Out Of The Mental Illness Box

Anne Strainchamps (00:00):

It's To the Best of our Knowledge. I'm Anne Strainchamps, and it's story time.

Eliza Smith (00:12):

So I'm about six years old. And I really want to tell a story. I have a story in my head.

Anne Strainchamps (00:23):

This is Eliza Smith, and here's a story she told her mother.

Eliza Smith (00:31):

So it's this group of people at this manor house in the middle of the English countryside. And it's totally dark at night. It's storming. They're having a great time. The fire's roaring, they're warm, they're cozy. And someone knocks at the door and interrupts their conversation and their laughter, and everything gets really quiet because who could be coming to the door at this time of night?

Eliza Smith (01:12):

The host goes to the door, and he opens it. And there's no one on the porch. The drive is totally empty. There's no carriage there. There's nothing. And he's about to shut the door. And he looks down at the ground, and at his feet, there's this small drawstring bag. And it's velvety purple with gold drawstrings, and he picks it up and he opens it. And inside, the bag is totally dark. And it's not just dark. It's like he's looking into a hole in the ground that goes on forever. It's like he's been locked inside of a bunker and there's no light, and he can't see his hand in front of his face. It's a darkness that has infinite depth.

Eliza Smith (02:29):

And as he's staring into this bag, two eyes appear, glowing in the darkness and then a set of glowing sharp teeth also appears in this bag. And that's where the story ends.

Anne Strainchamps (02:55):

That's where it ends?

Eliza Smith (02:56):

That's where it ends. As a kid, I didn't really know how to figure out, okay, rising tension, climax of the story, we need for it to end. But I remember my mom looking at me like, "Hey, this is a cool scene." And she said, "Let's call it The Pouch." And so we called it The Pouch together.

Anne Strainchamps (03:19):

Okay. The Pouch was Eliza Smith's first horror story, but definitely not the last. She's a big fan of slow footsteps, creaky doors, and curdling screams. It's hard to find a scary book she hasn't read or movie she hasn't watched. She even produces a public radio podcast called Spooked. So you might say horror consumes her life. Eliza would say horror saves it. And a word of caution, some content in this interview may be difficult for some listeners who struggle with mental illness.

Eliza Smith (03:56):

I just felt this insatiable need for fear. And it didn't really start making sense to me until I started having symptoms of anxiety after a really big trauma happened in my life when I was 16, something clicked into place. And it felt like I had created a therapeutic device for myself. Something a therapist of mine once said, "You're adding tools to your toolkit to help you when you have a panic attack." It was almost like I'd been stockpiling all of these tools so that when it happened, I'd be ready to face it, and I'd have the tools to face it.

Anne Strainchamps (04:42):

Wow. Okay. I want to roll back just a little bit, because first of all, that's hard for me to understand. But yeah, let's go back. When was your first serious mental health episode?

Eliza Smith (04:58):

So I know I had a panic attack or a handful of panic attacks in high school, but my first really bad one, episode, I was in my sophomore year of university and I stopped sleeping. I couldn't get to sleep. I'd hit the pillow, and my mind would just go 1000 miles per hour. And then I started having what... I didn't understand what they were, but every day I would feel like there was fire coursing through my veins all the time, and my heart was going a million miles a minute. And I felt like I was constantly in a cold sweat, and I was terrified all the time.

Anne Strainchamps (05:47):

So what does your fear feel like for you? And are there patterns to when and how it hits?

Eliza Smith (05:56):

A panic attack usually starts with a thought for me. My breath starts to speed up. Then over the last few, I'd say in the last 10 years, I've started having what are called dissociative episodes. And so, if my anxiety gets to a really bad place and I can't catch it and I can't go to the gym, for example, or do a meditation or pet my cat or hold my husband's hand, I will go into a dissociative state, which means that all of a sudden, I don't know where I am. I don't know who I am. I don't know who's in the room with me. And I don't know if I'll ever be okay again. It's like you're at the end of a long hallway, a really, really, really, really, really dark hallway. And you're on one end and you can see reality on the other end. It's like a little pinprick of light, but there's this huge space of, of darkness in between you and reality.

Anne Strainchamps (07:01):

Thinking back to that story you wrote as a six-year-old, the pouch filled with endless darkness and the monster in there. Do you think that's your illness?

Eliza Smith (07:14):

Yeah, I do. And I think that when I was a kid, I didn't know what it was, but I do remember as a child having days where... I remember one day where I started crying, and I couldn't stop. And I remember as a kid just having these extreme swells of emotion and not being able to really handle them, and my parents not necessarily knowing what to do with them. And they only got worse as I got older. And so, yeah, I think my little brain was able to intuit somehow what was going to come.

Anne Strainchamps (07:52):

So one of the items in that toolkit you've developed is horror movies, which just see totally counterintuitive. Tell me how horror movies help? You actually watch them when you're having a panic attack?

Eliza Smith (08:08):

Yes. 100%. So whenever I'm having a dissociative episode, one of the first things that... Jacob is my husband. One of the first things that Jacob will do is say, "Okay, let's turn on the TV." We have this voice activated thing on our remote. And he says, "Show me free horror movies," and we'll pick one, and then we'll just put it on and I'll watch. And then, basically what happens is I'll watch a horror movie and I'll be afraid. I do get really scared of horror movies, and that's really important.

