E81- Problems with Psychiatry, Psychedelics, Trauma work & Three Body Problem (Rose Cartwright returns)

Welcome back to the Thinking Minds podcast. My name is Alex. I'm a consultant psychiatrist today I'm in conversation with Rose Karstwright who's returned for her second conversation on the program She's written a new book the maps we carry all about trauma Our trauma can affect the development of different mental health conditions Psychedelics and meditation. She's also a writer on the hit Netflix TV show Three-body problem today. We talk all about a new book including the role trauma can play in the development of mental health problems Her criticisms of the medical model of mental illness her own experience with meditation and silent retreat and her experience is Using psychedelics to gain a deeper understanding of herself We also talk about her work on three-body problem What it was like to work with the creators of Game of Thrones Some advice as to how to pursue a creative profession and some of the important themes of three-body problem as it relates to Current world events today. We discuss Self-experimentation with psychedelics, but I would strongly advise not doing this at home I'm making sure to use medical supervision if you're ever using any kind of drug to treat a mental health condition Thanks for listening and here's today's conversation with Rose Karstwright Rose Karstwright. Welcome back to the show. Hello, Alex. Very happy to be here. Thank you for having me. You're our first Recurrent guests, you know, we have a few guests we've had in the past coming back, but you're the first one. So congratulations on that Thank you. That's very exciting. You know, we're a fan of the show. So pleased to hear that We've got a lot to talk about. A lot on your plate at the moment. You've got a new book coming out. It's Tuesday. Your new book's coming out Thursday You've just had a psychedelic series on BBC Radio 4 You're right around the hit show three-body problem. So there's probably way too much to talk about to fit into one podcast But we're gonna try our best. Let's talk about your your new book first. The maps we carry I've been lucky enough to to read this book already. I thought it was so interesting because you're so Transparent about the difficulties that you've gone through and it's it's quite unique. I think Anyone that has a bit of success in the mental health realm As soon as they start to encounter difficulties in their personal life Can make people fall into imposter syndrome quite easy. I've even noticed it in on a small scale myself Working as a psychotherapist if I'm encountering some personal difficulties. I can easily feel like I'm a bit of a fraud And I think maybe it's too much responsibility we put on ourselves sometimes, but let's roll the clock back You know your your Facebook pure all about OCD came out in 2015 that then got made into a show on Channel 4 Can you outline for us? What was it like after that? How are you feeling and how that led into you writing your second book sure? Yeah, as you've just said pure is a story of how I started getting intrusive thoughts very Disturbing violent and sexual intrusive thoughts when I was a teenager when I was 15 years old and Didn't understand that experience. It was terrifying. It was harrowing. It sort of took over my life and I It took me several years to find out that there was language for this kind of experience and The language that I found the framework that I found was that I I have a disorder called obsessive compulsive disorder and the intrusive thoughts and Compulsive attempts to neutralize the anxiety associated with those thoughts our symptoms of of that disorder and having kept those thoughts a secret for Over a decade. I decided to start to talk about them and Because I'm a writer the the the natural way that I found to talk about those experiences was on the page So I published an article that became a book that that then became the TV show pure about About that journey of of discovery of of of a finely-finding language for my For this very sort of shameful secret problem that I had and I sort of today. I'm looking back on that and then I sort of I Stand by most of what I said back then. I think that OCD on many levels made sense as a description of my problems and I still do I still identify with having had OCD what changed after the book came out and certainly after the show came out was that I started to encounter ideas that kind of challenged not my experiences, but challenged the way that they're framed as mental illnesses and That was very difficult for me because at that point, you know my diagnosis thinking of myself as having a Disease of the brain. I that was very dear to my heart like that was something that had helped me out of a deeply confusing time in my life and it had been a life raft of sorts and When I threw my advocacy work started to encounter ideas and speak to experts who perhaps sort of differently about mental health problems. I was resistant at first and And maybe I could have maintained that resistance only my mental health meant that I couldn't ignore it because I was after the show came out I had what I thought of at the time as a massive relapse symptoms and I was really at rock bottom and desperate for answers So the search had to continue and that search led me down quite a different path Looking at my problems in quite a different way and it ultimately led to me interviewing a bunch of people working in your field and in neuroscience and psychedelics too and Yeah, it became my new book the mass we carry what were the new ideas that you began to encounter and Importantly, how did they contradict the beliefs you had about your problems before those an idea out there in the ether when I was growing up that Chronic serious distress is down to a malfunction in the brain and that that is the root cause of the distress and that explains the distress and Because it's a simple idea it was very appealing to me and It wasn't necessarily something that I bought into it was just there. That's how I understood what I was going through and I started to learn that Certainly, you know, there's something going on to use your language at a biological level of analysis in OCD or anxiety or depression Probably when my OCD was at its worst if you'd scan my brain no one ever did but you you would have seen a Neural activity that correlated with my distress But where my view evolved is that I don't necessarily see that Brain activity is the root cause of my problems I think the root cause of my problems essentially is is chronic stress in my childhood and That's so it's not necessarily that the new