Shiv Gaglani: Hi, I'm Shiv Gaglani. You're in for a very special episode of Raise the Line today, where we'll be taking a unique, multi-generational look at psychedelic research. Dr. Bill Richards' extraordinary contributions to the field started sixty years ago and have continued at various universities and research centers through the decades. In 1999 at Johns Hopkins University, he and Dr. Roland Griffiths launched the rebirth of psilocybin research

after a twenty-two-year period of dormancy in the U.S.  His book, Sacred Knowledge: Psychedelics and Religious Experiences, was released in English in 2016 and has since been translated into multiple languages.  I actually just finished reading it over the weekend and I highly recommend it. It's a great overview of the field. 

His son, Dr. Brian Richards, completed a postdoctoral fellowship at the Johns Hopkins Behavioral Pharmacology Research Unit -- which is now the Center for Psychedelic and Consciousness Research -- where he contributed to some of the original research administering psilocybin with cancer patients and healthy normal adults. Dr. Richards also teaches and mentors students at the California Institute for Integral Studies, the leading psychedelic medicine certificate program worldwide. He was a lead psychologist on an innovative, simultaneous group administration, high-dose psilocybin trial with cancer patients

at the Bill Richards Center for Healing in Rockville, Maryland.

They currently both work for Sunstone Therapies, a company focused on the delivery of psychedelic-assisted therapy and defining the standards for optimal patient delivery through clinical trials. The co-founder and CEO of Sunstone Therapies, Dr. Manish Argawal, was previously a guest on The Raise the Line, and our friend, Zeshan Muhammedi is also an investor in Sunstone Therapies.

So, Bill and Brian, it's a true honor to have you on. Thanks for joining us. 

Dr. Bill Richards: Great to be with you. 

Dr. Brian Richards: Honored to be here as well. Thank you, Shiv. 

Shiv: Awesome. So, let's start with you, Bill. The intro I gave barely scratches the surface of your accomplishments and contributions to the field, which I think began based on your book when you were studying in Germany. What else would you pick out of your long career that you think

be important for our audience of current and future health care professionals to know?

Bill: Oh, boy. Lots of thoughts there. Yeah, I've been in this field a long time. I began when I was twenty-three years old in Germany and continued, especially at the Maryland Psychiatric Research Center in Baltimore for a decade. And then came the deep freeze. Then in 1999, it came alive again at Hopkins and now we're focused at Sunstone Therapies here in Rockville, Maryland, especially exploring the application of psychedelic therapy and palliative care.

It's a very hopeful time in the world of psychedelic research. 

Shiv: Yeah. Do you mind just commenting a bit about this unique moment in history just given all the things you've seen, including one of the coolest excerpts from your book, which was when you returned from Germany, going to that mansion and actually meeting Timothy Leary, a very controversial but interesting figure in psychedelic research. So, any commentary on the moment we're in in psychedelic research?

Bill: Well, when the research became dormant in 1977, my son, then I think three years old, helped me empty out my office. We thought it was the end of psychedelic research, and the great dreams we had were for some future generation. President Nixon had declared

Timothy Leary the most dangerous man in America and the soap operas had people jumping off skyscrapers and having deformed babies with LSD. It looked pretty bleak. 

The fact that now there are -- I forget how many -- but well over 100 studies with psilocybin alone on clinicaltrials.gov, all FDA approved. Research is just blossoming throughout the world, really, not just here in the United States. It’s come alive in ways I didn't dare hope for in my lifetime. We still have a lot of work to do, but it sure is looking promising.

Shiv: Absolutely. That's definitely what we've heard from other guests who have been on, including Rick Doblin, who I know you guys are pretty acquainted with at MAPS (Multidisciplinary Association for Psychedelic Studies). 

So, going to you, Brian, I'm very curious because I'm the son of a physician and followed in my father's footsteps -- and you are by yourself accomplished -- but I'm curious, what led you to pursue this field? And then can you add more to what I gave as far as background that you want our audience to know? 

Brian: Thank you. Yeah, I wanted to work in a career where I could really be authentic and helpful to people. Psychiatry and clinical psychology are both conducive to really meaningful depth-oriented work. I was a postdoc at Hopkins Behavioral Pharmacology Research Unit. At that time, this whole class of psychedelics, quote-unquote hallucinogens, hadn't been characterized. The scientific questions of what is their abuse liability, any therapeutic indications potentially, how can we safely administer...really more of the ground-level research questions that we got permission to work up research around. That was the genesis point of this research beginning again. 

