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This episode deals with anorexia and

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contains mentions of other eating

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disorders, as well as depression and

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suicide.

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So please take care.

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My first psychedelic ceremony

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was with Ayahuasca

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in 2016.

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By that point, I've been working on

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my recovery from anorexia

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and restrictive eating

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for about eight years.

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My intention was to not look

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at my eating disorder and

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I felt really afraid.

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And I thought by saying, I don't

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want to look at my eating disorder,

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I would avoid anything negative

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because the eating disorder felt

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like such a negative place.

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In the weeks before her first

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ayahuasca ceremony, Francesca

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Rose Annenberg was excited

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and nervous.

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She was given a small list of rules

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to follow, including dietary rules.

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No pork, no caffeine, no added

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sugar or processed foods.

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It was a little bit triggering in

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the lead up to that

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ceremony and I didn't quite know

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any better.

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The diet brought up old and

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familiar feelings.

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Even those few hours of fasting,

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slight restriction around the diet

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that woke up the disorder

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in a way that I hadn't experienced

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before.

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With her eating disorder now fully

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awake, Francesca made her

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way to the location of the ceremony

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on the appointed day,

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a spot outside of Cape Town in South

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Africa.

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The ceremony began.

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I don't really even remember an

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opening circle.

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Just feeling totally like

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unprepared and then sitting next

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to strangers who are

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making their own sounds that are

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purging.

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The medicine, even though it was my

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first time, was light for

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me.

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The constant chatter

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of I'm not good enough,

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of I am unworthy, I'm undeserving,

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I am a bad person, I don't belong

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here.

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All of the variations of

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those beliefs just

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quieted down.

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And in that was a

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sense of embodiment, like I was in

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my body.

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I could feel my body on the ground.

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I wasn't going too far

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into space.

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I was very much on the earth with

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my breath.

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And this feeling of genuine

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self-love, this sense of enoughness

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and this feeling of,

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I belong here on this earth and

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I'm part of this

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greater...

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orchestra and how wonderful is

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that that I have a certain

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sound to share,

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to sing, to contribute and that it

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matters.

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It was like a sense of

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innate enoughness, innate

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worthiness, innate belonging

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and what was really important was

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that it landed in a cellular

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way in the body.

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For Francesca, that experience

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was profound.

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And although it didn't free her of

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the anorexia she'd been struggling

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with since her teens,

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it did accelerate her recovery

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in ways she hadn't anticipated.

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Now, 10 years ago, scientists

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weren't actively exploring the idea

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of using psychedelic-assisted

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therapy to treat anorexia nervosa.

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But now they are,

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and there is real excitement

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around this idea.

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So, today on the show,

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anorexia is one of the deadliest

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mental illnesses, and recovery

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is notoriously difficult.

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But what if psychedelic-assisted

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therapy could change that?

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We'll hear about an ongoing and

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innovative clinical trial that's

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testing this idea in young adults

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using psilocybin.

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And we'll hear about

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what an attempt to self-treat this

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disorder without the benefit of

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therapeutic guardrails might look

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like.

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Because, as you've just heard,

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some people are definitely already

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doing that.

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I'm Arielle Duhaime-Ross, and this

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is Altered States.

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So my name is Francesca

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Rose Annenberg.

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Francesca lives in Cape Town,

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where she works as an eating

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disorder recovery coach.

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But in the 90s, she was

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a kid growing up in what she

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describes as a bubble shortly

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after the end of apartheid in South

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Africa.

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My early childhood passions

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were ballet and horse riding.

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I fell in love with horses when I

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was five and

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started competing at the age of 12.

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Show jumping, dressage,

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eventing, cross country.

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Ballet began also at about five

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and was competing from

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maybe, six, seven.

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At first, the dancing and

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horseback riding gave her

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confidence.

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They made her feel free.

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But that changed when she started to

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compete.

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She began showing signs of

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perfectionism.

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Because there was now a goal

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to gain,

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and there were people watching

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with judgments, perceived

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or real,

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and a certain way

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that I had to look,

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specifically with the ballet.

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At dance practice, for instance?

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I just tried to really

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nail the technique, but

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it was so hard to

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allow myself to be seen in practice,

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to share my vulnerability.

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Whilst I was trying to get something

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perfect.

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She was self-critical and constantly

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trying to meet the highest

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of standards, often to

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her detriment.

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I would come to practice

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completely expressionless.

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It's like my heart was not even in

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my body.

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And it took a lot of energy to

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withhold a lot of that emotion

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that I would feel in class.

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There would be a lot of emotion and

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then a lot of shame for feeling a

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lot of emotion.

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She developed this deep fear

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of failure.

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I was just terrified of people

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seeing me make mistakes.

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And growing older came with

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its own set of challenges.

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I was a late bloomer

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and at the same time didn't want

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to bloom even

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from a young age before

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major eating disorder symptoms

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showed up.

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I was seeing people, seeing

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their bodies changing and

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becoming fuller, bigger and

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that really scared me.

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I thought if I stay in

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this industry for

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much longer I'm going to develop an

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eating disorder.

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At the age of 15, she quit ballet.

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But still, come the age 16,

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Francesca found herself restricting

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her food intake for the first time.

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It began initially

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with a desire to lose

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some weight and then

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got really bad with a

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breakup. That happened about

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maybe five, six months

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later after that initial

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impulse to just cut

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back here, restrict over here,

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exercise a little bit more over

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there.

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At first, Francesca felt invincible.

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Feeling like I was a

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superhuman by how much I could

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control.

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Because I was eating so little,

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but doing all the things.

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And yeah, feeling this kind of weird

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superiority that anorexia

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can give.

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As she got smaller, so did her

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world.

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I wasn't very fun to have around

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because most

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of what I was engaging with

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was many obsessive thoughts

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in my head and the capacity

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to be socially engaged

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was just really offline and

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of course I wasn't eating enough so

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I didn't have a lot of energy.

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She started to push her sister and

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her parents away, but she

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kept up with her studies and

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horseback riding.

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It was the last three years of

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school, so I was just

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trying to eat as little as I could

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while still getting good

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grades and going to

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my horse riding classes and

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competitions.

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The obsessive behaviors continued and

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deepened.

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Looking at myself in the mirror from

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all angles, lots

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of times on the scale.

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As did the thought patterns.

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I'm fine.

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I just need to lose more weight.

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I need to run that extra

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kilometer.

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I'm only allowed to eat at this

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time.

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I am weak if I get hungry before

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then.

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Lots of anxiety when it came to

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social events.

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Wanting to avoid them or

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bring my own food, but I don't want

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to look weird.

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Maybe I can just eat a little bit,

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and then how will that impact the

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rest of my day, my next days?

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The thought processes, they

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sound superficial,

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but they're indicating very

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deep fears and dysregulation.

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Fear about change for example.

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People around Francesca, people who

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loved her, they noticed that she

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was different.

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My best friend, she came up to me

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and said, like, hey, like,

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are you, are

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your okay?

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You're, you've lost a lot of weight

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and you're not eating.

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You've become really internal

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and worried about you.

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And my immediate response was just

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defensiveness.

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She's overreacting,

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but knowing that she was right

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ultimately.

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Francesca's parents got her to see a

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therapist, but she went reluctantly.

293
00:09:51,800 --> 00:09:53,739
So as graduation loomed, her parents

294
00:09:53,740 --> 00:09:55,659
and dietitian decided that the best

295
00:09:55,660 --> 00:09:57,179
course of action would be to send

296
00:09:57,180 --> 00:09:58,719
Francesca to a mental health

297
00:09:58,720 --> 00:10:00,719
treatment center where she'd receive

298
00:10:00,720 --> 00:10:02,419
24-hour care.

299
00:10:02,420 --> 00:10:04,259
So when I'd finished school

300
00:10:04,260 --> 00:10:06,119
at 18, my friends went to go

301
00:10:06,120 --> 00:10:07,659
party and I went to an inpatient

302
00:10:07,660 --> 00:10:08,660
facility.

303
00:10:09,520 --> 00:10:11,719
It was a very unique experience

304
00:10:11,720 --> 00:10:14,139
being with nurses who would

305
00:10:14,140 --> 00:10:15,659
facilitate you in and out of the

306
00:10:15,660 --> 00:10:17,499
bathroom and

307
00:10:17,500 --> 00:10:19,599
getting certain health markers

308
00:10:19,600 --> 00:10:21,459
checked each day, each

309
00:10:21,460 --> 00:10:22,459
week.

310
00:10:22,460 --> 00:10:24,499
But it became a very safe place

311
00:10:24,500 --> 00:10:25,539
for me.

312
00:10:25,540 --> 00:10:27,379
I still tried to secretly

313
00:10:27,380 --> 00:10:29,319
exercise and

314
00:10:29,320 --> 00:10:30,320
got caught twice.

315
00:10:33,400 --> 00:10:34,679
The four weeks she spent at that

316
00:10:34,680 --> 00:10:36,619
treatment center didn't end

317
00:10:36,620 --> 00:10:38,399
her eating disorder.

318
00:10:38,400 --> 00:10:40,119
When I spoke with her, she read a

319
00:10:40,120 --> 00:10:41,899
passage from a diary entry she wrote

320
00:10:41,900 --> 00:10:43,659
shortly after she left the program

321
00:10:43,660 --> 00:10:45,129
in 2010.

322
00:10:45,130 --> 00:10:46,989
Today I didn't do yoga, but

323
00:10:46,990 --> 00:10:49,209
I went horse riding, toned,

324
00:10:49,210 --> 00:10:50,229
and walked.

325
00:10:50,230 --> 00:10:51,469
I'm already scared.

326
00:10:51,470 --> 00:10:53,949
This is the start of my laziness.

327
00:10:53,950 --> 00:10:55,629
I can't see my spine through my

328
00:10:55,630 --> 00:10:56,509
clothes.

329
00:10:56,510 --> 00:10:58,229
I really want it to show.

330
00:10:58,230 --> 00:11:00,029
I don't even know if it showed

331
00:11:00,030 --> 00:11:02,029
before, but now I can hardly feel

332
00:11:02,030 --> 00:11:03,869
it when I bend over.

333
00:11:03,870 --> 00:11:05,449
And the bones of my back, of my

334
00:11:05,450 --> 00:11:08,129
neck, don't feel as prominent.

335
00:11:08,130 --> 00:11:09,929
Once again, is it in my head or

336
00:11:09,930 --> 00:11:10,930
real?

337
00:11:12,400 --> 00:11:14,479
Francesca wasn't ready to let go

338
00:11:14,480 --> 00:11:16,479
of the anorexia, which by then

339
00:11:16,480 --> 00:11:18,799
had become a part of her.