information I was learning contradicted what I understood before it just It's sort of changed the aperture slightly if that makes sense Yeah, and in an important way your your part really reminds me of what I've encountered when I've read about personal growth and Particularly what I read when it comes to psychotherapy and how you as you mature and you encounter different challenges in life You go through different paradigms Mm-hmm And you can find a paradigm that can really help you and it can really help you for some time maybe a few years even And then it can start to wear off and there's that expression Today's epiphany can be tomorrow's crutch So it sounds like for you getting that initial diagnosis of OCD, which actually you have to work really hard to get You have to kind of discover it for yourself first rather than someone telling you if I remember correctly from the book But that that frame work as you described really helped you, but then you realized actually there are limitations to this and You were being prevented from understanding Your problems as deeply as you could have and then that lack of depth when there was a limit to help to the degree that you could grab Yeah, yeah, I'd agree with that. I mean, you know, the the new book is an exploration of different Models that people can use that helpful to understand their mental health and I think that You know, we need a plurality of models and and actually You know that kind of flexibility and not seeing your mental health problems in one specific way It's really important, but it also it wasn't it wasn't as simple as Finding a new world view that was more helpful. It was more I I've realized that actually There's not as much evidence as I thought there was for the ideas that I had for this idea that OCD is a mental illness Like illness like any other illness I went looking for that evidence and I found myself like unconvinced whereas I think There's overwhelming evidence Which times with our common sense intuitions about the world that mental health problems tend to stem from overwhelming stress in the environment And I know that's a that's a really simplistic summary But yeah, ultimately it yeah, it was what was helpful personally, but it was also I had to find out what the experts were saying What they weren't saying and and how well evidence each claim was and I think that makes sense and obviously it was very from We've had conversations offline about the sense of very from individual to individual and from conditioned condition, but I Actually released an essay on the podcast last week about psychiatric medications and how we can use them Sensibly and one of the principles I outlined in that Is certainly that our understanding of what's happening biologically Basically all mental health conditions is at the very least incomplete There's a lot of mystery. I do think that is largely because there is a huge amount of complexity because so many different factors are Interacting with each other someone's biology Someone's psychology and then all the different social factors obviously something like chronic stress can have a huge, you know Impact and you know, we know this from adoption studies for example, you take a a Condition like schizophrenia, which has something it's something like 50% heritable Which would suggest that 50% of the condition would or of the condition would be attributed more to differences in environment and 50% To genes, but that means that the environment is clearly having a huge impact And so it's really it really feels like People can have genetic predispositions perhaps but unless there is that environmental trigger People can never develop a particular condition at all. I mean, so let's get into it then. So, you know, the example you give us schizophrenia like If you'd asked me 10 years ago what I thought that meant I would have said that you know that everyone with that has a diagnosis of schizophrenia that comes out of a doctor's office with it with that diagnosis Has in common the same specific biological signature In their brain, which is not which is not the case which is not the case, but but I think a lot of people in psychiatry Who's like you will say something like schizophrenia and they know that it's a it's a construct whereas people like me Blay people think you're talking about something that you found in the brain. That is that is schizophrenia and I think that that there's a lot of confusion around that and it took me a long time to sort of unravel that Yes, and that that's a point I found myself having to see More and more often as well, which is I don't I don't think you can get away from the fact that our diagnoses are constructs And I think that's true and and their constructs based on clinical presentation. So they're based on a collection of science and symptoms as we know go together very often Whereas I guess what you're saying is that the way Medical professionals can communicate can give the impression that this kind of Oh, we found this particular thing going wrong in the brain. Mm-hmm. Yeah, yeah, exactly and it's you know diagnoses are based on presentation but also each clinician's interpretation of that presentation as well So I think there's a lot I think there's a lot more subjectivity around the diagnostic process than I understood Like if you think about when I landed on an OCD diagnosis the way I characterise that and this is a sort of a trope I see out there in the mental health advocacy space that that was the correct diagnosis and that every other diagnosis leading up to that was wrong and I don't when I was spoken that way I don't think I really even understood what diagnosis means and like what like if it's objective How can a diagnosis be correct or incorrect it's correct if it chimes with? If someone personally identifies with it and it's correct if the clinician in their subjective opinion Which I'm not saying it's not based on expertise and strong literature, but it is the ultimately subjective Yeah, I've lost my thread, but you got it Yeah, and different problems can co-ocar and different problems can contribute to each other So for example I see a lot of patients with I assess a lot of patients with ADHD Which helped me know is is very controversial in the media space, but Very frequently when you're assessing people who very likely meet the criteria for an ADHD diagnosis They have a history of anxiety and depression in the past and very typically they're diagnosed with anxiety and depression several times Before eventually they feel like it's not really the most elegant explanation for the whole scope of different difficulties that they've encountered But