

Thank you for having me.

SPEAKER_00 0:53

I can see that you're involved in a lot of things. It kind of reminds me of how the way I went about my career, for better or for worse. You're a neuroscientist, therapist, writer. One thing I noticed on your website, you mentioned that you're drawn to uncertainty when it comes to human interactions. And I'd love to know a bit more about what intrigues you about that.

SPEAKER_01 1:14

Yeah, I think it's the one area that I could find that really connected all of these different areas that I've I've explored in my life and my career. Um, I think fundamentally what draws my attention naturally is the way that human beings communicate and the ways that there are things that are unsaid or things that we don't manage to communicate with each other, the conversation under the conversation, if you like. I feel like my eyes are trained on that underlying conversation. I think that's fascinating, both in a psychological experimental kind of domain, but also in art. So I would say that that's the level on which I I meant it, but I think it it goes a lot deeper than that as well.

SPEAKER_00 1:57

Do you think that's a cause of a lot of human suffering, this misunderstanding each other?

SPEAKER_01 2:03

Definitely. Yes. I definitely think that if we knew how not just to communicate better, because I think that that could be understood a little too superficially, but I think if we uh really learn to see and understand each other, I think that the world would be a lot easier, a lot more peaceful.

SPEAKER_00 2:21

And I guess what I'm thinking of as well is maybe this maybe when people think about communication problems, they think, I know what I want to say, could I communicate it better? But I also think at the deepest level, communication problems can arise when people aren't self-aware. They themselves aren't quite sure what they want to communicate because they don't understand themselves well enough.

SPEAKER_01 2:43

Yeah, I I couldn't agree more. I think sometimes we're there are situations where we might be using strategies that we've learned. We might use I statements and use all the right terminology, but something is not quite happening there. And I think the piece that is sometimes missing is fundamentally empathy, like actually being able to put ourselves in each other's shoes and feel what it's like. But uh, on the converse, on the happier side of that coin, I've one of the things that I've found really useful to uh observe and to realize as a therapist is that on the deepest level, there's so many different types of clients that I've been uh exposed to now, so many different types of people I've had the fortune of meeting in my life. And on the deepest level, I really do believe that the language of emotion is a universal one, and that if we can actually reach that, which I think it takes self-awareness to reach, we can connect with almost anyone. Perhaps I'm an optimist, but yeah.

SPEAKER_00 3:43

So say so saying that we all have a universal emotional life, and if we can just understand that that about each other, it opens up an avenue for empathy which would otherwise be difficult.

SPEAKER_01 3:57

Yeah, uh to put it very simply, I would say that we connect with each other by feeling together.

SPEAKER_00 4:03

That's interesting. And maybe too often we communicate more through intellectual means. I'm thinking especially online.

SPEAKER_01 4:10

Yes, absolutely. And I think that's one of the biggest areas where we can get lost, and that's sort of what I meant in saying that sometimes we can speak about communicating better in a more superficial way. Of course, you know, knowing how to use the right language helps, but there's something a bit deeper than that about which we're if we actually allow ourselves to just be in the most natural sense, I think uh we would be able to connect with each other. And sometimes even that intellectual part can get in the way.

SPEAKER_00 4:39

Yeah, that's true. That's true. Do we uh do we understand empathy at a neuroscientific level?

SPEAKER_01 4:45

Well, it's a difficult question. It's to be honest, I haven't actually delved very deep into the concept of empathy from my my neur with my neuroscience hat on. Obviously, you know, a lot of people talk about mirror neurons. There, there's a little bit of research about that, which to be honest, I think has fallen to the wayside in the the in recent years. But uh I mean there's really a nice research by Lisa Feldman-Barrett on emotions.

SPEAKER_00 5:12

Uh the theory of constructed emotion.

SPEAKER_01 5:14

Exactly, which does rest on some of some principles that I was sort of raised with as a scientist, which is this idea that the brain is constantly making predictions about the world, that it's in essence a predictive organ, and that we are constructing our perceptions of things, including emotions, based on not just what we're perceiving. We're not just constructing a carbon copy of the world outside, but that our per perceptions and experiences are colored by what we deem most likely to be true based on our past experiences, which does tell us a little bit about how individual every experience is and how um how differently we'll perceive the same thing based on who we are. But the interesting part of that is this idea of embodied perception, not just that this is something that we apply to information for the world outside, but also information from our own bodies.

SPEAKER_00 6:08

Meaning that when we're in a situation, we partly hypothesize what's going on based on what we're feeling in our body.

SPEAKER_01 6:16

Yes, exactly. So we might perceive a signal, a sensory signal, like some sort of discomfort from our bodies, and our brains in this, as we say, top-down manner, will try and find an explanation for why we're feeling that way. And I think that that's that's very interesting. I think that's fundamental to the concept of how we understand other people's minds as well, because those models that we make do inform how we expect other people to be experiencing things as well.

SPEAKER_00 6:48

I think the predictive processing model is fascinating. I also think it's incredibly useful to understand. When I first came across it a few years ago, it really helped me. For people who don't know, could you frame this predictive processing model maybe a concrete example that's easy to understand?

SPEAKER_01 7:05

Yeah, so I suppose in terms of like visual perception, for example, illusions are quite uh a nice example that we our our our brains may have seen something in a particular context. There's a I think it's called the Konitska illusion where you see you have uh three circles that are positioned in such a way that makes your brain perceive a triangle. Most people will perceive a triangle there. And typically when we see lines positioned in that way, usually what we're looking at is a triangle. Um, so it's it's kind of a nice example of how our prior experiences will color what we're perceiving. Something I quite like to use in my lectures as another sort of visual example. It's a sort of these two-tone filtered images. Basically, it looks like a slightly garbled version of a photograph. And they're quite interesting because they're these things images that when you look at them, it looks like nonsense, a little bit like a Rorschach kind of splotch. But then after you actually look at the unfiltered image and then you look at the filtered image again, you can't unsee it. And in a way, in real time, your brain has updated its expectations of what it's seeing.

SPEAKER_00 8:19

Yeah, and you see that with all of those illusions on the internet where you see it for the first time, and then once you see it for the first time, it primes you. And I guess just speaking of psychological priming as well, that surely is also explained by this predictive processing model that you can prime people with information which will influence what kind of decision they're likely to make or how they're likely to react in a given situation.

SPEAKER_01 8:44

Absolutely. It's it's the sort of thing that once you see it, you see it everywhere. Uh, that it colors all of our perception, really.

SPEAKER_02 8:51

Yeah.

SPEAKER_01 8:51

So examples of it abound throughout psychology. There was this famous gorilla experiment that was on YouTube for a while. That's a nice experiment example of that, where you were you look at change blindness again, because we don't expect a gorilla to walk across the scene. Again, that that's another classic example where you wouldn't necessarily originally have described it in terms of predictive processing, but it is a nice example of how the brain rests on prior information to colour our perceptions.

SPEAKER_00 9:20

And I I like to think about it in broad psychological terms as well. Like I'm always fascinated by when you're talking to someone, you'll often find they come out with a similar narrative going after going through multiple situations. Like a person will go through three jobs and have roughly the same narrative after every job. Like, oh, I went in the job, this went bad, this went bad, and then the job ended, or maybe someone with abandonment trauma, for example, might go into lots of situations and then end up feeling abandoned. Sometimes the abandonment can happen, sometimes it's perceived abandonment, but it's this predictive model at a larger scale, not simply concentrated on a particular image, but a broad narrative of how you even see a kind of a complex interpersonal situation.

SPEAKER_01 10:09

Yes, absolutely. I I actually think that this has been a very useful way of for me personally thinking about things that I I have learned training as a therapist, um, such as the therapist's favorite word transference, this idea that we and my transfer on usually unresolved experiences from the past onto a present interaction. And I think that that resonates very well with this idea that our experiences are colored by the past.

SPEAKER_00 10:37

Well what came first for you was it the neuroscience or the psychotherapy?

SPEAKER_01 10:41

It was the neuroscience, actually. Yeah. So I I grew up in that world. But the psychotherapy happened fairly naturally, I think, as a follow-on from that, or to be honest, along the side.

SPEAKER_00 10:53

And it's quite it's a lovely combination to have. So you think it's it would be great if more therapists had neuroscience in their background.