340
00:11:18,800 --> 00:11:20,639
That would change in time,

341
00:11:20,640 --> 00:11:22,689
but just not right away.

342
00:11:22,690 --> 00:11:24,549
I feel some

343
00:11:24,550 --> 00:11:26,569
grief for that part of

344
00:11:26,570 --> 00:11:28,449
me and how much torment

345
00:11:28,450 --> 00:11:30,489
I was in to

346
00:11:30,490 --> 00:11:32,709
control my

347
00:11:32,710 --> 00:11:34,769
body and its size and

348
00:11:34,770 --> 00:11:36,729
how ultimately out of

349
00:11:36,730 --> 00:11:38,909
control I was.

350
00:11:38,910 --> 00:11:41,409
I was a completely different

351
00:11:41,410 --> 00:11:43,329
paradigm of existence and I'm

352
00:11:43,330 --> 00:11:45,029
so grateful that I'm not there

353
00:11:45,030 --> 00:11:46,030
anymore.

354
00:11:46,450 --> 00:11:48,109
Still, Francesca told me that her

355
00:11:48,110 --> 00:11:49,449
time at the clinic helped her

356
00:11:49,450 --> 00:11:50,969
realize that she didn't want to get

357
00:11:50,970 --> 00:11:52,529
any worse.

358
00:11:52,530 --> 00:11:53,530
Something in me, woke up.

359
00:11:54,850 --> 00:11:56,609
I want something different for my

360
00:11:56,610 --> 00:11:57,610
life.

361
00:11:58,250 --> 00:11:59,849
Francesca eventually found tools

362
00:11:59,850 --> 00:12:01,269
that helped her heal.

363
00:12:01,270 --> 00:12:03,269
She credits a few things, her

364
00:12:03,270 --> 00:12:05,169
connection with nature, therapy she

365
00:12:05,170 --> 00:12:07,069
received later on, her meditation

366
00:12:07,070 --> 00:12:09,289
practice, her love of dance,

367
00:12:09,290 --> 00:12:11,009
and her experience with

368
00:12:11,010 --> 00:12:12,469
psychedelics.

369
00:12:12,470 --> 00:12:14,369
Beginning with that one ayahuasca

370
00:12:14,370 --> 00:12:15,729
trip that you heard about at the top

371
00:12:15,730 --> 00:12:16,730
of the episode.

372
00:12:17,690 --> 00:12:19,769
It was like a sense of

373
00:12:19,770 --> 00:12:21,689
innate enoughness, innate

374
00:12:21,690 --> 00:12:23,070
worthiness, innate belonging.

375
00:12:24,350 --> 00:12:26,189
So there was a real sense

376
00:12:26,190 --> 00:12:28,109
of coming home to

377
00:12:28,110 --> 00:12:30,229
me and me in the wider world

378
00:12:30,230 --> 00:12:32,249
without needing to achieve

379
00:12:32,250 --> 00:12:34,069
or perform or

380
00:12:34,070 --> 00:12:36,129
do something to earn that

381
00:12:36,130 --> 00:12:37,130
belonging.

382
00:12:38,040 --> 00:12:39,979
Less than a year later, Francesca

383
00:12:39,980 --> 00:12:41,600
attended another ceremony.

384
00:12:42,760 --> 00:12:44,759
This one was pretty different.

385
00:12:44,760 --> 00:12:47,159
For one thing, she took psilocybin.

386
00:12:47,160 --> 00:12:49,079
And for another, she went

387
00:12:49,080 --> 00:12:51,279
in with the explicit aim of

388
00:12:51,280 --> 00:12:53,079
tackling her eating disorder.

389
00:12:53,080 --> 00:12:55,059
And so this time, she was

390
00:12:55,060 --> 00:12:57,219
actually able to see this embodied

391
00:12:57,220 --> 00:12:59,499
version of her eating disorders as

392
00:12:59,500 --> 00:13:00,500
she was tripping.

393
00:13:01,400 --> 00:13:03,319
It came to her in the form of a

394
00:13:03,320 --> 00:13:04,569
box.

395
00:13:04,570 --> 00:13:06,169
Just carrying around this box

396
00:13:06,170 --> 00:13:08,129
wherever I go and I can

397
00:13:08,130 --> 00:13:10,049
choose to put down that

398
00:13:10,050 --> 00:13:12,909
box at any time.

399
00:13:12,910 --> 00:13:14,229
And with that was this feeling of

400
00:13:14,230 --> 00:13:16,949
I'm not my eating disorder and

401
00:13:16,950 --> 00:13:18,949
then that question of well then

402
00:13:18,950 --> 00:13:20,090
who am I?

403
00:13:21,150 --> 00:13:23,109
So that was a really

404
00:13:23,110 --> 00:13:25,289
important realization to

405
00:13:25,290 --> 00:13:27,169
see it as something

406
00:13:27,170 --> 00:13:29,169
that I was holding and not

407
00:13:29,170 --> 00:13:31,070
my whole identity.

408
00:13:33,390 --> 00:13:35,489
I could create some distance

409
00:13:35,490 --> 00:13:37,529
and being able

410
00:13:37,530 --> 00:13:39,609
to put it down like I can choose

411
00:13:39,610 --> 00:13:41,649
to put it down gave me

412
00:13:41,650 --> 00:13:43,969
a sense of responsibility

413
00:13:43,970 --> 00:13:44,970
and choice and autonomy.

414
00:13:49,250 --> 00:13:51,569
She had heard all of this before.

415
00:13:51,570 --> 00:13:53,049
She talked about it in therapy

416
00:13:53,050 --> 00:13:55,149
plenty of times, but she'd

417
00:13:55,150 --> 00:13:57,829
always been resistant to the idea.

418
00:13:57,830 --> 00:13:58,989
There was always that invitation of

419
00:13:58,990 --> 00:14:00,689
someone else saying to me, "You can

420
00:14:00,690 --> 00:14:01,569
put the box down.

421
00:14:01,570 --> 00:14:02,570
You can. You can."

422
00:14:05,070 --> 00:14:06,669
Now, under the influence of

423
00:14:06,670 --> 00:14:08,749
psilocybin, she finally saw

424
00:14:08,750 --> 00:14:09,750
that it was possible.

425
00:14:14,099 --> 00:14:15,359
I can. And so the realization itself

426
00:14:15,360 --> 00:14:17,259
wasn't necessarily new,

427
00:14:17,260 --> 00:14:19,279
but it came from within

428
00:14:19,280 --> 00:14:21,159
me and

429
00:14:21,160 --> 00:14:24,039
came with a feeling of empowerment

430
00:14:24,040 --> 00:14:26,039
that I hadn't experienced in therapy

431
00:14:26,040 --> 00:14:27,040
before.

432
00:14:30,220 --> 00:14:32,359
When you look back on those first

433
00:14:32,360 --> 00:14:34,139
two ceremonies, how do you

434
00:14:34,140 --> 00:14:35,219
characterize the role that they

435
00:14:35,220 --> 00:14:37,139
played in your eating

436
00:14:37,140 --> 00:14:38,479
disorder recovery?

437
00:14:38,480 --> 00:14:40,499
It's a reminder of you are more

438
00:14:40,500 --> 00:14:42,979
than the seeding disorder and

439
00:14:42,980 --> 00:14:45,459
you are the co-creator

440
00:14:45,460 --> 00:14:48,319
of your reality and

441
00:14:48,320 --> 00:14:51,019
the psychedelics opened up

442
00:14:51,020 --> 00:14:52,859
that doorway and of course

443
00:14:52,860 --> 00:14:54,839
it is my own two feet to

444
00:14:54,840 --> 00:14:56,779
walk through that doorway that

445
00:14:56,780 --> 00:14:58,379
it requires active choosing and

446
00:14:58,380 --> 00:14:59,380
choice.

447
00:15:02,200 --> 00:15:04,039
Francesca's story offers a glimpse

448
00:15:04,040 --> 00:15:06,159
into a complete cycle,

449
00:15:06,160 --> 00:15:07,899
the downward spiral brought on by

450
00:15:07,900 --> 00:15:09,779
too many factors to count,

451
00:15:09,780 --> 00:15:11,759
and in this case, a

452
00:15:11,760 --> 00:15:13,579
hard-fought recovery that happened

453
00:15:13,580 --> 00:15:15,439
over years and for more

454
00:15:15,440 --> 00:15:16,440
reasons than one.

455
00:15:18,240 --> 00:15:20,219
And as moving as this story

456
00:15:20,220 --> 00:15:22,379
is, Francesca is

457
00:15:22,380 --> 00:15:24,639
just one person,

458
00:15:24,640 --> 00:15:26,359
so we can't really draw any

459
00:15:26,360 --> 00:15:28,119
generalizable conclusions from her

460
00:15:28,120 --> 00:15:29,319
story.

461
00:15:29,320 --> 00:15:31,079
For that, we turn to clinical

462
00:15:31,080 --> 00:15:33,119
trials, where many people

463
00:15:33,120 --> 00:15:35,239
receive the same treatment and

464
00:15:35,240 --> 00:15:37,419
data are gathered, analyzed,

465
00:15:37,420 --> 00:15:38,759
and published.

466
00:15:38,760 --> 00:15:40,799
Unfortunately for us, results

467
00:15:40,800 --> 00:15:41,800
are coming.

468
00:15:42,640 --> 00:15:43,839
I spoke with a doctor who's

469
00:15:43,840 --> 00:15:45,499
currently conducting a trial to test

470
00:15:45,500 --> 00:15:47,679
if psilocybin-assisted therapy

471
00:15:47,680 --> 00:15:49,519
might lead to better outcomes

472
00:15:49,520 --> 00:15:51,859
for young adults with anorexia,

473
00:15:51,860 --> 00:15:53,439
people who are around same age

474
00:15:53,440 --> 00:15:55,199
Francesca was when she entered the

475
00:15:55,200 --> 00:15:56,200
clinic.

476
00:15:56,520 --> 00:15:58,579
I was blown away not just

477
00:15:58,580 --> 00:16:00,539
by the reasons why researchers think

478
00:16:00,540 --> 00:16:02,739
this might work, but also

479
00:16:02,740 --> 00:16:05,299
how they're setting up this trial.

480
00:16:05,300 --> 00:16:07,059
More on that after the break.

481
00:16:17,030 --> 00:16:18,949
Since 2022, scientists have

482
00:16:18,950 --> 00:16:20,629
completed four clinical trials

483
00:16:20,630 --> 00:16:22,669
examining the use of psilocybin

484
00:16:22,670 --> 00:16:24,590
to treat anorexia nervosa.

