Host Leslie is joined by Dr. Jennifer Ellice to discuss psychedelic therapy and how ketamine specifically can help with depression, addiction, PTSD, and more. Dr. Jenn also provides advice for individuals who are curious about exploring psychedelic therapy, emphasizing the importance of guided, respectful journeys. Dr. Jenn is an emergency room physician and the founder of Golden Afternoon, a Ketamine Clinic in Los Angeles.
Host Leslie is joined by Dr. Jennifer Ellice, founder of the Golden Afternoon Ketamine Clinic and emergency room physician, to discuss psychedelic therapy and how ketamine specifically can help with depression, addiction, PTSD, and more. Dr. Jenn shares her journey from working in a methadone clinic to discovering the healing powers of ketamine in the ER. She shares compelling stories from her practice, highlighting the profound changes in perspective, emotional insights, and healing possible with this approach. Their discussion also touches on the broader implications for mental health care within a capitalist system. Finally, Dr. Jenn provides advice for individuals who are curious about exploring psychedelic therapy, emphasizing the importance of guided, respectful journeys.
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[Music]
Welcome to The Nature of Nurture with Dr. Leslie Carr, a podcast for your mental health. I'm your host, Leslie. If you're watching this podcast right now, you can find the audio version in any podcast app. And if you're listening, you can also watch this episode on YouTube @TheNatureofNurture. You can find that link in the show notes.
Today, I'm here with Dr. Jennifer Ellice. Dr. Jenn is an emergency room physician and the founder of Golden Afternoon, a clinic here in Los Angeles that provides cutting edge therapy for its patients in the form of ketamine treatments. Jenn and I met recently and really hit it off, so I am thrilled to be introducing her and her work to you today.
I just love how this woman thinks. You're going to hear us talk about a lot of things today, like how ketamine works and why people are experiencing such incredible breakthroughs with it. But the thing that really made me want to bring her onto the podcast is the way that she and I connect in our beliefs about why the previous or current model, what I like to sometimes call the mental health industrial complex, is failing so many people.
Dr. Jenn studied at Princeton University and the University of Rochester School of Medicine, and she completed her residency in emergency medicine at Brown University. She first noticed the transformative power of ketamine infusions while using it in the emergency room for anesthesia, and she believes in the brain's innate capacity for regeneration and healing.
Please join me in welcoming Dr. Jennifer Ellice. Thank you for being here. Um, so there are so many things I'm excited to talk to you about. I almost don't know where to start, but I want to bring us back to the moment. There was a moment when you and I first met when we were on that original Zoom, when I had this moment of thinking to myself, I have got to get this woman on my podcast.
And what was happening for me in that moment was when you were talking about kind of how you got into this ketamine business and some criticisms that you have of just the pre-existing or previous model that have motivated you and inspired you here. And I wonder if you can just let people know what some of those criticisms are of the model that previously or has already existed.
Yeah, well, it's kind of a long story, but I guess it sort of starts back when, before I knew I wanted to be a doctor. I was, like many people, kind of bumming around in New York City in my 20s, not sure what I was going to do, and I ended up working at a methadone clinic. Um, and in those days, we, we, they would sort of hire young people to be counselors, air quotes and all that.
Um, but really what we were doing was we were just documenting on every patient, like, uh, we urged them to stop using drugs. Okay, so that's basically what the job was. But we would talk to people who were suffering from opioid dependence. Junkies pretty much, all day long, for very little money and they, they would line up.
I mean, nowadays you can get methadone in different ways, but back then it was just at the clinic. So everybody would come, whether you worked on Wall Street or you were homeless, to this clinic, and so I would talk to people all day long and you know, these were some of the most resilient, intelligent, capable human beings on the planet.
In New York City, I mean, which is a place full of capable human beings, right? But they were suffering so much. I mean, most of my patients smelled like urine, okay? So just to set the context. But they, I mean, if you are a junkie and you've survived to age 68, You're smart, and you're tough, and you've been through it.
You have survived some stuff. You have survived. Yeah. And after, you know, months of doing this and just talking to these people all day, I just was just struck by the absolute loss of human potential. Their mental health struggles had taken on not just them, but on society. I mean, at the time I lived on Wall Street with a bunch of, you know, my ex Princeton College roommates that were all heading into Wall Street jobs.
And I would head off, you know, and get into the subway and I would, I would come out and I would meet these people. And I just was just struck by how little we all over the world as a society care about, about mental health. I mean, we care about it, but not as much as we should, just based on how much potential, you know, was lost.
And so, being, you know, young and proud and kind of dumb, I thought to myself, Well, I'm, I guess I better, I'm gonna be a therapist. I'm gonna fix this, you know? And I didn't know how to be a therapist, so I, I looked it up, and I was like, Well, I guess I could get a PhD in psychology, or I could get a PsyD, but that's like five years or seven years.
I don't think I, I can't do that. So, then I thought, Oh, well, look, there's a psychiatrist. How do you be a psychiatrist? Oh, well, you go to med school. And that's only four years. Okay, I'll do that. That should be easy.
I love that that seemed more efficient to you somehow, becoming a medical doctor. That's how little I knew about anything, okay?
So,] I went off and did it, which, you know, was like its own thing, but um, by the time I got to medical school, I was doing my psych rotations and I was really kind of, really disappointed and horrified by how little we had to offer. That medicine had to offer. That It was, I mean, in contrast to all the other things that medicine can do in urology and cardiology, this was like the stone ages.