I remember at that time, myself, Bill, Roland Griffiths...I mean, I don't think any one of us could have imagined that a couple decades later, there would be large multinational companies and lots of people doing this research and the cultural narrative really beginning to change

around the medical use of these psychedelics: how they can be safely and effectively delivered in healthcare systems at scale; whether there might be novel CPT codes and insurance reimbursement. And so I'm really honored to be at a point in history where we can really contribute to, in a sense, the normalization of psychedelics and expanded states of consciousness as conducive to overall health and well-being, both for people who might have a diagnosable psychiatric illness, but also for people who want to really self-actualize, really develop their understanding of being human, of consciousness, of meaning and purpose in their lives with or without a disease state. So I think it's a really important time to contribute to the evolution of psychedelic medicine in the present moment. 

Shiv: Yeah, absolutely, and you guys have great platforms for doing so. On that topic of psychedelics not just being used for clinical use cases, I know just yesterday, one of the previous guests on Raised the Line, Dr. David Yaden, was appointed as the inaugural Roland Griffiths professor. I'm sure you guys were there or obviously very involved in that

whole thing with the work you do with Roland as well. 

Bill: I celebrate the moment. 

Shiv: So, obviously, you guys did a lot of the pioneering work at Hopkins to lead to the renaissance that we're in. Do you mind taking us back to maybe the formation of Sunstone Therapies and what gets you most excited about the work you all are doing? One note I'll make is I caught up with Manish Agrawal a couple weeks back and I'm very excited about the first-of-its-kind clinical trial you are doing with not just the patients who have terminal cancer diagnoses, but also their caregivers. I think that's a very unique study. So, maybe you can talk a bit about Sunstone's development and then what gets you most excited about it. 

Brian: I think part of what is an original contribution around Sunstone is its location. First of all, in a community cancer center -- we’re on the third floor of the Aquilino Cancer Center, named so because Michael Aquilino helped contribute to the formation of this building -- a place where full person healing can take place. There’s surgery, radiation, chemotherapy, oncology, nutrition, mindfulness classes, and also for those who might be interested in exploring psychedelic medicine, welcome to the third floor and Sunstone therapies right off the elevator. Here you can participate in clinical trials. 

It's a purpose-built space. As we learn about what helps a person have an optimal experience with a psychedelic medicine, it’s about attention to the five senses -- a space that you walk into that's not medical, where everything medical is really behind a wall and people can come in and make themselves an espresso if they wish, sit down, relax, overlook a Zen garden, flowing lines, specialized lighting -- so really all of the senses. People often have a relaxation response, a sense of ease, a feeling of welcome as they come into the space. There's a great deal of research on architectural design, all these elements that go into the space itself. 

Bill: And interpersonal design, the welcoming staff.

Shiv: Yeah. I'll let you continue, Brian, but I'll just say Manish mentioned in his interview, the two values that you guys are guided by at Sunstone are love, which is clearly what you're describing, and rigor too. And that's obviously the research studies you guys are doing. So

I'll let you continue. 

Brian: Yeah. Thank you. And the rigor piece includes therapeutic activity, professional supervision, training, conduct, collegial support of one another, ongoing learning, iterating these studies so that we learn from prior studies, learning from ongoing studies, how we communicate that and really continue to refine as a team the clinical piece and the operational piece. How do we manage efficiencies? How do we really create a system that is relatively seamless, that consistently delivers very good quality of care safely to people who are properly screened? Not only the experience around the medicine, but the preparation, set and setting elements, and also the integration...how they can continue to learn and grow from what could be obliterating epiphanies or whatever the experience is for them, however profound. How can they bring those realizations or insights into their ordinary, everyday life months and years after their participation in the clinical trial? We're really paying attention to these details and learning and growing from them. That's the rigor. 

And both hand in hand, the love -- as I think Manish eloquently conveys -- but not to forget the rigor, because that's what it will also take, really, for us to be able to have other community cancer centers nationwide that are able to take some of what we've learned and be effective and be successful as a clinic. 

Shiv: Yeah, absolutely, that makes a lot of sense. Bill, would you like to add anything to what Brian was saying?

Bill: Yeah, just to pick up on your reference to what we call our dyad study where we have two MDMA-assisted sessions with a cancer patient and a significant other -- maybe a spouse or a close family member or friend -- and they have two sessions: the first at the same time, but with separate therapists in separate rooms; and then in the second session, all four are in the same room. So, it really facilitates communication between the two people coping with cancer, the one whose death appears to be quite imminent, and the one who has to build a life after that death. 

