All right, well good afternoon everyone. It's 1.30 so we're gonna get started to keep us on time. Welcome. I know, feel free to move seats, come up closer if you want. We, you know, hopefully can have a good exchange. At the end of this we've allocated about 20 minutes for Q&A and feel free to chime in, use the microphones or get closer. So I'm really excited. This hopefully will be a an opportunity for folks to hear about some things in relation to spirituality, religion, and psychiatry from some angles that perhaps you haven't heard explored specifically. We're looking today and honing in on the idea of spiritual experiences in particular and you're going to hear a number of different viewpoints and perspectives on the impact, the influence that spiritual experiences can have, whether it's through sort of negative experiences that folks have had and how that influences behaviors and thinking, to thoughts about psychedelics and some of the emerging literature and experiences around psychedelics and spiritual experiences, and then finally talking a little bit more also around the relationship between consciousness and spirituality and spiritual experiences. So without further ado I'm going to pass it off to my to my colleagues here to give, you know, a brief introduction of themselves. Before I do that I'll say my name is Jeff DeVito and I am an addiction psychiatrist and I'm based actually not far from here up in Marin County and I work with Marin County Health and Human Services as well as with Partnership Health Plan, which is a big Medicaid plan here in California, and with that I'll pass it off to my colleague Jim Lomax. So Jeffrey, thanks for the introduction and for organizing us to get us together today. As you can tell, the title of my talk is God's Lost, Found, and Reconsidered Discovering and Managing Negative Religious Coping and Spiritual Struggles in Clinical Care. As Jeffrey said, my name is Jim Lomax. I'm recently retired. My wife says I'm trying to retire as a clinician educator at Baylor College of Medicine where I was vice chair for education for 45 years. The talk is about the spiritual struggles and the negative aspects of the occasionally difficult downsides of certain types of religious participation. I'll have a couple of objectives today. One is to kind of do a very, very brief summary of research which summarizes why clinicians need to be aware of about particular aspects of our patients' religious and spiritual lives and then tell a clinical story to illustrate utilizing the research information in clinical care. As part of my disclosures of interest, I would also like to say, of course, I have no financial conflicts of interest for this topic, but there are certain personal things that do have a big influence on my personal career in this presentation. One caveat is that my personal development did not include any consistent participation in a faith community. In fact, my mother's religiosity was more intense and more troubling at times of her bipolar 2 related mood disorder, so I left my childhood with a sort of anxious avoidance of anything that had to do with religion and spirituality. The second and related caveat is that I'm what's called Presbyterian by choice and that means that I chose to get married and my wife chose for me to be a Presbyterian. My participation in kind of getting interested in and studying this interface between medicine, religion, and spirituality actually began when the retiring director of medical student education at Baylor asked me to take his voluntary job at what is now called the Institute for Spirituality and Health, or ISH, and that'll come up a couple of times in the talk today. My role at ISH was to participate in our first annual psychotherapy and faith conference, and last November we held our 31st annual psychotherapy and faith conference. The brochure from last year is actually quite pertinent to my talk today, and it is about spiritual struggles, and the title, Shaken to the Core, Restoring Faith in Psychotherapy, does have two meanings, which I think will be evident in my presentation. The conference focused on the contributions of research by Julie Eckstein and Kenneth Pargament, which was summarized in their 2022 textbook, Working with Spiritual Struggles in Psychotherapy, and their research and my clinical translation of it will be the core of my presentation today. The third confession of influence is that I'm a graduate of the Houston Galveston Psychoanalytic Institute and was a training analyst there, and psychoanalytic psychotherapy or psychoanalysis accounted for most of my 20-hour a week practice during the 45 years I was at Baylor. My final disclosure has to do with another somewhat accidental interest of mine, which is positive and negative aspects of professionalism and the ways to nurture the former and attenuate the negative aspects of it. Here my work is greatly influenced by that of Maxine Papadakis at UCSF and Jerry Hickson at Vanderbilt. Again, I did not have an initial interest in professionalism per se, but a serious error by the Texas Medical Board, which stigmatized physicians who were seeking treatment for depression, led me to that interest in problems in professionalism and the work of Papadakis and Hickson. Again, another very brief summary, the best predictor of physician difficulty, including losing their licensure, is a history of problems in professionalism that are not attended to by their educational faculty, not depression, as the Texas Medical Board decided to pursue. Moving on to religious and spiritual coping, threat, separation, loss, injury, and medical and particularly psychiatric illness frequently evokes religious and spiritual coping as part of the response to deal with these problems. Kenneth Pargament helped us to discern positive and negative religious coping and their consequences. Ken's work, particularly early on, focused on the consequences of these types of coping in medically ill patients over time, but it's been duplicated on a variety of different settings and very, very different types of clinical entities. Again, a very simplistic summary of Pargament's work is that if you view your illness, separation, loss, or betrayal as God's punishment for something about your essence or something about your past or recent behavior, you're more likely to have a negative health consequence of that, even with the same degree of disease burden as an ordinary group of people. In contrast, if you think of yourself as loved, cared about, and cared for by God in spite of relational or physical adversity, there's an outcome advantage. How we think about things does matter. Let's move on to spiritual struggles and, you know, I'm not going to go much into this literature, but there's an overall quite significant positive correlation between active participation in one's religious and spiritual life and healthy outcomes. However, there's also this darker potential of spiritual struggles. We can define spiritual struggles, or they're defined by Pargament and X-Linus, tensions or conflict around spiritual matters within oneself, intrapsychic, interpersonally with other people or interpersonal types of struggles, and with the divine or supernatural struggles, and the case will focus mostly on that one. Spiritual struggles are more likely to be experienced by people dealing with more serious types of stressors, persons with an insecure or ambivalent attachment style in their relationship to God, and that's measurable by various psychometrics, and also people with higher levels of neuroticism. Spiritual struggles are clearly linked to a variety of measures of psychopathology and, for our purposes, specifically including mood, anxiety, and substance use disorders. My case story today is an example of someone who came to see me with a spiritual struggle who presented with a fairly typical case of mild to moderate depression with associated inability, irritability, and uncooperativeness that produced a lot of unprofessional behavior. However, it was only after we developed a very secure and tested therapeutic alliance that I learned that the origin of my patient's mood episodes and unprofessional behavior was a preceding spiritual struggle that she had never talked about with anyone. So we're going to go on now to the case. I'm going to call the patient Sylvia, and of course I've misidentified things about her to protect confidentiality and privacy, but the specifics of the story are things that actually happen. Again, for the purposes of our talk today, Sylvia was an early career pediatric hospitalist referred by her clinic unit director and long-term colleague of mine as an alternative to being placed on probation by her department because of her progressive irritability, uncooperativeness, and recurring Monday morning absences, of course, which interfered with the function of her team and was causing a lot of concern in her department. And her performance was especially surprising given her prior academic excellence and personal history of an awful lot of volunteer community service. As part of my routine questioning in the routine in the first session, she obviously had mild to moderate major depression and needed treatment for that, and as part of my routine questioning, I asked her about her use of religious or spiritual resources. Sylvia really responded to that. She angrily snapped, I knew you were going to ask me about that. It's none of your damn business. I don't want anyone telling me to go to Sunday school. So I was a little shocked and said, how