of course if you have undiagnosed ADHD Which will span a huge amount of problems problems with concentration Distractions staying on task hyperactivity and positivity sensory over when it's much more likely that you're going to experience something like anxiety and depression You're going to encounter things would be more difficult for you So it's not surprising that problems can compound each other and co-ocar and maybe this is something you've experienced as well I mean, yeah, it absolutely is, you know I've received many different diagnoses over the years my problems ranging from you know, OCD, obviously depression, generalizing anxiety disorder, body dysmorphic disorder, and like At each point of diagnosis, I think they those labels like seemed to offer a ray of hope And you know a way to understand my problem What I was what I'm grappling with in the new book is that like ultimately, I think that that it was a it was a false Consolation and that those diagnoses didn't actually lead me to solutions that really helped and my concern is that you know especially mentioned ADHD like we've seen just explosion and explosion of rates of diagnosis of ADHD and It's tricky because if you sort of express skepticism of that explosion it makes it sound like you're Denying that these people are suffering and I'm not doing that at all like I think um, I think people are presenting are going to doctors and presenting with symptoms that look like ADHD because like they're genuinely suffering and they're struggling And they're looking for answers, but but what I see out there is that a lot of people think that when when they come out of the doctors surgery with that diagnosis it means that they've um, yeah, that they have this specific problem in their brain that they share in common with everyone else with ADHD and Problematically that there are targeted medications that can solve that problem and I don't I you know While I think medications can be very helpful and should stay an option on the table I don't think it's as simple as I've got a diagnosis and I'm going to go and take a medicine to improve the symptoms Yeah, absolutely. I think with all of these conditions it really comes down to how the diagnosis is delivered I mean, I yeah, well how the diagnosis is delivered and how sufficiently transparent you are about the diagnostic process and the limitations of the diagnosis as a concept and then further to that when it comes to management House should a person think about managing their condition. So when it comes to ADHD for example It's important to be transparent about what the diagnostic criteria are and that a diagnosis Cannot at this stage in the game be pointing to a specific brain abnormality because we're not testing for brain abnormalities We're testing for a range of clinical symptoms And should they meet the criteria? There'll be a whole range of ways of dealing with their difficulties Which should really depend on their specific situation. So when it comes to ADHD lots and lots of Patients have experienced trauma traumas more likely in your history if you end up with a diagnosis of ADHD And this is of course the case with a lot of mental health conditions And so part of the treatment should involve addressing that trauma with specific therapies that can actually target it obviously then there are lifestyle factors various psychological techniques medications all of these play a role but by being Transparent about the diagnostic process and taking a more holistic view I do think we can come up with plans and pathways for patients which are a bit more elegant and a bit more Individually tapered to their needs Yeah I've asked I've asked a few doctors, I think including you like what like How and why diagnosis is justified and The response that I've had back is that it's justified because it offers Comfort to The person who's struggling and it offers them a way to understand themselves um But do you think that I also think that diagnosis is the result of just the way it's always been done? Do you think that like if it hadn't been done like that for the past 50 60 years like Would that be the go-to way that you would help people understand their problems? I think there are other things that diagnosis offers And I think there is quite a lot of truth in in diagnosis in that it helps us to understand that different seemingly unrelated problems often co-occur together So with ADHD is a good example. It might not be obvious that someone who has problems Organizing themselves organizing their times a developing routine Um organizing their personal things and someone who also has problems with significant restlessness fidgeting um Someone who says things impulsively without a lot of self-control sort of is that those problems are necessarily related Uh, but when we you know carry out the research and find out that a lot of these problems actually go together in this cluster in a syndrome if you like Uh, it can help people explain things which are otherwise very hard to explain And then I also think it helps them find a degree of community because even though People who have diagnoses of ADHD can still present Uh, very much in unique ways. There's still a lot of commonalities that can be found Do you really you do see the same stories uh over and over again? It's important that a person doesn't over-identify with the label and just make their life about for example having ADHD because there'd be so much about themselves Which is nothing to do with their diagnostic label yet at the same time Connecting with other people through those common arcs Can help them not only have a bit more comfort around it but can help them meaningfully um Then actually start start to tackle the issue, I think it does Diagnosis also informs what you should do uh about your problem now If you you can tackle that in a more simplistic sort of mechanistic way Uh, and if you think about a problem with ADHD for example the most simplistic way of thinking about ADHD would be like There's too little dopamine and northern in your brain And therefore you should take a drug which increases that and while there's truth to that it's too simplistic And then there are other things you need to take into account for example Trauma and chronic stress may have impacted you in such a way that makes these problems more likely And then you have to figure out how to unwind that stress so i'm not did I that I answer your question Yeah, you did I yeah, I I was saying that I you know that I've heard Doctors say that they think diagnosis is justified on the basis of Uh, that it's comforting and you think it's it's deeper than that which I appreciate and