We just had a session yesterday, and it was very, very inspiring...very, very beautiful. Somehow the MDMA makes it easier to talk about difficult topics together. 

Shiv: Yeah. Our listeners may have heard about the Netflix docuseries, How to Change Your Mind, where both Bill and Brian appear, and I think episode two is your own personal experience with your wife, Ilse, Bill who is Brian’s mom. You instruct about the process you all went through, the poignant moment there. Do you mind educating our listeners about some of that and how that's informed your life's purpose or your work with Sunstone? 

Bill: It's a wonderful example, I guess, of how suffering can be constructive and meaningful. Basically, Brian's mother, my wife, Ilse, struggled with cancer for a decade and died when Brian was eleven years old, and clearly, we handled that as well as we could. His mother was a psychiatric nurse who worked with me giving psychedelics to cancer patients. So we thought, Gee, if anyone could handle this, we ought to be able to.” But it was still clearly difficult. Going through that experience of her death, in retrospect, was kind of part of the training for both Brian and me to do what we're doing today. I have no idea where her consciousness may be these days, but I suspect she would be celebrating what we're doing in the world, really continuing her own calling before she died.

Shiv: I'm sure. I'm positive of that. Brian, would you like to add anything as well from your own

experience as a child going through this? 

Brian: Oh, yeah. I think for me as an eleven-year-old -- never having experienced death of any kind -- the death of my mother created a sense of the universe being utterly unfair and capricious, and my own path of kind of feeling like life was very different for me in a really poignant, wrenching way. My own personal process of growth came through therapy, exploration of mysticism, sacred texts, really asking the questions, because for me, existentially -- earlier in my life perhaps than for many -- was a catastrophic loss and trauma. So, really honoring that. 

I mean, just as we think about what helps a psychedelic therapist be an effective psychedelic therapist, do they need to take a psychedelic? And to what extent will that be essential in their training or recommended? I think for any therapist, it's really vital for us to do our own work,

even though it's very hard and at times interminable, so that we can hold the kind of anguish and suffering and absolute disbelief and denial -- all the things people are going through when they have a cancer diagnosis -- and really be able to help them feel understood and be present with them. And so I really think that a lot of that comes from not only our own personal

suffering, but our personal growth in and through that. So, I certainly hope and make an effort to kind of be present with other people, knowing that I share with them -- although I often will never disclose this to them -- some of the similar pain and traumas that they're going through right now in real time. 

I believe that really helps some of the outpatient oncology patients I work with really feel that therapy is helpful, that there's a space where nothing is unspeakable. Often with cancer, people feel like they can't really talk about it with anyone, because then it becomes about that person's fear and they're managing that person's negative associations to what cancer means in their mind, or they really don't feel that other people can fathom how much the life course changes with serious illness, curative or non-curative, with cancer. 

So, I guess I try to learn and grow from all experiences, positive and negative, but without question the loss of my mother when I was eleven was a catalyst -- certainly that I did not want or imagine at the time -- but I think that has helped translate to the present moment, I hope, a level of maturity and spiritual depth that helps the people I'm tasked with being of aid to.

Bill: There's a pre-story that, while we're on the topic might be relevant, and that is that Ilse, Brian's mother, was born in 1936 in Germany, and she experienced the bombing of Dortmund as a seven-year-old child. She was traumatized by it and developed post-traumatic stress disorder. Early in our relationship, whenever she heard a fire engine, she thought it was always an air raid siren and she would tense up and panic. But then she became a psychiatric nurse working with me in psychedelic research with cancer patients, and it happened that one of our cancer patients had been a nineteen-year-old kid dropping bombs on Dortmund. And so here she is a few decades later holding the hand of the man who literally released bombs and caused her trauma as a child. And they're connecting, listening to Bach and Brahms together in a completely different scenario, in a different period of history. 

Shiv: Wow. 

Bill: It's really rather inspiring.

Shiv: It is. Wow, that synchronicity is amazing. The more I've pulled on the threads and spoken to people like yourself -- and we've had Jim Fadiman on, who's obviously been a pioneer in the field for a couple of decades, too -- the more of these stories appear. One other related thing that reminds me of from your book is your good friend Walter Pahnke from the Good Friday Experiment...that section where you were talking about the precognition that he had for his own unfortunate death scuba diving, and seeing beads of light, which potentially is what he saw in his final moments. So, it's remarkable how these things operate, and maybe if there is something beyond, it certainly makes a lot of people spiritual who may be more secular, it seems.

