What a Long Strange Trip: The Fall and Rise of Psychedelics in Medicine – Dr. Jim Fadiman, Author and Pioneer in Psychedelic Research

Shiv Gaglani: Hi, I'm Shiv Gaglani, and today I'm delighted to welcome a pioneer in the study of psychedelics for mental health treatment and the father of microdosing, Dr. Jim Fadiman. Over the last forty years, he has held a wide variety of teaching, consulting, training, counseling, editorial and other positions. He’s also produced a wide variety of writing and artistic projects, including films. 

Among his publications is the book The Psychedelic Explorers Guide to Safe Therapeutic and Sacred Journeys, as well as Symphony of Cells, which I just finished reading a couple of weeks ago on his recommendation, as well as the recommendation of Sam Harris who he has a wonderful group of dialogues with. 

I'm looking forward to hearing from Jim about rising interest in plant-based medicines and other psychedelics to address mental health issues and what the students and providers in the audience should know about the space. So, Jim, it's an honor to have you on. Thanks for joining us.

Jim Fadiman: Well, I'm very supportive and interested in what you're doing, and I'm very glad to be here.

Shiv Gaglani: Thank you so much. We share a graduation reunion year. You were at Harvard in Leverett House 1960. I was in Mather House, in 2010. Your stories from your books are very fascinating. You mentioned how you got into this space, largely because you were taught by Ram Dass himself and met up with him in Paris, I believe, when he was on the way to a conference with Timothy O'Leary and Aldous Huxley in Copenhagen. For our audience members who don't know, we'd love to hear more about that experience and what got you interested in this space in the first place.

Jim Fadiman: Well, Dick Alpert at the time – known as Ram Dass later -- was my undergraduate kind of professor and then mentor. Then I was an intern for a summer of research. So we were friends. I was living in Paris, avoiding the draft and recovering from college. He came over on his way to the first conference of international psychologists that would talk about psychedelics. And he said, “The greatest thing in the world has happened to me.” And I thought, Well, that's nice, my friend. And he said, “I want to share it with you.”  I thought, how bad can that be? Then he takes from his breast pocket this little bottle of pills, and I freak. I am so straight, I don't drink coffee, okay? 

Shiv Gaglani: (laughs)

Jim Fadiman: But he's my friend, and so I have what was then a moderate dose of psilocybin. We were sitting outdoors in Paris at a café, and its colors are getting brighter, and the noises are getting clearer, and I'm aware of the conversations with people behind me as they walk by. Then I realized, I don't speak French that well. I've been living in France, like ten months. I've never been able to hear those conversations. So I say, “This is too much for me. And he says, “Too much for me, too.” And I said, “Well, you didn't take anything. He says “It’s my first night in Paris.” 

So, we retired to my sixth-floor walkup, where there was at least room for both of us, and I learned a lot about what I was attached to and what was important and what wasn't. A week later, I followed him to Copenhagen and found out more. A few months later, my draft board and I worked out an agreement that if I went to graduate school, they would wait to send me to Vietnam until it was over. At graduate school, I actually then worked with an off-campus research group, approved of by the government, giving LSD in then high doses as a clinical facility, and it was from those that experience with that group that my career unfolded. 

Shiv Gaglani: And it's been quite a career since and obviously that origin story was pretty remarkable. There's been a renaissance in the space of plant-based medicines and psychedelics. A lot of popular figures, including most recently Will Smith – who is a little less popular after the Chris Rock incident -- but he himself spoke about many of his experiences with plant-based medicine and trying to better understand himself and, you know, going through bouts of depression, among other things. So, this renaissance has come about, and fortunately, you're here to help explain to our audience a bit more about the evidence around microdosing, around psychedelics and what gets you most excited about the space and the renaissance itself We’d love to hear any commentary you have on that. 

Jim Fadiman: Well, let’s step back a little and talk about plant-based medicine. Many in your audience know that probably 70% of what are called pharmaceuticals are plant-based medicines. So, when we say “plant-based medicines” out here in the psychedelic space, we're talking about a few plants that happen to grow in most places. We're also talking about fungi. There are 200 species of psilocybin mushrooms that are found around the planet. It's not an uncommon life form. Someone very reasonably said this isn't a renaissance. It's really a revival. It’s simply bringing back something that for forty years the federal government said, ‘thou shalt not learn anything about’ and catching up.

We're now doing the kind of research that we were doing really forty years ago, only now we have a lot more elaborate procedures and elaborate protocols. But we're getting basically the same results, which is that in a good setting with trained people, high doses of psychedelics apparently are beneficial for a number of conditions.  I'm being deliberately vague because the number of conditions keeps growing. 