SPEAKER_01 10:59

I'm glad you think so. I I also think so, but I might be biased.

SPEAKER_00 11:03

Do you get put like what what do your neuroscience colleagues think about the therapy offshoot?

SPEAKER_01 11:08

I've had very positive responses, actually. Uh in general, I think you know, you mentioned at the start that I have quite a few different kind of paths that I've taken. And that's always been the case for me, but I what I've learned over time, and certainly the therapy training has been helpful for this, is to apologize for it less.

SPEAKER_00 11:29

Okay. No, that's that'd be something interesting to zoom in on. Like did you at one point feel a need to apologize for it?

SPEAKER_01 11:36

Yeah, for a long time, actually. Uh as with a lot of people throughout school, there's a lot of pressure to sort of you're confused if you want to do different things or if you have different interests. I think we've kind of perhaps in a productivity age lost the concept of uh polymath or the value thereof. And it it that sort of narrowing down never really felt very natural to me. And I I had these different interests and I I felt compelled to explore them. And I most of all I think it's that the boundaries didn't seem very obvious to me. The connections between uncertainty that underlies all of these things, selfhood as well, all of these things I think can be cast through an artist's lens, but it can also be cast through a scientist lens. And the boundaries were never really that obvious. But when people who are older than you and why are seemingly wiser than you are telling you that nobody you have to choose something, otherwise you'll be confused, otherwise you're not being serious enough, it does feel like you're there's something wrong.

SPEAKER_00 12:37

Narrowing down is definitely the best business strategy. It's hard to argue with because if you can find a neat like I'm speaking with like my business hat on. If you like narrowing down means you can find a niche, which means you can market yourself better, which means you can communicate your value more easily to a client in whatever setting that might be. But personally, my biggest nightmare is having to do the same thing day in and day out, and that's why I ended up I've ended up doing a few different things.

SPEAKER_01 13:06

It's very true. I mean, I've converse to that, I have had to learn how to narrow down, and it has been really important. So I've I have had to balance out that part of my nature, and I'm in the weird position now of sometimes having to tell my students that okay, this is what we can achieve in the time frame that we have. I love all your ideas and their wonderful big ideas, but we we have this limited time or limited money, and it's an interesting thing to think about. So I think that that having an awareness of what the goal is is really important and how much what is feasible or achievable is really important. But I think when you apply that mindset to your entire selfhood, to your entire self, that that can really be quite limiting.

SPEAKER_00 13:48

And the counterpoint, even from a career development perspective, is there are real it can be it's very inefficient, cost-wise, and time-wise to do lots of things. But there is a huge strength because you develop a certain cross-section of skills which is unique. Like how many therapists are there, like millions, how many neuroscientists, millions, but how many therapists slash neuroscientists are there? All of a sudden you've narrowed the field significantly. And if you add another thing on top of that, like writing, creative work, even more so, and perhaps this might become even more relevant in the age of AI, where you have software that can replace niche kind of repetitive jobs very easily, but can they really that can they replace someone who has two or three different sets of skills simultaneously? At least it becomes a little bit harder for your job to be replaced.

SPEAKER_01 14:39

Well, that's quite reassuring and validating as well. Because now I'm starting to realize, like I was saying, my colleagues generally have received my various interests very positively, which I'm grateful for. And it's interesting having come through all the curtains that had veiled the path for me previously, or more specifically, now that I'm in more of a position of responsibility in academia, I realize that actually it's just people on the other side.

SPEAKER_03 15:06

Yeah.

SPEAKER_01 15:07

It seems trivial, but it was it's actually quite a big realization, and that those people like to know who I am as a whole person. And I've only I've had a lot of people come to me and say, Oh, I saw that you do these different things, and uh that actually it was quite reassuring for me because I thought I had to hide things about myself, or it would make me seem unserious.

SPEAKER_00 15:27

Even thinking about my podcast, even you could argue my podcast would be more successful if I just made it about psychiatry, say bipolar, schizophrenia, depression, or just about therapy, or just about self-development. I mean, we even discuss films on the podcast once a month, but because I do, you know, the reason for me doing it is to because it's interesting.

SPEAKER_01 15:49

So isn't that the best reason to do anything?

SPEAKER_00 15:51

That's the best, that's why that's the most self-sustaining reason. But uh, I guess it's something we're both we're gonna be struggling with for a while.

SPEAKER_01 16:00

Yeah, absolutely. I mean, I personally think one of the most powerful real realizations for me, actually, again, kind of peeking behind the curtain and seeing that it's people on the other side, is really I think it's quite nicely encapsulated by a Maori proverb that I learned a little while ago from a good friend, which asks, What is the most important thing in the world? And the answer is it is the people, it is the people, it is the people. And it sounds so simple, but the funnily enough, it's my work and my trajectory in science that has really taught me the most about how true that actually is.

SPEAKER_00 16:39

You mean like from your colleagues and working with them?

SPEAKER_01 16:42

Partly, yeah. Um, I think I've sort of realized just how much even the very content of science is so influenced by the people that do it. There's the obvious cynical conversations around that, around who pays for the science and where does the money come from and the political agendas that shape who gets to do the research, which institutions are more privileged and which aren't. It doesn't mean that there are people who aren't extremely capable at smaller institutions, but they have less funding. So there is that. But even on a more intimate level, like I've even had some colleagues who are really brilliant and really senior, but they they have their own personal Achilles heel, like an inability to say no. And it means that their very prestigious names are on papers that from the inside have flaws, but from the outside, because their name is on it, it would carry more weight. And uh and that's the very content of science. I mean, the published papers are what we hold as what we regard as science are those published peer-reviewed papers. Yes, exactly. So it's quite interesting. That's just one example, but even from a sort of positive perspective as well, I feel like having a having a positive culture of the people around you, which I have to say, being in this field of psychedelic research, I really have found, and it is almost amusing just how specific the culture of different fields are. One of the things having moved through different fields is that you really get a sense of how different people are attracted to. Different personalities are attractive.

SPEAKER_00 18:10

So, what kind of personality is attracted to the psychedelics field?

SPEAKER_01 18:13

I would be very curious to know what you would guess.

SPEAKER_00 18:15

I would guess optimistic people. People who are high in trait openness to experience, probably.

SPEAKER_01 18:23

Yes, absolutely.

SPEAKER_00 18:24

Not yeah, that's that's probably as far as I'm gonna need to go. But yeah, people are optimistic who want to innovate, yeah, who want to see change.

SPEAKER_01 18:32

Definitely. And there's a lot of I mean, defin definitely fewer sort of self-social boundaries. So even just even just evidenced in the fact that the way that we greet each other in different fields is different. So if you meet someone who's a psychedelic researcher, they mo almost like most likely will greet you with a hug. Whereas in other fields that I've been in, it's probably more likely a handshake or just a hello.

SPEAKER_00 18:56

I can imagine that. I've met a few psychedelics researchers, so I can imagine that. Do you I mean, speaking of psychedelics research, driven by a lot of optimism and a lot of hope that things can change and that new treatments can be made available to people. Do you think speaking broadly, the data about psychedelics assisted treatments is living up to that optimism so far?

SPEAKER_01 19:20

In many ways, yes. There's I mean, it's such a a new field in the sense I I I know that you've got you've had David Nutt on the podcast before, so you uh you probably will have had him speak a bit about this psychedelic renaissance idea, but for anyone who's new, there's been a bit of a winter of psychedelic research for around. Like 50 years, was it? Something like that, around 40. But in the 60s especially, there was already about a thousand published articles that were quite hopeful about the use of psychedelics in in therapy or for mental health. I mean, arguably the quality of the science that was done was of a different level, but still there was a lot of hope. And then there was a big gap, and now things are sort of picking back up again as uh as of the last few decades. Uh again, fueled by new technologies like like neuroimaging. There wasn't really the advent of brain scanning previously in that earlier era. But it does mean that there's a lot of work that's happening, a lot of very exciting things. There aren't very clear answers about mechanisms, which is what personally I'm most interested in. What are the underlying mechanisms of how these drugs work in the brain and in the mind? But what what there definitely does seem to be a lot of evidence for is that clinically there are extremely good outcomes for a lot of people in ways that are very different to traditional psychiatric medicine.