Bill: That's right. People use different words for the spiritual -- some more in harmony with traditional organized religion and some in other frameworks -- but there's something sacred deep within each of us that keeps getting rediscovered. And that's pretty profound.

It suggests that the psychedelics really have relevance not only for medicine, but also for education and religion. We'll take it one step at a time here.

Shiv: (laughs) Yeah, you dedicate an entire chapter to the potential of psychedelics for education. I think Philosophy 599 was the course you mentioned that some may be interested in taking. 

Bill: (laughs) I'd like to experience what Plato is writing about.

Shiv: (laughs) In his cave, exactly. I want to pull on this thread about end-of-life care and hospice, because one of the most influential books I’ve read is Being Mortal by Atul Gawande, which made me, and I'm sure many who read it, think differently about the last couple of years of life whether cancer is involved or not. And obviously, there's the traumatic dealing with death. Most cultures, or at least our culture, doesn't really talk about it. It's stigmatized, which is why the work you guys are doing is very interesting and important. But also, it leads to a lot of financial costs. I think the stat is 20% of healthcare costs go to the last five years of care, because people don't necessarily accept their inevitable mortality. That's one reason. Ancient philosophies like Stoicism are making a comeback, saying “memento mori”...meditating on your death, premeditation. 

I'm just curious, in your hopes and dreams, if you look towards the next ten years -- obviously you're pioneering the work with end-of-life care for cancer patients -- but do you see this as something that maybe could be much more widespread? And what are the steps to get there for most people experiencing ego dissolution or dying before they actually die?

Bill: In my most idealistic moments, I join others in fantasizing that maybe the whole way our culture approaches death could evolve, just as it has with sex. If you go back a few decades, hardly anyone ever talked about sex. There were lots of problems with anxiety, depression and inability to function that psychiatrists were dealing with. Now, sex is kind of out in the open, and it's pretty accepted and respected and valued.

Maybe the same thing could happen to death. Instead of thinking it's something that sometimes happens to other people, we could say, “Hey, it's part of life. Everyone who's ever born has died.” There's a good chance each of us is going to die someday, so let's look it straight in the eye. 

Shiv: (laughs) 

Bill: One of the amazing things we experience with our volunteers here who receive psychedelic therapy is that those who have these transcendental experiences typically claim to have lost the fear of death, and they live as fully as they can each day. They're thankful for each day they have, and they don't become suicidal. They just live more fully, and it's really beautiful to see.

Often, there's change in perception of pain. If pain is there, they may say, “Well, the pain is still there, but it doesn't bother me like it did before.” There’s less depression, less anxiety. I mean, they don't become saints. They still get angry now and then, you know, but they're relating to people instead of withdrawing from the world. 

The syndrome that so many cancer patients experience is, “I don't want anyone to see me like this” and so they kind of hide in the bedroom waiting for the next dose of pain medication, and they miss a lot of living. I suspect that when you're not depressed, you also care better for yourself, and maybe your immune system functions better, and you enjoy your relationships. Wouldn't it be great if that became more normative in our society? Think of all the

mental health problems that are caused by constipated, unresolved grief, words of forgiveness that were never spoken that get manifested in symptoms of depression and anxiety and tense muscles. Boy, you know, if a family and group of friends can be open about talking to someone who's getting close to death, and some of those old hurts can be resolved, that has profound mental health implications for the survivors. 

Shiv: Yeah, that's absolutely right. That's a very astute observation and something I know I've heard from people who've experienced the therapies you guys are doing. Another theme we pull on on Raise the Line is artificial intelligence and large language models. A topic I've been very excited about is being able to capture text, videos, pictures and other kinds of conversations. I talked to Manish about privately recording those sessions that your patients are going through with their loved ones and seeing if that could potentially be a way for them to hold on to those memories or even consult, say, a large language model that was fine-tuned with someone's last words about their lives, et cetera. 

Brian: Well, a big question. I wish I had a more erudite response to it. I I'm still learning about what the implications and real-world possibilities might be with artificial intelligence...what those technologies and models might actually look like and how they might be helpful therapeutically. I really have no idea, currently. I think we will all, in different ways, live into these technologies as they're further advanced. But I really don't know what that would

look like currently. 

Shiv: Yeah, it's obviously anyone's best guess. It's a thread I'll pull on at some point more with you and Manish and others because I think it's a fascinating topic. How does AI integrate with psychedelic-assisted therapy? For example, I know people are already using it to create visuals of the things people have experienced. If you describe what you've seen, potentially, one of these image generators can help bring that to life. Maybe you can convey it better to those around you. But anyways, that's another topic. We could spend hours talking about just that one.