I don't disagree with Yeah, and it does it help us to inform the the management But it's all about the the I think what it comes down to is the skill And the new ones with which the diagnosis the delivered the degree of transparency The and the degree of humility and then How uh open and holistic your your your management plan is that's how I see it yeah In terms of your journey then where so what specifically happened to you and where where did you go? What ideas did you discover that's really helped you so where I left off uh after The TV show came out and you know we opened this conversation by you we're talking about imposter syndrome and that a lot of people feel like After they told their mental health stories and they run into trouble that they then feel like frauds and imposter's and I certainly did um You know, I there was a lot of attention coming my way after the TV show came out and um Having sold what I thought was a redemption story of how CBT had helped reduce my symptoms And having had this massive relapse um I I was at rock bottom and that was a a Very challenging level of cognitive dissonance get my head around, you know, I have people emailing me every day So thanks so much for telling your story like you know, can you give me the email address of your therapist or like Give me any tips for like what worked for you and I'm there like self-harming um and coming face-to-face with The reality that like everything that I thought had worked from like my Sort of medical worldview to the specific treatments like hadn't worked um and I was in a really really bad place um and You know, there was a I was I was able to appreciate later that there was still like a spark in me um still like a A bit of me that wasn't beaten and you know, it still had curiosity and still had energy to put towards trying to get well and um I was following the psychedelics clinical trials um having Attended a couple of talks. I started watching very closely what was going on there. So I'd reading quite a lot of literature and um a lot of the stuff I was reading about How psychedelics can help people become unstuck was very resonant and the way that you know, this word trauma kept coming up and Whilst I was aware that I'd been through really difficult things when I was a kid um And I'd tried to explore those things through talk therapy those are part of me that was still very locked off to The pain and the reality of all of that stuff and something compelled me to explore psychedelics further and um, you know, I was very aware that taking psychedelics especially when you're having a mental health crisis is a risky thing to do um Equally, I felt like it was a risk we're taking given that um, I felt I couldn't really get any lower and I thought if I lost my mind You know, there's nothing to lose. So um, I found found a couple of psychedelics guides and answered um Um, when in completely terrified which you know, I think a degree of Fear and anxiety around psychedelics is appropriate um because it's a huge experience Um, when in and had a massive um, sort of devastating five gram Pruffle journey and uh, it was it was one of the worst days of my life But um, almost also one of the most revelatory, you know, I it the The sort of the reality of the pain of the things that I've been through just like hit me in a very As they often do on psychedelics simple and profound and unambiguous way um And I came away from that experience with a sort of new lens on my problem and um I can talk a little bit more about like the childhood stuff that sort of led to me feeling the way I did But um essentially yeah, it was that that was a that was a turning point moment in which Well, the sort of catalyst of uh and one catalyst in a series of catalysts that led me to reframe my problem What do you think in terms of the psychedelics uh experience itself? Uh what happened and how do you think that led you to a deeper understanding of your problems? It was a extremely intense Experience it was in many ways a kind of classic bad trip in terms of like all the sort of nightmarish qualities or the incoherence um What I would think of as a sort of ego death type experience whereby nothing existed um And uh the peak of the trip. I had a very powerful vision as uh I well before the peak of the trip I was It was a really beautiful moment where I was surrounded by my entire family and I was enjoying this like proximity to my mom There was tenderness there. There was safety there um And at the peak of the trip all of that got sucked into a colossal black hole in the sky and I was screaming and bashing my Fist against my ears begging my mom not to leave me um and You know really kind of like blockbuster nightmare stuff and um Coming coming around from that experience um I just I just mysteriously understood I was like oh yeah like all my problems are at root about the pain of dealing with a mom who had bipolar disorder and who was repeatedly taken away from me and put in psychiatric Hospital, you know, we're talking for you know the first 20 years of my life. That was going on Longer actually, but you know my entire up until I was 18 my entire childhood um and uh You know it you know in short those experiences like watching her go through what she went through um hearing the things I heard You know it devastated me and and I think that my OCD evolved in my adolescence Um as some way to kind of cope with managed contain or distract me from that overwhelming stress and um it's It's at once a very simple answer, but also a very complicated one Um, and you know you can have that insight, but that doesn't lead to um Uh healing and that was you know the book is about like that that healing process Yeah, and I I think that that leads to your I guess the one of the fundamental points You're trying to get across in the book, which is uh uh An unsophisticated Medical model that views your OCD process purely as an illness Fails to grasp that a lot of your symptoms were a defense A way of trying to cope with all the really difficult things which happened to you. Yeah exactly um You know in a way and I think the and I think a sort of A compassionate view of the medical model which is one I tried to take in the book even though I'm a critic of it is that like uh I needed I needed comfort. I needed a way to understand what I've been through and in a way to think of myself as having a medical problem as having a mental illness and the problem originating in the matter of my brain um That sort of colluded in that the protection from trauma Um, and I think that's one reason why that story has become successful because people go to doctors for wanting that comfort and