SPEAKER_00 20:46

And what what makes it different?

SPEAKER_01 20:48

So I think the simplest way of putting it is that a lot of the existing psychiatric medications, like previously I was interested in treatment resistant psychosis, and uh a lot of the people with psychosis or schizophrenia, where you know, the most common disorder where psychosis manifests, there's about 33% of patients for whom antipsychotics just won't work. Um, so those people have no treatment options, and it's quite harrowing to come to titrate on and off a drug like that. Um, similarly for depression, around a third of people with depression don't really have any treatment options. So uh, and then you know, the drugs themselves come with their side effects. But I think uh most fundamentally there's the way that those drugs are prescribed. They're sort of you take them every day, it doesn't matter the context in which you take them.

SPEAKER_00 21:39

And the conventional drugs.

SPEAKER_01 21:41

Yes, exactly. Um, so like antipsychotics or antidepressants, they help they do help a lot of people, but the way that they work is just you take the pill, and it's the pill that's doing the job on its own. You do it, and it's sort of indefinite. And I think crucially, it has this sort of numbing effect, to put it very uh broadly. But a lot of people describe uh sort of emotional blunting. Yeah. Right. So, uh, and I think that that's key where your experience is narrowed, is how I see it. Whereas with psychedelics, actually, for a short period during the effects of the drug, your experience is actually heightened and widened. And I think that's a very important difference because it means that practically speaking, what you're actually doing is um bringing things to the surface and intensifying whatever is present in that, in that time, which means that what happens during that time, you often hear the phrase set in setting, of course, the the mindset with which somebody comes into the experience and the environment, the people around make all of the difference. So, in a sense, I would personally say, and what I think a lot of the scientists in the field would say, is that to have psychedel psychedelics as from a clinical perspective without the psychotherapy or some kind of human support doesn't really make sense.

SPEAKER_00 22:57

That's what that was going to be my next question. So, do you think psychotherapy is an essential adjunct to getting the psychedelics treatment itself?

SPEAKER_01 23:06

I think as far as a sort of Western clinical perspective goes, I would say yes. Obviously, I have some caveats uh around that because their psychedelics have been used by indigenous communities, for example, around the world for thousands of years, and they have their own ways of using them for medicine and for other things as well.

SPEAKER_00 23:25

But I suppose in those contexts, there's a there's a whole ritual that's designed to make the process hopefully safe and also useful in some way, which is different to the total absence of a ritual that could happen, I imagine, could happen in a Western context.

SPEAKER_01 23:40

Yeah, absolutely. And it's an interesting sort of thing to navigate because on one hand, there's a lot we can learn from people who have so much wisdom from you know thousands of years, but also knowing that there are we are sort of working with the realities of this Western medical system where we are at least.

SPEAKER_00 23:57

Yeah, I mean ketamine in particular, it seems to be administered quite a lot in the NHS without any kind of therapy. But I think still showing some results for depression. But in your view, should we be seriously considering pairing ketamine with with some sort of psychotherapy itself as well?

SPEAKER_01 24:15

Yeah, I would say so. I mean, this is a good example of where circumstantial things have made something the case. And I think the reason that ketamine has sort of so quickly led the way in I mean, uh I was going to say psychedelic research. Some some people would think ketamine's a psychedelic. They might contend mainly because it it works on a different neurotransmitter system and it has a slightly different, more dissociative sort of experience. But you know, uh the it there's a similar principle as far as the therapy component is concerned. And so I I I would definitely say that it makes most sense again to support someone through this very intense experience, and that it's there's a lot of evidence also pointing towards the fact that the experience itself is one of the most important factors that underlies the therapeutic outcomes.

SPEAKER_00 25:03

Not just the pure biological interaction of the drug with your physiology, but also the actual psychedelic experience you have while on the drug.

SPEAKER_01 25:12

Exactly. And that I think is actually one of the things that I find most interesting about being in this field, that it sort of forces us to ask certain questions or question certain underlying philosophical assumptions that perhaps would I think certainly for me as a scientist growing up in other fields, uh, I didn't even realize that I had.

SPEAKER_00 25:31

So, what what kind of assumptions do you think this challenged for you?

SPEAKER_01 25:35

I mean, one of the main things is around sort of this mind-body dualism, like this, which I think really is quite fundamental in psychiatry as well. I mean, even the fact that psychiatry, psychotherapy, and neurology are considered separate disciplines is quite telling, I would say. And uh I think but there are so many subtle ways in which that influences the way that we perceive the mind, the way that we give clinical care. And there's something about the intensity of the psychedelic experience and all of this evidence that we're having about a very different way of treating mental illness that is kind of forcing us, I think, to question some of those assumptions, particularly around the separation of the mind and the body.

SPEAKER_00 26:18

So we're we're learning maybe at a practical level that the mind and the body are more one than we're used to thinking about in a Western context.

SPEAKER_01 26:27

Yes, absolutely. And the thing is, we're seeing that with cutting-edge neuroscience. And uh there is something about, you know, uh it's interesting to me that this information has been around there, but there's something that even in a meta sort of way, that when when we can say it with science, it's easier to actually give it some credibility or give it some attention.

SPEAKER_00 26:50

Yeah, and I guess I guess we want we want science to help us give us that credibility, but I suppose maybe one problem with scientism, if you like, maybe a fixation on science is that it can close your mind to possibilities which at least before science is done, your mind hopefully should be open to different hypotheses before things are conclusively proven as possible or not possible.

SPEAKER_01 27:14

Yes, for sure. And and it's funny, actually, being a scientist myself, I again this is where another place where I've been trying to resolve certain boundaries that haven't really been that obvious to me. And again, I I think with science, I I kind of see it as an extension of what our brains are doing anyway, this predictive processing thing that we were talking about. Uh, but fundamentally the drive there is to seek consistency with the reality of the world outside.

SPEAKER_00 27:41

Reality testing. Exactly. Essentially.

SPEAKER_01 27:43

Whereas with science, I mean, in a way, we're doing exactly the same thing. We want to arrive as at accurate a reality as possible. It's just that we've formalized ways of doing that in a very rigorous way.

SPEAKER_00 27:56

Can you can you one one thing I'd love people to understand about science is just how hard it is, how difficult it is. Can you speak to that?

SPEAKER_01 28:05

Yeah, definitely. I I mean, I don't even know where to start. Um, I mean, I can talk about the study that we're currently doing. I mean, that's interesting because I I've really had to learn that for myself firsthand as I've been trying to set the study up. It's really been a labor of love. In in short, what we're doing and what hopefully we'll be starting in about a month to do is uh giving people high doses of LSD and putting them in a high-resolution brain scanner and uh mapping their subjective experience over time. So, as I was saying, you know, we're interested in the experience because it's so important for the therapeutic outcomes. But in getting to this point, it has taken four years to get to a place where we can actually uh do this study that we've wanted to do all along.

SPEAKER_03 28:51

Yes.

SPEAKER_01 28:52

And all of that has been so much, you know, there's just so many different loop hurdles and paper, paperwork and admin, and uh, and then of course being able to have, like I was saying, funding to do the research that we want to do. All of these things are quite a lot, and it's there's so much to do. And we're as researchers, we we're not usually trained to do those things when we're in our training, when we're in university. We're we're trained to think about science.

SPEAKER_00 29:20

But not all the logistics, yeah. The innumerable logistics and decisions and teamwork that has to happen around.

SPEAKER_01 29:28

Exactly. Absolutely. So there's all of that. There's a really nice opinion piece that was written a couple of years ago in the journal Brain by one of the editors called Masood Hussein, who writes about this really nicely with an article called The Mountain of Small Things.

SPEAKER_00 29:43

Which I think is sort of that phrase is just making me shiver.

SPEAKER_01 29:46

It was quite self-explanatory, but I think that expresses it better than I ever could. All these little things that sort of pile up. And this is just one thing. I mean, I to be honest, I think for from the perspective of researcher in research, this might I I'll put my neck out and say this might be the biggest thing that is actually the the hurdle at the moment. But of course, there are other things as well. There are societal things, there are there's a glass ceiling for for women and people of color and all of that. There's this there's those those considerations as well. But yeah, there's there's challenges as with any other area.