were you so certain that I was going to bring up religion? She said that she had googled me after I was recommended by her sanctimonious service chief, and she had seen that I had written, quote, a bunch of religious crap, but she had not, she also said she hadn't read any of that because that would have been snooping. Well, I was a little surprised by the intensity of how we were getting started, but managed to say a version of, it sounds like you're really pretty desperate and trying hard to figure out what sort of partner I might be with an important project. That's my version of prioritizing empathy. Well, Sylvia just grunted, and we spent the rest of our time at the first meeting talking about a trial of an SSRI to help manage the symptoms of depression. At this first meeting, she denied or minimized any questions I asked about substance use. Over the next few weeks, Sylvia's symptoms slowly began to attenuate, and during that time, we agreed that I could take a more developmental history to get to know her better. Significant in that history was that she was the oldest child of a career military and very conservatively religious father, and reared with expectations of thinking that she should follow orders and do good things and have good thoughts so that good deeds would happen when lived out in a solid faith community. That's her father's, her version of her father's words. Well, I was influenced by the work of Anna Maria Rizzuto on God Image, and internally, I wondered about the interpsychic connection of God and her father, images, and the implications of that connection for her other attachment relationships, including at work and with me, but I didn't say anything about that. I was going to stay focused on symptom reduction and developing our therapeutic alliance. Later, about three months into our relationship, the symptoms of depression were pretty much gone, and her Monday morning absences had stopped entirely. At that point, I felt able to ask her if she had any further reflections on the rocky start we had when I had asked her about her religious and spiritual resources in life specifically, and this exchange was thankfully quite different than my first attempt. She went on to tell me that her father was quite pleased when she first mentioned applying to medical school. In fact, he was excited and sure that she wanted to become a medical missionary in their faith tradition and be a soldier like him, but fighting a different crusade. Again, her words of her father's language. And for a while, Sylvia did consider a career in medical missionary work, but later developed her academic interest and aspirations. She thought a compromise might be found in providing education and service within pediatric intensive care units at an academic medical center. She told me that her father expressed some disappointment but accepted this change in plans. However, as an early career faculty at a tertiary care hospital with caring for a lot of very ill patients, something unexpected happened within her. In her words, as she repeatedly watched innocent children die from horrible illnesses and medical treatments that produce more harm and suffering than cure. Her words. This change was consolidated and really exacerbated in her treatment with a little boy named Paul. She described him as an adorable six-year-old with advanced neuroblastoma. His last six months of life included four miserable hospitalizations under her care. She remembered his last night tearfully in one of our sessions and loudly reported in our session her angry declaration, no loving God could let something like this happen. That was Sylvia's spiritual struggle with the divine and that type of conceptual framework. She went on to say that she felt deceived by both her father and her God. We began to wonder if her disappointments might have also been expressed in her general sulliness or lack of cooperativeness with colleagues and her harshness with students as well. At this point she reluctantly acknowledged she might have been preparing for Mondays with weekend substance overuse. Continuing along about six months later into our work, her cognitive and vegetative symptoms of depression had all attenuated, but she wondered about a feeling she had that there was still something missing in her life. She reported that she had left the faith community of her childhood before we started meeting as her mood symptoms were beginning to increase and she wondered if that community was what was missing and but very quickly before I could say a single word she said she could not and would not return to a belief system that produced so much guilt when bad things happen to good people. This was the image that came to my mind as she was telling me the story. This is Andrew Wyeth's Christina's world painting and it's it made me think of the way Sylvia was describing her both seeking for and fear of connection and what might happen if she let her people get connected with important people. She told me about this and then she went on to say that she had this silly idea of exploring a very different faith community and her awareness that she was afraid of even saying anything about this to me. She said that when she thought about telling me about this interest she imagined me saying that she was wishy-washy and waffling. I expressed my concern that the shadow of your little girl relationship with your father makes some paths hard to explore in our project. That's my version of a transference interpretation. This time she kind of smiled and mentioned the particular faith community she had considered based on comments of a friend and colleague at work. She didn't know much about this community and their specific beliefs except that they were very different from those in her childhood. She wondered if she would have to believe exactly like them in order to be welcomed. Somewhat fortuitously I happened to know the leader of that community through our mutual work at the ISH. I perhaps a little over eagerly asked gratuitously if she would consider arranging a meeting with him to have that discussion. She pulled back said she might consider doing that but quickly admonished me from speaking to him. Don't you dare in her words. And she then observed that I seemed a little more directive than usual. Well after that time and as she was planning this meeting with the faith leader I was of course concerned about what would happen at their meeting and what might happen within her about my boundary crossing. And I made an unfortunate negative enactment in that session. So the next time we got together I was actually quite relieved as she began to tell me about their discussion. They had discussed the value of spiritual community as opposed to very separately from particular religious beliefs. She was welcome in that community and David had also suggested a book by a different faith leader and ISH faculty member that described a theology without the linear relationships between ideas, feelings, behaviors, and outcomes which had led to her traumatic disillusionment, irritable depression, and isolation. Then she went on to tell me about her first time at the service and the again how silly she felt there. She had no idea what the cantor was singing about but his voice and the music played brought tears to her eyes and a deep sense of relief. I responded that I wouldn't be any help thinking about the cantor's beliefs or ideas but I thought that finding some intimation of a sacred community seemed more like an important achievement and potential healing than something silly. That was my version of trying to be supportive of her positive coping without being too directive as she had found objection to before and also using Luke Timothy Johnson, the theologian from Emory's definition of healing as restoration to community. She had found that community that Christina and she were both looking for. So let's talk a little bit about how we might think about Sylvia's story and how it leads to some sense about the framework. I think her mood disorder and unprofessional behaviors was her expression of this conflict about feeling at war with a God and abandoned and betrayed by her God. I think that she had unfortunately begun to use these negative religious coping skills feeling that she was at fault not quite sure why and then alternating between that and feeling that her God was betraying her. In the therapeutic practice field of our relationship she started experimenting with things. She was very concerned that I was going to repeat the sort of controlling sense of dictatorship that she experienced in her early childhood and in some relationships that she had had. And so as we began to work with that she felt more freedom in our relationship and began to explore what it was like to find different people with different views from her including the very different faith community which turned out to be a better fit for her in her life experiences. And she also became aware that she was suffering from an awful lot of her assumptions when she made predictions about how people in her especially her work area were going to respond when she expressed reservations or questions about what she was being asked to do. And she often wound up feeling both angry and isolated because of those assumptions and some of the religious beliefs. As a kind of byproduct of this discussion she also became much more accepting of human imperfection in herself and others. Her presenting symptoms left but she still felt that something was missing. Again beginning in our