Vigilante Psychopharmacology: Treating OCD with Psilocybin Mushrooms
By Brian Normand
What was it like having severe OCD?
Most people think of OCD as excessive washing, and while that's certainly a fairly common form, there are many others. My OCD revolved around decision making: I'd agonize over even the most trivial choices (say, what shirt to wear), and as soon as I did decide, I would feel an overwhelming compulsion to reverse my choice. When I gave into that, I would suddenly realize my first choice was really the right one, and reverse again. I'd lose hours every day on these sorts of minor decisions, and bigger ones (say, choosing which apartment to move to) could completely incapacitate me for weeks.
Did you have any prior experience with psychedelics before you embarked on this vigilante psychopharmacology?
I'd tried LSD, MDMA, and mushrooms, but only once each. The LSD and MDMA had zero effect beyond mild stimulation - I now know that's because I was on high doses of SSRI anti-anxiety medication, which often negate psychedelic effects. Mushrooms had a moderate effect.
Why did you decide to try and treat your OCD with mushrooms?
Utter desperation. By the time I read about the Moreno study*, I'd tried over a dozen different medications, seen a multitude of therapists, experimented with all sorts of holistic approaches and fringe therapies, but the OCD just kept getting worse. This is actually quite common: research shows that about half of OCD sufferers have no real response to medication, and those who do respond generally see only moderate symptom reduction. Therapy can work wonders for some, but many others are like me deemed "treatment-resistant", which basically means, psychology and psychiatry can offer little help. Sometimes in those cases they'll actually do psychosurgery, permanently destroying certain brain regions, even though the benefits are variable and the procedure can cause irreversible cognitive impairment and occasionally paralysis.
*(The study he’s referring to is Safety, Tolerability, and Efficacy of Psilocybin in 9 Patients With Obsessive-Compulsive Disorder investigated by Francisco Moreno, MD at the University of Arizona, Tucson in 2006. There have been no follow up studies.)
How many times did you experiment?
Well, if you see the show, you'll learn that I only had one real mushroom trip. At the time, for whatever reason, mushrooms were very difficult to find, at least in New York. But then I discovered mescaline containing cacti (specifically, Bolivian torch cactus, Echinopsis lageniformis, and San Pedro, Echinopsis pachanoi).
The first time I tried these it had almost no effect, and I realized I would have to get off the SSRIs, which I did (not easy by the way, talk about withdrawal!). But even after that, I still had a very high tolerance, which I attribute to residual effects of being on SSRIs for almost 15 years. With cacti there's a limit to how much you (or at least I) can choke down, so I could never really get beyond a mild trip.
But then I met Hamilton Morris - not through the drug world, but through comedy - we were both working the same club. (Hamilton doesn't do stand up anymore, sadly, as he was one of the most naturally gifted comics I ever worked with. I've tried to prod him to get on stage again to no avail.) And through Hamilton, the wonderful world of research chemicals. I went pretty far down that rabbit hole, trying at least a dozen different synthetic tryptamines and phenethylamines. All in all, I tripped a lot - perhaps 30 experiences over the course of a year. The technical term for this is "being an idiot" - I was trying to force a certain outcome, but of course that's antithetical to the psychedelic experience: you have to allow things to happen.
If you look at the research coming out now, you're seeing phenomenal results with just a single experience. But the key thing is, none of the study protocols are just "take this drug and report back."
A lot of the research happening now is not on psychedelics, it's on
psychedelic-assisted therapy, and that's a huge difference. Clearly, the way to use these chemicals/tools/medicines/drugs (whatever your preferred term is) is embedded within a very carefully designed therapeutic context. When that happens, negative outcomes are drastically reduced and positive outcomes drastically enhanced.
What was the experience like? What were your insights?
Well, there were many experiences and quite a few insights. But let me try to sum up the most valuable experience from a therapeutic perspective.
OCD is all about control: trying to ensure things are perfect; precisely the way we think is best. It's that attempt to control, to eliminate uncertainty, that causes all the suffering. Because, of course, we actually control so little, and certainty simply doesn't exist - it's like "nothing", a vague concept that can't be found anywhere except the human mind. It's that compulsive need to find certainty that drives OCD. (E.g., the need to be certain you're perfectly clean drives hand washing compulsions.)
Now, I recognized all this intellectually, but the OCD was so ingrained, that insight didn't alter my behavior. Under psychedelics, for the first time, I viscerally (and even that word's not quite right, but anyone who's tripped hard will know what I'm referring to: a realization that exists more in body than mind) saw that I wasn't in control, and therefore, I had nothing to lose by letting go of trying to control everything. (And the letting go itself was visceral rather than intellectual.) Once I was able - or willing - to do that while tripping, I gradually learned to do it while sober. And that changed everything.