SPEAKER_00 30:22

So the function of this study is to determine what's happening to the brain under the influence of LSD, is that the goal of the study, or how that correlates with someone's subjective experience as well?

SPEAKER_01 30:35

There are there are many different uh arms to this study, and given that we've taken so long to get to this point, we we want to collect quite a lot of data. But the fundamental core of it is to try and explore, it's exploratory, uh, whether we can see any relationships between aspects of the subjective experience that's reported by the participant, but over the entire trajectory of the experience. So not just a cross-section or not just, you know, typically in the past that people have been in in psychedelic studies are given questionnaires after the experience the next day or something like that. But in this case, we're sort of trying to map it over time and then correlate it to any brain activity that we see that's happening at the same time. So basically, what kind of brain activity do we see when we see certain aspects of subjective experience? Right.

SPEAKER_00 31:22

So this is happening to me at this moment. Yeah. What could be happening at the brain or at the brain level, which could be explaining potentially or at least correlated with what this person is experiencing?

SPEAKER_01 31:33

Yeah, exactly. And is that different on LSD? We expect it to be quite different on LSD.

SPEAKER_00 31:39

Then uh control who's getting a placebo?

SPEAKER_01 31:41

So it's not with a placebo, it's actually what we call within subject. So the same person will uh be scanned off the drug and then also on the drug. So we'll be comparing the same person to themselves. Yeah.

SPEAKER_00 31:53

Okay. Themselves before taking it?

SPEAKER_01 31:55

Before taking the drug, yeah. So a couple of days before they come in and have have a scan without any LSD. Yeah. And then a couple of days later they have multiple scans while on LSD.

SPEAKER_00 32:06

And what kind of scan are you using? It is a f is it a functional MRI?

SPEAKER_01 32:10

So it's actually a seven Tesla functional MRI, which is a high high-resolution scanner, which allows us to go into a lot more detail than a standard scanner, which is quite exciting. It means that we can kind of look at more uh detailed sort of underlying structures and the ways different parts of the brain communicate with each other during a psychedelic experience, which is you know the way that a lot of neuroimaging is moving in the field of research, people are going a little bit beyond the typical thing that we see in popular science of uh these are the blobs that light up and talking more about the ways different parts of the brain communicate with each other, through the connections or connectivity is something we talk about a lot.

SPEAKER_00 32:52

You said it's an exploratory study, but do you would you have would you in a study like this go in with any hypotheses?

SPEAKER_01 32:59

Well, very broadly, of course, we're expecting to see very different brain activity and a lot more. I mean, we're basing this on other studies that have been done. There, there is, for example, quite a seminal study that was done fairly similar to this with but with a standard scanner at Imperial in 2016.

SPEAKER_00 33:17

And was that the Robin Calhardt-Hara study?

SPEAKER_01 33:20

Yes, exactly. And uh so they gave people LSD and they found that there were, for example, increased connectivity between different, many different regions of the brain. There's also a kind of a reduction in activity in a network that's called the default mode network, which is typically associated with self-monitoring.

SPEAKER_00 33:38

So like when the default mode network is active, that's associated with like a lot of self-consciousness.

SPEAKER_01 33:44

Yeah, so early studies that kind of identified that network actually found it was active at well, what you would call at rest. So often when people do this kind of studies, you'll be doing a task of some kind, like trying to remember some words or looking at some pictures or whatever inside the MRI scanner. And what was interesting was that they would often see that there was these particular regions of the brain that were active at rest when you were not doing anything at all. And that was effectively the default mode network. So at rest, people were often sort of probably mind-wandering, and people got interested in that, and it's sort of emerged that that typically is associated with sort of self-monitoring, thinking about yourself. I would say that very broadly speaking, that seems to kind of reflect the kind of mental chatter or the inner monologue, maybe that quietens.

SPEAKER_00 34:32

And my understanding is meditation and being an experienced meditator is correlated with also having lower baseline activity in the default mode network. Is that right?

SPEAKER_01 34:43

I I believe so. I don't know a lot about that, to be honest. But there are is a lot of overlap between the psychedelic experience and the meditative experience. And actually, even a lot of people in psychedelic research are getting interested in breath work as well, which can sometimes induce similar states. These, I mean, uh, as a whole, spoken about as the altered states of consciousness. And breath work can certainly elicit these altered states of consciousness.

SPEAKER_00 35:07

One thing to point out for the listener is so this isn't a clinical study in the sense that the study isn't going to answer any questions about LSD's usefulness as a medical treatment, right?

SPEAKER_01 35:19

Yeah, no. So um it is an important distinction, actually, between uh clinical trials, which will is effectively the goal of a clinical trial is to assess whether or not a particular drug is effective for a particular disorder and will look quite different, therefore, to what broadly speaking you'd call a basic science study, which is interested in understanding, in this case, mechanisms of what these exactly, what it does in the brain or how it influences your experience, that sort of thing.

SPEAKER_00 35:52

And curiously, I've noticed LSD is quite absent from a lot of these clinical studies.

SPEAKER_01 35:58

Yeah, well, uh there's a reason why it's it's actually more absent from quite a lot of even basic studies as well. There are actually clinical trials now that are underway with LSD as well. I I'm actually a part of one of them. Uh I don't know how much I can say about that. It's not my own, but I'm I'm actually involved with that as a therapist.

SPEAKER_00 36:18

Are you able to say what kind of condition they're studying?

SPEAKER_01 36:21

Generalized anxiety. Okay, great. Yeah, yeah. But so there so it is being used. But the reason I think one of the reasons that people have avoided LSD is that it just practically speaking, the duration of effects are really long. How long does LSD last? Around at a typical dose, macro dose of 100 micrograms, which is for anyone who does have experience with it, around the equivalent of a tab of acid. It would probably be between eight to twelve hours.

SPEAKER_03 36:51

Right.

SPEAKER_01 36:52

So yeah, I mean, in a way, gluttons for punishment. We're testing on a Sunday, spending the entire 12 hours in our testing facility pretty much every week for a year on a Sunday. Wow.

SPEAKER_00 37:05

And it's also remarkable how potent the drug LSD is, and that's for those who don't know, 100 micrograms is a tiny, tiny dose. You'd never have an an antidepressant, for example, administered at that dose. Do we have any idea why it's so potent?

SPEAKER_01 37:20

To be honest, that I don't know. I mean, it it really is a remarkably small amount to the extent that Albert Hoffman, who first synthesized it, the chemist in 1938, who was actually working for a pharmaceutical company trying to find drugs for for childbirth, etc. And uh he uh apparently was exposed himself to it but didn't really expect it to have any effect at that particular dose, but ended up having um quite an intense psychedelic experience. Yeah, it is a remarkably small dose. But yeah, it can it can sort of it has fairly similar effects to psalocybin, which is the active component in magic mushrooms. Um but the main difference, of course, being the duration of effects. Um so they are very, very potent substances, and I think it is also worth mentioning that it it's not to be taken trivially.

SPEAKER_00 38:15

And was there a particular reason he landed on LSD for your exploratory study?

SPEAKER_01 38:20

Partly because not many people have explored it. Um I mean the other reason I should say is that it it seems to have more stigma around it. So that's another reason it's not explored very much.

SPEAKER_00 38:31

And is there any justified reason for that stigma in your view?

SPEAKER_01 38:35

I think it's more historical and political, actually. When when it was synthesized, it was it it was it became of quite a lot of interest in the US. A lot of those thousand studies that I mentioned were about LSD, and uh at some point it sort of, as they say, leaked out of the lab and ended up being strongly associated with this pacifist counterculture movement, the the sort of hippie culture. And uh that became kind of a target of quite a lot of political propaganda because it started to become uh a bit of a nuisance to sort of the Nixon administration.

SPEAKER_00 39:14

And I I feel like people can also have a bit of a stigma against synthetic drugs as well. So for those who don't know LSDs, synthetic man-made psilocymen, for example, is not, and a lot of psychedelics aren't. And I think people can have this inherent reaction that if it's man-made, this it's worse in some indescribable way.