therapeutic relationship, she started nurturing this ability to be more curious about not only herself but those in her environment, different ideas and values, the different faith community. Her participation in the new faith community was not an easy transition for her family of origin. However, the family was also very aware of how miserable she was at the time. She was almost placed on probation and eventually accepted that at least she had found some sort of religious home. So in conclusion, I hope I've presented a conceptual frame for why it's important to learn about our patients' religious and spiritual lives and their resources and the positive and negative consequences of whatever practices they bring to our sessions. Hopefully the case of Sylvia illustrates a practical translation of that into clinical situations that sound familiar to you because this is something, things that you will find in your practice, I think, pretty regularly. So in our questions and answers, I hope I hear from you about your experience with these matters and what has happened in your interactions with your faith communities and your home communities. So thank you. My email is on that slide. If you want to get more detail of the references, I'm happy to respond to anything like that. Thank you. And so bear with us here because we're going to be pivoting pretty dramatically from speaker to speaker in terms of content and what we're covering. So I'm going to start actually this particular section and then pass it off to my colleague, Dr. Epson. I'm very briefly going to talk about, again, this is the part, bear with us, we're transitioning very dramatically. We're going to talk a little bit here about psychedelics and hallucinogens and their relationship to the spiritual experience and what influence that can have on working with our patients. In particular, we're going to focus a little bit more specifically on substance use and the impacts that it might have there. I always think it's worth taking a moment to have a word about words because words matter and different definitions, people might have different connotations to different definitions. So very briefly, just putting this up here, this is just three of probably many, many more terms that have been used in different contexts to refer to substances that can change or alter a person's perception of reality. And you'll hear Dr. Epson and I kind of use some of these terms interchangeably. I tend to use the word hallucinogen a little bit more and I know that Dr. Epson tends to use the word psychedelic a little bit more as well. There's meaning behind this, we'll talk a little bit about sort of what that means. My use of the word hallucinogen is primarily because I'm going to be talking about this, my little section here on some of the neuroscience in relation to the hallucinogens and a lot of that literature uses the term hallucinogen because that's the DSM term. And what Dr. Epson is going to be talking about is going to be much broader than that. So that was for dramatic effect there, the much broader part. But let's look at this very briefly. Why hallucinogen? So my brief section here is designed or is aiming to give you a sense of why we would think about hallucinogens in the treatment of addictive disorders. There are other people presenting at this conference who know a lot more about hallucinogens and know a lot more about the research behind this and are giving excellent talks throughout this conference. I'm not here to say that I'm an expert, as a matter of fact, I'm not an expert, which is why I put these slides together to give a sense of answering this question, why? Why would we even think about using hallucinogens in the treatment of addiction? Well, for starters, there's some history here. For those that aren't aware, Bill Wilson, who was one of the founders of AA, had his own experiences with hallucinogens and felt that they were a significant or potentially a significant tool for facilitating what he described as the spiritual experiences that were fundamental and foundational to what was necessary transformationally through the process of 12-step programming. This was controversial. This remains controversial in AA amongst other 12-step programs. Pivoting from that, I want to look at that and say that one of the things that Bill Wilson talked about was this idea that the spiritual experience, the transformative aspect of the spiritual experience was an experience in which the self was de-emphasized and that you developed a sense of connection to other people and a selflessness and that that contributed to the transformative aspects of 12-step. Now, why is that important and why do I set the stage there? Well, here's, again, this is my take on this. If you think about, if you reconceptualize addiction as a learning process, that you have learned behaviors, you have learned to behave in a certain way around a particular substance, then you can think of treatment as being unlearning that behavior, right? And this shouldn't, I mean, this is a room of psychiatrists and mental health professionals, this shouldn't be all that foreign to folks. So when we think about addiction treatment, what we typically do with addiction treatment is that this is our predominant model is we say, let's stabilize the addiction first, then let's handle the learning needs. Let's try, let's stabilize you first, then let's do the CBT, let's do the learning things that you might need to do. And the idea here with hallucinogens is that perhaps hallucinogens provide an opportunity to put this model on its head and address the learning needs first or concurrently with the stabilization piece. And let me explain how this might potentially work. If we reframe addiction as a learning process and we think about addiction treatment as an unlearning process, this is the part that, you know, bear with me when I talk about this. If you think about what, if you really think about what gets in the way of you learning new material, what gets in the way of you learning new skills, I would argue that what gets in the way is you, your ways of thinking. So the example that I give, for better or for worse, is that I don't know Spanish. But if I wanted to learn Spanish, and I've learned some other languages, if I wanted to learn Spanish, I know that one of the most challenging things that I'm going to face is how to learn, how to abandon some of my ways of thinking in English in order to accommodate space to learn things in Spanish. So in essence, I'm going to get in the way of myself learning this new language. So what happens, what's proposed to happen with hallucinogens is this idea that it changes your receptivity. It changes the self, the ego, the sense of self is dissolved away. And as a result, you're left with a receptive environment for better learning. That you can learn new ways of thinking, new ways of behaving as a result of that dissolution of the ego. Again, so bear with me on this. This is, again, a non-expert describing what goes on here. Now, there is neurobiology behind this that supports this. There is this thing called the default mode network. Many of you have probably heard about it. It's been talked about in lots of different areas. And one of the ideas around the default mode network is this is the function, the program that's going in your brain all the time that allows you to differentiate yourself from other people, yourself from the environment, yourself from time. You need that to survive, right? Because if you walked around without any differentiation between you and the environment, it would be very difficult to survive, especially in sort of earlier evolutionary states. So the default mode network perpetuates this sense of ego, not in the Freudian sort of sense of ego, but the sense of self. That default mode network is contributing to that sense of self. So in a nutshell, the hallucinogens are believed to help dissolve or help shut down, and the science would support that it impacts and decreases the activity of the default mode network, which is also shown to be hyperactive in people with addictive disorders. So that's the logic behind why we would think about using hallucinogens in the treatment of addictive disorders. That's a very neuroscientific perspective of it. That's a very sort of, you know, very superficial look at this. I want to pivot now and hand it off to my colleague, Dr. Epson, in relation to looking at this in terms of what's actually happening from a spiritual standpoint, because that's something that's going to become significant when we look at how the use of hallucinogens in the literature has been shown to be effective. One of the common factors is that the intensity of the experience in the research studies, the intensity of the experience correlates to the magnitude of effect that you see in behavior. So it's not just that something's happening at your receptors. It's also that there's something happening in the experience that's changing behavior. And with that, I'll pass it off to Dr. Epson. Thank you very much. My name is Dr. Epson. It's always good to be presenting and working with my good close friend and colleague, Dr. DeVito. I work for the downtown VA clinic. I also work for Marin County Department of Behavioral Health. I am on faculty at UCSF. I'm a general psychiatrist and a forensic psychiatrist. And I have a few comments I've prepared, and I look forward to more discussion. And thank you very much for your attention. But I'm really grateful for the opportunity to be here. And I