Anne Strainchamps (08:41):

Why is that important?

Eliza Smith (08:43):

Because the horror movie helps me simulate the fear that I'm feeling during my panic attack in a controlled environment. And the controlled environment is completely make believe. The controlled environment is the plot of the movie and the supernatural entity that's attacking everybody. I only watch horror movies when I'm freaking out. I'll only watch horror movies that have a supernatural element, so that it feels even more controlled because then it can't possibly be real. So basically, I go through and I experience these extreme swells of emotion while I'm watching the movie, and they match the feelings of anxiety that I'm having.

Anne Strainchamps (09:31):

And why does that help?

Eliza Smith (09:33):

Because it's cathartic. One of the things that I've learned from my therapist is that anxiety is basically a blanket that you throw over an emotion that you don't want to have. And so generally, if I start to have a panic attack, it's because there's an emotion that my body is protecting me from. So I'll have a panic attack that will give me a huge distraction or the numbness that I need, to take me away from feeling the actual emotion. Let's say it's sadness.

Eliza Smith (10:03):

But my therapist has always told me that the most important thing you can do is to feel a feeling instead of feel the anxiety, and really very, very, very, very intensely. So if I watch a horror film, I'm able to feel those feelings, like fear, which is the pure anxiety. Once I feel the pure anxiety and I'm okay with it, then I can start to feel whatever emotion is underneath. And because I'm doing it in the context of a film, it feels a lot more manageable. It's this space where I can feel the fear and keep going.

Anne Strainchamps (10:42):

I have so many reactions to that. So partly, it reminds me of desensitization therapy for people with phobias. Partly I'm thinking, "Wow, it's like you're taking your own fear and displacing it and putting it in the movie world. It's not in you anymore. It's out there in the movie world." And then partly, I'm just really struck by... It's like instead of running away from something, you run straight into it and make it bigger. I don't know. Almost like an immune response.

Eliza Smith (11:21):

Yeah. When I was a kid, my mom's preferred method of treating us was with homeopathic remedies. And the whole thing with homeopathic remedies is that you treat one symptom with something that actually causes that symptom. The theory is called like cures like. So if you have a headache, you take a drug that actually will give you a headache. And so your body will have an immune response and cure itself.

Eliza Smith (11:46):

And so, I think of that with horror, that if I want to treat a horrible panic attack, I want to induce as much terror in my body as possible because the two, they cancel each other out through a process of catharsis.

Anne Strainchamps (12:03):

Wow. Can you give me an example? Walk me through, was there a recent episode, and what was the film you saw? And then what was the process as the film went along?

Eliza Smith (12:16):

Recently, we went down to Los Angeles to do some work and to see family. And I always get a little anxious around big family trips. I think everybody does. Even though I have a really great, awesome relationship with my dad and my stepmom, it was just going to be a really busy weekend, and I could feel my anxiety start to creep up.

Eliza Smith (12:37):

So on our first night, we decided that instead of staying home, we would go out and we would see It Chapter Two. And what I love about the current It franchise is that it's a roller coaster ride through every disgusting image you could ever possibly want, all rolled into one. It's not super scary, but it's really fast paced, and it's really, really gross. And it's really, really visceral.

Eliza Smith (13:07):

So we went to the ArcLight in Culver City, and we were just sitting there, front row, having so much fun. It was like you went up the lift hill and then it dropped you, and we were going through. And by the end of it, I was able to say, "Hey, I feel so much better. I'm totally ready to tackle this week. Let's do it." It was like going to a yoga class, but 10 times better because I had this endorphin high afterwards.

Anne Strainchamps (13:35):

Wow.

Eliza Smith (13:36):

Yeah. I just like things that make my heart race because my heart's always racing.

Anne Strainchamps (13:52):

Eliza Smith is the lead producer of the podcast Spooked, true life, supernatural stories presented by Snap Judgment. And this brings us to today's theme, which no, is not horror. It's unconventional ways to treat mental illness. Not instead of medication, therapy, or whatever your doctor prescribes, but in addition. Extra tools for your psychological toolkit. Maybe it's horror movies, could be psilocybin, or a prescription for 30 pushups. It's going to get interesting. Don't go away. I'm Anne Strainchamps. It's To the Best of our Knowledge from Wisconsin Public Radio and PRX.

Anne Strainchamps (14:44):

We've known for years that exercise is important for mental health for so many reasons. It makes endorphins, increases blood supply to the brain, creates new neurons. Study after study shows that regular exercise can be as effective as medication for depression, anxiety, and other mood disorders. But question is, what kind of exercise?

Anne Strainchamps (15:07):

Well, Claudia Reardon is a medical school professor and sports psychiatrist at the University of Wisconsin, Madison. She prescribes exercise, very specific exercises, for different mental health conditions. Our producer, Charles Monroe-Kane, is bipolar and very intrigued.