I want to switch to healthcare professionals, because you both are caregivers, providers. Our audience are medical, nursing, PA, pharmacy, psychology students all around the world. Many of them are interested in this field and the implications it has. What's involved in the

training to become somebody who can provide psychedelic-assisted therapy? And then what advice would you give them both about pursuing a career in this field, but also just in general? So, a two-part question, and I'd love to hear from both of you.

Bill: We're happy to explore that. And very frankly, we're going to need an awful lot of psychedelic therapists if just the palliative care application of psilocybin therapy starts to spread into oncology centers throughout the country and the world, not to mention treatment of addictions and treatment of depression and so on. There's no way we're going to require seven years of psychoanalysis for each of them. It's just not going to work. I'm not even sure that would be a good idea. So, we're asking ourselves all the time, “What is the most crucial knowledge to have?” And where I am right now is, first just having almost the instincts of a counselor, therapist, psychologist, psychiatrist, social worker, pastoral counselor...you name it. Actually, one source of therapists in the future in this work in oncology may well be chaplains and pastoral counselors. How can we make use of these people who have some counseling skills, some ability to rapidly establish a deep sense of trust with another human being, someone who really likes other people, someone who really values diversity, where it's an honor to be beside another person at a critical juncture in life? You're not coming in as the expert to fix the person, but you're in the world with the person, sensitively, openly, genuinely. 

So, we could take those people, and then we give them some additional education about psychedelics. Actually, we're developing one set of training tapes here of videos and dialogue with a coach and so on to help speed that up. How to prepare a person and establish a deep rapport in a very brief period of time, how to guide and be present during the action of psilocybin or MDMA, and how to help the person integrate and apply the insights that occur in the drug assistance session afterwards. 

There's so much more involved than just throwing the drug in your mouth and having an experience. The drug kind of gives an opportunity, opens a door, if you will. But what you do with that opportunity depends on how safe you feel, what your motivation is, how courageous you are. If there's something frightening that emerges, it's critical that the person go towards it. Like, what's this all about? What's going on in my mind? I want to know. Maybe it's unresolved grief from years ago that you’ve got to tumble through, or guilt, or whatever. The problem may be from childhood, but if it comes to you, you meet it, you dive into it. You don't fight for control and run away from it. Because if you do, you're going to have a panic reaction and maybe get paranoid. What are you running away from? Something within yourself that's seeking resolution, is the way we see it. 

So, in psychedelic therapy, we trust -- I’ll use a philosophical term here -- entelechy, the meaningful unfolding of content from within the person's mind. Whatever emerges, we embrace, we welcome, we work with it. Whether it's initially beautiful, or ugly, or boring, or exciting, or transcendental, or mundane, it doesn't matter. We're just with the person as the session unfolds, and we view that as a healing process. So, what the psychedelic therapist does is support, welcome, facilitate this healing process that emerges in people's minds when they've taken a psychedelic. 

Shiv: That's a beautiful description, and I think aligns well with kind of where maybe the whole field of healthcare or medicine is going. Where we're trying to select for people who are naturally very good at the so-called soft skills of medicine, providing someone their undivided attention, empathy, compassion, making them feel supported fully. That's obviously very important, as Brian was mentioning, in the sessions you guys do.

Brian, what would you like to add to the training process, having actually trained so many people as well at CIIS, and Hopkins, et cetera.

Brian: Yeah, thanks. I also try to imagine, like, through the eyes of the study volunteer, what that person needs, would find most helpful. We're asking them to choose to trust -- which may not be easy at all -- to be supine, lying on a bed, eyeshades on, and to focus on the present moment, breathe, and welcome whatever arises in the mind, even if it's beyond comprehension. It could be utterly terrifying, unwanted, inchoate, and an experience that may go beyond name and form, meaning a very profound meditative state, they're no longer physically identified with their body. They could be in another part of another universe, having an experience beyond any language. Moving into that kind of space requires not needing to be vigilant to anything outside of the self. 

So then, as a therapist, what is my presence in that moment over an eight-hour day attuned to that person? And how do I also train others around that skill set? How do we self-regulate as therapists so we really are attuned and present, well-rested, compassionate, but also we've already agreed to the boundaries of any touch. Meaning, there may be, you know, checking in, touching on the person's shoulder. If they don't want any contact, thumbs up, thumbs down. We can bring them anything they need such as water or helping them ambulate to the bathroom and back. Importantly, if they're bolt upright and it's really overwhelming, we want them to go back into their own mind and put the eyeshades back on and encounter and express

whatever is coming up for them. 