And I sort of couldn't believe that there was even a whole specialty based on the basically like three classes of medications that we could offer, right. And that many of them didn't really seem in my, like what I saw, they didn't seem to be helping people. And so, um, you know, I was kind of disillusioned that I ended up going into emergency medicine instead because it seemed like a good enough way to help people.
And I did that for almost 20 years. And you know, in ER, we end up working with a lot of, um, different kinds of medications in different scenarios. But one of them is to do, um, a kind of an anesthesia. And in doing that, I would use this medication ketamine, um, as an anesthetic. I started to notice using that over the years, some interesting things and I think, um, when the science finally caught up and it started to rise up enough into my consciousness that I heard about the excellent studies that had been done about it, then it really sort of cemented like, Oh wait, this might be a whole new paradigm, like a whole new way of helping people, psychedelic medicine.
Wow. Holy cow. Yeah, that's incredible. So will you say a little bit about, what were you witnessing in the ER with what you were doing with ketamine? Right. So what we use it for just to be clear, it's a, it's an, it's the most widely used anesthetic on the planet. Okay, but it's very safe. And the reason why it's very safe is because it doesn't overly depress your blood pressure or your respirations.
So, you know, paramedics use it. They sometimes use it in dentist's offices, even like, you know, Cosmetic stuff like lasers and stuff. They might use it right, but we use it in the ER for for procedural sedation mostly or for intubation What that means is if you dislocate your arm and I can't get it back in just clunking it in I have to kind of knock you out a little bit. Then I might use ketamine. And the way I trained on it was to use for children, what back in when I was in residency, because it's so safe.
We would use it for you know when kids get to cut on their cheek, they won't hold still we would kind of knock them out And then we would sew them up right and I, you know, I would I love to do it so much that I would actually even volunteer to do it for other doctors. Because I would see these amazing things and I'll give you one example.
So one day this older, uh, Indian woman came in, um, and she was like a grandmother and she, you know, she was an immigrant, obviously, and she had these deep, deep set frown lines. Right. I just remember her whole face, her entire countenance was just this person who, she just seemed, you know, miserable and blunted and sad. And I, I didn't know what it was and I was actually working on like, I don't remember what, like, resetting a bone or something for her.
Um, she had an accident of some sort so we were going to use the ketamine for that. Um, and she would not, she, she had what in medicine we call guarded faces, like she, she was very, um, not expressive. Okay. And the only expression she seemed to make was like a frown. Wow. And so I, I, we ketamined her and, um, I tried to explain to her like through her daughter was helping interpret for me.
And when she came out of it, she looked like a different human being. And when I, I kind of couldn't believe how different she looked. And so I was sort of in my brain like, what is different about her? And the thing that was different was she was using, like, all these facial muscles that you could tell she had not used in a long time.
And so her face had a different shape and a different, I don't know if you've seen that kind of thing happen before, but. Well, I can imagine what you're saying, absolutely. And it's amazing how you can tell so much about a person's interiority by what their facial expression is doing, whether their, you know, eyebrows are furrowed or there's a permanent frown. And it just must have been amazing to see her look like a different person.
It was like the difference between seeing someone asleep and when they wake up, right? Like they can look totally different if you take a picture. Anyway, so she comes out of it and she looks up at me and she says, you know, through her daughter interpreting, Oh my God, thank you so much. And I was like, for setting your leg?
Yeah, you're welcome. She goes, no, no. She goes, I realize now. Yeah. Life, it's, it's a circus. It's a beautiful, beautiful circus. What are we all so worried about? And I was kind of like, thought maybe it was a translation issue. So I was like, oh, to the daughter, like, and the daughter was looking back and forth, like she hadn't seen her mom act like that in so long.
She was like, no, that's what she means. She's saying circus. Right. And I'm like, the word circus? Really? Yes. Life is a beautiful circus and you should really understand that. And why don't we understand that more? And, you know, that's just like one story, but I would see that I saw that over and over again.
And, and it kind of, it kind of struck me like there's something about this medication. I didn't really think too much about it. I just kind of dug it. I liked seeing people happy. So I would, I would kind of preferentially choose it instead of propofol or instead of fentanyl or other, you know, sedatives, because I was like, this is kind of fun seeing people transformed after.
You know, what, 30 minutes of, of an anesthetic. Yeah. It's really amazing. Yeah. And so, you know, when I finally, when the, when the literature finally bubbled up into my consciousness and I finally saw that this isn't just an observational thing, this is like, there's 20 years of good, you know, scientific evidence, like rigorous high quality evidence that shows that this is actually something that helps people with depression, anxiety, PTSD.
I was like, you know, I think I need to make a change. I think I need to like, I'm going to need to go back and try to help people with this. Oh, it's incredible. So will you tell us a little bit about what the data shows, like what, what is revealed by the data? So most of the studies are done on depression and specifically what we call treatment resistant depression.
And there are a lot of other studies going on and, uh, in process looking at all kinds of other things. Including, um, brain injuries of people who've had strokes, but the main, yes, PTSD, anxiety, autism, like there's tons, they're looking at tons and for psychedelic medicine in general, there's, it's a, it's a kind of the potential is enormous, right?
But specifically for ketamine, what is getting the most attention is something called treatment resistant depression, right? And what that means. It sort of depends where you look for a definition. But most professional societies would define it as someone who's failed. More than one SSRI. Yes. Okay. Um, and so.
And something I'll point out that's a little bit disturbing about that is that I'm totally with you that there are different definitions of that term, but I think the prevailing definition of it is someone who has tried two SSRIs and failed. It does not include whether that person ever went to psychotherapy.