485
00:16:26,110 --> 00:16:28,029
Among them were a pair of

486
00:16:28,030 --> 00:16:29,709
trials funded by one of the most

487
00:16:29,710 --> 00:16:31,129
prominent psychedelic companies in

488
00:16:31,130 --> 00:16:33,489
the world, Compass Pathways.

489
00:16:33,490 --> 00:16:34,609
The results of only one of those

490
00:16:34,610 --> 00:16:36,509
studies has been published so far,

491
00:16:36,510 --> 00:16:38,489
but Compass Pathway is moving

492
00:16:38,490 --> 00:16:40,469
forward with its clinical trials.

493
00:16:40,470 --> 00:16:41,689
Hoping that the U.S.

494
00:16:41,690 --> 00:16:43,049
Food and Drug Administration will

495
00:16:43,050 --> 00:16:44,889
approve its patented formulation

496
00:16:44,890 --> 00:16:46,869
of synthetic psilocybin to

497
00:16:46,870 --> 00:16:48,530
treat anorexia nervosa.

498
00:16:49,690 --> 00:16:51,509
There is genuine excitement

499
00:16:51,510 --> 00:16:53,369
that people with anorexia might

500
00:16:53,370 --> 00:16:55,229
soon have more options for

501
00:16:55,230 --> 00:16:57,109
treatment, which any doctor

502
00:16:57,110 --> 00:16:58,469
who treats eating disorders will

503
00:16:58,470 --> 00:17:00,289
tell you is very much

504
00:17:00,290 --> 00:17:01,469
needed.

505
00:17:01,470 --> 00:17:02,969
We just absolutely need more

506
00:17:02,970 --> 00:17:03,970
options.

507
00:17:04,750 --> 00:17:06,529
Marissa is one of those doctors.

508
00:17:08,869 --> 00:17:10,649
My name is Marissa Raymond-Flesch.

509
00:17:10,650 --> 00:17:12,149
I work at UCSF.

510
00:17:12,150 --> 00:17:14,008
I am a physician and

511
00:17:14,009 --> 00:17:15,009
a researcher.

512
00:17:15,530 --> 00:17:17,689
Marissa is a pediatrician who mostly

513
00:17:17,690 --> 00:17:19,848
works with teenagers and sometimes

514
00:17:19,849 --> 00:17:21,689
in her practice, she

515
00:17:21,690 --> 00:17:22,949
feels helpless.

516
00:17:22,950 --> 00:17:24,769
It is absolutely

517
00:17:24,770 --> 00:17:26,989
heartbreaking to watch

518
00:17:26,990 --> 00:17:29,369
a patient starve to death.

519
00:17:29,370 --> 00:17:31,189
That feeling is why Marissa is

520
00:17:31,190 --> 00:17:32,549
now running a clinical trial,

521
00:17:32,550 --> 00:17:34,109
looking at whether psilocybin

522
00:17:34,110 --> 00:17:35,929
assisted therapy might work as

523
00:17:35,930 --> 00:17:37,929
a treatment for anorexia nervosa

524
00:17:37,930 --> 00:17:40,049
in young adults, something that

525
00:17:40,050 --> 00:17:41,489
still surprises her.

526
00:17:41,490 --> 00:17:42,669
I was a D.A.R.E. Student of the

527
00:17:42,670 --> 00:17:43,889
year.

528
00:17:43,890 --> 00:17:45,769
I never set out to do this

529
00:17:45,770 --> 00:17:46,889
work. I think that's really

530
00:17:46,890 --> 00:17:47,759
important to know.

531
00:17:47,760 --> 00:17:49,699
She was the just say no to

532
00:17:49,700 --> 00:17:51,459
drugs girl, and she didn't come to

533
00:17:51,460 --> 00:17:53,119
this work because of her interest in

534
00:17:53,120 --> 00:17:55,039
eating disorders either, at least

535
00:17:55,040 --> 00:17:56,499
not at first.

536
00:17:56,500 --> 00:17:58,239
What got her here is her love of

537
00:17:58,240 --> 00:17:59,739
working with teenagers.

538
00:17:59,740 --> 00:18:01,819
Oh my gosh, they're so much fun.

539
00:18:01,820 --> 00:18:04,219
They are just blooming, and

540
00:18:04,220 --> 00:18:06,339
the potential for impact is huge.

541
00:18:06,340 --> 00:18:08,339
It's so fun to see their

542
00:18:08,340 --> 00:18:10,199
energy, to see their hopefulness, to

543
00:18:10,200 --> 00:18:12,259
their incredible capacity

544
00:18:12,260 --> 00:18:13,919
for growth.

545
00:18:13,920 --> 00:18:15,739
And I love to witness

546
00:18:15,740 --> 00:18:17,499
that and support young people as

547
00:18:17,500 --> 00:18:18,519
they do that.

548
00:18:18,520 --> 00:18:20,379
And then really discovered what

549
00:18:20,380 --> 00:18:22,199
a challenge eating disorders are

550
00:18:22,200 --> 00:18:23,719
for our patient population.

551
00:18:26,220 --> 00:18:27,939
As a pediatrician, Marissa had

552
00:18:27,940 --> 00:18:29,759
always seen eating disorders in her

553
00:18:29,760 --> 00:18:31,599
practice, but at

554
00:18:31,600 --> 00:18:34,179
the height of the COVID-19 pandemic,

555
00:18:34,180 --> 00:18:36,629
things suddenly got much worse.

556
00:18:36,630 --> 00:18:38,089
All mental health concerns for

557
00:18:38,090 --> 00:18:39,509
adolescents and young adults just

558
00:18:39,510 --> 00:18:41,022
exploded. And when I say that, I
mean, literally exponentially
worsened.

559
00:18:44,520 --> 00:18:46,519
The hospital where Marissa works had

560
00:18:46,520 --> 00:18:48,379
reached capacity and

561
00:18:48,380 --> 00:18:50,259
couldn't admit all of the

562
00:18:50,260 --> 00:18:51,779
patients coming in with severe

563
00:18:51,780 --> 00:18:52,839
anorexia.

564
00:18:52,840 --> 00:18:54,379
We just don't have beds and

565
00:18:54,380 --> 00:18:56,099
resources in our hospital to do

566
00:18:56,100 --> 00:18:57,819
that. That's something we just

567
00:18:57,820 --> 00:18:59,519
couldn't have fathomed needing to

568
00:18:59,520 --> 00:19:00,702
learn about our service a couple of

569
00:19:00,703 --> 00:19:01,703
years before.

570
00:19:02,350 --> 00:19:04,309
Not only that, but because of the

571
00:19:04,310 --> 00:19:05,629
isolation that many people

572
00:19:05,630 --> 00:19:07,009
experienced during the first two

573
00:19:07,010 --> 00:19:07,601
years of the pandemic.

574
00:19:07,602 --> 00:19:09,749
Our patients were presenting

575
00:19:09,750 --> 00:19:10,829
later and sicker.

576
00:19:10,830 --> 00:19:12,969
And things had already started

577
00:19:12,970 --> 00:19:15,309
to worsen even before that.

578
00:19:15,310 --> 00:19:17,429
Patients are presenting at younger

579
00:19:17,430 --> 00:19:18,469
ages.

580
00:19:18,470 --> 00:19:20,009
There's been an increase in the

581
00:19:20,010 --> 00:19:21,929
incidence of anorexia in kids

582
00:19:21,930 --> 00:19:23,999
below the age of 15.

583
00:19:24,000 --> 00:19:26,179
The age of onset may be falling or

584
00:19:26,180 --> 00:19:28,159
our ability to detect it earlier may

585
00:19:28,160 --> 00:19:30,019
be improving, but we are starting

586
00:19:30,020 --> 00:19:32,019
to take care of people at younger

587
00:19:32,020 --> 00:19:33,739
and younger ages.

588
00:19:33,740 --> 00:19:35,959
Marissa told me one of her patients

589
00:19:35,960 --> 00:19:37,179
in particular.

590
00:19:37,180 --> 00:19:39,279
I remember being in a patient's

591
00:19:39,280 --> 00:19:42,019
room who was profoundly sick.

592
00:19:42,020 --> 00:19:43,439
Most of my patients don't actually

593
00:19:43,440 --> 00:19:45,039
want to die, but she was really in a

594
00:19:45,040 --> 00:19:46,419
place where she did want to die.

595
00:19:46,420 --> 00:19:47,979
She didn't want to eat.

596
00:19:47,980 --> 00:19:49,599
We had to support her with a feeding

597
00:19:49,600 --> 00:19:51,159
tube, which is rare, but something

598
00:19:51,160 --> 00:19:52,359
that happens for some of our

599
00:19:52,360 --> 00:19:53,399
patients.

600
00:19:53,400 --> 00:19:55,359
And she wanted so much to

601
00:19:55,360 --> 00:19:57,299
die that she was able

602
00:19:57,300 --> 00:19:58,819
to sort of take that feeding tube

603
00:19:58,820 --> 00:20:00,159
out in a way that I've never seen

604
00:20:00,160 --> 00:20:01,659
someone do.

605
00:20:01,660 --> 00:20:03,579
And I felt really

606
00:20:03,580 --> 00:20:05,339
powerless. I didn't know what I was

607
00:20:05,340 --> 00:20:06,739
going to do to help her.

608
00:20:08,520 --> 00:20:10,599
Anorexia is one of the most fatal

609
00:20:10,600 --> 00:20:12,419
mental health conditions.

610
00:20:12,420 --> 00:20:14,279
It has the second highest fatality

611
00:20:14,280 --> 00:20:16,419
rate of any mental health condition.

612
00:20:16,420 --> 00:20:17,759
It's second only to opiate use

613
00:20:17,760 --> 00:20:19,719
disorder right now in terms

614
00:20:19,720 --> 00:20:20,669
of likelihood of death.

615
00:20:20,670 --> 00:20:21,670
Feeling

616
00:20:22,630 --> 00:20:24,769
overwhelmed and more powerless

617
00:20:24,770 --> 00:20:26,649
than I think most doctors would like

618
00:20:26,650 --> 00:20:28,489
to feel, Marissa got

619
00:20:28,490 --> 00:20:28,969
to thinking.

620
00:20:28,970 --> 00:20:31,229
That was a moment when I

621
00:20:31,230 --> 00:20:32,689
would say I let my heart and mind

622
00:20:32,690 --> 00:20:34,449
open to this thing that had been

623
00:20:34,450 --> 00:20:36,409
floating in the back of my mind,

624
00:20:36,410 --> 00:20:37,999
the idea of psychedelics.