Charles Monroe-Kane (15:25):

Not all exercise is the same, of course. You have somebody lifting weights who wants to be a bodybuilder. You have someone training for a marathon. These are very different body types, and they do very, very different exercises. Is there a difference in the mind when it comes to what kind of exercise you do? Especially the big short bursts versus long... and there's lots of minutia.

Claudia Reardon (15:43):

Fascinating question. So the research really has looked at this as what are the kinds, types, durations of exercise most beneficial for depression, and how about for anxiety? And there do seem to be important differences. For example, depression seems to benefit from merely five minutes of exercise.

Charles Monroe-Kane (16:02):

Really?

Claudia Reardon (16:02):

Go outside, go for a brisk five minute walk, depressive symptoms will lower. On the other hand, anxiety-

Charles Monroe-Kane (16:09):

Can I interrupt for a second? Because I want to actually understand this. There are people out there who get depressed because it's the middle of the winter or something happen in their relationship. There are also people who are clinically depressed. Is that the same, even if you're clinically depressed?

Claudia Reardon (16:22):

Yes, yes. That there will be at least temporary mood elevating effects benefits on depression, if you get five minutes of exercise. Now, the optimal dose is seemingly more than five minutes, but even just a five minute session is worth something when it comes to depression. As compared to anxiety, which for a lot of people and according to the preliminary research on this topic, seems to require longer bouts. So 45 minutes of high intensity, that aerobic, heart rate elevating exercise seems most beneficial for anxiety.

Charles Monroe-Kane (16:58):

Okay. So I'm bipolar, and I go to a gym, and at my gym I do basically weightlifting strength stuff. I also ride my bike to work, so I only bike three or four miles. Because in my world, I'm surrounded by people who are bipolar. I know a lot of people with bipolar. What's the best exercise for us?

Claudia Reardon (17:13):

There has been some research on this. Some folks have written about this, and bipolar is really an interesting condition when it comes to impact of exercise. So we know if you are in, for example, a bipolar manic state, you are going to have increased activity levels in a number of different ways. Maybe that means that you're up all night, cleaning your house. Maybe it means you're writing a 5000 page book. Maybe, and in the cases of a handful of athletes that I've taken care of who have bipolar, it means you're actually not doing your normal two hours of exercise a day, but in fact, you're up running around campus an extra 25 miles a day, hours and hours and hours of extra exercise a day because of all that extra energy that you have.

Claudia Reardon (18:00):

So the question becomes, what do you do? What should you do about exercise [crosstalk 00:18:05].

Charles Monroe-Kane (18:04):

Yeah, what do you do with that?

Claudia Reardon (18:04):

When you are bipolar, you don't necessarily want to be doing something that's going to fuel that mania, that's going to be just lighter fluid on that fire of mania. What you're aiming for ultimately is a good, stable mood, neither depressed nor manic, fully functional. And so, what people have hypothesized about this and what seems to likely be the case is that rhythmic, calming ritualistic exercise seems perhaps most helpful for bipolar disorders.

Charles Monroe-Kane (18:37):

It's funny you said that. I've been thinking about this interview. And so, I was at the gym this morning, and I was thinking that the feeling you get, the rush from the hardcore endorphin rush from the really intense box jumps and then whatever. I'm like, "Oh, this does mimic a manic phase. It does mimic rapid cycling." I never thought about it until I thought about you [crosstalk 00:18:58]

Claudia Reardon (18:57):

It's a really insightful observation you have. So people have studied populations of bipolar patients and found that those who engage in risky, risk taking, extreme sports are more likely, if they have bipolar, to spend more time manic. So things [crosstalk 00:19:15] like rock climbing, extreme mountain biking, those kinds of things. Seemingly, the idea being that that is just perpetuating that feel good state.

Charles Monroe-Kane (19:25):

Do you see yourself... you're a doctor, you give someone say lithium for this, for their bipolar, they're depressed, and they take Zoloft, whatever. Do you also see yourself as saying, here's the medicine you should take that's for your body. If you're feeling this way, you should take 18 pills of pushups or... Is this a dose for you? A medicine?

Claudia Reardon (19:43):

Absolutely. So a patient is going to take your exercise recommendations, in my experience, far more seriously if you give it the time, attention, and detail, just as you do to the medication. That means talking about the dose, that means getting out an actual, literal prescription pad. I had one patient frame the exercise prescription that I gave her and hang it on the wall. It really conveys the sense that this is real. This is just as important as the Zoloft you're giving to me.

Charles Monroe-Kane (20:11):

I have been hospitalized many times in my life, unfortunately. I have been to countless group therapy sessions I go to now every week. I've seen probably 100 different therapists. I've seen multiple psychiatrists over my time, different many, many, many, many meds. I think I've lost track of all the meds that I've had over my time. Why am hearing about this for the first time right now?

Claudia Reardon (20:35):

Well, so I think that doctors don't get trained in this, in how to actually talk to our patients about exercise. I think for a long time, there has been a dearth of research on the topic, and that's for a number of reasons. What kinds of sexy research gets lots of grant dollars to do it? Typically, it's the new groundbreaking drug. And I think that doctors do get this sense of learned helplessness after talking to countless patients with exercise recommendations, and it's seemingly not sticking. So it's a sense of, well, they're not going to me anyways. But the problem is that if they actually, the doctors gave the time and attention to the exercise discussion just as they do to the discussion of the medication prescription, perhaps they'd find that their patients are able to do this.