Doctors understandably want to give it um, so uh, yeah, I think I think I do see it as a As a barrier of some kind and but you know ultimately it was that barrier that you led me to the only living half a life as well And psychedelics are helpful because they Break it down for you and they show you what you've been avoiding. That's also why they're terrifying Yes, and it's it's funny how that that restriction I'm struggling to put it into words, but you know that phrase living half a life Stands out to me. Could you tell me more about that? Is that living half a life because you felt You were blocked off from parts of yourself I mean, I explore I explore lots of different ways um of Thinking about the sort of symptoms of trauma and mental health problems in the book and um no one No one description like captures it in its entirety and like as I've grown up I've figured out different ways to think and talk about it um, what do I mean by living half a life? Um, I mean So looking backwards and like how I feel now um The healing has not just been about um a reduction in distress or anxiety or a lot of intrusive thoughts But it really feels like a kind of all-body Experience a kind of connectivity and I know it's very trendy to talk about the nervous system now um and how like trauma healing can make you feel more whole and more grounded, but um That kind of language really really does capture What it feels like to be um to be much better um, I feel like I'm Uh In relationship with the world and a way that I wasn't um, you know, I notice Things like eye contact and like you know, what it's like to notice that when you smile Like it makes someone else smile or like I'm more responsive to physical touch. I'm a nervous system feels alive so um Before I think my nervous system was very very shut down um because CD or whatever however um, however you want to describe that mechanism had to kind of constricted my ability To be fully present and fully relational in the world because being present was terribly painful and and I think Um, if we if we use trauma language uh, I think um the trauma response is quite crude um, you know, it's it's um It's like, you know, in the book, I describe it as like putting suppressant foam on a situation It's not discriminating. It's shutting you down as a person. So um, yeah, you know, half a life I think um Yeah, that's exactly what it felt like and that trauma response It's really good in the short term can really help you through a traumatic situation But then Is problematic in the long term and funnily enough we see that A lot in in physical medicine that uh, I think I may have told you this at some point a lot of chronic health problems result from scar tissue So scar tissue obviously really good can stop you from bleeding But you get scar tissue building up over years and you'll live it that's cirrhosis scar tissue uh building up or in your arteries that's atherosclerosis that can give you a heart attack or can give you a stroke So it's this idea that our body whether it's physically or psychologically can do things that can really save our life in the moment But then continue to interrupt our lives in the long term. Yeah, I um I like that metaphor. I think that medical metaphors are really apt often another one I like is the idea of an abscess, you know like um and abscess is The body like walling off um a sight of infection um and That's important because it stops the infection spreading But it causes problems because then the infection can never heal and I think it was I think poor Conti Traumatologist uses that um and I like it I think it works And to give people an idea how many Psychedelic strips uh did you take it was quite a repeated process from what I understand how many roughly do you think It took i what pointed you start to feel like a sense of kind of relief and and things really improving for you It's really it i mean it's really tricky to say because I don't necessarily draw a distinction between what It's difficult because psychedelic therapy is not a legal thing. It's not an established thing yet So we don't really have a definition for what psychedelic therapy is um, you know, is it is it psychedelic therapy if I Repeat the maps protocols in my bedroom and trip on MDMA on my own. I don't know um You know, is it psychedelic therapy if I'm taking ecstasy at a rave and I'm having some profound insights about my life um You know arguably not but um like you know, I had very profound experiences in casual recreational settings um And in terms of like formal psychedelic psychotherapy so I did In total, I did three like big uh Like five gram uh not quite five gram two big five gram psilocybin journeys and one hippie flip Which is slightly lower about three point five grams of psilocybin with mixed with MDMA. So it did three big psilocybin trips and then um six more formal um MDMA guided experiences and then in and amongst that raving partying um, but this was all over space of four years And what so I did a lot of yours and were you having therapy uh Outside of the psychedelic trips as well. Yeah, I mean um You know, there's a lot to talk about the importance of like not just it's not just uh Taking a drug. It's about everything that goes with that um, it's how makes you making sure you have psychological support Making sure integrating your experiences and because again because there aren't like official channels through which you can do that Um, I mean there are people are rolling out things like integration programs, but um there's not much So I was working separately with a psychotherapist A brilliant psychotherapist um and I was she wasn't the person who was in the room with me when I was tripping um, but She was on board with what I was doing even though she didn't necessarily you know condone it um, but I would then so I would trip and then I would book in a session with her and talk about everything that came up and you know that was That was a really important space for me to just like stay anchored even though I was uh, you know I don't want to say maybe I do want to say taking risks So I was taking risks with my mental health and it it was important to know that um there's Yeah, that I have somewhere to explore all the material that was coming up and at the opening of the book He talked about going on silent retreat and meditation and what role did that have in all of this? so meditation uh Has been huge for me um, I don't I can't imagine having My life having changed where it has without meditation. It was actually meditation. So I had my first And I feel like I should Uh, prefaces by saying that you know, I'm I'm an atheist and I'm a skeptic