Microdosing is a totally other world. Microdosing can be defined by saying it has no classic psychedelic effects, no distortions in the visual world. No visions. No God speaking to you personally and also not being eaten alive by giant Anaconda snakes. 

Shiv Gaglani: (laughs)

Jim Fadiman: That’s very common, by the way, with ayahuasca plants. There’s none of that fascinating stuff, no incredible insights and reliving several past lives. Microdosing is closer in its overall effects to Adderall and coffee. People report that their system works better when they are microdosing, and that the microdose is such a small dose that someone described it as sub-hallucinogenic, meaning no distortions and no interference with functioning. 

Now, that definition actually comes from the citizen science part of microdosing, which we'll talk about. It is the heading of a subreddit in Reddit called Microdosing, and if any of your listeners look it up, they will notice it has 200,000 members. 

Shiv Gaglani: Wow.

Jim Fadiman: So, this is not a cult. This is not a kind of scientific oddity. This is even not what all the rest of the renaissance is doing. This is a worldwide interest. I have reports in my research crowd and my data from fifty-one countries. But that was a few years ago. A recent article in Nature Science Reports included data from I think 84 countries. So, this is not a rare event. It has been highly studied and observed by thousands and thousands of people and a few research groups. But they came later, we'll note what they found if we get that far.

Shiv Gaglani: No, we definitely will. There's obviously a lot of interest and you've tapped into the citizen science community where people have documented their use of microdosing, among other dosages. You’ve developed an approach that's known as the Fadiman Protocol for microdosing where it's one day on and two days off. So, for our audience -- some of whom probably are doing this, and others definitely have patients who come to them who are doing this -- can you explain that, and maybe what things they should know about or look out for if people come to them?

Jim Fadiman: Let's look at the whole question of protocols, which is a kind of classy word for “how often.” The protocol I came up with about 11 years ago was a research protocol. I was trying to find out what was going on. What were people reporting and could they tell the difference between microdose days and non microdose days? That’s kind of the first level of determining if this is a placebo. What I found is people would report that the day in which they microdose, they were very aware of how they felt. The next day, they had most of the same feelings and the third day they felt they were where they'd started. So, they went back to base and that's a perfect research design, to use your own subjects over and over again, starting from base. Understand that this was a pure research protocol. There was no awareness that it would become popular as a using protocol. 

We also asked people to take fairly elaborate notes for a month and send them to us. Why months? Because we figured that's about the limit that people who are basically helping other people they don’t know are willing to do. What we found is that after about thirty days -- which would be eight or nine cycles -- people were reporting the third day was pretty good, too. So that become a popular protocol. 

One of the important things about microdosing, and psychedelics in general, is if you use it too often you develop tolerance, which means there is no effect. And what has emerged in the microdose community -- totally unresearched and totally agreed on -- is that when people are microdosing regularly more than a month or two, they believe it's a good idea to take from a week to a month off. That is pretty well standard around the world with the various groups who've emerged who are now doing kind of microdosing more professionally. Almost everything I'm going to tell you is both citizen-science based, and fairly large numbers of people have reported the same thing independently which is the way science has always been until very, very recently.

Shiv Gaglani: Yeah, that is fascinating. It's interesting how it started off as a research protocol and now is used quite commonly. And it’s not just about psilocybin or other psychedelics. You know Michael Pollan who has popularized this field. He cites you often in his books. He was talking to Joe Rogan on one of his podcasts about caffeine and how Roland Griffiths at Johns Hopkins – the researcher using psilocybin for end-of-life care among cancer patients -- recommended that he try getting off of caffeine, which is a very common plant-based medicine that most of us are on. He writes very beautifully in his most recent book about the evolutionary basis of caffeine. I'm curious…why do you think these effects even evolved? Like, why would a fungus or these plants have these psychedelic effects? And then, how is it working in the mind? 

Jim Fadiman: Why is it that Nature does that? Why is it that Nature puts into a mushroom that grows most easily in the dung of animals…

Shiv Gaglani: (laughs)

Jim Fadiman: …something that gives people improved health at low doses, and a vision of transcendent love and humanity at a higher dose? Is that a really serious question that human beings are supposed to answer? That's kind of like saying to a tree, “How come you're so big?” 

Shiv Gaglani: (laughs)

Jim Fadiman: The fact is that we have receptors that different chemicals in the world effect. There is a lovely theory that the human brain began to enlarge when we started using psilocybin. When the climate change happened and forests were going away savannas were coming, there were ruminants who ate and therefore there was dung, and therefore there were mushrooms. There's other theories that I happen to like better, such as the invention of fire, which changes your ability to absorb protein by cooking food. There's a lovely theory that says social animals, of which primates are very complicated example, have larger brains because when you're in a relationship, it really stretches your brain. 