Charles Monroe-Kane (21:20):

You seem like you're talking about balance. People don't talk about balance with me a lot. Diet, exercise, medication, therapy. It seems like that doesn't happen. I think most people are just given medication and then you're done.

Claudia Reardon (21:32):

Right. No. And I think exercise can involve balance and fine titrations of dosing. Now again, we don't have a lot of research to show exactly what that looks like, but you hit on something important, and that is if someone with bipolar disorder is getting more and more depressed, at that time, do we ramp up the amount of exercise? Do you fold in a different kind of exercise [crosstalk 00:21:53].

Charles Monroe-Kane (21:53):

Yes. Right, right. Exactly.

Claudia Reardon (21:54):

That might be more stimulating, more endorphin generating.

Charles Monroe-Kane (21:57):

I take four medications, one on demand. Why not have four different exercise regimens that I can do?

Claudia Reardon (22:04):

Medications, yes, a part of the treatment for a number of people. But we do need to think about non-medication treatment interventions. Exercise is a hugely powerful, life-changing activity that you can do to pretty quickly turn around your physical and mental health. It's not an easy habit to start for those people who grew up not seeing their family members exercise, who grew up where that wasn't regarded positively, and it was maybe just a selfish thing or no role models to suggest that was the thing to do. It is really hard as an adult to say, "Now, I've never exercised in my whole life. No one I looked up to ever did. And I'm just going to start to exercise."

Claudia Reardon (22:45):

No. So, you start gradually, and my typical starting dose for exercise is walking 10 minutes, three times a week. There's nuance, depending on what the person wants. But on average, that is a typical starting dose and regimen for exercise and go from there. And you get people to get some confidence and some early wins, and it can really turn things around.

Anne Strainchamps (23:14):

Claudia Reardon is a professor at the University of Wisconsin, Madison Medical School. She's also a sports psychiatrist for Badger Athletics. Charles Monroe-Kane talked with her.

Anne Strainchamps (23:31):

This hour, we're talking about alternative ways to treat mental illness. And these are by no means meant to replace existing therapy or medication. We just wanted to take a look at some unconventional methods people are exploring to cope with their own mental illness.

Anne Strainchamps (23:47):

One of the most promising and radical new treatments for mental illness is psychedelic therapy using hallucinogens to treat depression, addiction, or PTSD. A few years ago, that would've been practically unthinkable. Steve Paulson has been following this development for years. Steve, what's new?

Steve Paulson (24:09):

It seems like everything is new. Even in the last year or two, the whole landscape of dealing with psychedelic therapy has just changed. There's a lot more openness. And now, the FDA has recently approved what's called breakthrough therapy to test to see if psilocybin would act actually help in treating severe depression.

Anne Strainchamps (24:27):

And this is not just in the US. You were at a psychedelic conference in Berlin recently.

Steve Paulson (24:31):

Yeah. A few months ago. And there were 500 people from 33 countries there. And the thing that's so fascinating about that is there are different rules and laws governing psychedelics in every one of these countries, so everyone is trying to figure this out. It's a bit of the wild west, and how do you move forward to get some of this therapy approved?

Anne Strainchamps (24:51):

You've talked with a lot of the major people in the field. What in particular stands out to you?

Steve Paulson (24:56):

One thing that's fascinating is for a lot of these researchers and scientists, there's often a moment of discovery, a turning point when they realize that this is what they want to do with their lives.

Rosalind Watts (25:09):

I guess the key moment would be when my best friend went to Peru to try iowaska.

Steve Paulson (25:17):

This is Rosalind Watts. She's a clinical psychologist in London.

Rosalind Watts (25:23):

She'd suffered from depression for a long time. Told me that she was going to go to the jungle and drink a brew made of certain vines in the middle of the rainforest. And she was going to do it with a shaman. I was working as a clinical psychologist at the time, and I just completely freaked out about it. I thought it was a terrible idea. Googled iowaska, found that people had died drinking iowaska, and begged her not to go.

Rosalind Watts (25:58):

The really key moment for me, discovering psychedelics as a therapeutic tool, was when she came back after her retreat. And she was very happy. And at first, I did wonder whether it was a... She's taken a drug, she's had a high, it's all going to come crashing down. But I knew when I saw her that it wasn't like that. I've known her since we were very young. When we were children, she was very popular, very sparkly, very bright. Then when the depression hit, it was like she seemed to have lost the sparkle. Her eyes went quite flat, and she seemed pale and gray. It felt like her whole body was in depression. It was a bit like a plant that's wilting. And yeah, when she came back, she just looked like the plant had been watered.

Steve Paulson (26:53):

That was seven or eight years ago, and today her friend is thriving.

Rosalind Watts (26:59):

It was one of those moments of complete recognition and realization of, okay, this is something that I've never seen. In the room I sit with people in, I never see this kind of change, and I definitely wanted to work in it.