and if somewhat if I'd heard myself say this like 10 years ago I wouldn't have believed it was me but on a meditation retreat in 2017 I had a spontaneous mystical experience. I had a full-blown all-ter-state of consciousness as strong as if I'd taken psychedelic drugs and I hadn't taken anything um That was in 2017 which is in the midst of the supporting relapse that was having and I spent um more than a hour and a half Completely free of intrusive thoughts or or any kind of mental health symptoms or even any sense of like me as um As who I thought I was it was a non-dual experience no um no mediation between myself and experience um just experience and It blew my mind. I came away from that like You know, that was one and I mentioned earlier that there was a series of catalyst that led me to question whether or not I had a mental illness. I was like well if I've got a mental illness How can the symptoms of it spontaneously disappear for an hour and a half that doesn't fit with my understanding of the fact? I've got a broken brain um And it was that it was that experience so yeah, it was in my my my journey into psychedelic started with a sober trip um and um The meditation has continued to Support me giving me a place to explore what's going on in my body and my mind um and Is remains a stable presence in my life and a way to access Community so yeah, it's been invaluable and I see meditation psychedelics as fairly sort of adjacent practices in terms of the insights that Can come up. Yeah, that makes a lot of sense and and now these still I used to doing using psychedelics Um, I haven't done any formal. I mean it's so funny saying formal because there is no formal like There's a network of underground guides offering sort of therapeutic services But I haven't done any of that for every year um undoubtedly a willing future um I still a few times a year will go to a day party, but I'm kind of a grandma these days, you know The raving the raving is is happening much less frequently um, but yeah, I mean it's still a part of my life and um I think it always will be You spoke to Robin Calhardt Harris recently on a radio program. He did about psychedelics people can check it out I put a link in the description What was he able to tell you about the current state of the science or what he's working on? Well the scientist is very optimistic because I understand he's studying Silicide bin for treatment um of depression and anorexia and fibromyalgia you get chronic pain and Yeah seeing incredible results um in terms of like What's going on neuroscientifically? I couldn't summarize what he told me because it would be a disservice to him Um, but it's but um yeah, I think there's I think there's a lot of warranted excitement in the space and also you know skepticism like it's um You know, we It it feel in one sense. It's late. It feels late to be talking about psychedelic therapy in in another sense It feels too soon, you know, we can't even have like a grown-up like adult conversation about drugs and drug policy And we're talking about prescribing these things to people and connect so it's a weird time um But um, you know The clinical trials are ongoing and from what Robin told me like it's all moving in the right direction, but but equally I don't think it's a dead sir that this is all going to be rolled out I mean more so for MDMA, you know, it looks like that's coming imminently especially in America But um, we still aside bin it's there's still a this sort of fairly long road ahead Yeah, it's definitely super exciting to see what's going to happen with that and I do think It would help um break a sense of stagnation that's that's been Present within mental health for some time kind of partly for some of the reasons that we've outlined today In parallel to all of this at the same time as you've been writing your second book you've been working on an ethics show called Three Body Problem Which Now as I understand as well the most viewed shows in the world. What does it feel like To be a writer on a show that's doing so well that everyone's talking about Yeah, it's been really it's been really exciting. It's um It's a sort of a new dimension to my career, you know um Writing about mental health and writing books is like very very dear to my heart um and I think I'll always do it But it's not necessarily the most accessible way of getting your creativity out in the world Whereas you know a TV show especially like you know big blockbuster sci-fi like It launched a specific day and everyone was watching it at the same time and like my dad was watching it and my nephew was watching it. It's like everyone can kind of get on board Um, and that was a really new experience, you know and and Strange that it's happening at the same time as the book coming out, you know those two launches happened within three weeks of each other Because one you know one is reaching hundreds of millions of people one will have a very very modest reach um, and you know it's kind of a case of breath and depth though right because The book might reach fewer people but probably will hit that much greater depth Yeah, I hope so um, but yeah, no, it's been really really cool. Um, I couldn't I don't think I could do The mental health stuff and like write books if I wasn't also doing the screenwriting um You know just practically I need those strings to my bow um, but yeah, you know it was fantastic It's you know shooting a show like that is it is a really it's a wonderful experience and it of you know gave me a lot of community like a film set is a village and you spend 10 months there um And I was a the huge factor in in my mental health as well, you know I felt it when we stopped shooting I felt the loss of not being surrounded by people every day and being engaged in creativity um, I think that's a really sort of underserved aspect of mental health generally is Having people around you like united in in something meaningful um, uh, yeah, it's been wonderful And on this project you got to work with the creators of Game of Thrones What do you think you learned about the writing process from them? Well, it's a big question. Yeah, um David Benioff and Dan Wise um my co-writers and friends they um you know they They came off the back of Game of Thrones and uh They decided to Try and make something Arguably even more ambitious and even just that as a a move as a play was really inspiring to me Um, because they are under like so much scrutiny um, you know The wind blows strongest at the top of the mountain like they're at the top of the mountain when it comes to TV production Um, so just like watching them um just like a cope with the pressure of