And what the studies also show us is that psychotherapy is more effective than antidepressant medication. Again, that's not what most people are experiencing. So I just want to point that out to the listeners that it's, it's kind of a troublesome term, but it is a very troublesome term. Also because of the fact that different insurance companies will say different things.
So some of them will say treatment resistant depression is too necessary. Some of them will say three and then also have time, you know, where they have to have beyond them and within this amount of time and everything. And I think that's an odd concept because we don't say like you have antibiotic resistant appendicitis, right?
You know, like it's a weird, right? It's, it's a strange, I'm totally on board with the problematic nature of that. But however, those are the cohorts that were studied. And so just back to the evidence for people with treatment resistant depression or suicidality. This medication can be almost miraculous, and I hate to use the word miraculous.
I know you do. I know you do. I am a very rigorous person when it comes to speaking scientifically, but I think that some of this stuff is miraculous. And so what they'll show is up to 60 to 80%, depending on the study you look at, of people with treatment resistant depression will get better and have sustained remission from their depression after six or eight treatments in series.
And that, you know, that's, those are phenomenal numbers. Yeah. For pharmacology. Yeah. For medicine in general. Yes. However, I will point out to the listeners too, you know, what does that mean practically? If you're a patient coming to me, what that means is if there are 10 people who come to me, two or maybe four, up to anywhere from two to four people may not get any benefit from this.
Mm-hmm. If that's, if you're one of those people hearing this and you're like, Oh my God, this is a miracle treatment and it does not work for you. There's nothing wrong with you. Right? No, there's no medication or no treatment that's perfect for everyone. And it still means if you failed ketamine or other psychedelics, there are other modalities to try - to just to kind of caveat that.
Absolutely. I love that so much. It's so important. And it is also wild to think that potentially six of those people or 60 percent of those people could go from feeling profoundly suicidal to feeling like, okay. they are suddenly affirmed in their desire to live again, which is wild. Not just that, but there are some people, it's within 45 minutes of their first treatment.
Like, like for the example of that woman I talked about that, that older Indian woman, right away you go in suicidal and you come out not. Right. That's crazy. It is crazy. There is nothing else in mental health care. There's very little in medicine that works that well, short of like surgery or setting a bone, you know?
Yes. Yes. And so that's, I mean, that got my attention. When I read that, I, the first time I was looking at the, at the literature, I was like, No, that can't be. Over and over again, all over the world, not just in America, but studies all over the world have shown that that can be the case. And so that's, I mean, we got, we have to look at that, right?
We definitely do. That's something very interesting. Absolutely. And so one of the things that I think is, uh, there's so many things I'm excited to talk to you about, but one of the things that I think is amazing about what we're talking about is This experience that some people seem to have when they are experiencing the drug, when they're getting the treatment, when they're on the journey, whatever, you know, language you choose to use, where they have something resembling what we could call a spiritual experience, that there is something that is so many different ways that we could put this and you and I are gonna, we're gonna really language this different ways because there's so many ways to say it.
None is right. None is wrong. But it's almost as if people have the opportunity to sort of zoom out from whatever they have been granularly focused on. And have an experience that is what most people would call something resembling a spiritual experience. A religious experience. A religious experience.
Yeah, absolutely. I mean, let's say it. That's what, that's what it is for some people. And, you know, that's something that is not, you don't, you can't quantify that. And because you can't quantify it, you can't study it. So because of that, it's left out. Of a lot of science about this, you know, but that's something that is actually so deeply important to the human condition and so deeply important to a sense of hope, a sense of potential, a sense of living for so many people that I think we do, like, I think we as doctors, as clinicians, as providers, we do need to talk about it.
Yes. And it's like everybody shies away from talking about that because it sounds so mumbo jumbo or it sounds so, you know, woo. Mm hmm. But that's part of the experience for a lot of people. And if it's not spiritual or religious, it's philosophical, deeply philosophical. And we need to engage with that because I actually believe that that's part of how it helps.
Yeah. Yeah. So will you say a little bit more about that? How is that the mechanism of action that helps it to be useful? Well, so just to be clear, the mechanism of action that, that we think it works, the way we think it works is, is kind of in two ways. Um, the first is the trip itself. Um, and the second is the neuroplasticity afterwards.
Yes. And, you know, As a doctor, as a medical doctor, I'm more comfortable with that, with explaining the concept of the neuroplasticity than I am with the trip itself, because the trip itself is so individual and so variable, but essentially what's happening when you're tripping on any psychedelic, really, is that the executive function part of your brain is taken offline or shushed for a second, and all these other parts of your brain are allowed to talk to each other, okay, and you would think that that happens all the time, but it doesn't, your brain is actually regulating very carefully what you're talking about.
Parts of it are allowed to communicate and what you are actually thinking or feeling right now is very tightly controlled and regulated as it should be because you can't feel everything everywhere all at once. Right? You can't because it's not conducive to say driving on the freeway. So when you take that part of your brain offline, all these other parts of your brain are talking.
So normally if you and I are not on psychedelics and we, and we put you in a functional MRI, you'd look at the connections between the parts of your brain, would look like maybe more like a tic tac toe. Okay. But when you're on a psychedelic, It looks more like a dream catcher or like a cobweb. Okay. Like the connections are just everywhere.
Some of them are random. And what that produces is maybe something profound, like profound insights, recovered memories. People talk to dead loved ones. They see the face of God, but it can also be some kind of like spurious or sort of ridiculous stuff that doesn't make any sense and maybe isn't meant to make any sense.