Steve Paulson (27:19):

So Rosalind quit her job where she was feeling burned out and to work at the Center for Psychedelic Research at Imperial College London. She's now a psychedelic guide, what she calls a trip sitter, and today she's one of a growing number of therapists and psychiatrists who believe psychedelic therapy could revolutionize the treatment of mental illness.

Roland Griffiths (27:41):

Yeah. Psychedelic research is blossoming. So we came into this research 20 years ago, asking for permission to give a high dose of psilocybin to healthy volunteers. And that was a stretch for our culture.

Steve Paulson (27:59):

And that's Roland Griffiths, a psychiatrist at John's Hopkins. More than anyone, he's the guy who legitimized the resurgence of psychedelic research, which had been completely shut down back in the '60s.

Roland Griffiths (28:12):

When we initiated our study, it wasn't clear that we could ever even get approval. And there was a lot of pushback at all levels of science and psychiatry. But since that time, we've run a whole series of studies. At this point now, 20 years later, we have given psilocybin in almost 700 sessions.

Steve Paulson (28:41):

Which is remarkable, considering that a few years ago, this research was mostly done under the radar. But just a few months ago, John's Hopkins received a 17 million dollar donation from philanthropists to open a new center for psychedelic research. And now several other universities want their own psychedelic institutes. These studies are still in the testing stage, but scientists studying psychedelics are now actually talking with the Food and Drug Administration about how they might use psilocybin, the psychoactive component in magic mushrooms, as a prescription drug to treat depression. And the reason they're so excited, the most popular medications, SSRIs like Prozac, Zoloft, and Paxil, simply don't work that well for depression.

Charles Raison (29:30):

It's arguably the major health problem in the world.

Steve Paulson (29:32):

Wow.

Charles Raison (29:32):

It's a huge problem.

Steve Paulson (29:34):

So you're basically saying that the current medical model for treating depression just basically doesn't work.

Charles Raison (29:39):

Well, no. It works, just not nearly well enough.

Steve Paulson (29:43):

Charles Raison is a psychiatrist at the University of Wisconsin and at Usona Institute, a medical research group that's studying psychedelic therapies. He says recent studies have shown that SSRIs only work for a quarter to a third of the people who take them. And once you've taken them for years, they are really hard to get off of. Like so many psychiatrists in the vanguard of this movement, he believes we need novel ways to treat depression.

Steve Paulson (30:10):

So you are very actively engaged in research on one of these novel ways, which is to use a particular psychedelic drug to treat depression, psilocybin.

Charles Raison (30:19):

Correct.

Steve Paulson (30:20):

Why are you interested in this?

Charles Raison (30:21):

Well, it appeared that a single dose produces profound antidepressant response that lasted for months after a single dose. Unheard of. Unheard of in our world. Psychedelics like atom smashers for the heart and soul, and they allow you to see things that you wouldn't see without them.

Steve Paulson (30:39):

And in just the last few months, a number of universities, including Johns Hopkins, NYU, and Imperial College, got the green light to test psilocybin as a treatment for major depression. These are rigorous studies. So there are strict protocols. Some people get the psilocybin pill, while the control group gets either a placebo or a low dose of psilocybin. And just in case you're wondering, this is not like taking acid at a party. These are powerful mind altering drugs, so it's in a clinical setting with two therapists on hand to make sure people are safe and prepared for an intense experience.

Rosalind Watts (31:20):

We have a very careful screening process. We have thousands of people contacting us, wanting to participate. And then we check that they don't have any personal or close family history of psychosis.

Charles Raison (31:31):

Then we set up an appointment for you to come in and do what we call a baseline assessment. And we measure how depressed you are and all that.

Rosalind Watts (31:40):

And then we have the afternoon preparing. So we spend three or four hours talking through whatever they have questions about. So it's a little guide for how to navigate those waters, really.

Charles Raison (31:55):

And then you come in your dosing day, and if all is good, you get a 50% chance of getting a placebo or 50% chance of getting psilocybin. And you spend seven hours or so on a couch. We encourage people to wear eye shades and to listen to music. There's a powerful interaction with psychedelics with music. They make music really pop.

Rosalind Watts (32:14):

And then at the end of the day, they go back to their accommodation. And the next morning they come in for integration, and that is for them to talk us through what happened.

Charles Raison (32:22):

The thing that seems to be relevant for their psychiatric effects is their ability to induce these powerful, emotional experiences like, "Ah, I see." And to the degree that happens or to the degree that people have this sense that, "Oh my God, I didn't realize I'm part of a larger interconnected whole." When those two things happen, that's what seems to predict an antidepressant response.

Steve Paulson (32:47):

Now you may be thinking, "What happens if you have a bad trip?" Well, Rosalind Watts says the difficult experiences can actually lead to the biggest breakthroughs. In fact, she urges people to go into what's really hard.

Rosalind Watts (33:02):

The pain is a huge teacher. So if there is pain there, if there is suffering there, then something's not working. When you run away from those monsters, the monsters just get bigger and bigger and scarier, and you're constantly in fear.

Steve Paulson (33:16):

So, what does that mean to turn around and face the monster during a psychedelic experience?