first want to express my gratitude to the Ohlone people, because it's their ancestral land where I now call home here in the Bay Area. And they played a part in me developing these ideas. So I'm very aware of what we're trying to do. And we're going to give a little bit of a glimpse. But I'm grateful that we're able to share a little bit of insights. Particularly, I'm coming from a community psychiatrist standpoint. And I treat individuals with severe chronic mental illness, as well as comorbid substance use disorders. And I use the lens of a general psychiatrist, a forensic psychiatrist. I'm a lifelong student of religious and spiritual inquiry. And I apply my perspective through my studies of law and politics using a sociocultural lens. So I have some remarks based upon our discussions with Jeff, Jim, and Alexander. And I wanted to just think about the relevance that my recent work, particularly with the Multidisciplinary Association for Psychedelic Studies, as I went through their MDMH therapy training program. And I'm just now ending a year-long series of immersive trainings at the UC Berkeley Center for the Sciences of Psychedelics, the BCSP. And this has been in their Psychedelic Facilitator Program. And I think there's some value in some of these trainings that we might take away, some different perspectives. Since our time together at Divinity School at Harvard, Dr. DeVito and I have been working in ways to better bridge our clinical experiences in addiction and community psychiatry with spirituality. In the last couple of years, our work has led us to, you know, examine the role of psychedelic research as a way to incorporate religious and spiritual dimensions within clinical medicine. Research in psychedelics bridges both the scientific and medical understanding of the mind. Interest in psychedelics serves as a potential for treatment, as we heard, for substance use disorders. But this has taken on new urgency in the wake of the pandemic, as we've seen increase in overdose deaths, as well as general disease burden. Our interest has come at a time of convergence, you know, when the pandemic highlighted a need for the existential clinical voice. And psychedelic research is strengthening its own language, you know, that comes and crosses this divide in multiple ways, in multiple axes, and crosses the divide of disciplinary kind of silos into the realm of meaning. This space is ripe for learning, discussion, for the work of clinicians, spiritual professionals, mental health workers, and researchers alike. This is not your typical, as Dr. DeVito said, hot topics discussion on psychedelics, nor the deep dive into psychedelic mechanisms. Here instead, as theologically informed clinicians, we highlight targeted shared space, especially for clinicians who might train or treat through the lens of psychedelic facilitation. Our goal is to highlight interdisciplinary commonalities that are often addressed in indirect ways when we're discussing it purely through a neuroscience lens. We want to open this door and peek through, not with rigid, colonial, clinicalized, but those of a learner and as members of a community with special, but not infinite, knowledge. And our humbling work has been to find ways to bring the experience of the sacredness together with clinical work and treatment. And the machinery of modern medicine is often experienced as an impediment for us operating at our best and most inspired selves. We think we can learn more from psychedelic research than the power of the serotonin 2A receptor, or the meaning derived from neural circuits. These are really questions about who we are, not what we are. If it sounds a little like a sermon cloaked in scientific language, trust that it is by design. Imagine, if you will, taking a journey, a clinician's journey into the training world of psychedelic facilitated therapy. Let's consider what theoretical and practical lessons we might take back to our regular clinical practices. What relevance could we find in this space? The first question we must ask is, why now? Psychedelic research has been around for decades, with the most high quality occurring more recently. But psychedelic use in psycho-spiritual practices has been around for millennia. Only recently has modern clinical science found itself in alignment with ancient spiritual and social practices. This reawakening of science to sociocultural knowledge is a challenge of integration. Combining disparate disciplines, hierarchies of knowledge over space and time, all while negotiating these internal and external nodes of power, this is integration. It's a tall order, and this answers the question of why now. Now integration is usually at the end of psychedelic treatment. Psychedelic therapy, as it is usually deployed today in research studies, starts with the preparatory sessions and then moves to dosing sessions, and then ends with integration sessions. Integration means we are trying to answer the hard questions, like what is consciousness? Can a cosmic feeling, even an illusion, be still meaningful, even transformative? Does the dream need to be real to be revolutionary? Now this isn't the recruitment to become a psychedelic chaplain, but I propose that the members listening here are already doing this sort of work. If you work with individuals who are intoxicated, in recovery, experiencing substance-induced mood or psychotic disorders, patients in the midst of existential suffering, I argue you are already doing the work that is being described as psychedelic chaplaincy. You just do it in different language and with a different lens. I propose that modern psychiatric medicine has the psychedelic treatment architecture embedded in its formula. We get distracted when we see beautiful images of brain scans and dive into the role of various receptors. We strum the strings of nostalgia of the 1950s and 60s when scientific research in psychedelics first took off and we commit to a revisionist history. We feel like explorers and pioneers, mythologizing, that we are conquering new frontiers that no other human has traveled before. While the depth and detail of psychedelic research point us to an underlying bio-sociocultural architecture, an interplay of psychospiritual experiences and psychedelics history shows that this is nothing new. We've been here before. We count founders of modern medicine such as Galen, Hippocrates, as members of the cult of Asclepius. This healing cult lasted for nearly 800 years among the frothy and tumultuous marketplace of healing and revelatory ideas in the ancient Greco-Roman world. Entering the Asclepion, one engaged in a preparatory or incubation period. Students prepared with potentially some aid of psychoactive substances, dreams, or visions were encouraged and interpreted while reclining on a couch. Sound familiar? Students of ancient Western medicine know these familiar descriptions and yet in our discussions today of modern psychedelic research, we often fail to remember our professional history. The ancient Western roots of multidisciplinary psychosomatic healing share similarities to modern psychedelic research. Incorporation into the social folds was also accomplished in the initiation rites of the Eleusinian mysteries in which, you know, in group settings, people went through the process of preparation, likely dosing with a psychedelic substance and integration. This same process has been an embedded in practice for millennia in shamanic traditional practices around the globe, sometimes utilizing the amplifying effects of psychoactive substances. The recycling of psycho-spiritual material has been seen in our scientific incorporation of contemplative and meditative practices and repackaged into interventions and treatments. Now don't be thrown off by the term shaman as I once was. Rather an alternative of the role of shaman is those with experience by training or trade at attunement, holding space and offering practical insights to foster meaning. Sounds a little closer to home, doesn't it? Our goal here is to rethink the concept of mysticism not as an esoteric direct experience of the universe but instead as a form of shifting consciousness that we all experience to some degree on some cohesive spectrum. It's normal to have these direct experiences. We just call them by different names and think of them somehow as unrelated to the mysterious versions encountered in the psychedelic space. Our process here of integration moves us from our traditional clinical lens into the everyday potential sort of mystical, religious, altered consciousness experience. Psychedelic research calls us to include basically now a bio-psycho-spiritual perspective to our work particularly with patients who are already struggling with other substances. This brings us back to the question of why now? We heard in Jim's presentation about the crisis in our post-pandemic times, the issue of moral injury and the existential questions that spring from that injury. We have to take stock and address these injuries in our colleagues and society as we collectively emerge from our first experience of a global pandemic. The speed, breadth, simultaneity of this pandemic have left their imprints on us all. We need these processes of integration. We need to make sense of difficult experiences to find meaning and belonging, the markers of resilience. We see that reliably psychedelics can create a robust manifestation of these peak experiences. In our UC Berkeley training program, we were fortunate enough to hear directly from one of the authors of this