And apparently to go back to something you were saying before, that idea of it being a circus is a theme that you've heard again and again. And I will get back to that. Um, And so the trip itself is, it's so variable. And it's hard for me to prepare people for kind of what they will experience because on one hand, on one end of the spectrum, you'll have someone who will say, you know, I don't know, doc, I just sort of felt like I was floating on a roller coaster out of body.
It felt kind of relaxed, but I didn't see anything weird. And on the other hand, you'll have someone who said, Oh my God, that was the most significant spiritual experience of my life. I lived a thousand lifetimes. I saw the birth of the universe. I talked to God and, and that could, that same, that could be the same person on two different days with the same dose.
So that's how crazy and how sort of chaotic and variable those experiences are. Yeah. So that's the mechanism of action of the trip itself. And, and, and if you do happen to have amazing insight there, that can be invaluable. People will talk about, they will say, they will wake up and they'll say, Oh my God.
That was like 20 years of therapy in 45 minutes. I've heard more than one person say that. Which, you know, okay, that's a lot. But it's compelling. But you can also wake up and be like, Oh, that was weird. I just saw a bunch of purple bugs. You know? But the neuroplasticity part, you know, it's kind of been sort of like it's the new sort of buzzword and so I don't want to like oversimplify it but the idea is maybe we are inducing a little state of increased neuroplasticity for about 24 to 72 hours after each infusion.
Should we quickly define neuroplasticity for anyone who's watching and doesn't know what that means? Yeah, so in a nutshell when we're born we, and as we're children, we have the same Our brain is just exploding and growing neurons, okay, we have to, right? But what neurons you're growing, well, it kind of depends on what you need to do.
So, you know, if you learn to play the piano when you're 7, it kind of comes more easily than when you're 70. Sure. Because you have more neuroplasticity, you're sort of primed to do that. Right. To learn and grow. It's easier to learn a language when you're younger than it is when you're 70. It doesn't mean that you can't learn it when you're 70.
It's just harder. Because that neuroplasticity window closes around the end of adolescence, right? And so you're not learning, you're not throwing down new neurons as fast as you did before. But neuroplasticity is something that we know is very helpful for, Well, I mean, the human [00:20:00] existence and life and everything, but also specifically with depression, we see that people who are depressed have these parts of their brain that are over pruned.
So when, when compared to air quotes, healthy people, um, they're, they're parts of their brain that, that are shorter and smaller, they need to kind of grow more. And afte ketamine, um, there and other psychedelics. Those parts have grown back and more closely martch the brain of a quote unquote healthy person or a person who isn't suffering from depression, right?
And so that neuroplasticity is the mechanism of action that we think is actually driving what's helping. But as you said, there's also this huge black box about the trip itself and about the realizations about it and all the philosophical and spiritual questions it raises. Yeah. One of the ways that you put it to me the other day that just left me feeling riveted was when you talked about the idea that there are, uh, how did you put it?
The idea that there are. Awe pathways in the brain. Is that, am I getting the phrase right? You know, how do we make sense of that? Right. So, you know, one of the more interesting things is people need awe and beauty. Yeah. I mean, we know this, people need beauty in their life and you, you can hike to the top of Mount Kilimanjaro and look down and feel the swelling sense of awe inside of you and overcome with the beauty of life and existence.
And. That can be medicine. Yes. We don't understand. There are very few people studying pathways for awe, but we obviously have them because you can experience awe and we need to, right? You, you know, I, when I was younger, I, um, I was once hiking in the backcountry in Utah. It was so remote that we were pretty much thousands of miles in any direction from any civilization.
We got to this place and we set up camp and it was so quiet and we looked up and the Milky Way was splashed across like a cathedral in the sky just hanging, you know, and you know, I had grown up in mostly cities my life my whole life. And so it occurred to me, this incredible thing that is inspiring all this in me, I just welling up in me our ancestors lived under this every day.
Yeah. Before, you know, modernity and civilization and light pollution, the Milky Way hung over us and inspired us in this way, probably every night when you went to bed. Right. Yeah. And it was kind of so surprising to me that I had not ever seen it in my life before that. And it, and it occurred to me that like, whatever, you know, pathways that we had evolved under the, this curtain of the Milky Way for thousands and thousands of millions of years.
And whatever pathways that I was feeling, that sense of awe that they hadn't been juiced in a while, you know, and that it sort of, it, it felt really healing. And so people do talk about that. We talk about nature baths being healing. We know when we talk about that. And one of the things that psychedelics can do is they can sort of induce a sense of awe and that awe gives you perspective.
It gives you hope. Yeah. It gives you a sense of love and belonging. And it's sort of like, it's, it's a black box. I mean, very, you can look at the literature. There's very few people studying this. One of the things that it makes me think of is also the notion of gratitude in the sense that part and parcel of so much of what you're saying right now has to do with our ability to feel grateful for the beauty that exists in our lives, grateful for the experience of seeing the Milky Way in Utah.
Thank you. And I don't know if I've ever mentioned this to you, but one of the things that I specialize in is working with people who are suicidally depressed. It's something I've worked with a lot in my life. And one of the things that I've noticed time and again, in a way that can be incredibly heartbreaking, is that when people are really struggling with feeling depressed, and when it gets to the point where they are suicidally depressed, there just seems to be virtually no gratitude for anything.
Even when people sort of technically have lots and lots and lots to be grateful for. They can't see it. They can't feel it. It's, you know, it's all bouncing right off of them. So it's interesting to think about the interplay of these things, right? The, the ability to feel awestruck by this, you know, one crazy life we all get to live or whatever.