Rosalind Watts (33:22):

Saying yes to it. Sometimes people see their pain or they're suffering or their traumas is a visual manifestation, like a dragon or something, so like a monster coming towards them. And you can choose to either go the other way and not look at it, distract yourself, or to see that monster and to choose to go towards it and to dive right into it and say to yourself, "That's a scary looking thing, but really, I'm curious. It can't hurt me. I'm going to go towards it and learn."

Steve Paulson (33:48):

Why isn't that just totally overwhelming? Because the thing about a psyche experience is it's totally disorienting. It can be very scary. And you're talking about going down and dealing with the darkest pieces of that. Why does that work?

Rosalind Watts (34:02):

Because it's all, everything you're seeing is in you. So if that stuff is there, it's been torturing you and haunting you and being scary for you anyway. The really bad trips are the ones where people say no. Resistance is what's difficult. Actually saying yes, and when we're talking about a situation where someone has got two therapists either side of them, probably holding their hands, and whatever is going on, those therapists are completely there. And whatever happens, the person might feel that they're exploding or being set on fire or experiencing immense pain, it moves. It passes. They go through it. And they feel that they've conquered it. It's a hero's journey, that they've conquered the dragon.

Steve Paulson (34:46):

So there's a huge question about psychedelic therapy. Why does it work? Can a single dose of psilocybin really cure depression? The truth is no one really knows, but there are some clues. Brain imaging studies show the frontal cortex is often shut down during a psychedelic experience. So the ego, that planning, scheming, analytical part of our brain, temporarily goes offline, which then unleashes all kinds of buried emotions and can often lead to an ecstatic experience.

Steve Paulson (35:21):

Robin Carhart-Harris is a leading neuroscientist at Imperial College. He believes our brains are actually wired for profound changes in consciousness. This happens when psilocybin triggers the serotonin 2A receptors.

Robin Carhart-Harris (35:38):

I think that there are special receptors. Humans have a lot of them. And my feeling is that they're there for profundity, in a sense. They're there for fundamental shifts in perspective.

Steve Paulson (35:52):

You've described this as a reset. It's like the brain gets jumbled up, it's knocked out of its old way of thinking, and new neural pathways are opened up.

Robin Carhart-Harris (36:02):

Yeah. There's pretty good evidence for that now, of the sprouting of new components of neuronal communication via exposure to psychedelics, something referred to as synaptogenesis.

Steve Paulson (36:16):

So it's pretty remarkable to hear how psychedelics can actually rewire the brain, but there's still so much we don't know. And it's worth pointing out, we're still in the early stages of psychedelic research. We don't even know what the right dose is. And for some people, a single dose of psilocybin can be life changing, but for others, the effects seem to wear off after two or three months. And of course, psilocybin and most other psychedelics are listed as schedule one drugs and only legally available in clinical trials. But most of the experts I've talked to believe FDA approval is coming in the next decade, maybe even in a few years. And for people with chronic depression, well, as the psychiatrist, Charles Raison says, this could be a total game changer.

Charles Raison (37:02):

Especially when you are depressed, we have these very rigid beliefs about the world, these very rigid perspectives. And psychedelics blow them up for a while.

Steve Paulson (37:10):

It seems like one of the effects for many people who have these psychedelic experiences is they come away with some profound sense of meaning or purpose that was lacking.

Charles Raison (37:20):

Yes. Correcto. Now that, I think, is probably the core thing. When you talk about them, they can sound stupid. "Oh, I felt one with the universe." Yeah. Well, yeah. You and everybody else. Right? But if you feel it a certain way, it's not a verbal thing. It's this body felt knowledge. Yeah. All of a sudden you realize, "Oh, I'm part of something larger. My life has meanings that I didn't see." That's a very powerful antidepressant.

Anne Strainchamps (37:53):

That's our executive producer, Steve Paulson, on the latest in psychedelic therapy. I'm Anne Strainchamps. It's To the Best of our Knowledge from Wisconsin Public Radio and PRX.

Anne Strainchamps (38:10):

This hour, we're talking about different ways to treat mental illness. And we've gone to some pretty far out places, like treating depression with psychedelics or anxiety with horror. For the poet Shira Erlichman, it's all about naming, pushing back the shame of a mental diagnosis with words. Name the meds, name the illness.

Shira Erlichman (38:42):

I'm sitting with Bjork in my bathtub. And she leans, takes my knee in her mouth like a puppy. This is her song. I am a pale mountain from her native landscape. She moans, and it is my name. It is not sexy. It is sexual. My blue wrist suckled in her other mouth is an enchilada.

Shira Erlichman (39:13):

I think about how my car won't sell on Craigslist. I think about how ill prepared I am to do my taxes. I take her photograph, and it is a selfie. There are so many ways to need yourself. A faint nipple through the bubbles. She has no reason to hide from me. We are sisters in the army of almost. It is the way we flirt. We are never bored. Bjork uses a can opener to open the bath water. It's working. She slides my mental hospital evaluation papers into the water, so they dissipate into tiny paper fish.