625
00:20:38,000 --> 00:20:40,179
Which brings us back to her ongoing

626
00:20:40,180 --> 00:20:41,180
trial.

627
00:20:42,100 --> 00:20:44,379
That trial is a study of psilocybin

628
00:20:44,380 --> 00:20:45,599
for young adults with anorexia

629
00:20:45,600 --> 00:20:47,559
nervosa. And we are enrolling

630
00:20:47,560 --> 00:20:49,479
young people between 18 and

631
00:20:49,480 --> 00:20:51,319
25 years old.

632
00:20:51,320 --> 00:20:52,939
And what we're really testing, and I

633
00:20:52,940 --> 00:20:54,999
wanna emphasize this, is psilocybin

634
00:20:55,000 --> 00:20:56,619
assisted therapy.

635
00:20:56,620 --> 00:20:58,179
So this isn't just about the

636
00:20:58,180 --> 00:20:59,199
medication.

637
00:20:59,200 --> 00:21:01,239
It's about having appropriate

638
00:21:01,240 --> 00:21:03,519
psychotherapy support while

639
00:21:03,520 --> 00:21:04,520
engaging with this medication.

640
00:21:05,680 --> 00:21:07,659
The trial focuses on young people

641
00:21:07,660 --> 00:21:10,139
whose brains are still developing.

642
00:21:10,140 --> 00:21:12,079
The brain continues to change

643
00:21:12,080 --> 00:21:13,080
and develop into the mid-20s.

644
00:21:14,740 --> 00:21:15,979
And Marissa says that unlike

645
00:21:15,980 --> 00:21:16,613
previous trials.

646
00:21:16,614 --> 00:21:18,539
We're enrolling patients down

647
00:21:18,540 --> 00:21:20,439
to a BMI of 12 because we really

648
00:21:20,440 --> 00:21:22,359
want the sickest patients,

649
00:21:22,360 --> 00:21:23,459
the patients who need these new

650
00:21:23,460 --> 00:21:24,999
treatments most to be able to access

651
00:21:25,000 --> 00:21:26,000
them.

652
00:21:26,450 --> 00:21:28,329
BMI, or body mass

653
00:21:28,330 --> 00:21:30,289
index, is a metric that doctors

654
00:21:30,290 --> 00:21:31,909
use to determine if a person's

655
00:21:31,910 --> 00:21:34,169
weight is, quote, healthy in

656
00:21:34,170 --> 00:21:35,829
relation to their height.

657
00:21:35,830 --> 00:21:37,429
It's an imperfect metric.

658
00:21:37,430 --> 00:21:39,569
But for people in their 20s,

659
00:21:39,570 --> 00:21:41,289
the general recommendation is that

660
00:21:41,290 --> 00:21:43,469
their BMI should fall between 19

661
00:21:43,470 --> 00:21:44,969
and 25.

662
00:21:44,970 --> 00:21:47,269
So 12 is really

663
00:21:47,270 --> 00:21:48,349
low.

664
00:21:48,350 --> 00:21:50,149
And the researchers had to take that

665
00:21:50,150 --> 00:21:51,889
into account when they designed the

666
00:21:51,890 --> 00:21:53,949
study, right down to the dose

667
00:21:53,950 --> 00:21:54,950
of psilocybin.

668
00:21:56,319 --> 00:21:57,559
The first dose is a 20-milligram

669
00:21:57,560 --> 00:21:59,219
dose, which is a little lower than a

670
00:21:59,220 --> 00:22:00,599
lot of other clinical trials use

671
00:22:00,600 --> 00:22:02,079
just because of how medically

672
00:22:02,080 --> 00:22:03,003
fragile some of our patients are and

673
00:22:03,004 --> 00:22:04,004
we want to make sure they're okay.

674
00:22:05,670 --> 00:22:07,689
Each participant will also undergo

675
00:22:07,690 --> 00:22:09,649
extensive medical testing throughout

676
00:22:09,650 --> 00:22:10,789
the trial.

677
00:22:10,790 --> 00:22:11,709
You need to show up to medical

678
00:22:11,710 --> 00:22:11,964
visits? You need to show up to some
brain scans, you need to show to a

679
00:22:11,965 --> 00:22:11,978
lot of psychotherapy. I think the
total for our trial is about 21
visits.

680
00:22:11,979 --> 00:22:11,992
And then there's two full days off of
work or school for the actual

681
00:22:11,993 --> 00:22:12,006
dosing days in our trial. And really
asking people to make as much room

682
00:22:12,007 --> 00:22:12,018
in their lives as they can for
processing these experiences, right?
You

683
00:22:12,019 --> 00:22:12,031
shouldn't kind of have a psilocybin
dosing day and go straight to taking

684
00:22:12,032 --> 00:22:13,032
finals.

685
00:22:37,370 --> 00:22:37,889
And.

686
00:22:37,890 --> 00:22:38,969
Because of...

687
00:22:38,970 --> 00:22:40,789
What we know so far about what

688
00:22:40,790 --> 00:22:42,229
is helpful in supporting young

689
00:22:42,230 --> 00:22:44,189
adults through treatment, we are

690
00:22:44,190 --> 00:22:45,509
actually asking each of the young

691
00:22:45,510 --> 00:22:47,109
adults who enrolls in the trial to

692
00:22:47,110 --> 00:22:49,289
bring in two support people.

693
00:22:49,290 --> 00:22:51,269
Very often that's family members,

694
00:22:51,270 --> 00:22:52,969
but at least one up to two people

695
00:22:52,970 --> 00:22:54,869
who have been supporting the young

696
00:22:54,870 --> 00:22:55,870
adult for at least a year with their
illness.

697
00:22:57,740 --> 00:22:59,379
The researchers had originally made

698
00:22:59,380 --> 00:23:01,119
it mandatory that each participant

699
00:23:01,120 --> 00:23:02,979
bring two people into the trial

700
00:23:02,980 --> 00:23:04,959
with them, but Marissa told

701
00:23:04,960 --> 00:23:06,519
me that fairly early on they

702
00:23:06,520 --> 00:23:08,159
recognized that they had to revise

703
00:23:08,160 --> 00:23:09,160
the requirement.

704
00:23:10,229 --> 00:23:11,569
This is a very isolating illness.

705
00:23:11,570 --> 00:23:13,049
It was very hard for some people to

706
00:23:13,050 --> 00:23:15,109
find two people, so we backed down

707
00:23:15,110 --> 00:23:16,929
to one support person to make it

708
00:23:16,930 --> 00:23:19,309
more accessible for more people.

709
00:23:19,310 --> 00:23:20,849
How many participants are you hoping

710
00:23:20,850 --> 00:23:22,309
to enroll?

711
00:23:22,310 --> 00:23:23,209
Forty.

712
00:23:23,210 --> 00:23:25,189
And we are trying to recruit

713
00:23:25,190 --> 00:23:26,649
across all genders, across all

714
00:23:26,650 --> 00:23:28,009
races, across all ethnicities and

715
00:23:28,010 --> 00:23:28,929
socioeconomic statuses.

716
00:23:28,930 --> 00:23:30,969
The trial is open

717
00:23:30,970 --> 00:23:33,349
to anyone who fits the criteria.

718
00:23:33,350 --> 00:23:34,669
And the recruitment?

719
00:23:34,670 --> 00:23:36,809
It was a crucial element for Marisa,

720
00:23:36,810 --> 00:23:38,249
in part because of the stereotypes

721
00:23:38,250 --> 00:23:39,509
that are associated with the

722
00:23:39,510 --> 00:23:40,510
illness.

723
00:23:42,900 --> 00:23:43,699
I think sometimes when people think
about anorexia

724
00:23:43,700 --> 00:23:45,559
nervosa, they picture someone,

725
00:23:45,560 --> 00:23:46,639
perhaps someone who is white,

726
00:23:46,640 --> 00:23:48,319
perhaps someone who was female.

727
00:23:48,320 --> 00:23:49,579
Sometimes even the stereotype

728
00:23:49,580 --> 00:23:51,499
extends to socioeconomic class

729
00:23:51,500 --> 00:23:53,139
to someone who has more financial

730
00:23:53,140 --> 00:23:54,359
resources.

731
00:23:54,360 --> 00:23:56,119
But that is not actually what we see

732
00:23:56,120 --> 00:23:57,579
at all in practice.

733
00:23:57,580 --> 00:23:58,679
There's a large chunk of our

734
00:23:58,680 --> 00:24:00,499
patients who are Latine,

735
00:24:00,500 --> 00:24:01,919
a large chunk of patients who have

736
00:24:01,920 --> 00:24:03,619
various Asian backgrounds.

737
00:24:03,620 --> 00:24:04,939
And then given kind of our

738
00:24:04,940 --> 00:24:06,839
geography, a smaller portion of our

739
00:24:06,840 --> 00:24:08,479
patience who are black identifying

740
00:24:08,480 --> 00:24:10,709
and other racial and ethnic groups.

741
00:24:10,710 --> 00:24:12,949
But it is not an overwhelmingly

742
00:24:12,950 --> 00:24:14,949
white group and there's no reason

743
00:24:14,950 --> 00:24:16,469
to believe that it doesn't occur

744
00:24:16,470 --> 00:24:18,509
with the same frequency

745
00:24:18,510 --> 00:24:19,510
in all populations.

746
00:24:20,560 --> 00:24:22,519
To make it easier to recruit a wide

747
00:24:22,520 --> 00:24:24,379
range of individuals, Marissa

748
00:24:24,380 --> 00:24:25,779
and her team are conducting the

749
00:24:25,780 --> 00:24:27,959
trial in both Spanish and English.

750
00:24:27,960 --> 00:24:29,229
And because of what we know about

751
00:24:29,230 --> 00:24:30,609
the patient population that we treat

752
00:24:30,610 --> 00:24:31,849
at UCSF.

753
00:24:31,850 --> 00:24:33,029
In the future, I would love to roll

754
00:24:33,030 --> 00:24:34,969
it out in other Asian languages as

755
00:24:34,970 --> 00:24:35,970
well.

756
00:24:40,470 --> 00:24:41,829
One thing that impressed me when I

757
00:24:41,830 --> 00:24:43,769
spoke with Marissa was how badly

758
00:24:43,770 --> 00:24:45,909
she wants to get this right.

759
00:24:45,910 --> 00:24:47,409
She told me that part of her process

760
00:24:47,410 --> 00:24:49,009
when she was designing the study

761
00:24:49,010 --> 00:24:50,909
involved forming two advisory

762
00:24:50,910 --> 00:24:51,869
boards.