So, there are lots of reasons why the brain might have gotten larger. The other question is why is it that it’s this mushroom and not that mushroom? Or the bark of this tree? Or peyote, which is the smallest and maybe the ugliest of plants -- and also, by the way, the slowest growing cactus that we know -- why do all these things not only affect human beings, but how did human beings know enough to pick them up and eat them? One can make an argument that mushrooms might taste good, as many mushrooms do. Why did anyone in the world ever eat peyote? It doesn't go from the rational kind of western point of view. 

If you say to the indigenous groups, “Why is it that you're using ayahuasca, which is one plant, and then some other plants, and then you boil it for five hours? Anthropologists theorize that it’s by chance. What's your theory?” And the natives say, “It's hard to imagine how stupid you are, but I'm going to be nice to you because you're in my forest and you don't do very well. But probably the reason we use it is the plant suggested it.” There is in numerous different indigenous systems worldwide the notion that some plants are teachers, that one of their designs, like having fruit, is to have information and that information is valuable to at least our species. Mushrooms are eaten by at least thirty-one primate groups. Amanita muscaria

-- the Christmas mushroom that you've seen in all the little children's pictures -- is eaten by reindeer. So, there are connections between the plant and animal world, which if you take away the notion that humans are the only smart species ever, it makes a lot of sense.

Shiv Gaglani: Absolutely. And there's documentation that even dolphins have psychedelic type experiences from puffer fish that are toxic in high doses, and probably still a little toxic in lower doses, leading to these interesting states, euphoric states.

Jim Fadiman: You know, most dolphins know enough not to overdose.

Shiv Gaglani: (laughs) Humans can learn a lot from that, too, I guess. One of my favorite lines in your book, The Psychedelic Explorers Guide, is if you take a little bit of a psychedelic, you think you can talk to God; if you take a little bit more, you think God is talking to you; and if you take a little bit more than that, you don't know the difference between you and God. And so I'm curious about any insights you have from a dosage perspective around mechanisms of action. For instance, if you're microdosing .1 grams versus taking a hero dose of five grams, what exactly is happening in the body? Not just mentally, but I'm sure there's systemic effects that you've studied and know a lot more about than most of us.

Jim Fadiman: That’s just a wonderful question, because we're still in a kind of primitive stage of observing there are many more colored lines in the pictures of the brain with psilocybin. We know more colored lines means more connectivity between parts of the brain. Now, the question is, when you raise the dose do you just have more connectivity, or are there thresholds in which other phenomena can occur? It probably is that. The next question is, why is it that a high dose seems to almost be able to produce on demand -- with the right set and setting -- a transcendent experience? And why does that transcendent experience map perfectly with transcendent experiences as written in the great religious and mystical traditions? 

So, it looks like it's accessible to human beings. Now, why is that? Or how is that done? Probably Western medicine is not very good at figuring that out. For instance, they talk about a particular neuron 2A, and its affinity for psychedelics. Then they say, “Brain, brain, brain, brain, brain.” Every once in a while, if I get a neuroscientist sitting down, I say, where are all the neurons in the body? Are they all in the brain? No. Are there more in the gut than in the brain? Maybe. Have you measured anything in the in the gut? No. Are you aware that there's 10,000 species of bacteria in the gut that affect cognition, respiration and sexual arousal on their own? Yes, we know about that, but we haven't figured anything out yet. So, we're at a very early stage. It’s a wonderful question. Call me back in 100 years and I'll give you the agreed upon answer, and three of the other groups who disagree. 

Shiv Gaglani: (laughs)

Jim Fadiman: The question that I'm interested in is, where is it safe and useful? And where is it not safe and not useful? That's all I can handle.

Shiv Gaglani: Let's get into that because it's been a tough couple of years, to say the least, with COVID. One of our previous Raise the Line guests was Thomas Insel, who was the director of the National Institute of Mental Health. He came out with a wonderful book recently, and Joe Biden, in the State of the Union, talked about the mental health crisis and because of COVID and Ukraine and all sorts of things happening in the world, there’s much more interest in mental heath. Many people in our audience are healthcare professionals or students on their way to being professionals. What do you want them to know about that question around use cases when their patients come to them with these issues? What should they know?

Jim Fadiman: The issue for mental health is the psychopharmaceuticals don't work very well. Period. That is even if you read the promotional literature from the companies. They admit admit from the onset 30% of people will get no benefit from SSRIs. What they don't discuss is long- term effects of using SSRIs. And it turns out that if you go to the companies who make several billion dollars a year off of any given SSRI and you say, “Can I see your long-term studies for five, ten, fifteen years of use?” They say, “Well, we don't have any.” “Well, what do you have?” “We've got some six-month studies.” So if you go to the federal government, which actually did a few of these studies, it turns out that on a long term study, people with depression who use SSRIs have a worse prognosis than people who never do. 