Shira Erlichman (40:03):

This is her song. I am a mossy stone remembering its past life as a bird. She names every doctor who never met my eye. It is not political. It is a curse. My chest is an ivy wall replenished by her hacking hands. I think about how I threw up the bad medicine. I think about being told to just swallow it. She can tell I am reliving the neon isolation of mind jail. She doesn't flinch, just sucks a Jawbreaker. I see her tongue change color and exhale a puff of rivers. There are so many ways to crown yourself.

Shira Erlichman (41:01):

A perfect nipple glaciers through. She has no reason to judge me. We are sisters in the queendom of self. It is the way we work. We are sweetened sweat. Bjork puts a straw to my forehead and drinks the suds. It's lovely. Her eyes are truth wagons, chugging along ancient dirt.

Anne Strainchamps (41:38):

That's poet Shira Erlichman reading from her book, Odes to Lithium. She told Charles Monroe-Kane that even saying the word lithium, or bipolar for that matter, used to fill her with shame. And a word of warning, some content in this interview may be difficult for some listeners with a mental illness.

Shira Erlichman (41:57):

I couldn't say the word like lithium out loud, really. I wouldn't really admit that that's the medication I took, even after a decade. And I started to investigate that and think about that.

Charles Monroe-Kane (42:06):

What did you say? What did you say?

Shira Erlichman (42:08):

I just take medication ,or yeah, I take pills too. I just wasn't... Even as a writer, I would write... The whole project came from writing a poem called Pill that was an ode. Now it's The Watchman in there, but it was an ode to lithium, but originally it didn't say lithium at all. And I had to start to investigate that and say, "Why... I'm writing an ode. How can shame be at the root of an ode, of a praise poem? That doesn't make any sense."

Charles Monroe-Kane (42:29):

Right. That's fair.

Shira Erlichman (42:30):

So I had to go back in there and be like, okay, well, to name, it's not to get power over something. It's to acknowledge shame and equalize yourself to it. Say, "Okay, boogieman, what's so scary? Let's talk about this." And then it's so interesting because I've had these moments where, let's say I've done an interview where I'm very forthcoming or written a poem that feels like, "Oh my God, this is exposing." But then once it's out there, the P word like power, it does feel like something really changes. And something that did have a hold over me is like dust. It doesn't feel as strangling or derailing.

Charles Monroe-Kane (43:07):

There's two things that frustrate me.

Shira Erlichman (43:08):

Yeah.

Charles Monroe-Kane (43:12):

The first one is, you've been hospitalized and I've been hospitalized a bunch of times and it's very negative experience, but then you have these people, either like, "Oh, I've been hospitalized." "Oh, what was wrong? Did you have your appendix out?" You're like, "No, I was hearing voices and they locked me up."

Shira Erlichman (43:21):

Yeah.

Charles Monroe-Kane (43:22):

Is that people are always like, "Oh yeah. I remember when I hurt my hip," or "I know what it's like. Like I said, had my appendix out." I'm like, "No, you don't know what it's like. It's actually not the same thing at all." I find that frustrating. The other thing I find frustrating, and this comes up in a bunch of your poems, is the person at the cocktail party who you're like, "Oh, what's your book about? That's Odes to Lithium. What's that about? You have a mental illness." And they're like, "Oh, you don't seem like someone who's bipolar. You don't act like someone who's bipolar." I'm always like, "What does that person act like?" [crosstalk 00:43:50]

Shira Erlichman (43:49):

That's the perfect response. That's the perfect response. Oh, tell me more. Tell me what's in your head. What do you see?

Charles Monroe-Kane (43:54):

What do you see?

Shira Erlichman (43:55):

What do you envision?

Charles Monroe-Kane (43:56):

What do you see, simpleton? Do you ever worry that you take these meds, and they take away who you are?

Shira Erlichman (44:02):

I never worry that. And I've had, when I was first hospitalized, I was not on lithium, and I was on a cocktail of different things that made me gain weight and made me a little slow minded, really knocked me out for 10 days. But in essence, I don't feel that way. And for me personally, I would rather take something that makes me have short term memory loss, which lithium does, than walk into traffic because I think that I'm directing like Moses. For me, that is an okay trade. [crosstalk 00:44:33].

Charles Monroe-Kane (44:34):

Seems like a reasonable [crosstalk 00:44:35].

Shira Erlichman (44:35):

It seems reasonable. But the thing is, and Kay Redfield Jamison said, "I realized I'd have to do something about my moods." This doctor, amazing writer wrote An Unquiet Mind, also a patient and lives with bipolar disorder and has written so many texts on it. But she said at one point when she was really sick, "I knew I was sick. I knew I had to do something about my moods. So I had to decide if I would go see a psychiatrist or buy a horse. That would be my fix. So of course, inevitably, I bought the horse." [crosstalk 00:45:00].

Charles Monroe-Kane (45:00):

Bought the horse. Right.

Shira Erlichman (45:01):

And so for me, I've bought the horse. I've tried to trick myself out of medication. So it's really, you're going to learn it your own way and at your own pace. And it may be five years, it may be 50, unfortunately, but you're going to have to find, am I going to pick the horse, or am I going to pick what's going to work for me.