763
00:24:51,870 --> 00:24:53,649
One made up of parents of people

764
00:24:53,650 --> 00:24:55,669
with anorexia and another made

765
00:24:55,670 --> 00:24:57,629
up of young adults with anorexia or

766
00:24:57,630 --> 00:24:59,669
a history of anorexia.

767
00:24:59,670 --> 00:25:01,769
And she got some important feedback

768
00:25:01,770 --> 00:25:03,869
from both of those boards.

769
00:25:03,870 --> 00:25:05,329
To illustrate this, she told me

770
00:25:05,330 --> 00:25:06,989
about speaking with the members of

771
00:25:06,990 --> 00:25:08,709
the young adult board about the need

772
00:25:08,710 --> 00:25:10,709
for preventing low blood sugar.

773
00:25:10,710 --> 00:25:12,769
During and after the dosing

774
00:25:12,770 --> 00:25:13,889
sessions.

775
00:25:13,890 --> 00:25:15,069
She asked them.

776
00:25:15,070 --> 00:25:16,070
I really need our patients in

777
00:25:17,040 --> 00:25:18,919
this study to eat on dosing

778
00:25:18,920 --> 00:25:20,839
day. How can I talk with

779
00:25:20,840 --> 00:25:22,279
our patients about that and make

780
00:25:22,280 --> 00:25:23,239
sure that the participants

781
00:25:23,240 --> 00:25:24,759
understand the reason for it and

782
00:25:24,760 --> 00:25:26,179
come up with a structured way to do

783
00:25:26,180 --> 00:25:28,159
it that will be as least

784
00:25:28,160 --> 00:25:30,359
anxiety provoking as possible.

785
00:25:30,360 --> 00:25:31,579
And one of the answers was

786
00:25:31,580 --> 00:25:33,639
unexpected, but also deeply

787
00:25:33,640 --> 00:25:35,619
informative, she told me, because

788
00:25:35,620 --> 00:25:37,379
one of the young advisors mentioned

789
00:25:37,380 --> 00:25:38,159
that.

790
00:25:38,160 --> 00:25:39,239
The first thing I would have thought

791
00:25:39,240 --> 00:25:40,759
if I was enrolling for this trial at

792
00:25:40,760 --> 00:25:42,599
the height of my illness is you

793
00:25:42,600 --> 00:25:44,439
want to get me high and then feed

794
00:25:44,440 --> 00:25:45,779
me all day.

795
00:25:45,780 --> 00:25:47,619
And so you need to tell them

796
00:25:47,620 --> 00:25:48,899
that that is not your intention.

797
00:25:48,900 --> 00:25:50,559
That needs to be the first thing you

798
00:25:50,560 --> 00:25:51,379
say.

799
00:25:51,380 --> 00:25:53,419
And it was simultaneously like

800
00:25:53,420 --> 00:25:54,639
heartbreaking and I was deeply

801
00:25:54,640 --> 00:25:55,640
grateful to have that feedback.

802
00:25:57,640 --> 00:25:59,159
After that Marissa worked with the

803
00:25:59,160 --> 00:26:00,479
board members to develop food

804
00:26:00,480 --> 00:26:02,419
options that felt appropriate,

805
00:26:02,420 --> 00:26:03,979
where participants have a few

806
00:26:03,980 --> 00:26:05,719
options and can also feel safe

807
00:26:05,720 --> 00:26:07,559
knowing exactly what they are

808
00:26:07,560 --> 00:26:08,479
eating.

809
00:26:08,480 --> 00:26:09,979
We created a sheet so that people

810
00:26:09,980 --> 00:26:11,619
could literally see like this is the

811
00:26:11,620 --> 00:26:12,799
exact kind of soy milk we're

812
00:26:12,800 --> 00:26:13,939
offering you.

813
00:26:13,940 --> 00:26:16,579
And now that the trial is underway,

814
00:26:16,580 --> 00:26:18,619
all anyone can really do is hope

815
00:26:18,620 --> 00:26:20,419
that all that careful planning pays

816
00:26:20,420 --> 00:26:21,420
off.

817
00:26:22,200 --> 00:26:23,949
How is the trial going so far?

818
00:26:23,950 --> 00:26:25,809
In the exit interviews participants

819
00:26:25,810 --> 00:26:27,509
have been glad that they have

820
00:26:27,510 --> 00:26:29,209
participated and found it really

821
00:26:29,210 --> 00:26:31,309
meaningful and most family

822
00:26:31,310 --> 00:26:33,809
members have felt that way too.

823
00:26:33,810 --> 00:26:35,489
We're hearing a little bit about

824
00:26:35,490 --> 00:26:36,809
participants and families feeling

825
00:26:36,810 --> 00:26:38,489
more connected and able to

826
00:26:38,490 --> 00:26:40,369
communicate which wasn't a

827
00:26:40,370 --> 00:26:41,869
specific intended consequence

828
00:26:41,870 --> 00:26:43,849
exactly but something that makes me

829
00:26:43,850 --> 00:26:45,749
hopeful and obviously

830
00:26:45,750 --> 00:26:47,529
we will wait and see what the data

831
00:26:47,530 --> 00:26:49,009
looks like as the trial progresses.

832
00:26:50,349 --> 00:26:51,549
Marissa and her team are still

833
00:26:51,550 --> 00:26:53,629
recruiting participants right now,

834
00:26:53,630 --> 00:26:54,929
and they'll be checking in with them

835
00:26:54,930 --> 00:26:56,849
for up to a year after their second

836
00:26:56,850 --> 00:26:58,929
session, so it'll be a while before

837
00:26:58,930 --> 00:27:00,889
we see complete results.

838
00:27:00,890 --> 00:27:02,909
But thanks to previous trials

839
00:27:02,910 --> 00:27:04,809
that were done on treating PTSD

840
00:27:04,810 --> 00:27:06,889
and alcohol use disorder with

841
00:27:06,890 --> 00:27:08,789
psychedelic assisted therapy, as

842
00:27:08,790 --> 00:27:10,289
well as the published results from

843
00:27:10,290 --> 00:27:12,189
one very small safety trial done on

844
00:27:12,190 --> 00:27:14,269
patients with anorexia, Marissa

845
00:27:14,270 --> 00:27:16,879
told me that she has some sense of

846
00:27:16,880 --> 00:27:18,619
what psilocybin might be able to do

847
00:27:18,620 --> 00:27:20,869
for participants in her trial.

848
00:27:20,870 --> 00:27:22,909
We have a few different hypotheses.

849
00:27:22,910 --> 00:27:24,729
The biggest one is if

850
00:27:24,730 --> 00:27:26,049
you have a severe and enduring

851
00:27:26,050 --> 00:27:27,509
mental illness, your mind kind of

852
00:27:27,510 --> 00:27:28,329
gets stuck in ruts.

853
00:27:28,330 --> 00:27:30,149
You can imagine like a sled

854
00:27:30,150 --> 00:27:31,889
going through the snow over and over

855
00:27:31,890 --> 00:27:33,389
and in the same circle.

856
00:27:33,390 --> 00:27:34,789
And after a while, it's very hard

857
00:27:34,790 --> 00:27:36,049
for the sled to change course,

858
00:27:36,050 --> 00:27:37,269
right?

859
00:27:37,270 --> 00:27:38,889
Psilocybin is like if you had that

860
00:27:38,890 --> 00:27:40,829
in a snow globe and you shake the

861
00:27:40,830 --> 00:27:42,889
snow globe, right, all

862
00:27:42,890 --> 00:27:44,049
the ruts disappear.

863
00:27:44,050 --> 00:27:46,269
It's a huge moment of potential.

864
00:27:46,270 --> 00:27:48,409
And we actually can kind of see that

865
00:27:48,410 --> 00:27:50,879
on brain scans using fMRI.

866
00:27:50,880 --> 00:27:52,759
We can actually see

867
00:27:52,760 --> 00:27:54,979
this change in connectivity in

868
00:27:54,980 --> 00:27:56,999
the brain when people are on

869
00:27:57,000 --> 00:27:59,059
psilocybin and after psilocybin.

870
00:27:59,060 --> 00:28:01,059
That rut, that stuck place is

871
00:28:01,060 --> 00:28:02,799
called the default mode network, how

872
00:28:02,800 --> 00:28:04,379
we think about ourselves.

873
00:28:04,380 --> 00:28:06,059
And it's often where our mind rests

874
00:28:06,060 --> 00:28:07,419
when we don't give our mind anything

875
00:28:07,420 --> 00:28:08,579
else to do.

876
00:28:08,580 --> 00:28:10,459
So for some of my patients with

877
00:28:10,460 --> 00:28:12,399
eating disorders, it might be I'm so

878
00:28:12,400 --> 00:28:14,159
fat, I'm so ugly, it's never going

879
00:28:14,160 --> 00:28:15,099
to get better.

880
00:28:15,100 --> 00:28:16,879
Our patients need help out of those

881
00:28:16,880 --> 00:28:18,719
ruts, and then they need help to

882
00:28:18,720 --> 00:28:20,639
make new pathways, where they have

883
00:28:20,640 --> 00:28:21,939
more choice.

884
00:28:21,940 --> 00:28:23,819
And on fMRI, we

885
00:28:23,820 --> 00:28:25,339
see that that really tight

886
00:28:25,340 --> 00:28:27,519
referential loop gives way

887
00:28:27,520 --> 00:28:29,939
to this incredible interconnectivity

888
00:28:29,940 --> 00:28:31,500
over the brain surface.

889
00:28:32,790 --> 00:28:34,329
There's still a lot that we don't

890
00:28:34,330 --> 00:28:36,069
know about how this works in human

891
00:28:36,070 --> 00:28:37,969
brains, but Marissa told

892
00:28:37,970 --> 00:28:39,589
me about some interesting research

893
00:28:39,590 --> 00:28:41,089
in mice.

894
00:28:41,090 --> 00:28:42,609
After just one administration of

895
00:28:42,610 --> 00:28:44,549
psilocybin, an isolated neuron

896
00:28:44,550 --> 00:28:46,289
from a mouse will grow extra

897
00:28:46,290 --> 00:28:48,189
dendrites, those little arms that

898
00:28:48,190 --> 00:28:49,449
reach out to connect to other

899
00:28:49,450 --> 00:28:50,450
neurons.

900
00:28:50,870 --> 00:28:52,269
Some scientists think this might be

901
00:28:52,270 --> 00:28:54,209
happening in humans, too, and

902
00:28:54,210 --> 00:28:56,469
that maybe those growing dendrites

903
00:28:56,470 --> 00:28:58,309
are related to a therapeutic

904
00:28:58,310 --> 00:28:59,329
effect.