now dated but seminal piece of work for a double-blind study with 30 hallucinogen-naive individuals who were given either psilocybin or methylphenidate in counterbalance order. I know that the date seemed long ago, but I'm biased towards the integrity and the body of the work of the authors. And I do love that this represented a research bridge in language between these two worlds we're discussing here. Let's start with something that matters. And then we can talk about things like treating specific disorders, but let's have a conversation about the neuroscience of what matters. Sixty-seven percent of these volunteers rated the experience with psilocybin to be the single most meaningful experience of their life or among the top five most meaningful experiences of their life. And one notable detail about this study was that the use of the mysticism scale, which had not been previously used when analyzing drug experiences. As scientists and clinicians, we must step back and marvel in our own experience of awe of the synchronicities of biology, neuropsychopharmacology unfolding before our eyes. Nature, through fungi and our neurochemistry, come together in the most profound and synergistic ways. We propose that the role that psychedelics play is a prima facie evidence of basically infinite mystery, the mysticism embedded in the quantumness of science. And this brings us to reconsider the idea of a perennial philosophy, where the author Aldous Huxley describes the common core of mystical experiences as consistent universal substrate. I like to use the word architecture. It's underlying, basically, in this theory, all religious and spiritual paths, reflected in every religious tradition. When we think about mysticism, these are some of the common core elements that we think about, the elements of a mystical experience. I never thought about dissecting mysticism until I started on this most recent path, but these are some of the things we think about. There's a profound sense of positivity, sometimes described as joy, bliss, infinite tenderness. The moments are experienced with a sense of sacredness, and you don't have to be religious to experience this sacredness. These are episodes that are imbued with deep meaning, like a sense of ultimate reality. And this is where the ego gets involved. There's a sense of the internal unity and external unity, you can either internally lose yourself, you can have this ego dissolution you heard from Dr. DeVito, where you have the loss of the eye, versus you can be projected outward and have a better sense of connected to all living things, all that exists. It's a recognition of the oneness of all. You oftentimes, I used the word awe earlier, get the sense of a transcendence, where you get a perspective of space and time that gives you a moment of pause and real perspective and grounding. The problem is, and this gets into lots of issues later on, is it's very difficult to describe these direct experiences of the infinite in limited words. So that gets into the ineffability of mystical experiences. And you're trying to basically talk about the paradoxicality of a finite existence, yet in an infinite universe that you're conscious of. So Dr. DeVito talked about the default mode network. And as he described, you can hear from our colleagues and other aspects of this conference, describing the role of the default mode network and how it plays a critical role as a gatekeeper between our ordinary waking consciousness and alternatives. In psychedelic facilitation training, we spend a lot of time studying this research network. And a common theme, as Jeff mentioned, is the default mode network plays a prominent role in the intensity of the narrative versions of ourselves. In the limitations of our science, though, we have yet to characterize the transitions of this on-off again, processing of the default mode network. We don't often hear how the default mode network also plays a prominent role in our sense of beauty and is often down-regulated during the production of art. When doing art, we can lose our narrative sense of self, even momentarily our ego. And it's our transition back to ordinary consciousness with our first impressions of our own experiences, coming back from an altered state of consciousness that tells us how to characterize our experiences, whether it's a good or bad experience. This transitional space of substance-induced shifts in consciousness is where clinicians in substance use disorder treatment live and breathe. I cannot tell you the number of times I've sat in a cramped community clinic office just right down the street from here with my patients struggling with chronic homelessness, justice involvement, and who are expressing mystical-like experiences on substances they were abusing, and I could only categorize them as symptoms of substance-induced psychotic disorders or mood disorders. And using antipsychotics and standard substance use treatments basically missed an important aspect of their experiences, aspects of their experiences that the psychedelic model teaches us. Not only have I reconsidered my patient population, they might be experiencing these poorly integrated, incompletely integrated experiences, but also my initial training in psychedelic facilitation has shifted my thinking of psychedelic and mystical experiences. I now do not see them as some exotic, esoteric phenomenon, but instead these peak experiences, non-ordinary states of consciousness, extraordinary states of consciousness. You choose the term. Alternative states of consciousness, expanded states, you'll hear them all, are in line with normal and culturally aligned, yet invisible versions of shifts in consciousness. We think it is common to draw meaning and symbolism from dreams. We think of it very typical in our profession, in our conceptualization. Many of the same stressors and practices, often religious and spiritual, can generate similar, albeit less intense or prolonged, hyperplastic states. We've seen pathology playing the role of perturbance and disruption of consciousness. Our colleagues on the consultation liaison service see the many manifestations and etiologies of delirium as part of accepted mode and model of alternative states of consciousness, sometimes with frightening and existentially unsettling effects. As Jeff mentioned, Bill Wilson had a profound experience with hallucinogens prior to his use of LSD. I've proposed that we treat individuals, we treat them all the time. People who are using illicit substances, legal substances, or even over-the-counter substances, they're potentially having psychedelic experiences right in front of us. Their experiences often need the framework of integration and have been a potentially clinical blind spot in clinical psychiatric medicine in treating substance use disorders. So, this gets us to the ultimate meaning questions, and this is the fun part about asking the deeper questions of why do we suffer? And this is our process of integration, is we have to ask. If we don't ask in the clinical setting, who will? It's sometimes the assumption that maybe it's a spiritual professional who will, but we operate in the same space, and I in many ways think we're obligated to ask, these fundamental questions. We're gonna get to some of them. Is consciousness, is there consciousness beyond this finite version of life? Are we alone in our experiences? What is the nature of fundamental reality? What is real, and who am I? I think in my last slide, it gets us to some potential bigger picture benefits. This approach gets us into thinking in a more ecological kind of perspective. It generates interconnectedness. It gives us that we've already been talking about, a sense of meaning and purpose, but it does help us with a sense of, cultivating a sense of compassion, not only in ourselves, in others, but also we've seen that it results in healthy practices. So, thank you very much for your time and attention. And I'll pass it over to my colleague now, Alexandra. Thank you. Well, good afternoon, everyone. I'm Alexandre Moreira Almeida. I'm from Brazil. I'm a professor of psychiatry at the Federal University of Juiz de Fora, that is close to Rio de Janeiro, and I'm the past chair of the spiritual section of the World Psychiatric Association. And my main purpose today is to discuss the nature of spiritual experiences. We have been discussing here the implications, the importance of spiritual experiences to clinical practice, to substance use disorders. And the idea is, what can we learn about the nature of mind based on spiritual experiences, and how this experience can help us also in treating and dealing with substance use disorders. First of all, it's important to state that the World Psychiatric Association published recently a position statement about the importance of taking consideration spirituality in teaching, in clinical practice, and also in research in psychiatry. And this position statement, it has been translated into eight different languages, and it is freely available at religionpsychiatry.org, that is the website of the spiritual section of the World Psychiatric Association. Basically, my talk today will be based on this book that discuss exactly the implications of spiritual experiences to understanding of mind, and even to non-physical aspects of mind, and also in the guidelines that have been just published about the use, the integration of spirituality in the prevention and treatment of alcohol use disorders. First, to start with definitions, spirituality, there is a lot of