And also just to feel grateful for sometimes even the most mundane moments that exist in it. You know, the thing is like for depression and what you mentioned, like it's, it's, it's not just the inability to feel grateful, it's the inability to feel anything sometimes. Mm hmm. Anything other than grief, overwhelm, pain.
It's just like at some level it's just pain. Yeah. And it can't go on any longer and you can't even, you don't even understand anymore what it feels like to have gratitude. To feel, yes, yes. Joy. Yes. Hope. Yes. And so, you know, yeah, I mean, it's hard to explain. Like I try to explain to my patients like when they talk about their intentions, setting their intention to go into it.
Um, it’s hard to, it's kind of hard to explain how feeling something is a kind of a way of knowing it. So for example, just what you were saying, just to play off what you were saying, you can explain about gratitude. You can try to practice it. You can read about it, but when you feel it. Yes, you know it right?
Yes, and so sometimes after a treatment, people will come out and they will be like, oh my god. I've been working on this like, for example shame, that's a very good one. You can explain why you're not guilty for say, your brother dying or something like that. You can explain why you should not be ashamed to be who you are if you're, if you're non-normative in some way.
You can explain that, you can read about it, but you, until you feel that shame lifting or that guilt lifting, you don't know it. You don't know it, right? And, uh, something I read a while back, someone said, emotion is not the opposite of reason. You know, we very often will, will, will say that it's kind of this idea.
It's not. In fact, I think emotion is a kind of reason. And so. Part of the way that psychedelics work and part of the way that ketamine works so well is to show you that feeling again of gratitude. It shows, your brain shows you because your brain does still know it. It still can access it. It's in there.
Yeah. Exactly. And, and I'll give you an example. I had, um, I had this woman, she was so amazing, she was in her 70s, a lifetime of depression. When she was younger, addiction hospitalized multiple times for suicidality. She somehow made it into her 70s. She came into my office, just this long gray hair, no makeup, just like goals, okay?
She's so beautiful. But she spent her lifetime saying, she said to me, I spent my life thinking I'm unlovable. I don't feel lovable. Okay, that had led to her addictions that had led to her hospitalization like her whole life. That was her deal. And, so we worked with her and we had that as an intention. And during one of her trips, she explained to me that she had, she was suddenly in the mind, in the eye, looking out from the eyes of a dog that she once had.
She had this dog. She had this dog that she loved. She loved it so much that she still had a picture on her mantle, even though it had died like 10 years ago or something, right? And she said that suddenly she was in the eyes of this dog as it was bounding across the rug to her in her old apartment from 15 years ago, and she was in the mind and the heart of the dog and she looked at herself and she jumped into her lap, her own lap.
Okay, but she's looking out the eyes of the dog and she felt the love and gratitude that the dog felt for her. Wow. And she woke up and she looked like, I mean, she looked like she was thunderstruck. Like the way you are when you're just like, Oh my God. Yeah. And she, she said, like, I see that I am lovable now.
Like I, I mean, people have been telling me that my whole life. I know that I've been repeating that my whole life, but I felt it. Yeah. To actually have that moment of sort of embodying to feel it, right. To feel it for herself. She looked at herself through the eyes of this creature that did love her and she felt it.
And she was transformed. I mean, she was like, this really helps her so much. And I like, that's the kind of thing that it's very hard to explain or quantify with science. Like, but that's, that's what I, that's what I try to work with my patients on is getting that emotional intelligence, if you will. I don't, there's probably a better way of putting it, but like the emotion behind, kind of some of these things.
Yeah. And maybe just to sort of say that it's experiential. That you're actually having the experience of something rather than, you know, there are certain things that we can't learn from reading in a book. Or they're, they're not really going to move the needle for us. They're not going to shift things.
And people are having an experience of something that is moving the needle for them very much. But it's a kind of a knowledge. It can be. I mean, I've had other examples, people who suddenly have like memories, recovered memories. Yeah. Yeah. Of when they were much, much younger that turn out that they, I, I see them again next week and they corroborate it with their parents.
Like it's true. Like, so they always knew there's something that they always knew, but they never accessed before. So, yeah, which is wild because it sort of feels like part of what we're talking about is tapping into the unconscious, you know, which is this sort of, uh, you know, ephemeral sort of thing that is hard.
It's hard to quantify. It's hard to talk about. We can't. It's hard to put a, you know, too fine of a point on it. And yet it's sort of interesting to think that there are certain things in the brain that are unknowable to us so far, like what we call the hard problem of consciousness. We have not located the seat of consciousness in the brain.
And we also haven't located this notion of the unconscious, even though it houses everything, the memories of every experience we've ever been through in our lives. Absolutely. And not to get too Jungian on it, but a lot of times people feel like they're also tapping into a connection with other people.
Absolutely. And the whole planet and sometimes with humanity and sometimes with people who have passed on and, and when they talk about that, you know, that's very hard. We don't have the language for that. Yes. But I've heard almost every iteration of that. And that's incredible. I mean, because I had always been fascinated by the concept of the collective unconscious.
Just, just fascinated, almost like in a fairytale way, because I'm like, I'm much more of a concrete person and the whole idea sounded sort of hokey and religious. But hearing so many different people. explain what is probably the collective unconscious and their experience of going into it. It's really interesting.
I mean, there's something there for sure. For sure. I mean, I personally am a believer. I think it's taken me a while to get to the point where I feel like I can believe these things and I can have faith in these things without there being so much incredulity around it, perhaps it takes a while, like skepticism, you know, it takes a while or it takes a shift or whatever it is that it takes.