We have this self-concept and the story that we're identified with of who we are in the world, our individuality relative to other people. When that completely disintegrates, it's really important that the therapist be helpful, present, supportive, non-judgmental, safe. That safety piece is really absolutely vital for the person to be able to continue their experience in a meaningful way so that the therapist doesn't inadvertently or unintentionally impede the quality or depth of the experience. 

So then for the therapist, what does he or she need so that they trust the medicine, to not feel a need to do something performative, to not attempt to interpret or guide the person preemptively. And as we think about the value of not only the very meaningful, profound experiences, but also really into our own darkness, our own monstrous aspects, our own deep regrets, our own things we've said and done that we wish we'd never said and done for every human being, moral injury for combat veterans, into that space as well. And the therapist to be compassionate and helpful and supportive.

I will say that I find it very meaningful to help as a clinician with psychedelic medicine, but it also teaches me a great deal about the mystery of life, the human condition, and its near infinite iterations and expressions. It's also important for the therapist to go through their own ontological shock and reflection when a person has an experience beyond our cultural model, our understanding. Sometimes it's so profound that I need to kind of process with some of my colleagues, what does that even mean? I don't understand, nor will I perhaps ever understand fully, but I appreciate that for this person, they had an experience that was potentially very meaningful. How does any therapist support the kind of extraordinary, uniquely individual path of a person's life? They've had this experience with a psychedelic and what can they take from it that is inspirational to them living their lives more fully, that helps them be connected with life, with nature, with other people, honor a sense of meaning and purpose, and what do they want to create or embody in their lives? That's really important. 

So the quote-unquote integration part of what we're learning is the neuroplastic window may be forty-eight hours, two weeks -- we're still figuring all that out -- but how do we help the person really within themselves develop a value of taking these insights and bringing them into their lives and their relationships with other people? That's the larger piece that I hope psychedelic medicine might help ignite or be an inspiration to, and then the therapist's role is to also support that.

Bill: You know, I always like to stress for listeners who may not be familiar with psychedelics and psychedelic research that there's no such thing as the psychedelic experience, but that there are many strata, many varieties of alternative states of consciousness. Some may be very mild and kind of meaningless -- pretty colors, geometric patterns, and maybe a little panicked now and then -- but then others can have very vivid scenes of reliving earlier life events and working through dynamics of childhood. Some can be visionary in religious or non-religious context of imagery of other civilizations and who knows what. Where does that come from? Some people think it's encoded in our DNA somewhere, but they're incredibly vivid, fascinating experiences. And then there are these experiences we call mystical, of a kind of a unitive consciousness, of a sense of love as an indestructible creative force in the universe and so on, that feels more real than our everyday sense of reality. 

Could be a big delusion, but it sure is convincing when you're there, you know? And it seems to be very therapeutic for a lot of people when they tap into that dimension. It's the realm that religions call revelation, really. The people who benefit most dramatically are typically those who have a glimpse of kind of an eternal dimension of the mind.

Shiv: That's profound. That's incredible in terms of the description of you guys having experienced it and sat through so many sessions with people. I did want to pull on that. I'm glad Brian mentioned moral injury for combat veterans. That's where some of the most successful clinical trials have been with for PTSD. The MAP studies in phase three clinical trials showing two-thirds of patients with severe PTSD are symptom-free within a couple of months of the treatment with good integration, etc. Very promising. 

Moral injury is also a term used to describe what's happened in our healthcare workforce. One of our core themes about raising the line is it's one thing to train more healthcare professionals -- which is obviously what Osmosis has been focused on for the last decade -- but it's like filling a leaky bucket when you have all these clinicians who, because of administrative burden, because of the trauma they experienced through COVID, because of all sorts of reasons that they decide to leave the workforce. It's too much. I'm just curious, having sat with hundreds of

people, can you comment at all about maybe the implications of this therapy for the practitioners themselves, the caregivers themselves, healthcare professionals, and whether maybe there could be other studies or are there just anecdotes you guys can describe about whether there's promise for psychedelic-assisted therapy to help reduce moral injury or burnout among the healthcare workforce? 

Brian: Wonderful question. I think maybe I could just speak as an N of 1 subjectively as just one healthcare professional. It's really helped me to have some very profound experiences -- some with psychedelic medicine, some with other approaches such as sensory overload, deprivation, etc -- but ways of moving beyond the ordinary normative state of consciousness and the kind of recurring self-referential pattern in my mind, my fears, my insecurities, the things I need to do, repeat, repeat, repeat tens of thousands of times a day...spaces where I move outside of that, and that's inclusive of the individual narrative but also invites in all these other perspectives. 