discussions about the meaning of spirituality, but usually most of authors, and we agree with them, propose that spirituality is the relationship or contact with a transcendental aspect of reality. So basically, all spiritual traditions throughout history and throughout the globe accept that there is some transcendental aspect of reality, something that goes beyond the physical world. It could be spirit, spirits, gods, ancestors, whatever. There is some transcendental realm that is actually the ultimate truth that is sacred. So this is basically the core idea of spirituality. But the idea is, from where this idea of a transcendental reality come from? Many authors agree that one of the, perhaps the major source of the beliefs in a spiritual or transcendental realm of reality comes from spiritual experiences, because spiritual experiences are exactly the experience of sensing or perceiving or being in touch with this non-physical aspect of reality. So you can have many different spiritual experiences in the sense like end-of-life experiences, for example, dying patients that see their deceased loved ones coming to greet them in the other realm. It's very common, we know about that. Near-death experience, out-of-body experiences, persons that see themselves out of their bodies and having different perspectives, and many other of this experience, all of them. And it's also very interesting, because throughout cultures, most people who have this experience, they state their major explanation is that there is some transcendental, some spiritual realm. For example, we have many recent studies on near-death experiences, and even decades after a near-death experience, by large, almost all people claim that this experience were actual real and they had a transcendental aspect. And this experience usually are strongly related to higher, to the increase of beliefs in survival after death, beliefs in a spiritual aspect of human beings, okay? And the importance of spiritual experience in the history of psychiatry and psychology cannot be dismissed. Many of our current ideas about dissociation, about subconscious mind and other functions of mind came from studies, especially in the 19th and early 20th centuries of spiritual experience, especially trance experiences. So we could recover these studies and resume this new sort of investigation. And actually, we have performed a systematic review a few years ago investigating these sorts of experiences that could add some way suggestive of consciousness beyond the brain. And we just investigate at the web of science the database web of science that is the most rigor database of academic papers that we have. And we found almost 2,000 papers investigating those experiences. And it's interesting because the impact factor of the journals who published these papers were in the same level of other more mainstream areas, okay? But the idea is what are these experiences? Near-death experience, out-of-body experiences, trance experiences, mediumistic experience, what are these experiences? Quite often, we jump to the conclusion or we think that we can easily explain them away as just caused by brain malfunctioning or just cultural expectations. Because some quite often is assumed that science had already proved that the brain generates the mind, that the mind is nothing but the product of electrical and chemical activities of the brain. Of course, this is a respectable hypothesis. However, it's far from proved that this is the case. So there is a lot of discussions about the mind-brain relationship. Is mind a product of brain activity or mind is something beyond the brain that use the brain as a tool for manifestation of mind, okay? William James, for example, more than 100 years ago exactly proposed these two possibilities, the brain as a producer or as a filter, a transmitter for mind manifestation. So this is still an open question. We need to be very aware of not importing to science some prejudices, spiritualist or physicalist prejudice. We need to be open-minded, but at the same time, very rigorous investigating that. And one of the most common spiritual beliefs that we have in all cultures, in all spiritual traditions is the belief in some sort of survival after death, in some way that consciousness would be something beyond the brain that would survive death. And this afterlife belief is actually one of the most pervasive beliefs throughout cultures and religions. Even nowadays, most of the world's population, even in Eastern Europe, Western Europe, Eastern Europe, and even here in America, believe in some sort of life after death. And contrary to many people usually think, there is no inverse correlation between educational level and afterlife beliefs. Actually, in some countries like Russia, France, and in Brazil, the higher the educational level, the higher the belief in afterlife. So it brings us to try to understand the impact of these beliefs. There are some studies, there are not many studies, but there are quite a number of studies investigate the impact of belief in afterlife in mental health, okay? So preliminary data have shown that people who have higher levels of afterlife belief have lower levels of anxiety, lower levels of acceptance of suicide and euthanasia, and also a lower level of suicidal deaths. There is an increased levels of life satisfaction and lower levels of psychiatric symptoms, okay? But this data needs to be replicated in more study, but these are the most common data. Now, okay, we know that these beliefs have been very prevalent. They have been related to many spiritual experiences, and they have impacted health and world views, but the point is, is it possible to perform a scientific investigation in the survival of consciousness after death, or is it just a religious or philosophical question? Actually, in the last 150 years, there has been many researchers, actually, many of the brightest scientific and philosophical minds in the Western world have been involved in the scientific investigation of survival after death, survival of consciousness. But how can we translate this religious or philosophical idea of survival of consciousness or survival of soul, of mind, whatever? How can we translate this in a scientific question that could be investigated through empirical investigation to scientific investigation? The point is, how can we determine that a person is a person? For example, I have a friend, Bob. How do I know that that person is my friend, Bob? Of course, I can see. I can see my friend, and I recognize the face. But let's imagine that my friend, Bob, suffers a terrible accident, and he has his body completely burned, but he survives, but he's completely disfigured. I cannot see him and identify him anymore by his body, by his appearance. And let's imagine that we do not have DNA tests. How can I know that the disfigured body is my friend, Bob? I can know that by the continuity of memory and character. If that disfigured Bob displays the memories that I know that Bob is supposed to have, and if this disfigured body also has the personality traits, the character, the skills of my friend, Bob, I can say that this is my friend, Bob. Okay, but what about if my friend, Bob, actually died in the accident? How could I have any sort of evidence of his survival after death, of his consciousness? Exactly in the same way. It would be the continuity of memory and personality and character. That would be exactly the same thing. So is it possible to find any way to detect if in some sense the memory of Bob, the character, the personality is still surviving? This is exactly what has been investigated in these studies. So let's move on quickly to some sorts of the main lines of empirical evidence regarding spiritual experiences to survival of consciousness. The first and the most studied the recent decades is near-death and out-of-body experiences. Basically, for example, people under cardiac arrest, under cardiac arrest, we know that the brain start, stop working in a few seconds, usually about third seconds about after the heart stops, the brain, the electrical activity is flat. We have no deep brain reflexes, so the brain is not working anymore. However, many people claim to be loosed, to be aware during these periods. But even more, they are not only, they claim that they are loosed and aware and conscious during that period when the brain is not working, but they also claim that they are more loosed than ever. And in some case that have been some reports on that, for example, that reference at the Lancet, that is a case published by Pim van Lommel, a cardiologist from Netherlands, about veridical perceptions. The patient, when the patient is resuscitated, when the patient recovers later, the patient is able to describe details of what happened, about the conversation, about the movements and the appearance of people, of what happened while the patient was under cardiac arrest when the brain was not functional. So it suggests, in some sense, the consciousness that the mind or the soul, if you prefer, can, in some sense, be active when the brain is not working during the cardiac arrest, okay? And these experiences, as it was said previously, had deep impact on people. There are several studies, follow-up studies, even for 20 years follow-up, showing a lasting impact in personality, in behavior, and also in the belief system, specifically also increasing the spiritual beliefs and spiritual practices. A second and even more challenging experience is what's called mediumistic experiences, people who