The costs and benefits of psychedelics

Psychedelic art, a movement that started in the 1960s, was inspired by the insights derived during the use of psychoactive substances that are known as psychedelics. From the unique riffs of Janis Joplin’s Summertime to the designs of Wes Wilson’s posters, psychedelic art overwhelmed the audience with kaleidoscopic images and fractal sounds. Albert Hoffman, the Swiss scientist who first discovered and ingested LSD, directly attributed the inspirational source of his era to psychedelics.

So, then an important question concerns what makes psychedelics so special that under their effects artists can access such stimulating sources of inspiration.

There are various accounts that aim to explain this phenomenon. One of them is ego dissolution. Ego dissolution refers to the disappearance of the distinction between the sense of self and the outside world. Under psychedelics, people seem to lose their sense of self and report feeling as though they are one with the universe. These descriptions are similar to mystical experiences that are reported throughout history with or without the effects of any drug. And it is possible that ego, or the sense of normal, waking self, relies on a certain set of biological functions that filter the outside world. In other words, normal waking consciousness may rely on a function that eliminates or inhibits sensory stimuli and filters it down to a set of sensible and meaningful thoughts and feelings. Earlier models of psychedelics in the 1960s posited that psychedelics disrupted this filtering function and opened up the gates of consciousness, leading to experiencing a greater number of perceptions, emotions and thoughts.

Recent neuroscientific theories closely echo these earlier theories. For example, Entropic brain theory of psychedelics suggest that ego dissolution can be explained by changes in brain entropy. Entropy is a measure of a system’s physical disorderness and can be applied to biological phenomenon like brain function. When brain is in a state of waking consciousness, it yields greater entropy than when it is at a state of sleeping. Similarly, patients in vegetative state shows reduced entropy compared to healthy controls. So, entropy in this context also relates to the richness of conscious states. Entropic brain theory suggests that psychedelics increase entropy in the brain by reducing the activity of the centers of the brain that usually correlates with self-referential thinking (e.g. ego). This network of the brain is called the default mode network, and this network is usually active when we are not doing a task. During task, it is muted. So then by inhibiting the activity of this network, psychedelics are considered to permit a greater repertoire of brain activity which leads to greater entropy. Evidence for this account comes from studies that test brain connectivity under the effects of psychedelics. These studies show that brain network that usually don’t activate together, couple with each other under the effects of psychedelics.

Despite differences in their definitions, all these models (i.e. the compromised ego, the reduced default mode network functioning or an opened filtering valve) converge at the loss of something (i.e. sense of waking consciousness) at the expense of another (i.e. sense of unity). As if these two states of being cannot co-exist.

However, this trade-off is often true for waking consciousness as well. Waking consciousness is regulated by a cognitive process called, cognitive control. Cognitive control is the ability that allows us to stop scratching a wound or listen to a lecture while taking notes. Cognitive control comprises of functions that commonly trade-off with each other. For example, focusing at a presentation trades-off with switching our attention to checking our mails. This is because there is a limit to our cognitive abilities, creating a bottleneck in processing. That means cognitive control operations hold an intrinsic opportunity cost: one can only do one at the expense of another. Therefore, the value of a task determines the cost of another. The trade-off between focus (i.e. stability) and switching (i.e. flexibility) has led researchers to dub this duality, the stability-flexibility paradox.

On the opposite ends of this stability-flexibility spectrum, lives psychopathologies. Too much stability (i.e. focused thinking) is associated with obsessive cognition and rigid behaviors. Too much flexibility (i.e. switching between thoughts) is associated with distractibility. A balance between stability and flexibility is necessary for optimal task performance. However, environmental cues, task context or rewarding one process over another will bias behavior towards one or the other. That means, engaging in this stability-flexibility balance is an adaptive process. The mechanism that tracks and learns the value of either state is called ‘meta-control’. Meta-control operates as an arbitrator between states of stability and flexibility by accounting for environmental or internal factors. For example, consider this day and age of social media. An average person is exposed to hundreds of social media posts, feeds in a continuous way on a daily basis. In this rapidly changing environment, being more distractible may be more adaptive than focusing on one image or a video, for maximizing information gain. This is where meta-control gets into the picture and dictates a bias in our cognitive control process towards flexibility.

On the other hand, contexts of adversity and stress may do the opposite. A person who is in an environment that requires behavioral inhibition for survival (i.e. abuse), may adopt a more focused control strategy. Importantly, these control strategies are adaptive as long as they provide utility. Control strategies that linger outside of their context may prove dysfunctional. For example, outside of this context of adversity, staying in a state of inhibition may come across as rigidity.

Similar to external factors, changes in internal states also drive changes in cognitive control strategies. And what is a quicker and stronger way to alter internal states other than by the use of psychoactive drugs?