doing what they do um Was yeah with really inspiring um, they've taught me They've taught me so much about characterization about story structure about um, you know, the constraints of budgets on locations And you know, it's it was a really like 360 immersion into into TV writing um And yeah, you know, I was also um, you know, I was working under them like supporting them as producers as well And you know, it's not just writing. It's like taking your script to the point at which you're shooting and going up to the writers and giving them critique On their lines and their intonation Um, so uh, it's a much more involved process than writing a book and um, yeah, I'm just I'm lucky that I got to do it alongside them Very lucky and then I might ask different question, which is What do you feel you were in a position to uniquely add to the show, you know, what could you Deliver with your voice in terms of in terms of the writing on that show I mean, I think you know, it's a it's a room. The writer's room is like full of very very strong writers um I don't think I'm necessarily unique in my dialogue because everyone's dialogue is brilliant But um, I what I love to do and think what I'm best at is um Just like getting into people's ears and inhabiting characters in a really natural way that makes people on the page feel like real people That's why I love to do um, many different aspects to writing like you know structuring the story beat by beat in a writer's room with cue cards up on the wall is very different to sitting Down and and running characters lines in your head and figuring out how they speak and what's going on in their heart And that's the bit that I really love and I think um I think Well, I hope you can you can feel it in the in the dialogue that I created for that show. Yeah, yeah for for a long time Sci-fi has been a really interesting genre to use, you know, fantastical ideas To to express, you know, interesting or important themes about what's happening now Uh, you see this with with dune 2 which is also out at the moment, which is also uh, which I would also highly recommend um What are some of the themes within three body problem that you really gravitate towards that you really think all these are messages Really worth expressing in the show So, you know humans have just found out that aliens are coming in 400 years right and um But the show isn't about aliens at all It's about human beings and it's you know Me, what I resonated with in the material and this comes from the books by Sitchin Liu, which are just fantastical in their scope um Was this idea that was it was a question really is like can human beings Collaborate and cooperate when they face existential threat and I think one of the reasons why the shows been really successful is because it feels like and I think every generation feels like this It feels like we are facing unique existential threats right now um and uh, you know I've had I've seen it read into three body problem that the aliens coming is a you know metaphor for climate change um, and you know climate change is a theme in the show. I don't think that's necessarily as sort of explicit top line But um, it certainly makes sense as an interpretation um, you know, that in the episodes one and two is that we show lots of deforestation um Yeah, when jere invites the aliens because she feels like human beings are going to destroy the planet unless we have intervention um, but yeah, I mean, I think you know impending aliens is is is is a very broad Metaphorical container for affees right now Um, which is why it was sort of fun fun place to play as a writer Yeah, and aliens always have been in a way aliens, I guess First became aliens were first injected into the popular culture right after we created nuclear weapons And it's I don't think that's you know a surprise and I think you know among all the existentialists climate change Pandemics, I think nuclear weapons. I certainly feel with Partically with the war in Ukraine. Obviously There's this rising field of existential threat from world war nuclear weapons things on those lines and Three body problem definitely captures That sense of Anxed That we can all feel that this could all go away very quickly Which is really a very new thing. It's only about 78 years old that any given human could feel like the entire world could collapse I suppose in the past a person might think of my society might collapse but there's something categorically different about thinking the world itself may end as a result of human intervention And it's you know when I first interviewed for the show back in 2020 the boys asked me whether or not I was a sci-fi fan And I said not particularly because I'm not I love a bit of grounded sci-fi, but like my background You know my reading background my reading history is not in sci-fi But I said to them what does interest me is metaphor And you know I You know metaphor has been really helpful to me in my healing from mental health problems as well like metaphor is like Comparing one or looking at one thing in terms of another and I For me metaphor is about integration and and and immersing myself in stories And especially metaphorical stories was like a really important part of of integrating my psychedelic experiences I've like staying open and exploratory rather than getting sort of fixed on another static idea about what my problem was yeah absolutely absolutely And what you know it's it's so hard to succeed in a creative profession and you know anyone that is trying You know, we're always looking to people who have achieved a certain level of success To try to learn from them. What what advice Will do you give to someone who's either starting out as a writer or really in any creative field? What what advice would you give them as to how they can push forward? Uh, I mean, I would say what Dan why I said to me what trust your intuitions like um It's when you do creative work There's a lot involved and it's not just it's not just the creating part. It's also the sharing part and um the capitalizing part and that last part can be very very reductive You're constantly fine that your ideas are simplified and reduced down in ways that you can predict and um That can be really challenging, but and it's but it's also inevitable in the climate You know whether you know the reason I wrote the book is because it's a it's Offers real authorship in a way that many other media don't um, but even then you know, you have to like you you have to let go of a certain level of control um And you can only do that if you really stay true to like your vision for the creative project and just like know that um That the