But, you know, I think that there are so many things about the universe that we live in that we just don't fully understand yet. And I think we're kind of in that territory. So much. And, and it's, it's not even that it's like we don't even understand what we don't understand, you know? Yeah. You know, we don't even know how to ask the right questions yet.
You know, I think it's in a previous podcast episode of mine, season two, episode five, I'm nearly positive. I interviewed a friend of mine named Rhadhika Dirks, who is a quantum physicist. And one of the things that we talked about is how hard it is for human beings to truly understand themselves, because it's a thing study itself, you know, like in a, in a universe that we can't, we don't quite have the distance and sort of by, uh, by our very nature, by its very nature, we kind of can't get that distance entirely.
So, you know, I personally am at a point where I'm okay swimming in the unknowable, but I hear you that as a scientist and as a doctor, I'm sure it is, it's, It's comforting and it's grounding and I think it gives us something to work with that we, we have some ways that we can start to grapple with a scientific understanding of this.
We can look at MRI scans. We can, you know, it's not, it's not, we're still in the world of science. It's true. It's true. And, but you know, I'm actually much more comfortable being skeptical. I feel very happy in that space of questioning and being skeptical and sometimes even looking at things more negatively.
But, but to your point, like, yeah, maybe we'll never. Understand it. I mean, it's possible that we'll never understand the nature of consciousness. Maybe, maybe we will. I also, I have a friend who's also, um, in quantum physics and he's a professor and he, um, one day, one night we were sitting around a fire and he was trying to explain to me time.
Yeah. Because, because, you know, a lot of my patients talk about how their time isn't linear when they're in their trips. Right. So I was like, okay, lay it on me, bro. Like what? Explain time to me. I mean, I'm going to botch his German accent. So forgive me any German listeners, but he basically was like, Oh, that is simple.
Time is just the basic unit of consequence. What? The basic unit of consequence? He goes, Oh yes. Because if you have if and then there is if between the ifs and the then, there It's the time. Like a centimeter for distance. And I was like, okay. Yeah. I don't think, but, but I mean, and, and still like I talked to him for an hour, he tried to explain to me, I still didn't understand it.
But it's just like, even something like, as simple as time, which we think of as a dimension, right? Something that we live with. We don't understand. Well, and I'll tell you something that blows my mind. You might appreciate this. So it's, you know, I have studied quantum physics a lot in my life. I've been reading books about it since I was like 19, but the kinds of books that are written for people that aren't great at math, you know, I'm sorry, I sort of need those kinds of books.
Yeah. And one of the things that we know about time, it's, you know, in a nutshell, there's a lot of evidence that time, how we experience time is largely a construct of the human brain. Because time, as we think of it, is not actually really how it exists, kind of in physics, outside of a human brain, linear sense of past, present, future, and, you know, we don't need to bring this conversation sort of totally in a, you know, stratospheric direction, but it's, it is, there's just a lot about being human that we do not entirely understand.
To your point, I mean, what you're saying is like, our understanding of this existence is limited by our neurobiology. And we don't even actually understand our neurobiology that much. We, everything we know about physics, I heard someone say recently. We learn in the last 100 years. Almost everything, almost everything we know about mental health I will say has been about the past.
And so I was right. And I would even extend that to medicine. Yes. We are just beginning to understand this, right? It is. Right. Yeah. Someone said to me the other day, and then I have a question I want to ask you, that's going to shift gears ever so slightly because there's something that's super interesting to me.
But someone said to me the other day that we literally might need to build AI in order to start to ask these questions. I think so. I do. I do. I think so. I think we can't, kind of get quite out of ourselves enough to ask the right questions. Yeah, I think actually I'm really excited about that. I actually, I'm not a pessimist about it.
I actually think that there could be, we might break through some, some things. Absolutely. I think that there are going to be some groundbreaking applications and this might be one of them. But so to shift gears ever so slightly, you know, one of the things that is really important to me, and it's in the sense that it's a big part of what this podcast is about, is sort of how we explain the nature of our suffering in terms of, um, kind of the origins of it, right?
So if somebody is struggling in their mental health, you know, I'm so much more interested in things like PTSD than I am, like, Genes and the notion of a chemical imbalance, because if there's anything we know about the idea of genes, it's that we have things like epigenetics, like, in the world of mental health, for the most part, genes are not destiny.
So, when we're talking about classic psychiatry, you know, the idea that, depression is a chemical imbalance that's best treated with a pill. To me that feels super fraught because of what it says about sort of who we are and why we suffer. So now we have this whole new groundbreaking treatment called ketamine, right?
Do you think that it says anything about kind of how we come to suffer in the first place? Like, if a drug like ketamine can heal people, what does that mean about the nature of the injury or the nature of the suffering that it's healing? Well, I'm glad you, you brought the word, the phrase chemical imbalance, because I just want to tell you I hate that.
Mm hmm. Because that is not only an oversimplification, but it's, it's sort of wrong. Yeah. It's just not like how biology works. It's not like, there's a chemical that's supposed to be like this and it's like this. And so that's what's wrong, which is the serotonin explanation that people sort of thought, you know, think of all like everything that's alive is trying to achieve homeostasis or is reacting to outside input and has to use chemicals to change, okay, change. So everything that's alive is constantly either in a state of trying to change to react to something or maintain homeostasis and not change, okay? And that involves a lot of chemistry. A lot of chemistry.
So the, so the idea that it's a chemical imbalance with one thing is, it's just sort of, it's, it's just sort of silly. It's like, it doesn't make any sense. It's, it's not a helpful concept. It's not one receptor, one chemical that you need more of. And it, that's just not how it works. It's just way more complex than that.