So, the mental health crisis is that we don't have good solutions. Remember, we had a COVID crisis and we've come up with vaccines that work enormously well for almost everyone. That's terrific. Mental health has not done so well. When you have a system that isn't working well, it's much more open to innovation, and what we know is that carefully-given high dose psychedelics have a likelihood of mental health improvement across diagnostic categories. Now you say, well, but what's the research? We know that these studies say we don't take people who have prior psychotic breaks, we don't take schizophrenics, we don't take bipolar people. And the answer is, you don't take them because they spoil the study because if they get crazy later, you'll be blamed. 

In the citizen science world, where I live, where people have access to the psychedelics -- and I've had that since they were before they were illegal -- we have a lot of data of people with serious mental illnesses self-improving by self-administering high doses of psychedelic. I don't recommend it, but the data is there. You know, I was interested in bipolar, and I asked my smart science buddies, what's the data since you never take anyone into these current studies? So, I got some data and there was none. They basically have not been testing the group who need it most. Ever. 

I then went to where we go for serious scientific evidence, which is Facebook. I went to the bipolar sites and I asked the moderator, “Can I ask your site: do you guys have anything to say about psychedelic use?” And they said, we do. If you're bipolar, don't take a psychedelic high dose. When you're manic, you're already losing it. When you're depressed, it's very helpful. So that's just information that's out there. When you get into microdosing, which seems to have as good a track record as high dose and certainly better than SSRIs, we find, firstly, for depression, approximately 80% of the people who take it for depression are enormously improved. Remember, you only take a psychedelic for depression if you've tried what your physician gave you, so we're dealing with this crazy misnomer called treatment resistant, which means the treatments weren't good. None of the patients ever resisted, okay? These are what we call treatment failures. 

About 80% of the people who report from the surveys of microdose use also report improvement. Now, remember, whenever you're looking at a survey, you're gonna get a much higher percentage of people who find it valuable. If you're asked to rate soft drinks and you don't like any of them, you're not going to fill in the study and they'll never know. So all surveys are kind of by definition optimistic. However, if you're dealing with a mental health crisis and it seems to help a lot of people, it looks like it's worth a try particularly if it has a low toxicity problem and a low intervention with other medications problem, and it doesn't interfere with normal function. 

That's really where we are with microdosing. We’ve just been adding one more level, which is microdosing with coaching. This comes really perhaps out of the executive coach world where very healthy people can still get help. We're finding that microdose coaching -- that is now done in about ten countries -- seems to also be very helpful since it also corrects issues that come up in a microdosing regime. Remember, we're not talking about one dose. This is a periodic use, and so you're really observing people over months. 

Let me give you just one example that should startle the medical people. We don't have a lot of cases, but in botany and biology and astronomy, one case says it exists. In medicine, they say well, we need a larger sample, which really usually means send more money for another study. But let me just give you an example of one person. This is a diabetic. The diabetes is totally controlled with insulin, same dose level, under medical supervision. For fourteen years she was very stable. For other reasons, she gets interested in microdosing and she works with a micro dose coach. Within about a month, her insulin use begins to drop. Several months in, she's taking 20% of her insulin dose. Now, we all know that diabetes is highly physiological…we're talking about cells that are not working properly. We know a lot about the system. There is no known reason that this woman should exist except if you have a very different view of the way the mind-body works.

Shiv Gaglani: It's very exciting. These unknowns, these gaps of knowledge -- even anecdotes and stuff -- are very exciting because especially for those of our audience who are interested in this space, there's so much research they could be doing, especially now that things are opening up again. And that is a question I have for you. You've been through the desert, you know, and now back out to the revival. Say it's 2050. Where do you see us? Is it Aldous Huxley's Brave New World? 

Jim Fadiman: Right now in Holland - a country that is not as frightened as we are -- truffles are legal. There’s a group called the Microdosing Institute in the Netherlands and they basically suggest that people can purchase truffles in a number of shops, and they take a small amount over a protocol like the Fadiman Protocol and other protocols. They have about 5,000 people they worked with, so we have a lot of evidence of it being used in a normal way, in a normal civilized country. There’s a lot of research now coming out of it because, as they say, it's inexpensive, it's legal, and we use volunteers so our costs are very low. 