When I think of suffering and the stories I've heard, the people I've worked with whose cancer has worsened, who have died, and other people who I've provided care to at different points in time where I wish I'd said or done something different, advocated for them... I wouldn't say that I carry within myself a strong sense of moral injury, at least in the present moment, but I can really appreciate burnout and being so overloaded, just exhausted clinically and having ten-hour days ahead through the rest of the week. How do we find a way to hold all the suffering and be helpful and presence-centered and effective in our work, whatever the discipline might be? 

I think that it is possible for psychedelics to help healthcare professionals not only have these experiences of self-transcendence, but also to bring into their work, their everyday ordinary

work, a more expansive sense of appreciation of the human condition and its joys and its suffering, but with a greater care and attention where it is no longer burdensome and overwhelming. There's a way of kind of potentially reframing how we look at the experience of life -- and not dispassionately, not purely objectively -- but it carries with it, as Manish spoke to, love and rigor. Again, we bring our deep care for our patients, but then are not as overwhelmed by their suffering. We can appreciate it as part of the nature of life itself, accept it, try to be of aid, but also not be so inundated by it that we burn out or we underperform or we start making major, major errors in the conduct of our work. 

And so I think that there is a space for psychedelics to be very helpful, potentially, to different healthcare professionals, to, in a sense, reconnect with these deeper perspectives...remember, re-embody a sense of openness and care for their patients. I think that's also needed because the demands of healthcare are continuing to grow. I would love to help create a protocol or a process, even at Sunstone Therapies, where healthcare professionals could come in and we could really be genuinely helpful to them and confident in our ability to be of aid to them, to rebalance what's going on and then continue to be helpful and not take a path of increasing use of alcohol, other drugs, underperforming, getting that whole cascade that for some people they feel they're fated to, or that is somehow inevitable. That's not true. But we also need to have pathways people can take that are efficient, accessible, reasonable, and genuinely help them. I would love to do groups of healthcare professionals here at Sunstone and really help people in that way.

Bill: One of the insights that often occur with these transcendental experiences is described in different ways, but it's basically a feeling of the interconnectedness of us all. Hinduism calls it the Jeweled Net of Indra...that somehow within us, we are all part of something bigger

than any of us individually. And so it's not that you're the sick one and I'm the healthy one, you know? We're in this together. You are my brother or my sister. And the implications of that for your own well-being and the effectiveness of your work can be quite immense.

Shiv: Absolutely. Thanks for both of those responses. I think there's a lot of promise here for many different groups. We've talked about combat veterans. Sexual assault survivors is another group that's been studied. There’s cancer patients. We talked about really anybody who's going to die, which is everybody, and then healthcare professionals. Hopefully, as Sunstone grows and more psychedelic therapy centers pop up, there will be a focus area around healthcare professionals, too. It could just be economically a good thing for hospitals to do because they spend so much money trying to recruit and retain nurses and doctors that it would make sense to use a viable protocol to help retain them and provide them more meaning. That could be very helpful for really any workforce issues. 

I know we're coming up on an hour, so I just have two other questions for you. The first is, you both obviously have known each other all your life, at least in Brian's case. What is it like working together as father and son? Are there any kind of anecdotes you can share about, you know, times you've been extremely proud to be able to work together and sit for patients together? Or maybe sometimes you disagree that maybe that led to some breakthrough

discussions after that?

Bill: We're genuine colleagues and we happen to be related. Sometimes we're at conferences and we both speak and a lot of people don't realize that we're from the same family. They think it's just a coincidence that we happen to have the same last name. But it's a joy. It's a privilege. We do disagree now and then, but not much. 

Shiv: Brian, do you agree with that?

Brian: I really try to remember to appreciate the present moment. We agree, we disagree, we're father and son -- whoever listens to their parents -- that whole dynamic, but also to really recognize this is kind of remarkable in some ways that there's a father-son duet working in psychedelic medicine. We are learning from one another. I'm honored to be contributing to the field in this way, learning from my father, and I know this will not be forever. This will come and go. So, it’s about really valuing what we're doing right now and having a sense of its significance, and maybe having a sense of urgency to really doing things well so we really are helpful. 

I was reading Brian Muraresku’s book, which is absolutely remarkable. There's good archaeological evidence that in ancient Greece, the Eleusinian mysteries probably included a potent psychoactive admixture of lysergic acid amide and a ritual around it that continued for 2000 years. And so we may have forgotten, and perhaps we're remembering, the potential of psychedelics just as a part of the culture, and a meaningful optional pathway people can take if they wish at any point in their lives.