905
00:28:59,330 --> 00:29:01,159
That's still unclear at this point.

906
00:29:01,160 --> 00:29:03,179
But in the trial, Marissa and

907
00:29:03,180 --> 00:29:04,699
her team are looking at the brains

908
00:29:04,700 --> 00:29:06,659
of participants using fMRI

909
00:29:06,660 --> 00:29:08,599
brain scans to see if they

910
00:29:08,600 --> 00:29:10,480
can spot new connectivity.

911
00:29:11,540 --> 00:29:12,939
And then I don't have to go into a

912
00:29:12,940 --> 00:29:14,319
deep detail, but we are

913
00:29:14,320 --> 00:29:15,619
hypothesizing, and there's growing

914
00:29:15,620 --> 00:29:17,319
evidence in the field, that

915
00:29:17,320 --> 00:29:18,479
psilocybin also has

916
00:29:18,480 --> 00:29:20,599
anti-inflammatory properties in

917
00:29:20,600 --> 00:29:21,719
some illnesses.

918
00:29:21,720 --> 00:29:22,879
And there are some people who

919
00:29:22,880 --> 00:29:24,359
hypothesize that there is an

920
00:29:24,360 --> 00:29:26,279
inflammatory aspect of anorexia

921
00:29:26,280 --> 00:29:27,099
nervosa.

922
00:29:27,100 --> 00:29:28,359
So that's something that we will be

923
00:29:28,360 --> 00:29:30,399
investigating as well.

924
00:29:30,400 --> 00:29:32,039
And those ruts, we're gonna be

925
00:29:32,040 --> 00:29:34,059
measuring cognitive flexibility

926
00:29:34,060 --> 00:29:35,119
is the technical term.

927
00:29:35,120 --> 00:29:36,959
So like how quickly can people learn

928
00:29:36,960 --> 00:29:39,119
new rules, adapt to different rules,

929
00:29:39,120 --> 00:29:40,439
adapt to things.

930
00:29:40,440 --> 00:29:42,059
And that's hopefully a proxy for

931
00:29:42,060 --> 00:29:43,439
like, are you able to get out of

932
00:29:43,440 --> 00:29:44,940
these ruts and these stuck places?

933
00:29:46,329 --> 00:29:47,189
Right, because there is an

934
00:29:47,190 --> 00:29:49,709
incredible rigidity involved in

935
00:29:49,710 --> 00:29:51,749
the way that anorexia manifests,

936
00:29:51,750 --> 00:29:53,249
right? Like, that's right.

937
00:29:53,250 --> 00:29:54,409
No, I can't do this before I do

938
00:29:54,410 --> 00:29:55,829
that. This is the right way.

939
00:29:55,830 --> 00:29:57,849
And this is what I always eat.

940
00:29:57,850 --> 00:29:59,269
And, this is the time at which I

941
00:29:59,270 --> 00:29:59,969
eat.

942
00:29:59,970 --> 00:30:00,929
That's exactly right.

943
00:30:00,930 --> 00:30:01,389
Yeah.

944
00:30:01,390 --> 00:30:02,789
And so the idea is that this could

945
00:30:02,790 --> 00:30:04,489
break down some of those walls,

946
00:30:04,490 --> 00:30:05,449
shake that snow globe.

947
00:30:05,450 --> 00:30:07,209
And from a therapeutic standpoint,

948
00:30:07,210 --> 00:30:08,269
what are we talking about?

949
00:30:08,270 --> 00:30:10,289
Giving you an opportunity to build

950
00:30:10,290 --> 00:30:11,290
back different?

951
00:30:11,970 --> 00:30:13,609
Exactly, that's exactly right.

952
00:30:13,610 --> 00:30:14,729
And we're trying to hit this kind of

953
00:30:14,730 --> 00:30:16,869
place where there's more room for

954
00:30:16,870 --> 00:30:18,749
that plasticity and that connection

955
00:30:18,750 --> 00:30:20,389
and that growth.

956
00:30:20,390 --> 00:30:22,509
And I'm curious about what

957
00:30:22,510 --> 00:30:24,069
that means in terms of their ability

958
00:30:24,070 --> 00:30:25,930
to change behaviors and thoughts.

959
00:30:27,040 --> 00:30:28,459
As I was listening to Marisa, I

960
00:30:28,460 --> 00:30:29,759
couldn't help but wonder why there

961
00:30:29,760 --> 00:30:31,719
aren't any medications that have

962
00:30:31,720 --> 00:30:33,179
been approved to treat anorexia

963
00:30:33,180 --> 00:30:34,419
already.

964
00:30:34,420 --> 00:30:35,739
Because if psilocybin assisted

965
00:30:35,740 --> 00:30:37,579
therapy ever gets this kind of

966
00:30:37,580 --> 00:30:40,239
approval, it'll be the first.

967
00:30:40,240 --> 00:30:41,479
We've tried a lot of different

968
00:30:41,480 --> 00:30:43,319
medications for anorexia,

969
00:30:43,320 --> 00:30:45,019
including antidepressants.

970
00:30:45,020 --> 00:30:47,199
And they can help with some of the

971
00:30:47,200 --> 00:30:49,119
symptoms that arise related to

972
00:30:49,120 --> 00:30:51,439
anorexy in some cases,

973
00:30:51,440 --> 00:30:53,179
but none of them shift the core

974
00:30:53,180 --> 00:30:55,159
symptoms and the core drive towards

975
00:30:55,160 --> 00:30:57,079
thinness or energy restriction or

976
00:30:57,080 --> 00:30:58,080
body dysmorphia concerns.

977
00:30:59,270 --> 00:31:00,629
Most of the antidepressants

978
00:31:00,630 --> 00:31:03,309
prescribed in the US are SSRIs,

979
00:31:03,310 --> 00:31:05,089
and these drugs, they target the

980
00:31:05,090 --> 00:31:06,869
serotonin system in the brain.

981
00:31:07,980 --> 00:31:09,779
Into the synapse, the place kind of

982
00:31:09,780 --> 00:31:11,759
between neurons and the brain, and

983
00:31:11,760 --> 00:31:13,659
they keep your serotonin there so

984
00:31:13,660 --> 00:31:14,759
it can work for longer.

985
00:31:16,060 --> 00:31:18,199
And having enough of it allows

986
00:31:18,200 --> 00:31:19,939
those circuits to be more regulated

987
00:31:19,940 --> 00:31:21,819
related to feeling down or

988
00:31:21,820 --> 00:31:23,279
feeling anxious.

989
00:31:23,280 --> 00:31:25,259
But anorexia can break that

990
00:31:25,260 --> 00:31:26,279
system.

991
00:31:26,280 --> 00:31:28,019
The problem is that if you're

992
00:31:28,020 --> 00:31:29,759
severely malnourished, you don't

993
00:31:29,760 --> 00:31:31,629
actually make enough serotonins.

994
00:31:31,630 --> 00:31:33,709
You have to be eating tryptophan

995
00:31:33,710 --> 00:31:35,669
and the amino acids that you need in

996
00:31:35,670 --> 00:31:37,189
order to make those

997
00:31:37,190 --> 00:31:38,829
neurotransmitters.

998
00:31:38,830 --> 00:31:40,589
So our patients are often very

999
00:31:40,590 --> 00:31:42,529
depressed and anxious because of

1000
00:31:42,530 --> 00:31:44,549
their lack of serotonin, but these

1001
00:31:44,550 --> 00:31:47,029
medications have nothing to work on.

1002
00:31:47,030 --> 00:31:48,889
And it's variable from individual to

1003
00:31:48,890 --> 00:31:50,629
individual and how malnourished

1004
00:31:50,630 --> 00:31:52,309
someone is. All of those things are

1005
00:31:52,310 --> 00:31:54,369
factors, but it's one of the reasons

1006
00:31:54,370 --> 00:31:56,029
these medicines don't work as well

1007
00:31:56,030 --> 00:31:57,529
and don't target the core symptoms

1008
00:31:57,530 --> 00:31:59,289
for anorexia.

1009
00:31:59,290 --> 00:32:00,629
So right now, the standard of care

1010
00:32:00,630 --> 00:32:02,009
for young adults is different forms

1011
00:32:02,010 --> 00:32:03,569
of psychotherapy.

1012
00:32:03,570 --> 00:32:05,309
But a lot of the time, it just

1013
00:32:05,310 --> 00:32:06,469
doesn't work.

1014
00:32:06,470 --> 00:32:08,629
Relapse rates are as high as 52%.

1015
00:32:10,070 --> 00:32:12,449
But maybe combining therapy

1016
00:32:12,450 --> 00:32:15,049
with psilocybin could change that.

1017
00:32:15,050 --> 00:32:16,709
And interestingly, one of the

1018
00:32:16,710 --> 00:32:18,069
reasons Marissa thinks that's

1019
00:32:18,070 --> 00:32:20,029
possible is because of the results

1020
00:32:20,030 --> 00:32:21,989
from a recent trial on alcohol use

1021
00:32:21,990 --> 00:32:22,869
disorder.

1022
00:32:22,870 --> 00:32:24,030
This is how she explained that.

1023
00:32:26,040 --> 00:32:28,239
Substance use disorders and

1024
00:32:28,240 --> 00:32:29,379
eating disorders, especially

1025
00:32:29,380 --> 00:32:31,559
anorexia, have a particular quality

1026
00:32:31,560 --> 00:32:33,419
that is often true for

1027
00:32:33,420 --> 00:32:35,239
patients who have them that's

1028
00:32:35,240 --> 00:32:37,199
different from many other illnesses.

1029
00:32:37,200 --> 00:32:39,219
They're egocentonic.

1030
00:32:39,220 --> 00:32:40,220
Egocentonic.

1031
00:32:40,720 --> 00:32:42,259
What that means is that the illness

1032
00:32:42,260 --> 00:32:44,359
may feel like part of someone or

1033
00:32:44,360 --> 00:32:45,519
like something that they don't want

1034
00:32:45,520 --> 00:32:46,359
to give up.

1035
00:32:46,360 --> 00:32:47,279
That's not always true.

1036
00:32:47,280 --> 00:32:48,869
It's not true for all patients.

1037
00:32:48,870 --> 00:32:50,709
But it's a common feeling that comes

1038
00:32:50,710 --> 00:32:53,109
up for those two sets of disorders.