So, for instance, there’s a study now looking at does microdosing effect ADHD? There’s lots of anecdotes by students who report improved focus since they’ve been microdosing and they also have nice measurables, which is their grades. We have a lot of what people call anecdotal data, what I just call citizen science. Someone is now doing a study with a couple of hundred people who have a diagnosis of ADHD. And what's beautiful about this study is half of the sample, approximately, are on medication and half aren't. That's an easy to do piece of research. 

There's a lot of reports in the microdose world on migraines. No one I know in my study eliminated migraines, but they did drop them 70, 80, 90%. Many of your listeners who deal with headaches and with migraines know there's really very little we do that helps. We can help certain classes of migraine sufferers, but not most of them. Here's a microdose which has no discernible side effects that you would ever worry about, and there's a number of people who've found that it helped their migraines. A little more esoteric is something called cluster headaches. Those are the worst pains known to human beings. High doses work well, but high doses need to be repeated. People come to us, and we say no, go to cluster busters.com and learn all about what works for cluster headaches. Some people say, well, I just wanted to write you and say I was microdosing and my cluster headaches went away. For some people, that's a possibility. So, we have some areas where we have enough evidence that conventional research is going to find it very easy to do it right.

Shiv Gaglani: That's exciting. I mean, the fact that it's already happening in places that have decriminalized it – you mentioned Holland – but also Portugal, Oakland, Denver, Portland, and several other cities have decriminalized it, so I think we'll see some really interesting results coming out in the coming years. 

Jim Fadiman: You know, when we look back 100 years from now, people will say, “You took medications that help everybody and you made them illegal. That was terrible. How could you have done that? And it’s a very curious answer. Psychedelics were made illegal in the United States because President Nixon found a way in which he could attack his enemies. According to John Ehrlichman, his White House Counsel, it was never about the drugs. “Did we know we were lying? Yes, of course we did.” Okay? So, the revival is simply taking away a bit of legislative dishonesty and getting us back to, “Gee, these drugs seem to be there. Maybe they're helpful for people.” There’s an anti-malaria pharmaceutical that very often causes heavy nightmares and people have to make that trade-off. But it's a very valuable drug. Psychedelics, particularly when microdosing, are among the pharmacologically safest drugs we know, and that they are illegal is simply a curiosity of political reality, not scientific reality and not medical reality. What's embarrassing for the medical community, is they invented a whole lot of theories of why they were illegal, even though they know better.

Shiv Gaglani: Yeah, where the political situation leads the science as opposed to the other way around and even…

Jim Fadiman:In psychology, it's called rationalization where you make up stuff after the fact so it doesn't look like you’re crazy. The medical community, unfortunately, did that. But it's now releasing it and probably it’s because the truth is, so many of the people who are listening to this program have had psychedelic experience. They may have had it in high school, they may have had it in college. I find in the medical community, everyone took Advanced Organic Chemistry and that is a time when an amazing percentage of people -- while they are trying to figure out how to invent different molecules -- say why don't I do LSD or mescaline? I have to do a project anyway. 

Shiv Gaglani: (laughs)

Jim Fadiman: So, a lot of people in the medical community who end up at the FDA and in the enforcement community have all now had psychedelic experience. Now, let me give you the number, just about LSD -- not about psilocybin, not about all the others -- just LSD: since it was made illegal, about 30 million Americans have taken high doses of LSD. If you do it by education, those people are the more educated half of the country. There's a huge awareness that the laws are pointless, or just are bad for people's health. What the health provider needs to do is -- when they're asked about psychedelics -- either learn something, or admit ignorance but don't say, “Well, I can't talk about it because they're illegal.” Because your patient is going to say, “I've just lost respect for you, because you just found a way to avoid dealing with my genuine, issue, question and problem.”

Shiv Gaglani: Absolutely. You have to develop trust and being overly paternalistic in some of these ways gets in the way of that.

Jim Fadiman:Well, being paternalistic is to be a good father. I'm not against being paternal or maternal. What I don't want is someone that says, “We're not going to talk about that.” Wait, wait, wait…this is medicine. I'm a client, you're the physician or the nurse or whoever. You can tell me you don't know anything, or you're not supposed to talk about it, but you can't say, “Let's not talk about it.” Because then we'll go back fifty years and say I'd like to discuss having birth control -- and remember, birth control was illegal in this country. Then it got legal if you were married, and there was a court case not about birth control, but about information for birth control because it was illegal to tell people about it. Medicine does not leap ahead, it kind of gets shoved from behind. The wonderful thing about citizen science is, when you have thirty million people who already have experience you can get to the question of, is this good for you now with your condition? Is this bad for you now? Should you get coaching? Should you get support? Should you go to Jamaica and go to a resort? Should you go to Holland and go to a retreat? Should you go to Peru? Those are real questions, and either you have answers or you should know where to send people for answers.