I think there's an eloquence to that...that maybe our culture is remembering this, and how can Bill, myself, and others keep it safe so people can go to a medical center -- Sunstone, or another -- and be confident that they'll be cared for, that they'll have potentially a beneficial outcome,

that this medicine with this therapy envelope will be helpful to them. The hope is that just becomes an option with a $20 copay and maybe a doctor's order or recommendation of where to go from their therapist. It’s part of the person's personal growth and healing, and it's entirely normative to the culture. 

Bill: I often think that psychedelics have been around for a long, long time -- perhaps since the dawn of man, certainly a few thousand years -- and they emerge in cultures and sometimes they stay around for several generations, and then they get suppressed. Kind of like mushrooms: they appear and disappear, appear and disappear. Right now, in the early 21st century, they're emerging in Western culture. I would like to think that we are sufficiently evolved to safely and wisely integrate them into our culture. 

So yeah, Medicare covers them. If you need psychedelic therapy, why not? Maybe there can be spiritual retreat centers for those who want them, where you can go and receive a psychedelic with maximal safety and support, as in ancient Greece. It's a non-addictive substance that when it's used wisely, it's very helpful to many people. What are we afraid of? Self-knowledge? Resolving our neuroses? Maybe we've got some collective guilt we have to deal with, so maybe we should get around to looking at that, you know? But I'm hopeful that we can genuinely, responsibly, and wisely integrate them into our culture in the next few years.

Shiv: Yeah. Again, in your wonderful book, Sacred Knowledge, you talk about the comparisons to alcohol and other substances and how we've been able to integrate them. Psychedelics have, in many evidence-based papers, shown less risk. We had Dr. Fred Barrett on the show who talked about LSD being actually part of a measurement for non-addictive substances. So, there's a lot of promise there. And I love the context you're providing over the centuries. The book that Brian's referring to, for those who haven't read it, is The Immortality Key. It's very good at talking about how religions were potentially even birthed because of psychedelics or in part with psychedelic experiences being behind them. 

My last question for you both, and this again is in two-parts, is just what advice would you give to our audience about approaching their careers in healthcare, and then any other things you want to share about yourself, about psychedelics, about Sunstone, or anything else? 

Brian: I would say I remember being originally inspired by Joseph Campbell's idea to follow your bliss. But also work really hard, be willing to do things that you don't want to do, that are burdensome, inconvenient, challenging, etc. But the idea of meaning and purpose...that's been useful for me when we think longitudinally about the life course. For human beings who do ask the questions, who do seek meaning and purpose, have the ethos of learning from experiences of failure and throughout the course, seek meaning and purpose -- whatever that may be for them -- they live longer, they're psychologically, medically healthier. 

So, there's something about the human experience and opportunity where if we do personally and individually go a little deeper, that will reward us, life will be more meaningful, we will be more vibrantly alive, helpful, inspirational to others. At the point of death, looking back, we will likely feel that we lived a full life. So, how can I live in that way myself and be helpful to people to cultivate those ideas? I guess I would say to healthcare professionals really explore, really challenge yourself and learn. If psychedelic medicine resonates, find pathways to safely, legally, take these medicines, learn from them. 

If you're a healthy person living a full life that is often helpful to others in whatever discipline you may work from -- as a physician, as a nurse, as a pastoral counselor, psychologist, etc -- being healthy, living a wholehearted full life, in and of itself is part of being helpful to others. And so how people create that for themselves, I guess that may be one of the focal questions, but to invite people to really take that on, because life really will come and go, and we don't know when. So the more we're mindful, focus attention on the present moment, live life fully and meaningfully, that's very helpful to do, however challenging it may be at times. 

Bill: Yeah, I don't know what I can add to that, Brian. That's great. For those of you early or even late in your careers, if you're really interested in this frontier, just know that we need you. If this is really going to take off, we need many well-trained psychedelic therapists and it's worth checking out if you're not familiar with it.

Shiv: On that very positive note, I really want to thank you both, Bill and Brian, for taking the time to be with us on Raise the Line, but more importantly, for the work that you've done over the last several decades to literally birth this field and bring it to where it is right now. So, thank you both again for raising the line. 

Bill: Well, thank you, Shiv. 

Brian: Yeah, thanks for all the work you're doing as well, Shiv. Really honor your contribution to the field. 

Shiv: Thank you. And with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to raise the line and strengthen the healthcare system. We're all in this together. Take care.