claim to be in touch with spiritual entities, specifically here with deceased people. We don't have time here to go deeper, but this is a paper that we published recently at the Journal of Nervous and Mental Disease investigating if the medium is able to produce information that is very unlikely that he had access through normal means. And actually, he did, he produced a consistent pattern of memory, of personality, and even of skills, like poetry, that were expected from the deceased personality. And there are also some triple-blind studies. This is a math analysis that investigated in controlled situations showing that mediums were able to produce this information above chance level and with the control of fraud. And finally, another very challenging but very widespread experience throughout the globe also are children who claim to remember previous lives. Usually, children about two years old, as soon as they start to talk, they start to claim that they have a previous life. Okay, it can be imagination, however, in many of these cases, there are actually more than 2,000 cases documented in academic literature. These children claim a previous life and provide details, names, mode of death, and habits, and many other stuff that actually match the life of a deceased person. And quite often, this person has no contact, no previous contact with the children and the family of the children. So it's, in some sense, these children presents memories, quite often skills, personality traits, and even phobic symptoms that could be related to the claim of a previous life. This is also a review paper that we published last year investigating the scientific literature in this field. So moving to the end, the idea is that all these spiritual experiences, they are quite suggestive in some sort of non-physical aspect of our consciousness and of our mind. And these spiritual experiences are also very important in substance use disorders. We know that quite often, several authors propose that substance use disorders is related to a kind of misguided quest for transcendence, misguided quest for spirituality. It's a spiritual void. And especially in the AA and the NA, there are some evidence showing that the spiritual awakening is one of the key aspects of the impact in the recovery of these patients. And quite often, we can have some sudden changes, like Bill Miller called the quantum change. People had some sudden change, usually motivated by these spiritual experiences, this kind of changing their perception or themselves' perceptions of life. And this could have a very important aspect. Exactly because of that, now moving to the guidelines. The guidelines are available online, okay, free of charge, the paper. The idea that we must take into consideration the patient's spiritual beliefs, spiritual practices, and specifically, we should be able to try to identify the spiritual resource that the patient have, and how can we integrate these spiritual resources in the recovery of the patients in their skills. And also, if they have negative coping, as Professor Lomax presented here also, we need to engage. And also, it's very important, a bio-psycho-social-spiritual approach, because quite often, people that defend the biological aspect just focus on biological aspect. People who accept the spiritual aspect neglect the biology and psychology and social. So we know that people are struggling, people from different clinical or research areas are disputing with each other, but at the expense of the patient. We need to take in consideration all these points. And also, we can and we must have a better integration with religious community to be able to take care of these patients, not to dispute with the religious community, I'm the owner of the patient, or the religious community has the patients. No, we should unite our efforts in that sense, okay? So these guidelines were exactly an effort to see the best available evidence on the subject. And also, in Brazil, we included the endorsement of the three major religions in Brazil, the Catholics, the Protestants, and the Spiritism. So the major leaders of these religions endorsed these guidelines, the Brazilian Psychiatric Association. And we also got endorsements from the key leaders in Brazil and abroad in the study of spirituality and health, and also in the study of substance use disorders, okay? So here are my contacts, okay? If someone is also interested in the book, this week, Springer, you can buy this book at Springer with 70% discount, 70% discount at Springer website, just for the conference, for the APA, okay? And here are my contacts. Thank you very much. Thank you. Thank you to each of my colleagues here, and thank you all for attending. I don't know about you all, but that gives me a lot to think about on a lot of different levels. So I appreciate that greatly. We do have some time for some Q&A. So if you feel free, we're a small enough room, we can probably... I'm guessing we do. Yeah, I think that perhaps one of the deepest aspects of relationship in spirituality is exactly... Most spiritual traditions talk about our relationship with this ultimate ground of the universe, with God, with whatever the name that we call this. We are part, in some sense, in relationship with the deeper and most meaningful aspect of the universe. This is one aspect. And the second aspect is also most spiritual traditions also foster and stimulate the community interaction, the support of each other. I think these are two aspects, and these two aspects are very important in recovery of substance use disorders, because quite often they are alienated, and they are also only involved with the community that people that are also using substance. So this is one way why religious communities can be so supportive, because they can provide a new way of dealing with people and a new community of integration. I was just going to add that the idea that when we share things, it could be positive, it could be sort of an energy release is common, but the idea that we need to be also careful and cautious, I think embedded in there is a sense that we were hearing a little bit about this with Alexander's talk about we can sort of have a permeable membrane between ourselves and others that's not physical, and we leave imprints on each other. We can see the neural correlates of that, we think about early experiences in our lives that leave sort of neural imprints about connectivity, but I think what you're getting at is sort of the practice of that. How does that manifest in the spiritual realm? And I think it does make sense, especially when dealing with the psychedelic world. We talk a lot about, you know, it's good to have these open hyperplastic experiences maybe, because if you're in that hyperplastic, open, raw state, you're also very vulnerable. So that's the other important aspect of this. So we need to be able to get to these experiences, have the vulnerability, but in a safe place, be able to kind of come back to sort of ordinary, shared sort of space with our defenses back up. Defenses are not always bad. So I think that's embedded in there is a sense of we shift in and out, and in those transition periods, I mentioned this, that's when we need to be most careful. I might just add on top of that that I think that there is, in my line of work, in my particular jobs, I do a lot of educating of people about addiction, for example. And I think that there's a lot of emphasis on kind of different models of addiction that we talk about. There's sort of like the, you know, there's the moral model, there's the medical model is kind of the one that has become much more prominent. And I think that we do a lot of educating around one model at the expense of another model. And I think that the true aspect or the truest picture is one that incorporates all of that. One of the examples that I give when I'm, you know, when I'm talking about this is that essentially, you know, the relationships matter. And the secret sauce for a lot of people in recovery is that reestablishment of relationship because there's nothing that's sort of more isolating and more, and generates more separation than the use of substance and be in, you know, in the throes of a substance use disorder. Briefly, the example that I give is I say, well, listen, if it was all about biology, then the sort of the Vietnam War experiment, not experiment, the Vietnam War experience with the sort of Operation Golden Flow, people might have heard of this, but a lot of American service people that were stationed in Vietnam got exposed to and developed habits in relation to opium and other opiates. And there was a concern that if you bring folks back, that they're going to continue to use while they're back in the United States. So they instituted a program which, you know, was not officially named Operation Golden Flow, but it was in which they, you had to provide a negative urine test before you came, were allowed to come back. And one of the interesting findings was that if this was all about biology, if it was all about dopamine in the brain, you would expect that basically all the individuals that were using and had a substance use disorder while in service, upon coming back to the United States, that most of them would resume use of substances when they came back. Because it's not like they're not accessible in the United States either. What they found, and I'm blanking on the actual number off the top of my head, I think it was something less than 5% of those that came back, resumed or even used