Shiv Gaglani: Absolutely. And that's why we recommend your book and several other resources. Michael Pollan and Roland Griffiths and Rachel Yehuda all fall into this category.

Jim Fadiman: The nice thing is there now are resources.

Shiv Gaglani: Yeah, it's true.

Jim Fadiman: I mean, my book The Psychedelic Explorers Guide is used more as a resource than I would really like. Because what that indicates is that we haven’t gone much past what I said eleven years ago. Now, we've gone way past it with microdosing, but the high dose method that's been developed is actually replicating exactly what we developed in the 1960s: a comfortable living room like setting -- flowers, paintings, a nice feel, nothing medical looking or smelling; a man and a woman supporting you; and a lot of support on both ends. That's a wonderfully expensive, but wonderfully successful system we developed in the 1960s because it worked, and it still works.

Shiv Gaglani:For sure. That’s the protocol now for a lot of things. I know you just spoke at Mount Sinai. That's where Dr. Rachel Yehuda is doing FDA-cleared trials with MDMA-assisted psychotherapy for patients who have PTSD. These are really well-defined use cases that are making the case better than anyone else can that these things need to be explored more.

Jim Fadiman: Well, here's the problem I found -- and I got it really from Mount Sinai and some other medical groups I've talked to -- medical students seem to be trained to ask, “What is the research on this? By that they mean, what is the particular kind of Western double blind research, when that is an inappropriate research design and it's asking them to deny common sense. When I was talking to medical students, it was hard for them to say, “Well, if Reddit has 200,000 people discussing microdosing, maybe that information is as valid as twelve people in a study done by Johns Hopkins.” I watched them and it was hard because there's so much emphasis on ‘if it isn't in the research, you can't do anything.’ And I'm on the explorer side, which is, ‘the only way you're going to do research is if somebody gives you something of interest that you want to explore.’ 

Shiv Gaglani: Yeah, I think the nuance is key. One point I make to medical students about biostatistics and design is look at the Purdue pharma case where they took this one study in a hospital setting and the conclusion from that study was, ‘opioids were not addictive, OxyContin is not addictive.’ That one study was used and touted by the salespeople of Purdue and several other companies Fast forward ten, fifteen, twenty years and it led to much too much prescription of OxyContin, and then this massive opioid crisis we still have. So, just because there isn't a study doesn't mean it's not a valid therapy or treatment, and just because there is a study doesn't mean it's completely safe because things can change.

Jim Fadiman: Now and then people say, well, aren't there research studies that show microdosing has no effect? And I say, it looks like that if you read them closely, but maybe not. But let's assume they're good. There are ways you can design a study where you won't show an effect. For instance, I have here a new headache preparation that I'm holding in my hand, and it's better than anything on the market. But, I was told to do a study. Most studies are with very healthy people, and I divided them into two groups. One I gave my mixture to and the other, I gave the most successful headache medication to, and there was no difference between the two groups. In fact, no one in the group had a headache -- either before, during or after the study.

Shiv Gaglani: Yeah. (laughs) That's right. I get that point.

Jim Fadiman: That was the point of their doing it. They had an enormous bias to find that there was no effect. Some of the other studies that I think were a little more mature, said, “Wow, we didn't find an effect. Let's look at what we do.” And what they're finding is, again, the sample is critical. Also, the timing is critical. There are a few things you learn. I suspect if I read the opiate study, it was very short term.

Shiv Gaglani: Six months or less, yeah.

Jim Fadiman: Okay. So, how long does it take to get addicted? For some people, it takes longer than six months. We know that there is no law that forces a pharmaceutical company to reveal all of its studies to the FDA. Guess what? If you're a pharmaceutical company, what studies are you not likely to share? And they've tightened up some of the rules on that. You can get hold of the studies that weren't submitted, but it's really hard. 

I keep saying the Western medical model is different than the Eastern or the Chinese or a lot of others. They're all based on whether it helps people in a real-world setting. There is a technical term that is really valuable. If you get nothing else out of this, it's called ‘real-world evidence.’ With psychedelics, we have literally thousands of years of results that we are now filtering through the medical filter to see what makes sense, and that's a very different model and it's not surprising that there are some differences between laboratory and real world.

Shiv Gaglani:That is really fascinating. That's, well nuanced. We could talk for hours about this topic, and I certainly want to have you say some final words on it, but I did want to give some time towards your latest book Symphony of Selves, because I found it personally very satisfying. Fascinating, too, because most of us think about moods, and that we are the same person…there’s a very strong ego and, you know, we're just having a bad day or are in a bad mood or a little hungry or hangry. Your book is interesting because it lays out a lot of the evidence and some interesting theories around multiple selves theory and how we actually have a symphony going on.