The effect of psychoactive drugs on cognitive control operations is relatively well known. For example, attention-deficit/hyperactivity disorder (ADHD) medications, like Adderall, are designed to decrease distractibility and increase focused or stable thinking. Dopaminergic medication Parkinsons’ Disease patients take to reduce tremor help them become more flexible in their thinking. In fact, Parkinsons Disease patients show greater creative performance under the effects of their dopaminergic medications than patients without.

In the context of psychedelics, we see somewhat conflicting results. Under the effects of psychedelics, creative task performance that requires focused thinking is reduced and creative task performance that requires flexible thinking is enhanced, leading to null effects of psychedelics on creativity on average. Then, what about psychedelic art? How was that born if psychedelics did not enhance creativity?

First, psychedelics, just like other psychoactive drugs, will push the control system towards one state at the expense of another. In this case, from focused thinking towards greater flexibility. Second, being in a biased state is not good for standardized task measures, which rely on an optimal balance between stability and flexibility. Third, not everyone is affected by the same drug and dosage similarly. For example, ADHD drugs are not always used as prescribed but also used as smart drugs, specifically among college students. Mind you, not all college students who will use these drugs will have attention deficits. Studies show that the effects of smart drugs depend on the user’s baseline characteristics. While people who already have low levels of focused thinking may be improved by the drug, people with greater attentional capacity may be cognitively overdosed, leading to reduced task performance.

Under the acute effects of psychedelics, people may become more flexible. Depending on the dosage and the baseline characteristics, this flexibility may present itself as distractibility. One may switch their attention between continuously changing percepts without focusing on one or the other. Although this state is probably not exactly conducive to task performance, it also doesn’t mean that all control is lost. In fact, this may be an adaptive control strategy in response to the internal state induced by the drug. As the strong effects of the drug start dissipating, the balance will be restored. However, one thing is learned, that is the value and the richness of this highly distractible, and flexible state.

And this learning is likely here to stay with the increased neuroplasticity inducing effects of psychedelic drugs. Neuroplasticity refers to the brain’s ability to rewire itself and build new connections or generate new cells. For example, a neuroscientist at Johns Hopkins, Dr. Gul Dolen has shown that psychedelics might re-open a critical period of plasticity in adult brain. Critical periods refer to a time point where the brain is more malleable and sensitive to external influences, as in when we were babies. In a positive and rewarding setting, psychedelics-induced acute affects in cognitive control strategies may turn to long-term changes that may be specifically useful for certain population.

For example, people with major depressive disorder tend to ruminate and get fixated on certain thoughts and memories. What our lab has shown was that people with major depressive disorder had increased cognitive flexibility after psilocybin administration. That means, this level of flexibility at the expense of focused thinking may be life-saving for those with extremely rigid control strategies, such as people with major depressive disorder, obsessive compulsive disorder and people with substance use disorders. A great example of this therapeutic effect comes from a psilocybin session I witnessed.

This participant suffered from major depressive disorder and had a very set way of looking at things. Given their religious background, at times they failed to forgive their own past actions, leading to feelings of guilt and shame. During their psilocybin session, I could sense their anxiety building up and bringing them to dark, scary place where they felt trapped and desperate. I was worried about them, and I sincerely hoped they wouldn’t feel this way the whole time, as the trip lasts around 4-5 hours. They were listening to a pretty intense classical song we were playing in the session room and I observed them shrink into a fetus position, trying to hold onto the couch they were laying on. They were physically safe and unharmed but psychology, I could see their struggle.

As I was entertaining these worrisome thoughts in my head, an upbeat 60s song started playing. The song chorus sang, ‘here comes the sun’ and all of a sudden, they got up on the couch, looked around the room and found the picture of their child they placed in front of them before the session started and exclaimed, “it was right in front of my eyes the whole time!”

That was their breakthrough moment, at least from my perspective. They were able to get out of the dark place they found themselves in by shifting their attention. The song they were listening to, the picture they were looking at, suddenly became the object of their attention. They were able to get out of the depths of their mind and break the rigid patterns that made up their consciousness. What they achieved was a state of cognitive flexibility. They learned to flexibly switch their attention when needed, in a positive, rewarding and therapeutic environment. After all, even tough a life-time of adversity might have led them to adopt more rigid control strategy, this intense but safe experience was the evidence that flexibility could be valuable also.

Following days and weeks for this patient was gradually more filled with experiences of flexibility, where they tried new hobbies, saw new friends, visited new destinations. At our center, the research showed that the therapeutic effects of psilocybin on patients with major depressive disorder can last up to one year. Still, there is more research needed to explain the exact mechanisms underlying this rapid change but to me, what is the most clear is that there is learning, and a shift in control strategies that starts acutely and extends over a long period of time.