reported use of opiates upon return to the United States. So to me, it sort of drives home the point, if it was all about biology, then you wouldn't see that, right? There's something about connection, if you get someone back into an environment, literally get them out of war, get them in an environment in which they're surrounded by people that they might have trusted relationships with, that that can have an impact and contribute to recovery. Yes? I might just ask if you can stand up, because I'm not sure if the folks in, I can hear you, but I don't know if the folks in the back can. So yeah, I'm an addiction psychiatrist as well, and I really am a strong proponent of the 12-step model in addition to the medical model. And the way I kind of explain it is like, you're giving up control, you're joining a community, you're giving back to the community, it's less about ego, and accepting all parts of yourself, including the addiction itself, right? It's sort of nuts and bolts. The question that I get from patients is, where do psychedelics fit into this? And then I take the biological, this is, you know, so on and so on, we can talk about that. But how do you, if I was a patient, I was going to, any one of you would say that Strike was like the biologic spiritual psychiatrist, too. How do you answer the question if a patient was going to ask you, where do psychedelics come into 12-step treatment? And how would you answer that from this bio-spiritual model, maybe starting with the spiritual versus the biologic? And I don't mean to be, I know there's like this, this like, little bit of a pushing back in my voice, and I hear that, and where that's coming from is that I feel like I'm inundated with information about psychedelics, but I don't feel equipped to opine on it when it comes to an individual patient's care, to strongly recommend it, or strongly not recommend it. And I'm more inclined to say no, because of do no harm. Yeah, thank you so much. Great question. I do want to emphasize, you know, when I hear this from my patients, I have to let them know that all of the studies, let's not be generalists here, but so many of the studies that we see so far have done such a good job of screening out people with serious psychopathology. So serious substance use disorders, they test people, like toxicology screens, they actually also taper them down off of their psychotropic medications. So they have to be very stable and able to go through these studies. For the most part, that's very different in our typical patient population. So I start off there. I say, let's talk about the reality of these studies. These people are doing pretty well, and they're able to, you know, tolerate for sometimes weeks, even months, being off their psychiatric medications. Are we in that situation? That's what I just ask, you know. And then the other thing I usually talk about in terms of the spiritual component is a lot of this expectancy and expectations. This is going to be the substance that swoops in and saves me or does something different. And we have to adjust expectations. That might happen, or you might not have the experience at all that you anticipated. It actually might give you something, a sense of existential dread. Are we ready for that? It might give you more hardship. In many ways, it's not just the informed consent process, but it's also adjusting expectations is incredibly important. It might be helpful to think about where they're at in their recovery, but the big caution I always say is, have we tried all the other tools? Is everything else working? Is there something that we need in treatment that we need to go in a different direction? That's sort of the discussion I have. So just trying to think about the realities of research and translating. That's really what I'm talking about here. Translating all of this into clinical practice is going to look very different. It's going to take clinicians like yourself to kind of temper the enthusiasm and bring some reality check to individuals. There's a lot of possibility, but at the same time, there's also a lot of potential for adverse outcomes. We need to be, as clinicians, that's my standpoint, we need to be cautious and careful moving forward. So they hear about my interest and exuberance and enthusiasm, and then they're like, wow, you seem worried. I'm like, yes, I am. And let's talk about all of those variables. And I would just add on top of that that one of the fundamental things that this pushes back on is the general system of care, the way that we deliver mental health care, which is that if you're really going to be able to do this and be able to understand patient selection appropriately, you've got to have back to relationships. You've got to have a really good relationship with your patient. The system doesn't really necessarily always support that, the type of relationship. I like to joke that sort of like, and Jim hasn't heard me make this joke before, but bear with me on it. All roads lead back to psychoanalytic psychotherapy and psychodynamics, and all of those roads lead back to a relationship and really looking at how that relationship between provider and patient plays out. So I've never personally recommended to a patient that I've worked with with substance use disorder to engage in psychedelic treatment. It's just never come up. Most of the folks I'm dealing with are more on the acute side, and we're dealing more behaviorally and thinking about like, hey, what are you really looking for here? And are you really at that place where your expectation of this matches with the reality? And then sometimes I will kind of make a little bit of a joke out of it. I say, listen, you know, I've known a ton of people who have used hallucinogens or psychedelics. Almost all of them have pretty much the same problems as everybody else. So if you look at it in aggregate, you know, if it was the panacea, everybody that's taking them would be better, and they're not. So anyway, sometimes we'll joke about it that way, but yeah. Other thoughts or other questions? The question back there. That's a great question. In response also to the previous question, I was going to also recommend practice. There's so many non-psychoactive ways of practicing getting into alternative states of consciousness. So let's practice together. Let's practice some meditative processes, guided imagery. Let's do some breath work. Let's give you some homework to go on a non-psychedelic, psychoactive vision quest. Let's get you into the mindset that you're going to need to prepare. We often say in the research, they have these preparation sessions. I talked about that. Sometimes they're 90 minutes, one, two, three. I say, in reality, we need to maybe allow our patients to prepare much longer, maybe a half a year, maybe a year. In the abundance of caution, if we're really trying to do no harm, the timeline doesn't need to be following necessarily a small, constrained one. We should be feeling free to practice, practice, practice, to be ready to lay the fertile ground for potentially a positive experience, but also to prepare for potentially a negative one. So we are at time. I don't know if there's another presentation immediately after this, but we can stay here and answer some questions individually if people have them. But otherwise, thank you very much for attending and for your attention. I have a question. You guys talk about this bio-psycho-social-spiritual model, but from history, science and spirituality have been in conflict for a long time, especially in the Western cultural way. There are cultures when spirituality is very accepted, more of how we think of the mind. So just for day-to-day, how do we even talk about spirituality in the context of the bio-psycho-social-spiritual model? Because a lot of people just turn off, like Dr. Lomax was talking about, when we even bring that up, and kind of saying, now we are doing bio-psycho-social-spiritual model, which is not the norm yet, I don't think. That's a great question. My initial first response is, what I usually do is I ask very sort of micro-meaning moments. What are the times in the day that give you the most grounding, give you a sense of meaning, give you a sense of purpose, and we start to build those up. Because it could come in a form of a more structured, you know, and Jim can talk about this, like kind of spiritual-religious kind of review, or it can come in an individual sort of manifestation. Taking that specific example, if my patient Sylvia, when she said something was missing and she wanted to talk about using psychedelics instead of looking for a spiritual community, I would have used the formulation I had with her to ask her if she was still afraid to make contact and try to talk about that in her and my relationship, and then the relationship she was talking about, both with the friend she mentioned who had introduced her to this community and other people, to see, and I would have tried to get her to use a relationship or a meditation practice instead of a substance to do that, so my bias is that that's better and healthier, not particularly morally one way or the other. Thank you. Thanks again, everyone, and feel free to come on up if you have questions, otherwise everybody else, enjoy the rest of the conference.

spirituality

religion

psychiatry

mental health

substance use disorders

spiritual experiences

negative religious coping

psychedelics

addiction treatment

bio-psycho-social-spiritual model

mystical experiences

holistic treatment

spiritual beliefs