Jim Fadiman: What the book has is as little theory as I could possibly manage, because observations to me are much easier to work with and you don't have to defend an observation. You know, the patient died. There's no theory. We can say why they died. But the important issue is there. So, what we start with is we say, have you ever been angry with yourself? And everybody goes, yeah. Then we say, who was the other person? And everybody goes uh, uh, uh because they don't have a vocabulary. We've been brought up to imagine we're consistent. What we know -- especially if we've ever lived with anyone else is we're consistent, maybe, but they're not. How could you have done this? I don't know what came over me. My favorite is, I was beside myself. I love that because of the image of who is sitting next to you. So, we know that we move in and out of major mental states, and we call them “selves.” 

There's a page in the book where we have fifty different words that have been used by other people along the centuries to deal with the problem that we're not consistent. But if you think of us as a collective, then our goal is to not be consistent, but to be supportive. For instance, the part of me that is talking to you is not the part of me that I that I'm going to show when my two little dogs run after me and say, “Oh, my God, you're back! I love you!” Okay? The same parts of me aren't in use. We all have an example of this, which is we all go to large social events in our family and we all know there are certain pressures that happen because we are being treated as if we were younger. 

When I was about fifty, my mother looked at me and said, “Don't you think you should put on a sweater?” I knew she had rather poor circulation and she was always cold, so I understood where it came from. But I looked at her and I thought, “I've actually got a pretty good idea by now whether I need a sweater or not.” But when I'm with my mother, there's a tendency to be a child, and what I was seeing in her is a tendency to be a mother. So, we have those selves. 

If your goal is to have your selves working for you in harmony, the world begins to make sense. If you don't demand consistency from other people, you will find that you understand them better, and you start to forgive them the parts that you don't like. Then you realize, well, I could also forgive myself for the parts that I don't like. In fact, I could even look at the parts I don't like and see what they need, and see if there's some other way they can be satisfied rather than say, getting drunk on holidays, which the whole body doesn't like. So, that's what the book is about and it has literally a thousand examples. It's not a self-help book. It's an awareness book. When people read it, they say, “Oh, I'm beginning to see the world differently. I don't have to do anything.” If you go out with a geologist and start looking at a cliff, you'll never see that cliff the same way ever again because he's told you what all these incredible things are that you're seeing. You know, 300 feet up, is where the seashells are, and so forth. You begin to see the world differently, and you don't turn that off. The wonderful thing about learning is it's hard to lose it. You can neglect it and you can forget where it is, but you say, “Oh, yes. The atomic weight of cesium. I knew that.” It's in there somewhere, and there's a part of you that actually remembers that stuff.

Shiv Gaglani: I really love the book, and as I mentioned before we started the episode it is perspective altering. I can see the benefits already of being able to be more compassionate in interactions that we have with each other, which we definitely need in this day and age. 

Jim Fadiman: Let’s take a medical example. What just comes to mind is, what's the percentage of prescriptions that are not filled, and what is the percentage of prescriptions that aren't taken? A huge percentage. Now, who is not taking them? The person who came to you and said, “I really want something for my gout.” Okay, they want to take that medication, but parts of them don't. So, if I'm a practitioner, I want to be sensitive to whether I'm getting kind of a buy-in from enough of the person so they're going to do what I spent ten to twelve years learning how to do. Because if they come back a month later and say, “I still feel the same,” and you ask if they took the medication and they only did a couple of times, that's a very hard moment. If you get mad at your patient, that isn't going to work, but if you indicate, “So there's a part of you that really doesn't like medication?” “Oh, yeah, there's a part of me that just doesn't like any medication. I mean, I don't even like that part of me. I even have to fight to just use toothpaste.”

Shiv Gaglani: Yeah, exactly. I think that's what we all need, especially people who are willing to be permeable to new ideas like our audience. They're listening to this because they're permeable to go look at that. Because I think having that perspective or other frameworks for approaching life is invaluable, especially developing at an early age.

Jim Fadiman: This this past couple of years, anyone in the medical profession has been under excessive stress. We talked about the mental illness problem…the medical profession has had it hardest. When you're working twelve-to-fifteen-hour days and people keep dying on you, there's no way out except to compartmentalize, but there are compartments. And what many of us have learned is people will say, “Okay, now I'm going to put on my work clothes.” See, that's a hint to yourself to be the work person. And when you come home, you take off the work clothes, right? One of the crucial questions during early COVID was, “How can I go to work in my pajamas?” There's no reason I can't. At the moment, we're on Zoom. You don't know if I'm wearing pants, right? But it turns out an awful lot of people figured out that they needed to get up from their bedroom, and they needed to get dressed to go to work. Then they would walk to where their computer was and that would be “the office” and they could work. So, we all are working with selves all the time and if you do it consciously, it's a lot easier.