1039
00:32:53,110 --> 00:32:54,349
And generally, no one wants to be

1040
00:32:54,350 --> 00:32:55,929
depressed, certainly no one who

1041
00:32:55,930 --> 00:32:57,269
wants to have cancer.

1042
00:32:57,270 --> 00:32:58,949
But there are times for some

1043
00:32:58,950 --> 00:33:00,549
patients with eating disorders and

1044
00:33:00,550 --> 00:33:01,869
some patients with substance use

1045
00:33:01,870 --> 00:33:04,009
disorders where the disorder is so

1046
00:33:04,010 --> 00:33:05,609
close in that it feels like part of

1047
00:33:05,610 --> 00:33:06,649
them and feels like something they

1048
00:33:06,650 --> 00:33:08,599
don't want to give up.

1049
00:33:08,600 --> 00:33:10,119
The results from the alcohol use

1050
00:33:10,120 --> 00:33:11,500
disorder trial were promising.

1051
00:33:12,880 --> 00:33:15,399
So Marissa found herself asking.

1052
00:33:15,400 --> 00:33:17,439
We could see results in

1053
00:33:17,440 --> 00:33:19,159
some very early trials related to

1054
00:33:19,160 --> 00:33:20,359
substance use disorder.

1055
00:33:20,360 --> 00:33:22,239
Could that translate for my

1056
00:33:22,240 --> 00:33:24,259
patients with anorexia?

1057
00:33:24,260 --> 00:33:25,559
Because there are not very many

1058
00:33:25,560 --> 00:33:26,899
illnesses like that, that are

1059
00:33:26,900 --> 00:33:27,869
egocentonic.

1060
00:33:27,870 --> 00:33:29,809
So coming back to the snow globe

1061
00:33:29,810 --> 00:33:31,769
idea, maybe one

1062
00:33:31,770 --> 00:33:33,589
of the ruts that psilocybin is

1063
00:33:33,590 --> 00:33:35,449
able to erase is

1064
00:33:35,450 --> 00:33:37,109
that attachment.

1065
00:33:37,110 --> 00:33:39,109
Like Francesca's box, that she

1066
00:33:39,110 --> 00:33:41,729
suddenly knew she could put down.

1067
00:33:41,730 --> 00:33:44,129
And then hypothetically, maybe that

1068
00:33:44,130 --> 00:33:45,389
could give the therapy part of

1069
00:33:45,390 --> 00:33:47,229
Marissa's trial more of

1070
00:33:47,230 --> 00:33:49,429
an in, more of a chance to

1071
00:33:49,430 --> 00:33:51,389
work as it should.

1072
00:33:51,390 --> 00:33:53,789
Oh, and the whole low serotonin

1073
00:33:53,790 --> 00:33:55,509
thing that people with malnutrition

1074
00:33:55,510 --> 00:33:57,149
can experience?

1075
00:33:57,150 --> 00:33:58,749
Turns out that psilocybin might

1076
00:33:58,750 --> 00:34:00,930
provide a fix for that too.

1077
00:34:02,470 --> 00:34:03,809
Instead of trying to keep the body's

1078
00:34:03,810 --> 00:34:05,469
serotonin in place for the

1079
00:34:05,470 --> 00:34:06,269
medication to work.

1080
00:34:06,270 --> 00:34:08,149
What psilocybin does is it pretends

1081
00:34:08,150 --> 00:34:09,269
to be serotonin.

1082
00:34:09,270 --> 00:34:11,109
It goes in and locks into

1083
00:34:11,110 --> 00:34:12,309
the serotonin receptors.

1084
00:34:12,310 --> 00:34:14,009
So for even really malnourished

1085
00:34:14,010 --> 00:34:15,869
patients, we hypothesize

1086
00:34:15,870 --> 00:34:17,569
that it could be effective.

1087
00:34:17,570 --> 00:34:19,329
And we even had a little bit of data

1088
00:34:19,330 --> 00:34:21,569
in patients who've done psilocybin

1089
00:34:21,570 --> 00:34:23,289
trials related to end-of-life

1090
00:34:23,290 --> 00:34:25,129
cancer, anxiety and

1091
00:34:25,130 --> 00:34:26,769
depression, as well as end-stage

1092
00:34:26,770 --> 00:34:29,029
HIV, who were very malnoursed

1093
00:34:29,030 --> 00:34:30,488
population.

1094
00:34:30,489 --> 00:34:32,869
And so all of those things converged

1095
00:34:32,870 --> 00:34:34,809
to make us want to focus in

1096
00:34:34,810 --> 00:34:36,649
on psilocybin as a possible

1097
00:34:36,650 --> 00:34:37,949
medication for anorexia.

1098
00:34:39,230 --> 00:34:41,689
How did this trial come together?

1099
00:34:41,690 --> 00:34:43,669
Blood, sweat, and tears.

1100
00:34:43,670 --> 00:34:45,829
The real story is worth telling

1101
00:34:45,830 --> 00:34:47,908
because it showcases just how badly

1102
00:34:47,909 --> 00:34:49,968
people want new treatments for

1103
00:34:49,969 --> 00:34:51,509
anorexia.

1104
00:34:51,510 --> 00:34:53,149
Back when Marissa was just starting

1105
00:34:53,150 --> 00:34:55,109
to explore the idea of doing this

1106
00:34:55,110 --> 00:34:56,888
trial, she reached out to a

1107
00:34:56,889 --> 00:34:58,849
colleague of hers at UCSF.

1108
00:34:58,850 --> 00:35:00,729
Josh Woolley, whose lab

1109
00:35:00,730 --> 00:35:02,449
goes by the acronym TRIPPER, which

1110
00:35:02,450 --> 00:35:04,509
is a very fun acronym.

1111
00:35:04,510 --> 00:35:07,009
And after a little bit of pestering,

1112
00:35:07,010 --> 00:35:08,689
he agreed to work with her to get

1113
00:35:08,690 --> 00:35:10,589
the trial off the ground and

1114
00:35:10,590 --> 00:35:12,329
conduct it with her.

1115
00:35:12,330 --> 00:35:13,629
He said, okay, sounds like we're

1116
00:35:13,630 --> 00:35:14,689
gonna do this trial.

1117
00:35:14,690 --> 00:35:16,270
You just need to find $3 million.

1118
00:35:17,509 --> 00:35:19,689
Marissa was undaunted.

1119
00:35:19,690 --> 00:35:21,489
Within three years, she had the

1120
00:35:21,490 --> 00:35:22,989
money to get started.

1121
00:35:22,990 --> 00:35:24,869
And the funds, they didn't

1122
00:35:24,870 --> 00:35:26,129
come to her through government

1123
00:35:26,130 --> 00:35:26,909
grants.

1124
00:35:26,910 --> 00:35:28,449
We've had more than 100 individual

1125
00:35:28,450 --> 00:35:30,429
donors who have given a huge

1126
00:35:30,430 --> 00:35:32,389
range of donations

1127
00:35:32,390 --> 00:35:35,429
to make this trial possible largely

1128
00:35:35,430 --> 00:35:38,029
from families who have

1129
00:35:38,030 --> 00:35:40,229
children suffer with this illness.

1130
00:35:40,230 --> 00:35:41,669
When you say that there have been

1131
00:35:41,670 --> 00:35:43,609
more than 100 donations, can you

1132
00:35:43,610 --> 00:35:45,169
give me a sense of the range of the

1133
00:35:45,170 --> 00:35:46,269
donations?

1134
00:35:46,270 --> 00:35:48,389
You know, as small as, as large as?

1135
00:35:48,390 --> 00:35:50,229
As small as $5, as

1136
00:35:50,230 --> 00:35:52,689
larger as a million more.

1137
00:35:52,690 --> 00:35:52,849
Wow.

1138
00:35:52,850 --> 00:35:54,849
Yeah, so really a very wide

1139
00:35:54,850 --> 00:35:55,629
range.

1140
00:35:55,630 --> 00:35:57,109
That's incredible.

1141
00:35:57,110 --> 00:35:59,089
What is driving people to want to

1142
00:35:59,090 --> 00:36:00,949
donate to your clinical

1143
00:36:00,950 --> 00:36:02,059
trial?

1144
00:36:02,060 --> 00:36:03,299
Without sort of revealing any

1145
00:36:03,300 --> 00:36:05,739
personal information, I guess one

1146
00:36:05,740 --> 00:36:07,759
vignette that comes to mind is a

1147
00:36:07,760 --> 00:36:09,699
parent who has been

1148
00:36:09,700 --> 00:36:11,599
a really amazing champion of this

1149
00:36:11,600 --> 00:36:13,559
work. She told me, I

1150
00:36:13,560 --> 00:36:15,559
am running out of ideas about

1151
00:36:15,560 --> 00:36:17,239
ways that I can help my daughter,

1152
00:36:17,240 --> 00:36:19,219
and I feel powerless because

1153
00:36:19,220 --> 00:36:20,199
of that.

1154
00:36:20,200 --> 00:36:21,819
But you have power and privilege

1155
00:36:21,820 --> 00:36:23,479
because there's something you can

1156
00:36:23,480 --> 00:36:24,839
do.

1157
00:36:24,840 --> 00:36:26,799
And that was very striking to me.

1158
00:36:26,800 --> 00:36:28,979
I think it's been a big exercise in

1159
00:36:28,980 --> 00:36:30,809
trying to bring forth

1160
00:36:30,810 --> 00:36:32,309
power and privilege of a lot of

1161
00:36:32,310 --> 00:36:34,209
different people to see if

1162
00:36:34,210 --> 00:36:36,009
we can make change.

1163
00:36:36,010 --> 00:36:37,749
I'm hearing a certain amount of

1164
00:36:37,750 --> 00:36:39,249
emotion in your voice.

1165
00:36:39,250 --> 00:36:40,969
Yeah, I mean, I think, you know, I

1166
00:36:40,970 --> 00:36:42,289
use the words moral imperative.

1167
00:36:42,290 --> 00:36:43,909
As a physician, I have the privilege

1168
00:36:43,910 --> 00:36:46,549
of being trained as a researcher.

1169
00:36:46,550 --> 00:36:48,449
And it's my job to try and

1170
00:36:48,450 --> 00:36:49,829
make sure that my patients are never

1171
00:36:49,830 --> 00:36:50,830
without hope.

1172
00:36:52,680 --> 00:36:54,539
Do we think that this could also be

1173
00:36:54,540 --> 00:36:56,759
helpful for folks with

1174
00:36:56,760 --> 00:36:58,979
other forms of eating disorders?

1175
00:36:58,980 --> 00:37:00,719
Something that I'm very interested

1176
00:37:00,720 --> 00:37:03,219
in investigating over the long run.