SPEAKER_01 39:33

Yeah, I find that interesting actually, because um, to some extent, the fact that it's synthetic means that you have a little more control over what you're ingesting. Uh, on the other hand, you know, there are instances where, you know, like with the ayahuasca brew, there are other components of that particular brew that sort of balance out the active, the active molecule, which is a DNT in that case, and make the experience more palatable. So I suppose there is something to that, but but it's not quite as obvious as perhaps it's assumed that um synthetic just equals that.

SPEAKER_00 40:08

That's really interesting. I just feel that people always have that particular stigma. This exploratory study, do you think this would then help pave the way for further clinical studies as well?

SPEAKER_01 40:19

I hope so. Uh I mean I quite like to think that we need a combination of both in order to really be able to understand how we uh treat mental illnesses and how we best help people with any kind of mental condition. Because on one, I mean, you can say this for other psychiatric drugs as well. When I was working with in psychosis, for example, uh, in many ways we've been using antipsychotics because they work for a lot of people, but we can't say with a lot of confidence that we actually know exactly how they work.

SPEAKER_00 40:50

No, we have we have some theories and we have some data, but I guess I would add there's a lot we don't know as well.

SPEAKER_01 40:55

Yes, exactly. Um I mean, of course, we've gone gotten uh as far as to be able to say that there are certain receptors that we know that these drugs bind to, and we know what that that effects that might have on certain systems of the brain, both for antipsychotics and antidepressants, but also for psychedelics. So we do know those things, but I think there's a lot more that we don't know.

SPEAKER_00 41:16

And using the example of antipsychotics, it's also taken decades for us to realize how best to use them. So one huge mistake that was made with antipsychotics in the 50s and 60s around the time they were first discovered is they were simply given into way too high doses. So the stereotyped example that antipsychotics will inevitably zombify you or inevitably cause a huge amount of side effects. Yes, they can cause side effects, but a lot of this stereotyping is because drugs like haloperidol, for example, were given in doses which were way, way higher than we give them now, and now we realize actually we can give a much smaller dose and still get the majority of the clinical benefit.

SPEAKER_01 42:00

That's really interesting, and yeah, I think that's such an important uh point when it comes to drugs in general that uh the dose makes the poison. Um the dose makes makes it in general.

SPEAKER_00 42:10

And I I kind of have a similar hot take about antidepressants, not about the dose exactly, but more about how we use them. So one of the biggest problems I see with antidepressants is they're prescribed and and they may have some benefits, not always, they may have some side effects, and then patients are often left on them for years, sometimes five years, sometimes a decade even. They're often prescribed at the GP level, and just without any regular review, is this drug helping you? Is it not? Is it causing you side effects? Is it not? Should we consider changing it or just coming off it entirely? And I one thing I one thing I predict will change when it comes to antidepressant prescribing is hopefully we'll become a lot more surgical. It's not that they're not useful, especially in some situations, but there'll be a lot more care about okay, we're gonna start this antidepressant, but we're gonna check it every three months and we're gonna make sure it's actually helping you in some way, and hopefully pair it with the psychological and social interventions, which will also help the depression, anxiety, trauma, what have you. These are the reasons people usually take antidepressants, and that's my hope is that will become a lot more intentional because I think a lot of the harms of antidepressants come not just by using them, but by using them as blunt instruments and for just really long periods of time.

SPEAKER_01 43:31

Oh, I I couldn't agree more, and I really hope so too. I I think that intentionality piece is so important, um, but it takes really understanding, yeah, as we were talking about how things work and what the goals are ultimately, actually having even actually philosophical thoughts about what the point of it all is.

SPEAKER_00 43:51

Yeah, what why are you taking this drug? And it concerns me that a lot of patients don't necessarily know why they're on a drug. They might think, okay, it's for my mental health in the broadest possible. Sense, but actually it's quite a narrow set of symptoms retreating.

SPEAKER_01 44:05

Then there is a power dynamic there. Patients who will believe that because they're being prescribed something, that's just the way.

SPEAKER_00 44:11

Yeah. And I also think psychiatric prescribing, I mean, I think all prescribing should be reasonably collaborative. But I think psychiatric prescribing in particular, because we only have the patient's subjective experience to guide us as to whether it's working or not. I mean, their subjective experience, and perhaps you could say their behaviors and then maybe at the extreme and some objective risks, but mostly 80% say is their subjective experience. Are they feeling good or not? Are they sleeping well? Is their appetite okay? How are their energy levels? So they we need our patients in psychiatry to guide us. And so I see this a lot, for example, with ADHD prescribing. Where if someone's on an ADHD medication like Ritalin, you need to know is this actually having a benefit? Is it helping with your concentration? Is it helping you be more organized or less restless? Because if it's not, we need to take some considerations about whether or not you should even be on this drug. And for some reason, we really do this very actively and quite well with ADHD medication because it has some clear safety concerns and side effects. We don't do it as much with antidepressants.

SPEAKER_01 45:20

That's really interesting. Yeah, no, I I I relate very strongly to your point about the ADHD medication because I actually had a diagnosis of ADHD when I was at 22, and I did take Ritalin for a little while. It it didn't suit me very well. But I did find it interesting that that was the first course of action. I was quite sort of confused about it. How old did you have been? I was 22. 22, okay. Yeah. Um so I did see seek it myself. This is a little before there were the very long waiting lists for diagnosis that there are now. But I was I was surprised by the whole experience, to be honest.

SPEAKER_00 45:54

Were you given at the time of diagnosis, you recommended medication? Sounds like. No. Not at zero. Not at all. That's shocking. Yeah. So that's some, yeah, that's something that's another issue I have. I'd love to know if you're comfortable sharing. Do you think the diagnostic process and having the diagnosis is it useful for you?

SPEAKER_01 46:17

Yeah, this is something I've thought a lot about. Um, so I uh I've had a bit of a journey with the diagnosis myself, but in the first instance, I can't deny that I really needed it. I think there's all all sorts of things that you hear when you have ADHD or when you are neurodivergent in any way, like well, like you do too many things, like even things like you're lazy because you might sort of take longer to do things or and it it that that itself in a secondary sort of way takes its own toll over time. And I think I just needed at that point something for long long enough to take those burdens off my shoulders so that I could actually do something about myself, if that makes sense. So something to tell me that it's not all my fault.

SPEAKER_03 47:06

Yes.

SPEAKER_01 47:06

And I think at that at that point, that is actually exactly what I needed. Uh and and then from there I've been on a bit of a journey with it where I feel like having worked actually more in therapy on things like boundaries and limits and getting to know my own limits and getting to know um that it's okay to stop here and that this is actually where I'm at, and I don't have to keep pushing myself beyond that. Those have been things that have been uh unparalleled in helping me to psychological strategies. Yeah, and then things around acceptance, like you would see in acceptance and commitment therapy, for example. So accepting the fact, for example, that I'm not going to do things consistently every single day at exactly the same time. I'm just not that person. So I these days, if I have a big deadline, I will plan a certain amount of time right before the deadline to do that job. And so, and that's been much more kind of going with the flow of what I am and who I am as a person. And to be honest, as as long as the job gets done in my job now, nobody really cares.

SPEAKER_00 48:04

And are there any particular lifestyle strategies which you found useful?

SPEAKER_01 48:09

Yeah, I mean, one of the biggest things has been very consciously not trying not to rush. I think I have a little soapbox about rushing that I I really think that rushing is the source of many, many of the world's ills on so many levels. Not just sort of superficially, where of course we're more irritable. Oh good. I see what you think. But I I think there's layers to this. On the surface layer, of course, we're more stressed when we're rushing, we're more likely to make mistakes. Uh, but then I I think on a sort of meso level, we're also less present, which is a big thing. We're kind of giving up our present experience, our experience of life. Just a slight change in perspective. It's not necessarily that we're doing things a matter of doing things faster or slower. Rushing is a subjective mindset of I have to do this thing now. Exactly.

SPEAKER_00 49:01

I guess it's the now part that's so corrosive.

SPEAKER_01 49:03

Yeah, and doing thinking while you're doing it, thinking about the next thing that you have to do and the next thing that you have to do, and being driven by obligation in that way, as opposed to so it's sort of the opposite of presence and that leads to all kinds of things. And and I think it actually, to bring things a full circle, does get in the way of connection. So, how can you connect with someone if you're not actually authentically present?