gatekeepers don't know your subject like you know it so just stick to your guns I'm just like just yeah, just just keep going Yeah, and I guess even with the book you have a lot more agency, but you can't control Or someone might interpret what you're saying or how they may react to what you're saying You can't and you know like you know, for example, I It even just like the editorial process like having other people right about your work That is Dictating the way your work lives in other people's minds and you can't control that and you have to sort of become non-resistant to that um I was interviewed by broadsheet recently and in like over an hour's conversation. I probably Said one line about brain chemistry something along the lines of um Whatever these chemicals did to my brain. It was really powerful and I'm no doubt I did say that but that was the one pull out quote that they use in the and you know and it's like You can't and it's not it's not false like it that that's you know I did I did say that but it but just even like the way things are weighted um could you know Yeah, you can't control that but it's okay. Yeah, and even going back to our previous Conversation about Medical models and the way we pick out information. I think it's a It's a very human problem To see the world to have particular lens To overemphasize certain aspects of what you're seeing and to undemphasize others depending on your beliefs So I mean doctors will do that therapist will do that And we're all just trying to I think most people Have the best of intentions We're trying to figure out the world but perhaps there isn't sufficient realization that we have these kind of limited lenses that we're appearing through Which you know can lead to quite strong ideological positions And it's really the dialogue between different positions I think that can help us to continue to move things forward and to arrive at more sophisticated Understandings of complex problems. Yeah, I think so I think so I mean it was all just Huxley talked about that process As a reducing valve and that consciousness is constantly reducing The amount of information we can take in about the world at any given moment and And the information we receive is the information that's going to be helpful to us to survive but that but you know He encourages us after he did this big while he got into masculine um to To remember that that Valve is there and that what we're seeing is not necessarily The you know the full scope of reality as it's available to us and the there are other ways of seeing and I think that's the yeah That's why psychedelics can be really helpful in a in a mental health conversation that feels very In entrenched and intractable that doesn't feel intractable to you at the moment It does yeah, it really does like because it's um it I don't know like A mental health system is in a really bad way in my view um It's not working. It's um you know even treatments that were told at evidence-based just Too often are not working for people um and I think um a lot of people are chronically unhappy and um You know, I don't I don't think the medic that I don't think psychiatry bears a responsibility for that I think these are like very broad like social problems that are leading to people's distress but um I think I don't know it feels like psychiatry is also very resistant to innovation Um because of because it's badly incentivized and because it's an industry and I think people are suffering as a result of that so um I am excited about psychedelics potential, but I'm also slightly nervous because like you know I see I don't see things being in a good state out there in mental health care Yeah, I think there are definitely very very big problems within particularly NHS in this country Mental health systems that need to be challenged and in other countries as well and I think that informed criticisms critiques of the way we do things like yours and the way we Out the way you outline things in your book I think stuff like that's really helpful so that we can actually Improve and get better and arrive and more sophisticated understandings of things. Yeah, I mean the balance I was trying to find in the book was like um You know, I am at times quite scathing of the medical model of distress and um just why I see it's like the excesses of psychiatry of the past few decades um, but also I wanted to try and do that in a way as far as possible that was like uh You know compassionate to the people working within psychiatry who've been trying really hard for a long time to help Um, and I don't think it's that um that uh people working in mental health care aren't skilled or they don't care or they greedy or They're just pushing biomedical agendas for profit like none of that resonates with me um and I've I've read a lot of critical psychiatry literature and a lot of it I'm Very unbored with except that I find the tone of it quite grating sometimes that it's it's sort of It's just sort of repeating the credulity that's part of the problem in the first place um, so um yeah, I guess the book is an attempt to um be critical but um But yeah, you know sort of consul it consulatory way if possible Yeah, and I think that comes across and I also think that change happens at different levels I know many psychiatrists and other mental health professionals That I don't think they would largely agree with what you put in your book And I think it's once you get sufficient individuals within a system who start to change their way of thinking that then the system I think the system itself is usually the last thing to change Uh, and I think I remain quite optimistic about the future But I do think that change takes quite a long time because Systems have a tendency to stagnate and to remain quite ossified until Certain thresholds are reached. Well, I'm glad you're optimistic. That's that's good There are reasons for optimism. Yeah, okay. Well, thank you so much for Coming back on the show adding courage everyone to read your new book once it comes out in a couple of days Whether you're a mental health professional or not And we'll put a link to the book in the description as well Amazing. Thank you so much Alex. Thank you. Maybe we can make a hat trick next time. Yeah, that's it Okay, hi Thanks so much for listening this week if you've got any feedback as always do get in touch if you enjoyed the episode Why not give us a rating on Spotify or Apple podcasts because it really helps other people to find us if you want to get in touch She can find us on Instagram or Twitter or you can drop us an email and if you value the show more generally wine or bias coffee, thanks so much.