1177
00:37:03,220 --> 00:37:05,159
We started with anorexia because of

1178
00:37:05,160 --> 00:37:07,179
its fatality rate and

1179
00:37:07,180 --> 00:37:08,559
we're kind of enrolling people with

1180
00:37:08,560 --> 00:37:10,079
three different subtypes with

1181
00:37:10,080 --> 00:37:12,079
atypical restrictive and

1182
00:37:12,080 --> 00:37:14,079
binge purge anorexy for this

1183
00:37:14,080 --> 00:37:16,299
trial and we are

1184
00:37:16,300 --> 00:37:17,699
trying to enroll enough people so

1185
00:37:17,700 --> 00:37:19,199
that we will get a large enough

1186
00:37:19,200 --> 00:37:20,759
sample that'll allow us to do some

1187
00:37:20,760 --> 00:37:22,789
amount of analysis on each group.

1188
00:37:22,790 --> 00:37:24,149
And that will give us some data

1189
00:37:24,150 --> 00:37:25,969
about both safety and efficacy

1190
00:37:25,970 --> 00:37:27,729
for people with that binge purge

1191
00:37:27,730 --> 00:37:29,189
subtype and maybe help us start to

1192
00:37:29,190 --> 00:37:30,789
think about what about this might

1193
00:37:30,790 --> 00:37:32,049
translate to a population of

1194
00:37:32,050 --> 00:37:34,049
patients with bulimia nervosa?

1195
00:37:34,050 --> 00:37:35,909
What about binge eating disorder?

1196
00:37:35,910 --> 00:37:37,089
I think all of those are really

1197
00:37:37,090 --> 00:37:39,009
important questions.

1198
00:37:39,010 --> 00:37:41,169
Someone dies about once every

1199
00:37:41,170 --> 00:37:43,209
hour in the United States from those

1200
00:37:43,210 --> 00:37:44,349
conditions.

1201
00:37:44,350 --> 00:37:46,329
And it's really important to

1202
00:37:46,330 --> 00:37:48,249
understand that part of

1203
00:37:48,250 --> 00:37:50,009
the urgency in finding new

1204
00:37:50,010 --> 00:37:51,024
treatments is about how

1205
00:37:52,210 --> 00:37:54,249
fatal this condition is.

1206
00:37:54,250 --> 00:37:56,209
And it's such a new feeling to

1207
00:37:56,210 --> 00:37:58,189
be able to feel hopeful about a new

1208
00:37:58,190 --> 00:37:59,949
treatment in this illness.

1209
00:37:59,950 --> 00:38:01,809
And I'm trying to, of

1210
00:38:01,810 --> 00:38:03,769
course, keep my perspective

1211
00:38:03,770 --> 00:38:05,689
and stay very grounded in

1212
00:38:05,690 --> 00:38:07,289
the fact that we won't know how it's

1213
00:38:07,290 --> 00:38:09,269
going. But even just in my role

1214
00:38:09,270 --> 00:38:11,209
as a physician in this space,

1215
00:38:11,210 --> 00:38:13,089
it's exciting to be thinking about

1216
00:38:13,090 --> 00:38:14,569
new things. To just have new

1217
00:38:14,570 --> 00:38:15,729
treatments that are actually coming

1218
00:38:15,730 --> 00:38:17,529
down the pathway is so different

1219
00:38:17,530 --> 00:38:19,349
than where we were five years ago.

1220
00:38:27,430 --> 00:38:29,269
I don't typically report on clinical

1221
00:38:29,270 --> 00:38:31,209
trials that are still in progress,

1222
00:38:31,210 --> 00:38:32,989
because you really never know what's

1223
00:38:32,990 --> 00:38:33,929
going to happen.

1224
00:38:33,930 --> 00:38:35,109
I don't want to give anyone the

1225
00:38:35,110 --> 00:38:36,449
wrong impression.

1226
00:38:36,450 --> 00:38:38,389
As this study and others begin to

1227
00:38:38,390 --> 00:38:40,289
publish their findings, we may

1228
00:38:40,290 --> 00:38:41,809
find out that psilocybin assisted

1229
00:38:41,810 --> 00:38:43,369
therapy can help people with

1230
00:38:43,370 --> 00:38:45,549
anorexia, or we

1231
00:38:45,550 --> 00:38:46,829
may not.

1232
00:38:46,830 --> 00:38:48,689
If that's the finding though,

1233
00:38:48,690 --> 00:38:50,629
if it helps, then that

1234
00:38:50,630 --> 00:38:52,649
will be a huge deal for a

1235
00:38:52,650 --> 00:38:54,709
lot of people, as well

1236
00:38:54,710 --> 00:38:56,210
as their friends and families.

1237
00:38:57,720 --> 00:39:00,079
And I would know because I

1238
00:39:00,080 --> 00:39:01,999
had anorexia in my very

1239
00:39:02,000 --> 00:39:03,499
early 20s.

1240
00:39:03,500 --> 00:39:05,499
And much like Francesca, I

1241
00:39:05,500 --> 00:39:07,319
am so happy that I am free

1242
00:39:07,320 --> 00:39:08,320
of it today.

1243
00:39:09,020 --> 00:39:10,899
But man, it would have been nice

1244
00:39:10,900 --> 00:39:12,899
to not have to do it on my own,

1245
00:39:12,900 --> 00:39:15,358
to have the support of a medication

1246
00:39:15,359 --> 00:39:17,099
that could have helped me overcome

1247
00:39:17,100 --> 00:39:19,079
the biggest barriers associated

1248
00:39:19,080 --> 00:39:20,639
with recovery.

1249
00:39:20,640 --> 00:39:22,479
Instead of just fighting hundreds

1250
00:39:22,480 --> 00:39:24,499
of tiny, excruciating

1251
00:39:24,500 --> 00:39:26,579
battles with my brain Every

1252
00:39:26,580 --> 00:39:27,779
single day?

1253
00:39:27,780 --> 00:39:30,099
Year after year.

1254
00:39:30,100 --> 00:39:31,199
I don't care if it's

1255
00:39:31,200 --> 00:39:32,759
psilocybin-assisted therapy or

1256
00:39:32,760 --> 00:39:34,759
something else, we just need

1257
00:39:34,760 --> 00:39:36,459
better options than what we have

1258
00:39:36,460 --> 00:39:37,699
now.

1259
00:39:37,700 --> 00:39:39,019
So I'm rooting for that.

1260
00:39:47,620 --> 00:39:49,219
If you or someone you know are

1261
00:39:49,220 --> 00:39:51,419
struggling with an eating disorder,

1262
00:39:51,420 --> 00:39:52,819
help is available.

1263
00:39:52,820 --> 00:39:54,399
Please call the National Alliance

1264
00:39:54,400 --> 00:39:56,359
for Eating Disorders helpline at

1265
00:39:56,360 --> 00:40:00,719
866-662-1235.

1266
00:40:00,720 --> 00:40:02,679
And for 24-7 support,

1267
00:40:02,680 --> 00:40:04,279
please call the national suicide

1268
00:40:04,280 --> 00:40:06,699
prevention lifeline at 988

1269
00:40:06,700 --> 00:40:08,579
or text HOME

1270
00:40:08,580 --> 00:40:10,639
to 741-741

1271
00:40:10,640 --> 00:40:13,219
to reach the crisis text line.

1272
00:40:13,220 --> 00:40:15,079
Those numbers and links can also be

1273
00:40:15,080 --> 00:40:16,159
found in our show notes.

1274
00:40:22,000 --> 00:40:23,739
Altered States is a production of

1275
00:40:23,740 --> 00:40:25,159
the UC Berkeley Center for the

1276
00:40:25,160 --> 00:40:27,539
Science of Psychedelics and PRX.

1277
00:40:27,540 --> 00:40:29,159
This episode was reported and

1278
00:40:29,160 --> 00:40:30,519
produced by me, Arielle

1279
00:40:30,520 --> 00:40:31,520
Duhaime-Ross.

1280
00:40:31,740 --> 00:40:33,659
Adizah Eghan is our senior editor.

1281
00:40:33,660 --> 00:40:35,339
Our executive editor is Malia

1282
00:40:35,340 --> 00:40:36,299
Wollan.

1283
00:40:36,300 --> 00:40:37,459
Jennie Cataldo is our Senior

1284
00:40:37,460 --> 00:40:39,439
Producer, and our researcher is

1285
00:40:39,440 --> 00:40:40,939
Cassady Rosenblum.

1286
00:40:40,940 --> 00:40:42,719
Our associate producer is Jade Abdul

1287
00:40:42,720 --> 00:40:44,839
Malik, and our audio engineers are

1288
00:40:44,840 --> 00:40:47,139
Terence Bernardo and Jennie Cataldo.

1289
00:40:47,140 --> 00:40:49,119
Fact-checking by Graham Hacia.

1290
00:40:49,120 --> 00:40:51,379
Special thanks to Michael Silver.

1291
00:40:51,380 --> 00:40:53,039
Our executive producers are Malia

1292
00:40:53,040 --> 00:40:55,679
Wollan and Jocelyn Gonzales,

1293
00:40:55,680 --> 00:40:57,099
and our project manager is Edwin

1294
00:40:57,100 --> 00:40:58,159
Ochoa.

1295
00:40:58,160 --> 00:40:59,879
Our theme music is by Thao Nguyen

1296
00:40:59,880 --> 00:41:01,299
and Nate Brenner.

1297
00:41:01,300 --> 00:41:02,719
And I'm your host, Arielle

1298
00:41:02,720 --> 00:41:03,720
Duhaime-Ross.

1299
00:41:03,960 --> 00:41:05,799
Be sure to subscribe, rate, and

1300
00:41:05,800 --> 00:41:07,419
review Altered States wherever you

1301
00:41:07,420 --> 00:41:09,239
get your podcasts.

1302
00:41:09,240 --> 00:41:10,679
Most well-known psychedelics remain

1303
00:41:10,680 --> 00:41:12,379
illegal around the world, including

1304
00:41:12,380 --> 00:41:14,339
in the United States, where it is

1305
00:41:14,340 --> 00:41:16,139
a criminal offense to manufacture,

1306
00:41:16,140 --> 00:41:18,079
possess, dispense, or supply most

1307
00:41:18,080 --> 00:41:20,079
psychedelics, with few exceptions.

1308
00:41:20,080 --> 00:41:21,879
Altered states does not recommend or

1309
00:41:21,880 --> 00:41:23,939
encourage the use of psychedelics or

1310
00:41:23,940 --> 00:41:25,699
offer instructions in their use.