SPEAKER_00 49:25

Connecting to someone, but even just connecting to the moment here.

SPEAKER_01 49:27

Exactly. Exactly. And then even on the deepest level, uh, I know that you're also interested in personality, and I I think on some level actually I think of narcissism, this that was an area that I've become very interested in lately as well, as the ultimate form of rushing. In the sense that when you've grown up feeling like you have to be perfect, but you can never be vulnerable, you kind of are left no option but to pretend that you've already run the race without having even left the f uh the start line. You've already reached the finish point. That's the sort of the ultimate rushing.

SPEAKER_00 49:58

Yeah, no, I mean I think a lot of what you you're calling rushing, I think about all the time. And I I think of it maybe in terms of ambition. Like there's a few different levels you go through when you're trying to be more when you are more ambitious and you try to accomplish more. Level one is like you just start working way harder to say yes to commitments more and you just try your best to accomplish them. But what I've realized is that people then run into problems at this level one because if you're constantly engaged in the busy work of trying to be a so-called accomplished or ambitious person, it doesn't give you the time or the space to make more strategic kind of big picture decisions. So even if you want to be that person who's really ambitious and accomplished, rushing and being addicted to rushing and being addicted to get things done can stop you from even making the really important decisions you need to make to actually achieve your goals. And instead, what I see a lot of people doing is myself doing is burning themselves out by doing way too much and not having the time and space to yes, enjoy life, but also think, okay, what actually is the next best move? Because that's not always obvious. You need time to figure that out, and you can't really do that if you're constantly trying to tick the next task after this.

SPEAKER_01 51:20

It's it's so true. I I completely agree. And I I think a lot of it is driven by this productivity culture. And I think that it's important to say that like I think a lot of people probably do relate to this, and it's not that there's something wrong per se with those people or with us for feeling like there's an obligation to live that way. I think it's because actually I think the antidote fundamentally to it is actually gentleness.

SPEAKER_00 51:46

Um we're just not used to that as a way forward. Well it's gentleness.

SPEAKER_01 51:51

It's and it's really it's so anathema that I mean the first instance, this is why I wanted to make that caveat, because I can very much see somebody who has this penchant to towards rushing and obligation, hearing someone say that, well, rushing and obligation are fundamentally ruining ruining your life, and then to add that as another thing to feel obliged and guilty about. But actually, really what we need, I think, just in our culture, this productivity-driven culture, is a little more gentleness. And like you say, being able to sort of ride this wave of intrinsic motivation, which is far more, I think, sustainable sustainable, exactly. Like willpower is a limited resource, isn't it? And we act as if it's not.

SPEAKER_03 52:33

Yeah.

SPEAKER_01 52:34

But to be able to learn to ride this wave of intrinsic motiv motivation not only is more sustainable, but it also allows us more authenticity.

SPEAKER_00 52:42

We can live a life that reflects our values and what we care about.

SPEAKER_01 52:45

Exactly. Absolutely. And I think it's relevant to what we were talking about in the beginning about being able to exist in all of the different ways in which we identify ourselves, all the way, all the interests that we have to explore them unapologetically. Uh, I think that that's relevant to being able to just allow the allow for the those intrinsic motivations to exist. Obviously, you need to balance it and live in the real world and all of that, but I think we focus perhaps as a culture a little too much on the forcing and the pushing and the rushing and the willpower.

SPEAKER_00 53:20

Yeah, and I I often frame this as just modern life being strange and just getting stranger, in that I think life just had inbuilt slowness in it, so you didn't have to concentrate too much on the slowness because you had some slowness. Like even if we rolled the clock back 30 years to 1996, you have less internet, you don't have a smart supercomputer in your hands the whole time. Most people couldn't work from home, you couldn't immediately connect with everyone immediately, you had to pay long-distance phone bills, you know. So there was a slowness built into life, so you could concentrate on productivity knowing it has a natural cap. Whereas now the technology in the intervening years has just accelerated, and we have to learn this new skill, which is an equally important skill of putting the brake on to prevent ourselves from from burning out.

SPEAKER_01 54:12

It's true, the the evolutionary mismatch is growing. I talk about that a lot.

SPEAKER_00 54:17

My listeners are probably sick of thinking that so it sounds like so slowing down has been useful in terms of managing ADHD-like traits for you.

SPEAKER_01 54:27

Yeah, definitely. Uh, I mean, funnily enough, I had this realization in a yoga class. Uh, I don't know if you you're familiar with yin yoga. No. Um, so it's just a slightly different way of doing it. I was more familiar previously with kind of faster-paced styles of yoga like Ashtanga, which is just moving through certain poses that's more conventional yoga. Yeah, in a sense. Uh yin yoga is basically similar poses, but you just hold them for longer, effectively. But uh and I thought that that would be the extent of it. But what was really interesting about just slowing down and doing things for a little longer was that it it was a completely different philosophical perspective that it forced me to take. And I realized that actually uh I had been pushing myself beyond my limits. I I I actually couldn't hold this pose for very long. And I needed to sort of ease off a little bit and come to my true edge, find my true edge. And what was very interesting to discover when I started to actually have that humility and allow myself to step back a little bit was that I managed to progress a lot more quickly. Right. Because I was within that correct sort of window of challenge where I wasn't overwhelmed, I wasn't also underwhelmed.

SPEAKER_00 55:40

The zone of proximal development.

SPEAKER_01 55:41

Exactly, exactly. That's the one.

SPEAKER_00 55:43

Yeah, I do a bit of weightlifting at the gym, and the most common mistake, particularly guys, this is a uniquely male problem, make at the gym, is they lift how much the ego says they should be lifting.

SPEAKER_01 55:58

Ego lifting, yes. Ego lifting. Yeah, I've I've used that as an analogy before.

SPEAKER_00 56:02

Yes, yeah, so they go way too hard and then they injure themselves, which is exactly it sounds like was your situation with the yoga.

SPEAKER_01 56:09

Exactly.

SPEAKER_00 56:10

So one of the biggest strengths, because I wasn't I wasn't really much of a weightlifter earlier in my life, and I got to it kind of late in my late 20s, early 30s, but because of that, I had no ego around it. I don't care, I still don't care, which means I'm always going for that zone of proximal development. I'm never trying to lift how much I in theory should be able to lift, which who knows what that is. But I'm just getting to the point of can I do eight to twelve reps and my muscles feel like they're getting tired, which is basically where you want to be.

SPEAKER_01 56:39

Well, exactly. But I think that there's so much profundity in that realization of our limits.

SPEAKER_00 56:44

Well, that's where you want to be in anything that you want to grow in or learn, get better at, that's basically where you want to be. Enough to challenge you, but not so much to immediately wear you out. So I found I find the zone of proximal development idea very profound because it helps me calibrate not only what I should do in the gym, but where should I be with the podcast or other aspects of my career? It's just a very helpful frame of understanding, okay, where is your edge, assuming you want to grow. And I also think you shouldn't be growing in all areas all the time. Like there'd be some times where I'll be going to the gym just to maintain, yeah. And then sometimes you're trying to get better, and that applies to other aspects of my life as well.

SPEAKER_01 57:25

Oh, I agree. I I mean I think that applies on an economic level as well. There seems to be this assumption that eternal growth is economically somehow the best goal to have, but that never made sense to me. Yeah, absolutely.

SPEAKER_00 57:38

I'd love to talk a bit about psychotherapy, and in particular, I like to ask therapists about their general approach because everyone has a bit of a different answer. So I'd love to understand like how how do you how do you approach this process of therapy with a client?

SPEAKER_01 57:55

So I would say I'm trained in a in an integrative capacity, so essentially in multiple different schools of therapy, and then I draw from them kind of flexibly, dependent depending on what seems to fit the client best, and it changes over time, of course. I would say if there's one thing that kind of fundamentally is at the core of my belief system as a therapist, it's that the the relationship is key. So it's I would say that I'm a relational therapist.

SPEAKER_00 58:22

What does that mean? Why what does that mean?