That's like saying the ocean is just goldfish or something. I don't, I don't know. It's, it's, it's weird to me. I, I really hate it. Um, and so, to your point about suffering. Look, there are so many different ways to suffer. Mm hmm. Okay? Mm hmm. But there are actually a finite number of ways that the brain can heal itself.
Oh, that's so well put. Okay? And, and, and it's true. Like, one of the most eye opening things to me about going through the journey of becoming a doctor and learning anything about medicine is like, there are actually only very few ways we heal. Like, I mean, they're complex and we're learning more every day, but it's not like, it's not an endless thing.
There are mechanisms by which we heal ourselves. And so when people are suffering, they have the capacity to heal themselves. Yeah. External from other chemicals, right? I mean, it, you can, you can try to juice it this way and help this with this and a little, a little of that. And you can try to kind of nudge it with chemicals, but honestly, when people, when people survive their suffering and transcend their suffering, they're changing.
Okay. They're changing internally. And that can be terrifying. It can be exhilarating, but change is inevitable. And so, you know, I think the thing that I love about this modality that I work with, psychedelic medicine, is what it is doing is it's harnessing your ability to change yourself and your ability to heal yourself.
And like, I, you know, I used to say when I started, like, I'm going to change your mind. And people are, I don't say that anymore because people are a little off put by that. It feels scary. Like, you're going to what? You're going to do what to me? But like, that's what needs to happen and it's not just your mind, right?
We're going to change your heart. We're going to, we're going to help you heal yourself. And so as opposed to taking a pill and upping this chemical or that chemical, which isn't even how that really works anyway, so. It's so interesting. It reminds me of, you used a phrase when we were speaking the other day, the notion of waking up.
Like, what does it mean to wake up? And it's interesting to think, I mean, I think that you are hitting the nail on the head, where what happens that makes us so that we suffer in the first place. And anyway, however it is that we suffer doesn't have a whole hell of a lot to do with how we get better, you know, in the world of psychotherapy? For example, it's funny, there are lots of studies that show that, you know, high quality long term psychotherapy does help most people, but we have problems with access, who can afford that, you know, all of this stuff.
And we also have the very big glaring problem of the fact that it takes a long time. Yeah. You know, sort of stitching ourselves. And it takes trust, right? Yeah, exactly. And it's hard to find that, that it's, it's a delicate balance, right? But yeah, definitely. That's how people change themselves. They work with other people and they change themselves and sometimes slowly, sometimes more quickly, but it is a lot of work and it's hard and it's scary and life doesn't always afford you the time or the space.
Yeah. To make that kind of change. Or to commit to that kind of therapy. And I think anything that gives us an assist in any way, you know, if it can give us a real assist. You know, one of the things that I think sometimes when we're talking about ketamine is it almost feels like, this is just a metaphor, so don't get me wrong as an ER doctor, but it's almost like we're defibrillating the brain, right?
You know? Yeah. There's just a, there's a shake up of sorts. That's actually a, yeah. That's actually not a bad analogy. It sounds a little scary, though. I might not use that. It's not selling it. But, um, No, you know, the waking up thing, that's kind of hard to explain and it sounds almost too religious, like I shy away from it.
But I'll give you an example. I had a patient. She was, is, um, an incredibly accomplished woman. Um, she was an engineering, uh, major back in the day. She's older. She's also close to her seventies. Back in the day when women were not that kind of thing. And she quit to become an artist. Um, and she's became a very accomplished visual artist.
Um, gallery is everything. I mean, she's amazing. She, some life circumstances happened. She became very depressed, she stopped painting. Okay? About three years ago, she stopped painting. And she got kind of bummed out. And there were a lot of reasons for it. And she worked with therapy and she, she's, she was not suicidal.
She was, she was coming out of it, but she couldn't, she couldn't paint anymore. She sort of just put it away. And so she came to me and one of her goals was that she sort of wanted to pick that up again. She was sort of hesitant to even say, I think I miss it. I think I want to do it again. She was able to, Go through the work with her therapist, do the work with the ketamine and one day she came in and she showed me a painting that she did. It was, I, in my opinion, I liked it better than any of this stuff that she'd done in the decades before it was so beautiful.
It was abstract. She didn't usually paint in that, that style. And it was beautiful and she told me, you know, I feel like I woke up. Like I was asleep for three years, numb by the depression, and I woke up and here I am again, ready to play, give me my paint brushes, you know? And so that, that waking up, it's like so hard to, I don't, I don't know what it is.
I can't explain it, but sometimes it feels like that for people coming out of depression, you know? That's so beautiful. And it's, so there's, there's one last question slash set of questions that I kind of want to ask you right now, maybe before we kind of start to bring things to a close. But I'm thinking about what you're saying right now and how we kind of juxtapose it with a conversation that you and I were having at dinner the other night about.
The challenges of what we're talking about right now in a capitalist system when so many people, um, for so many people, what we're talking about just feels inaccessible, impossible. You know, we, we, we live in a world and particularly in a country where, you know, people's economic circumstances are stacked against them and that kind of stuff.
And so, I know this is something that's really important to you, and it's something that you think a lot about. Do you want to just comment a little bit on sort of how we even think about this concept of waking up in a world and in a country where a lot of people are arguably just sort of doing their best to get through their lives, you know, just amidst really difficult circumstances?