Shiv Gaglani:I totally recommend the book. I had two other questions for you. The first is, as you know, Osmosis is a teaching company and we like to fill in knowledge gaps. If you could snap your fingers and teach our audience anything -- a video, a course, another book -- what would it be and why?

Jim Fadiman: Well, I'd probably like to teach the science and research of microdosing, but until the federal government allows you to use it, it just makes people unhappy. It’s like giving a course on what restaurants to go in Paris, however, you're not allowed to go to France. So, I would probably do something with selves because that's like putting a tool in your toolkit. That's like you saying, “I have a screwdriver.” And I say, “Well, I have this thing and if you open the top, there's six or seven different screwdriver bits. It's really more useful.” You say, “But my screwdriver is really expensive.” I say, “Well, we weren't talking about expense. We were talking about what would make you able to solve more problems more easily, and be a better practitioner with less personal stress.” Now, I admit the way I just said that sentence sounds like my infomercial. “He's about to sell me a substance that only one elderly researcher in Japan has discovered. And I can only sell it on Instagram.” But that was your question. The answer is it would be very helpful for people. I have enough evidence now when people write and say, “Whoa, my life just got easier because I am not confusing this composite notion of a single self with reality.”

Shiv Gaglani:I agree 100%. And actually, as I was reading that book I was thinking, “What would an Osmosis video look like if we were to convey that?” Because it is a perspective worth considering for most people.

Jim Fadiman: I mean, I'd love to say something more general that doesn't have my book in it. The nice thing is when you have something that works, you want to share it, you know? When you've found a candy bar that's delicious but it's only made in Estonia, you want to share it with people. Selves, it turns out, is found everywhere, but since we have an overall system that says you only have one self, we don't have the vocabulary. We can't distinguish. And we can. We do have the vocabulary and we can distinguish. It just means letting go of one of those many, many, many things we learned that aren't true. 

Shiv Gaglani: That's a good point. My last question for you is, what advice would you give to our audience about approaching their careers in healthcare, or careers in general, in this day and age?

Jim Fadiman: The thing about health care is, it's a very much harder profession than those of us not in it know, and being a good role model turns out to be more valuable than people think. There's an enormous gain for your patients, clients, etc., if you're in good health. That's an opener. The other is, understanding selves will cut the stress level in your life. Microdosing, when it becomes allowed, will improve the functioning of your system. There are ways to make your physical and your emotional life easier that the system wasn't designed to teach you. I mean very simply, there's no category in the FDA for wellness. You have to have a defect in order to participate in the system. But as human beings, we don't work that way at all. Yeah, I feel good. I'd like to feel better. Oh, can my doctor help? Well, kinda, because he's gonna say ‘have a good diet, do exercise, sleep well.’ And you say, well, anything from the medical side? He says well it didn’t teach us anything. 

I know it used to be true that they never taught nutrition in medical schools. Frightening.

Shiv Gaglani: We had about three days of nutrition when I was in med school. 

Jim Fadiman: I'm horrified, because I'll tell you the one thing I know about every patient you will ever see is they eat. Okay? They may not have sex, they may not even be able to go to the bathroom, but they will eat.  It's useful to find out what that's about.

Shiv Gaglani: I love that advice to be a role model. There's this famous physician, Albert Schweitzer, who had a big impact on a lot of a lot of us and one of his great quotes is, “Example is not the main thing in influencing others. It's the only thing.Is there anything else I haven't asked you that you're dying to get to our audience?

Jim Fadiman: No. I think you've actually done a remarkable job in a small bit of time. And I think your own openness and your own background made me feel very much like I didn't know we were such good friends.

Shiv Gaglani: This is one of my favorite interviews, Dr. Fadiman.  Or Jim. Whichever self I'm talking to, it's a real honor to meet you. Both of your books have had a profound influence, not just on me, but many, many people I know. So, I really appreciate you taking the time.

Jim Fadiman: Well, we're in it together. And I love that you're going to do all the work. I get to be with all the people who've listened, and I didn't have to do any of the work. All I had to do was, you know, seventy or eighty years of work to get here. This was wonderful, and I've been admiring really what this site is about. We need this kind of education into the system, but not of the system. Because the system has its own needs that build in limitations. It's not its fault. Every bureaucracy ossifies. Trees get rigid. It's not their fault.

Shiv Gaglani: Well, again, I really appreciate you taking the time. And with that, I'd like to thank our audience, too, for being open minded and taking a deep interest in this interview. Hopefully, you will have picked up at least one or two tools that will help your selves or your patients.