SPEAKER_01 58:24

So there seems to be a lot of converging evidence. I mean, many people have taken an interest in what makes therapy effective. And one of the main things that seems to keep coming up over and over again is that the the quality or the nature or the strength of the relationship between the therapist and client is a very strong predictor of positive outcomes. I should say that it it can also be very a strong but negative relationship can also be a predictor of negative outcomes, and we should talk about that as well. But it is it is a very, very powerful, and I think personally I believe the core of the therapeutic process, where there's a lot that we can do by teaching people psychoeducation, as we would call it, teaching people certain concepts or giving them access to information about psychology, about the mind, and that can be really helpful. But there is a deeper sort of learning that can come from actually experiencing something with another human being that perhaps you've never experienced before, even for somebody who's had a lot of chaos in their lives and has never really had any consistency, to have someone that shows up for them every single week at the same time to have that consistency, or somebody who's never really felt seen before and have somebody who actually takes an interest in who they are, that makes them feel like they are actually are important enough to exist. I feel like experiencing that consistently for a while is so powerful, and that I think comes from feeling like you have a relationship with just this human being in the room.

SPEAKER_00 59:56

So would it be fair to say that in this respect therapy is helping to make up perhaps for deficits that a person may have had relationally, so maybe they didn't have that consistency, or maybe they never had a relationship where they felt fully seen, and so this is an experience that therapy can give you?

SPEAKER_01 1:00:15

I'd say that's one aspect of it. Yeah, definitely definitely it can be a corrective experience. I think I like to take a sort of uh as they say, person-centered kind of approach where in the just in as much as I think it's important that the client has agency and autonomy over what they're there for. So for some people it might not initially be obvious, and then that's part of the work together. But for some people they'll come in and they'll say, I want to feel less depressed, or I want to uh what do I want to achieve from this? I want to feel more authentic. Or I mean they might have a more practical problem in their lives. I mean, almost inevitably it it will, other things will come will become woven in. It's sort of my own therapist sort of likens it to pulling on uh uh the end of a ball of yarn, and it sort of uh ultimately turns out that it's all intertwined and it's all one thread.

SPEAKER_00 1:01:09

And I guess hearing us speak about relationships in therapy, one might come away from the imp with the impression that therapy is gonna be this kind of very pleasant experience, almost like a frictionless relationship. But is that true, or should a good therapy relationship involve some friction, involve some difficulty as well?

SPEAKER_01 1:01:31

Yeah, uh, I think that's really important. I think it it it should be as complex and wide-ranging and as nuanced as any other close relationship, which involves all of those things. I think obviously it it's there's a lot of people who come to therapy never having really experienced gentleness and kindness. So for many people that is what they need primarily, and it's the nicest thing to be able to give. But definitely there's some people who haven't been held accountable for their actions enough, and that that's not just something that affects other people, but it also leaves them feeling fundamentally helpless because like they, if you're not held accountable, you kind of lose a sense of agency, yeah. So it's actually quite an important thing to be able to say that what I what's what's your role in this? But it's yeah, it's it's as much an art as it is anything else, I would say. But I think that the point is quite well demonstrated by this new rise in AI psychosis cases. That I what you know, people talk about having AI therapy. I to be honest, I'm a little skeptical because of what we see when people try to communicate with Chat GPT. Yeah, for example, and so it doesn't do have this complex, nuanced, wide-ranging relationship, which also includes holding people accountable, which also includes uh expressing how it makes you feel as well.

SPEAKER_00 1:02:52

Yeah, and there must be something I haven't looked into the AI therapy, AI psychosis stuff enough. I I hopefully will soon on the podcast, but there must be something different about getting therapy from software and knowing at the end of the day there isn't a human being with their own agency or autonomy behind it. That even if they give you a kind of fake friction or they tell you you know you should be more accountable for your actions, that's different from a human telling you no or raising a boundary, or human you can there's there's actually benefits to therapy being once a week only for an hour, and that person, you know, they might get tired sometimes or they might not always be available because that mimics human relationships, of course. Whereas the frictionlessness of AI and the fact that it's available all the time can be a plus but can also be a negative because it's not really very realistic, so it's not really modeling a normal human relationship.

SPEAKER_01 1:03:51

Yes, absolutely. I think there's so much here actually that is very useful, you know, as a case study for what therapy is and isn't, or what it should and shouldn't be. I actually kind of find it fascinating. Um I smiled actually when you said uh that you know uh there must be something that's different to human relationships. Well, of course, there is, but what is really interesting to me is that um I think it tells us not just um about the algorithms of the AI, but it tells us about the algorithms that of ourselves, in that um the fact that we can develop these really you know deep connections um as human beings, and it's not just people who are extremely lonely, it's other people you know who wouldn't have considered themselves extremely lonely that have been really drawn into these sorts of relationships with AI bots. That uh, but I think it tells us something about our our deepest needs to relate.

SPEAKER_00 1:04:43

Yes, definitely needs to relate, yeah.

SPEAKER_01 1:04:46

And and some of the sort of uh underlying um ways in which those needs can be met. Um and those those sorts of validations, the sycophant, you know, sycophantic validations that you, you know, um, but fundamentally they are validations of our emotions that we are so hungering for, um, that can even something like that that is so obviously superficial in a way, can make us make our needs feel met on a way that is so, you know, many of us are so uh desperate for that it's so powerful.

SPEAKER_00 1:05:16

It's like I think emotional validation is the is a really deep need that we know we have, or I think most people know we have, or intuits we have. And I think boundaries are a need we also deeply have, but we don't realize that we have the need for the case. Oh, exactly.

SPEAKER_01 1:05:30

I think that's a matter of time scales that in the in the in the moment to no one wants boundaries. Yeah, exactly.

SPEAKER_00 1:05:36

It's always in retrospect. But you're like, I'm glad I had boundaries for them because I need them.

SPEAKER_01 1:05:42

Exactly. And that and that's often the case, I think, that we're competing against these short and long term goals. And the short short term ones will always win in terms of motivation. And I think I mean that that's how things like like this productivity kind of agenda like capitalism and all of that actually work.

SPEAKER_00 1:06:00

Back to narcissism, do you worry that narcissism has become a bit overused in modern culture?

SPEAKER_01 1:06:07

Sort of. Yeah.

SPEAKER_00 1:06:08

I I think it's it's like what what do people say is narcissistic versus how is a more what is a more useful definition?

SPEAKER_01 1:06:18

Yeah, I think it's definitely a word that is used frequently enough that there are many people who will use it f in frivolous ways, and that's it's uh undeniable that that is the case. To give you a sort of a broad definition, I would say that there are some core features that are sort of consistent through the form of what narcissism is, and that's particularly low empathy and high entitlement, and typically a tendency to exploit others, and then also things like excessive status seeking or excessive need for admi admiration, envy, high envy. So that there's there's certain things that characterize a narcissistic personality which can be on a spectrum. People can have sort of lower levels of this that can just make them kind of annoying, and higher levels of it that can make them really malignant, I guess. Exactly malignant. However, uh, to answer your original question, I actually think that in dismissing the the fact that a lot of people use the word narcissism these days, we actually miss the opportunity to ask a very interesting question, which is why are so many people interested in this? Which I think is not I think it's not a trivial question. You could actually say the same thing for psychedelics. Psychedelics gets a similar rap of, oh, it's uh a fad, lots of just people are just talking about psychedelics a lot these days, oh, it's another person saying this word. And I think it's the same thing with narcissism, but in both cases, actually, and it's probably what draws me to both of them as well, I think that there's something fundamental about these concepts or these ideas that naturally draw that intrinsic attention. And I think that that's because they're they tell us something about selfhood. They tell us something about ourselves. Um, psychedelics, obviously, morph our sense of self. And they, as we said, raise lots of questions about selfhood. I think narcissism as well, fundamentally is about selfhood and it's about connection and relationships. Um it it on one hand, some people some people might be fundamentally drawn to it as a concept because it's helped them so much to understand difficult relationships that they've had themselves. On a deeper level, some of the early psychoanalysts, etc., were really interested in narcissism on a deeper level to understand, for example, how a self develops, that we have this sort of primary narcissism.

SPEAKER_00 1:08:35

Like a hell is that like a healthy narcissism?

SPEAKER_01 1:08:37

I guess so. I mean, I I'm kind of on the fence about the term healthy narcissism.