What was your set and setting?
It varied. At first I was tripping in Manhattan; I realized soon enough that was not optimal, so I tried to have these experiences in nature. My favorite spot would be a secluded beach.
I hadn’t heard about treating OCD with psychedelics until we arranged this interview. Did it have lasting effects?
The short answer would be: Yes, but not in the way I thought it would. I was hoping for a silver bullet, a quick and painless elimination of the OCD. The reality is that I still have obsessions (i.e., repetitive thoughts) and compulsions (i.e., urges to take action to eliminate those thoughts). The difference, though, is that I rarely actually engage the compulsions. So while I still have anxiety over decisions, I generally don't get trapped in these cycles of making and reversing decisions. And that's fucking huge.
Because the anxiety isn't so much the problem, it's the behaviors that consume your life. And of course, those behaviors create massive anxiety - if you haven't left your house in days because of OCD, if you're losing career opportunities, friendships, etc. you're going to be anxious about that, which in turn just feeds the OCD.
You premiered the performance at the New York Fringe Festival. How has the reception been?
Haha I love this question - you've set me up perfectly to cite my reviews without seeming like I'm boasting!
Time Out New York said the show was "a true-life tour de force" and named it a Critics' Pick, The New York Times said I "mine a great deal of laughter from disabling pain" (they also called me awkward, which I think is fair), and we won the Fringe's Overall Excellence Award for Solo Performance.
But truly, the most gratifying response was from people who were touched, either because they have OCD, they know someone who suffers from it, or simply because the central struggle I recount is really universal: we all engage in behaviors to avoid pain that actually just create more pain, for ourselves and others. We all have addictions. We're all unconscious, to some extent.
How do you see psychedelics affecting mental health in the next decade?
Profoundly. If you really look at the data on psychiatric drugs, it's pretty abysmal. There's some evidence the antidepressants help severely depressed people, at least for a bit, but for people with moderate depression, the best meta-analysis really doesn’t show clear benefit over placebo.
I've already mentioned the inadequacy of current therapies for OCD. With schizophrenia it’s now clear that the newer antipsychotics that were hailed as wonder drugs actually aren't any better than first generation antipsychotics, which is to say, not very good.
So the point is, psychiatry doesn't have really good tools to help most people. Meanwhile, the early data on psychedelic-assisted therapy is phenomenal. You're getting results that are orders of magnitude greater than what's coming out of pharmaceutical companies. MAPS is predicting FDA approval of MDMA within five or six years. I suspect psilocybin will be the next to receive approval. So within a decade, I think/hope that these drugs will be readily available to those with medical conditions (probably not a prescription you'd pick up, but administered in a clinical setting). And if they are, I think they'll be very widely utilized simply because the other options suck in comparison.
What do you hope to accomplish with The Mushroom Cure?
One word: groupies. But really, while of course I want personal success and acclaim and validation, I have two slightly less selfish goals.
First, I want to increase general understanding of OCD. I've had quite a few people who've contacted me after the show to say they didn't realize they had OCD until they saw The Mushroom Cure. They'd been suffering for decades without really knowing what was going on. OCD is generally depicted in a very narrow and stereotypical way in popular culture, but in my experience I'd say at least half of OCD sufferers don't have the classic contamination fears.
Second, I want to increase awareness of the potential of psychedelic therapy. Obviously your readers are already aware of this, but hopefully my show is also reaching people who aren't familiar with this world. A key to getting people to be open to psychedelics is knowing people who've used them in a positive way, and by the end of the show, anyone in the audience knows me quite well.
How did you get linked up with MAPS?
I've been a great admirer of what they're doing for years. I really don't think there's a more important organization out there. To be sure, there are more urgent problems facing humanity (war, starvation, epidemics - take your pick) but those are complex problems that many, many people have been trying to solve for many, many years. Whereas, the solution to the current lack of psychedelic research is very simple: more funding. And really, not even that much more. If you look at what MAPS is accomplishing with an annual budget of $4 million, it's astounding. Pfizer spent over $200 million just to market Cialis last year.
You have the last words
I'm really happy Psymposia exists. The proliferation of psychedelic reform groups is a tremendously encouraging indication of how deeply and quickly the psychedelic renaissance is proceeding.
I really think we're at the point of no return, and that's a wonderful thing. Shit needs to change, and I don't think there's anything else that has the same potential to catalyze rapid, profound, and (when used intelligently and respectfully) positive transformation.