Yeah, you know, I um, working inside the American healthcare system as an ER doctor, there's kind of no better way to get very quickly disillusioned. Yes. with, um, modern medicine and with the intersection of medicine and healthcare. With healing. Right, right. Let me put it that way. With healing in capitalism, it's, it is like a pressure cooker. You know, someone said once, like being in the ER, it's every day, it's like if you were on a plane of 300 people that were crashing, the plane was crashing and you have to stop the plane from crashing every day.
That's what it's like. I mean, because honestly, Jenn, I have no idea how you do it. That just sounds so terrifying to me. It's pretty stressful sometimes, but, but, but it's like just, We, we don't have enough time, right? There's not enough time because capitalism always tries to squeeze the last bit of productivity out of everything.
So you have to see as many patients as you can in an hour with fewer resources. And every year it's worse, right? Because of the introduction of private equity into medicine. That's a whole nother conversation. Yeah, that's a whole separate podcast, but we're going to have to have episode two about that.
Right. So I, on the front lines of, of, of It's just sort of the intersection of capitalism and healthcare. I can tell you that it's even worse on the front lines than it looks, you know, from the 40,000 foot view where it is so bad, right? And there is so, it is becoming increasingly difficult to heal in that intersection.
Okay. And I'm not a Marxist by any means. So don't take this like the wrong way. No, I know what you mean though. I do. I know what you mean. But, but when it comes to, you know, people wanting help. There's, there's, there's so few avenues for some people to do that. And, and, and in terms of waking up, like, I think what we were talking about the other night was, sometimes I will have a patient in front of me in the ER who has metabolic syndrome.
So they have so many things wrong with it. They're, they're overweight. Their cholesterol is high. They're, um, they're, they can't breathe because they have COPD. They're basically, like every system is kind of like trembling, and about to fall down in a house that's trembling and about to fall down. Okay?
And they will tell me that they eat, you know, maybe McDonald's for breakfast, lunch, and dinner. Okay? And they don't, they do it because it's cheap and it's quick and they don't have time to eat healthy, but they're dying. Yeah. Inside. And you're giving them different medications that they can't afford, right?
Right. And you're trying to keep the house from falling down. You're trying to fix this problem and that problem, the blood pressure and the yes. And all of it is because they are sick because of everything in their life, almost. And that is so…Yeah, it's like a fish swimming in dirty water. Yeah, it's not their fault, right?
Exactly. It's not their fault. They're living in a food desert, maybe. There isn't, like, a good grocery store for them to go to. So they can't eat well. They can't exercise because they are working a shift, you know, somewhere. They're maybe even working two jobs. They're exhausted. Right. They can't spend time with their children.
They can't. And so, like, it's almost lik, you would have to, in order, you know, to say to someone, like, how do I get better under that circumstance? You would, sometimes it occurs to me, like, I would almost have to take them and shake them and say, you have to change everything about your life. And I'm not sure you can even if you wanted to because of the constraints of capitalism.
And I don't, I don't know how to help you because in order for you to heal and get better, you have to change everything. And the, the, the game is stacked against you. You know, the game is rigged so that you can't. Yeah. And that's like. So saying wake up to me, it's like, it's hard because I, I do feel strongly that we need to, but it feels like a privilege to wake up in a way, you know?
I, um, I think what you're saying is distressing to say the least. And also I think that if we can give anybody hope, I also know that some people do it seemingly against all odds when everything is stacked against them. Sometimes they do it. And in a universe where information is power, I think sometimes all it takes is people getting access to information.
And, and then all of a sudden they start making different decisions. And so I just hope that if anybody is listening to this and they're needing to make a change, or they're looking for something that will inspire them or inform them to heal or to grow, like, I think you've given people a lot of good iinformation and inspiring information to work with. Aw, thank you for saying that. I hope so. And I, you know, I want to just say one other thing. Like, if, if any of us are going to wake up, we need to help each other do that. We need to hold each other's hands. We need to like, we're here to help each other.
And so that's like something else I feel very strongly about. I absolutely agree with you. Is there anything else that you would like to tell anyone that I haven't already asked you about? Something that's burning in your mind, a question I didn't ask, you'd like to answer? I mean, one of the things that I encounter a lot is people who have never done any psychedelics at all.
Sure. Um, and who are scared, yeah, but are curious about it. Yeah, please speak to that. Um, I think there, They're right to be, they're, they're treating the trip with respect, right? If you're scared to have a journey, um, and I'll call it a journey or trip there, that, that's, that's, you're, that's good. You're smart.
You're treating it with respect. This isn't just getting high, right? If you're, if you're using psychedelic medicine, um, there are ways to navigate that. There are ways to navigate that fear, and I have helped a lot of people who have, I've, many of my patients have never even had a beer. They don't know what to, to be able to get to an altered consciousness.
They're very nervous about that. Yeah. And I can tell you that we can hold each other's hands, and I can help you get through it, and other people can, other practitioners can, right? There are ways. to get through it. So if you're scared to try it, don't be, we can get you through it. We can hold your hand and we can get you through it.
Awesome. Thank you so much. What an excellent way to wrap up, but thank you so much for doing this with me today. That's fun. Thanks.
You've been watching or listening to The Nature of Nurture with me, Dr. Leslie Carr. And I want to thank you for joining us. If you want to learn more about Jenn, you can find her at goldenafternoon.clinic. You can find me personally on Instagram, I'm @drlesliecarr.
Many thanks to Dr. Jenn for having this conversation with me, and to all the people who worked behind the scenes to make it happen. Full credits can be found in the show notes. If you found this conversation valuable, please let me know by leaving a review or rating, or by sharing the episode with at least one person who you think might enjoy it too.
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