SPEAKER_00 1:08:42

I sometimes joke that it's uh a bit like saying healthy cancer, like when you can say cell division, but but isn't it wouldn't it be fair to say we need to have a little bit of entitlement or we need to feel a little bit like we're special to get on in life and to have the the vivaciousness to go about to try things and take risks.

SPEAKER_01 1:09:03

Oh, I completely agree, and yes, that's why I say I'm on the fence because it's just more semantically using you know confusing things by using the same word. But but yes, absolutely, I think in a way there's also a problem of having too little entitlement, and that can lead you to be easily exploited. Um you don't believe that you even have basic human rights. That would be too little entitlement.

SPEAKER_00 1:09:23

And there is like a semantic problem, and in fact, the phrase I've landed on is positive self-regard, is that people need to have positive self-regard. And I actually think I suppose at the core of narcissism, like the the way I think about narcissism is it's a it's a very fragile shield that's around fundamentally a real lack of positive self-regard. And so I I what I think of positive self-regard is thinking positively about yourself in a basic sense, irrespective of your accomplishments, yes, taking into account your strengths in a realistic way, but also your flaws and being okay with that and being with okay with yourself, and if you can do that, then I think that's what you could call good self-esteem, positive self-regard. And if you can't do that, then there's a number of ways you respond. And one way is to really like disown yourself and really be compliant to other people, surrender too much to other people, and we would call that like being more dependent or hyper-agreeable or people-pleasing. But some people respond to that by being like, No, actually, I'm amazing in this way and that way, and they have to lean on image, uh, accomplishment, external validation, external perception, because they don't have that basic positive self-regard I mentioned earlier. So that's that's how I've talked about that.

SPEAKER_01 1:10:48

I think that's that was really nicely put. I think that's a really important piece that maybe isn't always obvious to people first kind of discovering the concept of narcissism or like they're starting to learn about it in the context of uh a relationship that they have had with somebody who has been quite narcissistic. That it'll often be sometimes one of these ways in which the word is used, I think it correctly, is just to simply mean someone who loves themselves. Right. Which I I think is is very inaccurate.

SPEAKER_00 1:11:16

Or my ex who mistreated me. Exactly.

SPEAKER_01 1:11:20

But I think that that's very, very inaccurate. I would say that um I completely agree with you that actually underpinning all of it is actually quite a profound self-loathing or self-abandonment. And uh, as you say, as a way of reacting to that, of you know, saving yourself from fundamentally this uh existential problem of being in a space where you feel like you don't deserve to exist. We need to believe that we deserve to exist. Right? If otherwise Unless we have a place in the world. Exactly. And and we have to find ways to deal with a feeling that we don't deserve to. And if we f have the deep misfortune of being in a in a position where we are made to feel like that as a child, I think we'll often reach for quite primitive ways of convincing ourselves that we do deserve to exist. And I think that, as you said, that narcissism, uh narcissistic facade is one way of escaping that sense of I don't deserve to exist, of just creating a completely false identity which is perfect and ideal, and maybe everything that your dismissive parent ever wants to.

SPEAKER_00 1:12:31

And and do you think something like narcissism is treatable with psychotherapy?

SPEAKER_01 1:12:35

Oh, that's a big question, isn't it? Yeah, uh basically, yes, I would say yes. But this is an interesting case study in I think being able to maintain two different realities which are equally viable or fee plausible, which is on one hand, if I had a client who was experiencing narcissistic abuse, they're in a very, very difficult relationship, and this per the person who is abusing them has narcissistic patterns. I I would have to maintain in my mind and the awareness that one of the things that will help them the most is the message, this is not going to change. Because almost universally, that is the thing that catalyzes uh a sort of being able to escape, not just not necessarily just physically, but at least mentally from feeling like everything is your fault or feeling completely confused by your situation. On the other hand, if I had in front of me someone who is very narcissistic as a client, I would as a therapist have to believe that they have the capacity to change. And both of those things are true just on different levels.

SPEAKER_00 1:13:38

Yeah. I mean, I guess the person in the narcissistic abusive relationship has to realize that it's not their fault. Well, I guess you could say it's something co-created between them. But if they have narcissistic patterns, their partner, that's gonna be really hard to shift and it's gonna require them that their partner to come to their own conclusions about it and to really actively want to change, which they may not necessarily be in a position to do.

SPEAKER_01 1:14:03

Yeah, and give depending on how extreme the situation is. I mean, I don't at a uh ultimate extreme, if there's domestic violence, and of course you would just want to leave as well. But but there's there is a sort of circular problem with narcissism, unfortunately, which is if you are very grandiose, it's going to be difficult to get to a position where you think you need help. And uh if you rely very strongly on that facade of you you've really managed to convince yourself of it. So it's very unlikely that you will seek help. Yeah. But if you do, I think you're just uh as deserving of help. But it it's just that for people who are in that uh situation of loving someone who treats them that way, who treats them without empathy and with with entitlement, it can be really, really difficult to uh accept the situation for what it is. It can be really difficult but to to sort of remove yourself, or even just mentally from uh from that mess.

SPEAKER_00 1:15:01

Yeah, no, for so many reasons. Wa one other thing I love to ask therapists is because a lot of people who want therapy really struggle to figure out what should I be looking for in a therapist. Do you have any views on that? What should people look for when they're trying out different therapists?

SPEAKER_01 1:15:18

Yes, definitely. I think it's such an important consideration, and uh it's really, really not a trivial process to find a therapist that's good for you, and I think a lot of people don't know what to expect from therapy. It results in at worst situations where they have therapists that really are not right for them, or worse, are the genuinely not good therapists, and it's the problem that we need to talk about, I think. But and then they don't really know or have the confidence to say that this isn't right. So yeah, I think it's really, really important. I think you should feel safe. I mean, there is a balance where you should feel challenged as well, but you should never really feel overwhelmed.

SPEAKER_00 1:16:01

Or at least not because of the therapist.

SPEAKER_01 1:16:03

Exactly, exactly. As in, it shouldn't be a uh a situation where somebody is forcing their views on you either or forcing you to believe something that doesn't sit right with you. So in general, I think one really important consideration as a therapist is is that the consideration of needs goes in one direction. Unlike many, many relationships in life, this is what one place where that is correct. That the consideration of needs goes from therapist to clients. Right. And the therapist should not be asking you to do things for them. There there are boundaries, certainly, but but that would be a red flag. The other thing uh I would say is that different people need different things. So there there are, but I think it's important to know that there are things that you have the right to ask for as a client as well, like information about someone's training or their approach. You you're allowed to ask for clarification of what what that what kind of interventions that person intends to use with you, what their beliefs are to some extent. So I think it's I think a lot of people don't realize how many questions they're allowed to ask, basically.

SPEAKER_00 1:17:11

Most clients don't ask any questions. And I I think they actually should ask more and be more um inquisitive and even discerning about their therapists.

SPEAKER_01 1:17:21

Certainly. And I I I really hope that that you know people will gradually it'll become more and more common for people to realize uh that what they have the right to expect. Because you are putting yourself in a very vulnerable position. In a way, you're you're trusting someone with your mind. And that's a huge responsibility for someone to carry the responsibility for your mind and the sanctity of it.

SPEAKER_00 1:17:45

And I suppose the elephant in the room as well in the UK is that, and in many other countries, is that psychotherapist isn't a legally protected term. So anyone can call themselves a psychotherapist. That's very important to know. Yes. Even if they've had no training or very little training or a weekend course, or if you've studied for five years, all of you can call yourselves psychotherapists.

SPEAKER_01 1:18:08

Yeah, and that that is uh scary, I have to say. I'm hoping that will change. But uh as as it ha as it stands, yes, absolutely. And I I think again, a lot of people don't actually realize that. So if somebody calls themselves a psychotherapist and says it with a lot of confidence, they they will just expect that that person is an expert.

SPEAKER_00 1:18:26

Dr. Bat, it's been wonderful to speak to you. Unfortunately, we are out of time. There's a lot more stuff uh I'd love to speak to you about, and we'd love to have you uh back at some point in the future.

SPEAKER_01 1:18:36

Oh, it's been a real pleasure.

SPEAKER_00 1:18:37

Thank you so much for coming on.

SPEAKER_01 1:18:39

Thank you.