Charles Monroe-Kane (45:15):

Could you read another poem for us?

Shira Erlichman (45:16):

Yeah, for sure.

Charles Monroe-Kane (45:16):

It's on page 53. Every so often in your book, there was a moment, this was one of the moments where I read the poem and be like, "Nope." And I put the book down and I walk outside, go have a cigarette, go sit outside and be like, "Nope."

Shira Erlichman (45:30):

Sure. I will say I never read this for that reason. I will happily read it now, but I [crosstalk 00:45:35].

Charles Monroe-Kane (45:35):

You don't have to read it.

Shira Erlichman (45:36):

[crosstalk 00:45:36] No, no, no. I'll happily, happily read it. I like the image of you having to close the book and leave it.

Charles Monroe-Kane (45:40):

An almost trigger.

Shira Erlichman (45:41):

Exactly.

Charles Monroe-Kane (45:41):

It almost triggered me.

Shira Erlichman (45:42):

Exactly. It was hard to write and it's hard [crosstalk 00:45:45].

Charles Monroe-Kane (45:45):

I bet it was hard to write.

Shira Erlichman (45:45):

It's hard to feel the things that are in here. So this is In the Hands of.

Shira Erlichman (45:52):

I sit down, but before she throws the smock around my neck to take up the issue of my hair, to douse in hot, hot spray and comb fingers through, at times too rough, working the untangling, to douse again in heat, the nozzle's mouth grinning a centimeter from my scalp. Before she says, "How much off?" I say, "It's been a hard couple months. Can you be gentle with me?" Too late. Already naked in the apple orchard, the other students working their way around me. Or that sleepless fall all on his voicemail, they're trying to kill me. Our parents, of course. Should I tell her bangs? Just a trim? Or a hospital bed, hijacked by demons, I wet. Years later, the thought that someone had to clean it, take it all off. A hard couple months means I thought my father killed children. Touched them. Me. Be gentle means you can't, but.

Charles Monroe-Kane (47:07):

Are you ever afraid to trigger yourself?

Shira Erlichman (47:11):

When I'm writing?

Charles Monroe-Kane (47:12):

Yes.

Shira Erlichman (47:15):

And I'm teacher too, and I always advised nothing is worth triggering yourself in the moment, writing. These poems were all written a lot later than the things that happened, save for a few, including this one. This was pretty recent. But if I feel my hand getting too close to the stove, I'm not like, "Put it in there." I really trust art making. I really trust poems to arrive when they need to and to have work done on them when they need to. Same with any of other thing, drawing, music. I don't feel a scarcity, and I don't feel a pressure.

Charles Monroe-Kane (47:55):

So you use love so many times in this interview. It's so interesting. I want to read you a line from the poem. I wrote this on a sticky note. If you get a sticky note in my world, that's good. I do a lot of sticky notes. I go to group therapy once a week, and I shared this line with the people in my group therapy. And I think it's very telling. You wrote, "It's because of you something heavy should fly." So was this a gift? Are you and I getting a gift here?

Shira Erlichman (48:18):

There's two gifts in my mind. The first is, I don't wish for anyone else a fissuring of reality, or to go through the hells that I have gone through, but I certainly feel like the curtain has been lifted for me about the universe or about the way we think things are so static and so certain, and they're not. And so we have had, you and I and anyone listening to this who has experienced mental illness, but maybe even has experienced grief, when time she changes and colors change and taste changes. For me, that's one gift. It's a horrible gift, but it also means that I can enter this life with some more clarity as to really what's at stake.

Charles Monroe-Kane (49:05):

It seems to me in the truest sense of the word, you're a romantic. I get that from talking to you, but I also get that from your book. I'm a romantic as well. So I'm not being disparaging at all. You wrote love poems to lithium. Geez, I don't think you can get more romantic than that.

Shira Erlichman (49:19):

It's so funny because it feels so practical to me. I'm actually like very Virgo, very practical person, where I'm like, if I approach... you know how they say if you see a spider and you're afraid of spiders, be curious about it, because that part of your brain that's curious will... Like a broom, take away the part that's afraid, and you'll be so like, "How many legs does it have and how many eyes?" And you're lost inside your questions and your curiosity. You don't have time to be afraid. This whole project was, I feel ashamed. I feel deep shame. How do I walk towards it? How do I be curious? And so, the truth is romantic. The truth is sensuous and interconnected and strange, in this case. I feel very lucky for that.

Anne Strainchamps (49:58):

Shira Erlichman is the author of the book of poetry called Odes to Lithium. Charles Monroe-Kane talked with her in our studios in Madison, Wisconsin.

Anne Strainchamps (50:15):

So this hour we've been talking about mental illness, which is a complicated, painful subject for so many of us. Everyone you heard in this hour has found a way to something that helps. Horror movies, poetry, exercise, psilocybin, and they found their way there by being curious, not ashamed. So we are not suggesting you take a horror films or psilocybin, but we are advocating an attitude of self love. And you can take it from there. I'm Anne Strainchamps, and from everyone at To the Best of our Knowledge, thanks for listening.

Speaker 11 (50:54):

PRX.